And it’s somewhat how it’s still is in some fields of it primarily cosmetic, elective surgery (including LASIC and the likes) and dentistry.
There are plenty of countries where the majority of the health care is provided by private firms even if the state picks up the bill or part of it including almost all countries with universal healthcare.
The US is pretty much unique in costs and distribution of burden and it’s not because of the free market approach to healthcare.
When 9 out of the 10 most profitable hospitals in US aren’t even private/for profit you can’t simply claim that the investment firm or HMO that owns the hospital tries to suck out as much profit as possible for their shareholders.
P.S. I don’t agree that regulations are the problem anyone who thinks that you somehow would get better results with deregulating healthcare is likely very wrong, the entire system in the US is however broken and not because of simply campitalism.
Stitches are very easy to administer. Nobody needs a uni degree to stitch up a wound. They need lots of practice.
It is impossible for a reasonably free market to charge $5,000 for 3 stitches; because an independent doctor would set up next door with a sign saying "Stitches; $4,500!" and drive home in his Lamborghini every day. The hospital and the independent doctor would then start undercutting each other until the margins were no longer outrageous and they have to think a bit before dropping their prices any further.
If a hospital can get away with charging $5k for 3 stitches, any market freedom has long ago been exorcised.
How exactly do you measure the profit of a non-profit?
Non-profit is a misnomer - not for profit is a more apt phrase. While they can't operate with the intent of generating profit, they're perfectly allowed to actually generate profit from various activities. With the intention that the profits from that activity will be a revenue stream that funds loss-making activities elsewhere which support their nonprofit mission (such as issuing grants). Hence it's kept on the books as net assets.
[1] https://smallbusiness.chron.com/non-profit-accounting-defini...
They have to reinvest their profits back into the business that can be grants but can also be increasing pay to their staff or expanding their operation.
Two thirds of US hospitals are NFP (public, community, university etc) or government hospitals.
Ironically the more money they make and the bigger they are the higher prices they tend to charge because they can negotiate higher rates with the insurance providers.
The US system is simply broken the US healthcare has a huge problem with uncompensated care which is one of the primary reasons why most hospitals lose money on primary care.
This means that hospitals are “forced” to extract as much money as possible form insurers so your healthcare costs do not only incorporate the risks of all policy holders for your specific provider but also the uncompensated care costs of the hospitals.
The insurers then extract as much money as they can from their clients which primarily are business which don’t seem to care that much as they can often write of much of that cost as operating expenses.
This pretty much causes a cycle of inflation that is unsustainable under normal circumstances and will utterly brake the entire systems under extremes like the current pandemic.
Also that kind of emergency care is quite rare. It's a very small part of the healthcare system and mostly confuses the discussion.
> Because that would be the worst imaginable PR.
You're wrong. "Bad PR" has not worked at all to encourage the healthcare industry to fix medical billing on its own. See this article for an example:
https://www.nytimes.com/2017/03/29/magazine/those-indecipher...
It's literally impossible to comparison shop healthcare, and I've tried. You can't properly diagnose yourself, for the same reason a doctor can't properly debug your code. You have no idea how treatment is going to be coded (and you'd have to be an expert to understand the codes and their implications, anyway). Hospitals will only tell you their inflated "list prices." Your insurance won't tell you anything about what they've negotiated with the hospitals in your area until you've been billed, since they consider that information proprietary.
Most healthcare is to solve real health problems (from mild to extremely serious). People won't decide to live with those problems unless they're forced to, so they can't opt out of the system until it's fixed.
Indeed this is true.
The solution to this, though, is to make it required for hospitals to post their prices, as well as to make it illegal for hospitals to give preferential rates to insurance deals.
But not trivial to implement correctly. What exactly is the menu of procedures, and who standardizes (and updates) it? It would be much harder to comparison shop if there were a million entries (and every hospital offers a subset). Can hospitals select their patients, e.g. post great prices & outcomes by only accepting patients under 50 (or just with few other health issues)?
If you have time to listen to the podcast, it can be very eyeopening.
Huh?
The question I answered was about "people who are literally passed out and bleeding out on stretchers to price shop"
I agree that medical billing is a corrupt disaster.
If they can do it, why the fuck can't doctors do the same? The system is so obviously rotten.
It took years to find that almost every facility nearby does the tests he orders for no copay at all. But Beth-Israel doesn't see a problem with charging literally over a hundred dollars after insurance for a blood draw.
I guess a very big and very evil problem for another time, but our health care system is a house of cards.
No one hates their food stores that I'm aware of, even though that demand is at least as inelastic as for healthcare.
Also, I would like to point out that the vast majority of medical issues are not emergencies.
Maybe there is a reasonable argument that ambulances, and emergency rooms should be highly regulated. But, fortunately, the vast majority of medical issues do not involve going to an emergency room.
Before the government got heavily involved in healthcare in the 1960s, healthcare was cheap.
Edit: requested cite: https://www.thebalance.com/causes-of-rising-healthcare-costs...
Feel free to make a moral case against Reagan's decision if you feel like it.
I bought a 383 big block engine for my dodge, and a friend of mine was helping me move it into the garage. I tripped and fell on top of the block, making quite a gash in my eye socket. Lucky I missed my eye. Still have a scar! Sadly, the block turned out to have a crack in it and was not salvageable.
That's still more than most Americans could easily afford. And that's for stitches.
Healthcare was cheaper before Reagan interfered in the health care industry to artificially inflate costs to the financial benefit of his buddies.
That's just one.
EDIT: There are also separate osteopathic graduate schools and foreign med schools (Caribbean) that aren't limited by the AMA and still funnel thru the same match program.
I had a few of my undergrad bio and chem labs with a Vietnamese doctor who came to the US, I always tried to be in his group whenever possible because he had the most insight into the Industry as a result of his transition.
Apparently, because he was educated and practiced in Vietnam he was forced to have to repeat the entire process to enroll into Medical school. I'm not sure if was on loans or doing it on his own, but he must of have been determined to make it happen, because I'd probably do the same as your colleague if forced to do it all again.
He was an older guy, I was 18 or 19 so anything over 25 was 'old' to me but I think he was in his 30s while we were in our 2nd year courses.
With all of the polemics surrounding COVID19, I think the least we should do is take away the power of the AMA-like Institution to determine how many medical students can be enrolled into any program and make any necessary accommodations to ensure it happens.
Making the current medical staff do the equivalent of an understaffed, under supplied death march has to make reason prevail regardless of our stance.
Private and Public medicine is an issue to come back to, but being short staffed in a pandemic is suicidal--Italy recalling retired medical staff was alarming, but also highlighting that a Public Medical system is not yielding the panacea many suggest, either.
And for anyone asking for a source on the AMA's practices look at his, I remember reading this in 2005 as I was in school, and being schooled and trained as if I wanted to take MCAT because of the looming shortages caused by retiring boomers, even though I had no interest in Medicine:
https://usatoday30.usatoday.com/news/health/2005-03-02-docto...
"Competition and Monopoly in Medical Care" by Frech
https://www.amazon.com/Competition-Monopoly-Medical-Care-Fre...
(I'm pretty sure that's not what the person you were replying to is going for - but it is a very problematic piece of the regulatory environment which is unique to hospitals)
The attachment of medical insurance to employment is another.
If you don't already know at least a few of these, you're probably a student or not interested.
Nobody knows all the regulations, and asking for a list seems a bit clueless.
What's clueless is to use the word "regulations" like it's some incantation.
Healthcare is heavily regulated because medical care is not usually something you can restitute after the fact. If you sell me a defective widget my life doesn't depend on I can get my money back or sue you to get it back. If a doctor sticks a defective medical widget in my body and I die, I can't really do much about it afterwards.
I'd prefer that doctor's certifications have some sort of regulatory oversight. I'd also like medical widgets to be regulated so there's stringent QA and manufacturing process qualifications.