9 ms·

This is why the very concept of insurance discounts are problematic. It might sound counter-intuitive to argue against "discounts" as a solution to bringing cos

This is why the very concept of insurance discounts are problematic. It might sound counter-intuitive to argue against "discounts" as a solution to bringing costs down, but it actually would. Medical facilities are forced to artificially inflate bills. Insurance then artificially gets a discount back to a sane price. This helps insurance look like they're "doing something" even when they aren't e.g. High Deductible when you pay 100% up to the deductible ("at least I got the insurance rate!"). Out of network also suffers from this. The networks themselves are discount networks and prices for uncovered patients are artificially high. If you banned insurance discounts and insurance had to pay the same dollar to dollar cash price (without kickbacks/incentives), it would help the uninsured, it would help re-align patient/insurer motivations (i.e. both demanding low cash prices), it would make price transparency actually meaningful, and it would eliminate insurance networks. But ideas like this, and removing employer provided healthcare (e.g. everyone on an open health insurance exchange) are politically impossible in the US because no politician can get elected for "taking people's employer insurance and taking their discounts." Even if they're the right thing to do to simplify, reduce costs, align goals, and force insurers to compete again.

JumpCrisscross 7y ago
> it would eliminate insurance networks It wouldn't. Insurers would still need to approve providers' prices, and those negotiations would have other levers that could be pulled. But broadly speaking, yes--requiring insurers pay the same price that is advertised and available to the uninsured public is basic price-transparency policy.
- Someone1234 7y ago
  Or they would just cap prices for specific procedures. Then the patient could use price transparency to see if they'd wind up with an overage bill, and consider if they'd be willing to pay the remainder (e.g. if the doctor was preferred). Right now insurance either do cover something or they don't. That in itself is problematic. If insurance would cover a procedure up to e.g. $500 at one medical clinic why do they cover up to $0 at another? Shouldn't it be $500 here or $500 there? Networks inherently pit you against both the insurer and healthcare provider. Instead you and your insurer should be on the same "side" against healthcare providers.
  - gowld 7y ago
    > Right now insurance either do cover something or they don't. That's vastly oversimplifying. Insurance often covers part of something.
- rogerbinns 7y ago
  Maryland addresses this by setting prices state wide that are the same for all payers. There is an independent commission that sets the prices. https://hscrc.state.md.us/Pages/default.aspx https://hscrc.state.md.us/Pages/default.aspx
lotsofpulp 7y ago
Voters are well aware that they would have to pay more if their silo’d employer group health plans with healthier white collar employees were removed, so they vote accordingly. Voters don’t want to pay extra to subsidize those that can’t afford healthcare, and the politicians reflect that.
- gowld 7y ago
  That's not really relevant. Who pays premiums is separate from how the structure works. USA has various welfare programs for the needy, with wide support. Social Security is one of the largest and most popular items in the Federal budget.
  - lotsofpulp 7y ago
    It’s the big reason people don’t want to be dumped on healthcare.gov. Employers can get cheaper premiums due to having healthier pools of employees and the rest of society, and they get to pay with pre tax dollars to boot, which has never made sense.
  - ztormbringer 7y ago
    Social Security DOES NOT come out of the general fund (tax revrnues) so cannot have any effect on the budget (which is the plan of how to spend the general fund). Social Security is paid out of the separate Social Security Fund. The only way it affects the General Fund is via the contracted repayment of borrowed monies (and interest) owed to the SSF which the government seemingly wants to default on.
- luckydata 7y ago
  That's just not true under any possible light you want to look at the issue. Single payer has proven in pretty much every western country to be massively less expensive than the insurance system in the USA.
  - lotsofpulp 7y ago
    I was agreeing with Someone1234 about people not wanting to lose their employer based healthcare. US voters haven’t had the option for single payer, but they did have options for removing employer sponsored healthcare.
criddell 7y ago
> If you banned insurance discounts and insurance had to pay the same dollar to dollar cash price (without kickbacks/incentives) It never occurred to me before that this is an option. That sounds like a good idea. I also wonder why health insurance should be allowed as an employee benefit. How does it make any sense to tie my access to healthcare with my employment status?
- lotsofpulp 7y ago
  Whatever historical reason there may have been to start it, the only reason it exists now is to give big businesses more power than smaller businesses, and individuals.
  - thfuran 7y ago
    That's reductive. If I have a choice between a job that offers health insurance and one that doesn't, all other things being equal, I'm definitely taking the former. That's also surely a large part of why it continues to exist.
    - lotsofpulp 7y ago
      I’m talking about the legal reason for it to exist, since employers can purchase insurance with pre-tax money, and the bigger and more white collar/younger the employer, the less their insurance costs.
    - wincy 7y ago
      Right but the reason large insurers can offer good insurance is they are a much larger risk pool. I work for a Fortune 500 and my daughter has probably cost the insurance $1m. No big deal rates didn’t even raise. Before I worked for a contractor and we cost THEM a million bucks, and they had to get rid of the low deductible plan, and boost insurance rates by $50 per WEEK per employee. We single-handedly destroyed their risk pool from three months of NICU stay, making it so they could no longer offer affordable insurance. Rather than accept the new rates we got cheaper plans on the Marketplace. Unfortunately though those aren’t tax deductible but we still came out ahead. It’d make far more sense to just have a marketplace for everyone and make the risk pool the entire US population, rather than let giant corps get good rates while small companies get devastated when an employee or their children get sick.
jjoonathan 7y ago
> Medical facilities are forced to artificially inflate bills. Are they? Or are they allowed to get away with it?
- dredmorbius 7y ago
  Remove the finger of blame by noting that a self-perpetuating spiral feedback loop is created. The question becomes how to break out of the loop. (GOTO considered essential?)
  - jjoonathan 7y ago
    People seem to think they can just break the loop by dumping insurance companies because hospitals have done a very good job of painting themselves as the victims. If we try that, I'd expect medical expenses keep going up and confused_pikachu.gif until people figured out that hospitals were never on their side. If this takes long enough, "bring back insurance companies" will be the solution, and then it won't work, and then we're back in an infinite loop with a longer cycle. Hospitals need countervailing price pressure, and anyone who doesn't accept that is liable to vote for catastrophically bad policy.
dredmorbius 7y ago
"Rebates" were a major element of anti-trust concerns against Standard Oil, in 1911: http://sites.gsu.edu/us-constipedia/standard-oil-co-of-new-jersey-v-united-states-1911/ http://sites.gsu.edu/us-constipedia/standard-oil-co-of-new-j... They remain a massive concern with monopolies today.
Ididntdothis 7y ago
“Medical facilities are forced to artificially inflate bills.” I don’t think it forces them. I would say it gives them an excuse to do so.
- fragmede 7y ago
  Hospital's costs don't magically change though. The MRI machine? Expensive as all hell. The liquid helium (or whatever) to run it? Also expensive as hell. Doctor's wages? Nurses wages (they're unionized, fwiw). X-ray machines, X-ray tech's, the cost of reagents, pharmaceuticals and all other medical supplies? The hospital, a for-profit business in the United States, isn't voluntarily going to give up profit, so they "hack" the system by raising prices. If InsuranceCo says they'll payback 20% of list price, but it costs the hospital $100 to run the test (including some nominal profit; hospitals aren't non-profits, for better or worse), the hospital must charge $500 for the test, just to break even on InsuranceCo's patients. Which they aren't refuse, because those patients are a significant portion of the hospitals revenues, or due to laws, in some jurisdictions. ER's can't (legally) turn away people they don't like (Eg African Americans or immigrants).
  - Ididntdothis 7y ago
    “If InsuranceCo says they'll payback 20% of list price, but it costs the hospital $100 to run the test (including some nominal profit; hospitals aren't non-profits, for better or worse), the hospital must charge $500 for the test, just to break even on InsuranceCo's patients.” I have never seen a real accounting of these costs so we can see whether they overcompensate. It’s the same with the high drug prices. They always say that other countries underpay and therefore the US has to pay more but you never see any real numbers.
  - FireBeyond 7y ago
    MRIs and most imaging is a huge profit center. Manufacturers will approach providers to form an "imaging group", promising recoupment within 18 months for the highest end machines. And is been shown that doctors who belong to such are more than 2.8 times more likely to refer patients for imaging.
impendia 7y ago
I've gotten into a long, annoying fight with my insurance company about whether they would cover a certain procedure. The dumb thing is, the bill won't hit my deductible cap for the year! (The procedure was done in 2018.) So, in any case, I will pay the full bill and the insurance company will pay nothing. But if the insurance company processes the bill, then I get the "discount". This is mind-bogglingly stupid.
- avs733 7y ago
  It's actually brilliant rent seeking. Evil but brilliant. They provide no service and negative value for the user. In exchange they help large employers maintain a way to restrict employee movement and value for shareholders. Honestly blue Cross blue shield is just like Facebook ..users are the product not the customer.
  - specialist 7y ago
    Illuminating analogy, thank you.
- colechristensen 7y ago
  You might be able to negotiate with the medical provider itself. Say you want to pay without insurance and ask about the cost and doing any reductions. The number on the bill before the insurance discount is entirely imaginary, no one pays it. There is always a built in cash discount for people without insurance. For example, for a while I was having trouble getting insurance cards (stupid reasons) at a new position so I was paying out of pocket for prescriptions and office visits. They were less expensive paying cash than with insurance pre-deductible.
  - FireBeyond 7y ago
    > The number on the bill before the insurance discount is entirely imaginary, no one pays it. Until they don't pay it. Then that entirely imaginary number becomes a very real debt that gets sold and reported.
  - 7y ago
tathougies 7y ago
> But ideas like this, and removing employer provided healthcare (e.g. everyone on an open health insurance exchange) are politically impossible in the US because no politician can get elected for "taking people's employer insurance and taking their discounts." Even if they're the right thing to do to simplify, reduce costs, align goals, and force insurers to compete again. To be fair, the current president ran partly on a platform to end surprise billing and has asked congress to deliver legislation to this effect
refurb 7y ago
If you’re interested, there is a long and sordid history behind how we got here. In the past, insurance just paid whatever the hospital charged it was called “usual and customary”. This came about because public plans were getting ripped off and gov’t said “no, you can’t charge us whatever”. Cycle through a series of different reimbursement systems in order to get a grasp on costs and you end up where we are now - chargemaster rates are ridiculously high (because they aren’t allowed to charge more than that) and the payers negotiate rates down as best they can so you end up with massive gross-net differentials. It’s really a complete mess.
- RazzleBerryPop 7y ago
  Where would you suggest for a starting point/keyword if I wanted to learn more about the 'usual and customary' system? I'd love to get a sense of what caused the transition out of that system.
- refurb 7y ago
  This is a good place to start if anyone is interested. https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasonable https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasona...
LorenPechtel 7y ago
I've been advocating this solution for prescription drugs for many years. The real enemy is the cost-shifting, ban that. I hadn't thought of it when it comes to the doctors but it probably would be a big help there, also.
esaym 7y ago
I'm part of a medical bill sharing plan. Its not insurance, but if I have a valid medical bill, I can submit it and in most cases I will be reimbursed from other members sending me checks directly. It works pretty well, though I've never had to use it. There is a private forum for members to discuss tactics on getting the biggest discounts. A member will typically ask for a self pay discount as we don't have "insurance". In many cases that knocks 25%-50% of the bill off right there. But you are still dealing with the normal hospital or clinic billing department at that rate. If you continue to decline this "discounted" rate and push to be transferred (in person or over phone) to the billing department's higher ups, you might even be able to get the bill lowered even more... but you must reject these as well. Eventually you will be turned over to a collections company, and right before they file against your credit score you will actually have the most bargaining power. Typically you will be able to knock another 50% off of the bill. There are many testimonies on the forum of people getting heart surgery or chemo and having bills in the $100k-$150k range and yet in the end, and after lots of phone calls and added stress... they walk away with paying only $20-30k. So basically, "insurance" does this bargaining for you.
- taurath 7y ago
  Kind of curious what the incentive is for the individual members to keep their costs low other than group identification?
  - esaym 7y ago
    Obviously the sharing ministry only has so much income per month. If the current total member needs are not met, then monthly member rates go up. So keeping your personal medical expenses down helps keep the monthly membership fees down.
- ggm 7y ago
  I'm unsure how I feel about this ethically. I don't disrespect anyone doing it, but the situation feels wrong. The discounted end price should have been the first price, or you've transferred costs into a real world loss for the system overall against your payment, and some imputed cost gap. Overall I think a NHS is better.
harimau777 7y ago
My concern about socialized medicine are the stories I hear about unreasonable rationing (e.g. https://www.dailywire.com/news/45698/thousands-elderly-patients-go-blind-britain-due-ashe-schow https://www.dailywire.com/news/45698/thousands-elderly-patie...). Maybe there is more to the story, but I haven't been able to find anything on the progressive side that addresses it. Can anyone point me in the right direction?
- 8bitsrule 7y ago
  According to the Telegraph page linked in the DW article, "eye clinics were unable to keep pace with demand.... In four out of five cases, those affected had chronic conditions requiring long term follow up, meaning they are not covered by NHS targets." https://www.telegraph.co.uk/news/2018/06/06/hundreds-going-blind-year-amid-nhs-delays-research-shows/ https://www.telegraph.co.uk/news/2018/06/06/hundreds-going-b... While pathetic, it's not clear how it follows, as the DW asserts, "This is what will happen in America if Democrats get their way on 'Medicare for all.'" There are lots of countries with socialized medicine without the problem that NHS has. DW fails to mention that, possibly because of its bias. Private insurers in the US, in the meantime, are widely known to pick-and-choose what they will cover ... and will not. Edit: here's a description of 'Medicare for All' from Forbes. https://www.forbes.com/sites/teresaghilarducci/2018/07/16/what-is-medicare-for-all/ https://www.forbes.com/sites/teresaghilarducci/2018/07/16/wh...
- kalleboo 7y ago
  You don't think that unreasonable rationing is happening in the US right now?
  - harimau777 7y ago
    I think that under the current system most of the rationing is in the form of people who don't have insurance not being able to afford care. Therefore, I think convincing the people who do have health insurance to take on some of the rationing will be a tough sell. Many people in the middle class would probably perceive it as "potentially sacrifice your health for the good of society".
- 7y ago
henvic 7y ago
We shouldn't seek to ban insurance or force them to work one way or another. The problem you identified is correct but the solution isn't right. You should let people be free to choose to freely associate with one another (or whatever insurance policy they prefer). Instead, get rid of legislation that makes hospital bills something awful for unensured people. Many things are driven by the insurance companies but others are by hospitals or even just politicians with bad ideas. Remove the barrears of entries and things tend to get better too.
u801e 7y ago
> If you banned insurance discounts and insurance had to pay the same dollar to dollar cash price (without kickbacks/incentives), it would help the uninsured, it would help re-align patient/insurer motivations (i.e. both demanding low cash prices), it would make price transparency actually meaningful, and it would eliminate insurance networks. An alternative approach would be to limit how much higher th e price could be compared to the median insurance re-imbursement for a particular procedure. If you set the limit low enough, then going out of network would not be much more expensive. And the total cost of having insurance and using them may be more than just paying out-of-pocket.

JumpCrisscross 7y ago

> it would eliminate insurance networks It wouldn't. Insurers would still need to approve providers' prices, and those negotiations would have other levers that could be pulled. But broadly speaking, yes--requiring insurers pay the same price that is advertised and available to the uninsured public is basic price-transparency policy.

Someone1234 7y ago
Or they would just cap prices for specific procedures. Then the patient could use price transparency to see if they'd wind up with an overage bill, and consider if they'd be willing to pay the remainder (e.g. if the doctor was preferred). Right now insurance either do cover something or they don't. That in itself is problematic. If insurance would cover a procedure up to e.g. $500 at one medical clinic why do they cover up to $0 at another? Shouldn't it be $500 here or $500 there? Networks inherently pit you against both the insurer and healthcare provider. Instead you and your insurer should be on the same "side" against healthcare providers.
- gowld 7y ago
  > Right now insurance either do cover something or they don't. That's vastly oversimplifying. Insurance often covers part of something.
rogerbinns 7y ago
Maryland addresses this by setting prices state wide that are the same for all payers. There is an independent commission that sets the prices. https://hscrc.state.md.us/Pages/default.aspx https://hscrc.state.md.us/Pages/default.aspx

lotsofpulp 7y ago

Voters are well aware that they would have to pay more if their silo’d employer group health plans with healthier white collar employees were removed, so they vote accordingly. Voters don’t want to pay extra to subsidize those that can’t afford healthcare, and the politicians reflect that.

gowld 7y ago
That's not really relevant. Who pays premiums is separate from how the structure works. USA has various welfare programs for the needy, with wide support. Social Security is one of the largest and most popular items in the Federal budget.
- lotsofpulp 7y ago
  It’s the big reason people don’t want to be dumped on healthcare.gov. Employers can get cheaper premiums due to having healthier pools of employees and the rest of society, and they get to pay with pre tax dollars to boot, which has never made sense.
- ztormbringer 7y ago
  Social Security DOES NOT come out of the general fund (tax revrnues) so cannot have any effect on the budget (which is the plan of how to spend the general fund). Social Security is paid out of the separate Social Security Fund. The only way it affects the General Fund is via the contracted repayment of borrowed monies (and interest) owed to the SSF which the government seemingly wants to default on.
luckydata 7y ago
That's just not true under any possible light you want to look at the issue. Single payer has proven in pretty much every western country to be massively less expensive than the insurance system in the USA.
- lotsofpulp 7y ago
  I was agreeing with Someone1234 about people not wanting to lose their employer based healthcare. US voters haven’t had the option for single payer, but they did have options for removing employer sponsored healthcare.

criddell 7y ago

> If you banned insurance discounts and insurance had to pay the same dollar to dollar cash price (without kickbacks/incentives) It never occurred to me before that this is an option. That sounds like a good idea. I also wonder why health insurance should be allowed as an employee benefit. How does it make any sense to tie my access to healthcare with my employment status?

lotsofpulp 7y ago
Whatever historical reason there may have been to start it, the only reason it exists now is to give big businesses more power than smaller businesses, and individuals.
- thfuran 7y ago
  That's reductive. If I have a choice between a job that offers health insurance and one that doesn't, all other things being equal, I'm definitely taking the former. That's also surely a large part of why it continues to exist.
  - lotsofpulp 7y ago
    I’m talking about the legal reason for it to exist, since employers can purchase insurance with pre-tax money, and the bigger and more white collar/younger the employer, the less their insurance costs.
  - wincy 7y ago
    Right but the reason large insurers can offer good insurance is they are a much larger risk pool. I work for a Fortune 500 and my daughter has probably cost the insurance $1m. No big deal rates didn’t even raise. Before I worked for a contractor and we cost THEM a million bucks, and they had to get rid of the low deductible plan, and boost insurance rates by $50 per WEEK per employee. We single-handedly destroyed their risk pool from three months of NICU stay, making it so they could no longer offer affordable insurance. Rather than accept the new rates we got cheaper plans on the Marketplace. Unfortunately though those aren’t tax deductible but we still came out ahead. It’d make far more sense to just have a marketplace for everyone and make the risk pool the entire US population, rather than let giant corps get good rates while small companies get devastated when an employee or their children get sick.

jjoonathan 7y ago

> Medical facilities are forced to artificially inflate bills. Are they? Or are they allowed to get away with it?

dredmorbius 7y ago
Remove the finger of blame by noting that a self-perpetuating spiral feedback loop is created. The question becomes how to break out of the loop. (GOTO considered essential?)
- jjoonathan 7y ago
  People seem to think they can just break the loop by dumping insurance companies because hospitals have done a very good job of painting themselves as the victims. If we try that, I'd expect medical expenses keep going up and confused_pikachu.gif until people figured out that hospitals were never on their side. If this takes long enough, "bring back insurance companies" will be the solution, and then it won't work, and then we're back in an infinite loop with a longer cycle. Hospitals need countervailing price pressure, and anyone who doesn't accept that is liable to vote for catastrophically bad policy.

dredmorbius 7y ago

"Rebates" were a major element of anti-trust concerns against Standard Oil, in 1911: http://sites.gsu.edu/us-constipedia/standard-oil-co-of-new-jersey-v-united-states-1911/ http://sites.gsu.edu/us-constipedia/standard-oil-co-of-new-j... They remain a massive concern with monopolies today.

Ididntdothis 7y ago

“Medical facilities are forced to artificially inflate bills.” I don’t think it forces them. I would say it gives them an excuse to do so.

fragmede 7y ago
Hospital's costs don't magically change though. The MRI machine? Expensive as all hell. The liquid helium (or whatever) to run it? Also expensive as hell. Doctor's wages? Nurses wages (they're unionized, fwiw). X-ray machines, X-ray tech's, the cost of reagents, pharmaceuticals and all other medical supplies? The hospital, a for-profit business in the United States, isn't voluntarily going to give up profit, so they "hack" the system by raising prices. If InsuranceCo says they'll payback 20% of list price, but it costs the hospital $100 to run the test (including some nominal profit; hospitals aren't non-profits, for better or worse), the hospital must charge $500 for the test, just to break even on InsuranceCo's patients. Which they aren't refuse, because those patients are a significant portion of the hospitals revenues, or due to laws, in some jurisdictions. ER's can't (legally) turn away people they don't like (Eg African Americans or immigrants).
- Ididntdothis 7y ago
  “If InsuranceCo says they'll payback 20% of list price, but it costs the hospital $100 to run the test (including some nominal profit; hospitals aren't non-profits, for better or worse), the hospital must charge $500 for the test, just to break even on InsuranceCo's patients.” I have never seen a real accounting of these costs so we can see whether they overcompensate. It’s the same with the high drug prices. They always say that other countries underpay and therefore the US has to pay more but you never see any real numbers.
- FireBeyond 7y ago
  MRIs and most imaging is a huge profit center. Manufacturers will approach providers to form an "imaging group", promising recoupment within 18 months for the highest end machines. And is been shown that doctors who belong to such are more than 2.8 times more likely to refer patients for imaging.

impendia 7y ago

I've gotten into a long, annoying fight with my insurance company about whether they would cover a certain procedure. The dumb thing is, the bill won't hit my deductible cap for the year! (The procedure was done in 2018.) So, in any case, I will pay the full bill and the insurance company will pay nothing. But if the insurance company processes the bill, then I get the "discount". This is mind-bogglingly stupid.

avs733 7y ago
It's actually brilliant rent seeking. Evil but brilliant. They provide no service and negative value for the user. In exchange they help large employers maintain a way to restrict employee movement and value for shareholders. Honestly blue Cross blue shield is just like Facebook ..users are the product not the customer.
- specialist 7y ago
  Illuminating analogy, thank you.
colechristensen 7y ago
You might be able to negotiate with the medical provider itself. Say you want to pay without insurance and ask about the cost and doing any reductions. The number on the bill before the insurance discount is entirely imaginary, no one pays it. There is always a built in cash discount for people without insurance. For example, for a while I was having trouble getting insurance cards (stupid reasons) at a new position so I was paying out of pocket for prescriptions and office visits. They were less expensive paying cash than with insurance pre-deductible.
- FireBeyond 7y ago
  > The number on the bill before the insurance discount is entirely imaginary, no one pays it. Until they don't pay it. Then that entirely imaginary number becomes a very real debt that gets sold and reported.
- 7y ago

tathougies 7y ago

> But ideas like this, and removing employer provided healthcare (e.g. everyone on an open health insurance exchange) are politically impossible in the US because no politician can get elected for "taking people's employer insurance and taking their discounts." Even if they're the right thing to do to simplify, reduce costs, align goals, and force insurers to compete again. To be fair, the current president ran partly on a platform to end surprise billing and has asked congress to deliver legislation to this effect

refurb 7y ago

If you’re interested, there is a long and sordid history behind how we got here. In the past, insurance just paid whatever the hospital charged it was called “usual and customary”. This came about because public plans were getting ripped off and gov’t said “no, you can’t charge us whatever”. Cycle through a series of different reimbursement systems in order to get a grasp on costs and you end up where we are now - chargemaster rates are ridiculously high (because they aren’t allowed to charge more than that) and the payers negotiate rates down as best they can so you end up with massive gross-net differentials. It’s really a complete mess.

RazzleBerryPop 7y ago
Where would you suggest for a starting point/keyword if I wanted to learn more about the 'usual and customary' system? I'd love to get a sense of what caused the transition out of that system.
refurb 7y ago
This is a good place to start if anyone is interested. https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasonable https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasona...

LorenPechtel 7y ago

I've been advocating this solution for prescription drugs for many years. The real enemy is the cost-shifting, ban that. I hadn't thought of it when it comes to the doctors but it probably would be a big help there, also.

esaym 7y ago

I'm part of a medical bill sharing plan. Its not insurance, but if I have a valid medical bill, I can submit it and in most cases I will be reimbursed from other members sending me checks directly. It works pretty well, though I've never had to use it. There is a private forum for members to discuss tactics on getting the biggest discounts. A member will typically ask for a self pay discount as we don't have "insurance". In many cases that knocks 25%-50% of the bill off right there. But you are still dealing with the normal hospital or clinic billing department at that rate. If you continue to decline this "discounted" rate and push to be transferred (in person or over phone) to the billing department's higher ups, you might even be able to get the bill lowered even more... but you must reject these as well. Eventually you will be turned over to a collections company, and right before they file against your credit score you will actually have the most bargaining power. Typically you will be able to knock another 50% off of the bill. There are many testimonies on the forum of people getting heart surgery or chemo and having bills in the $100k-$150k range and yet in the end, and after lots of phone calls and added stress... they walk away with paying only $20-30k. So basically, "insurance" does this bargaining for you.

taurath 7y ago
Kind of curious what the incentive is for the individual members to keep their costs low other than group identification?
- esaym 7y ago
  Obviously the sharing ministry only has so much income per month. If the current total member needs are not met, then monthly member rates go up. So keeping your personal medical expenses down helps keep the monthly membership fees down.
ggm 7y ago
I'm unsure how I feel about this ethically. I don't disrespect anyone doing it, but the situation feels wrong. The discounted end price should have been the first price, or you've transferred costs into a real world loss for the system overall against your payment, and some imputed cost gap. Overall I think a NHS is better.

harimau777 7y ago

My concern about socialized medicine are the stories I hear about unreasonable rationing (e.g. https://www.dailywire.com/news/45698/thousands-elderly-patients-go-blind-britain-due-ashe-schow https://www.dailywire.com/news/45698/thousands-elderly-patie...). Maybe there is more to the story, but I haven't been able to find anything on the progressive side that addresses it. Can anyone point me in the right direction?

8bitsrule 7y ago
According to the Telegraph page linked in the DW article, "eye clinics were unable to keep pace with demand.... In four out of five cases, those affected had chronic conditions requiring long term follow up, meaning they are not covered by NHS targets." https://www.telegraph.co.uk/news/2018/06/06/hundreds-going-blind-year-amid-nhs-delays-research-shows/ https://www.telegraph.co.uk/news/2018/06/06/hundreds-going-b... While pathetic, it's not clear how it follows, as the DW asserts, "This is what will happen in America if Democrats get their way on 'Medicare for all.'" There are lots of countries with socialized medicine without the problem that NHS has. DW fails to mention that, possibly because of its bias. Private insurers in the US, in the meantime, are widely known to pick-and-choose what they will cover ... and will not. Edit: here's a description of 'Medicare for All' from Forbes. https://www.forbes.com/sites/teresaghilarducci/2018/07/16/what-is-medicare-for-all/ https://www.forbes.com/sites/teresaghilarducci/2018/07/16/wh...
kalleboo 7y ago
You don't think that unreasonable rationing is happening in the US right now?
- harimau777 7y ago
  I think that under the current system most of the rationing is in the form of people who don't have insurance not being able to afford care. Therefore, I think convincing the people who do have health insurance to take on some of the rationing will be a tough sell. Many people in the middle class would probably perceive it as "potentially sacrifice your health for the good of society".
7y ago

henvic 7y ago

We shouldn't seek to ban insurance or force them to work one way or another. The problem you identified is correct but the solution isn't right. You should let people be free to choose to freely associate with one another (or whatever insurance policy they prefer). Instead, get rid of legislation that makes hospital bills something awful for unensured people. Many things are driven by the insurance companies but others are by hospitals or even just politicians with bad ideas. Remove the barrears of entries and things tend to get better too.

u801e 7y ago

> If you banned insurance discounts and insurance had to pay the same dollar to dollar cash price (without kickbacks/incentives), it would help the uninsured, it would help re-align patient/insurer motivations (i.e. both demanding low cash prices), it would make price transparency actually meaningful, and it would eliminate insurance networks. An alternative approach would be to limit how much higher th e price could be compared to the median insurance re-imbursement for a particular procedure. If you set the limit low enough, then going out of network would not be much more expensive. And the total cost of having insurance and using them may be more than just paying out-of-pocket.