There is no price transparency. Sure would like it since I have a high deductible plan.
Health insurance is supposed to cover you for catastrophic health issues that were previously unknown. For some reason it changed to also cover all your recurring or minor illnesses.
There is fairly strong evidence that if the cost of routine preventative care isn’t paid by insurance, quite a lot of people opt to skip it because they can’t afford it, leading to worse outcomes.
Do you have evidence of this part specifically? Because the Oregon Experiment found no improvement in health outcomes in a large randomized trial of low-income recipients of Medicaid. (Partly because their health was generally good in the first place.)
https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim...
While they credit the ACA with saving their life, had we had some form of socialized medicine from the start, this likely would've been caught much earlier, treated much more easily, and with significantly less long term effects.
I couldn't easily find studies on preventative care leading to better outcomes, but given how many diseases (like cancer for example) can go from easily treatable to a catastrophic nightmare depending on how early they are detected, I find it hard to believe that easy, cheap (or free) access screenings would have no effect on outcomes, though I realize how treacherous it can be to rely on instinct instead of data.
It did show an improvement is psychological outcomes, I presume due to peace of mind, because their wasn’t a corresponding increase in psychiatric medication.
It is part of large complicated model. If it was their entire model they wouldn't be operating medical offices and hospitals. It is the whole package that helps them control costs.
From this, I derived the argument that routine checkups are a *major* component of Kaiser’s system, to the point that, given the flow of discussion, I felt it appropriate to call it “their whole model”. I’m sorry my hyperbole was too far.
Well that and with Kaiser it's a lot easier to tell who is in network (they never commingle in and out of network care).
https://www.healthcare.gov/coverage/preventive-care-benefits...
Many people simply aren’t capable of shopping around, either: emergency care, cognitive impairments, limited geographic options, and the conflicts of interest inherent to for-profit medicine all make it hard for people to know what they need and whether it’s worth the money. As with preventative care, making it harder to get treatment is certain to lead to many people not getting problems treated prior to them becoming major.
Look at it from an economic incentive standpoint: Americans pay 2-3 times more for the same service. That is a huge amount of money, and it ensures that rooms full of smart people will be working to ensure that their employers continue to get it.
Hospitals have zero incentive to be transparent, and all the incentives to be opaque. So long as you’re a non-Medicare/Medicaid patient you’ll continue to suffer.
The American healthcare system is completely fucked (there’s no better word).
It's an underappreciated point. The US healthcare system is one of the largest wealth transfer systems ever invented. It's a heavily protected cartel that plunders wealth from the top 2/3 and lines the pockets of a few million employees in the system.
There is an excess cost bounty of $1.2 trillion (or more) being plundered and redistributed every year to the healthcare cartel.
There are millions of people working artificially high paying jobs in the healthcare cartel in the US courtesy of the hyper inflated costs in the system. From nurses to doctors to pharma sales reps to scientists to management and everything inbetween.
Nobody ever talks about the need to slash the pay of nurses & doctors though, it's far too unpopular of a subject, it's downright taboo. Just a notch below slashing the pay of teachers. They'd all go on strike tomorrow morning if a serious attempt were made to bring their pay in-line with other developed nations.
The US has to remove a minimum of $1.2 trillion in cost from its healthcare system (which would produce an end cost structure still far above that of eg Britain). Only about 10-15% of that can come from slashing costs out of the pharma drug price side. The bulk of it has to come out of inflated salaries of millions of workers in healthcare across the board.
When politicians talk about universal healthcare in the US, they always, without exception, go far out of their way to dodge this epic scale problem of inflated salaries in healthcare and of where to find $1.2 trillion in costs to slash (they primarily focus on high drug prices as a matter of political convenience; that segment by itself won't remotely cut it though). This is why every time a state decides it's going to look at doing universal healthcare, it immediately runs away after the cost study is completed, it's impossible until you remove a dramatic amount of cost from the system. Now someone go tell all the nurses and doctors in California they get to make 25%-35% less money (good luck).
Studies like this [1] led me to believe that massive rises in administration costs and inefficiencies due to insurance structure are bigger culprits than doctor/nurse salaries. But I am admittedly not very well informed in this area.
The people mentioned specifically in the comment are of more concern; sales, admin, etc. salaries in this field are also inflated compared to other industries.
There would be some overhead for single payer but it would be much more efficient and simple.
Massive insurance company dissolution might also be an unpopular reality for folks to come to terms with as well though
Did you know that hospitals make money by using name brand medications? They will get a contract with a brand, like Motrin, and charge you full price at $8 a pill. Then Motrin will will evaluate how much the hospital used and give them a big rebate to bring the hospital's cost down under $1 per pill. You can literally buy a bottle of ibuprofen for what they charge for a single pill, but of course in the name of safety (and really kickbacks too) they won't allow the cheaper outside medication. It's effectively an internal monopoly.
Most importantly, ALL of this planning and sense of choice goes out the window when you have a true emergency. When that happens all that matters is getting to an ER, fast.
Yep. I was a victim of this in the -worst- way. 11 years ago I was hospitalized, and it 'just so happened' that the only doctor that would take me while I was admitted was out of network.
BCBS of Michigan in fact later settled out of court in a class action over this behavior, although the 50 or 100$ I would have gotten certainly did not make up for the hundreds of dollars that the out of network provider cost me.
There was a thread here a while back about something like an emergency-mode uber for replacing ambulances for most ER trips. Something similar might also be done for shopping for cheaper urgent care too perhaps. Say a clinic that is open late and will check out your scary rash/cough/pain without charging so much.
There will always be a trade-off between quality and cost. If you accept nothing less than highest quality (enforced by law and an extremely litigious society), then you get the US hyper-inflation of healthcare prices.
Also in the US, I think ambulances typically only have EMT's and paramedics. Though sometimes it can cost as much as the ER itself.
The point was that the hospitals are doing things behind the scenes that are not well known that affect the pricing. In this example, they charge you more for using name brand medication and then get a kickback to make money for themselves.
Just completely clueless as to how things are/operate regarding healthcare in the real world.
If you get into a car accident tomorrow driving to work, the ambulance/paramedics aren't going to ask you to do your research prior to shuttling you to a hospital to get life saving treatment. Even if you could how would you be able to tell which hospital has what price structure, what services you'll actually need given your medical condition, and what arrangements they have with various drug manufacturers and how that relates to what you require to help your condition. Save it.. "no one to blame but yourself" is so incredibly idiotic is comical.
Take something even more benign, like someone falling and breaking/straining something. Wanna still do your research first? Is it a sprain, fracture, break? How do you know? Is it clear cut? What pain medication will you need? Will you require surgery? What lab work will you need? How many tests will you need? X-rays? CAT scan? MRI? What kind of surgeon? How many nurses? Will you require blood? Whats the recovery like? What about follow up visits? Do you expect us all to practice free market principles and know all that crap in advance for price discovery before deciding to seek treatment?
True free market principles require an asymmetry of information for the system to work, and even "fathers" of the theory understood that and acknowledge the need for regulation when its absent.
True free market principles require a symmetry of information for the system to work
I would emphasize that traditional forms of conservatism were never opposed to all regulation and never embraced this libertarian worship of the unregulated market. They were opposed to collectivism, but the only remaining option isn't radical individualism. Neither are good for the individual or for society.
You Americans are getting so screwed... I got 4 separate X-ray scans done for $40 recently, modern machine, sent home with physical copies and USB, etc.
You have no idea what that person's thoughts or beliefs are...
For instance if a provider billed a patient over 100% of their stated price or over 120% the minimum price for the same item published by comparable providers, there might be some public fine or tax on the biller and rebate to the patient in proportion to the entire amount by which the patient was over-billed regardless of their insurance status.
This would possibly amount to something similar to universal public price negotiation.
But yes the idea of using pricing transparency to suppress over-billing by monopolies could possibly be interpreted as suggesting a rejection of the alternative idea of centrally fixing all consumer facing prices using a public office and then determining all government facing prices from external suppliers providing necessary inputs for the public healthcare system through minimum bid.
There is the hyper-libertarian argument which says that if someone arrives at a hospital unconcious, and the hospital bills them the maximum amount they estimate the patient can pay before bankruptcy, so the hospital can maximize initially reported earnings before writing down unpaid debts, that this is somehow a voluntarily market price as long as the hospital is private and not owned by the government, because value is purely subjective and has no relation to cost.
Then there is the other argument which says if hospitals are over-billing people which are under duress, that this is bad and we want to do something about it, but we don't want to immediately nationalize healthcare and ban private health insurance. This second type of conservatism usually focuses on price controls or regulation of monopolies.
With pricing transparency regulations, it's probably possible to implement universal public price negotiation by fining non-elective healthcare providers which bill patients over 100% of their previously published price or 120% of the minimum price published by comparable providers. Then rebate patients the entire amount they were over-billed regardless of their insurance status.
With over-billing rebates there is less need to collect payroll tax to finance social insurance premiums. Need based assistance could be financed from more progressive property taxes on the rich, and the actual price controls could be implemented relatively cheaply by randomly auditing providers to ensure compliance, by allowing patients to manually submit invoices whenever they felt they were over-billed, and by financing rebates to patients entirely from fines on providers.
It's certainly possible that other systems would work better. However if we want to be nuanced there are many different strands of U.S. conservatism. Historically U.S. conservatives subscribed to some form of cost or labor theory of value. The kind of hyper-libertarian conservative movement which says private prices are always fair is probably less than 100 years old.
I'm guessing you've never been placed on an involuntary psych hold, or woken up at a hospital after an accident left you incapacitated.
A hospital has even more lock in than the App Store. They can literally legally lock you in.
Wasn't this already put in place by the previous administration?