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The US health system is full of stories like "Medicare payments are below cost therefore we have to charge other patients more", "International drug prices are

The US health system is full of stories like "Medicare payments are below cost therefore we have to charge other patients more", "International drug prices are too low, therefore we have to charge US prices more", "There are a lot of uninsured patients treated for free therefore we need to charge others more". I tend to call BS on all of them. None of them explains why especially hospitals tend to charge almost random prices for the same thing, make constant billing mistakes and haunt the patient for years with changes that already have been settled with the insurance. It doesn't explain why the medical device my company sells for 30k gets charged 140k by the hospital (happened to my girlfriend). Or why for the same 1 hour surgery one hospital anesthesiologist charges 12k while somewhere else the charge is 3k. The whole system is totally corrupt, opaque and highly profitable for doctors, administrators and middlemen. Each of them blames the other while never providing any real accounting with hard numbers.

tomohawk 7y ago
Not disagreeing on the fact that the system is broken. However, if cost is important, why are prices not transparent, and the same for all treatments (hint: medicare is a big reason)? Why do states have laws that prohibit competition? In many states, you can only build a new hospital if existing hospitals OK it. In our state, why is there a shortage of general practitioners? (hint: after paying malpractice insurance and student loans, its almost impossible to make a living). So, GPs are moving to other states. Mis-regulation has created an environment where market forces are prohibited from operating, predatory lawyers make a killing, cronies are comfortable - with predictable results.
- maxxxxx 7y ago
  You are blaming it on regulation, medicare, malpractice insurance and lawyers. How about also saying that hospital owner, managers and doctors make a killing in this system? They are not victims.
  - tomohawk 7y ago
    What I am saying is that all market forces have been suspended, and replaced with something that is not working. Market forces tend to keep a lid on the kinds of things we are seeing. The mis-regulation has not replaced these market forces with anything that is working. You can't have transparent pricing if medicare comes in and imposed unrealistic pricing. It only works if the advertised price is the same price for everyone. You can't have inexpensive malpractice insurance without the English Rule, and if the tort system is basically a lottery. The health insurance companies are a much bigger problem than the care providers. Things that might be productive instead of pointing fingers: * all medical services and medicines provided by a provider must have a single, public price * prohibit employer provided health insurance, replacing it with insurance purchased by individuals with pre-tax money * enable interstate purchase of health insurance * expand the health care exchange that federal employees have access to to create a single, unified market for purchasing insurance * introduce the English Rule to reign in trial lawyers
    - maxxxxx 7y ago
      "You can't have transparent pricing if medicare comes in and imposed unrealistic pricing. " Why not? You still can publish prices.
gremlinsinc 7y ago
Agreed, maybe medicare is too low -- but then single payer MINUS insurers could beef up medicare too something like 2x what it now, but as a nation we'd still pay less total on medical (if hospitals mark up insurance 4x and the insurer marks up 2x the cost or more, that's 6x the cost that we're all paying for... Cut off 4x and tell the hospitals to be happy and downsize their operations, and get costs under control. Medicines should only be charged at cost for delivery, charging $40 for a single ibuprofen tablet is INSANE! It takes a nurse 5 minutes to deliver pills, say she makes $50/hour, that's like $5 labor + 30 cents for an ibuprofen, so 5.30 even doubled to $10 is much fairer than $40 for a single pill, or hell make some sort of automated delivery system that pops out medicine by hydraulics as needed and cut the cost even more. With single payer the government could also put together some emergency grants/funds for hospitals that can't cope -- as long as they accept auditing from the government of all their processes/administration salaries/etc.. and follow guidelines take pay cuts to recommended averages, etc... TLDR; Medicare for all will solve this issue, it will need to set the low-end higher obviously to compensate for where hospitals make the bulk of their money, but it'll need to hold hospitals accountable for better money management, and pay structures, and price gouging. Not to mention one of the largest cost savings : single-bulk-payer for drug purchases.
- maxxxxx 7y ago
  Agreed. If Medicare really pays too little then let’s raise that. But I believe that the current system is much more profitable so they won’t push for raising Medicare in exchange for eliminating the current pricing practices.
- tomohawk 7y ago
  Single payer or medicare is basically the imposition of price controls, which cause shortages and leads to rationing. In the US, you can get an MRI pretty much immediately from one of many facilities. The wait time in Canada is pretty ridiculous, and far below the standard of care anyone should expect. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2017 https://www.fraserinstitute.org/studies/waiting-your-turn-wa... I've known people who moved to the US from Canada because they could not get adequate health care under the single payer system. Hospitals on the border with Canada routinely have to deal with the spill over from Canada because Canada's system does not have the capacity to deal with all of the cases (I have relatives in such hospitals who talk about this). Medical tourism to the US from Canada is one of the few options people have to get timely access to needed healthcare. We already have an enormous amount of regulation and control of this area by the government and it is not working. Regulation can be like violence - its practitioners always seem to want to use more if it when it is not working. It's time to take a step or two back and reevaluate.

tomohawk 7y ago

Not disagreeing on the fact that the system is broken. However, if cost is important, why are prices not transparent, and the same for all treatments (hint: medicare is a big reason)? Why do states have laws that prohibit competition? In many states, you can only build a new hospital if existing hospitals OK it. In our state, why is there a shortage of general practitioners? (hint: after paying malpractice insurance and student loans, its almost impossible to make a living). So, GPs are moving to other states. Mis-regulation has created an environment where market forces are prohibited from operating, predatory lawyers make a killing, cronies are comfortable - with predictable results.

maxxxxx 7y ago
You are blaming it on regulation, medicare, malpractice insurance and lawyers. How about also saying that hospital owner, managers and doctors make a killing in this system? They are not victims.
- tomohawk 7y ago
  What I am saying is that all market forces have been suspended, and replaced with something that is not working. Market forces tend to keep a lid on the kinds of things we are seeing. The mis-regulation has not replaced these market forces with anything that is working. You can't have transparent pricing if medicare comes in and imposed unrealistic pricing. It only works if the advertised price is the same price for everyone. You can't have inexpensive malpractice insurance without the English Rule, and if the tort system is basically a lottery. The health insurance companies are a much bigger problem than the care providers. Things that might be productive instead of pointing fingers: * all medical services and medicines provided by a provider must have a single, public price * prohibit employer provided health insurance, replacing it with insurance purchased by individuals with pre-tax money * enable interstate purchase of health insurance * expand the health care exchange that federal employees have access to to create a single, unified market for purchasing insurance * introduce the English Rule to reign in trial lawyers
  - maxxxxx 7y ago
    "You can't have transparent pricing if medicare comes in and imposed unrealistic pricing. " Why not? You still can publish prices.

gremlinsinc 7y ago

Agreed, maybe medicare is too low -- but then single payer MINUS insurers could beef up medicare too something like 2x what it now, but as a nation we'd still pay less total on medical (if hospitals mark up insurance 4x and the insurer marks up 2x the cost or more, that's 6x the cost that we're all paying for... Cut off 4x and tell the hospitals to be happy and downsize their operations, and get costs under control. Medicines should only be charged at cost for delivery, charging $40 for a single ibuprofen tablet is INSANE! It takes a nurse 5 minutes to deliver pills, say she makes $50/hour, that's like $5 labor + 30 cents for an ibuprofen, so 5.30 even doubled to $10 is much fairer than $40 for a single pill, or hell make some sort of automated delivery system that pops out medicine by hydraulics as needed and cut the cost even more. With single payer the government could also put together some emergency grants/funds for hospitals that can't cope -- as long as they accept auditing from the government of all their processes/administration salaries/etc.. and follow guidelines take pay cuts to recommended averages, etc... TLDR; Medicare for all will solve this issue, it will need to set the low-end higher obviously to compensate for where hospitals make the bulk of their money, but it'll need to hold hospitals accountable for better money management, and pay structures, and price gouging. Not to mention one of the largest cost savings : single-bulk-payer for drug purchases.

maxxxxx 7y ago
Agreed. If Medicare really pays too little then let’s raise that. But I believe that the current system is much more profitable so they won’t push for raising Medicare in exchange for eliminating the current pricing practices.
tomohawk 7y ago
Single payer or medicare is basically the imposition of price controls, which cause shortages and leads to rationing. In the US, you can get an MRI pretty much immediately from one of many facilities. The wait time in Canada is pretty ridiculous, and far below the standard of care anyone should expect. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2017 https://www.fraserinstitute.org/studies/waiting-your-turn-wa... I've known people who moved to the US from Canada because they could not get adequate health care under the single payer system. Hospitals on the border with Canada routinely have to deal with the spill over from Canada because Canada's system does not have the capacity to deal with all of the cases (I have relatives in such hospitals who talk about this). Medical tourism to the US from Canada is one of the few options people have to get timely access to needed healthcare. We already have an enormous amount of regulation and control of this area by the government and it is not working. Regulation can be like violence - its practitioners always seem to want to use more if it when it is not working. It's time to take a step or two back and reevaluate.