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No price transparency, no ability to choose between doctors, your job decides your insurance. There is no room for a market to function in our health system. W
by Taek 6y ago
No price transparency, no ability to choose between doctors, your job decides your insurance.
There is no room for a market to function in our health system. With no ability for consumers to move around or even see the differences between different providers, prices will naturally go up, and there will be no pressure to improve care.
- teucris 6y agoI haven’t done a ton of research - do you know of any big healthcare bills have been proposed that resolve these issues?
- pm90 6y agoMedicare for all
- rolobio 6y agoI do not want my health insurance provided by the people that gave us the VA. Look at how "the best of us" are treated by the government when they're no longer needed. How will they treat me who never served them?
- ceejayoz 6y ago> I do not want my health insurance provided by the people that gave us the VA. I mean, those same folks give us Medicare, which is both quite popular with the public and gets better marks on results, cost, and efficiency than private healthcare. I see no evidence my insurance company cares about me any more than the VA cares about its patients. Does the VA have problems? Absolutely. Is "give up and give it to for-profit corporations" likely to fix that? Nope.
- refurb 6y agoI’m not sure being private is the issue. Medicare Part D (pharmacy) is entirely run by private insurers, Medicare just funds it. And Medicare Part C is a private insurer option, where again, Medicare just funds premiums. It’s how the system is set up that’s the issue, not whether it’s managed by the government or a private insurer.
- criddell 6y agoPrivate insurers have a profit motive which is hard to align with public interest. Do you know if Medicare Part D insurers are able to get drugs at a lower cost than the Canadian system does?
- refurb 6y agoPrivate insurers do have a profit motive, but with the right regulations, that can help, rather than the US system where it encourages more spending. There are plenty of countries with universal coverage that rely on private insurers - the difference is the system is set up to control costs while providing a pretty standard set of benefits and cost-sharing. So one reason why Medicare Part D works pretty well is because the private insurers do the negotiating on drug prices. I've read reports that they actually get better prices than for their private plans (there is a ton of competition for Medicare prescriptions). Are the prices lower than Canada? No, not generally. But they are some of the lowest prices in the US (excluding Medicaid which has a mandatory discount).
- amanaplanacanal 6y agoWould you settle for a public option? So then you could choose either private insurance or Medicare.
- qppo 6y agoThat's the beauty of medicare for all, you can still buy insurance on the private market if you want to. For what it's worth, Medicare itself already does a pretty good job being the single largest insurance provider in the United States. Comparison to the VA is not apt. It's not the same people, it's not even the same concept as M4A.
- wpurvis 6y agoThe VA isn't a great thing to compare medicare-for-all to. The VA's entire customer base has afflictions you just don't see in the general public. I'd compare M4A to Medicare/Medicaid, if you look at patient surveys they are much happier in general than people who have to deal with insurance companies.
- criddell 6y agoWe really should fix the VA though too.
- afarrell 6y agoYes. I do not know why Democrats block bills to fix the VA.
- deleted 6y ago[deleted]
- ssully 6y agoTried to find what you are talking about. Turned up a lot of political meme's basically saying vote for Trump, because democrats tried blocking the VA Mission Act. Looked up the actual vote counts and it passed successfully with strong bipartisan support in both the house and senate [1]. Are you referring to something else? [1]: https://www.congress.gov/bill/115th-congress/senate-bill/2372/actions https://www.congress.gov/bill/115th-congress/senate-bill/237...
- ceejayoz 6y agoIf you're referring to Veteran's Choice, while Trump repeatedly and falsely claims to have created it, it was passed into law and signed by Obama in 2014. https://www.cnn.com/2020/08/08/politics/trump-veterans-choice-paula-reid/index.html https://www.cnn.com/2020/08/08/politics/trump-veterans-choic...
- criddell 6y agoWhy do you think Canada and Japan and England and Australia can do so much better? We (Americans) debate universal care like it's some radical idea. We pretend that there aren't successful implementations with different configurations all over the world.
- Someone1234 6y agoThey're also the same people that brought us Medicare, and people eligible absolutely love Medicare. The VA's problems are in no small part because of the way it is structured (i.e. duplicate facilities, staff, low salaries, etc) and funded (combined with other military appropriations). If VA benefits were provided via Medicare it would have a structurally better system.
- quicklyfrozen 6y agoMy father received good treatment from the VA, from bypass surgery to treatments for various complications from diabetes to a long recovery period from a stroke. So the whole system isn't broken. I'd be happy with that level of care compared to what's currently available for everyone, which is none.
- triceratops 6y agoIt doesn't have to be administered by the federal government. Every state can set up and administer its own system, like Canada does.
- pgrote 6y agoFor those unfamiliar, this was the last bill introduced. https://www.congress.gov/bill/116th-congress/senate-bill/1129/text https://www.congress.gov/bill/116th-congress/senate-bill/112...
- fwip 6y agohttps://www.congress.gov/bill/116th-congress/senate-bill/1129/text https://www.congress.gov/bill/116th-congress/senate-bill/112... is a pretty good one.
- robotnikman 6y agoLatest Action: Senate - 04/10/2019 Read twice and referred to the Committee on Finance I wonder what that means. I really hope something like this passes at some point.
- teucris 6y agoThanks. The comment I replied to seemed to be lamenting issues with an open market insurance system, which to my knowledge, Medicare for All is not. Am I missing something?
- fwip 6y agoIt is my opinion that the simplest way to fix the ills caused by an open market insurance system is to abolish it and replace it with single-payer healthcare.
- rolobio 6y agoI can't think of any other business that can get away with not even giving you a ball-park estimate on costs. If my car breaks down, my mechanic will at least give me an estimate within a hundred bucks or so. But a hospital has no idea what it will cost (and neither does insurance) until they finally negotiate that specific case. Another issue is that insurance does not have to compete across state lines. They've divvied up the country and are sticking to their corners (much like ISPs). Insurance should be required to accept customers from anywhere in the country. Hospitals should be required to publish prices. These seem like no-brainers to me. But hospitals and insurance make too much money, and give too much of it to congress for any real change.
- dbbk 6y agoWhy should a hospital have a price list? Does the fire department? The police?
- bjtitus 6y agoBoth public services which don’t directly bill you. Maybe something like a public health system is a good idea...
- exolymph 6y agoHospitals are not particularly equivalent to fire departments or the police, since the latter two are paid for by taxes. Some hospitals definitely do get some money from taxes, but as far as I know that isn't the norm.
- dbbk 6y agoThis is my point... it should be a public service paid for by tax.
- rolobio 6y agoThey do have a price list. I receive it every year as my property taxes.
- 6y ago
- metalliqaz 6y agoI would go further to say that what we have in the US doesn't even meet the minimum definition to be called a market. In addition to what you cited there is also massive regulation which can't be removed due to the nature of medicine, there is massive information asymmetry between patients and everyone else, and, oh yeah, the fact that a sick or injured person can't "shop around". It's insane. When my wife was in the hospital for days after a C-section, we were entirely at their mercy. They could add anything they wanted to our bill and we had no idea if it was justified or not. At the base of this pile of bullshit are simple, incontrovertible facts: Health providers make money when their customers are unwell. Insurance providers make money when they don't deal with the most vulnerable people. Employers only care as far as keeping their employees able to return value.
- piva00 6y agoMaybe all of that says that healthcare can't be a market. Due to its very nature it's not suited to fit in a market model. I don't understand why the USA is so adamant to see that forcing market solutions to every societal demand or problem might not be good a thing. To see that this ideology has had time enough to prove itself in the real world and has been found lacking. We need something different. Accepting that there are no absolutes and that perhaps some things shouldn't be market-based doesn't sound too revolutionary for a start...
- metalliqaz 6y agoThere are markets that can work in healthcare, but my point is that individual patients CANNOT partake, they don't have the information, power, or even agency (ie. currently bleeding to death). There could be a market of providers to payers, but again, care must be taken to ensure the interests of the payers aligns with the interests of the patients.
- ritchiea 6y agoIs there a country where market based health insurance works? Specifically where it works without there also being a strong public health insurance option. For instance in Germany you are required to be insured and as a young healthy person you can save money by choosing a private option. But eventually as you get older your insurance costs will go up. So most people choose and are extremely happy with the public option TK. A private health insurance marketplace seems like the type of industry ripe to take advantage of consumers. And what if the health insurers in the market conspire to fix prices? The government or a class action suit could fight against it but that's the type of corrupt business practice at large that could take over a decade to correct.
- lotsofpulp 6y agoSwitzerland I think, but only from stories I’ve heard.
- nitwit005 6y agoI'm not sure you can consider the US "market based" anymore, given that the government is paying for most of it: https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2015.302997 https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2015... I don't know what to even call it. A bizarrely paid for fragmented national health system with a goofy market component?