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> In theory, a competitive marketplace should be able to cut costs and improve outcomes Outside of theory, can you think of any example where this has actuall

by notadoc 10y ago

> In theory, a competitive marketplace should be able to cut costs and improve outcomes Outside of theory, can you think of any example where this has actually happened in US health care? The only cost cutting I can think of are notably lower payments to doctors, the insurers fighting every claim, and higher deductibles and co-insurance for the patients. So I guess that cut costs for the health insurer, but the providers and patients costs have gone up directly and dramatically.

bluGill 10y ago
The US health care market is not competitive in that way because of the incentives do not work that way. The US health care market is not consumer driving it is employer driven, and employers want all the things you bring up because it lowers their costs. What employers fear is that someone will offer a health insurance plan that is competitive to theirs, which makes it easier for my to change jobs. Employers like the fact that I pay $200/month for my health insurance, they pay $1000/month. If I want a health insurance plan that improves outcomes and which costs $1500/month I have to come up with the $1500/month, not just the $300 difference. (the above numbers are all made up, but they are realistic) I have long believed that we cannot solve the US health care problems without removing the incentives that force me to use my employers' policy like it or not. In short, you don't see those examples in the US because the system is not competitive on outcomes, only costs. Since cost is the only thing they compete one insurers offer lower payments to doctors, fight every claim, add higher deductibles (which is a hidden cost on me) and co-insurance for the patients. These are innovative, not all are innovations that I would want my insurance company to come up with, but since I'm not a customer they don't care what innovations I want.

by notadoc 10y ago

bluGill 10y ago

The US health care market is not competitive in that way because of the incentives do not work that way. The US health care market is not consumer driving it is employer driven, and employers want all the things you bring up because it lowers their costs. What employers fear is that someone will offer a health insurance plan that is competitive to theirs, which makes it easier for my to change jobs. Employers like the fact that I pay $200/month for my health insurance, they pay $1000/month. If I want a health insurance plan that improves outcomes and which costs $1500/month I have to come up with the $1500/month, not just the $300 difference. (the above numbers are all made up, but they are realistic) I have long believed that we cannot solve the US health care problems without removing the incentives that force me to use my employers' policy like it or not. In short, you don't see those examples in the US because the system is not competitive on outcomes, only costs. Since cost is the only thing they compete one insurers offer lower payments to doctors, fight every claim, add higher deductibles (which is a hidden cost on me) and co-insurance for the patients. These are innovative, not all are innovations that I would want my insurance company to come up with, but since I'm not a customer they don't care what innovations I want.