The article says insurers are required to pay:
> The doctors would instead have to work with patients’ insurance, which would pay the greater of the following two amounts: > > * The median in-network rate negotiated by health plans > * 125 percent of the average amount paid to similar providers in the same geographic area
That seems more than reasonable to me. They will get greater than market rate, if you define "market rate" as rates negotiated between insurers and doctors and not whatever nonsense they can get away with charging when the patient does not have pricing information and often isn't in a position to make a decision anyway.
> Here's a sensible solution: when it comes to emergency-based care, insurers must accept all comers as in-network. There's no such thing as "out of network" emergency-related care.
They are already required to pay for out-of-network emergency care even if the plan ordinarily doesn't cover out-of-network services at all, but they are only required to pay the usual and customary rates for those services, not the inflated nonsense bills (unless it's a state-regulated plan where state law requires the insurer to pay the inflated bills).
You're still paying for inflated healthcare costs either way; in a competitive labor market (not always the case but certainly is in SV), reduced benefit costs would be expected to increase cash compensation.
idk honestly, but i would be interested to find out. this is my first year working at this particular form so i will need to wait for my first w-2.
> You're still paying for inflated healthcare costs either way; in a competitive labor market (not always the case but certainly is in SV), reduced benefit costs would be expected to increase cash compensation.
sure, but the employer doesn't pay any tax on this type of benefit, whereas we would both face additional taxes if they simply paid me more.
all i'm pushing back on is the original statement that "people should demand an end to private insurers". people who don't get insurance through their employer and/or can't afford it themselves should probably oppose private insurance. software engineers, who already tend to have company insurance and be in high tax brackets, are pretty unlikely to benefit from any efficiency gains from a national health service. people like this can be wiped out by surprise out-of-network fees quite easily, so it is rational to focus on that aspect.
That argument seems like the equivalent of wasting money just for a tax deduction. You are right in a way though: if a single-payer plan is financed through progressive taxation or a payroll tax with no or a sufficiently high cap, higher earners will end up paying more than under the current system while lower earners will pay less.
> all i'm pushing back on is the original statement that "people should demand an end to private insurers". people who don't get insurance through their employer and/or can't afford it themselves should probably oppose private insurance.
Unless you get sick, are unable to work as a result, exhaust FMLA (if available), and can't get coverage through a spouse or parent (if under 26). Then hopefully you've got the savings or disability insurance to pay for COBRA (under which you have to pay the full premium your employer is currently paying) and/or Marketplace insurance in the interim, or you're stuck with Medicaid. Even worse, most Marketplace plans have narrow networks, so you may find that you're not able to keep some of your doctors -- particularly the specialists you're likely to need for an extended illness. Medicaid is even worse, because the reimbursement rates are so low.
And hopefully none of that happens to a loved one, who may not be in the relatively good position you are.
And that's ignoring the moral argument in favor of, well, not allowing people to die in a supposedly first-world country because they can't afford healthcare.
I actually agree. And to make this work insurers should stop negotiating individual rates with providers and instead providers should have a set price they charge no matter who pays. It's nuts that if you don't have insurance you pay 30k but with insurance suddenly the provider is OK with 7.5k.
It's not that simple, unfortunately. For one thing, Medicare reimburse at rates that are significantly below market prices [0][1]. Medicaid pays even less on average, and Medicaid reimbursement rates vary significantly from state to state [2]. Care providers need to make up for this by charging a higher rate to those who have private insurance or pay cash.
The obvious retort to the above is that providers could charge a single, higher rate for everyone except Medicare and Medicaid. But if you prevent providers from offering reduced rates to insurers that include them in their networks, insurers will have an incentive to make their networks narrower, charging higher out-of-network deductibles and copays for a larger proportion of providers. Eliminating provider networks entirely isn't a good option, since they're one of the only mechanisms keeping costs in check to begin with: insurers can remove providers from their networks if they become too expensive (or if the quality of care declines), pushing policyholders to cheaper (and/or higher-quality) providers.
To extend your example, say that instead of charging a 30k out-of-network rate and a 7.5k in-network rate for a particular insurer, a provider charges 15k for everyone. Are all insurers required to pay for the procedure at 15k (subject to deductibles and copays paid by policyholders)? If so, what's to stop the provider from charging 30k next year? And if not, what incentive do insurers have to pay for it?
[0] https://www.cbo.gov/system/files/115th-congress-2017-2018/wo...
I hinted about it here: https://news.ycombinator.com/item?id=18108839
More details here: https://news.ycombinator.com/item?id=18108870
If you forced insurance companies to accept all-comers, you’ve just drastically increased the cost of ER care.
My preference would be for the hospitals to hold the bag.
Fair enough.
How about everyone needing to pay the same rate regardless of whether they are insured or not: https://www.quora.com/Would-a-completely-free-market-healthc...
They could hire them with the agreement that they accept the insurer’s in-network rate.
And i’m not talking about situations where the entire hospital is out of network. It’s when the patient does their homework and the doctor and facility are in network and then some random doc shows up who is out of network and the patient gets screwed.
So you and I agree that change is needed, and action is necesary but what should be the course of action?
> Here's a sensible solution: when it comes to emergency-based care, insurers must accept all comers as in-network. There's no such thing as "out of network" emergency-related care.
Ah. I see you have good intentions but what you are saying is "Hospitals should be allowed to get paid whatever they charge and insurance companies should pay it"
Do you see the problem?
An example: https://www.publicintegrity.org/2015/06/15/17474/profit-hosp...
As a person who's extremely passionate about driving change in the U.S. Healthcare system, I communicate a lot with people who have falled on hard times due to a medical bill.
Here are two scenarios for you:
https://www.quora.com/Recently-my-husband-visited-the-ER-in-... https://www.quora.com/Why-did-the-doctor-charge-me-3600-hr-t...
When people ask me what I think is "wrong" with the health care in the USA, my answer surprises them:
Nothing is wrong with the health care in the USA. It is one of the very best in the world for those who can afford it.
The issue is that one should not have to look unexpectedly to a life completely ruined because they suddenly fell sick or got into an accident - they should be able to pick up their lives when they need to do it the most and go on from there.
I invite your feedback on:
https://www.quora.com/Would-a-completely-free-market-healthc...
https://www.quora.com/In-the-US-the-majority-of-people-under...
From what I’ve read/seen the system seems to be almost entirely a creation of unintended consequences of Congress, businesses, and well-meaning insurance companies. Sure there are bad actors but I don’t think they created the system, They only take it vantage of what was created (again, possibly unintentionally) by others.
They invest a large amount in very smart people predicting the consequences and then in lobbying (and bribing) politicians, and in supporting public information campaigns, to pass the laws that provide their desired consequences. For them to portray themselves as innocent and naive, if they do, would be cynical and absurd. It always seems to work out they make a lot of money, but probably unintentionally.
There doesn’t seem to have been a large investigation into the consequences of allowing healthcare coverage to be given to employees without counting as salary. That was one of the core sins.
Why do you think that? Is there something I could read? Certainly lobbying and financial incentives to politicians have existed forever.
I do love "sensible policy changes" that work by extracting money from physicians to cover patient bills rather than actually fixing the systemic dysfunction.
If you're the surgeon to hand, you don't get to refuse to do emergency surgery. You have to take care of that patient, ethically and legally. Oh, turns out they're out of network, and their insurer isn't obligated to give you a dime? Awesome, free surgery!
Here's a sensible solution: when it comes to emergency-based care, insurers must accept all comers as in-network. There's no such thing as "out of network" emergency-related care.
But hey, insurers have powerful leverage and a near-monopoly. What're the odds we'd take a slice off their profit margin?