7 ms·

I was not an advocate for gov't health care, but I am now for the same reason you stated. I have a high deductible plan, and have tried to get quotes in advan

by ttcbj 8y ago

I was not an advocate for gov't health care, but I am now for the same reason you stated. I have a high deductible plan, and have tried to get quotes in advance, but never can. I have been ripped off multiple times, despite trying to do my research, etc. My wife is a doctor, and at this point, I think single-payer is the least bad option.

SlowRobotAhead 8y ago
>have tried to get quotes in advance, but never can. >I have been ripped off multiple times, >I think single-payer is the least bad option. Can you help me understand why if everyone is paying for everyone's healthcare in a socialize system - how that reforms the transparency and stops the abuses?
- ryanobjc 8y ago
  The presumption that competition between doctors and hospitals will create lower prices has not come to fruition. Individuals have no leverage or ability to make meaningful choices. There is no real healthcare market as a result. In a larger system, we get lower prices via several mechanisms: - Preventative care replacing ER care due to universal coverage - Larger risk pool lowers per-participant costs - Single payer has more leverage and depth of time/knowledge to regulate/negotiate with individual hospitals The reality of a competitive landscape, hand of market, etc, that just didn't happen.
- smileysteve 8y ago
  Because, then the single payer, can say "your policies/prices don't work with our system", fix it, or we won't cover any patients, effectively shutting you down.
  - SlowRobotAhead 8y ago
    What is stopping insurance companies from doing that now? If you're paying for insurance, it's in your insurance company's best interest to pay low prices.
    - Arubis 8y ago
      They can and do, at which point the hospital or other billing party directly bills the beneficiary of care or their guardian, which is how folks that think they're financially secure end up bankrupt.
    - dv_dt 8y ago
      Because insurance companies are fighting at both ends. If their payments are too low, their network providers will stop taking that insurance plan or company and then they lose customers for lack of network reach. Also, well-intentioned overhead limit regulations to spend at least 80% of funds on care, creates a countervailing accounting pressure to increase costs so that administrative spending can be higher - flowing more money to the insurance company. I actually agree w/ overhead limits, but you also need other efficiency metrics to keep the anti-optimization in check. Or, personally I think we should go to some form of universal healthcare and wipe out private health insurance as it's currently constituted.
    - tosz25 8y ago
      A recent episode of An Arm and a Leg podcast explains this pretty well (https://armandalegshow.com/why-health-insurance-actually-sucks/ https://armandalegshow.com/why-health-insurance-actually-suc...). In many areas of the US, health networks are effectively local/regional monopolies and can pick and choose which insurance providers they accept. So there is effectively a "single seller" system for services that are in high demand.
  - conanbatt 8y ago
    Or it can tell the patient "this is the treatment that the state will afford" and then they shut you down.
- Arubis 8y ago
  The party responsible for payment (the government, in this case) can tell a billing party "I won't pay you more than ___ for that service, and if you don't like it, you can sue me" without taking on the same risk that an individual would. Lawsuits are a pretty inefficient, high-overhead way to bill out, so billing parties are incentivized to not raise accountants and auditors eyebrows.
  - SlowRobotAhead 8y ago
    I must admit I'm skeptical of the claim that "only government can negotiate a better price"... I think anyone that's worked on government systems knows that is not typically the case. Why wouldn't insurers argue for better prices now?
    - scott_s 8y ago
      They can and do, but as per an instance in the submitted piece, you can still encounter individual providers who never agreed to that price. Then the patient is responsible for it.
    - dv_dt 8y ago
      It works in 36 out of 37 modern OECD nations, with the US paying the most, and more than double all the other nations which have the government negotiate a better price. Even in our own VA system, their negotiated prices are lower for drugs than the Medicare part D program, barred from negotiating (and with large pieces managed by private companies). I think your skepticism should primarily be directed to wondering if private systems can ever negotiate a fair price in healthcare products and services.
      - dragonwriter 8y ago
        > It works in 36 out of 37 modern OECD nations The rest of the OECD has universal healthcare, but not necessarily fully public healthcare (the model vary considerably.) Which just means that there are lots of good proven models that the US could adopt.
- maxxxxx 8y ago
  Medicare seems to be able to do it even in the US.
- vec 8y ago
  Because it's not everyone paying for everyone's health care, it's one entity paying for everyone's health care (using funds they get from everyone). That one entity can unilaterally refuse to do business with abusive vendors. They can negotiate for lower prices. They can notice and investigate discrepancies in pricing between similar cases. They are in a position to judge which types of care are and are not cost effective and can refuse to cover the latter. So that explains why having an insurance company helps, but it doesn't explain why a private insurance company can't perform the same role. For that, we have to introspect a little into how insurance firms work. An insurance company is, in essence, a mechanism for transferring funds from lucky people to unlucky ones. If your car gets totaled then, in essence, a bunch of other people with working vehicles have all volunteered to chip in a couple of bucks toward buying you a new one. The insurer is mostly facilitating the transfer and skimming just enough off in the process to cover their administrative costs. The private insurance market works well enough for most types of property because the volunteers can't predict in advance whether they're going to be lucky or not and because there's a realistic upper bound on how much money the unlucky ones will need to be made whole. Neither of these assumptions are true for healthcare. Many people were born into pre-crashed cars, to stretch the metaphor, and at least for the foreseeable future it's not possible to decide to replace a body instead of attempting to repair it. So we need* some non-market mechanism to incentivize or compel insurance companies to cover the already unlucky: people with pre-existing conditions. But that introduces a new problem. The lucky people are being asked to volunteer to chip in more, and at least some of them will stop volunteering. That causes the prices to go up even more, which causes a few more volunteers to leave, which causes the prices to go up again, and so on. Pretty soon there's no volunteers left to transfer funds from. So we also need* some non-market mechanism to incentivize or compel healthy people to contribute to our insurance system. And with those two requirements (needs to cover everyone and everyone needs to contribute) we are left with a problem space that the State is really the only entity with the ability to implement a solution. It doesn't have to be socialized medicine, per se, but it does basically have to be big government of one stripe or another. \* Yes, we do technically have the option of compelling innocent people to suffer and die from otherwise treatable diseases that they're not wealthy enough to afford to cover out of their own pocket. If you're aware of that fact and comfortable with it then okay, but please do understand that it is the societal tradeoff that we would have to make to avoid some sort of serious state involvement in provisioning medical care.
rootusrootus 8y ago
I find myself in the same boat. I've spent more from my HSA this year than I put into it (and I put in $6900) while I'm nowhere near hitting my deductible ($6K) because for whatever reason the insurance only thinks I've spent $2.7K. During this time I've tried to shop around, find the least expensive option (none of my medical needs this year have been urgent) and it's been impossible. Nobody can tell me. "You'd have to talk to our billing department, and they probably can't tell you anything until the doctor is finished." I am now firmly in the single payer camp. Medicare for All, I guess. To the insurance companies and medical billing industry, and even doctors, I say: "Sorry, not sorry, when this train comes through try to remember you did it to yourself."
- briandear 8y ago
  The problem with single payer is that it results in shortages. Look at waiting lists for the NHS, especially for mental health or routine surgery. That is a direct consequence of single payer. An unpopular view, but it is a fact.
  - rootusrootus 8y ago
    I am skeptical of a causal relationship there. In the United States, approximately 2/3 of healthcare costs are already borne by the government. My parents are both enrolled in Medicare and they are very satisfied. Why would it not work if we just dropped the eligible age for Medicare to zero? Hasn't this been extensively studied recently?
    - dragonwriter 8y ago
      > In the United States, approximately 2/3 of healthcare costs are already borne by the government. Less than half; US healthcare spending was around 8.5% GDP public, 8.8% GDP private in 2016. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-u-s-similar-public-spending-private-sector-spending-triple-comparable-countries https://www.healthsystemtracker.org/chart-collection/health-...
maxxxxx 8y ago
You don't need single payer. Just get some regulations about pricing. Germany doesn't have single payer but you never hear about these shenanigans.

by ttcbj 8y ago

SlowRobotAhead 8y ago

>have tried to get quotes in advance, but never can. >I have been ripped off multiple times, >I think single-payer is the least bad option. Can you help me understand why if everyone is paying for everyone's healthcare in a socialize system - how that reforms the transparency and stops the abuses?

ryanobjc 8y ago
The presumption that competition between doctors and hospitals will create lower prices has not come to fruition. Individuals have no leverage or ability to make meaningful choices. There is no real healthcare market as a result. In a larger system, we get lower prices via several mechanisms: - Preventative care replacing ER care due to universal coverage - Larger risk pool lowers per-participant costs - Single payer has more leverage and depth of time/knowledge to regulate/negotiate with individual hospitals The reality of a competitive landscape, hand of market, etc, that just didn't happen.
smileysteve 8y ago
Because, then the single payer, can say "your policies/prices don't work with our system", fix it, or we won't cover any patients, effectively shutting you down.
- SlowRobotAhead 8y ago
  What is stopping insurance companies from doing that now? If you're paying for insurance, it's in your insurance company's best interest to pay low prices.
  - Arubis 8y ago
    They can and do, at which point the hospital or other billing party directly bills the beneficiary of care or their guardian, which is how folks that think they're financially secure end up bankrupt.
  - dv_dt 8y ago
    Because insurance companies are fighting at both ends. If their payments are too low, their network providers will stop taking that insurance plan or company and then they lose customers for lack of network reach. Also, well-intentioned overhead limit regulations to spend at least 80% of funds on care, creates a countervailing accounting pressure to increase costs so that administrative spending can be higher - flowing more money to the insurance company. I actually agree w/ overhead limits, but you also need other efficiency metrics to keep the anti-optimization in check. Or, personally I think we should go to some form of universal healthcare and wipe out private health insurance as it's currently constituted.
  - tosz25 8y ago
    A recent episode of An Arm and a Leg podcast explains this pretty well (https://armandalegshow.com/why-health-insurance-actually-sucks/ https://armandalegshow.com/why-health-insurance-actually-suc...). In many areas of the US, health networks are effectively local/regional monopolies and can pick and choose which insurance providers they accept. So there is effectively a "single seller" system for services that are in high demand.
- conanbatt 8y ago
  Or it can tell the patient "this is the treatment that the state will afford" and then they shut you down.
Arubis 8y ago
The party responsible for payment (the government, in this case) can tell a billing party "I won't pay you more than ___ for that service, and if you don't like it, you can sue me" without taking on the same risk that an individual would. Lawsuits are a pretty inefficient, high-overhead way to bill out, so billing parties are incentivized to not raise accountants and auditors eyebrows.
- SlowRobotAhead 8y ago
  I must admit I'm skeptical of the claim that "only government can negotiate a better price"... I think anyone that's worked on government systems knows that is not typically the case. Why wouldn't insurers argue for better prices now?
  - scott_s 8y ago
    They can and do, but as per an instance in the submitted piece, you can still encounter individual providers who never agreed to that price. Then the patient is responsible for it.
  - dv_dt 8y ago
    It works in 36 out of 37 modern OECD nations, with the US paying the most, and more than double all the other nations which have the government negotiate a better price. Even in our own VA system, their negotiated prices are lower for drugs than the Medicare part D program, barred from negotiating (and with large pieces managed by private companies). I think your skepticism should primarily be directed to wondering if private systems can ever negotiate a fair price in healthcare products and services.
    - dragonwriter 8y ago
      > It works in 36 out of 37 modern OECD nations The rest of the OECD has universal healthcare, but not necessarily fully public healthcare (the model vary considerably.) Which just means that there are lots of good proven models that the US could adopt.
maxxxxx 8y ago
Medicare seems to be able to do it even in the US.
vec 8y ago
Because it's not everyone paying for everyone's health care, it's one entity paying for everyone's health care (using funds they get from everyone). That one entity can unilaterally refuse to do business with abusive vendors. They can negotiate for lower prices. They can notice and investigate discrepancies in pricing between similar cases. They are in a position to judge which types of care are and are not cost effective and can refuse to cover the latter. So that explains why having an insurance company helps, but it doesn't explain why a private insurance company can't perform the same role. For that, we have to introspect a little into how insurance firms work. An insurance company is, in essence, a mechanism for transferring funds from lucky people to unlucky ones. If your car gets totaled then, in essence, a bunch of other people with working vehicles have all volunteered to chip in a couple of bucks toward buying you a new one. The insurer is mostly facilitating the transfer and skimming just enough off in the process to cover their administrative costs. The private insurance market works well enough for most types of property because the volunteers can't predict in advance whether they're going to be lucky or not and because there's a realistic upper bound on how much money the unlucky ones will need to be made whole. Neither of these assumptions are true for healthcare. Many people were born into pre-crashed cars, to stretch the metaphor, and at least for the foreseeable future it's not possible to decide to replace a body instead of attempting to repair it. So we need* some non-market mechanism to incentivize or compel insurance companies to cover the already unlucky: people with pre-existing conditions. But that introduces a new problem. The lucky people are being asked to volunteer to chip in more, and at least some of them will stop volunteering. That causes the prices to go up even more, which causes a few more volunteers to leave, which causes the prices to go up again, and so on. Pretty soon there's no volunteers left to transfer funds from. So we also need* some non-market mechanism to incentivize or compel healthy people to contribute to our insurance system. And with those two requirements (needs to cover everyone and everyone needs to contribute) we are left with a problem space that the State is really the only entity with the ability to implement a solution. It doesn't have to be socialized medicine, per se, but it does basically have to be big government of one stripe or another. \* Yes, we do technically have the option of compelling innocent people to suffer and die from otherwise treatable diseases that they're not wealthy enough to afford to cover out of their own pocket. If you're aware of that fact and comfortable with it then okay, but please do understand that it is the societal tradeoff that we would have to make to avoid some sort of serious state involvement in provisioning medical care.

rootusrootus 8y ago

I find myself in the same boat. I've spent more from my HSA this year than I put into it (and I put in $6900) while I'm nowhere near hitting my deductible ($6K) because for whatever reason the insurance only thinks I've spent $2.7K. During this time I've tried to shop around, find the least expensive option (none of my medical needs this year have been urgent) and it's been impossible. Nobody can tell me. "You'd have to talk to our billing department, and they probably can't tell you anything until the doctor is finished." I am now firmly in the single payer camp. Medicare for All, I guess. To the insurance companies and medical billing industry, and even doctors, I say: "Sorry, not sorry, when this train comes through try to remember you did it to yourself."

briandear 8y ago
The problem with single payer is that it results in shortages. Look at waiting lists for the NHS, especially for mental health or routine surgery. That is a direct consequence of single payer. An unpopular view, but it is a fact.
- rootusrootus 8y ago
  I am skeptical of a causal relationship there. In the United States, approximately 2/3 of healthcare costs are already borne by the government. My parents are both enrolled in Medicare and they are very satisfied. Why would it not work if we just dropped the eligible age for Medicare to zero? Hasn't this been extensively studied recently?
  - dragonwriter 8y ago
    > In the United States, approximately 2/3 of healthcare costs are already borne by the government. Less than half; US healthcare spending was around 8.5% GDP public, 8.8% GDP private in 2016. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-u-s-similar-public-spending-private-sector-spending-triple-comparable-countries https://www.healthsystemtracker.org/chart-collection/health-...

maxxxxx 8y ago

You don't need single payer. Just get some regulations about pricing. Germany doesn't have single payer but you never hear about these shenanigans.