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To: i-node who wrote (199789)	5/3/2009 10:44:06 AM
From: neolib	Read Replies (2) \| Respond to of 306849

How about when a hard drive crashes in your medical facility's server and you're having to pay me to get your network running again? How about when your car is making a strange noise and you take it to the shop to get it fixed? How about when you're charged with a crime and you engage the Dream Team to defend you? How about when you take your taxes to your CPA to have him prepare your return? The car example was particularly poor. You seem unaware that at least some states (CA for example) have laws (consumer protection laws) which specifically require auto repair shops to provide a written quote prior to any service. And you get to hold them to the quote afterwards. Why don't we have similar laws for medical services? All your other examples suffer from the simple fact that you can ask any of them for a quote first. If you happen to be in the habit of not doing so, that is your fault. When I ask my doc what something will cost, he usually stares back blankly, as though that is a very odd question. The general response is "That procedure is covered by insurance". That comment is the most telling about what is different in medical billing vs most other goods and services I purchase. The fundamental problem is that when people purchase medical services, neither they nor the providers think of it as a consumer purchase. Instead, it is assumed that insurance premiums have been paid monthly, as known expenses, and this sudden expense of the medical need is now paid by that wicked insurance co, who deserves to be reamed as much as possible. You might as well get the best, after all, you've already paid the premiums. Of course the premiums slowly creep up as the feedback from this disconnected mode of thinking has the obvious effect. I came to understand the above very early in my career when I had a mole removed by a Doc. After removing it, he was filling out a form, a copy of which I got. The form had a section specific to removing moles, and there were check boxes for the size. He had bumped the size up by two bins from reality. I didn't catch this while in his office, but later asked an intern friend of mine what was going on. He enlightened me on the realities of revenue enhancement in medical billing. He made the interesting comment that sometimes patients encourage him to do such things, since it helps the Doc out, and doesn't hurt the patient at all, just reams the insurance co. The fact that people on average are that stupid speaks volumes for what is wrong with our medical payment system. I'm well aware that any goods/service which are paid for by insurance suffer from the same problem, although the issue of wanting the best service under the guise of not taking risk is higher in many medical cases, and further drives up the cost. If you want to understand the potential cost differences of these issues, look at elective surgery not covered under insurance (think tit surgery) or for that matter laser eye surgery (and yes I know some plans will cover one or both, but lots don't or didn't historically). You can drive the freeways of LA and look at the billboards, and you will start to understand that medical science can be pretty damn cost competitive when it is structured as a seller/consumer system. With a healthy supply of competition between providers, consumers who care about the price up front, no insurance billing scams in-between the two parties, and Docs who concentrate on high volume of the same procedures, all the crap about how much talent the doc needs and how much in debt he/she was all of which justifies him ripping you off kind of vaporizes. What a shock. Of course single payer government insurance would not address any of this.