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The biggest problem is not the lack of single payer, it's the lack of price transparency. You have no idea how much any medical service will cost until you get

The biggest problem is not the lack of single payer, it's the lack of price transparency. You have no idea how much any medical service will cost until you get the bill, so everyone is free to price gouge you. An example of how bad the current system is: When my wife was pregnant and needed an ultrasound, her regular doctor was busy one month and recommended we go to the doctor upstairs. Our regular doctor charged us $200 for the ultrasound, the one upstairs sent us a bill for $1000! This 5x price difference was in the exact same building, just a different floor! Hospitals benefit from keeping the prices obscure, to the detriment of the rest of the country

sova 6y ago
Price Transparency + State Insurance Provider that can negotiate rates like a regular insurance company but must insure everyone by default would solve a bulk of the problem, don't you think?
- InTheArena 6y ago
  You must get rid of a lot of the red tape as well. Take a look at the stupidity around getting a authorization to test for COVID19, and realize that this is not a aberration.
gnusty_gnurc 6y ago
We're trapped in a system of perverse incentives and third parties. FDR mandated wage freezes and price controls under WWII - so guess how employers bypass a wage freeze? Start offering health insurance! The government saw this and thought "gee, let's encourage this by offering lower taxes for employer expenses on health insurance." And so began the growth of a parasitic, complex industry that accomplishes so little at such a great expense.
pozdnyshev 6y ago
Actually you’re wrong it is the lack of single payer.
bgorman 6y ago
The problem is health care is nothing close to a free market. In many parts of the country, it is illegal to open up a new hospital without a government license. Existing hospitals often lobby to prevent competing hospitals from opening up.
- subhobroto 6y ago
  > The problem is health care is nothing close to a free market. It's not a problem, it's a feature. In free market health care, those who can't afford care, die. We as a society have agreed that's not acceptable and hence the regulations, EMTALA being one
  - randyrand 6y ago
    Grocery shopping and farming are very competitive and mostly free, yet we still have food stamps don't let people starve to death. Why not have a system closer to food stamps but for healthcare? i.e. the government will cover costs for the poor up to some amount.
    - subhobroto 6y ago
      > Why not have a system closer to food stamps but for healthcare? i.e. the government will cover costs for the poor up to some amount. We have exactly that. It's called Medicare + Medicaid. The govt fixes the price for what doctors/hospitals can charge on these plans and that's why doctors/hospitals absolutely hate Medicare + Medicaid. For Native Indians, we also have the Indian Health Services. For veterans, we have the VA. That said, you nor I would really enjoy being on a Medicare + Medicaid system. Having the govt. set rates, getting out of the way and leaving who and how that price gets paid provides the ultimate flexibility and value.
      - randyrand 6y ago
        Food stamps are much simpler than Medicare. It's basically just cash and you pay market rates for whatever you buy. It seems we are on the same page.
subhobroto 6y ago
> You have no idea how much any medical service will cost Let's assume that that problem was solved tomorrow. Thanks to that, you now know the regular doctor charges $20000 for the ultrasound while the one upstairs would charge you $100000. What would you do next? The issue in the U.S. is the $20000, $100000 fees that is normal here - NO ONE ELSE in the WORLD Pays those rates! It's the same process to get a ultrasound done in Mexico, India, London, Poland, California - yet the prices are out of what when you introduce the US. into the table of prices (I am only talking about imaging, which is a fairly mechanical and routine process - not reading/interpretation). Transparency seems like it will help, until you really think about it > it's the lack of price transparency I have been working as a software consultant for decades now and always have a menu price ready. The reason why I get referrals is because my menu price quote is very similar to what the client ends up paying in the end unless there is intense customization. Even with this menu pricing, my customers still need my help in figuring out what they need from the menu because they have a very vague idea of what the solution is going to look like. They kinda understand their problem, even hurt from it, but they don't know how to fix it properly. 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.
- ZainRiz 6y ago
  Good point, but this sounds like a solvable problem. You would a primary doctor (at a known rate) who would say "You need X, Y, and Z now" and then refer you to a reasonably priced location. He could do that because now even he can see the prices and that doctor doesn't have too much of an incentive to send you to be fleeced by someone else There are some details where this would need to be worked upon, but it sounds like the kind of thing the free market would figure out.
tibbydudeza 6y ago
Not the US but my daughter needed her wisdom teeth removed in hospital and since there was a co-pay involved I got a quote from him upfront. Obviously it won't work for non-elective surgery.

sova 6y ago

Price Transparency + State Insurance Provider that can negotiate rates like a regular insurance company but must insure everyone by default would solve a bulk of the problem, don't you think?

InTheArena 6y ago
You must get rid of a lot of the red tape as well. Take a look at the stupidity around getting a authorization to test for COVID19, and realize that this is not a aberration.

gnusty_gnurc 6y ago

We're trapped in a system of perverse incentives and third parties. FDR mandated wage freezes and price controls under WWII - so guess how employers bypass a wage freeze? Start offering health insurance! The government saw this and thought "gee, let's encourage this by offering lower taxes for employer expenses on health insurance." And so began the growth of a parasitic, complex industry that accomplishes so little at such a great expense.

pozdnyshev 6y ago

Actually you’re wrong it is the lack of single payer.

bgorman 6y ago

The problem is health care is nothing close to a free market. In many parts of the country, it is illegal to open up a new hospital without a government license. Existing hospitals often lobby to prevent competing hospitals from opening up.

subhobroto 6y ago
> The problem is health care is nothing close to a free market. It's not a problem, it's a feature. In free market health care, those who can't afford care, die. We as a society have agreed that's not acceptable and hence the regulations, EMTALA being one
- randyrand 6y ago
  Grocery shopping and farming are very competitive and mostly free, yet we still have food stamps don't let people starve to death. Why not have a system closer to food stamps but for healthcare? i.e. the government will cover costs for the poor up to some amount.
  - subhobroto 6y ago
    > Why not have a system closer to food stamps but for healthcare? i.e. the government will cover costs for the poor up to some amount. We have exactly that. It's called Medicare + Medicaid. The govt fixes the price for what doctors/hospitals can charge on these plans and that's why doctors/hospitals absolutely hate Medicare + Medicaid. For Native Indians, we also have the Indian Health Services. For veterans, we have the VA. That said, you nor I would really enjoy being on a Medicare + Medicaid system. Having the govt. set rates, getting out of the way and leaving who and how that price gets paid provides the ultimate flexibility and value.
    - randyrand 6y ago
      Food stamps are much simpler than Medicare. It's basically just cash and you pay market rates for whatever you buy. It seems we are on the same page.

subhobroto 6y ago

> You have no idea how much any medical service will cost Let's assume that that problem was solved tomorrow. Thanks to that, you now know the regular doctor charges $20000 for the ultrasound while the one upstairs would charge you $100000. What would you do next? The issue in the U.S. is the $20000, $100000 fees that is normal here - NO ONE ELSE in the WORLD Pays those rates! It's the same process to get a ultrasound done in Mexico, India, London, Poland, California - yet the prices are out of what when you introduce the US. into the table of prices (I am only talking about imaging, which is a fairly mechanical and routine process - not reading/interpretation). Transparency seems like it will help, until you really think about it > it's the lack of price transparency I have been working as a software consultant for decades now and always have a menu price ready. The reason why I get referrals is because my menu price quote is very similar to what the client ends up paying in the end unless there is intense customization. Even with this menu pricing, my customers still need my help in figuring out what they need from the menu because they have a very vague idea of what the solution is going to look like. They kinda understand their problem, even hurt from it, but they don't know how to fix it properly. 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.

ZainRiz 6y ago
Good point, but this sounds like a solvable problem. You would a primary doctor (at a known rate) who would say "You need X, Y, and Z now" and then refer you to a reasonably priced location. He could do that because now even he can see the prices and that doctor doesn't have too much of an incentive to send you to be fleeced by someone else There are some details where this would need to be worked upon, but it sounds like the kind of thing the free market would figure out.

tibbydudeza 6y ago

Not the US but my daughter needed her wisdom teeth removed in hospital and since there was a co-pay involved I got a quote from him upfront. Obviously it won't work for non-elective surgery.