6 ms·

IMO, the most fascinating thing about this report is that it exposes a fight between two groups: 1) traditional health insurance companies 2) private equity bac

by danans 7y ago

IMO, the most fascinating thing about this report is that it exposes a fight between two groups: 1) traditional health insurance companies 2) private equity backed provider groups, both of whom would be opposed to universal single payer healthcare as a right. It almost reads like a turf war over which industry subgroup has more right to the unusually high healthcare costs paid by Americans, driven by demand for profits from shareholders, which probably indirectly includes someone like me who has a 401k. This fight has been going on for a very long time though. One reason (among many) that large medical provider groups started forming in the US more than a decade ago was to increase their leverage against insurance companies, who they felt were undercompensating them - small medical practices have little more leverage with insurance companies than consumers on the open insurance market. At some point these larger medical groups attracted the attention of private equity investors, who themselves demand a return on investment. In the end it seems like the loser here is the healthcare consumer, who will pay the higher costs of this system, especially those without significant capital in for-profit healthcare related enterprises.

lotsofpulp 7y ago
Without taxpayer funded healthcare, the consumer is at a disadvantage against healthcare providers as they are completely unknowledgeable about what they are buying, and have low ability to shop around. If everyone was forced to use healthcare.gov to purchase health insurance, then we could have a viable market similar to auto or home insurance, where consumers reward the insurance companies that negotiate lower healthcare costs by signing up for their lower premiums. It is the obfuscation of costs by way of the tax advantage given to employers subsidizing healthcare that greatly reduces the insurability of the people on healthcare.gov since many healthy people are silo’d out into lower risk employer pools, and therefore reduces the amount of insurers that can exist and compete for business.
- LanceH 7y ago
  I've said it before, but if I were allowed to make one rule in the current healthcare landscape it would be "consistent pricing". No charging different prices depending on who is paying.
  - __blockcipher__ 7y ago
    Agreed, the “charge master” system is crazy. In college I had to fight off debt collectors coming for a $3000 ER bill. $3000 to be given propofol and have my shoulder stuck back in the socket twice (they failed to restrain my arm after the first reduction, my arm flailed upon regaining consciousness and redislocated so they double charged me) I also wonder what a world where we removed almost all medical regulation would look like.we would at least get true competitive market dynamics. Why do I know exactly what I’ll pay at mcdonalds, but not what I’ll pay for a medical procesure? Instead we have just enough regulation to prevent healthy market dynamics, but not enough to have a single payer type system
    - aabeshou 7y ago
      > we have just enough regulation to prevent healthy market dynamics, but not enough to have a single payer type system this seems like a very concise summary of the problem. and insurance companies see the profits of this no-mans land
    - deleted 7y ago
      [deleted]
    - danmaz74 7y ago
      At McDonald's you pay for a completely standardized product, delivered by a non specialized workforce. Healthcare is almost the exact opposite.
      - indymike 7y ago
        Interesting. McDonalds defines quality by consistency. Health care defines quality by the credentials of the providers. Maybe healthcare could learn a lot from quickserve?
  - nine_zeros 7y ago
    > I've said it before, but if I were allowed to make one rule in the current healthcare landscape it would be "consistent pricing". No charging different prices depending on who is paying. Along these lines, POST THE DAMN PRICES ON A MENU FOR EVERYONE TO LOOK AT AND MAKE CHOICES!
tartoran 7y ago
How do we get rid of all this layer of inneficiency? Must be possible but nobody is talking about getting rid of this but "fixing" it. Fixing may not be possible or too expensive. As consumers we should avoid paying as few middle man as possible. Today I just found out my health insurance is,of course, going up.
- fzeroracer 7y ago
  The only way to get around this inefficiency is in my opinion to move towards single-payer and circumvent the system entirely. Otherwise you'd have to excise all of the rent-seeking parasitical behavior in our current system which I don't think is possible. Even if you attempted to make the costs of things more transparent to consumers, there's an inherent information asymmetry between a consumer and a insurer due to the economy of scale. There's also a lot of things a consumer can't know until it's too late.
  - toomuchtodo 7y ago
    If your Congressional representative does not support Medicare For All (single payer), run against them in the next election cycle or donate & volunteer for a competitor who does. That is all that is getting in the way of policy implementation, having enough votes to pass the bill in the House and the Senate. We'll get there! I'm working on a site that will obtain attestation from Congressional reps as to their support for M4A, and for those who don't attest support, campaign funding will be funneled to competitors of said representatives who do. https://www.congress.gov/bill/116th-congress/senate-bill/1129/text https://www.congress.gov/bill/116th-congress/senate-bill/112... (S.1129 - Medicare for All Act of 2019)
    - aabeshou 7y ago
      > I'm working on a site very cool idea. I suggest posting it on /r/socialistprogrammers if you need help or if you just want to spread the word :)
      - 7y ago
WalterBright 7y ago
> driven by demand for profits from shareholders All corporations are driven by demand for profits from shareholders. If you're looking at outsized prices in the health care sector, look elsewhere for the reason. Here's a helpful article about it: https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/ https://www.theatlantic.com/magazine/archive/2009/09/how-ame...
- xnyan 7y ago
  This was the standard conservative argument for a long time: HSAs and non-comprehensive insurance. It’s just what conservatives have been saying for the last 60 years (only give benefits that have meaning to those who already have money), and not even they are trying that tactic anymore. I would be interested if any country has a system that reflects the ideas outlined by the writer, and if so what the results were. All the successful healthcare systems I am aware of our nationalize either at the hospital level, administration and financial level or some combination of the both.
  - WalterBright 7y ago
    > if any country has a system that reflects the ideas outlined by the writer The article points out that Lasik eye surgery is not covered by government programs or private insurance, and the price of it has declined dramatically over the years while the quality of it has improved.
    - danans 7y ago
      Lasik is 100% elective, and nobody needs it done immediately to save their lives or relieve their suffering. It's a cosmetic procedure - like liposuction - one that you can shop around for until you find the right provider. You can't compare it to the type of non-elective or emergency procedures performed in other areas of health care, or treatments for severe chronic conditions. You can't even compare it to routine doctors' visits which are often put off by uninsured people due to the costs, allowing minor conditions to develop into more severe (expensive) ones.
wefarrell 7y ago
Congress and the corrupt system of political lobbying deserve a lot of blame. Practices that are outlawed in other industries such as opaque rebates and kickbacks are explicitly allowed by law. Hell, there's even a law on the books that prevents medicare from negotiating drug prices. The bill's architect in congress went on to make $2 million a year as the head of a pharma lobbying firm.
burnte 7y ago
> IMO, the most fascinating thing about this report is that it exposes a fight between two groups: 1) traditional health insurance companies 2) private equity backed provider groups, both of whom would be opposed to universal single payer healthcare as a right. As someone who works in a PE backed healthcare provider, I can assure you that we are not opposed to single payer. Some are, but they're mostly in spaces that provide out-of-network coverage or other services that are still "bill what you want and argue about it later" spaces that are rapidly disappearing. OON services are increasingly difficult and are generally covered by single-case-agreements which are negotiated either before service is rendered, or at the very beginning of the treatment process. Single payer is welcomes by a wide swath of PE back healthcare because it would reduce our costs DRAMATICALLY and provide predictability that currently we do not have. It used to be there were small changes in what insurers would cover from year to year, but now the changes are potentially HUGE and we have to adjust much more quickly. We pay gobs of money to departments filled with people who have to manually verify patient benefits, validity of insurance, continually monitor the patient progress to make sure we're fulfilling the various metrics each insurer sets that varies according to the patient's plan, audit each bill to make sure everything is coded correctly to avoid a typo getting an entire claim rejected (which then we have to resubmit), then once we bill it to the insurer there's the game of nagging them to pay claims they approved weeks ago. Single payer would eliminate almost all of that. We'd know everyone was covered. We'd know what is reimbursable and not. We'd have one set of rules for all patients, one set of metrics to adhere to. One source to bill, and one source to track payments from. Literally 20% of my company's staff is just for those things. Not to mention how much time our medical staff would save by having a single set of rules to work under. PE firms are in healthcare to try to leverage economies of scale to make the money side more efficient, and thus increase margins. A stable environment is good for any business. We work hard to make things as efficient as we can, and reducing the massive overhead attached to just making money would be a great efficiency. Single payer would be great news for the industry.
- danans 7y ago
  Well, TIL something about private equity backed healthcare providers, at least the kind you work at. FWIW everything you're saying makes sense to me personally since I used to do medical billing more than 25 years ago, and I clearly remember how disastrously complex it was for seemingly no reason. One of my first jobs was sitting in an office full of medical procedure face sheets, spending all day calling doctors offices to get billable diagnosis codes for procedures. The question I have is whether the medical provider community is ready to stand up for single payer, if only on the rationale you explained. That would go a long way toward convincing segments of the public who do won't support it on human rights grounds alone, but might support it because it makes more business sense.

by danans 7y ago

lotsofpulp 7y ago

Without taxpayer funded healthcare, the consumer is at a disadvantage against healthcare providers as they are completely unknowledgeable about what they are buying, and have low ability to shop around. If everyone was forced to use healthcare.gov to purchase health insurance, then we could have a viable market similar to auto or home insurance, where consumers reward the insurance companies that negotiate lower healthcare costs by signing up for their lower premiums. It is the obfuscation of costs by way of the tax advantage given to employers subsidizing healthcare that greatly reduces the insurability of the people on healthcare.gov since many healthy people are silo’d out into lower risk employer pools, and therefore reduces the amount of insurers that can exist and compete for business.

LanceH 7y ago
I've said it before, but if I were allowed to make one rule in the current healthcare landscape it would be "consistent pricing". No charging different prices depending on who is paying.
- __blockcipher__ 7y ago
  Agreed, the “charge master” system is crazy. In college I had to fight off debt collectors coming for a $3000 ER bill. $3000 to be given propofol and have my shoulder stuck back in the socket twice (they failed to restrain my arm after the first reduction, my arm flailed upon regaining consciousness and redislocated so they double charged me) I also wonder what a world where we removed almost all medical regulation would look like.we would at least get true competitive market dynamics. Why do I know exactly what I’ll pay at mcdonalds, but not what I’ll pay for a medical procesure? Instead we have just enough regulation to prevent healthy market dynamics, but not enough to have a single payer type system
  - aabeshou 7y ago
    > we have just enough regulation to prevent healthy market dynamics, but not enough to have a single payer type system this seems like a very concise summary of the problem. and insurance companies see the profits of this no-mans land
  - deleted 7y ago
    [deleted]
  - danmaz74 7y ago
    At McDonald's you pay for a completely standardized product, delivered by a non specialized workforce. Healthcare is almost the exact opposite.
    - indymike 7y ago
      Interesting. McDonalds defines quality by consistency. Health care defines quality by the credentials of the providers. Maybe healthcare could learn a lot from quickserve?
- nine_zeros 7y ago
  > I've said it before, but if I were allowed to make one rule in the current healthcare landscape it would be "consistent pricing". No charging different prices depending on who is paying. Along these lines, POST THE DAMN PRICES ON A MENU FOR EVERYONE TO LOOK AT AND MAKE CHOICES!

tartoran 7y ago

How do we get rid of all this layer of inneficiency? Must be possible but nobody is talking about getting rid of this but "fixing" it. Fixing may not be possible or too expensive. As consumers we should avoid paying as few middle man as possible. Today I just found out my health insurance is,of course, going up.

fzeroracer 7y ago
The only way to get around this inefficiency is in my opinion to move towards single-payer and circumvent the system entirely. Otherwise you'd have to excise all of the rent-seeking parasitical behavior in our current system which I don't think is possible. Even if you attempted to make the costs of things more transparent to consumers, there's an inherent information asymmetry between a consumer and a insurer due to the economy of scale. There's also a lot of things a consumer can't know until it's too late.
- toomuchtodo 7y ago
  If your Congressional representative does not support Medicare For All (single payer), run against them in the next election cycle or donate & volunteer for a competitor who does. That is all that is getting in the way of policy implementation, having enough votes to pass the bill in the House and the Senate. We'll get there! I'm working on a site that will obtain attestation from Congressional reps as to their support for M4A, and for those who don't attest support, campaign funding will be funneled to competitors of said representatives who do. https://www.congress.gov/bill/116th-congress/senate-bill/1129/text https://www.congress.gov/bill/116th-congress/senate-bill/112... (S.1129 - Medicare for All Act of 2019)
  - aabeshou 7y ago
    > I'm working on a site very cool idea. I suggest posting it on /r/socialistprogrammers if you need help or if you just want to spread the word :)
    - 7y ago

WalterBright 7y ago

> driven by demand for profits from shareholders All corporations are driven by demand for profits from shareholders. If you're looking at outsized prices in the health care sector, look elsewhere for the reason. Here's a helpful article about it: https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/ https://www.theatlantic.com/magazine/archive/2009/09/how-ame...

xnyan 7y ago
This was the standard conservative argument for a long time: HSAs and non-comprehensive insurance. It’s just what conservatives have been saying for the last 60 years (only give benefits that have meaning to those who already have money), and not even they are trying that tactic anymore. I would be interested if any country has a system that reflects the ideas outlined by the writer, and if so what the results were. All the successful healthcare systems I am aware of our nationalize either at the hospital level, administration and financial level or some combination of the both.
- WalterBright 7y ago
  > if any country has a system that reflects the ideas outlined by the writer The article points out that Lasik eye surgery is not covered by government programs or private insurance, and the price of it has declined dramatically over the years while the quality of it has improved.
  - danans 7y ago
    Lasik is 100% elective, and nobody needs it done immediately to save their lives or relieve their suffering. It's a cosmetic procedure - like liposuction - one that you can shop around for until you find the right provider. You can't compare it to the type of non-elective or emergency procedures performed in other areas of health care, or treatments for severe chronic conditions. You can't even compare it to routine doctors' visits which are often put off by uninsured people due to the costs, allowing minor conditions to develop into more severe (expensive) ones.

wefarrell 7y ago

Congress and the corrupt system of political lobbying deserve a lot of blame. Practices that are outlawed in other industries such as opaque rebates and kickbacks are explicitly allowed by law. Hell, there's even a law on the books that prevents medicare from negotiating drug prices. The bill's architect in congress went on to make $2 million a year as the head of a pharma lobbying firm.

burnte 7y ago

> IMO, the most fascinating thing about this report is that it exposes a fight between two groups: 1) traditional health insurance companies 2) private equity backed provider groups, both of whom would be opposed to universal single payer healthcare as a right. As someone who works in a PE backed healthcare provider, I can assure you that we are not opposed to single payer. Some are, but they're mostly in spaces that provide out-of-network coverage or other services that are still "bill what you want and argue about it later" spaces that are rapidly disappearing. OON services are increasingly difficult and are generally covered by single-case-agreements which are negotiated either before service is rendered, or at the very beginning of the treatment process. Single payer is welcomes by a wide swath of PE back healthcare because it would reduce our costs DRAMATICALLY and provide predictability that currently we do not have. It used to be there were small changes in what insurers would cover from year to year, but now the changes are potentially HUGE and we have to adjust much more quickly. We pay gobs of money to departments filled with people who have to manually verify patient benefits, validity of insurance, continually monitor the patient progress to make sure we're fulfilling the various metrics each insurer sets that varies according to the patient's plan, audit each bill to make sure everything is coded correctly to avoid a typo getting an entire claim rejected (which then we have to resubmit), then once we bill it to the insurer there's the game of nagging them to pay claims they approved weeks ago. Single payer would eliminate almost all of that. We'd know everyone was covered. We'd know what is reimbursable and not. We'd have one set of rules for all patients, one set of metrics to adhere to. One source to bill, and one source to track payments from. Literally 20% of my company's staff is just for those things. Not to mention how much time our medical staff would save by having a single set of rules to work under. PE firms are in healthcare to try to leverage economies of scale to make the money side more efficient, and thus increase margins. A stable environment is good for any business. We work hard to make things as efficient as we can, and reducing the massive overhead attached to just making money would be a great efficiency. Single payer would be great news for the industry.

danans 7y ago
Well, TIL something about private equity backed healthcare providers, at least the kind you work at. FWIW everything you're saying makes sense to me personally since I used to do medical billing more than 25 years ago, and I clearly remember how disastrously complex it was for seemingly no reason. One of my first jobs was sitting in an office full of medical procedure face sheets, spending all day calling doctors offices to get billable diagnosis codes for procedures. The question I have is whether the medical provider community is ready to stand up for single payer, if only on the rationale you explained. That would go a long way toward convincing segments of the public who do won't support it on human rights grounds alone, but might support it because it makes more business sense.