4 ms·

I see everyone getting excited about single-payer but it addresses the core issue of access via pricing as a mere sideffect that a single-payer happens to have

I see everyone getting excited about single-payer but it addresses the core issue of access via pricing as a mere sideffect that a single-payer happens to have serious leverage over pricing being, well, single-payer. The core issue though is price of medical services. When an ER visit to sew together 5 inches of a cut skin at 10AM can generate a claim for $40000, something is really broken. The single-payer can outright refuse to pay $40000 for such a thing while you and I would have that debt hound us for the rest of our lives. One solution that addresses the root issue is to clamp down on what is reasonable to charge to sew together 5 inches of a cut skin at 10AM. That is called an all-payer rate set system. It does not matter who pays - what matters is what price something is available at. Doctor's regular, scheduled visit? $150. You pay in cash? ? $150. You pay in chickens with white feathers ? $150. Your employer provides you with coverage and they cover the first $500 worth of expenses? $150. Your'e an uber driver and that doctor would appreciate a ride back and forth for the next month? $150. When the same doctor's visit can range in price from $10 - $1000 depending on what crap your employer signed you up for, we have a terrible access issue. The U.S. has one of the best health care in the world, but also one of the higest financial distress including outright bankruptcy for medical bills. Something's going to give soon as the system starts to come under strain due to SARS-COV2 and it's not likely to be pretty.

oblongx 6y ago
First step was making sure you can actually get quoted a price for that service. I might choose to go across town if it saved me $40K. https://www.npr.org/sections/health-shots/2019/06/24/735432387/trump-administration-pushes-to-make-health-care-pricing-more-transparent https://www.npr.org/sections/health-shots/2019/06/24/7354323...
- subhobroto 6y ago
  > actually get quoted a price for that service. I might choose to go across town if it saved me $40K I have been working as a software consultant for decades now and always have a menu price ready. Even with this menu pricing, my customers still need my help in figuring out what they need from the menu. If my customers already knew what they needed to solve their problems, I have 0 value to add as a consultant - at that point, they just need to either hire staff/developers to execute on their requirements. If I broke my hip today, how exactly would a menu of hip related items help me compare costs? How would I even begin to know which items from the menu apply to my situation without having some idea what is involved in fixing a broken hip? Do I need a MRI? XRay? Both? Which sections of the hip? We even have not started on diagnosis. Price transparency is only useful when one knows exactly what is needed. You pretty much have to be a doctor to shop prices unless you're doing an elective surgery where time is on your side and you can do some research as you wait and shop. I'm not sure anyone's doing price comparison when their wife's on the delivery table and has just had some complications.
vangelis 6y ago
Another thing for readers to take note, what percentage of the billed amount does insurance actually pay? Would this continue to be an issue if insurance companies didn't try to negotiate down costs?
- subhobroto 6y ago
  > insurance companies didn't try to negotiate down costs? The ACA forced insurance companies to pay out 80% of their revenues in care costs or refund premiums or pay penalties. Said differently, under the current ACA rules, insurance companies have 0 incentive to negotiate costs down. They won't get any return on that effort. It's less effort denying claims and narrowing networks so as to ration access naturally.
orange_fritter 6y ago
I agree that price regulation would be a great step. But if the patient's cost is constrained to $150, the government is not only regulating price, but taxes are probably subsidizing a portion of the cost. This basically brings us back to single payer.
- subhobroto 6y ago
  > taxes are probably subsidizing a portion of the cost If you forced a business to provide a certain service at $150 vs. not provide it at all, you will be surprised how innovative that business could become in providing the service at $150 A lot of doctors, right here in California see patients for $50 cash - no subsidies, no pro bono, no nothing, so $150 for an office visit does not sound unreasonable. Maybe the lounge music, the sodas, the Himalayan salt lamps, heated seats will have to go.

oblongx 6y ago

First step was making sure you can actually get quoted a price for that service. I might choose to go across town if it saved me $40K. https://www.npr.org/sections/health-shots/2019/06/24/735432387/trump-administration-pushes-to-make-health-care-pricing-more-transparent https://www.npr.org/sections/health-shots/2019/06/24/7354323...

subhobroto 6y ago
> actually get quoted a price for that service. I might choose to go across town if it saved me $40K I have been working as a software consultant for decades now and always have a menu price ready. Even with this menu pricing, my customers still need my help in figuring out what they need from the menu. If my customers already knew what they needed to solve their problems, I have 0 value to add as a consultant - at that point, they just need to either hire staff/developers to execute on their requirements. If I broke my hip today, how exactly would a menu of hip related items help me compare costs? How would I even begin to know which items from the menu apply to my situation without having some idea what is involved in fixing a broken hip? Do I need a MRI? XRay? Both? Which sections of the hip? We even have not started on diagnosis. Price transparency is only useful when one knows exactly what is needed. You pretty much have to be a doctor to shop prices unless you're doing an elective surgery where time is on your side and you can do some research as you wait and shop. I'm not sure anyone's doing price comparison when their wife's on the delivery table and has just had some complications.

vangelis 6y ago

Another thing for readers to take note, what percentage of the billed amount does insurance actually pay? Would this continue to be an issue if insurance companies didn't try to negotiate down costs?

subhobroto 6y ago
> insurance companies didn't try to negotiate down costs? The ACA forced insurance companies to pay out 80% of their revenues in care costs or refund premiums or pay penalties. Said differently, under the current ACA rules, insurance companies have 0 incentive to negotiate costs down. They won't get any return on that effort. It's less effort denying claims and narrowing networks so as to ration access naturally.

orange_fritter 6y ago

I agree that price regulation would be a great step. But if the patient's cost is constrained to $150, the government is not only regulating price, but taxes are probably subsidizing a portion of the cost. This basically brings us back to single payer.

subhobroto 6y ago
> taxes are probably subsidizing a portion of the cost If you forced a business to provide a certain service at $150 vs. not provide it at all, you will be surprised how innovative that business could become in providing the service at $150 A lot of doctors, right here in California see patients for $50 cash - no subsidies, no pro bono, no nothing, so $150 for an office visit does not sound unreasonable. Maybe the lounge music, the sodas, the Himalayan salt lamps, heated seats will have to go.