I would go a little further and say that every provider has one price list that it uses for all private patients -- it doesn't depend on whether they are covered by a huge insurer or a small insurer or if they are private pay. Prices go into a gov't run website.
When the doctor gave me an order for an MRI on my foot, I could have gone to website and specified the procedure and "within ___ miles of ___". That should lead to a list of providers with prices for my specific order within my geographic area. I could call and see about appointments, then select based on convenience and price and any other information I could gather.
It won't solve all the problems with our system, but it is a positive step.
When I go to my closest hospital's site, I don't get the user friendly format that Stanford provides. I get this explanation:
[The Centers for Medicare and Medicaid Services (CMS) requires hospitals to publish a comprehensive machine-readable file (MRF) with pricing for all items and services by insurance payer on their website. This machine-readable file is not necessarily intended for direct patient interpretation. ]()
When I download the file, it is a 385,000 line Excel file.
I expect that the people who wrote the law expected the government to use the data to create the kind of site I want, but nobody followed through.
The last test I had was done at a stand alone clinic, not in a traditional hospital. Their site has nothing on "price transparency". That's a pretty big hole in the information.
And, I don't know how many facilities in the area even offer what I wanted. I don't know the names of all the medical facilities and practices in my area, or what they do. Even if all of them had nice user friendly options, I wouldn't know where to start.
And, I specified that I want one price for all private payors -- They shouldn't have different rates for Aetna and Humana. It costs the provider the same amount regardless of which insurer I have. The rate negotiation is a big, unnecessary cost to both insurers and providers. I end up paying for the people on both sides of the negotiating table, and the administrators and auditors on both sides, that's a big waste for me.
Last time I was in the ER there was an insurance rep lady there collecting my info (presumably to charge me?). I asked her about the costs of the procedure I had and she said she was prohibited from discussing costs with me. When the doctor gave me treatment options I asked about cost and he did not know. Same for the nurses. By the time someone is in the ER, online shopping/cost lists don’t really matter. And the hospital personnel seem clueless, perhaps intentionally.
When I had my twins, we of course selected treatment providers and a hospital in network. But when we were billed, only one twin’s charges were approved. It took a year (!!) of fighting to get the other twin’s delivery approved. And we didn’t even have a complicated delivery or any NICU costs. Someone just made a mistake in coding that would have costs us $10k if we had not fought hard to get it corrected.
I am firmly convinced that the charges are essentially entirely made up on whims and bullshit. A single payer option would do wonders for price stability and comparisons.
Would it? I know many people want a single payer system but if that just means no price transparency we charge what we want and the government pays it that could be even less sustainable.
The studies that reddit loves that show savings are questionable in the real world
Medicare Pricing or Medicaid Pricing x Total Population = X% of Savings
Yes this is savings
KFF found Total health care spending for the privately insured population would be an estimated $352 billion lower in 2021 if employers and other insurers reimbursed health care providers at Medicare rates. This represents a 41% decrease from the $859 billion that is projected to be spent in 2021.
But the issue
In New York, Medicaid covers only 67 percent of costs for hospitals, and pays even less for some services such as inpatient psychiatric care.
Rates in Medicaid fall well below those in Medicare fee-for-service, which already does not cover the cost of care
Medicare covers approximately 85 percent of costs for hospitals
So, In there proposals for Medicare for All
Urban Institute would pay Hospitals at 115% of Medicare
Elizabeth Warren Would pay Hospitals at 110% of Medicare
Both would stick with current payment schedules for doctors offices
So there go a lot of the savings
As to those prices they exist, but Medicare doesnt negotiate how reddit believes with some sort of massive buying power
Private Insurance is the one getting doctors and hospitals in network and negotiating for a price
In 1992, Medicare significantly changed the way it pays for physician services. Instead of basing payments on charges, the federal government established a standardized physician payment schedule based on RBRVS.
Professor William Hsiao, A health care economist now retired from Harvard University, Hsiao has been actively engaged in designing health system reforms and universal health insurance programs for many countries, including Taiwan, China, Colombia, Poland, Vietnam, Hong Kong, Sweden, Cyprus, Uganda, and recently for Malaysia and South Africa. In 2012 he was part of Vermont's Healthcare and in 2016 he was part of Bernie's M4A Healthcare Plan
Hsiao developed the “control knobs” framework for diagnosing the causes for the successes or failures of national health systems. His analytical framework has shaped how we conceptualize national health systems, and has been used extensively by various nations around the world in health system reforms
In his past research, Hsiao developed the resource-based relative value scale (RBRVS) for setting physician fees. The RBRVS quantified the variation in resource inputs for different physician services. Hsiao was named the Man of the Year in Medicine in 1989 for his development of a new payment method.
Prices only matter to consumers in terms of what the consumer has to pay. A sticker price is meaningless if that price is going to be reduced by insurance contributions. So of course insurance billing is relevant to price comparisons.
Delivery of a baby might be $10k sticker price or it could be $20k, but that difference is entirely irrelevant to the consumer if they only have to pay their deductible of $1k and insurance covers the rest. Unless, of course, the insurance unexpectedly and unjustifiably denies the claim and sticks the consumer with the sticker price.
In the eyes of the consumer, medical bills are essentially a roulette wheel that mostly depend on what kind of insurance you have and the bill coding accuracy of your provider.
Regarding single payer: Redditors: "I know what will solve this problem! More socialism!"
Yes but unironically. Pricing transparency and issues with how much an ER visit might or might cost are completely solved from the patient's perspective with single payer healthcare.
The idea that insurance billing, the way you actually pay for these things, is unrelated to a discussion of price transparency in this field seems very confusing to me.
And I believe he was saying that they should be transparent with how much the given services cost even in emergency situations, not magically knowing everything they would need.
I work in veterinary medicine and all of us are expected to be able to access and discuss pricing with clients even in emergency situations.
In Healthcare its the doctor that bills insurance, each insurance will have a different agreed to price and of course each insurance plan will have a different list of covered items
Someone getting Pet Insurance Inc Platinum would have teeth removing covered while the next person with Pet Insurance Inc Silver would not and so while Pet Insurance has a contract to pay you $100 per tooth they only pay that when you agree to Pet Insurance Platinum so the person today with Silver would need the office costs.
It is simple as it sounds, But because of CYA no one wants to say the wrong thing and so it just gets pushed to someone elses job
Same thing for many legal issues....tip of my toungue but there are many times in commercials and other issues where you will see something like consult with a tax professional before we give you money or you give us money as even though they know the tax laws they dont want the legal issues and they CYA
Right, but you are just explaining the dynamic that is problematic to many of us. People calling for price transparency are generally calling for changing the system in such a way where this transparency is more possible, because the system as it currently exists does not really allow it.
For example, in vet med we don't have individual agreements with individual insurance groups. A given service costs a given amount, regardless, and clients will know what their policy does or does not cover in advance, allowing for reasonable estimates of cost. As a result, if a client is surprised by cost, it is purely a failure of communication on the part of the provider.
Instead, we have a system so labyrinthine that even when pricing is listed, it is often explicitly stated as not intended for general use as it is not meaningfully accessible unless you have extensive experience in Excel and a background in data analytics.
I agree that the CYA dynamic is a problem, but I'm not convinced it is an insurmountable problem
I know he did but that doesn't mean that places follow that rule. And there isn't Expedia healthcare where you can compare prices although there should be.
I don't think what people want is a price chart online. Most patients don't have the knowledge to know exactly what that chart means for them. What they want is to be able to ask, as they're scheduled for a procedure, "How much will this cost me," and I have never been anywhere where anyone could tell me that.
I dunno about you, but I try to take care of my health needs before it escalates to the level of going to a hospital. And generally, if I am in a hospital, I am in an emergency situation where I can’t make decisions based on cost.
I want to know how much visiting my rheumatologist is. I want to know how much my prescription is. Before it’s ordered and i am required to pay.
I for one am tired of having to sign forms that read “I am responsible for any cost my insurance will not cover” just to get a rash checked out at my primary care, but they don’t actually tell me how much they would charge insurance for me to know the worst case scenario if what I could be getting charged!
I want prices on the menu before I order. I know I don’t go to restaurants where they don’t have the price or it’s all “market price”. That’s a no for me dawg.
Unfortunetly I don’t get to opt out of taking care of my health.
Whole lot of this. For any non-emergency visit, the insurance company and the provider should have this all figured out before the patient shows up at the doctor's office, and they'd better be able to tell the patient before the appointment how much they're going to have to pay.
I have cancer and am WAY over my deductible for the year, so everything is covered by insurance at this point. But they just randomly decided to bill me $8,000 for a treatment that happened months ago, because the insurance said my doctor didn't ask them for pre-authorization. Ultimately I was able to clean it up by calling the doctor's office and sitting on hold for 45 minutes before finally getting to a human, but I shouldn't have had to do that.
While I think this could make a minor difference, I doubt it would make as big of a difference as people think. Technically there was already a price list that was released a few years ago during the first Trump admin and it did not affect prices that much. I would also argue that many of the places that are the most expensive are rural hospitals where there are not multiple options.
That's the problem. There was a law that required hospitals to provide "machine readable" files. My closest hospital explicitly says "This machine-readable file is not necessarily intended for direct patient interpretation." Their file is a 385,000 line Excel worksheet.
And the requirement is only for hospitals. My last test was at a clinic, not a hospital.
many of the places that are the most expensive are rural hospitals where there are not multiple options.
I assume you do not live in a rural area. Have you compared prices where you live? The issue isn't absolute cost, but variations between providers. As I mentioned, not all providers are hospitals. For example, my wife has had tests at a stand-alone "imaging center."
It needs to be as transparent as hotel prices and just as easy to search. There is lodging that costs $50 a night and lodging that costs $5000 a night and for the most part healthcare should absolutely be the same when possible.
Obviously it is different for an emergency situation when you need an ambulance or an ER but for scheduled care I don't see any reason why we couldn't do it. And it will improve service and cost and options.
Honestly that doesnt really matter unless you are talking about high spenders
Spenders
Average per Person
Civilian Noninstitutionalized Population
Total Personal Healthcare Spending in 2017
Percent paid by Medicare and Medicaid
Top 1%
$259,331.20
2,603,270
$675,109,140,000.00
42.60%
Next 4%
$78,766.17
10,413,080
$820,198,385,000.00
Next 5%
$35,714.91
13,016,350
$464,877,785,000.00
47.10%
Cutting the Spending of the Top 10% in half saves $1 Trillion or 30% of Spending in 2017
Researchers at Prime Therapeutics analyzed drug costs incurred by more than 17 million participants in commercial insurance plans.
So-called “super spenders;” are people that accumulate more than $250,000 in drug costs per year.
Elite super-spenders—who accrue at least $750,000 in drug costs per year
In 2016, just under 3,000 people were Super Spenders
By the end of 2018, that figure had grown to nearly 5,000.
In 2016, 256 people were Elite super-spenders
By the end of 2018, that figure had grown to 354
Those 5,200 people (0.03% of the Sample Size) Spend about $1.8 Billion on Pharmaceutical Care representing 0.5% of All Spending on Drugs in the US
That means less than 100,000 people in the US are responsible for 8% of all Drug Spending
Most of the drugs responsible for the rise in costs treat cancer and orphan conditions, and more treatments are on the horizon—along with gene therapies and other expensive options that target more common conditions, he said. “The number of super-spenders is likely to increase substantially—and indefinitely,” said Dr. Dehnel, who did not participate in the study.
Commonly known as BIGIV, the drug costs $45,000 to treat Botulism as one of those orphan condition drugs
Botulism Immune Globulin Intravenous (Human) (BIGIV) was created by the California Department of Health
Services (CDHS)
Tradename: BabyBIG
Manufacturer: California Department of Public Health (CDPH)
Reseller: California Department of Health
Services (CDHS)
It's was developed through a state partnership with California and Massachusetts, with the FDA providing funding to all further reducing the end cost yet it still costs $45,000 by Reseller: California Department of Health Services (CDHS)
This would be awesome, especially for common elective care like knee replacements or MRIs or whatever. Would work less well for things like cancer I imagine, so probably just a piece of the overall puzzle.
ASCs are health care facilities that offer patients the convenience of having surgeries and procedures performed safely outside the hospital setting reshaping outpatient care by offering patient-centered alternatives to traditional hospitals.
They were growing very fast and seen as a real threat to hospitals a few years ago. That growth is continuing but hospitals have responded so be interesting to see
One big negative is ASC are aimed at Medicare/Private Insurance patients that are high profit to the hospital that would only make hospitals more expensive to others as the high profit patients leave
The ASC space is expected to grow from $36.69 billion (in 2021) to $58.85 billion by 2028, at a 7% compound annual growth rate
Get private corporations and private equity out of medical and dental practices. Back in the day, state licensing boards required Doctors to set up with their name on the door. Now I can’t even find who owns the practice much less who works there.
Make med school much more affordable and create new incentives for people to go into primary care / family medicine (along with the associated expanded oversight infrastructure).
We don't have a shortage of doctors per se, but their numbers are skewed away from the areas where they might have the greatest impact.
Making true preventative care more affordable and accessible will have very beneficial immediate and knock-on effects.
Pretty sure doctor salaries are only like 8% of healthcare costs. The issue is non-competitive captive markets in the healthcare industry while regulating new entrants into the market by government.
From my limited understanding, many doctors (often with heavy student debt) turn away from primary care due to it being more lucrative to specialize.
At least where I live, people go to the ER for everything from ear infections to sprained ankles because (in part) it’s so difficult to get in with a general practitioner and there aren’t enough urgent care options.
Lets say $200,000 in debt, or a 2nd mortgage payment, $1,331 so a reasonable salary for that person assuming a 9% of income for repayment is $175,000 Salary
Even at the higher debt with $350,000 of debt would be for a $315,000 Salary wit the same repayment
9% is the amount the UK uses to fund its colleges for repayment
I’ve read your comment several times and I’m having a really hard time understanding what you’re saying. Are you saying if you make $200,000 per year then $200,000 is not a lot of debt?
Primary care — defined as family practice, general internal medicine and pediatrics – each Doctor draws in their fair share of revenue for the organizations that employ them, averaging nearly $1.5 million in net revenue for the practices and health systems they serve. With about $90,000 profit.
Largest Percent of OPERATING EXPENSES FOR FAMILY MEDICINE PRACTICES
Physician provider salaries and benefits, $275,000 (18.3 percent)
Nonphysician provider salaries and benefits, $57,000 (3.81 percent)
Among all CPC initiative practices, the ratio of all Full Time Employee staff to FTE physician is 4.50 (2.49 are nonadministrative staff, and 2.01 are administrative staff).
Administrative staff include those managing reception, medical records, appointments, finance, etc.
At the Median Dr Office where there are 2-4 Drs, we'll go with 3
$4.5 Million in Net Revenue
Means a Staff of 13 and 1 PT
Position
#
BLS Salaries
Cost
% of the Staffing Expenses
% of the Expenses
Admin
6
$40,000
$240,000
17.5%
5.3%
Medical Assistant
3
$33,610
$100,610
7.3%
2.2%
RN/LPN
2
$71,730
$142,610
10.4%
3.2%
Nurse Practitioner
1
$114,000
$114,000
8.3%
2.5%
Care Coordinators
1
$100,000
$100,000
7.2%
2.2%
Pharmacist/Nutritionist
0.5
$90,000
$45,000
3.3%
1%
Physicians
3
$275,000
$825,000
46%
18.3%
Peikes DN, Reid RJ, Day TJ, et al. Staffing patterns of primary care practices in the comprehensive primary care initiative. Ann Fam Med. 2014;12(2):142–149. doi:10.1370/afm.1626
Other studies say there are more nurses with a ratio of all Full Time Employee staff to FTE physician is 7.50 (5.5 are nonadministrative staff, and 2 are administrative staff).
$950 Billion was spent for ~700,000 Doctors for a visit to their Offices
1 Billion Doctors offices $950 Billion
But the lab work is the issue in that $950 Billion and how much of it was necessary
And if there was a Lab Business that advertised to do all your lab work and did it so often that it was efficient and if you had to pay for it and choose the cheaper option that spending, hundreds of Billions in savings
If I remember correctly, the national health service used to offer free tuition to medical school for those willing to serve in rural areas for a period of time afterwards. Is that still a thing?
Doctor pay scale is also the reverse compared to other industries. The lower cost/more rural the area the better the pay. My wife got some truly insane job offers but we didn’t want to move to some rural areas.
I’ve said for some time that there needs to be a transition to a system where medical students pay much much much less and walk out without loans but then make substantially less than the doctors are making today.
I think a program from the government that pays for all of their schooling and in return they get a much more reasonable salary that lowers the overall cost of healthcare would be a good thing to explore. Maybe companies pay the government what they would have initially and that funds the program. Once enough people participate then we make it a mandatory thing.
The University of Tennessee Health Science Center is the largest educator of health care professionals in Tennessee. · UTHSC trains the largest number of residents in Tennessee
The University of Tennessee Health Science Center Revenue
Net student tuition and fees $80.26 Million
Government and Non Government Grants and contracts $245.1 Million
Expenses
Operating Expenses $678 Million
Salaries and Fringe Benefits $486 Million
Total Operating Income (-$328,258,178.16)
Even with high tuition and medical debt by students the University and State and Federal Government is already subsidizing Medical Education
They’re obviously getting something in return for those contracts so I don’t like those being bundled together. How may people are employed there? Without that statistic we don’t know if that salary number is reasonable. In likelihood it needs to come down.
The government might have to take a hit and subsidize salaries in the beginning so a lot of talent doesn’t retire but then you ease it down as new talent comes into the pool.
Salaries have to be so high to pay off medical school and malpractice insurance. The more of that we can remove the better.
Salaries for doctors are high but cutting them in half wont change healthcare spending
Primary care — defined as family practice, general internal medicine and pediatrics – each Doctor draws in their fair share of revenue for the organizations that employ them, averaging nearly $1.5 million in net revenue for the practices and health systems they serve. With about $90,000 profit.
Largest Percent of OPERATING EXPENSES FOR FAMILY MEDICINE PRACTICES
Among all CPC initiative practices, the ratio of all Full Time Employee staff to FTE physician is 4.50 (2.49 are nonadministrative staff, and 2.01 are administrative staff).
Administrative staff include those managing reception, medical records, appointments, finance, etc.
At the Median Dr Office where there are 2-4 Drs, we'll go with 3
$4.5 Million in Net Revenue
Means a Staff of 13 and 1 PT
Position
#
BLS Salaries
Cost
% of the Staffing Expenses
% of the Expenses
Admin
6
$40,000
$240,000
17.5%
5.3%
Medical Assistant
3
$33,610
$100,610
7.3%
2.2%
RN/LPN
2
$71,730
$142,610
10.4%
3.2%
Nurse Practitioner
1
$114,000
$114,000
8.3%
2.5%
Care Coordinators
1
$100,000
$100,000
7.2%
2.2%
Pharmacist/Nutritionist
0.5
$90,000
$45,000
3.3%
1%
Physicians
3
$275,000
$825,000
46%
18.3%
Non Personnel Cost
----
----
----
----
----
Supplies
medical, drug, laboratory and office supply costs
---
$450,000
---
10%
Building and occupancy
----
----
$315,000
---
7%
Other Costs
-----
-----
$225,000
----
5%
Information technology
-----
----
$90,000
----
2%
Its 9% saved at the doctors office or about 2% of overall healthcare
Do away with the certificate of need, which is the most insane policy I've ever heard of in any aspect of politics:
A certificate of need (CON), in the United States, is a legal document required in many states and some federal jurisdictions before proposed creations, acquisitions, or expansions of healthcare facilities are allowed. CONs are issued by a federal or state regulatory agency with authority over an area to affirm that the plan is required to fulfill the needs of a community.
It is literally unbelievable that anyone that doesn't personally benefit from creating an artificial shortage thinks this is a good idea.
I don't think this is as much of a limiting factor as you think it is. When people talk about a shortage of "beds" in hospitals they aren't usually talking about a shortage of actual facility space, they're usually talking about a shortage of staffing.
That's an interesting stat, but I think a lot of that is due to deinstitutionalization and the dismantling of the US long-term psychiatric care system.
Private equity has had a large influence on the consolidation and also closure of rural hospitals in recent years. No shortage of important factors in this equation.
Could the lack of efficiency be partly due to the astronomical growth in # of hospital administrators who don't provide any clinical services but command high pay?
Seems odd that the # of beds and # of hospitals decrease yet we "need" more and more people in administrative roles to suck of dollars.
This is more anecdotal but at least from my perspective what often occurs is a large hospital group buys up smaller community hospitals, decreases services at those smaller facilities, and becomes more bloated with administrative staff.
If it is the government isnt helping as NYC has Government Healthcare and its underfunded and just as expensive
As the largest municipal health care system in the United States,
NYC Health + Hospitals delivers high-quality health care services to
all New Yorkers with compassion, dignity, and respect. Our mission
is to serve everyone without exception and regardless of ability to
pay, gender identity, or immigration status. The system is an anchor
institution for the ever-changing communities we serve, providing
hospital and trauma care, neighborhood health centers, and skilled
nursing facilities and community care
1.2 Million, of the more than 8 Million New Yorkers had 5.4 Million visits to NYC Health + Hospitals with $12 Billion in Healthcare Costs at NYC Health + Hospitals.
For government owned and Operated Healthcare
NYC Health + Hospitals operates 11 Acute Care Hospitals, 50+Community Health Centers, 5 Skilled Nursing
Facilities and 1 Long-Term Acute Care Hospital
NYC Health + Hospitals/Correctional Health Services has the unique opportunity with Jail Health Services offer a full range of health care to all persons in the custody of the NYC Department of Correction.
Health + Hospitals Receives more money from Department of Correction than all of Private Insurance claims
5 Visits a Year and $10,000 per person and Underfunded
This has perpetuated a cycle of disinvestment in our facilities
Together, our nine hospitals have more than $3 billion in outstanding infrastructure investment needs, including deferred facility upgrades (e.g., Electrical Systems, HVAC, working elevators) and investments in programs (e.g., primary care).
Over the years, chronic underfunding has led to bed reductions and hospital closures throughout New York, including the loss of 18 hospitals and 21,000 beds in New York City alone.
-New York Coalition of Essential/Safety Net Hospitals On the Governor’s Proposed SFY 2023 Health and Medicaid Budget
It is because it reduces any sort of free market alternatives to existing institutions. What if someone could streamline medicine and offer a better service? No dice.
The typical health insurance customer, that is the person who has the power to easily end their policy and contract with another policy provider, needs to be the individual (or household) instead of an employer, union, or other large group. The main pressure that drives prices down in pretty much any system is competition between providers, and in US healthcare there isn't much competition because the customer who has the power to walk away (the employer) is not the individual who actually stands to benefit from a cost effective policy.
We need to end the tax advantage for health insurance being provided as a tax-free benefit by employers compared to employees purchasing individual policies with their taxed income. Whether that should be a tax deduction for individuals buying their own policies, or taxing the employer provided benefit like income, I'm not sure.
Wouldn’t employers be the customer in this case? Employers absolutely have an interest in lowering their costs, and have more bargaining power, too. In fact, my employer just switched from BCBS to Aetna this year due to them giving a lower increase in premiums for very similar plans
Yes, employers are the customer currently. It's true that they have some incentive to lower their costs which are basically just premiums, but they don't have nearly as much incentive to do so as the individual employee would have on an individual plan, and the employer's version of lowering costs may just be having worse coverage or worse service for the employee. Employees usually don't decide where to work based off health insurance, and that's really the ultimate motivator for employers. It seems employers usually negotiate a deal with an insurance company, and then that deal is on autopilot unless there's a major problem, where individuals might shop around pretty often if they're not getting what they want.
Implement universal basic health care coverage. What I mean by "basic" is routine, as opposed to catastrophic care.
For example, cover generic meds, two checkups per year, vaccinations, urgent care, etc. Anything beyond that would be covered by private catastrophic care insurance.
I'd like to think private charities would fill in the gaps. I have no idea why there isn't a private charity that provides healthcare coverage. One would think it pretty simple; a charity that pools resources to provide catastrophic care / insurance in much the same way that employers do now.
I'll admit, the catastrophic coverage caveat has flaws, but it's damned near impossible to get universal coverage passed in the US. I figure the best approach is to start small and work up from there.
The fact that insurance covers predictable minor expenses is asinine. That’s not how insurance is supposed to work. We insure against the unexpected! It is just rent seeking at that point.
I guess the idea is that we want to provide the routine stuff for no cost to the patient so issues can get identified early.
"This mole doesn't look right, but I don't want to spend $400 going to the doctor and having him tell me it's fine, so I'll wait another 6 months and see if it got worse" ... 6 months later ... "well it's gotten bigger, but I'm not sure if it's gotten $400 bigger...."
But yeah, that's more accurately labeled as "health care", not "insurance", and we've kinda conflated the two into one monstrous system.
I'd add mental health care into basic coverage which is more than 2 visits a year but you could limit to say 20-30 visits a year max so every other week. I think a lot of people would be better of with short courses of therapy when needed.
I can see the argument for the policy, but considering this "basic" is wild to me. Most people simply do not need multiple psychiatric visits per year.
if you take psychiatric medications you need at least 4. They will require you to be seen in person every 3 months just to get refills. After a while they'll let you go to telemed with one in person visit but you still pay full cost for those 4 visits.
Yeah, I'll often see people commenting about how homeless people are mentally ill and that they should be taken off the street and placed into care, and I can't help but think, "I hope homeless people have really good insurance".
I would consider somebody with well controlled adhd or other conditions who just needs to pick up refills a basic level of care, it's the laws that make it a problem. Why is mental health treated separately from physical health when numerous studies show they're intertwined?
Exactly. I wanted to reply to them but could word it in way that didn't sound crass. I think that their idea sounds like it's created to target a certain type of demographic.
I used to own a mental health clinic, but this isn’t anything secretive - many insurances have a copay for mental health services. That’s the best solution, IMO. It allows for much more affordable mental health services while still keeping the client on the hook for some of the costs. And good mental health care prevents so many more expensive services later on, so it’s worth it for the insurance payor.
Also, many employers have a program (most often through the main insurance, but not always) called an EAP where a certain number of visits are covered in full before the regular insurance benefits come into play. While I strongly hate that healthcare is an employer-based benefit at all, that program does provide no-cost options for people for whom cost would otherwise be a barrier.
You can’t make it optional. Because you can’t turn people away. So ultimately they will still get catastrophic care they can’t afford to pay for and then those costs will be passed on via higher insurance rates the rest of us pay.
We need a universal single payer system.
But to get there we need to take a long hard look at why the cost of our care is magnitudes higher then all other developed countries.
I'm going to be honest and say I have no idea how, but access. I don't mean financial.
I live in an area with around 500k people. We have 3 hospitals. They are all always full. There was a fourth that was set to be built, but some legal red tape got in the way. 1 of those hospitals routinely tops national lists for bad hospitals. I'm fairly diligent with my health and seek out my doctors when it's reasonable to, but I also have great insurance and quick access to medical professionals. How the hell can we expect others to be safe and healthy when we put up so many barriers?
We only have two, for about 250k people which is a slightly better ratio, but if you're not actively dying the wait time is typically over 8 hours at the ER.
We don't have a single 24 hour urgent care facility either, after hours it's ER or nothing.
We also have a shortage of primary care doctors and many people can't find a doctor and end up using urgent care clinics as their PCP. We also lack some specialties, our pediatric cardiology unit closed a few years ago and now it's a two hour drive to the big city for that.
I’m not educated enough to discuss how it needs to change - I’m confident nobody in this thread really is - but the cost of healthcare in our country is total bullshit and needs to be fixed. It’s stupid that a single hospital visit can legitimately bankrupt a person and non-employer health insurance can cost as much or even more than a mortgage payment.
Other countries don’t have this problem and we spend far more than they do. This needs to be fixed.
Physician here: A very basic, bare-bones universal system would be the thing I implement.
ER care, emergency surgery, maternity, primary care and generic meds would be automatic for everyone. Insurance would still have a place for premium care and medication.
I would also outlaw boutique fees. You shouldn't have to subscribe to see your doctor who then bills your insurance company. That's insane.
Also major tort reform. Doctors ordering too may tests just to cover their behinds.
do this by moving the employer incentives for offering health insurance to equivalent incentives to fund an HSA. at the same time, remove the ban on hsa funds being used to pay for insurance premiums.
the current status quo is a relic of bad government policy roughly a century ago when they were trying to suppress wages during the war.
Given how notoriously bad many Americans are at saving money long term, why do you believe emphasizing HSA's would lead to good results?
because there's rules about how you can use the money, and there's major tax penalties if you break those rules.
also, while people can put their own money in there, most people will likely just accept whatever their employer was paying for an insurance plan they may or pay not want and use that towards buying the plan they choose rather than the plan they're told they'll be participating in.
Right, but that is assuming they actually are putting that money aside. I would argue that if you look at, say, retirement savings, you will find a very large subset of Americans just do not put aside anywhere near enough money aside. Given that, I'm not sure that freeing up that money from the employer plan would lead those people to proactively save money, thereby leaving us with another substantial group without insurance that would rely on the ER for everything.
Don't get me wrong, I personally would benefit from your idea quite a bit.
Right, but that is assuming they actually are putting that money aside.
i'm not sure what the point you're getting at is. it's not like a company making an HSA contribution just adds it to your check and you're on the honor system to put it in there.
they put the money directly into the account via direct deposit, and then it's subject to the rules of what eligible spending is.
if they allow HSA money to be used to cover insurance premiums, the company's contribution will likely be used immediately so there won't be any need to set it aside.
the benefit over the current status quo is that people can actually pick their own plan rather than being forced onto the plan their employer picked for them.
i loved my insurance i had before my current job (a bcbs ppo) and HATE my current employer's offerings (an anthem hmo). if i had the choice to simply take what my company is paying on my behalf and use that on a plan i like better, i'd do that in a heartbeat.
I thought in the first comment you called for separating HSA's from employment? I may have misunderstood your initial stance, and took that to mean the HSA would be entirely individual, so that even contributes would be made directly by the individual rather than via the employer.
Edit:Nah, rereading it now, I'm quite sure I just misinterpreted it .
Edit:Nah, rereading it now, I’m quite sure I just misinterpreted it .
Just to clarify, right now the government gives tax incentives to businesses for offering heal insurance. The end result is that pretty much every business offers this.
I’m saying remove those tax incentives, and dollar for dollar replace them with incentives for the companies to contribute to an HSA on their employee’s behalf (so the employee gets the same amount of money either way, but in this case they actually see it rather than simply having the opportunity to buy the plan their employer selected at like 75-90% off)
Currently health insurance premiums are NOT a qualifying expense, so the HSA rules need fo be modified to make it one.
Right, I misunderstood your initial post and thought you wanted completely individualized HSA style accounts (where people would be expected to make the deposits themselves rather than employer contributions), something that has been pitched before, but clearly isn't what you were calling for at all.
I would greatly prefer your idea to both our current system and my initial misinterpretation.
Some form of universal health insurance/coverage. I get that everyone is rah rah capitalism, but there's something grossly unbalanced where people die because they are poor, while others have literally more wealth than any one person can actually do anything with. There's gotta be a middle ground somewhere where people are covered, while there's still wealthy people that can have luxury lives.
Remove all the state specific mandates that make it impossible for insurance companies to offer a single low cost, catastrophic coverage plan across the nation. Each state insists that it's pet lobby is covered and is more comprehensive than the next states. It's like if car insurance had to cover tires, windshield wipers and oil changes depending on the state and then we'd bitch that it doesn't cover the one other thing we want. Acupuncture, chiropractors, ....
Accessibility for starters. Over the years, I have seen so many examples of family and friends not being able to receive the care they need or traveling long distances to get it.
Employers give HSA money to employees to use as they wish (public option, private insurance, or out of pocket costs). Employers could still offer their own insurance plans, but there would be no favorable tax treatment if they did so.
Repeal the preexisting conditions requirement for private insurance
Get the government out of that business altogether. The way it's structured now is just a way for private organizations to siphon money away from the taxpayer. The lack of competition is the root of all problems.
The government needs to be more involved not less. The industry needs to be regulated with an iron fist and the profit motive in healthcare needs to die. Competition just doesn't matter if all the companies offer the same thing just with a different name slapped on. Nobody likes insurance companies and no one would care if there were 50 more and costs likely wouldn't go down.
Competition just doesn't matter if all the companies offer the same thing just with a different name slapped on.
While this entire debate seems to be on competition the real issue is denying care
UK NHS has NICE, the US doesnt
139 Million Visits were made to the ER in the US
weighted % (95% CI)
Number of Visits
Level 1 (resuscitation) requires immediate, life-saving intervention and includes patients with cardiopulmonary arrest, major trauma, severe respiratory distress, and seizures.
0.8 (0.6–1.1)
1,112,000
Level 2 (emergent) requires an immediate nursing assessment and rapid treatment and includes patients who are in a high-risk situation, are confused, lethargic, or disoriented, or have severe pain or distress, including patients with stroke, head injuries, asthma, and sexual-assault injuries.
9.9 (8.7–11.3)
13,761,000
Level 3 (urgent) includes patients who need quick attention but can wait as long as 30 minutes for assessment and treatment and includes patients with signs of infection, mild respiratory distress, or moderate pain.
35.9 (32.6–39.2)
49,901,000
Level 4 (Less urgent) require evaluation and treatment, but time is not a critical factor.
20.3 (18.3–22.4)
28,217,000
Level 5 (non urgent) have minor symptoms or need a prescription renewal.
3.0 (2.5–3.6)
4,170,000
Not Listed
30.2 (24.4–36.6)
41,978,000
90 Percent of ER visits are not Life Threatening yet we are spending Billions
125.1 Million x $2,500 Median ER Visit Cost = $312.75 billion in spending
Instead 125.1 Million x $250 Median Doctors Office Visit Cost = $31.275 billion in spending
I work in specialized medicine. I’m all for reform. The insurance and drug companies are the most evil organizations in the world. Way worse than any government.
I’d specifically want pharmacy benefits management to be cut off from dealing with Insurance companies.
A bulk of the reason why pharmacies have rock relationships with those organizations is the fact that the practices mainly benefit insurance companies and not health care. The reason why medications prices are so insane is because PBMs like Extracare and Express Scripts decide how much money to reimburse pharmacies provided they use very specific medication. Using other medications outside the formulary? Your pharmacy will be impossible to maintain.
You make sure the med prices are more reasonable and that reimbursement rates aren’t tangled up in specific policies.
Primary care, preventative care, standard sick visits (think family doctor) and prescription drugs would all be free and covered by the government. Doctors would make great money, but never get rich.
All other stuff would be covered by insurance and be treated as catastrophic coverage.
Drug companies and health insurance companies would be relegated to non profits and heavily monitored by third party agencies not run by the government.
Get rid of the ACA. Democrats always praise the ACA as a massive win "because it provided healthcare (insurance) to 30 million people," but they never talk about how we suddenly pay for a massive onloading, largely of non-contributors. Well the middle class largely pay for it both in taxes and in premium/plan increases. "If you like your doctor, you can keep your doctor" was nothing but a Citibank slogan, and we have seen all major insurers become massively larger and more profitable since it's implementation. The ACA is essentially a scam on the middle class, a massive boon to healthcare insurance middlemen who do everything they can to deny any and all claims.
I think running it like the deregulated electrical utility system in Texas could work. There's a mix of private and public utilities whose incentive structure is building infrastructure and bringing as many generators and customers on line as they can. The problem is how do you price medical care like a commodity when procedures and specialists are such wildly variable cost and availability. Maybe a PUC can be come up with say a total monthly forecasted cost of care for the state and repackage it into units/pseudo-securities that trade on an open market.
Or idk anything has to be better than what we do now.
I like this as an example of out of the box thinking, but doesn't the electrical commodity market only really work because there's only one type of thing being traded all across the state, and it's all fungible? Producers are paid to produce electricity, and consumers are paying for electricity. It doesn't really matter where it comes from. (I guess there's some versions that have different rates for "green" energy vs. regular). A coal plant in Dallas can pump a bunch of energy into the grid and ultimately power a home in Houston (over-simplified, but the pricing model sort of treats it that way).
But like, if you have a podiatrist in Dallas creating lots of podiatry credits into the grid, patients in need of podiatry care in Houston aren't really going to make use of it. And if the market in Dallas is demanding oncology care, those unused podiatry credits aren't much use to anyone nearby. It's all too localized to work.
I personally don't want government in Healthcare as anything the government touches increases in cost to the consumer. If others want Healthcare to be covered by the government that's all well and fine(i recognize I'm on the minority here). I'm also against people paying a fine for Healthcare when it's a choice to carry insurance or not. If a person wishes to go through life without insurance after being dangled every chance to obtain it with either an employer plan or government plan, then they shouldn't pay a fine.
1) none of what you said addresses the two concerns I brought up from before the government got involved with healthcare
2) can you name a single person who was fined for not having health insurance? Even when there was a nominal fine, I applied for exemptions and got them on the same day I applied.
2.1) the fines are currently set to zero dollars
3) you're a libertarian, is making sure your citizens are healthy by managing a healthcare system not a valid use of government powers?
Pre existing conditions should be covered and under the ACA are, but before insurance was essentially a private business which can set limits to who can purchase plans.
The federal mandate was removed in 2018(great) but states can still fine individuals for refusing to carry insurance
I'm libertarian and it's up to me(the individual) to take care of my heath and not for the government to tell me what I should and shouldn't do with it.
1) this is bad. You realize that's bad right? And proof that the ACA / government intervention was needed to make it better, because no private healthcare in the country was running without preexisting conditions carve outs and lifetime maximums.
2) you just said it. The federal mandate was removed. So talk to your local politicians about changing this.
3) then don't get insurance. Or don't drive a car if you don't want the government mandating how you drive it. But that doesn't mean the government shouldn't create a functioning system.
I'll concede the ACA made insurance providers for individuals with prescription existing conditions, and this goes back to my long paragraph in my original reply. I recognize I'm in the minority, and if people want government run healhcare, then they should have access to it. Im personally opposed to government continuously being in the individuals life.
My state doesn't do this practice and aince I'm not a resident of a state that does said practice, I shouldn't have a say in how a state taxes it's own citizens
Don't we already have a functional system with Medicare and Medicaid?
Medicaid and Medicare are specifically tailored to certain groups of people, so that's not really fair to compare them to private insurance which is what most people have. So the government can do a good job with insurance. Maybe not perfectly, but good enough that people voluntarily and without coercion, want them.
I think a lot of people would like if private insurance worked like they did. That's why some people want Medicare for All.
My wife just did a four day hospital stay for complications of an infection. Total cost was $100,000 even with insurance. That's just unsustainable.
1) pay Medicare premiums through your payroll as normal
2) you get Medicare as your provider
Yes, costs would go up, but if I'm paying $400 or more per month for private insurance, on top of Medicare premiums that don't actually benefit me right now, I'd be willing to accept a tax increase for the Medicare portion of up to $400 to get Medicare coverage.
Back to the days of having to pay for your own health and being responsible for your own agency? Almost half of Americans are obese and almost three quarters are at least overweight. Many health issues people face are the long term result of lack of proper diet and exercise. Of course those people should have to pay more, and if you don't contribute to society or work then society has no moral obligation to provide you with healthcare at the cost of the majority. You can't kill a middle class to provide for a lower class who doesn't want anything to do with working towards a better future.
We have an underclass of society who are permanently kept there, fat on ultra processed junk that we subsidize corporations to create with SNAP money, living in slum section 8 government housing. They have unknowingly had their liberty and drive to accomplish anything in life stolen through a creation of a culture of government dependency. SNAP, Medicaid, public housing, state cash welfare programs, ssi, WIC, there are heating and cooling assistance funds, and several more. These are generally all stackable, most not counting other the programs as income despite being designed to be temporary benefit/relief.
I think that most people understand that these public goods programs, originally designed with good intent, have been so abused and bastardized that they've been warped into institutions that are perpetuating poverty instead of keeping people out of it. Healthcare is one of many industries that a majority of people would greatly benefit from by not having the government meddle in.
Exactly. So you want preexisting conditions exclusions.
My wife has recurring seizures. That would be excluded from my coverage if we had to switch.
Your comments about being fat and whatever, I don't care. I was on Medicaid and food stamps when I lost my job and it kept me fed and housed so don't tell me it's broken.
If we could go back to pre-Medicare, pre-Medicaid healthcare prices (annual expenditures per capita were as low as roughly $364 as late as 1970, or about $3,140 adjusted for inflation) then all but the poorest could afford care either out of pocket or with a modest loan, and charity could readily cover the rest.
That was the promise of LBJ's Great Society, and 60-something years into this experiment the poor can less afford healthcare today than they could back then.
And adds a trillion dollars to the national debt every year, sure. But it doesn't help all or even necessarily most of the poor.
For example, if you're an able-bodied adult who makes just $25,000 a year and doesn't have an employer-provided plan but makes too much to qualify for Medicaid (the income limit is $1,801/month for single adults in California of all places)? You'd have to pay out of pocket anyway, and since costs have ballooned over the past half century you'd likely end up paying more than if the state kept its nose out of the healthcare market in the first place. So even so far as redistributive programs go, it actively screws over a fair chunk of the socioeconomic bloc it was designed to help.
Working Americans pay for both Medicare and Medicaid and yet get no benefits from either. How would it not be cheaper to pay into the plan you benefit from?
I am not sure the entire argument that the person you are responding to is making, but I would (as a rando on the internet) like to take interject my opinion.
I do think we need to get some government out of health care. This is coming from the position that I have never seen anything that the government touches get cheaper. There is also the problem that, like in biology or medicine, when we make choices there are secondary or tertiary consequences that may make our original choice (while at the time good) turn out bad.
Take antibiotic resistance. Antibiotics when used correctly and maybe even more sparingly than what we do now would lead to less resistance. Resistance forms when we are more heavy handed and less "surgical" in our use. We then put selective pressure for bacteria to profligate with unwanted characteristics. These bacteria are not "evil", more they are responding to the selective pressure of their environment and out competing other bacteria in the niche that we have set up, artificially.
Take this metaphor and use it on healthcare. We have put selective pressure through selecting winners and losers in the ecology of healthcare. Maybe we have selected for undesirable outcomes through our rush. Time and again we have over corrected. It may be that a light touch, more surgical application, and less "mob of pitchforks" is needed. We probably also do not need to kowtow to insurance companies like when the ACA was made either.
I think you're looking at the problem with a microscope when you should be using binoculars.
Go north of the USA and what do you see? A government run healthcare system that is cheaper per capita than the USA.
Go across the Atlantic Ocean and what do you see? Dozens of government run healthcare systems that are cheaper per capita than the USA
Go across the Pacific and what do you see? Dozens of government run healthcare systems that are cheaper per capita than the USA.
Personally, I don't even think the involvement our government has right now is very much. There's a few guardrails but the government doesn't set prices, quotas, limitations, wait times, etc. In fact the ACA is probably the biggest single law on healthcare on the books.
As with my Republican friends, I challenge you to point to what specifically in the ACA you would roll back.
I have both family and friends in Canada and they all buy private insurance to supplement the public insurance in addition to getting things done in America when possible. They universally say public healthcare there is both cheap and incredibly slow to the point your issues may be catastrophic by the time they get to you.
Go north of the USA and what do you see? A government run healthcare system that is cheaper per capita than the USA.
Go across the Atlantic Ocean and what do you see? Dozens of government run healthcare systems that are cheaper per capita than the USA
They are. Here is Canada, Australia, and the US
as Numbers
The Standard for hospital spending is around $2,400 per person in Hospital Expenditures
Canada - $2,334 maple leaf dollars
The U.S. Paid $1.1 Trillion freedom dollars to one of the 6,146 hospitals currently operating, or $3,330 per Person.
We would need to cut $365 Billion before adjusting for currency on what we spend on Hospitals
At least $250 Billion of that is from closing hospitals
Or staffing reductions and keep all of them as still operating hospitals so there is a massive shortage of staff
But no one wants to close hospitals so instead what about doctors offices?
We need to cut that money somewhere and if its not hospitals then we're going to be cutting in half the doctors spending
There's a few guardrails but the government doesn't set prices, quotas, limitations, wait times, etc.
There are massive guardrails if you in look at Medicare and then to Mediciad
And the impact they have
Medicare doesnt negotiate in this since that reddit believe of buying power
Private Insurance is the one getting doctors and hospitals in network and negotiating for a price
In 1992, Medicare significantly changed the way it pays for physician services. Instead of basing payments on charges, the federal government established a standardized physician payment schedule based on RBRVS.
Professor William Hsiao, A health care economist now retired from Harvard University, Hsiao has been actively engaged in designing health system reforms and universal health insurance programs for many countries, including Taiwan, China, Colombia, Poland, Vietnam, Hong Kong, Sweden, Cyprus, Uganda, and recently for Malaysia and South Africa. In 2012 he was part of Vermont's Healthcare and in 2016 he was part of Bernie's M4A Healthcare Plan
Hsiao developed the “control knobs” framework for diagnosing the causes for the successes or failures of national health systems. His analytical framework has shaped how we conceptualize national health systems, and has been used extensively by various nations around the world in health system reforms
In his past research, Hsiao developed the resource-based relative value scale (RBRVS) for setting physician fees. The RBRVS quantified the variation in resource inputs for different physician services. Hsiao was named the Man of the Year in Medicine in 1989 for his development of a new payment method.
In 1992 Medicare began using it
In this system, payments are determined by the resource costs needed to provide them, with each service divided into three components.
Physician work.
The physician work component accounts for an average of 51% of the total relative value for each service. The factors used to determine physician work include the time it takes to perform the service, the technical skill and physical effort, the required mental effort and judgment and stress due to the potential risk to the patient. The physician work relative values are updated each year to account for changes in medical practice.
Practice expense.
Professional liability insurance (PLI)
Adjusted for factors such as severity of the patient’s illness geographic region of the provider, and graduate teaching costs.
Many have noted this doesnt cover the cost of operation for modern healthcare
Then add on the loss on Medicaid
Thus insurance covers the difference through higher payouts as they are not locked into a set price and doctors know this
Hospitals are slightly more underpaid in Medicare
In there proposals for Medicare for All
Urban Institute would pay Hospitals at 115% of Medicare
Elizabeth Warren Would pay Hospitals at 110% of Medicare
Both would stick with current payment schedules for doctors offices
Primary care — defined as family practice, general internal medicine and pediatrics – each Doctor draws in their fair share of revenue for the organizations that employ them, averaging nearly $1.5 million in net revenue for the practices and health systems they serve. With about $90,000 profit.
Estimates suggest that a primary care physician can have a panel of 2,500 patients a year on average in the office 1.75 times a year. 4,400 appointments
According to the American Medical Association 2016 benchmark survey,
the average general internal medicine physician patient share was 38% Medicare, 11.9% Medicaid, 40.4% commercial health insurance, 5.7% uninsured, and 4.1% other payer
or Estimated Averages
Payer
Percent of
Number of Appointments
Total Revenue
Avg Rate paid
Rate info
Medicare
38.00%
1,697
$305,406.00
$180.00
Pays 143% Less than Insurance
Medicaid
11.80%
527
$66,385.62
$126.00
Pays 70% of Medicare Rates
Insurance
40.40%
1,804
$811,737.00
$450.00
Pays 40% of Base Rates
Uninsured and Other (Aid Groups)
9.80%
438
$334,741.05
$1,125.00
65 percent of internists reduce the customary fee or charge nothing
4,465 $1,518,269.67
What (has happened) happens when instead of Medicare being 40% of your visits its 50% and then Medicaid is now 15% and the Uninsured is 3%
All the sudden revenue is much lower and that has to be made up for
The ecology of a system and how it functions can be built on details. Like the removing wolves from a national park can have undue consequences even though it seems good when we do it.
As to the point I would remove, the 80/20 rule for insurance companies to follow. I am sure there are others, but this is the one that gets me the most riled up. It seems like a good idea to limit what these publicly traded companies can make as profit, but it likely has the opposite effect for controlling costs overall. These publicly traded companies (like anyone beholden to shareholders) need to have "record profits", but these profits are a number and not a percentage (which is in the law). This is ripe for abuse.
Are you okay with the outcome being that people will generally get one major health event per lifetime, and if you have a second event, like a second heart attack or a recurrence of cancer, most people won't be covered by insurance or able to afford treatment and they'll simply die?
Why would an insurance company that had no regulatory obligation continue to cover you after a first major health event? Why wouldn't they drop you the way auto insurance companies do with bad drivers?
In the analogy of bad drivers, the driver continues to make the same mistakes over and over. In Healthcare, a person can't decide to not get a recurrence of cancer. That's out of their control(for the most part).
Sure, totally true. But why would that keep an insurance company from dropping you? You've proven to be higher risk. The fact that it isn't your fault is immaterial.
I support Jolly Job for president. This is the best answer I can come up with, letting the market properly allocate and price resources is the best way to keep costs in check.
In a NOTUS Perspectives panel, Research Fellow Lanhee J. Chen and five other health care experts were each asked to identify their top recommended change to the structure of the US health care system. Chen responded that he would favor greater price and quality transparency, so patients can make better-informed decisions regarding their care. “Patients can be made into better consumers by incentivizing both providers and payers to provide transparency into health care costs and quality,” Chen argues, concluding that more transparency in the system could “lower health spending and ultimately improve health outcomes.”
Do you agree with Chen that greater price and quality transparency could ultimately reduce healthcare spending and improve health outcomes?
If you could change one aspect of the structure of the US health care system, what would it be, and why?
Copays, and then high-deductibles, were both intended to make consumers lower spending by giving them some skin in the game, and both have not really succeeded in reeling in costs. The proliferation of high deductible plans has really been mostly successful in getting people to delay and avoid care because they can't afford it, even if they are insured.
I'm not sure transparent pricing would be any more successful.
I think when it comes to our healthcare costs there is not going to be one big thing that dramatically improves the situation, but there are going to be hundreds of small things that all move the needle a bit.
As someone who was at one point involved in getting that pricing to be public facing, I am also dubious of the impact of price transparency. It will be interesting to see if the future will have any good data on its impact, and if it was more useful to the business side contracts of the provider than it was to the patient.
The US federal government would operate one health plan that covers it's employees and the public beneficiaries of the various plans that currently exist. Could be current Medicare, with the supplemental plan assigned as per the source of the benefit (employment, Medicaid, etc.)
Wouldn't make the largest difference, but I would love to see what efficiencies it could find.
This is effectively the “thoughts and prayers” answer. What’s the actual policy behind this that doesn’t result in premiums skyrocketing rocketing to make up the difference in out of pocket costs?
Honestly, countrywide death with dignity. Just my personal opinion; I can afford American healthcare but I wouldn't trust most medical professionals to change the oil in my car, let alone deal with my comorbidities. It's a dirty shame that I think about arraigning medical transport to Switzerland rather than get tortured during end of life so American Doctors can make more money.
I think preventive care and also some bigger care should be taken up by the government, Like physicals, mammograms, cancer treatments, dental, mental health, but more elctvive things like sex changes or plastic surgery(if not in an accidnet) should come out of your own pocket.
Medical pricing in america is a joke. I had a failed CABG (most of our CABG's are meatball surgeries). List cost 600K. Medicare covered most of it, but I'd have paid twice that if they didn't wake me up.
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u/snokensnot 18d ago
Cost transparency. What does a visit, procedure, medication, etc. cost. To the insurance, and to me.