There's a reason medical providers refuse to tell you the cost before a procedure. They honestly do not know, there are just so many complications and unforeseen events that can happen. While the Trump executive order forced some consolidation of medical codes there's still a massive difference between providers, so you can't even compare the lists of two hospitals since they're not charging for the same things.
Their prices are all-inclusive with followups on case something goes wrong and therapy for procedures that need it.
The founder was on econtalk (https://www.econtalk.org/keith-smith-on-free-market-health-c...) where he also claimed that their prices have been steady and that surgeons earn more there than at other hospitals. Meanwhile insurances don't want to work with them because they don't get to advertise how much money was saved from the Brutto cost based on their negotiation with the provider because they would have to pay the sticker price like everyone else.
If they can't predict a complication, shouldn't they be setting an ahead of time fee that will on average cover it? Why does the provider get to push the unpredictable risk onto the patient who has less control than they do?
Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly.
I agree the fee for service is a bad model. Capitated payouts have seen a lot of success in Medicare and kaiser Permanente. But that's just how it works today.
FWIW, it's not the surgeon, it's the hospital. Surgeons are paid a fee for each surgery that is a 90-day global fee: any postop appointments, any re-operations, any hospital visits within that 90 days get not a nickel.
If the amount to bill the patient's insurance is determined after the complication, it's not an unpredictable risk, it's a fact. If it can't be predicted, then it more or less exists for each procedure, but that isn't reflected in the cost, the patient that has the bad experience gets charged extra for it.
Insurance exists to cover losses from unexpected events. Medical complications are unexpected events.
Your hungover surgeon is a bullshit strawman - most complications have nothing to do with provider malice or incompetence.
Again since that seems to be the angle you are starting with you clearly have no interest in a grown up discussion or too ignorant and also full of hubris to understand any of this (which fits in perfectly well on this site).
If you throw a massive clot after a surgery and stroke out who’s fault was that if all the standard protocols for clot prevention were followed. Maybe you’re a smoker (or not) and 5 years later that unknown cancer will finally declare itself.
> more or less exists for each procedure
This is extremely misleading as it does not exist in any meaningful level of risk across the entire patient population.
I think you're getting hung up on a joke about the hung-over doctor. The problem is that whatever the complication is, it should be amortized over all the deliveries of that treatment, not the one case where it happens to occur.
If they can predict the complication, they can bill for it ahead of time.
It is all insurance in the end, but the incentives created by pushing the providers to bill ahead are better than the ones created by letting them bill for what they do.
Depressingly, this is closer to reality than most people realize. It's not just the risk of complications in treatment, it's also that most providers send off several hundred or thousand claims in a 1-2 week period and get a lump sum check a few months later from the insurance company. Believe me when I say the best and brightest in finance are not working in billing reconciliation in hospital systems. Most are only capable of saying "oncology reimbursements are up 0.7% this month yoy" and not much more.
They are pointedly uninterested in calculating what your particular surgery will cost you or your insurance. All they know is that you're one of 200 this month and your insurance pays, on average after all the adjustments and adjudications, about 15% less than average so please be quiet and don't make a fuss.
Car mechanics are perfectly fine giving estimates, explaining possible complications and contingencies, working on a time and materials basis, and even doing well-defined services on flat fees despite the long tail of things that can go wrong.
The reason medical providers don't know is because they don't care to know. Their systems are purposefully complex so their computers can do battle with the "insurance" company computers. And when you try to ask a doctor this highly relevant question, they condescendingly feign as if money shouldn't matter despite it being the foremost thing in many people's minds.
