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> If patients are being charged this much for anything, the money must be going to someone? Who's making all the money? Drug companies? Hospitals? Health insura

> If patients are being charged this much for anything, the money must be going to someone? Who's making all the money? Drug companies? Hospitals? Health insurance? Doctors or nurses? Why don't people honestly follow where the money end up and actually solve the problem once and for all. Increase the supply of X or many other bottlenecks by deregulation and result in decreased price? There are a lot of reasons for the inflated costs, but a big one is the way the billing system itself works. Legally, providers have to charge patients the same amount in an initial bill, regardless of insurance status. They can reduce it later, but they can't bill different amounts. Medicare and Medicaid reimburse less than COGS, which means that providers start off by losing money per patient on publicly-insured patients. To stay afloat, they increase the amount they bill, so that private insurers essentially cover the difference. Uninsured patients are collateral damage here - they end up paying the sticker price that's intended for insurers as a highball starting point for negotiation. The insurers end up paying something around 3-10 times what Medicare pays, but less than the sticker price. This system is unfortunately unlikely to change, because any efforts to increase price transparency would decrease Medicare's ability to pass on costs to private insurers, and they would oppose that heavily.

LeifCarrotson 9y ago
> they would oppose that heavily. Who is 'they'?
- chimeracoder 9y ago
  Much as people don't like to think of Medicare that way, Medicare itself is an institution with an enormous degree of influence. Medicare is arguably even more powerful than private insurers, because it's both the single largest and also one that receives a lot of special protections in law that private insurers don't. Currently, Medicare is able to balance its own books regardless of any increases or decreases to its tax revenue, because they can set the prices they pay unilaterally, with no mandate to cover their own costs (which is why they already don't cover their own costs). Any decreases in revenue purchasing power, whether due to tax cuts, budget cuts, or inflation, they simply lower their own reimbursement rates, and eventually private insurers will be forced to cover that difference. Medicare - and those who benefit from posturing themselves as supporters of Medicare politically[0] - would frame price transparency as cuts to Medicare. It's not really a cut to Medidcare's revenue; it'd be a reduction in their ability to reduce costs by extracting money from private insurers, but the latter doesn't really roll off the tongue, so they'd be pretty successful in messaging it as "cuts to Medicare". [0] which is not the same as people who actually benefit from Medicare or supporting Medicare, as we already know.
- syshum 9y ago
  The government that likes to blame what is left of the private market for all the problems when in reality the government created the problems in the first place. They want to move everyone to the bankrupt medicare system that which be a catastrophe for everyone

LeifCarrotson 9y ago

> they would oppose that heavily. Who is 'they'?

chimeracoder 9y ago
Much as people don't like to think of Medicare that way, Medicare itself is an institution with an enormous degree of influence. Medicare is arguably even more powerful than private insurers, because it's both the single largest and also one that receives a lot of special protections in law that private insurers don't. Currently, Medicare is able to balance its own books regardless of any increases or decreases to its tax revenue, because they can set the prices they pay unilaterally, with no mandate to cover their own costs (which is why they already don't cover their own costs). Any decreases in revenue purchasing power, whether due to tax cuts, budget cuts, or inflation, they simply lower their own reimbursement rates, and eventually private insurers will be forced to cover that difference. Medicare - and those who benefit from posturing themselves as supporters of Medicare politically[0] - would frame price transparency as cuts to Medicare. It's not really a cut to Medidcare's revenue; it'd be a reduction in their ability to reduce costs by extracting money from private insurers, but the latter doesn't really roll off the tongue, so they'd be pretty successful in messaging it as "cuts to Medicare". [0] which is not the same as people who actually benefit from Medicare or supporting Medicare, as we already know.
syshum 9y ago
The government that likes to blame what is left of the private market for all the problems when in reality the government created the problems in the first place. They want to move everyone to the bankrupt medicare system that which be a catastrophe for everyone