5 ms·

How is universal care going to reduce the shortage of primary care doctors? How is universal care going to eliminate patents for pharma? How is universal care

How is universal care going to reduce the shortage of primary care doctors? How is universal care going to eliminate patents for pharma? How is universal care going to make non-profit hospitals cheaper? How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers? How is universal care going to reduce healthcare spending?

maxxxxx 8y ago
Countries with universal care also usually have tight regulations on what can be charged and how. A first step would be to make all prices transparent so people can actually compare. In my view the biggest problem in the US is that the billing aspect of health care is intentionally opaque.
- conanbatt 8y ago
  Medicare is justs as opaque, and also distortive: Medicare costs 11k a year, but retirees pay less than half its cost as it is. The main reason pricing is opaque is because patients dont have freedom to compare between insurance companies, and because insurance companies are not a good model for frequent care. If you had High-deductible plans, you would make a much better system but people hate those plans. You need a big change in popular sentiment to make pricing work well. (i am all for HDPs)
  - arcticbull 8y ago
    Most Americans can’t afford $500 in case of an emergency, which is why high deductible plans are a non starter to provide coverage. For them a $5000 deductible is as good as not being covered in the first place.
    - conanbatt 8y ago
      Health insurance costs 800$ a month so not having 500$ means you dont have insurance. Thats another level of poverty, for the which there is medicaid and a different set of programs and way to deal with those cases.
      - arcticbull 8y ago
        That's not true. First of all $800/month is what you'd expect to pay if you were young and healthy and with moderate deductibles. Good luck being older or sicker. The $500 that I'm referring to is $500 beyond what they budgeted for after their monthly expenditures. No, Medicaid doesn't always apply to these people, you should look into it. It also requires extreme levels of financial hardship. Medicaid takes a lien against your house to recover their costs. Not to mention the donut hole for whom having their house taken isn't even an option. It's brutal. When I said most of America, I meant it. It's fifty seven percent of America. [1] Are you going to put them all on Medicaid and take their houses? I thought you were arguing for private cover :) This is the kind of thinking that pushes up costs. Creating barriers to seeking care early makes everything more expensive as the longer you wait, the more it costs to resolve. Let's be rational about this. The US median individual income is $39,336. [2] Your take-home pay would be approximately $2614 per month after tax assuming you save nothing toward your retirement. Taking out $800 leaves you with $1814. The US median rent is $1500 per month [3]. This leaves you with $314 for food, gas, transportation, electric, water and sewer combined. And this is the best possible case: you're single. Then you want them to handle a $5000 deductible?! [1] https://www.cbsnews.com/news/most-americans-cant-afford-a-500-emergency-expense/ https://www.cbsnews.com/news/most-americans-cant-afford-a-50... [2] https://en.wikipedia.org/wiki/Personal_income_in_the_United_States https://en.wikipedia.org/wiki/Personal_income_in_the_United_... [3] https://www.prnewswire.com/news-releases/us-median-rent-hits-a-new-high-at-1-500-a-month-but-rent-growth-slows-heading-into-fall-300720740.html https://www.prnewswire.com/news-releases/us-median-rent-hits...
        conanbatt 8y ago
        It doesnt change the math to charge 5000U$S in advance through a payroll tax, than to have a 5000U$S deductible afterwards. The key metric is if the healthcare services are better utilized and are cheaper.
        arcticbull 8y ago
        Sorry, would you require everyone get a raise in the amount of their health insurance benefits? Sounds like interventionist overreach into the free market to me. Remember how the 2017 tax windfall for companies would yield huge raises for everyone, but instead, only lead to stock repurchases? What makes you think this would be any different? Since you also suggested in a different thread that it'd no longer be tax deductible, that $5000 would drop immediately to $3000 or less -- $250/mth. That's still dancing on a razor's edge. Your key metric of "cheaper" and "more available" and "better utilized" is provably solved with a socialized model. There's no active private care model that outperforms one of the OECD socialized models, or else you'd have at least mentioned it by now. Instead, we keep revisiting unsubstantiated ideological libertarian talking points. I've got real world implementations to support my theories.
  - maxxxxx 8y ago
    With a high deductible plan they still will give you no estimate or something like "between 1000 and 200000 dollar". All actual prices that got paid need to be published.
    - conanbatt 8y ago
      Above the deductible it doesn't matter. Below the deductible is easier to manage. Primary care generally has public pricing.
      - maxxxxx 8y ago
        That doesn't match my experience. Do you have direct experience? Your other responses sound more ideological than direct experience.
        conanbatt 8y ago
        Yes, for example sutter health has public pricing on their Primary care services (https://www.sutterhealth.org/for-patients/health-care-costs-charges-smf https://www.sutterhealth.org/for-patients/health-care-costs-...). They treat millions of patients so its a pretty big driver. Price opaqueness is a big issue, but there is no transparency with so much distortion.
        arcticbull 8y ago
        Transparency is kind of irrelevant, if I'm bleeding out unconscious somewhere in the street, I'm in no position to make hospitals compete for my business. This isn't buying a new cell phone, these are peoples' lives.
        conanbatt 8y ago
        Transparency is important to choose any service and care is one of them. The vast majority of healthcare services are not urgent. There's a case for price insensitivity for emergency care, but that is also resolved by choosing insurance before hand: the same way there is price sensitivity to life insurance. A bigger problem to me than transparency is distortion: the value of the service being public means little if the patient is not paying for it. A patient that has 20% co-insurance or 20$ copay have completely different price sensititivities. They are also price-insensitive when they select insurance because they get it through the employer that picked it and payed it for them. As a patient, the price tag on a service is relevant to you depending on insurance: validating insurance is much more important than seeing the price. A socialized medicine scheme will have the same problem: if a patient is shielded from the actual cost of the visit, then he is more likely to use it and thus over-use it.
arcticbull 8y ago
(1) How is universal care going to reduce the shortage of primary care doctors? I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough. (2) How is universal care going to eliminate patents for pharma? It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere else. There's a perception that in Canada "drugs are cheap" -- prescription drugs administered outside of hospitals largely aren't covered by OHIP. Provinces act as bulk buying groups and negotiate prices with pharma companies. You want to partake in the market, great, let's figure something out. It works surprisingly well. Patents are your temporary monopoly on creating an invention in exchange for sharing it with the world. (3) How is universal care going to make non-profit hospitals cheaper? By regulating fees for services, by lowering the price of drugs via negotiation and bulk purchase agreements, by eliminating marketing budgets, by eliminating insurance billing departments and by capping executive compensation. Hospitals and doctors are public servants elsewhere in the world, not elite rockstars who can bill as they so choose. That doesn't mean they're not well compensated. Oh, and by socializing malpractice insurance. In the US high-cost states OBGYNs pay $85-200K/yr just in medical malpractice insurance. [1] In Ontario it's around $70K CAD. (4) How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers? By having a single table of rates that apply to everyone. Ideally with a single payer. This makes billing much, much easier. (5) How is universal care going to reduce healthcare spending? Everything I indicated above put together. If you want a concrete example Medicare does most of the above (they can't negotiate drug prices, and they're not single payer, and they haven't socialized malpractice insurance) but they're substantially more efficient. Medicare spends 2-5% of the budget on administrative, where private plans spend 12-18%. That's without recognizing some of the other savings I pointed out. [2] [1] https://equotemd.com/blog/obgyn-medical-malpractice-insurance/ https://equotemd.com/blog/obgyn-medical-malpractice-insuranc... [2] https://www.washingtonpost.com/news/fact-checker/wp/2017/09/19/medicare-private-insurance-and-administrative-costs-a-democratic-talking-point/?utm_term=.e38da042cc76 https://www.washingtonpost.com/news/fact-checker/wp/2017/09/...
- arcticbull 8y ago
  Further to (2) by affording preventative care to everyone, people in the early stages of serious diseases can obtain preventative care and coverage thereby eliminating expensive treatments later on. In the US if you walk into a hospital near death they're required to look after you -- not so much if you walk in seeking preventative care. Imagine if they spent the $5 early on to treat you instead of the tens of thousands when you're near death? It's yet another reason why universal healthcare is a good, cheaper thing to have.

maxxxxx 8y ago

Countries with universal care also usually have tight regulations on what can be charged and how. A first step would be to make all prices transparent so people can actually compare. In my view the biggest problem in the US is that the billing aspect of health care is intentionally opaque.

conanbatt 8y ago
Medicare is justs as opaque, and also distortive: Medicare costs 11k a year, but retirees pay less than half its cost as it is. The main reason pricing is opaque is because patients dont have freedom to compare between insurance companies, and because insurance companies are not a good model for frequent care. If you had High-deductible plans, you would make a much better system but people hate those plans. You need a big change in popular sentiment to make pricing work well. (i am all for HDPs)
- arcticbull 8y ago
  Most Americans can’t afford $500 in case of an emergency, which is why high deductible plans are a non starter to provide coverage. For them a $5000 deductible is as good as not being covered in the first place.
  - conanbatt 8y ago
    Health insurance costs 800$ a month so not having 500$ means you dont have insurance. Thats another level of poverty, for the which there is medicaid and a different set of programs and way to deal with those cases.
    - arcticbull 8y ago
      That's not true. First of all $800/month is what you'd expect to pay if you were young and healthy and with moderate deductibles. Good luck being older or sicker. The $500 that I'm referring to is $500 beyond what they budgeted for after their monthly expenditures. No, Medicaid doesn't always apply to these people, you should look into it. It also requires extreme levels of financial hardship. Medicaid takes a lien against your house to recover their costs. Not to mention the donut hole for whom having their house taken isn't even an option. It's brutal. When I said most of America, I meant it. It's fifty seven percent of America. [1] Are you going to put them all on Medicaid and take their houses? I thought you were arguing for private cover :) This is the kind of thinking that pushes up costs. Creating barriers to seeking care early makes everything more expensive as the longer you wait, the more it costs to resolve. Let's be rational about this. The US median individual income is $39,336. [2] Your take-home pay would be approximately $2614 per month after tax assuming you save nothing toward your retirement. Taking out $800 leaves you with $1814. The US median rent is $1500 per month [3]. This leaves you with $314 for food, gas, transportation, electric, water and sewer combined. And this is the best possible case: you're single. Then you want them to handle a $5000 deductible?! [1] https://www.cbsnews.com/news/most-americans-cant-afford-a-500-emergency-expense/ https://www.cbsnews.com/news/most-americans-cant-afford-a-50... [2] https://en.wikipedia.org/wiki/Personal_income_in_the_United_States https://en.wikipedia.org/wiki/Personal_income_in_the_United_... [3] https://www.prnewswire.com/news-releases/us-median-rent-hits-a-new-high-at-1-500-a-month-but-rent-growth-slows-heading-into-fall-300720740.html https://www.prnewswire.com/news-releases/us-median-rent-hits...
      - conanbatt 8y ago
        It doesnt change the math to charge 5000U$S in advance through a payroll tax, than to have a 5000U$S deductible afterwards. The key metric is if the healthcare services are better utilized and are cheaper.
        arcticbull 8y ago
        Sorry, would you require everyone get a raise in the amount of their health insurance benefits? Sounds like interventionist overreach into the free market to me. Remember how the 2017 tax windfall for companies would yield huge raises for everyone, but instead, only lead to stock repurchases? What makes you think this would be any different? Since you also suggested in a different thread that it'd no longer be tax deductible, that $5000 would drop immediately to $3000 or less -- $250/mth. That's still dancing on a razor's edge. Your key metric of "cheaper" and "more available" and "better utilized" is provably solved with a socialized model. There's no active private care model that outperforms one of the OECD socialized models, or else you'd have at least mentioned it by now. Instead, we keep revisiting unsubstantiated ideological libertarian talking points. I've got real world implementations to support my theories.
- maxxxxx 8y ago
  With a high deductible plan they still will give you no estimate or something like "between 1000 and 200000 dollar". All actual prices that got paid need to be published.
  - conanbatt 8y ago
    Above the deductible it doesn't matter. Below the deductible is easier to manage. Primary care generally has public pricing.
    - maxxxxx 8y ago
      That doesn't match my experience. Do you have direct experience? Your other responses sound more ideological than direct experience.
      - conanbatt 8y ago
        Yes, for example sutter health has public pricing on their Primary care services (https://www.sutterhealth.org/for-patients/health-care-costs-charges-smf https://www.sutterhealth.org/for-patients/health-care-costs-...). They treat millions of patients so its a pretty big driver. Price opaqueness is a big issue, but there is no transparency with so much distortion.
        arcticbull 8y ago
        Transparency is kind of irrelevant, if I'm bleeding out unconscious somewhere in the street, I'm in no position to make hospitals compete for my business. This isn't buying a new cell phone, these are peoples' lives.
        conanbatt 8y ago
        Transparency is important to choose any service and care is one of them. The vast majority of healthcare services are not urgent. There's a case for price insensitivity for emergency care, but that is also resolved by choosing insurance before hand: the same way there is price sensitivity to life insurance. A bigger problem to me than transparency is distortion: the value of the service being public means little if the patient is not paying for it. A patient that has 20% co-insurance or 20$ copay have completely different price sensititivities. They are also price-insensitive when they select insurance because they get it through the employer that picked it and payed it for them. As a patient, the price tag on a service is relevant to you depending on insurance: validating insurance is much more important than seeing the price. A socialized medicine scheme will have the same problem: if a patient is shielded from the actual cost of the visit, then he is more likely to use it and thus over-use it.

arcticbull 8y ago

(1) How is universal care going to reduce the shortage of primary care doctors? I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough. (2) How is universal care going to eliminate patents for pharma? It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere else. There's a perception that in Canada "drugs are cheap" -- prescription drugs administered outside of hospitals largely aren't covered by OHIP. Provinces act as bulk buying groups and negotiate prices with pharma companies. You want to partake in the market, great, let's figure something out. It works surprisingly well. Patents are your temporary monopoly on creating an invention in exchange for sharing it with the world. (3) How is universal care going to make non-profit hospitals cheaper? By regulating fees for services, by lowering the price of drugs via negotiation and bulk purchase agreements, by eliminating marketing budgets, by eliminating insurance billing departments and by capping executive compensation. Hospitals and doctors are public servants elsewhere in the world, not elite rockstars who can bill as they so choose. That doesn't mean they're not well compensated. Oh, and by socializing malpractice insurance. In the US high-cost states OBGYNs pay $85-200K/yr just in medical malpractice insurance. [1] In Ontario it's around $70K CAD. (4) How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers? By having a single table of rates that apply to everyone. Ideally with a single payer. This makes billing much, much easier. (5) How is universal care going to reduce healthcare spending? Everything I indicated above put together. If you want a concrete example Medicare does most of the above (they can't negotiate drug prices, and they're not single payer, and they haven't socialized malpractice insurance) but they're substantially more efficient. Medicare spends 2-5% of the budget on administrative, where private plans spend 12-18%. That's without recognizing some of the other savings I pointed out. [2] [1] https://equotemd.com/blog/obgyn-medical-malpractice-insurance/ https://equotemd.com/blog/obgyn-medical-malpractice-insuranc... [2] https://www.washingtonpost.com/news/fact-checker/wp/2017/09/19/medicare-private-insurance-and-administrative-costs-a-democratic-talking-point/?utm_term=.e38da042cc76 https://www.washingtonpost.com/news/fact-checker/wp/2017/09/...

arcticbull 8y ago
Further to (2) by affording preventative care to everyone, people in the early stages of serious diseases can obtain preventative care and coverage thereby eliminating expensive treatments later on. In the US if you walk into a hospital near death they're required to look after you -- not so much if you walk in seeking preventative care. Imagine if they spent the $5 early on to treat you instead of the tens of thousands when you're near death? It's yet another reason why universal healthcare is a good, cheaper thing to have.