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Health insurance companies are useless
- ptah 7y agoseems obvious to me
- sidlls 7y agoThis article is spot on. Unfortunately the Health Insurance industry is extremely powerful--the NRA have nothing on them. Real change in our health care system requires destroying these companies.
- opportune 7y agoRegulating the hole-digging and hole-filling industries out of existence is a politically difficult move considering how much money they’re shoveling into the back-hoe business
- jschwartzi 7y agoAnd anyway we'd prefer to have broken windows, because otherwise what work will employ our glaziers?
- 29athrowaway 7y agoEntities that dispute claims can make the system more efficient. Insurance can serve a useful role. What went wrong in the American healthcare system is collusion and price fixing.
- AdrianB1 7y agoMergers and acquisitions are also a problem, when companies grow large they have too much power and do much wrong. You cannot have competition if you allow mammoths to rule the market.
- howard941 7y agoHow do you butcher the mammoth? Lacking effective antitrust laws and a useful FTC there's positive feedback loop of medical providers merging and consolidating for the enhanced bargaining position vis-a-vis the merged and consolidated insurance industry.
- AdrianB1 7y agoThe AT&T mammoth was butchered, it shows it can be done. In this market anything higher than 5% should be forced to split.
- howard941 7y agoIt was, back when we had a pre-Bork standard for antitrust violations, and a more effective FTC. Not much more but more than totally ineffective. (Incidentally I like the cut of your 5% jib - 20 players may not be enough for some markets)
- abfan1127 7y agoThis article is interesting in the fact that it highlights several real issues, but completely fails to understand the true root causes. "they pay more for hospitals and doctors so they can just raise premiums..." What kind of crap is that? They can raise premiums without paying more to hospitals. In fact, that would raise their "fat cat" salaries even more.
- tialaramex 7y agoIt's about percentages. The law says they can keep a _percentage_ of the premium. If they charge you $1000 maybe they're allowed to keep $100 of that as profit. If they charge $900 they only get $90. So, provide a "better" service and charge $1500 then they get to keep $150. The law used to let them keep whatever they could make, so you'd be right, they could buy $400 of healthcare, charge $1000 for and they've made $600 profit. But the percentage rules mean they'd be told to give you $560 back, they'd only be able to keep $40 in profit. So hence as the article says they choose to spend more so they make more money.
- zip1234 7y agoAmazing how good people are at finding loopholes in government regulations.
- grepthisab 7y agoNot a loophole,it was specifically written into the ACA to ensure insurance companies spend money on benefits rather than just pocketing everything. Of course, it also has the effect of making the market hard to enter. See, e.g., Oscar
- makomk 7y agoIt's worse than that. The ACA limits the percentage of their premium that can be used for all non-medical costs - including the insurers' profits, yes, but also including administrative costs like paying people to investigate potentially fraudulent claims. If they put resources into (say) catching that one guy who was fradulently billing them for workout advice at inflated rates[1], not only does it shrink the pool of money they're allowed to keep as profit, the cost of the investigation comes out of that pool and eats directly into their profits. The Affordable Care Act effectively penalizes insurers for rooting out false or inflated bills. [1] https://www.propublica.org/article/health-insurers-make-it-easy-for-scammers-to-steal-millions-who-pays-you https://www.propublica.org/article/health-insurers-make-it-e...
- AdrianB1 7y agoWhat is the alternative for a private person? I understand that large companies can deal directly with hospitals in their region, but if you are not a large company what can you do? Even in Europe we have health insurers, some are state owned (usually the worst), some are private. European model is considered better, how is that?
- qsymmachus 7y agoThe alternative is universal single payer health care, paid for by taxation.
- baggy_trough 7y agoSo government death panels with no opt-out?
- AdrianB1 7y agoAnd who is dealing with the hospital fees? You need some organization to do this, this is how it works everywhere.
- cranky_coder 7y agoLast I checked, governments are still organizations?
- AdrianB1 7y agoI live in Europe, I dealt with the health care system. Governments here do not manage health care, they have organizations doing that. In my country (Romania), it is called National Health Insurer. Public institution, but it is an insurer - this is what I said. We also have private ones. Yes, Romania is part of the European Union and it has a system that exists in other countries in EU.
- opportune 7y agoYou are aware this currently already happens with Medicare and Medicaid correct?
- decoyworker 7y agoRent seeking. Literally getting paid to have a pile of money and sometimes pay part of people's medical care while skimming fat profits.
- lotsofpulp 7y agoWho will double check a doctor’s orders? Voters clearly don’t want the government to do it. Do people have enough money to visit a second or third doctor to get opinions regarding decisions that costs tens of thousands of dollars?
- dv_dt 7y agoMedicare is strongly supported by the seniors who receive it - surviving against decades of attempted rollbacks. I don’t know how one ends up thinking people are unhappy with government administered billing and payments in healthcare.
- merpnderp 7y agoStrongly supported because they love it, or strongly supported because they have exactly zero other options?
- dv_dt 7y agoThey have Medicare Advantage private options. Anecdotally I think people vastly prefer the public Medicare over the more complex private versions.
- howard941 7y agoThe MA programs typically offer better benefits than 80/20 Medicare part B because they selectively market to groups of seniors in relatively good health but mostly because they get one hell of a taxpayer subsidy. To the surprise of no one the promised efficiencies never materialized.
- martythemaniak 7y agoAs an outside observer, sure, you don't strictly speaking need them in some theoretical America, but in the America I see there's a large group of people who do not believe government can or should do this work and will work very actively to make it happen. The last bit is crucial. Suppose that you are disappointed that Obamacare did not contain a public option. Suppose that Obamacare did contain this provision in the law, it would most likely be implemented the way the cfpb was. The cfpb is great, except how good it is depends on how good the government in place is. If there's people in government that want it to fail it will simply fail. Thus merely incorporating the public option into law is not enough to have to have a dedicated political body that wants to make it work. I don't think that's the case in America. I guess what I'm saying is, the specificity of the law doesn't seem to be as important as peoples dedication to making things work
- decebalus1 7y ago> I see there's a large group of people who do not believe government can or should do this work and will work very actively to make it happen do you have any numbers to back that up? There's a very 'vocal' minority holding that opinion but don't assume that group is large enough to matter when it comes to voting for/against it.
- smacktoward 7y agoYou can see Gallup's historical polling results on this question here: https://news.gallup.com/poll/4708/healthcare-system.aspx https://news.gallup.com/poll/4708/healthcare-system.aspx Since 2000, the percentage of respondents who have said that providing healthcare coverage "is not the responsibility of the federal government" has fluctuated from a low in 2006 of 28% to a high in 2013 of 56%. (In their most recent survey, it's 42%.)
- dboreham 7y agoI've always wondered why people seem to think it should be "the responsibility of your employer". As someone who didn't grow up in the US, who is now a US business owner, it seems totally insane but everyone just nods..
- jvagner 7y agoInsurance companies actively work to not-deliver the thing they are paid to deliver.
- derg 7y agoThey are quite literally, the death panels republicans were screaming about during the effort to pass the ACA.
- tialaramex 7y agoTo be fair: This role actually has to exist in some form. By definition healthcare will cost resources and so providing all conceivable care will cost infinite resources. You don't have infinite resources, so there will be rationing, your choice is _how_ to ration, not whether. In the UK for example we have NICE the National Institute for Clinical Excellence, which uses a methodology called Quality Adjusted Life Years (QALYs) to decide what a treatment is "worth". Resources are, as I said, finite, so we need to decide how many blind toddlers regaining their sight is worth one teenager who will otherwise die of brain cancer; how many hip replacements that let a nice little old lady walk to the shops without excruciating pain are worth a new treatment that prevents a newborn baby dying from exposure to the air? Politicians have to periodically re-learn that meddling with this is not in their interests. The UK had a period recently for example in which politicians overrode NICE to create a cancer fund. Cancer is sad you see, so a pile of money was put aside to buy people cancer drugs. Nothing else, only cancer drugs, because cancer is sad. But, wait, we just got done arguing about how many blind toddlers is worth one dead teenager - well, the cancer fund said the answer is Infinity. If we can save one cancer-struck teenager, with that fund we should, no matter how many toddlers are blind instead because blind toddlers don't get access to that fund. And eventually the voting populace realised this was bullshit and turned on the cancer fund and it went away again.
- derg 7y agoYes, that is entirely fair and I'm being somewhat flippant about it but there's a huge disconnect over private insurance and the fact that it's in their best interest to spend the least amount possible for maximum gain, whereas any government run system should have the interests of it's citizens in mind, and a healthy society is generally a more productive and happy society
- zubair_io 7y agoSo what happens to our economy when 100s of thousands to people are out of a work because the government shit down the insurance company they worked for? I not saying things can't be better but a instant (or even a short roll out time) would kill our economy. Why doesn't anyone mention that.
- derg 7y agoThey work during the transition period and get jobs working for the single payer type system which will need to be expanded. Those who don't, can find another job and(!) still have insurance.
- opportune 7y agoThat’s barely a blip in the US workforce and I think they could find other administrative jobs given enough time. Nobody objects to other jobs becoming technologically obsolete (except coal mining for some reason) so not sure what the issue is
- mywittyname 7y agoMost of the people on the hospital side of this are medical professionals with active licenses and degrees, so finding another hospital job would not be an issue for them. I'm not sure about the insurance side, but I think it's the same situation: they employ medical professionals to review claims to dispute the care given. The non-medical personnel should also not have any issues finding new jobs. Executives, accountants, managers, and IT people have cross-industry skillsets.
- qsymmachus 7y agoSure we could ban child labor, but then millions of children would be out of a job. I'm only half joking – the problem with this argument is that it can be used to justify almost any injustice or inefficiency if there is a cost to fixing it. You are right to flag the issue, and most serious proposals to introduce single payer healthcare in the United States also lay out a transition plan for health care workers to move from the private to public sector.
- 7y ago
- rhacker 7y agoI can't remember it but there was a group of people in Oregon trying to start their own health insurance company. They figured out how to do it like a billion times cheaper than the big companies. Eventually they got blasted by a government agency that didn't allow them to operate at those rates because it would be untenable. Unfortunately I think the government doesn't realize it but they have been bending over backwards for the insurance companies to regulate that way. If you take out the rent seeking apparently healthcare and health insurance may actually be cheap. We just have a ton of laws preventing us from having that. If anyone heard about this group on NPR/OPB let me know I can't seem to find them.
- javagram 7y agoNot sure if this is what you’re thinking of, but https://en.m.wikipedia.org/wiki/Health_care_sharing_ministry https://en.m.wikipedia.org/wiki/Health_care_sharing_ministry is similar. They were grandfathered under Obamacare and are apparently legal in most states. Of course the thing is the reason the costs are cheaper than insurance is also because they don’t cover as much. Some insurance plans are incredibly expensive just because they have to spend multi-millions on a single person’s care.
- rhacker 7y agoNo it definitely was not a sharing ministry. Those are not real insurance companies. This was an effort to start a real insurance company with rates that reflected a careful study of how much money is really needed to protect its population.
- WkndTriathlete 7y agoInsurance plans are incredibly expensive because not only are you paying for legitimate health-care expenses, you are also paying for: * hospital administrators to interact with insurers * insurers employees/administration * ICD9/ICD10 coding overhead * and add 10% for the maximum legal profit health insurers are allowed to make I have to think that removal of those four elements from health insurance costs would result in significantly lower health care cost outlay in the US. Routine care can be cheap. We really only need coverage for catastrophic care - broken bones, herniated disc, acute injuries, etc., etc., and routine care benefits for those so impoverished as to not be able to afford it. IMO, of course.
- HillaryBriss 7y agoIDK. I'm not a fan of insurance companies. They can go away for all I care. OTOH, it seems to me that a risk to Medicare-for-all is that the hospital industry and doctor's groups will lobby and capture the very Medicare payment agency that supposed to be saving all the money. Then we're right back to spending 17% of GDP on healthcare.
- checktheorder 7y agoEven if that scenario happens (which I would argue wouldn't happen) then American citizens would STILL be far better off. They would retain that health care coverage during periods of unemployment or while working for employers who don't offer health insurance coverage, and they would never be kicked off their insurance plan due to pre-existing conditions.
- HillaryBriss 7y agoi think those conditions also hold true under the ACA plans right now (unless Trump dismantled those conditions.) anyway, a major selling point for Medicare-for-all I'm hearing is that overall it will result in a big savings. if that system-wide savings does not materialize, if we still have to pay the same amount we're paying now through higher taxes that amount to the same thing, then I would think Medicare-for-all didn't actually deliver on the promises. the other thing I wonder about is: look at prescription drug prices now: the FDA has been captured by Big Pharma. drug prices are way higher than they need to be. Medicare-for-all needs some real safeguards, something really strong, to prevent that sort of price inflation. and since single payer would eliminate competition, it has to be some other mechanism.
- checktheorder 7y agoI think it's safe to say that the savings would definitely arise if (if...) M4A is implemented in good faith. Decades of hard data from basically every other developed nation with universal health care demonstrates this. All it will take is the political willpower which is now starting to emerge on the federal level. One also needs to carefully consider what constitutes a "tax" when it comes to health care funding. Premium payments, co-pays, and deductibles all need to be factored in to an apples-to-apples comparison of individual taxpayers' contributions to any M4A system. There's also a simple mechanism to fix drug pricing: repeal the laws passed in 2003 that ban most US federal agencies from negotiating for bulk medical product pricing, and pass new laws requiring it of all agencies. Currently, I believe that only the Department of Veterans Affairs is legally allowed to negotiate bulk drug pricing. They take full advantage of that, and enable active and retired service members to significantly cut their prescription costs. They're a perfect example of the power of bulk pricing. And again, revising the law in this way is a political-willpower problem, not an economic one.
- Erudire_Genius 7y agoDon't get rid of them... remove the shackles of government interference and, for the first time in history, allow an actual free market to set prices. Don't think that will work? Research LASIK eye correction, which has NEVER been covered by insurance, and thus bound by true market pressures. Health insurance is expensive for the same reason your cable internet provider is: NO free market competition. This factor, of course, was made MUCH WORSE by Obamacare.
- mnm1 7y agoThese are the most insane claims I've ever heard. The bullshit coming out of these insurers is ridiculous. "Synergy?" Are you fucking kidding me? And Americans love insurers? They love the companies that kill their fathers, mothers, families, and friends? Are you fucking kidding me? Even for the dumbest of the dumbest this cannot possibly be true. Politicians need to wisen the fuck up. These are the real murderers and thieves in our society that make traditional murderers and thieves look amateurish. These scum need to be eliminated from our lives, their companies eradicated.
- 18pfsmt 7y agoHow are these anti-tech, anti-innovation comments from this account withstanding scrutiny? This is an account that appears driven by hate (given the last 3 comments; which is as far as I could make it). I am sorry for anyone experiencing pain in their lives, but attributing malice to strangers is perverse. HN has gotten some weird sickness somewhat recently, and I wish someone (i.e. dang) could explain it.
- howard941 7y agoThe world has gotten sicker. HN reflects it, but we survive. I think you can probably block that user's comments forever if you want. But it has a decent amount of karma. Have you attempted to walk in his moccasins?
- not_a_cop75 7y agoYou should probably also agree that hospital conglomerates are also useless, since normally they force the market for an area to charge more, not less for products.
- privateSFacct 7y agoFor all the slams on insurance companies - folks should check out what your local hospital or physician group charges if you don't have insurance. I know everyone loves these medical groups - but I'm not impressed with their billing.
- linsomniac 7y agoI tried that once, I had a procedure that insurance wouldn't cover if done at the hospital, but the hospital was the only place with the equipment to do it. I had experience with paying cash for procedures being dramatically less expensive, like half, so I called the hospital to find out the cash price. "So you want the price you would pay if you didn't have insurance and directly paid for it?" "Yes." "But you do have insurance, so you have to contact your insurance company to find out what their contracted rate for that procedure is." We went back and forth a few times, but she absolutely refused to give me a number for how much someone without insurance would pay for that procedure.
- raintrees 7y agoIsn't the whole point of insurance the basic bet that I will need an expensive service so I will make small payments towards that possibility, against the insurer's bet that I will not need that service and will instead be able to keep those payments as a profit? If so, that arrangement has been abused by using it for health care, instead of insuring against a low probability major health incident... It seems this would be the same as car insurance also paying for tolls, road maintenance, car maintenance, etc. instead of just covering against person/property injury from vehicle operation. If health insurance instead is used for typical day-to-day payments for health care coverage, then the costs of that insurance will logically exceed the cost of that care because the insurance company exists to make a profit through offering that service. Similar to paying the government to do something that would be more efficiently done privately - Maybe the same outcome (if one is fortunate) for far greater cost. Anecdotally, I used to have a health insurance plan that had a very high deductible and fairly low monthly payments for my wife and myself. It's sole purpose was to hedge the bet that one of us might need ambulance and major medical treatment at an expensive facility (hospital) that might break us financially without that hedge in place. The Affordable HealthCare Act in the USA ended that arrangement, we now have triple the payment size for a third of the coverage we used to have. To me, that is a clear case of my government getting involved and the results being a net loss. Edit: Sorry, it did not end that arrangement, it made it far, far more expensive.
- decebalus1 7y agoExactly. ACA and any other business friendly arrangement proposed by the 'private sector' sponsored democrats (the proverbial 'establishment') will have that effect. Because it still 'stimulates' the business side of things to react in a way that makes it profitable. This should be an all-or-nothing type of deal.
- thanatos519 7y agoThe point of health insurance is that nobody should worry about the costs of regular maintenance and emergency service to their meatbag. Ever. As you point out, it costs much more if there is a for-profit organization in the middle. Single-payer tax-funded health insurance means that each person contributes based on their capacity, and nobody has to pay when they receive services. Then the tax collector has an incentive to increase effectiveness of health services by educating and encouraging the population to eat well and exercise daily.
- jkingsbery 7y agoMany of the arguments in this article are great arguments against rent-seeking, but many would apply to a public options. For example: consolidating the market didn't create more efficiency because it reduced competition - yet somehow consolidating the market into one single payer and eliminating competition will create efficiency (even though there's no more competition). The author is concerned about private insurers trying to keep their lucrative position, but government organizations face similar incentives in trying to keep theirs.
- jjwhitaker 7y agoI agree, though I think a universal, single payer system under government oversight without profit seeking drive would be better. Consolidation under the current system is identical to McDonalds and Burger King consolidating the fast food industry, they will still be driven to outperform the other to consumers and to investors/owners. Instead, a single system under the Us government shifts negotiation of drug prices, care expenses, and more to one entity backed by the government, not just a set of insured customers, which has excessive power to negotiate. Like other nations that function this way, there is no skimming off the top for shareholders or profits and as the only other party at the table suppliers/hospitals can't play opponents against each other or take a kickback to give better pricing to the larger insurer or something. Ideally, it consolidates and simplifies negotiating pricing or allows the government to step in and say, "No thanks, we'll pass a law or budget for that on our own unless you lower prices or cut a better deal. Also, a government system could cut out administrative and bureaucratic paperwork like billing, coding, and more potentially removing a large % of overhead costs that exist currently, by default lowering expenses for healthcare similar to Canada. the biggest issue I see is that about 1/6th of the US economy is built on health care/insurance/etc companies. shifting that away from corporations into private hands could cut tens of thousands of jobs (like billing and adjusters) while shifting that cash flow under the US government as well. There would be fallout as people would need social safety buffer for unemployment or retraining or education. I don't think it could happen without pairing up with reduced/free college and smart expansion of some needs based aid. That requires some sort of tax, maybe like Warren has suggested, to cover intermediate costs and friction. The good news is it could save the average family over $5000 per year in insurance costs alone while bringing millions out of medical debt and providing a better standard of care and options for everyone. It's not libertarian to shift something under the government but if it makes economic and ethical sense to give such a monopoly to the feds (like with infrastructure, the military, and more) while improving choice for citizens (no longer tied to employer healthcare or entering debt to resolve acute or handle chronic medical issues) it could be a huge boon for choice and freedom. I'd be one of the first to start my own business if I didn't have to worry about my chronic health issues being fully covered and paid for by my employer plan.
- DebtDeflation 7y agoI would propose a 3 tier system: - You pay the first thousand or so a year out of pocket with an HSA-like vehicle to make sure people aren't overconsuming. - Government program pays 100% of everything over like $20k or so a year - Optional private insurance fills in the gap between the $1K out of pocket and the $20K where the government starts picking up the tab, and would be very affordable since their liability is capped at both ends. They actually have something roughly similar to this in Singapore.
- speby 7y agohttps://www.pacificprime.sg/blog/public-and-private-hospitals-differences/ https://www.pacificprime.sg/blog/public-and-private-hospital... Read up on Singapore's model. While it works well for them, I'd be interested to see if it could work here (like hospital quality/comfort, wait times, etc. based on tiers).
- beat 7y agoIt's not just insurance companies that are a problem, and that's a common but annoying oversimplification. Other countries (such as Japan, Germany, and Switzerland) integrate private insurers without the massive cost overruns of the American model. It looks to me like there's a systemic feedback loop somewhere that leads to price inflation. And if private insurers aren't the root cause of that feedback loop, then getting rid of them won't solve the problem. Example: I suffer from a rare chronic illness (respiratory papillomatosis, aka warts on my vocal cords) that requires regular laser surgery treatments to control - two to four times a year. Until recently, treatment consisted of going to the specialist's office, where he had the laser and endoscopy camera. He conducted the operation with two assistants - a laser tech and an ordinary nurse. I was in and out in an hour. But my most recent treatment was different. This time, I had to go to their "surgical center", wear a gown, get wheeled to the room, and there were a half-dozen assistants that were mostly not doing anything. I had to wear a blood pressure cuff, which kept retriggering when I wiped away tears during the treatment (it HURTS and tears of pain happen). I complained to the doctor about this, and he didn't like it either, and said flat out he thinks they do this to charge more money. This isn't a dangerous surgery. It's as unpleasant as it sounds, but... it's wart removal. I'm not under general anesthesia. I'm not going to stroke out. He can't kill or even seriously injure me with that laser. The old, simple office-based routine was better for patient and for doctor - and a lot less expensive, I'm sure. And that's the point there, isn't it? So there's your feedback loop, maybe. Insurance companies can be hit on to cover even unnecessary work, so providers tack on unnecessary work, which raises premiums, which means more money is available, so...
- fatbob 7y agoAlmost(?) every other developed country has price controls (all payer rate setting) - that's a more general reason why prices are lower.
- beat 7y agoI find it fascinating that price controls are pretty much the only difference between the US and Japanese models (well, that and price controls eliminate the concept of networks), and the Japanese model costs half what ours does for better and universal care.
- korethr 7y agoThe problem with the "insurance" companies is that they're not really insurance companies anymore. As the current top comment by raintrees points out, our so called "insurance" is acting far less as insurance (coverage in the case of a major but unlikely incident), but additionally standard payment for regular healthcare services. And this creates all manner of perverse incentives that messes with the pricing and makes it more expensive for everyone. Ironically, when I had a bout of un-/under-employment in the 2008-2009 downturn, my only option for medical care was to ration my healthcare services to those actually needed, and pay cash when I actually received service. I paid less per service individually by paying cash (doctors, imaging, and testing clinics, etc, all really like cash, it makes their life much simpler). And overall I paid less by paying only for the services I needed when I needed it, instead of paying into some high monthly payment to have a battery of services I may or may not ever need pre-selectedly available for me. I think healthcare costs would come down for most if we could get back to something approximating that: medical insurance being actually and only medical insurance -- covering high cost emergencies to prevent such from breaking one financially -- and covering only that. Paying for day-to-day regular medical services can and should be handled differently. In all fairness, I don't know how to get there, and I don't know what the options for the latter would look like, or what they should be. But I do think it would be helpful in the near and long term to put our energies in that direction.
- darawk 7y agoI agree in principle, though i'll add that part of the problem is that if you insure high cost emergencies only, you incentivize people to transmute their low-cost non-emergencies into high cost emergencies. The simplest way of performing that trick is to ignore your low-cost non-emergency until it becomes a high cost emergency. This is part of the reason why insurance companies want to pay for regular checkups and things like that. It's also why they want to incentivize healthy lifestyles, to avoid hyper-expensive things like, e.g. diabetes. The problem with healthcare is that everything is connected. The low-cost regular stuff feeds back into the high cost stuff in a way that means anyone insuring you for the high cost stuff also ought to care about the low cost stuff. It's really a nasty problem.
- 7y ago
- jefe_ 7y agoPrivate Insurance pays healthcare providers higher rates than Medicare. Private Insurance rates serve as a subsidy for healthcare providers, allowing them to fund advanced services & facilities while also accepting the lower Medicare rates. I don't understand how removing this Private Insurance, and then moving everything to Medicare rates, wouldn't instantly reduce the amount of money flowing into the healthcare sector and cause massive slowdowns in all areas, from research, to quality of facilities, to provider pay (nurses, doctors, phlebotomist, hospital janitors), to real estate, and most other sectors of the economy. It would be great if industry rates were lowered, but many aspects of the economy are relying on rates as they exist presently. It seems the more optimal route would be to slow the increase of rates, but this seems to be at odds with the process of untangling Private Insurance and implementing a new Medicare for All System. So my question is, how does Medicare for All cut costs without collapsing the healthcare sector?
- seanmcdirmid 7y ago> So my question is, how does Medicare for All cut costs without collapsing the healthcare sector? Administrative and collections costs, which are a large part healthcare industry already (probably more people work in billing than in actually doing the healthcare work). Our current system is a huge mess, mainly related to all the complexity of our insurance system, and just by getting rid of that complexity huge savings can easily be had (though at the expense of a lot of administrative healthcare jobs). There is a good reason why the USA pays far more than most countries for healthcare received.
- malandrew 7y agoOne thing I've been curious about is whether insurance companies are useful as negotiators with healthcare providers. At the end of the day, they are for profit enterprises. The cynic will naturally state that they make money only by denying claims while taking people's money. But were I in charge of such an enterprise, only doing that would leave a lot of money on the table since there are still lots of claims that an insurer is still paying out and there is a strong economic incentive for insurers to bargain aggressively with healthcare providers to get access to the pool of healthcare customers they represent. With this in mind, does anyone familiar with the industry know the impact insurers have on bringing down healthcare costs by putting the squeeze on healthcare providers?
- mattmcknight 7y agoThe quickest fix is to just put in next year's Medicare contract that no provider is allowed to charge any payer more than they charge Medicare. Much of what insurers do to negotiate in-network and out-network pricing with the various hospitals, pharma companies, and doctors becomes irrelevant, and they just end up varying in the reimbursement schedules. Get all of the supposed cost savings of single payer, without a single payer. If things really do get cheaper, it gets a lot easier to figure out universal coverage. If they don't get cheaper, we learned a lot without having to implement single payer. https://www.manhattan-institute.org/medicare-for-all-maryland-hospital-healthcare-price-regulation https://www.manhattan-institute.org/medicare-for-all-marylan...
- jjwhitaker 7y agoI am often disappointed in US healthcare discussions for similar reasons on gun violence discussions. It can work a lot better, we have many examples of this around the world that can scale and be even cheaper/better like the Canadian system or German system. But for some reason, we want to do it our own way with profit seeking companies who can game the system or lobby the government for their benefit, not citizens. Maybe that's BC/BS or the NRA, maybe it's libertarians or conservatives that want smaller government (that time and time again fails like in Kansas or with the federal deficit hawks and their lovely tax cut). We have solutions in front of us. We just need to shift momentum and get there instead of spinning our wheels and debating doing anything at all.
- musicale 7y agoI tend to agree that health insurance isn't really insurance - it's more like a costly, inefficient payment intermediary that collects money from the young and/or healthy to pay for care for the old and/or sick. Which seems like an OK idea in principle, but it isn't working very well for patients.