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> all prices need to be +\- 50% of what Medicare pays. This is actually close to what happens with private insurers- they negotiate with a hospital to pay n-ti
by huac 8y ago
> all prices need to be +\- 50% of what Medicare pays.
This is actually close to what happens with private insurers- they negotiate with a hospital to pay n-times what Medicare pays for some set of treatments.
So why does Medicare pay the least? Because they have the most patients covered of any insurance network in the US. That's a hell of a bargaining factor. More patients = cheaper prices.
The logical conclusion is to then have Medicare for all. That'll regulate all prices to be exactly what Medicare pays!
- feanaro 8y agoThat still doesn't explain how prices of medical services in many other countries turn out several order of magnitudes smaller than commonly encountered prices in the US.
- peteretep 8y agoAre the prices that Medicare pay orders of magnitude different? ISTR that Medicare and the VA both pay about $10k per patient per year, which I think is comparable with the NHS. No sources as this is half-remembered.
- philtar 8y agoWe would also need to know the average number of visits per patient before this data means anything otherwise it's just data without context or meaning.
- TwoHeadedBeast 8y agoNHS spending is £2892 per person/year, that's quite a bit lower.
- peteretep 8y agoHuh, that's much lower than I thought.
- DanBC 8y agoThere's a bit of complication because we're comparing one system with not much insurance with a different system that has a lot of insurance. Here's a nice run through of the numbers. https://www.bbc.co.uk/news/uk-42950587 https://www.bbc.co.uk/news/uk-42950587
- bboreham 8y agoInteresting, this paper gives £2256 (table 2) https://www.health.org.uk/sites/default/files/AutumnBudgetWhatItMeans.pdf https://www.health.org.uk/sites/default/files/AutumnBudgetWh... This page gives $4246: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/ https://www.healthsystemtracker.org/chart-collection/health-...
- bbddg 8y agoPeople on Medicare are over 65 and people in the VA have been in the military. Both of those groups of people are going to have much higher medical needs than the general population.
- neffy 8y agoUS health spending in aggregate is between 2-3% more than comparable European countries. Life expectancy is several years lower.
- setr 8y agoI've discussed this before, but I think there's quite a bit of funny money in hospital bills -- a 10k bill rarely actually materializes in 10k transferred across all parties involved. Doctors bill $10k to your insurance, the insurance decides its too much, lawyers are on-hire to negotiate and take a 30% cut of the outcome, and finally 2k is paid out; the absurd bill naturally accounts for the absurd process, and I don't think anyone except the consumer ever expects 10k to really be 10k. And ofc, the insured consumer only ever pays $500 of it from his deductible. This was basically Shkreli's defense as well -- the insured patient doesn't pay anything close to the bill given; and I'm pretty sure, neither does the insurance. If you want to raise the price be $10, you add $1000 to the bill.
- StudentStuff 8y agoThis type of billing practice causes a mess of winners and losers, essentially unless your insurer has good pricing with wherever you end up getting treatment (often not a choice you get to make in an emergency), you can end up holding the bag for the cash price, usually half of the $10k number you mention. Quite ridiculous when other insurers are paying less than half that price, smells of a scam.
- conductr 8y agoMy conspiracy theory is it was designed this way over time so that people “needed” insurance (before it was required).
- SlowRobotAhead 8y agoNot too much of a conspiracy theory. What’s ironic (?) is that by mismanaging a scheme to get everyone on private insurance they’re really working towards socialized insurance. Which good or bad, there is no going away from once you have it.
- tertius 8y agoAgreed, providers are not as willing to negotiate with you as they are with insurance companies. Probably because they've already negotiated... Just go all cash with an HSA.
- lotsofpulp 8y agoBecause doctors in the US can easily make $300k+.
- mtgx 8y agoExcept republicans and bush passed a law a decade ago saying the government can't negotiate drug prices for Medicare. It's beyond stupid and the main reason you see so many niche drugs go up 50x in price overnight lately. The companies have figured out they can exploit that law this way.
- conductr 8y agoNo. Medicare pays the least because the don’t negotiate. They just set prices. As a hospital/doctor you can choose to accept Medicare patients or not. Most providers lose money on Medicare patients, or so the like to say.
- alkonaut 8y agoWouldn’t it make more sense to properly separate private and public? If hospitals can be either Medicare-only or no-Medicare (using Medicare as the name of a future broad/universal system much larger than Medicare/aid is today) then hospitals would chose to be Medicare in proportion to how many are covered. If everyone (including those who chose a private insurance) pays a full insurance premium for the public system on their taxes, the private insurers’ patient lists would shrink very quickly, and so would the number of hospitals that could survive by providing treatment to those patients. So looking from outside it looks like “hospital prices” is just another one of the problems that would be solved by a tax funded public universal healthcare insurance? Example (Sweden): I pay a full public insurance through taxes, and I have a private insurance via my employer that lets me cut some waiting times for certain procedures from 90 to 14 days. It’s an expensive way for my employer to make sure I’d be back to work quicker than I would otherwise be. Obviously, this is a luxury few use or need so the number of hospitals that provide this care is extremely limited (a few percent).
- conanbatt 8y agoIf you have public hospitals that are tax funded and private hospitals, you will see that private hospitals will only provide profitable services (cardian, neuro, etc) and give all loss patients to public hospitals (psychiatry, managed care, etc). Public hospitals will have a unreasonable burden of high-cost patients.
- alkonaut 8y agoI think you misunderstood: anyone who uses private would do so while also paying for a full public health insurance. That is, the public system is fully funded regardless of whether anyone wants to operate private hospitals.
- conanbatt 8y agoSo if you eliminated medicare and put all those patients into private insurance, they would all lower prices?
- refurb 8y agoSome insurers benchmark Medicare rates for some procedures. It certainly isn’t the majority of rates, those tend to be percent of charges. And no, Medicare doesn’t have the lowest rates (Medicaid does). The rates aren’t low due to negotiation (hah!), it’s the gov’t basically saying “here is what we pay, take it or leave it”.