5 ms·

Single payer would be ideal for most Americans, but those in power (both government and industry) seem to prefer the high deductible health plans with health sa

by jobu 10y ago

Single payer would be ideal for most Americans, but those in power (both government and industry) seem to prefer the high deductible health plans with health savings accounts. Unfortunately I don't see high deductible plans working for anyone unless healthcare providers and pharmacies are required to list all prices up-front. As it is there's no way for consumers to "shop around" because they can't get prices for most tests, procedures, or even medications until they bill through insurance (which can take weeks).

scotch_drinker 10y ago
Exactly this. It's a falsehood to think that HSA/HD will cause you to be a better consumer because you can't be a better consumer when the sellers refuse to provide price information. We had our first child this year and the hospital coded some things to my wife and some to my daughter which caused us to pay two deductibles. I tried to get an itemized breakdown repeatedly from the hospital and was met with "we can't do that." Never mind the fact that you can't exactly shop around for places to deliver when your OB/GYN only has admitting privileges at one hospital. I'm about as free market as they come but when the providers flat refuse to tell you what they are going to charge you. Try going to one of those corner ERs, you'll have to sign a form saying you are solely responsible for all charges but they sure won't tell you what those charges are until you sign it.
- dpark 10y ago
  Does anyone claim that HD plans make people more savvy consumers? I've always thought it was a transparent way to make people of moderate means think twice about any care that could be considered elective. Whether it's a good idea or not, paying out of pocket for a $3000 procedure might make you question the need for a CAT scan. High deductible plans definitely don't make anyone smarter consumers. The market is opaque and your options are limited to in-network in the best case.
GiorgioG 10y ago
High-deductible plans are not the answer. They are a symptom of the problem. You assume risk up to say $10,000 (your high deductible) because you don't expect to need it unless you wind up in the hospital. If you have a chronic illness, high deductible plans don't do shit for you. As long as we view this as a "not my problem, I'm not sick" issue, this will never be fixed.
- bduerst 10y ago
  Not even chronic illness - as you get older you expect a certain level of health complications or maintenance, and you adjust your deductible accordingly. A $10k/mo deductible is catastrophe insurance, and is only really useful for people < 30.
  - GiorgioG 10y ago
    If we'd realize that we're all one unfortunate random event from a dire (medical and financial) situation, a single payer system would be a no-brainer for everyone.
  - JumpCrisscross 10y ago
    > A $10k/mo deductible is catastrophe insurance, and is only really useful for people < 30 HDHPs quote their deductible as a maximum out of pocket per year. Paying $10k a year to manage a chronic illness doesn't sound ridiculous.
    - null000 10y ago
      Then you live in a bubble. Most people I know don't have 10k a year sitting around, just those lucky enough to have relatively well-paying jobs - and having a chronic illness will only make finding such a job harder.
    - GiorgioG 10y ago
      I pay $19,200/year for insurance and another $3000+ for medical supplies. My 5 year old didn't ask to get a lifelong illness (type 1 diabetes.) I'm lucky to be able to afford it, but it's highway robbery.
      - bduerst 10y ago
        $14,300/year is the max out of pocket for family ACA plans. What are you buying that's not insured?
    - deleted 10y ago
      [deleted]
dgfgfdagasdfgfa 10y ago
> Single payer would be ideal for most Americans Not for Americans who care more about economic ideology than health. This is how many Americans appear to vote.
- bduerst 10y ago
  That would be true if all voting Americans were economic idealists. The truth is that many don't even know that Obamacare and the Affordable Care Act are the same thing.
  - dgfgfdagasdfgfa 10y ago
    Well, I'm not saying the idealists understand what's going on, but it remains that people have a dogmatic attraction to the free market, regardless if it means they pay more for the same service and have reduced freedom in finding efficient health care.
Broken_Hippo 10y ago
> As it is there's no way for consumers to "shop around" because they can't get prices for most tests, procedures, or even medications until they bill through insurance (which can take weeks). To complicate things further, some of these things will happen while people have passed out and taken to the emergency room. This might be the only sort of debt you can incur while both unconscious and without prior specific authorization. Many other medical decisions are made under duress - sickness and pain, with an occasional risk of death.
- ams6110 10y ago
  All of this nonsense is exactly because everyone expects insurance to pay for all medical care from hangnail to heart failure. Single payer would be even worse, because it's even more of a "not my money -- I don't care" situation for the individual. Dentists, optometrists, physical therapists, etc. all have straightforward pricing for each procedure, and you can call and ask them what it is and it's not too hard to shop around. Only medicine has mystery prices hidden behind third party payers.
  - CaptSpify 10y ago
    > Dentists, optometrists, physical therapists, etc. all have straightforward pricing for each procedure, and you can call and ask them what it is and it's not too hard to shop around. Not IME. I've gotten different prices from what I was quoted, and some places have refused to quote me a price.
    - micahbright 10y ago
      It is possible to get prices and negotiate - healthcare providers just aren't used to it. I was just listening to a good friend who doesn't carry insurance negotiate on price for an elective procedure he was thinking about having. They came down 20% right off the bat. After a callback, he had them down 50%. That was just for the physician. He had to make another call to the hospital, and the anesthesiologist, so I can't tell you the outcome. Point being, it isn't as hard as you might think.
DrScump 10y ago
Single payer would be ideal for most Americans, but (opponents) seem to prefer the high deductible health plans I think a single-payer system would be far more efficient, but the problem is: how do you just "shut down" a huge economic system (insurers, for-profit providers) and keep it Constitutional? They have equity in their current structures, but how do you fairly compute a "fair market value" for their market share and investments when you effectively use Eminent Domain (unless you could amend the Constitution accordingly) to dismantle an entire industry? I can imagine how Britain's NHS could be created in a time of great national unity, scarce resources, and complete Labor control, but I can't picture the mechanism by which health care could be nationalized in the present-day USA, even if a popular mandate existed.

by jobu 10y ago

scotch_drinker 10y ago

Exactly this. It's a falsehood to think that HSA/HD will cause you to be a better consumer because you can't be a better consumer when the sellers refuse to provide price information. We had our first child this year and the hospital coded some things to my wife and some to my daughter which caused us to pay two deductibles. I tried to get an itemized breakdown repeatedly from the hospital and was met with "we can't do that." Never mind the fact that you can't exactly shop around for places to deliver when your OB/GYN only has admitting privileges at one hospital. I'm about as free market as they come but when the providers flat refuse to tell you what they are going to charge you. Try going to one of those corner ERs, you'll have to sign a form saying you are solely responsible for all charges but they sure won't tell you what those charges are until you sign it.

dpark 10y ago
Does anyone claim that HD plans make people more savvy consumers? I've always thought it was a transparent way to make people of moderate means think twice about any care that could be considered elective. Whether it's a good idea or not, paying out of pocket for a $3000 procedure might make you question the need for a CAT scan. High deductible plans definitely don't make anyone smarter consumers. The market is opaque and your options are limited to in-network in the best case.

GiorgioG 10y ago

High-deductible plans are not the answer. They are a symptom of the problem. You assume risk up to say $10,000 (your high deductible) because you don't expect to need it unless you wind up in the hospital. If you have a chronic illness, high deductible plans don't do shit for you. As long as we view this as a "not my problem, I'm not sick" issue, this will never be fixed.

bduerst 10y ago
Not even chronic illness - as you get older you expect a certain level of health complications or maintenance, and you adjust your deductible accordingly. A $10k/mo deductible is catastrophe insurance, and is only really useful for people < 30.
- GiorgioG 10y ago
  If we'd realize that we're all one unfortunate random event from a dire (medical and financial) situation, a single payer system would be a no-brainer for everyone.
- JumpCrisscross 10y ago
  > A $10k/mo deductible is catastrophe insurance, and is only really useful for people < 30 HDHPs quote their deductible as a maximum out of pocket per year. Paying $10k a year to manage a chronic illness doesn't sound ridiculous.
  - null000 10y ago
    Then you live in a bubble. Most people I know don't have 10k a year sitting around, just those lucky enough to have relatively well-paying jobs - and having a chronic illness will only make finding such a job harder.
  - GiorgioG 10y ago
    I pay $19,200/year for insurance and another $3000+ for medical supplies. My 5 year old didn't ask to get a lifelong illness (type 1 diabetes.) I'm lucky to be able to afford it, but it's highway robbery.
    - bduerst 10y ago
      $14,300/year is the max out of pocket for family ACA plans. What are you buying that's not insured?
  - deleted 10y ago
    [deleted]

dgfgfdagasdfgfa 10y ago

> Single payer would be ideal for most Americans Not for Americans who care more about economic ideology than health. This is how many Americans appear to vote.

bduerst 10y ago
That would be true if all voting Americans were economic idealists. The truth is that many don't even know that Obamacare and the Affordable Care Act are the same thing.
- dgfgfdagasdfgfa 10y ago
  Well, I'm not saying the idealists understand what's going on, but it remains that people have a dogmatic attraction to the free market, regardless if it means they pay more for the same service and have reduced freedom in finding efficient health care.

Broken_Hippo 10y ago

> As it is there's no way for consumers to "shop around" because they can't get prices for most tests, procedures, or even medications until they bill through insurance (which can take weeks). To complicate things further, some of these things will happen while people have passed out and taken to the emergency room. This might be the only sort of debt you can incur while both unconscious and without prior specific authorization. Many other medical decisions are made under duress - sickness and pain, with an occasional risk of death.

ams6110 10y ago
All of this nonsense is exactly because everyone expects insurance to pay for all medical care from hangnail to heart failure. Single payer would be even worse, because it's even more of a "not my money -- I don't care" situation for the individual. Dentists, optometrists, physical therapists, etc. all have straightforward pricing for each procedure, and you can call and ask them what it is and it's not too hard to shop around. Only medicine has mystery prices hidden behind third party payers.
- CaptSpify 10y ago
  > Dentists, optometrists, physical therapists, etc. all have straightforward pricing for each procedure, and you can call and ask them what it is and it's not too hard to shop around. Not IME. I've gotten different prices from what I was quoted, and some places have refused to quote me a price.
  - micahbright 10y ago
    It is possible to get prices and negotiate - healthcare providers just aren't used to it. I was just listening to a good friend who doesn't carry insurance negotiate on price for an elective procedure he was thinking about having. They came down 20% right off the bat. After a callback, he had them down 50%. That was just for the physician. He had to make another call to the hospital, and the anesthesiologist, so I can't tell you the outcome. Point being, it isn't as hard as you might think.

DrScump 10y ago

Single payer would be ideal for most Americans, but (opponents) seem to prefer the high deductible health plans I think a single-payer system would be far more efficient, but the problem is: how do you just "shut down" a huge economic system (insurers, for-profit providers) and keep it Constitutional? They have equity in their current structures, but how do you fairly compute a "fair market value" for their market share and investments when you effectively use Eminent Domain (unless you could amend the Constitution accordingly) to dismantle an entire industry? I can imagine how Britain's NHS could be created in a time of great national unity, scarce resources, and complete Labor control, but I can't picture the mechanism by which health care could be nationalized in the present-day USA, even if a popular mandate existed.