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> Like list prices are often incredibly far removed from the actual dollars paid, and the actual amount paid is all dependent on insurer contracts. Exactly thi

> Like list prices are often incredibly far removed from the actual dollars paid, and the actual amount paid is all dependent on insurer contracts. Exactly this. The numbers that hospitals bill are largely fictitious compared to cost of care. What a lot of people don't realize is that hospitals use inflated billing from paying patients to cover the costs of uninsured patients that the hospital is required by law to treat in the ER. A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't--just through hospital billing.

danharaj 8y ago
> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't--just through hospital billing. It would be refreshing to have a conversation with someone who holds such a position that was willing to say that hospitals should turn uninsured and poor people away at ERs and let them die in the streets. Its at least more honest.
- mikeash 8y ago
  I’ve been saying for a while that until and unless people start advocating for the repeal of EMTALA (the law which requires ERs to treat everyone), there isn’t any debate over whether we should have socialized medicine, merely over how.
  - tntn 8y ago
    I don't think that socialized medicine is certainly necessary. Compulsory private health insurance like Switzerland is workable.
    - arethuza 8y ago
      So who pays for the treatment of people who can't afford to pay for their own private health insurance?
      - komali2 8y ago
        If it can be simply made up for by the Swiss equivalent of SS I guess that'd be nice, seems like private health insurance wouldn't care either way. Then again this goes against my theory that socialized aid should come directly in the form of the thing needed - voucher for healthcare, food (or very specific food vouchers), rent free housing or vouchers for housing, rather than cash which is a bit silly to give to someone the government failed to give good financial education to (speaking from experience here...) There's a reason theres a huge market for under the table financial management among the trapped impoverished.
    - mikeash 8y ago
      My point isn’t about whether or not it’s necessary. It’s that we have it already, just in a weird and inefficient form. Our politicians pretend to debate over whether we should have it, when in fact we’ve had it for three decades and nobody serious is proposing to change that.
- deleted 8y ago
  [deleted]
- kendallpark 8y ago
  Furthermore, even the capitalistic idealism of "multiple private insurance companies competing with each other will drive prices down" doesn't work. At the end of the day, Medicare decides what it's going to pay for a procedure, and the rest of the insurance companies base their compensation off that. The government is still in control of pricing, by and large. Even the Singapore model (which looks capitalistic on the consumer end) relies on huge amounts of government price-fixing on the hospital side of things.
- nostromo 8y ago
  You're presuming that our only two options are requiring hospitals to admit everyone or let people die in the streets (and then calling people dishonest). It's a bit like assuming grocery stores must give away food to anyone or people will starve in the streets. In fact, there's other ways to get food to those in need.
  - danharaj 8y ago
    Propose an alternative.
    - cft 8y ago
      1. Deregulation - reduce compliance and legal burdens. That would bring cash prices down, so instead of 1% perhaps 50% can afford them. That's a start. 2. Charities. You can start your own: give 5% of your income to underinsured. For example: http://www.philanthropyroundtable.org/almanac/hall_of_fame/john_d._rockefeller_sr http://www.philanthropyroundtable.org/almanac/hall_of_fame/j... At the urging of Frederick T. Gates, perhaps his most trusted philanthropic adviser, Rockefeller became increasingly devoted to medical research. In 1901, he funded the Rockefeller Medical Research Institute in New York City. Modeled on the Institut Pasteur in France and the Robert Koch Institute in Germany, it was the country’s first biomedical institute, soon on a par with its European models. The results were dramatic. Within a decade, it created a vaccine for cerebrospinal meningitis and had supported the work of America’s first winner of a Nobel Prize in medicine. Today, known as the Rockefeller University, it is one of the leading biomedical research centers in the world. Twenty-four Nobel Prize winners have served on its faculty. But don't force charity on others who may be struggling.
      - icebraining 8y ago
        What if even with the amazing price reductions achieved by deregulation, charities still can't cover for all uninsured patients?
        0care 8y ago
- bluedino 8y ago
  Or hospitals could have on site urgent care
  - maxerickson 8y ago
    In lots of places they do. (I guess more so in areas where freestanding urgent care is a less interesting investment) There's even hospitals that provide urgent care style care (and billing!) in their ERs, undermining the argument that this isn't viable.
- komali2 8y ago
  I have had this debate. The right has learned to be very slippery. You won't ever hear them suggest people should die in the streets - why that'd be just unhospitable! They'll instead say - "why don't they have insurance? Why don't they get a job so they have health insurance? Why should I have to pay for people that don't feel like working when I go to work every day without complaint?" If you suggest all the myriad of reasons the trapped impoverished don't have a job, they'll counter with "those are obstacles to getting a job, sure, but it's not impossible." If you point out that many people have jobs that don't offer health insurance, you'll either get a sarcastic reply about Obamacare, or the question "why don't they just get a better job? Why don't they go to night school and get a degree?" Empathy has been replaced by the desire to be infallible in debate.
  - darpa_escapee 8y ago
    I'd argue that the desire to appear infallible in debate is a facade to shroud the overriding desire to pay less in taxes no matter the human cost, coupled with a lack of empathy.
  - ajmurmann 8y ago
    I blame identity politics. If you want to identify with your right wing group you must stick to those believes. Compliance with the group norms you identify with is more important than health care for abstract "poor people".
  - nostromo 8y ago
    You're arguing against a far-right strawman. Take a non-strawman like Paul Ryan, who is in every way a typical Republican, and his proposal is not to abandon Medicaid, but to make it into an Obamacare-like system whereby people are provided subsidized insurance.
    - komali2 8y ago
      If by "strawman" you mean my Trump-supporting friends back in Texas, sure. They are real, and I am paraphrasing from actual conversations I've had. I think it's insincere to claim "well actual republicans aren't like that" when republican propaganda seems aimed at creating a population exactly like that. Ah, Paul Ryan. >There’s nothing inherently wrong with high-risk pools, but they have to be adequately funded in order to work properly because the people in them are so expensive to care for. Many states had high-risk pools before Obamacare was enacted, but they charged much higher premiums than normal and excluded coverage for certain services. The federal government also had a high-risk pool temporarily, but it grew too expensive and had to cap enrollment. According to some estimates, the $10 billion a year allocated in the AHCA would still not be enough. https://www.theatlantic.com/health/archive/2017/03/the-biggest-criticism-of-paul-ryans-health-care-pitch/519138/ https://www.theatlantic.com/health/archive/2017/03/the-bigge... > Unless the amount of the credit is linked to the cost of coverage comparable with what people received under the Affordable Care Act (and subject to indexing), it will represent a reduction in coverage (or higher costs if people want to "buy up"). If people will be reduced to buying catastrophic coverage, their deductibles may be larger, not smaller than they were under Obamacare policies. That's a step backward for many Americans, who complain that the deductibles are too high already. Moreover, depending on the differential between the credit for older and younger Americans, older people (who use more health care) may wind up paying more. >Equally problematic is the use of health-care saving accounts in lieu of the subsidies available on the Obamacare exchanges. If working-class people do not have the extra income to contribute (albeit on a pre-tax basis), once again they will be worse off than they were previously. > Without massive new taxes to pay for it, it's hard to deliver more coverage for less. In other words, Republicans promised more and are delivering arguably less than Obamacare does. http://www.chicagotribune.com/news/opinion/commentary/ct-paul-ryan-obamacare-replacement-20170217-story.html http://www.chicagotribune.com/news/opinion/commentary/ct-pau...
- eaandkw 8y ago
  I would argue that healthcare is not a right. But most of the comments here seems to leave only two choices: all or nothing. Just because someone is against socialized, universal, or free healthcare does not mean that they want people dying in the street. They just see the argument as a lot more complicated. As crazy as it sounds I think we should do away with health insurance in general. I think that would do more for cost control then any scheme the government could come up with. I do believe that making hospitals publish their prices would be a good start. The first thing I think that would do is bring to light the difference in price between paying in cash versus using insurance. From there we could make arguments why the same service has a 10x to 100x difference in price depending on how or who pays for it.
  - omegaworks 8y ago
    How would you then hedge against unexpected high-cost procedures? Your assumption is that ridding the world of insurance would magically, dramatically lower the cost of every drug and procedure on the market. Not everyone gets cancer, the medical insurance profit model is predicated on a bet that most people won't. The more people in the coverage pool, the less likely you will be paying out for every single person. Socialized care is just the expansion of that model to encompass the entire country's citizen population. What would have been privately-captured profit from people that were healthy members of the pool can instead be used to reduce the premiums paid by all members of the pool.
    - eaandkw 8y ago
      I am arguing from the point of view that at current prices very few if anyone would be able to afford a high-cost procedure. When that happens prices would come down. This is partly why a bottle of snake venom antidote in Mexico can cost $100 but in the U.S. costs $10,000. Another example is eye surgery. Originally the procedure was expensive but now it is more affordable because it is not covered by insurance. Comparatively, plastic surgery is relatively affordable because it is not normally covered by insurance. Reducing or eliminating health insurance would also eliminate a lot of the medical administrators that provide zero care but due incur a cost due to their salaries. As far as getting rid of the profit motivation but capturing the profits and giving it to those without health insurance I believe that you would also eliminate any reason to innovate and create new drugs. I will admit that if you got rid of health insurance tomorrow that there would be a lot of short term pain. But I also believe that in the long run people would be better off because they would be able to afford there healthcare. Using a different example look at the cost of college. I believe that we could fix that problem one of two ways. The first way would be to get rid of government loans and grants. The other way would be to allow people to file bankrupcy for student loans. The first way would attack the problem by getting rid of easy money. Because easy money makes things expensive. The second way could work by shifting the risks of the loans from the student to the banks. The problem with this solution would probably make it harder to pay for degrees that don't pay well. To summarize my arguments, cheap money makes things expensive and is destroying almost everything is this country. Edit: added the college example.
monetus 8y ago
-- Which amplifies the cost incredibly, through reactionary rather than preventative care. Sadly, it seems like most people I've had to inform of this perceive more than one bogeyman in more socialist systems.
wklauss 8y ago
> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't--just through hospital billing. I don't know where you get this. In my experience nobody who advocates for socialized healthcare is under this impression. They know how the system works, just don't think it's an efficient way to run it (it isn't). The way the incentives are structured on the American healthcare system now are beyond ridiculous and having public published prices is a way to start a much needed debate about the underlying issues, with data and facts instead of political viewpoints. It's absurd that having a baby in an average facility in the US "costs" five times more than a private hospital in Switzerland. I put quote marks on cost because that's usually billed price and insurance tend to negotiate down, so in reality is more like twice the cost, but still absurd at any level.
- kendallpark 8y ago
  > In my experience nobody who advocates for socialized healthcare is under this impression. Did you misread? I said that many that are against socialized healthcare don't realize that wealth redistribution is already happening in the American system.
  - wklauss 8y ago
    I'm sorry. I actually misread that, yes.
andrewla 8y ago
> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't--just through hospital billing. In fact it's really the opposite; it takes extra money from those who can't pay (the uninsured) and gives it to those who can (the insured), because it's the insurance companies that negotiate the lower rates.
- tntn 8y ago
  Both happen. I think the point OP was making is that the cost for anyone who pays (insured or not) is higher in order to compensate for the required care to people who never pay.
- kendallpark 8y ago
  It's more complicated than that. If you're uninsured, you can apply for aid. If your financial need is considered great enough, they might write off part or all of your bill. Hospitals set aside a certain amount of "charity" money to cover these cases (from the extra they get from other sources). In this case, the uninsured person is having their bill paid by others. If you're uninsured and rich, well, you're paying sticker price and making the hospital very happy. If you're uninsured and somewhere in the middle, you could be helped by the hospital, you could be screwed, really depends on the hospital. Private insurance companies pay more than Medicare/Medicaid on basically all procedures. The price they negotiate is lower than the list price of a procedure, but remember, these sticker prices are hugely inflated. Hospitals will often raise the list price to renegotiate higher prices with insurers. In the end, I would suspect it is largely private insurance providing extra income for the hospitals (more common than cash patients, and they pay a greater % of the list price than Medicare). Here's more info: https://www.nbcnews.com/health/health-care/hospitals-highest-markups-n371741 https://www.nbcnews.com/health/health-care/hospitals-highest...
- gowld 8y ago
  Obviously they aren't taking money from people who can't pay. They take money from people who can pay.
topspin 8y ago
>> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't A lot of people against socialized healthcare are perfectly aware of this cost shifting.
- toomuchtodo 8y ago
  [removed]
  - dotancohen 8y ago
    GP is implying that it is those who would abuse such a system (or represent people who would abuse such a system) that are making those decisions.
    - deleted 8y ago
      [deleted]
    - topspin 8y ago
      I'll speak for myself. I meant what I wrote; putative opponents of 'socialized' healthcare are not, in fact, ignorant of the endemic cost shifting that occurs in medicine. My intent was to satisfy my probably foolish urge to disabuse people on the Internet of their cherished strawmen. Unfortunately I haven't the time today to indulge that compulsion further, so I'll bid you all adieu.
  - adventured 8y ago
    > I’m just surprised their voice is so loud. It's a voice backed with $3.7 trillion in total economic value per year (18.x% of the $20 trillion US economy). In terms of size, it would just about be the fourth largest economy on earth, comparable to Germany. There are millions of very well paid hands in that pot of gold, from doctors & nurses to scientists and pharma sales reps, hospital admin and insurance industry employees. Consider for a moment that US drug costs - the most notorious example of abuse in US healthcare costs - are about 10-11% of the total US healthcare expenditure, and our per capita spending is about 2x what it should be: ie nearly everyone in healthcare is partaking in the plunder. That makes for a very loud voice.
Retric 8y ago
What's more telling is many countries such a Canada with full socialized healthcare spend less taxpayer money per person than the US does. At this point socialized medicine could literally save US taxpayers money while also removing the need for health insurance.
- brandall10 8y ago
  Right, when you have a system working as more of a cohesive hole incentives are realigned such that preventative care, reasonable drug prices, and less middlemen, lobbying $$, etc, are part of the process.
- AnIdiotOnTheNet 8y ago
  It isn't actually about costs. The thing about Americans, culturally, is that we hate other Americans. As a society, we would gladly pay $5 more to ensure our neighbor doesn't get $1 we don't think they deserve. See: drug testing of welfare recipients.
ethbro 8y ago
The key point of prices being published in a machine accessible and machine readable format isn't the numbers. What numbers are published can be haggled over in future laws. But the requirement for some numbers to be published is a big win. FWIW, the move to digital health records was basically realized through Medicare demanding it. Providers can't afford to go without Medicare payments; like Texas and California, so goes Medicare, so goes the market.
gowld 8y ago
> use inflated billing from paying patients It's not even that. "Sticker price" is simply the opening of negotations, sam as with any big-ticket purchase like real estate and vehicles and school tuition, and to a lesser extent airfare and hotel rates. As with any high-overhead business with room for high-marginal-profit on units, they simply seek to maximize total revenue or at least cover costs. They don't care which customers pay how much.
- lostapathy 8y ago
  I think this captures the mismatch better than you intended. My routine healthcare is not a big-ticket purchase and should not be the kind of thing I need to negotiate over. The total package between hospitals and insurers is, but my transaction is not.
celticninja 8y ago
This could still lead to lower prices by giving consumers better information. I have always wanted to set up a site to allow people to compare prices for healthcare in different hospitals/areas in the USA but this information is not publically available on the scale that would make it feasible.
- eaandkw 8y ago
  Here is a good example of a hospital that is doing it right. Granted I have not been there but I would really consider it if I needed surgery and I was in the area. Maybe domestic medical tourism. https://surgerycenterok.com/ https://surgerycenterok.com/ edit: forgot to add the link.
gnopgnip 8y ago
The inflated costs have very little to do with ER and uninsured patients. It is mostly about getting more money from insurance reimbursements. ER operations are subsidized by taxpayers in most of the US, and the ER is only a small part of the overall system. The reimbursement rates are loosely based on the inflated billing costs, with many insurance companies demanding a minimum discount of 50% being common.

danharaj 8y ago

> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't--just through hospital billing. It would be refreshing to have a conversation with someone who holds such a position that was willing to say that hospitals should turn uninsured and poor people away at ERs and let them die in the streets. Its at least more honest.

mikeash 8y ago
I’ve been saying for a while that until and unless people start advocating for the repeal of EMTALA (the law which requires ERs to treat everyone), there isn’t any debate over whether we should have socialized medicine, merely over how.
- tntn 8y ago
  I don't think that socialized medicine is certainly necessary. Compulsory private health insurance like Switzerland is workable.
  - arethuza 8y ago
    So who pays for the treatment of people who can't afford to pay for their own private health insurance?
    - komali2 8y ago
      If it can be simply made up for by the Swiss equivalent of SS I guess that'd be nice, seems like private health insurance wouldn't care either way. Then again this goes against my theory that socialized aid should come directly in the form of the thing needed - voucher for healthcare, food (or very specific food vouchers), rent free housing or vouchers for housing, rather than cash which is a bit silly to give to someone the government failed to give good financial education to (speaking from experience here...) There's a reason theres a huge market for under the table financial management among the trapped impoverished.
  - mikeash 8y ago
    My point isn’t about whether or not it’s necessary. It’s that we have it already, just in a weird and inefficient form. Our politicians pretend to debate over whether we should have it, when in fact we’ve had it for three decades and nobody serious is proposing to change that.
deleted 8y ago
[deleted]
kendallpark 8y ago
Furthermore, even the capitalistic idealism of "multiple private insurance companies competing with each other will drive prices down" doesn't work. At the end of the day, Medicare decides what it's going to pay for a procedure, and the rest of the insurance companies base their compensation off that. The government is still in control of pricing, by and large. Even the Singapore model (which looks capitalistic on the consumer end) relies on huge amounts of government price-fixing on the hospital side of things.
nostromo 8y ago
You're presuming that our only two options are requiring hospitals to admit everyone or let people die in the streets (and then calling people dishonest). It's a bit like assuming grocery stores must give away food to anyone or people will starve in the streets. In fact, there's other ways to get food to those in need.
- danharaj 8y ago
  Propose an alternative.
  - cft 8y ago
    1. Deregulation - reduce compliance and legal burdens. That would bring cash prices down, so instead of 1% perhaps 50% can afford them. That's a start. 2. Charities. You can start your own: give 5% of your income to underinsured. For example: http://www.philanthropyroundtable.org/almanac/hall_of_fame/john_d._rockefeller_sr http://www.philanthropyroundtable.org/almanac/hall_of_fame/j... At the urging of Frederick T. Gates, perhaps his most trusted philanthropic adviser, Rockefeller became increasingly devoted to medical research. In 1901, he funded the Rockefeller Medical Research Institute in New York City. Modeled on the Institut Pasteur in France and the Robert Koch Institute in Germany, it was the country’s first biomedical institute, soon on a par with its European models. The results were dramatic. Within a decade, it created a vaccine for cerebrospinal meningitis and had supported the work of America’s first winner of a Nobel Prize in medicine. Today, known as the Rockefeller University, it is one of the leading biomedical research centers in the world. Twenty-four Nobel Prize winners have served on its faculty. But don't force charity on others who may be struggling.
    - icebraining 8y ago
      What if even with the amazing price reductions achieved by deregulation, charities still can't cover for all uninsured patients?
      - 0care 8y ago
bluedino 8y ago
Or hospitals could have on site urgent care
- maxerickson 8y ago
  In lots of places they do. (I guess more so in areas where freestanding urgent care is a less interesting investment) There's even hospitals that provide urgent care style care (and billing!) in their ERs, undermining the argument that this isn't viable.
komali2 8y ago
I have had this debate. The right has learned to be very slippery. You won't ever hear them suggest people should die in the streets - why that'd be just unhospitable! They'll instead say - "why don't they have insurance? Why don't they get a job so they have health insurance? Why should I have to pay for people that don't feel like working when I go to work every day without complaint?" If you suggest all the myriad of reasons the trapped impoverished don't have a job, they'll counter with "those are obstacles to getting a job, sure, but it's not impossible." If you point out that many people have jobs that don't offer health insurance, you'll either get a sarcastic reply about Obamacare, or the question "why don't they just get a better job? Why don't they go to night school and get a degree?" Empathy has been replaced by the desire to be infallible in debate.
- darpa_escapee 8y ago
  I'd argue that the desire to appear infallible in debate is a facade to shroud the overriding desire to pay less in taxes no matter the human cost, coupled with a lack of empathy.
- ajmurmann 8y ago
  I blame identity politics. If you want to identify with your right wing group you must stick to those believes. Compliance with the group norms you identify with is more important than health care for abstract "poor people".
- nostromo 8y ago
  You're arguing against a far-right strawman. Take a non-strawman like Paul Ryan, who is in every way a typical Republican, and his proposal is not to abandon Medicaid, but to make it into an Obamacare-like system whereby people are provided subsidized insurance.
  - komali2 8y ago
    If by "strawman" you mean my Trump-supporting friends back in Texas, sure. They are real, and I am paraphrasing from actual conversations I've had. I think it's insincere to claim "well actual republicans aren't like that" when republican propaganda seems aimed at creating a population exactly like that. Ah, Paul Ryan. >There’s nothing inherently wrong with high-risk pools, but they have to be adequately funded in order to work properly because the people in them are so expensive to care for. Many states had high-risk pools before Obamacare was enacted, but they charged much higher premiums than normal and excluded coverage for certain services. The federal government also had a high-risk pool temporarily, but it grew too expensive and had to cap enrollment. According to some estimates, the $10 billion a year allocated in the AHCA would still not be enough. https://www.theatlantic.com/health/archive/2017/03/the-biggest-criticism-of-paul-ryans-health-care-pitch/519138/ https://www.theatlantic.com/health/archive/2017/03/the-bigge... > Unless the amount of the credit is linked to the cost of coverage comparable with what people received under the Affordable Care Act (and subject to indexing), it will represent a reduction in coverage (or higher costs if people want to "buy up"). If people will be reduced to buying catastrophic coverage, their deductibles may be larger, not smaller than they were under Obamacare policies. That's a step backward for many Americans, who complain that the deductibles are too high already. Moreover, depending on the differential between the credit for older and younger Americans, older people (who use more health care) may wind up paying more. >Equally problematic is the use of health-care saving accounts in lieu of the subsidies available on the Obamacare exchanges. If working-class people do not have the extra income to contribute (albeit on a pre-tax basis), once again they will be worse off than they were previously. > Without massive new taxes to pay for it, it's hard to deliver more coverage for less. In other words, Republicans promised more and are delivering arguably less than Obamacare does. http://www.chicagotribune.com/news/opinion/commentary/ct-paul-ryan-obamacare-replacement-20170217-story.html http://www.chicagotribune.com/news/opinion/commentary/ct-pau...
eaandkw 8y ago
I would argue that healthcare is not a right. But most of the comments here seems to leave only two choices: all or nothing. Just because someone is against socialized, universal, or free healthcare does not mean that they want people dying in the street. They just see the argument as a lot more complicated. As crazy as it sounds I think we should do away with health insurance in general. I think that would do more for cost control then any scheme the government could come up with. I do believe that making hospitals publish their prices would be a good start. The first thing I think that would do is bring to light the difference in price between paying in cash versus using insurance. From there we could make arguments why the same service has a 10x to 100x difference in price depending on how or who pays for it.
- omegaworks 8y ago
  How would you then hedge against unexpected high-cost procedures? Your assumption is that ridding the world of insurance would magically, dramatically lower the cost of every drug and procedure on the market. Not everyone gets cancer, the medical insurance profit model is predicated on a bet that most people won't. The more people in the coverage pool, the less likely you will be paying out for every single person. Socialized care is just the expansion of that model to encompass the entire country's citizen population. What would have been privately-captured profit from people that were healthy members of the pool can instead be used to reduce the premiums paid by all members of the pool.
  - eaandkw 8y ago
    I am arguing from the point of view that at current prices very few if anyone would be able to afford a high-cost procedure. When that happens prices would come down. This is partly why a bottle of snake venom antidote in Mexico can cost $100 but in the U.S. costs $10,000. Another example is eye surgery. Originally the procedure was expensive but now it is more affordable because it is not covered by insurance. Comparatively, plastic surgery is relatively affordable because it is not normally covered by insurance. Reducing or eliminating health insurance would also eliminate a lot of the medical administrators that provide zero care but due incur a cost due to their salaries. As far as getting rid of the profit motivation but capturing the profits and giving it to those without health insurance I believe that you would also eliminate any reason to innovate and create new drugs. I will admit that if you got rid of health insurance tomorrow that there would be a lot of short term pain. But I also believe that in the long run people would be better off because they would be able to afford there healthcare. Using a different example look at the cost of college. I believe that we could fix that problem one of two ways. The first way would be to get rid of government loans and grants. The other way would be to allow people to file bankrupcy for student loans. The first way would attack the problem by getting rid of easy money. Because easy money makes things expensive. The second way could work by shifting the risks of the loans from the student to the banks. The problem with this solution would probably make it harder to pay for degrees that don't pay well. To summarize my arguments, cheap money makes things expensive and is destroying almost everything is this country. Edit: added the college example.

monetus 8y ago

-- Which amplifies the cost incredibly, through reactionary rather than preventative care. Sadly, it seems like most people I've had to inform of this perceive more than one bogeyman in more socialist systems.

wklauss 8y ago

> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't--just through hospital billing. I don't know where you get this. In my experience nobody who advocates for socialized healthcare is under this impression. They know how the system works, just don't think it's an efficient way to run it (it isn't). The way the incentives are structured on the American healthcare system now are beyond ridiculous and having public published prices is a way to start a much needed debate about the underlying issues, with data and facts instead of political viewpoints. It's absurd that having a baby in an average facility in the US "costs" five times more than a private hospital in Switzerland. I put quote marks on cost because that's usually billed price and insurance tend to negotiate down, so in reality is more like twice the cost, but still absurd at any level.

kendallpark 8y ago
> In my experience nobody who advocates for socialized healthcare is under this impression. Did you misread? I said that many that are against socialized healthcare don't realize that wealth redistribution is already happening in the American system.
- wklauss 8y ago
  I'm sorry. I actually misread that, yes.

andrewla 8y ago

> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't--just through hospital billing. In fact it's really the opposite; it takes extra money from those who can't pay (the uninsured) and gives it to those who can (the insured), because it's the insurance companies that negotiate the lower rates.

tntn 8y ago
Both happen. I think the point OP was making is that the cost for anyone who pays (insured or not) is higher in order to compensate for the required care to people who never pay.
kendallpark 8y ago
It's more complicated than that. If you're uninsured, you can apply for aid. If your financial need is considered great enough, they might write off part or all of your bill. Hospitals set aside a certain amount of "charity" money to cover these cases (from the extra they get from other sources). In this case, the uninsured person is having their bill paid by others. If you're uninsured and rich, well, you're paying sticker price and making the hospital very happy. If you're uninsured and somewhere in the middle, you could be helped by the hospital, you could be screwed, really depends on the hospital. Private insurance companies pay more than Medicare/Medicaid on basically all procedures. The price they negotiate is lower than the list price of a procedure, but remember, these sticker prices are hugely inflated. Hospitals will often raise the list price to renegotiate higher prices with insurers. In the end, I would suspect it is largely private insurance providing extra income for the hospitals (more common than cash patients, and they pay a greater % of the list price than Medicare). Here's more info: https://www.nbcnews.com/health/health-care/hospitals-highest-markups-n371741 https://www.nbcnews.com/health/health-care/hospitals-highest...
gowld 8y ago
Obviously they aren't taking money from people who can't pay. They take money from people who can pay.

topspin 8y ago

>> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't A lot of people against socialized healthcare are perfectly aware of this cost shifting.

toomuchtodo 8y ago
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- dotancohen 8y ago
  GP is implying that it is those who would abuse such a system (or represent people who would abuse such a system) that are making those decisions.
  - deleted 8y ago
    [deleted]
  - topspin 8y ago
    I'll speak for myself. I meant what I wrote; putative opponents of 'socialized' healthcare are not, in fact, ignorant of the endemic cost shifting that occurs in medicine. My intent was to satisfy my probably foolish urge to disabuse people on the Internet of their cherished strawmen. Unfortunately I haven't the time today to indulge that compulsion further, so I'll bid you all adieu.
- adventured 8y ago
  > I’m just surprised their voice is so loud. It's a voice backed with $3.7 trillion in total economic value per year (18.x% of the $20 trillion US economy). In terms of size, it would just about be the fourth largest economy on earth, comparable to Germany. There are millions of very well paid hands in that pot of gold, from doctors & nurses to scientists and pharma sales reps, hospital admin and insurance industry employees. Consider for a moment that US drug costs - the most notorious example of abuse in US healthcare costs - are about 10-11% of the total US healthcare expenditure, and our per capita spending is about 2x what it should be: ie nearly everyone in healthcare is partaking in the plunder. That makes for a very loud voice.

Retric 8y ago

What's more telling is many countries such a Canada with full socialized healthcare spend less taxpayer money per person than the US does. At this point socialized medicine could literally save US taxpayers money while also removing the need for health insurance.

brandall10 8y ago
Right, when you have a system working as more of a cohesive hole incentives are realigned such that preventative care, reasonable drug prices, and less middlemen, lobbying $$, etc, are part of the process.
AnIdiotOnTheNet 8y ago
It isn't actually about costs. The thing about Americans, culturally, is that we hate other Americans. As a society, we would gladly pay $5 more to ensure our neighbor doesn't get $1 we don't think they deserve. See: drug testing of welfare recipients.

ethbro 8y ago

The key point of prices being published in a machine accessible and machine readable format isn't the numbers. What numbers are published can be haggled over in future laws. But the requirement for some numbers to be published is a big win. FWIW, the move to digital health records was basically realized through Medicare demanding it. Providers can't afford to go without Medicare payments; like Texas and California, so goes Medicare, so goes the market.

gowld 8y ago

> use inflated billing from paying patients It's not even that. "Sticker price" is simply the opening of negotations, sam as with any big-ticket purchase like real estate and vehicles and school tuition, and to a lesser extent airfare and hotel rates. As with any high-overhead business with room for high-marginal-profit on units, they simply seek to maximize total revenue or at least cover costs. They don't care which customers pay how much.

lostapathy 8y ago
I think this captures the mismatch better than you intended. My routine healthcare is not a big-ticket purchase and should not be the kind of thing I need to negotiate over. The total package between hospitals and insurers is, but my transaction is not.

celticninja 8y ago

This could still lead to lower prices by giving consumers better information. I have always wanted to set up a site to allow people to compare prices for healthcare in different hospitals/areas in the USA but this information is not publically available on the scale that would make it feasible.

eaandkw 8y ago
Here is a good example of a hospital that is doing it right. Granted I have not been there but I would really consider it if I needed surgery and I was in the area. Maybe domestic medical tourism. https://surgerycenterok.com/ https://surgerycenterok.com/ edit: forgot to add the link.

gnopgnip 8y ago

The inflated costs have very little to do with ER and uninsured patients. It is mostly about getting more money from insurance reimbursements. ER operations are subsidized by taxpayers in most of the US, and the ER is only a small part of the overall system. The reimbursement rates are loosely based on the inflated billing costs, with many insurance companies demanding a minimum discount of 50% being common.