4 ms·

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 peopl

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.

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.