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Monday, November 5, 2012

Healthcare Dealers

Most computer salesman hate me.  They've been trained to a certain way to size up a customer, ask them questions about what they want in a computer, show them a few tricks on the units they've been told to sell, and pitch it. They never sell me anything.  I know too much, and drive them off.  No thanks, I don't need any assistance, I'm just looking, I tell them.  Then I buy what I need with confidence.

My cable company auto-routes me to level 2 support because by the time I'm calling them, I've already rebooted the modem, the router, et cetera, and I've don't tracert, ping and a few packet traces and network captures.  Yes, I tell them, I'm certain this is a problem at your end.  You aren't responding to DHCP requests.

I don't go to car dealers for service, because they've institutionalized price gouging.  I needed a part for lift gates on my wife's car.  Installed the pair of parts would cost me $350 at the dealer.  I bought the parts on Amazon for $20 (w/ shipping) and installed them in 20 minutes.

I've got a couple of local car repair guys who provide me with great service, and understand the difference between perfect, and good enough, and the value that good enough has when I have to weigh the difference between options.  I'll take a $50 weld that fits close enough for my ten-year-old car, rather than replacing the entire door frame for the perfect fit.  The difference can only be detected as wind noise past 50 MPH.

I understand these things well enough to make informed decisions about good-enough.  In being an engaged patient, I try to understand similar cases for my health, and so do other family members.

It's scary to see that some of the "car dealer" institutionalized gouging going on in some healthcare settings.  My wife figured out that that the ice-pack used during each PT visit was costing us $45 dollars each visit (that's an expensive ice-pack), and told them she'd do that at home.

I like my doctor, but it's hard for me to tell whether he's one of the local guys, or one of the "dealers".  To figure that out, I need to keep learning.  I wish there was a consumer reports for human care.

-- Keith


  1. You and the Washington Post's Matt Miller are thinking along the same lines. See this piece by him that was published on August 24. An excerpt:

    All this shows why the entire Medicare (and broader health) debate needs to be recast. Rightly understood, health-care entitlement reform is not, as conservatives suggest, a matter of lessening the dependency of big chunks of the population on government largesse. It’s about weaning the members of our medical-industrial complex from their entitlement to far higher payments, despite shabby results, than their counterparts abroad get. This license for inefficiency, issued by both parties to doctors, hospitals, health plans, drugmakers and device firms, is diverting precious resources in an aging America from urgent non-health care, non-elderly needs.

    This is what’s really going on. It’s also what’s slated to continue, regardless of what you’ll hear in the campaign about big “cuts” a-coming.

    The politics of reform are awful, because every dollar of health care “waste” is somebody’s dollar of income. And no one has a sure fix, though I’ll look at promising ideas in a future column (or five). As with any alcoholic, however, the path to renewal begins with admitting that you have a problem. When “cuts” that leave U.S. health care wildly inefficient compared to our peers are damned by both sides as “savage,” our political process dooms us to denial.

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