42 ms·

It should go further. End the in-network / out-of-network crap. One price per procedure that is the same for all customers. All providers should accept all insu

by imgabe 7y ago

It should go further. End the in-network / out-of-network crap. One price per procedure that is the same for all customers. All providers should accept all insurances. The system we have is insane.

maxcan 7y ago
YES! MFN pricing would be a huge social benefit.
geggam 7y ago
Good luck with this. Those insurance contracts can keep you from paying cash for services. If they can do that the in and out of network is much simpler to defend in court. Recently had a situation where we were pressed for time and was waiting on insurance approval. I offered to pay cash and the Dr had to ask permission from the insurance company.
lonelappde 7y ago
What would it mean to have one insurance vs a different one then? That just sounds like nationalized done payer with extra steps
- burnte 7y ago
  Anything that gets the US to single payer is fine.
- WillPostForFood 7y ago
  You could have a low cost high deductible plan, or high cost low deductible plan but the procedure would always be billed at the same price.
subhobroto 7y ago
Upvoted! The most efficient solution is an "all payer rate set system" - aka One price per procedure. YES, the system we have is insane. NO, unfortunately none of us are doing anything about it because we don't think beyond "single payer" system which itself has its own set of issues no one digs into because "single payer" is so awesome. Everytime I mention "all payer rate set system" the discussion halts as if I am an alien from outer space. If we are make ourselves go through an overhaul, and all the pain and suffering it entails, our sights should be on an "all payer rate set system" that's already proven to be way more effective than whatever people mean by "single payer" system.
- JuettnerDistrib 7y ago
  > The most efficient solution is an "all payer rate set system" - aka One price per procedure. I'd like to hear more about this. According to Wikipedia [1], Maryland uses an "all payer rate set system", and it had one of the first per-capita costs. On the other hand, Germany also has the system, but much lower healthcare costs. What's going on? [1] https://en.m.wikipedia.org/wiki/All-payer_rate_setting https://en.m.wikipedia.org/wiki/All-payer_rate_setting
jefftk 7y ago
Currently rates are set via negotiation between providers and insurers. Roughly, when the provider and insurer can't agree on a price, then the provider will be out of network for that insurer. Let's say we remove this, and now we have a doctor who wants to charge $200 and an insurer that wants to pay $100. How should it be resolved?
- goalieca 7y ago
  In Canada, the province sets the rate.
- imgabe 7y ago
  The insurance company could do their freaking job and crunch the numbers to figure out what the average price is going to be at the providers their customers go to and set their premiums accordingly so they can cover what they expect to pay. Some of their customers will go to a doctor where a procedure costs $200, some where it costs $50, some where it costs $100. If the prices were published patients could actually make a choice based on that information.
  - jefftk 7y ago
    If the patient chose to see someone who charged $200 vs $50 would the patient pay a different amount?
    - imgabe 7y ago
      Perhaps the insurance would choose an amount to reimburse and the patient could pay the difference if they want to go somewhere more expensive. Isn't that the way most other insurances work? If my homeowner's insurance pays me to repair my house, they don't make me go to an "in-network" contractor. And if that contractor has an "out-of-network" subcontractor I don't suddenly get charged 10x more. If the patient could choose any doctor because they aren't limited to in-network only and the doctors couldn't charge different prices for insurance vs. cash, and if patients actually knew what the prices were beforehand there would be actual competition and downward pressure on prices.
arcticbull 7y ago
Or the government sets the price and then all doctors are independent contractors to the government, and file for reimbursement for their services rendered. The patient can then pay on their 1040 according to their means, literally solving the problem once and for all like every other developed country. The solution is right in front of America’s nose, but too many are running around with their fingers in their ears screaming simultaneously about the communists and how much they hate the system they’re advocating for.
- rayiner 7y ago
  Many countries don’t do it that way, including many with ostensibly universal healthcare. (Germany has 100+ different insurance companies, for example.)

by imgabe 7y ago

It should go further. End the in-network / out-of-network crap. One price per procedure that is the same for all customers. All providers should accept all insurances. The system we have is insane.

maxcan 7y ago

YES! MFN pricing would be a huge social benefit.

geggam 7y ago

Good luck with this. Those insurance contracts can keep you from paying cash for services. If they can do that the in and out of network is much simpler to defend in court. Recently had a situation where we were pressed for time and was waiting on insurance approval. I offered to pay cash and the Dr had to ask permission from the insurance company.

lonelappde 7y ago

What would it mean to have one insurance vs a different one then? That just sounds like nationalized done payer with extra steps

burnte 7y ago
Anything that gets the US to single payer is fine.
WillPostForFood 7y ago
You could have a low cost high deductible plan, or high cost low deductible plan but the procedure would always be billed at the same price.

subhobroto 7y ago

Upvoted! The most efficient solution is an "all payer rate set system" - aka One price per procedure. YES, the system we have is insane. NO, unfortunately none of us are doing anything about it because we don't think beyond "single payer" system which itself has its own set of issues no one digs into because "single payer" is so awesome. Everytime I mention "all payer rate set system" the discussion halts as if I am an alien from outer space. If we are make ourselves go through an overhaul, and all the pain and suffering it entails, our sights should be on an "all payer rate set system" that's already proven to be way more effective than whatever people mean by "single payer" system.

JuettnerDistrib 7y ago
> The most efficient solution is an "all payer rate set system" - aka One price per procedure. I'd like to hear more about this. According to Wikipedia [1], Maryland uses an "all payer rate set system", and it had one of the first per-capita costs. On the other hand, Germany also has the system, but much lower healthcare costs. What's going on? [1] https://en.m.wikipedia.org/wiki/All-payer_rate_setting https://en.m.wikipedia.org/wiki/All-payer_rate_setting

jefftk 7y ago

Currently rates are set via negotiation between providers and insurers. Roughly, when the provider and insurer can't agree on a price, then the provider will be out of network for that insurer. Let's say we remove this, and now we have a doctor who wants to charge $200 and an insurer that wants to pay $100. How should it be resolved?

goalieca 7y ago
In Canada, the province sets the rate.
imgabe 7y ago
The insurance company could do their freaking job and crunch the numbers to figure out what the average price is going to be at the providers their customers go to and set their premiums accordingly so they can cover what they expect to pay. Some of their customers will go to a doctor where a procedure costs $200, some where it costs $50, some where it costs $100. If the prices were published patients could actually make a choice based on that information.
- jefftk 7y ago
  If the patient chose to see someone who charged $200 vs $50 would the patient pay a different amount?
  - imgabe 7y ago
    Perhaps the insurance would choose an amount to reimburse and the patient could pay the difference if they want to go somewhere more expensive. Isn't that the way most other insurances work? If my homeowner's insurance pays me to repair my house, they don't make me go to an "in-network" contractor. And if that contractor has an "out-of-network" subcontractor I don't suddenly get charged 10x more. If the patient could choose any doctor because they aren't limited to in-network only and the doctors couldn't charge different prices for insurance vs. cash, and if patients actually knew what the prices were beforehand there would be actual competition and downward pressure on prices.

arcticbull 7y ago

Or the government sets the price and then all doctors are independent contractors to the government, and file for reimbursement for their services rendered. The patient can then pay on their 1040 according to their means, literally solving the problem once and for all like every other developed country. The solution is right in front of America’s nose, but too many are running around with their fingers in their ears screaming simultaneously about the communists and how much they hate the system they’re advocating for.

rayiner 7y ago
Many countries don’t do it that way, including many with ostensibly universal healthcare. (Germany has 100+ different insurance companies, for example.)