4 ms·

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

by 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.
    - dv_dt 8y ago
      There are lots of good models which all have in common a strong gov't negotiated price control somewhere in a system driven by universal healthcare principles instead of profit and market oriented principles.
  - krupan 8y ago
    Is cost the only measure we want to optimize for?
    - dv_dt 8y ago
      I think the US has better cancer survival rates in areas than other nations, but if that is all-around significant one would think that would reflect out in better life expectancy overall. However, the US is a huge negative outlier in life expectancy and child mortality with universal healthcare nations outperforming on those measures too. https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus https://ourworldindata.org/the-link-between-life-expectancy-... The most recent life expectancy numbers are the hardest to interpret, the US has the only three-year-running negative life expectancy growth in the first world nations - but some argue we should separate healthcare from the suicide numbers that are a big contributors. I don't know that I agree with that as there is a fuzzy line between healthcare and social care efforts.
      - amalcon 8y ago
        Life expectancy is a weird stat by which to measure healthcare outcomes. For starters, it responds rather strongly to demographics. E.g. having more males reduces life expectancy holding all else equal. There are many things like this. Age-adjusted all-cause death rate is the better stat for measuring life-saving outcomes. Child mortality is certainly a useful stat for its purpose, though.
        dv_dt 8y ago
        > Age-adjusted all-cause death rate is the better stat for measuring life-saving outcomes. Are there sources of that stat over time and between nations that you would recommend?
        amalcon 8y ago
        WHO is the best source I know of for most things like this. I was unable to find the exact stat I was looking for, but here is e.g. data on all-cause mortality rate between ages 18 and 60: http://apps.who.int/gho/data/view.main.1360?lang=en http://apps.who.int/gho/data/view.main.1360?lang=en It probably still supports the point you are trying to make, I just get grumpy about statistic selection.
- debatem1 8y ago
  Insurers are both victims and beneficiaries of a system in which people are terrified to go without medical insurance, but where that medical insurance often doesn't meaningfully protect you. The proposed alternative is to give tremendous power to an organization with less conflicted responsibilities.
- Arubis 8y ago
  I'm getting into hand-wavey territory here, IANAprofessional in a related discipline, etc., and my personal leaning is towards socializing public services such as medicine already. So disclaimed... I think "only (any large organization) can negotiate a better price" is a little misleading on the surface. On a macro level it should, in theory, be true, and should already be happening with private insurers; when I've looked at my own EOBs, they consistently will list a service, a coding, a billed price, an "allowed" price that is always much less than the billed price, and the amount paid (which predictably matches the "allowed" price). And yeah, when we're watching politicians pontificate, we end up having strong opinions about the total price of healthcare and its effect on the economy. That said, does anyone _really_ make personal healthcare decisions based on the macro effect on the economy? I personally doubt it. I posit that the vast majority of US citizens and residents wouldn't care if the annual healthcare spend changed by US$200 million, but any individual American cares A WHOLE LOT if you bill them personally for US$100,000 and their insurance doesn't cover it (or much of it). It seems to me that a much better approach to this entire conversation is "let's drastically reduce the number of Americans forced into bankruptcy because they or their dependent got sick". My own inclination is that that'll require government intervention, because the incentives for a for-profit insurance company are to pay out as little as possible, but I'm open to anything that addresses that problem.
- nradov 8y ago
  In most cases it's not a matter of negotiation, it's a matter of law. For many categories of goods and services it's literally illegal to charge any other customer a lower price than you charge the US government. People are in federal prison today for doing that.
- krupan 8y ago
  You have hit the fallacy on the head. Our (U.S.) system now is a terrible mess of regulations and tax breaks that drive stupid behavior. Single payer government health care is not the only alternative to what we have now. It would not produce maximums of quality, innovation, efficiency, satisfaction, or freedom. It would provide basic care to everyone.

by Arubis 8y ago

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.
  - dv_dt 8y ago
    There are lots of good models which all have in common a strong gov't negotiated price control somewhere in a system driven by universal healthcare principles instead of profit and market oriented principles.
- krupan 8y ago
  Is cost the only measure we want to optimize for?
  - dv_dt 8y ago
    I think the US has better cancer survival rates in areas than other nations, but if that is all-around significant one would think that would reflect out in better life expectancy overall. However, the US is a huge negative outlier in life expectancy and child mortality with universal healthcare nations outperforming on those measures too. https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus https://ourworldindata.org/the-link-between-life-expectancy-... The most recent life expectancy numbers are the hardest to interpret, the US has the only three-year-running negative life expectancy growth in the first world nations - but some argue we should separate healthcare from the suicide numbers that are a big contributors. I don't know that I agree with that as there is a fuzzy line between healthcare and social care efforts.
    - amalcon 8y ago
      Life expectancy is a weird stat by which to measure healthcare outcomes. For starters, it responds rather strongly to demographics. E.g. having more males reduces life expectancy holding all else equal. There are many things like this. Age-adjusted all-cause death rate is the better stat for measuring life-saving outcomes. Child mortality is certainly a useful stat for its purpose, though.
      - dv_dt 8y ago
        > Age-adjusted all-cause death rate is the better stat for measuring life-saving outcomes. Are there sources of that stat over time and between nations that you would recommend?
        amalcon 8y ago
        WHO is the best source I know of for most things like this. I was unable to find the exact stat I was looking for, but here is e.g. data on all-cause mortality rate between ages 18 and 60: http://apps.who.int/gho/data/view.main.1360?lang=en http://apps.who.int/gho/data/view.main.1360?lang=en It probably still supports the point you are trying to make, I just get grumpy about statistic selection.
debatem1 8y ago
Insurers are both victims and beneficiaries of a system in which people are terrified to go without medical insurance, but where that medical insurance often doesn't meaningfully protect you. The proposed alternative is to give tremendous power to an organization with less conflicted responsibilities.
Arubis 8y ago
I'm getting into hand-wavey territory here, IANAprofessional in a related discipline, etc., and my personal leaning is towards socializing public services such as medicine already. So disclaimed... I think "only (any large organization) can negotiate a better price" is a little misleading on the surface. On a macro level it should, in theory, be true, and should already be happening with private insurers; when I've looked at my own EOBs, they consistently will list a service, a coding, a billed price, an "allowed" price that is always much less than the billed price, and the amount paid (which predictably matches the "allowed" price). And yeah, when we're watching politicians pontificate, we end up having strong opinions about the total price of healthcare and its effect on the economy. That said, does anyone _really_ make personal healthcare decisions based on the macro effect on the economy? I personally doubt it. I posit that the vast majority of US citizens and residents wouldn't care if the annual healthcare spend changed by US$200 million, but any individual American cares A WHOLE LOT if you bill them personally for US$100,000 and their insurance doesn't cover it (or much of it). It seems to me that a much better approach to this entire conversation is "let's drastically reduce the number of Americans forced into bankruptcy because they or their dependent got sick". My own inclination is that that'll require government intervention, because the incentives for a for-profit insurance company are to pay out as little as possible, but I'm open to anything that addresses that problem.
nradov 8y ago
In most cases it's not a matter of negotiation, it's a matter of law. For many categories of goods and services it's literally illegal to charge any other customer a lower price than you charge the US government. People are in federal prison today for doing that.
krupan 8y ago
You have hit the fallacy on the head. Our (U.S.) system now is a terrible mess of regulations and tax breaks that drive stupid behavior. Single payer government health care is not the only alternative to what we have now. It would not produce maximums of quality, innovation, efficiency, satisfaction, or freedom. It would provide basic care to everyone.