Patients keep getting charged for crying
sicknote.co
sicknote.co
The more I encounter scale, the more terrified I am of it. We don't seem to have any great answers. I spent my youth frustrated that the suits were going to complicate my elegant simplicity, that some series of meetings would pile on needless complexity, but the miserable truth is they aren't exactly wrong.
Sentences that begin with "Why don't we just-" are usually fatally shortsighted. Startups that appear to have finally cut through the burdensom red tape of the crusty establishment are doomed to become their parents: at scale, they start to do what they were fighting in the first place. Google looks like Google for a reason.
We love a fresh start, because we see in it the promise of a new take, someone applying the simplicity to a problem we intuitively feel is there, but sooner or later they must face the meat grinder of scale.
I hope it isn't true that processes must trend toward the absurd, that patently outlandish medical billing is the fate that awaits us all.
The problem is that these activity/diagnostic/lifestyle codes exist for good reasons but existing incentives can push diagnostic coders toward exploitation for maximum funding rather than as a tool for capturing treatment burdens.
It's not even slightly comparable. They are the clear outlier on Earth.
As you mentioned scale I will cite Brazil as a baseline since we’re talking about US here.
Even in one of the most {corrupt, poorest} places in the world the entire infrastructure of what we know as public health care was built in a timespan of 28 years, serving a population equivalent with USA with a more pulverised population (e.g. see the demographic composition of Amazonas and Pará states).
The case for Google is another one. The incentives of the company slowly changed as it moved onto the path many corporations took before. It isn't a necessity, but the drive to growth put them there where they are today. They wanted money, the problems of software logistics were already solved when they were a smaller company. In fact only when they were successful more and more people wanted an in on the profit.
Of course problems are often more complicated in detail, but I don't think too many people looking at the larger picture are really the problem.
> Naive ideological purity
That is just a rant, I don't think there is any evidence of that happening anywhere.
Unfortunately, you win the election, you run the social network, your revolution is successful, and you come face to face with the actual challenges your predecessors faced. This is the source of our continued frustration with elections doing nothing.
Without a theoretical leap in solving problems at scale, there is little to be done, and the variances between solutions are just fiddling with coefficients.
It’s easy to think that some shadowy league of dentists is preventing a cavity cure from reaching the market, or that the forces of for-profit healthcare are arrayed together in an alleyway. We love to think that a very large series of people have just not had the balls to stand up to our favorite caricature of an enemy, but the truth is usually nuanced, complex, and slow.
The asterisk at the end of simple solutions is usually “provided everyone agrees with me or bends to my will”
We’d likely both chew our own leg off to escape the meeting to eliminate this billing line item, both blaming it on some complexity upstream we can’t agree on.
but we do. economics, especially behavior econ is the study of understanding why large scale systems work differently than the de facto rules.
yes, every separate "systemic incentive failure" is a terribly complex pathological state in the abstract phase diagram of the dynamics, but we luckily have a higher level control, we can introspect ourselves, our systems.
yes, the resistance from the beneficiaries is always strong, but not impossible to overcome eventually.
how it goes from well intentioned healthcare initiative to showing up as a billing item on patient statements remains an exercise to the reader.
People enter medicine for the money, maybe a little for the prestige. This is nowhere more self-evident that in their billing practices - and the fact that most medics seem to be always operating at the absolute edge of their competence and have nothing but unbridled contempt for patients. Not exactly symptomatic of “I care” so much as “I charge”.
Same with lawyers and bankers. Unimaginative, lucrative, “follow in thy father’s footsteps” professions full of avaricious dullards.
B) OTOH - don’t cry and you save $40
C) Devil’s advocate: It says emotional assessment. If someone is under emotional distress the hospital has to do an assessment and see if they are getting enough medication or there are other problems: abuse, depression, etc.
What an embarrassment for us being the only developed country without universal healthcare.
The problem here is the excessive charging itself. Or the fact that they can think they can do it.
In Quebec for example all hospitals are public and you can't have a private hospital.
In the rest of Canada, hospitals are required to be not-for-profit, though they are still private, you can't have a for-profit private hospital.
I’m a US citizen living abroad and my biggest fear is getting sick when I go home to visit family.
Just because something can be done does not mean it should be done.
That said, keep doing it! These stories have real legs! Catch and spread nicely enough to be highly effective universal health care advocacy.
Personally, there is absolutely no way I would allow stuff like this to happen. I bet many physicians are busy and do not review billing to the degree our current policy requires them to. One would think fear of this discussion happening would be right at the top of a short list titled: "bad things are likely to happen"