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Price controls don't work. This will only lead to a shortage of doctors that take an insurance plan. > we should also add that paying cash means you get the M
by linuxftw 7y ago
Price controls don't work. This will only lead to a shortage of doctors that take an insurance plan.
> we should also add that paying cash means you get the Medicare price.
Medicare doesn't pay enough. What if the doctor doesn't accept medicare?
- Aloisius 7y agoMedicare's reimbursement rates are already higher than every other developed nation. The idea that it doesn't pay enough is, frankly, bs. Of course, reimbursement rates are hardly our only problem. We also use more expensive treatment options for the same conditions, give doctors (and thus patients) a level of flexibility unheard of elsewhere that allows to spend money on unnecessary medicine just to make a patient happy and have ridiculous administrative overhead costs.
- coredog64 7y agoWe overtrain docs and we’ve built hospitals that focus on private rooms instead of wards. Both of those hugely increase the labor cost and will take a long time to undo.
- subhobroto 7y agoNot really. You tell the working parents that they can deliver the baby in the shared room for no additional cost or upgrade to the private suite for $100k.
- projektfu 7y agoWhat are you trying to say? It wasn’t clear.
- sah2ed 7y agoPerhaps that the actual cost to use private rooms for delivery is being subsidized?
- subhobroto 7y agoI did not mean exactly that, but this happens too. Not every new parent can afford the expense of birth. So the hospitals try and squeeze out as much as they can from every party to try and even it out. As a high income earner, I'm specially vulnerable to this practice. No judge or newspaper or activist has particular empathy that I got charged $200k for a delivery or $6k for an 2 mile ambulance ride. I can afford to pay it so why am I being so picky about it?
- stolsvik 7y agoAre you serious with the $200k?!?
- subhobroto 7y agoYou seem surprised. It's such a regular occurrence that it does not make news anymore. Much higher amounts make the news now: https://www.theguardian.com/us-news/2018/jan/16/why-does-it-cost-32093-just-to-give-birth-in-america https://www.theguardian.com/us-news/2018/jan/16/why-does-it-... https://www.cbc.ca/news/canada/saskatoon/jennifer-huculak-kimmel-billed-950k-us-after-giving-birth-in-u-s-1.2839319 https://www.cbc.ca/news/canada/saskatoon/jennifer-huculak-ki...
- subhobroto 7y agoSee, the OP said: > We overtrain docs and we’ve built hospitals that focus on private rooms instead of wards. Both of those hugely increase the labor cost and will take a long time to undo. If I was a patient at a hospital, I would not be able to control this: > We overtrain docs That part is outside my control. ... but, I, as a patient at a hospital, would be able to control this: > we’ve built hospitals that focus on private rooms instead of wards Infact, some of hopitals in the U.S. do have ward deliveries - I believe Kaiser Permanente have shared rooms? However, that is the rub - people are not explicitly requesting private rooms - hospitals just have them so they can charge as much as they can. If you walk into a hospital, you cant ask to have a ward delivery. They take you to a private room by default - no questions asked. That's all they have. Then the bill comes and the game begins - if the insurance company does not pay, the hospital will then come after you. They will put you on a payment plan. If you can't make payments, they will sell you to collections. Some hospitals might settle for an upfront cash payment but then it cannot go through your insurance and you are out of money AND you did not meet your family deductible either. If there was a choice to new parents between ward deliveries for $50k and private rooms for $150k, I know which one I would take. I don't have that choice because my employer might not be offering care though Kaiser Permanente and the hospitals in network might only have private rooms. So change employers because I prefer ward deliveries?
- projektfu 7y agoOK thanks. I was confused. I thought you were saying patients wouldn't accept shared rooms and this is built into our cost structure.
- subhobroto 7y agoMy pleasure. Thank you for pointing out where I can end up confusing a reader. I write occasionally. Example: https://www.quora.com/Do-all-citizens-have-a-right-to-affordable-health-care/answer/Subhobroto-Sinha-1 https://www.quora.com/Do-all-citizens-have-a-right-to-afford...
- nanis 7y ago> Medicare's reimbursement rates are already higher than every other developed nation. The idea that it doesn't pay enough is, frankly, bs. Medicare's reimbursement rates could just as well be published by Gosplan. If you squint hard enough, they are almost an application of the Labor Theory of Value: There is an intrinsic value of everything determined by how much labor went into producing it. That, of course, leads to all sorts of fun stuff like seniors in Florida loading up on cosmetic surgery and ED medication on the backs of the younger generations.
- zxcmx 7y agoSo with true state provided healthcare: The “price” is really just the unit cost. Companies seem to have no problem computing unit costs (and thus margins!), no gosplan-like apparatus is required for this beyond supply-chain management and accounting. The U.S. situation is complicated considerably by all the different parties involved which I guess is why this idea might work less well there. Correspondingly I suppose the “true value” would be the value provided to the recipient of the procedure and society as a whole, and as you observe is much more subjective and probably best not even measured in dollars. I think “quality of life adjusted years” is a thing. The major problem is when the you and the state disagree on the value of a procedure and whether it justifies the costs... Another way to look at it, “socialised medicine” is just health insurance collected by the state with full vertical integration; your insurer also runs the hospitals and provides the care. The upside is you’re covered, the downside is you don’t get to choose a plan.
- meerita 7y agoWhy people downvoted this. Price control doesn't work. Just read any economic book and you will realize it's true. It hurts, but it's true. If price control works, then why prices never were freezed. Why don't freeze it forever? Because it doesn't work.
- StephenAmar 7y agoPrice control works in other countries for healthcare.
- Fjolsvith 7y agoWhich ones and for how long?
- cav71b 7y agoMost European countries for at least 70years
- rayiner 7y agoLargely because the US continues to subsidize medical R&D. Free riding is a good gig if you can get it.
- paulryanrogers 7y agoNow that advertising drugs to the public had ballooned marketing budgets beyond R&D is that still true? I imagine that dollar-for-dollar a non-profit with the right incentives and oversight could out do the VC-backed leeches driving up prescription med prices.
- astazangasta 7y agoThe US subsidizes drug development, that's about all. Other medical R&D doesn't really come out of any publicly funded research system, it comes from medical practitioners. The cost of US drug development subsidy is maybe $40 billion, accounting for basic research and development by pharmaceutical companies. This is pretty much peanuts compared to global healthcare spending. Also, this money is arguably not really that well spent, since most of drug development is useless, and nations can improve their health systems and outcomes much more through things like routine care and monitoring than they will through expensive research.
- pwodhouse 7y agoParent comment didn't mention price controls.
- asdfasgasdgasdg 7y agoPrice controls have been demonstrated to work in a number of other countries. I agree, in general, but when you have a proof by existence of efficacy, you can't really claim that they don't work in medicine.
- meerita 7y agoWhich countries? Price control doesn't work. It generates scarcity and supply problems. The case against price controls is not merely an academic exercise, restricted to economics textbooks. There is a four-thousand-year historical record of economic catastrophe after catastrophe caused by price controls. This record is partly documented in an excellent book entitled Forty Centuries of Wage and Price Controls by Robert Schuettinger and Eamon Butler, first published in 1979.
- thefringthing 7y agoI live in Ontario where prices for medical care are negotiated by the provincial government, which you might regard to be a price control. The result is excellent, and one of several reasons I would never consider living in the United States.
- asdfasgasdgasdg 7y agoSwitzerland is one of many examples.
- meerita 7y agoThe system is universal, but not complete. In fact, you should pay and that's how it works and it doesn't generate scarcity. There is 3 types of services in Switzerland: public with 2500 bed, subsidised private and private. I will quote: > The insured person pays the insurance premium for the basic plan up to 8% of their personal income. If a premium is higher than this, the government gives the insured person a cash subsidy to pay for any additional premium. So, it's a basic insurance that doesn't cover everything. Also quoting: > "Health insurance covers the costs of medical treatment and hospitalization of the insured. However, the insured person 'pays part of the cost of treatment' and 'For hospitalisation, one pays a contribution to room and service costs'." As you can see, there's no 'free' but subsidizied basic healthcare treatments, but then you should pay everything.
- michaelmrose 7y agoSimple don't let doctors choose patient by insurance plan or negotiate a higher rate. Everyone pays the same. There are first world countries wherein the massive profit potential at every step between patient and care just doesn't exist and they in general have better health outcomes than we do.
- MR4D 7y agoI’m pretty certain that would violate the Constitution. Any lawyers around that could comment on this?
- cannonedhamster 7y agoWhat part of the Constitution covers medical billing? Doctors can get tort protection but patients can't get billing protection? Wages have been set by the U.S. government before so I'm not sure you could argue that, and there's no personal expression protection with accepting insurance. I'm really unsure of where this could possibly become Constitutional other than the right to life.
- MR4D 7y agoPerhaps it’s the ambiguity when I read the parents post about not allowing doctors to charge different rates. Does that mean not allowing me to charge more than you, or not allowing a doctor to charge one patient more than the former. When I originally read it, it seemed like the former, but given everyone’s responses it must be the latter.
- michaelmrose 7y agoI'm for capping costs AND not allowing a provider to charge different rates to different patients for clarity. Neither would violate the constitution. It's not that long a document and written reasonably clearly. If you disagree please cite the section.
- username90 7y ago