Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No prices are labeled in store, they just detect whatever you take and send you a bill at the end of the month. (Differing brands of the same food product are not available in store of course.) Individuals are charged 3-100x more per product than negotiated rates, but can't find out until afterwards. Grocery "insurance" would then become a necessity. People would trade away disproportionate amounts of their salary to get good grocery benefits from their employers, i.e. to not get price-gouged by virtue of being an individual on the market. Stores would run discount programs for the very poor, which they could point to when people get outraged (as drug companies do now.) When politicians would threaten the system, grocery stores would fund ads about the "long lines" and limited food availability that would occur. Instead laws would get passed reinforcing the system by making sure everyone gets grocery insurance, as its a necessity (and it would _be_ a necessity).
I'm not saying that health care _could_ be exactly like grocery stores, with many alternatives, transparent pricing, and customers making the final decisions, but that it would have to be much _more_ like grocery stores to call it a free market. What we are working with now is just a system of pricing cartels supported by fear and lobbying. It needs to go.
This is a good analogy because it highlights the important problem. Insurance companies are incentivized to have healthcare prices increase so long as they get a discount. Why? Because it increase their value to the consumer to the point of necessity.
From the consumer perspective, calorie needs are stable and predictable, fundamentally different from what insurance is for.
From the supply chain’s perspective, there is a very sophisticated insurance system to smooth out issues with crop yields, weather, etc. called the commodity futures market.
Can you explain to a Non-American what forces this system of employer insurance onto the US? Why don't independent insurance companies emerge that offer other models of insurance?
Consumers using grocery insurance would have no real say or insensitive in what groceries they get - it doesn't matter if all they need is some chicken and a cheap wine. All the grocery store sells are filet mignon and Dom Perignon, and that's what everyone gets.
This would be great if health choices were being made by rational consumers. But when I break my leg, I want services quickly and I don’t have time or energy to price compare ambulances. Healthcare is not a marketplace that will have compassionate outcomes if we allow deregulation.
In a just world, nobody would go hungry, nor would anyone die prematurely or suffer needlessly due to lack of care. We can obviously afford both, in this country, just like they can everywhere else in Europe or Canada. So this entire argument about insurance is a straw man.
It’s not the doctors who set up this world. It’s people who want to pay less taxes, but blame doctors.
> but that it would have to be much _more_ like grocery stores to call it a free market.
Except not really. If I'm poor I can choose to eat nothing but ramen. I might not like it, it might not be the best for me, but it'll keep me alive. If I'm poor and have a heart attack I can't choose to just take tylenol, I do need that bypass surgery.
The ability to walk away from a transaction entirely is what makes the market free, and because health care is life or death there is simply no way to make it a free market, you are compelled by your life to make (many? most?) of the transactions.
The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions.
- Doctor's are paid too much... why?
- Well they need to be paid a lot because medical school debt is 250k or more... why?
- Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot... why?
- I honestly don't know.
But the current political climate in the US is incapable of dealing with any kind of multifaceted problem.
One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will occur.
(I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous)
> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will occur.
Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down. Don't want to pay what the government says it is going to pay? Good luck finding customers then, because the government is bargaining on behalf of all of the customers in the US.
People who say this stuff are the same people who proclaim there is no solution to a problem that the only occurs in the US. Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.
> (I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous)
It is illegal for Medicare to negotiate drug prices. That needs to be fixed.
> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous
I appreciate your reasonable breakdown, but I don't understand this one. I've seen many reports talking about how the costs of basic supplies and procedures are dramatically higher in the US (and vary wildly within the US). Things like X-Rays, MRIs, etc, being off by an order of magnitude or more (though I'm sure if the median price differences are less dramatic than the extreme examples, the results I vaguely recall said there was still a noteworthy difference)
How does this not indicate some fundamental difference between the US and other "developed" nations outside of the factors you list above? (Honest question)
You can also branch off here: because malpractice insurance is insanely expensive. Why? Because people sue over absolutely everything. Why? Because lawyers in this country are vultures.
If anything is overly expensive, you can usually track it back to insurance costs somewhere, which can typically be tracked back to the fact that we live in a litigious society.
> I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries
That's... not true at all. In European countries, single payer covers almost everyone, and the government has negotiating power to drive down prices. This is proven workable and effective in many places, including Canada. Literally every other industrialized nation has solved this problem.
If you don't agree with universal healthcare, fine, whatever, but don't go throwing around clearly obvious falsehoods.
This is like one of those "we can't solve it" arguments like gun violence where literally every developed country except for the US has solved it.
> One thing that will not make healthcare less expensive is "Medicare For All".
A large part of what makes American per-capita healthcare costs so outrageous is how much is treatment rather than prevention. Because going to a doctor is so expensive people just don't go, and then mundane problems that could have been fixed with at worst a routine surgery end up in an emergency room on life support expending a hundred thousand dollars of resources a day to correct.
Thats in addition to substantive productivity losses incurred by people being sick all the time without the financial resources to actually fix their ailments.
Even when you have health insurance the absurd deductibles mean you can't see a doctor anyway without being out the equivalent of half the months food or your entire utility bill.
It is absolutely imperative that any nations people have affordable access to medical professionals before they are suffering ill from all the things they noticed were off but didn't want to become indebted over.
> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous
This is not a fair comparison. Medicare/Medicaid predominantly covers the elderly. You can't compare their price spend to a mix including many more healthy people covered in single payer systems in other countries.
There is a WHY (or at least a general why):
Obfuscation.
- lack of clarity on competitive pricing
- obfuscation by adding multiple layers in buying process (broker - insurance - claims adjuster - hospital)
- obfuscation through too-many-options syndrome (Obamacare versus Medicare versus state-driven healthcare versus emergency-only healthcare)
- lack of clarity when being billed (getting several bills from several different departments)
There's also the problem of insurance companies being a for-profit enterprise that answers more to stockholders than to patients.
This is the result of "free market" idealists at work. Health is something that everyone needs, so businesses want a piece of the big pie by trying to wedge themselves somewhere in there. Only massive government overhaul can fix this.
> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people.
One of the myriad reasons healthcare in the US expensive is the middlemen who stand to profit from taking as big a cut of your premiums as possible, while paying for as little care as possible. Without this fundamental force driving healthcare prices it doesn't seem clear to me at all that prices would stay the same. Your dismissal of single-payer plans like M4A glosses over the largest proposed change to the structure of medical billing.
Yep, and what people don't always realize is that because employer health plans get more expensive every year for employers, it negatively impacts wage growth. You are paying for it even if you don't necessarily feel it.
It seems like a strange omission for this article not to mention that the reason health insurance is so expensive in the US is that health expenditures are so high. The US spends more than $10,000 per year per person on health care[1], more than any other country. Clearly, on average, premiums clearly must be higher than the amount paid out on behalf of the customer.
If you want lower premiums, you somehow need to lower the amount spent on health care. The problem is that, perversely, health insurance companies are incentivized to spend more on health care rather than less. By law, they must spend at least 80% of the money collected as premiums on health care costs[2]. The more they pay, the larger the 20% they are allowed to keep.
So if you want to reduce the cost of health insurance in the US, you need to reduce the cost of health care. If you want to reduce the cost of health care, you somehow need to change the incentives so that the big players benefit when the cost of health care goes down rather than up. Failing that, you need to change the system so those big players are no longer in control.
Only the latter option is a feasible solution. If you look at countries with mixed systems (like South Africa), a great deal of the cost savings disappear. Tim Faust has a great new book that breaks this down. Also, recommend his interview on the Death Panel podcast.
I would love if everyone that seems to be in support of a single player system would make a mental note right now that they were in support of it, and then years later after the US moves to such a system (seems pretty likely?) they review how much it helped.
I grew up in a single payer system and I'm theoretically in support of it for the many reasons people already listed in the comments (larger negotiation position, spreading the risk to more people, because it's humane, because it removes an incentive to stay in the wrong job, etc). But while I agree with those arguments I also have a strong conviction that if such a system were to be adopted in the US, it will NOT result in better care and more efficient and overall reduce the costs in the system. Not without many other changes in other laws and even cultural changes. Just because something works in Germany for example it doesn't mean it will work in the US, there are different demographics, different mentality, different service expectations, different tax system and a largely different legal and law system. Not to mention we were just discussing a few days back about the increasing national debt and this needs to be done without increasing the deficit.
I see alot of the proposed solutions to the US healthcare system boil down to some form of "Medicare for all". I think a single payer system would be great and I am all for it.
That said, I doubt it would solve all the problems in the US healthcare system at this point. It seems to me the biggest one is that providers, i.e. doctors, hospitals and drug companies all bill way too much. I think it is just politically less palatable though to go after doctors than after a big anonymous insurance company.
I do remember when I had an appendix operation a few years ago and was billed $50,000 for it, including some gems such as $4,400/night just for the hospital room and $50 for 2 tylenol that the Walgreens down the road would sell you for $5 a 24-pack.
I know several doctor acquaintances making >$1m and even $2m a year - I know they get together regularly where they actually discuss techniques to bill their patients the most money. One dermatologist discovered that removing 2 skin lesions on the same day was a bad idea - he got paid about 50% less for the 2nd one that way. Sending the patient home and telling him to come back next week for the 2nd one would however double the bill. So that's what he does! More patient inconvenience and added expense - but who cares?
The real issue generally speaking is people with union negotiated healthcare tend to really like their health insurance because in at least certain cases, they're getting Cadillac plans that give them a one up on seeing the best doctors around, in addition to in certain cases paying less in premiums than they would be taxed for M4A.
The second piece is that M4A is a huge unknown, and so they'd want to keep their health insurance because they're afraid that what the government will offer will ultimately be worse.
The first point is certainly easy to address as that money would then likely be renegotiated to result in salary increases, but with regards to the second, what would stop a republican administration from doing things like, effectively banning abortion by refusing to pay doctors who perform them through executive order.
I like my health insurance in the sense that I am fairly confident that I will like my current health insurance better than the insurance I will have in five years. The same way that I liked the insurance I had five years ago better than the insurance I have today.
Basically I think no one expects it to get better, so they are just all hoping it doesn't continue to get worse (while expecting that it will).
That statement was a stumbling block in one of the recent Democratic debates. I have no idea why none of the candidates drive the point that insurance != doctor home(in most cases) .
I felt this is something that politicians say to two groups: the insurance companies and the "anti-socialism" libertarian crowd (who have injected themselves into the republican party).
I just got my renewal quote: $2,372/month for a family of 4 is going to $2,883/month. That's a ~20% increase, to $34,595 PER YEAR.
(And this is while benefits continue to be cut back: $150/month for many prescriptions, etc.)
As others have written, there's no single reason. But, I think there's a major unintended structural problem: under US law, insurance companies are required to pay a high percentage (like ~90%) of their premiums out to service providers. The intent is to cut administrative overhead.
The effect: it's very hard for an insurance company to invest in technology or administrative improvements. So, the status quo persists.
WORSE, the admin overhead is pushed onto the providers, so the overhead cost gets hidden. It's not uncommon for a family medicine general practitioner to have a back office of 3-5 people dealing with billing and insurance paperwork.
Insurance companies need to be expropriated. The entire thing needs a restructure from the ground up, there are too many critical path issues that will keep things expensive if we try to have two systems at once (medicare for all + private)
the US should get real medicare, then move to a public/private system where you get base coverage through medicare and pay extra for fancy coverage.
I think another thing about employer-based healthcare that few think about is that if you work for a large company then it is almost certainly self-insured, meaning that you or your employer is paying premiums into a fund that it is managing itself.
How crazy is it to think that not only does Apple or Ford or Trader Joe's need to manage it's own business but that it is also hiring actuaries/insurance specialists/consultants etc to manage a complex insurance program for all of its workers? I'm not sure many people that work at large companies realize that their employer knows every diagnosis, procedure, and prescription you've ever picked up, and actively trying to incentivize you to use as little healthcare as possible.
Sharing this idea in order to gather critique.
The cost of healthcare in the USA is insane.
Could we look for insight into the US Military?
Example: This morning, a coworker told me she's going to have an operation on her back. The "cost of the tray" (I have no idea what this is) is $14,000. She has to pay $8,000 up-front two days before the operation, and the remainder will be financed over two years.
To me, it's insane to think the US Military pays $14,000 for this same operation in US Veterans' hospitals.
Why don't we look into the military to see how they're doing it?
In no other country is your healthcare tied to your employment but the US. Germany has had a national healthcare system since around 1880 (after the country was unified, based on what Krupp did for their employees). Why is the US the outlier (also in cost per capita)?
Even at famously generous employers they will try very hard to push you towards high deductible plans by giving you 1-2 thousand extra dollars per year in your HSA. Of course the high deductible plans discourage you from seeking care so it saves your employer peanuts it can add to its war chest in Ireland
Some of this probably has its roots in the ACA adding extra taxes onto “Cadillac insurance plans” though which I didn’t even learn about until recently. Yes, apparently you may need to pay extra taxes for extra good insurance
There aren't many industries where price shopping is as hard as healthcare. When you remove the cost of a good so far from the actual beneficiary costs become incredibly hard to control.
Not many here will remember when the insurance markets started in the US, but the original deal was that people pool their resources and get a discount vs street rates. However now that everyone is pooled, what possible metric can you use to determine if you are actually getting a good deal?
Sure, we hear stories of outrageous bills that are sent to patients that their health insurance "covers". However, the reality is the insurance company expects a discount which has caused an opposite effect to uninsured patients. Costs go up so that the "deal" the insurance company gets looks good. All the stories about $20 pill of Advil, is all pointing to the leverage hospitals and doctors used to fight cost cutting at insurance providers.
I think there are only two ways to resolve this at this point. Build a free market solution where price transparency is required and make it easier to shop for non-emergency care, while the government continues to cover emergency visits or full single payer healthcare with the government footing the bill.
Based on the moral logic that many U.S. citizens see healthcare and life savings services as fundamental right, I think we inevitably will need a single payer system in the US. I know the desire is to see something federally mandated but I am quite surprised that not one state has taken up the idea of single payer and made it a system available to all residence who prove they have resided in their state at least X days. I'd like to see the different solutions presented in each state and let the state with the best healthcare solution win and eventually become federal.
The U.S. is supposed to be immune to this in principal due to the nature of states being test beds of policy. The only reason this is happening in all states is because of federal policy that has destroyed the ability of states to experiment in this area.
When you ask for zero risk, you are asking for infinite cost.
My last reading of their work was years ago, but at the time the study found that folks will use fewer health resources when on a high deductible plan. However--the study allowed folks to revert to their old insurance (i.e., lower cost insurance) if they got sick. Meaning the study would show those in high-deductible plan would use fewer resources only because the people in that plan who used more resources quit the study.
The entire health insurance industry makes ~$25B in profits a year, correct? That doesn't seem overly large considering it is the entire insurance industry.
[+] [-] comnetxr|6 years ago|reply
I'm not saying that health care _could_ be exactly like grocery stores, with many alternatives, transparent pricing, and customers making the final decisions, but that it would have to be much _more_ like grocery stores to call it a free market. What we are working with now is just a system of pricing cartels supported by fear and lobbying. It needs to go.
[+] [-] throwaway66920|6 years ago|reply
[+] [-] closeparen|6 years ago|reply
From the supply chain’s perspective, there is a very sophisticated insurance system to smooth out issues with crop yields, weather, etc. called the commodity futures market.
[+] [-] kmjg88nvf8|6 years ago|reply
[+] [-] Apes|6 years ago|reply
[+] [-] pmart123|6 years ago|reply
[+] [-] plughs|6 years ago|reply
Alternatives and transparent pricing isn't going to make brain surgery affordable to the average consumer.
[+] [-] nextstep|6 years ago|reply
[+] [-] doctorpangloss|6 years ago|reply
In a just world, nobody would go hungry, nor would anyone die prematurely or suffer needlessly due to lack of care. We can obviously afford both, in this country, just like they can everywhere else in Europe or Canada. So this entire argument about insurance is a straw man.
It’s not the doctors who set up this world. It’s people who want to pay less taxes, but blame doctors.
[+] [-] BrainInAJar|6 years ago|reply
Except not really. If I'm poor I can choose to eat nothing but ramen. I might not like it, it might not be the best for me, but it'll keep me alive. If I'm poor and have a heart attack I can't choose to just take tylenol, I do need that bypass surgery.
The ability to walk away from a transaction entirely is what makes the market free, and because health care is life or death there is simply no way to make it a free market, you are compelled by your life to make (many? most?) of the transactions.
[+] [-] eric_b|6 years ago|reply
- Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot... why? - I honestly don't know.
But the current political climate in the US is incapable of dealing with any kind of multifaceted problem.
One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will occur.
(I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous)
[+] [-] mullen|6 years ago|reply
Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down. Don't want to pay what the government says it is going to pay? Good luck finding customers then, because the government is bargaining on behalf of all of the customers in the US.
People who say this stuff are the same people who proclaim there is no solution to a problem that the only occurs in the US. Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.
[+] [-] evantahler|6 years ago|reply
Because of redundancies in the US system, there are like 5:1 administrators for each doctor. That’s a huge source of the costs.
Medicare for all will likely cut a lot of those jobs to gain the savings. This show talks about if that’s good or bad for society.
[+] [-] hristov|6 years ago|reply
Medicare/medicaid does not negotiate drug costs down because it is prohibited by law from doing so. This is because of a law signed by the Bush administration (https://en.m.wikipedia.org/wiki/Medicare_Prescription_Drug,_...).
[+] [-] kaibee|6 years ago|reply
It is illegal for Medicare to negotiate drug prices. That needs to be fixed.
[+] [-] ergothus|6 years ago|reply
I appreciate your reasonable breakdown, but I don't understand this one. I've seen many reports talking about how the costs of basic supplies and procedures are dramatically higher in the US (and vary wildly within the US). Things like X-Rays, MRIs, etc, being off by an order of magnitude or more (though I'm sure if the median price differences are less dramatic than the extreme examples, the results I vaguely recall said there was still a noteworthy difference)
How does this not indicate some fundamental difference between the US and other "developed" nations outside of the factors you list above? (Honest question)
[+] [-] geddy|6 years ago|reply
You can also branch off here: because malpractice insurance is insanely expensive. Why? Because people sue over absolutely everything. Why? Because lawyers in this country are vultures.
If anything is overly expensive, you can usually track it back to insurance costs somewhere, which can typically be tracked back to the fact that we live in a litigious society.
[+] [-] jorblumesea|6 years ago|reply
That's... not true at all. In European countries, single payer covers almost everyone, and the government has negotiating power to drive down prices. This is proven workable and effective in many places, including Canada. Literally every other industrialized nation has solved this problem.
If you don't agree with universal healthcare, fine, whatever, but don't go throwing around clearly obvious falsehoods.
This is like one of those "we can't solve it" arguments like gun violence where literally every developed country except for the US has solved it.
[+] [-] glitcher|6 years ago|reply
I fear this may be true of all political issues now.
Sound bites and catch phrases that way oversimplify complex issues to the point of absurdity seem to sway a lot of voters.
[+] [-] zanny|6 years ago|reply
A large part of what makes American per-capita healthcare costs so outrageous is how much is treatment rather than prevention. Because going to a doctor is so expensive people just don't go, and then mundane problems that could have been fixed with at worst a routine surgery end up in an emergency room on life support expending a hundred thousand dollars of resources a day to correct.
Thats in addition to substantive productivity losses incurred by people being sick all the time without the financial resources to actually fix their ailments.
Even when you have health insurance the absurd deductibles mean you can't see a doctor anyway without being out the equivalent of half the months food or your entire utility bill.
It is absolutely imperative that any nations people have affordable access to medical professionals before they are suffering ill from all the things they noticed were off but didn't want to become indebted over.
[+] [-] cma|6 years ago|reply
This is not a fair comparison. Medicare/Medicaid predominantly covers the elderly. You can't compare their price spend to a mix including many more healthy people covered in single payer systems in other countries.
[+] [-] adamredwoods|6 years ago|reply
- lack of clarity on competitive pricing
- obfuscation by adding multiple layers in buying process (broker - insurance - claims adjuster - hospital)
- obfuscation through too-many-options syndrome (Obamacare versus Medicare versus state-driven healthcare versus emergency-only healthcare)
- lack of clarity when being billed (getting several bills from several different departments)
There's also the problem of insurance companies being a for-profit enterprise that answers more to stockholders than to patients.
This is the result of "free market" idealists at work. Health is something that everyone needs, so businesses want a piece of the big pie by trying to wedge themselves somewhere in there. Only massive government overhaul can fix this.
[+] [-] oarabbus_|6 years ago|reply
[+] [-] anarchodev|6 years ago|reply
One of the myriad reasons healthcare in the US expensive is the middlemen who stand to profit from taking as big a cut of your premiums as possible, while paying for as little care as possible. Without this fundamental force driving healthcare prices it doesn't seem clear to me at all that prices would stay the same. Your dismissal of single-payer plans like M4A glosses over the largest proposed change to the structure of medical billing.
[+] [-] tempsy|6 years ago|reply
[+] [-] nickgrosvenor|6 years ago|reply
An entire generation is draining their savings to keep up with premium costs.
Not to mention the millions of people locked into careers they would otherwise get out of, if not for the health coverage.
This situation is probably going to lead to unbelievable outcomes.
[+] [-] badrequest|6 years ago|reply
[+] [-] nkurz|6 years ago|reply
If you want lower premiums, you somehow need to lower the amount spent on health care. The problem is that, perversely, health insurance companies are incentivized to spend more on health care rather than less. By law, they must spend at least 80% of the money collected as premiums on health care costs[2]. The more they pay, the larger the 20% they are allowed to keep.
So if you want to reduce the cost of health insurance in the US, you need to reduce the cost of health care. If you want to reduce the cost of health care, you somehow need to change the incentives so that the big players benefit when the cost of health care goes down rather than up. Failing that, you need to change the system so those big players are no longer in control.
[1] https://www.healthsystemtracker.org/chart-collection/health-...
[2] https://www.healthcare.gov/health-care-law-protections/rate-...
[+] [-] claudeganon|6 years ago|reply
https://www.mhpbooks.com/books/health-justice-now/
https://deathpanelpodcast.com/2019/02/02/all-care-for-all-pe...
[+] [-] d1zzy|6 years ago|reply
I grew up in a single payer system and I'm theoretically in support of it for the many reasons people already listed in the comments (larger negotiation position, spreading the risk to more people, because it's humane, because it removes an incentive to stay in the wrong job, etc). But while I agree with those arguments I also have a strong conviction that if such a system were to be adopted in the US, it will NOT result in better care and more efficient and overall reduce the costs in the system. Not without many other changes in other laws and even cultural changes. Just because something works in Germany for example it doesn't mean it will work in the US, there are different demographics, different mentality, different service expectations, different tax system and a largely different legal and law system. Not to mention we were just discussing a few days back about the increasing national debt and this needs to be done without increasing the deficit.
[+] [-] arbuge|6 years ago|reply
That said, I doubt it would solve all the problems in the US healthcare system at this point. It seems to me the biggest one is that providers, i.e. doctors, hospitals and drug companies all bill way too much. I think it is just politically less palatable though to go after doctors than after a big anonymous insurance company.
I do remember when I had an appendix operation a few years ago and was billed $50,000 for it, including some gems such as $4,400/night just for the hospital room and $50 for 2 tylenol that the Walgreens down the road would sell you for $5 a 24-pack.
I know several doctor acquaintances making >$1m and even $2m a year - I know they get together regularly where they actually discuss techniques to bill their patients the most money. One dermatologist discovered that removing 2 skin lesions on the same day was a bad idea - he got paid about 50% less for the 2nd one that way. Sending the patient home and telling him to come back next week for the 2nd one would however double the bill. So that's what he does! More patient inconvenience and added expense - but who cares?
[+] [-] KoftaBob|6 years ago|reply
[+] [-] zjaffee|6 years ago|reply
The second piece is that M4A is a huge unknown, and so they'd want to keep their health insurance because they're afraid that what the government will offer will ultimately be worse.
The first point is certainly easy to address as that money would then likely be renegotiated to result in salary increases, but with regards to the second, what would stop a republican administration from doing things like, effectively banning abortion by refusing to pay doctors who perform them through executive order.
[+] [-] war1025|6 years ago|reply
Basically I think no one expects it to get better, so they are just all hoping it doesn't continue to get worse (while expecting that it will).
[+] [-] ihm|6 years ago|reply
[+] [-] southphillyman|6 years ago|reply
[+] [-] Consultant32452|6 years ago|reply
[+] [-] taurath|6 years ago|reply
[+] [-] cwbrandsma|6 years ago|reply
[+] [-] payne92|6 years ago|reply
(And this is while benefits continue to be cut back: $150/month for many prescriptions, etc.)
As others have written, there's no single reason. But, I think there's a major unintended structural problem: under US law, insurance companies are required to pay a high percentage (like ~90%) of their premiums out to service providers. The intent is to cut administrative overhead.
The effect: it's very hard for an insurance company to invest in technology or administrative improvements. So, the status quo persists.
WORSE, the admin overhead is pushed onto the providers, so the overhead cost gets hidden. It's not uncommon for a family medicine general practitioner to have a back office of 3-5 people dealing with billing and insurance paperwork.
[+] [-] weeksie|6 years ago|reply
the US should get real medicare, then move to a public/private system where you get base coverage through medicare and pay extra for fancy coverage.
[+] [-] tempsy|6 years ago|reply
How crazy is it to think that not only does Apple or Ford or Trader Joe's need to manage it's own business but that it is also hiring actuaries/insurance specialists/consultants etc to manage a complex insurance program for all of its workers? I'm not sure many people that work at large companies realize that their employer knows every diagnosis, procedure, and prescription you've ever picked up, and actively trying to incentivize you to use as little healthcare as possible.
[+] [-] knob|6 years ago|reply
To me, it's insane to think the US Military pays $14,000 for this same operation in US Veterans' hospitals. Why don't we look into the military to see how they're doing it?
Or am I completely off-base here? Thoughts?
[+] [-] patrickmay|6 years ago|reply
[+] [-] coldcode|6 years ago|reply
[+] [-] opportune|6 years ago|reply
Some of this probably has its roots in the ACA adding extra taxes onto “Cadillac insurance plans” though which I didn’t even learn about until recently. Yes, apparently you may need to pay extra taxes for extra good insurance
[+] [-] kxrm|6 years ago|reply
Not many here will remember when the insurance markets started in the US, but the original deal was that people pool their resources and get a discount vs street rates. However now that everyone is pooled, what possible metric can you use to determine if you are actually getting a good deal?
Sure, we hear stories of outrageous bills that are sent to patients that their health insurance "covers". However, the reality is the insurance company expects a discount which has caused an opposite effect to uninsured patients. Costs go up so that the "deal" the insurance company gets looks good. All the stories about $20 pill of Advil, is all pointing to the leverage hospitals and doctors used to fight cost cutting at insurance providers.
I think there are only two ways to resolve this at this point. Build a free market solution where price transparency is required and make it easier to shop for non-emergency care, while the government continues to cover emergency visits or full single payer healthcare with the government footing the bill.
Based on the moral logic that many U.S. citizens see healthcare and life savings services as fundamental right, I think we inevitably will need a single payer system in the US. I know the desire is to see something federally mandated but I am quite surprised that not one state has taken up the idea of single payer and made it a system available to all residence who prove they have resided in their state at least X days. I'd like to see the different solutions presented in each state and let the state with the best healthcare solution win and eventually become federal.
[+] [-] mensetmanusman|6 years ago|reply
When you ask for zero risk, you are asking for infinite cost.
[+] [-] xphilter|6 years ago|reply
My last reading of their work was years ago, but at the time the study found that folks will use fewer health resources when on a high deductible plan. However--the study allowed folks to revert to their old insurance (i.e., lower cost insurance) if they got sick. Meaning the study would show those in high-deductible plan would use fewer resources only because the people in that plan who used more resources quit the study.
[+] [-] throwawaysea|6 years ago|reply