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Medicare for all is not a solution. The solution is make health insurance act like insurance. Health service provider needs to post their price like all service

by wdn 7y ago

Medicare for all is not a solution. The solution is make health insurance act like insurance. Health service provider needs to post their price like all services and products. They need to compete for our business.

journalctl 7y ago
Stop with this free market nonsense. This is healthcare, this is real lives. It’s not the same as choosing which burger joint to patronize, it’s life and death.
- AnthonyMouse 7y ago
  > This is healthcare, this is real lives. It’s not the same as choosing which burger joint to patronize, it’s life and death. We're not talking about the life and death part though. There are already laws requiring emergency rooms to see anyone who shows up. The question is how to pay for it, which is a matter of economics. Medical providers not being able to provide the total cost for a non-emergency procedure up-front but then expecting people to pay whatever price they make up after the fact is practically fraud. The fact that it leads to outrageous costs is entirely predictable.
  - pbourke 7y ago
    > Medical providers not being able to provide the total cost for a non-emergency procedure up-front but then expecting people to pay whatever price they make up after the fact is practically fraud. The fact that it leads to outrageous costs is entirely predictable. I’d like to turn the question around and ask folks who believe that the healthcare problem is one of not enough market freedom: what’s an example of a country that gets a free market in medical care right, from your perspective? We universal healthcare advocates have a couple of dozen examples lined up to support our perspective, what about from the other side?
    - AnthonyMouse 7y ago
      The Netherlands and Switzerland both have functioning private insurance systems. There are also several functioning hybrid systems, like Germany and Israel. But the primary reason you don't see more successes is the lack of attempts. It's not as if there is a long list of countries with failed free market healthcare systems, either.
      - Aeolun 7y ago
        The Netherlands does not have a private health insurance scheme. Or rather, it does, but all the prices are basically fixed, and the biggest choice you have is whom you are paying money to. The services are ultimately much the same.
      - deleted 7y ago
        [deleted]
      - Betelgeuse90 7y ago
        Here in Israel the majority of large health providers are essentially contractors, are largely indistinguishable and don't compete on price at all. Everybody pays a health tax as a percentage of their income. You don't have to pay anything aside from it, but if you want additional coverage like improved dental and discounts for non-essential medication, the best available coverage through the largest providers would cost you about $25 a month on top of the health tax. I don't know in what meaningful sense Israel is a "hybrid" system, it functions almost exactly like a 'Medicare for all' type proposal would.
      - Shacklz 7y ago
        Swiss here: Our health insurance providers might be privatized, but they're strongly regulated and every Swiss citizen must have healthcare. They do function, but not because of their free market incentives (my opinion), but because of strong regulations. Also, if there was a vote to go from public -> private insurers again (historically, they were public once), I think they'd stay public, because we're not really seeing the benefits of their privatization, only the downsides (tons of ads, calls, arcane coverage rules etc.)
- novalis78 7y ago
  The problem with avoiding market solutions to your problem is that many other areas of life could also make that argument "cell phones are needed to call the police, it's a matter of life and death, they should be free". "Houses keep people warm, they should not cost anything" etc. Reign in the cost of healthcare by allowing actual (cross state) competition and eliminate laws that give incumbents a free check. They should have to fight for your business as transparently and as hard as your tech company.
  - Broken_Hippo 7y ago
    "cell phones are needed to call the police.." In the US, all cell phones with a charge can call the police (there are laws for this!) and there are programs to get free phones to those in danger. We already do this. "Houses keep people warm, they should not cost anything" etc." I'm not sure who is arguing this, but it isn't a stretch for folks to agree that everyone should have access to shelter, even if you cannot afford it. I personally wouldn't mind standard and basic housing being free (Small kitchen/living room, bathroom, and bedroom or bedrooms) I'd also point out that cross state competition would only help a little. Your laws need to be the same state to state, minimally, and most of the providers wouldn't change. Most insurance is provided through a job anyway, and I'd like to mention that most people's "tech company", besides social media, are ISP's with little to no competition.
fzeroracer 7y ago
Absolute nonsense. What about the poor people who only have one hospital nearby that might not accept their insurance? What about people who go to a hospital that's in their network, but it turns out one of the many doctors was not? The people who have a time critical illness who can't afford to do the whole Free Market thing right after a accident? How does anyone know that when they arrive somewhere the exact number of treatments needed to cure their illness? Are you expected to walk out of the hospital and refuse treatment because you've tabulated all of the prices for all of the services needed, then ask the ambulance to take you somewhere else? The free market solution to health insurance simply does not work and it's insulting to see people suggest it time and time again. It ironically only works in heavily centralized areas where people actually have a choice, and not the more rural areas where hospitals are far more spaced out. There's far too many variables at play for even software engineers to manage unless you dedicate a significant amount of your free time to maintaining an excel spreadsheet of every hospital near you and their prices, formulate the exact cheapest plan on the fly according to your personal needs and can pull that out immediately when you have a medical emergency. And that's assuming they didn't decide to go out of network the day before and delayed updating their database.
- AnthonyMouse 7y ago
  > What about the poor people who only have one hospital nearby that might not accept their insurance? What about people who go to a hospital that's in their network, but it turns out one of the many doctors was not? The people who have a time critical illness who can't afford to do the whole Free Market thing right after a accident? All of these only apply to time-critical procedures. Otherwise you should be able to use the doctor and hospital which is covered. Let's assume that emergency medicine should be provided by cities in the same way as other emergency services like fire companies. What's the argument for doing it that way for all medical services, including the ones that are not time sensitive and allow you plenty of time to shop around and choose the provider with the best combination of price, distance, scheduling availability, etc.? > There's far too many variables at play for even software engineers to manage unless you dedicate a significant amount of your free time to maintaining an excel spreadsheet of every hospital near you and their prices, formulate the exact cheapest plan on the fly according to your personal needs and can pull that out immediately when you have a medical emergency. This is hardly the only circumstance where there are many variables. Should the government buy everyone the same car because there are so many different choices between prices and safety ratings and fuel economy and performance? How does that even help, since the solution space is the same and government knows less about your priorities than you do?
x86_64Ubuntu 7y ago
The nature of medical care doesn't allow for "users" to decide rationally. This is primarily due to the lack of domain knowledge concerning medicine. If you have a lump somewhere, and a doctor wants to X-Ray/Biopsy/Open You Up, you generally don't know which one is best. So prices don't help at all. And that's if by chance you are conscious and able to consent. When you are under, you don't get to consent to the actions of the surgeons ,anesthesiologists or whomever else they decide to bring in to assist.
- AnthonyMouse 7y ago
  > The nature of medical care doesn't allow for "users" to decide rationally. This is primarily due to the lack of domain knowledge concerning medicine. If you have a lump somewhere, and a doctor wants to X-Ray/Biopsy/Open You Up, you generally don't know which one is best. So prices don't help at all. How do prices not help? You at least know how much you'll have to pay, which is certainly relevant information. You still may not know which one is best (no guarantee that it's the one that costs more), but what solution are you proposing to that anyway? Even if the government was paying for your medicine, how would that help you choose which doctor to listen to? > When you are under, you don't get to consent to the actions of the surgeons ,anesthesiologists or whomever else they decide to bring in to assist. Which is why it may make sense to have an insurance plan that fully covers emergency services regardless of network. But emergency services aren't the majority of medical costs.
  - Broken_Hippo 7y ago
    "How do prices not help? You at least know how much you'll have to pay, which is certainly relevant information." First things first, you probably have little choice in where you are going to get things checked out, as there may only be one place in town or one place your insurance covers or one place that works with the hospital your doctor goes to. It isn't like you can opt out if you suspect things like breast cancer, which might kill you, or if you are getting anything done in an emergency fashion. AT best, knowing the cost might give relief or stress and at worst, it'll cause some folks to die a slow death because they can't afford the cure. IIRC, they aren't always upfront about this stuff during surgery. You simply don't know or there might not be folks in your network available for a variety of reasons (like your anesthesiologist being sick that day).
CamperBob2 7y ago
It's not a free market if you're forced to participate. And if you're alive and want to stay that way, you're forced to participate. So, no, "insurance" will never under any circumstances be the correct model to work from. (And no, I don't know what is.)
jliptzin 7y ago
> They need to compete for our business. No, they don't. When you're out of breath with pain running down your left arm and are about to collapse, you're going to try to get to the nearest hospital, not first shop around to see which one has the most competitive rates like you're buying a new car or something.
- tehlike 7y ago
  Emergency is one thing. For others you could have time to shop.
  - Broken_Hippo 7y ago
    Ok. So when you have flu complications? Gall bladder issues? When you fell and twisted your ankle but don't need emergency services even though you can't really walk? When you need a stint put in? Or how about when you've been diagnosed with an autoimmune disorder? Sure, you technically have time to shop, but it seems to me that this is just an excuse and makes sick people suffer more.
    - kgantchev 7y ago
      In all of those cases you can: 1. Take 30 mins to find the most affordable option. 2. Ask for a lower price.
      - TheOtherHobbes 7y ago
        1. The most affordable option may be a complete waste of money, and you have no way to tell ahead of time. 2. Ditto. You also could just live in a country with a good single payer health service, and know that you'll be treated without any bullshit. The fact that anyone would seriously suggest shopping around for treatment, as if there is a convincing and credible reason why anyone should even have to consider this, is beyond astonishing to me.
        tehlike 7y ago
jvagner 7y ago
Sure it is, as has been demonstrated in many, many countries.
novalis78 7y ago
Completely agree. the main problem is not insurance, but healthcare cost. regulatory capture and lobbying lead to ballooning administrative costs and corruption on all levels. The Surgery Center of Oklahoma cannot be mentioned enough as a shining example how things should be done.

by wdn 7y ago

journalctl 7y ago

Stop with this free market nonsense. This is healthcare, this is real lives. It’s not the same as choosing which burger joint to patronize, it’s life and death.

AnthonyMouse 7y ago
> This is healthcare, this is real lives. It’s not the same as choosing which burger joint to patronize, it’s life and death. We're not talking about the life and death part though. There are already laws requiring emergency rooms to see anyone who shows up. The question is how to pay for it, which is a matter of economics. Medical providers not being able to provide the total cost for a non-emergency procedure up-front but then expecting people to pay whatever price they make up after the fact is practically fraud. The fact that it leads to outrageous costs is entirely predictable.
- pbourke 7y ago
  > Medical providers not being able to provide the total cost for a non-emergency procedure up-front but then expecting people to pay whatever price they make up after the fact is practically fraud. The fact that it leads to outrageous costs is entirely predictable. I’d like to turn the question around and ask folks who believe that the healthcare problem is one of not enough market freedom: what’s an example of a country that gets a free market in medical care right, from your perspective? We universal healthcare advocates have a couple of dozen examples lined up to support our perspective, what about from the other side?
  - AnthonyMouse 7y ago
    The Netherlands and Switzerland both have functioning private insurance systems. There are also several functioning hybrid systems, like Germany and Israel. But the primary reason you don't see more successes is the lack of attempts. It's not as if there is a long list of countries with failed free market healthcare systems, either.
    - Aeolun 7y ago
      The Netherlands does not have a private health insurance scheme. Or rather, it does, but all the prices are basically fixed, and the biggest choice you have is whom you are paying money to. The services are ultimately much the same.
    - deleted 7y ago
      [deleted]
    - Betelgeuse90 7y ago
      Here in Israel the majority of large health providers are essentially contractors, are largely indistinguishable and don't compete on price at all. Everybody pays a health tax as a percentage of their income. You don't have to pay anything aside from it, but if you want additional coverage like improved dental and discounts for non-essential medication, the best available coverage through the largest providers would cost you about $25 a month on top of the health tax. I don't know in what meaningful sense Israel is a "hybrid" system, it functions almost exactly like a 'Medicare for all' type proposal would.
    - Shacklz 7y ago
      Swiss here: Our health insurance providers might be privatized, but they're strongly regulated and every Swiss citizen must have healthcare. They do function, but not because of their free market incentives (my opinion), but because of strong regulations. Also, if there was a vote to go from public -> private insurers again (historically, they were public once), I think they'd stay public, because we're not really seeing the benefits of their privatization, only the downsides (tons of ads, calls, arcane coverage rules etc.)
novalis78 7y ago
The problem with avoiding market solutions to your problem is that many other areas of life could also make that argument "cell phones are needed to call the police, it's a matter of life and death, they should be free". "Houses keep people warm, they should not cost anything" etc. Reign in the cost of healthcare by allowing actual (cross state) competition and eliminate laws that give incumbents a free check. They should have to fight for your business as transparently and as hard as your tech company.
- Broken_Hippo 7y ago
  "cell phones are needed to call the police.." In the US, all cell phones with a charge can call the police (there are laws for this!) and there are programs to get free phones to those in danger. We already do this. "Houses keep people warm, they should not cost anything" etc." I'm not sure who is arguing this, but it isn't a stretch for folks to agree that everyone should have access to shelter, even if you cannot afford it. I personally wouldn't mind standard and basic housing being free (Small kitchen/living room, bathroom, and bedroom or bedrooms) I'd also point out that cross state competition would only help a little. Your laws need to be the same state to state, minimally, and most of the providers wouldn't change. Most insurance is provided through a job anyway, and I'd like to mention that most people's "tech company", besides social media, are ISP's with little to no competition.

fzeroracer 7y ago

Absolute nonsense. What about the poor people who only have one hospital nearby that might not accept their insurance? What about people who go to a hospital that's in their network, but it turns out one of the many doctors was not? The people who have a time critical illness who can't afford to do the whole Free Market thing right after a accident? How does anyone know that when they arrive somewhere the exact number of treatments needed to cure their illness? Are you expected to walk out of the hospital and refuse treatment because you've tabulated all of the prices for all of the services needed, then ask the ambulance to take you somewhere else? The free market solution to health insurance simply does not work and it's insulting to see people suggest it time and time again. It ironically only works in heavily centralized areas where people actually have a choice, and not the more rural areas where hospitals are far more spaced out. There's far too many variables at play for even software engineers to manage unless you dedicate a significant amount of your free time to maintaining an excel spreadsheet of every hospital near you and their prices, formulate the exact cheapest plan on the fly according to your personal needs and can pull that out immediately when you have a medical emergency. And that's assuming they didn't decide to go out of network the day before and delayed updating their database.

AnthonyMouse 7y ago
> What about the poor people who only have one hospital nearby that might not accept their insurance? What about people who go to a hospital that's in their network, but it turns out one of the many doctors was not? The people who have a time critical illness who can't afford to do the whole Free Market thing right after a accident? All of these only apply to time-critical procedures. Otherwise you should be able to use the doctor and hospital which is covered. Let's assume that emergency medicine should be provided by cities in the same way as other emergency services like fire companies. What's the argument for doing it that way for all medical services, including the ones that are not time sensitive and allow you plenty of time to shop around and choose the provider with the best combination of price, distance, scheduling availability, etc.? > There's far too many variables at play for even software engineers to manage unless you dedicate a significant amount of your free time to maintaining an excel spreadsheet of every hospital near you and their prices, formulate the exact cheapest plan on the fly according to your personal needs and can pull that out immediately when you have a medical emergency. This is hardly the only circumstance where there are many variables. Should the government buy everyone the same car because there are so many different choices between prices and safety ratings and fuel economy and performance? How does that even help, since the solution space is the same and government knows less about your priorities than you do?

x86_64Ubuntu 7y ago

The nature of medical care doesn't allow for "users" to decide rationally. This is primarily due to the lack of domain knowledge concerning medicine. If you have a lump somewhere, and a doctor wants to X-Ray/Biopsy/Open You Up, you generally don't know which one is best. So prices don't help at all. And that's if by chance you are conscious and able to consent. When you are under, you don't get to consent to the actions of the surgeons ,anesthesiologists or whomever else they decide to bring in to assist.

AnthonyMouse 7y ago
> The nature of medical care doesn't allow for "users" to decide rationally. This is primarily due to the lack of domain knowledge concerning medicine. If you have a lump somewhere, and a doctor wants to X-Ray/Biopsy/Open You Up, you generally don't know which one is best. So prices don't help at all. How do prices not help? You at least know how much you'll have to pay, which is certainly relevant information. You still may not know which one is best (no guarantee that it's the one that costs more), but what solution are you proposing to that anyway? Even if the government was paying for your medicine, how would that help you choose which doctor to listen to? > When you are under, you don't get to consent to the actions of the surgeons ,anesthesiologists or whomever else they decide to bring in to assist. Which is why it may make sense to have an insurance plan that fully covers emergency services regardless of network. But emergency services aren't the majority of medical costs.
- Broken_Hippo 7y ago
  "How do prices not help? You at least know how much you'll have to pay, which is certainly relevant information." First things first, you probably have little choice in where you are going to get things checked out, as there may only be one place in town or one place your insurance covers or one place that works with the hospital your doctor goes to. It isn't like you can opt out if you suspect things like breast cancer, which might kill you, or if you are getting anything done in an emergency fashion. AT best, knowing the cost might give relief or stress and at worst, it'll cause some folks to die a slow death because they can't afford the cure. IIRC, they aren't always upfront about this stuff during surgery. You simply don't know or there might not be folks in your network available for a variety of reasons (like your anesthesiologist being sick that day).

CamperBob2 7y ago

It's not a free market if you're forced to participate. And if you're alive and want to stay that way, you're forced to participate. So, no, "insurance" will never under any circumstances be the correct model to work from. (And no, I don't know what is.)

jliptzin 7y ago

> They need to compete for our business. No, they don't. When you're out of breath with pain running down your left arm and are about to collapse, you're going to try to get to the nearest hospital, not first shop around to see which one has the most competitive rates like you're buying a new car or something.

tehlike 7y ago
Emergency is one thing. For others you could have time to shop.
- Broken_Hippo 7y ago
  Ok. So when you have flu complications? Gall bladder issues? When you fell and twisted your ankle but don't need emergency services even though you can't really walk? When you need a stint put in? Or how about when you've been diagnosed with an autoimmune disorder? Sure, you technically have time to shop, but it seems to me that this is just an excuse and makes sick people suffer more.
  - kgantchev 7y ago
    In all of those cases you can: 1. Take 30 mins to find the most affordable option. 2. Ask for a lower price.
    - TheOtherHobbes 7y ago
      1. The most affordable option may be a complete waste of money, and you have no way to tell ahead of time. 2. Ditto. You also could just live in a country with a good single payer health service, and know that you'll be treated without any bullshit. The fact that anyone would seriously suggest shopping around for treatment, as if there is a convincing and credible reason why anyone should even have to consider this, is beyond astonishing to me.
      - tehlike 7y ago

jvagner 7y ago

Sure it is, as has been demonstrated in many, many countries.

novalis78 7y ago

Completely agree. the main problem is not insurance, but healthcare cost. regulatory capture and lobbying lead to ballooning administrative costs and corruption on all levels. The Surgery Center of Oklahoma cannot be mentioned enough as a shining example how things should be done.