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> and the government is the one negotiating the prices Where can I read about this? It runs counter to what you typically hear about how healthcare pricing wor

> and the government is the one negotiating the prices Where can I read about this? It runs counter to what you typically hear about how healthcare pricing works. The government also pays costs that I don't think private insurers need to worry about. For example, if you can't pay, you don't have private insurance, so private insurers don't really need to worry about paying for the long term care of people in nursing homes. I also imagine that the elderly and poor are more likely to require expensive care than the population covered by private insurers in general. Especially since private insurers will happily say "no!" to customers that are not profitable. So I'm not convinced that being "the majority of spending" is the same thing as being irresponsible with the money. I will also point out the private insurance on this document is a plurality of spending and makes up most of the administrative cost (complete waste, on other words).

lotsofpulp 5y ago
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-physician-payment-schedules https://www.ama-assn.org/practice-management/medicare-medica... https://www.ama-assn.org/about/rvs-update-committee-ruc/rbrvs-overview https://www.ama-assn.org/about/rvs-update-committee-ruc/rbrv... https://healthinformatics.uic.edu/blog/what-is-healthcare-reimbursement/ https://healthinformatics.uic.edu/blog/what-is-healthcare-re... https://www.mcknights.com/blogs/guest-columns/understanding-medicaid-reimbursement/ https://www.mcknights.com/blogs/guest-columns/understanding-... >The government also pays costs that I don't think private insurers need to worry about. For example, if you can't pay, you don't have private insurance, so private insurers don't really need to worry about paying for the long term care of people in nursing homes. I also imagine that the elderly and poor are more likely to require expensive care than the population covered by private insurers in general. This does not seem relevant to a discussion about government being a party in the price negotiations for healthcare services. >Especially since private insurers will happily say "no!" to customers that are not profitable. Health insurers have been forced to offer coverage to anyone under age 65 since ACA was passed in 2010. >So I'm not convinced that being "the majority of spending" is the same thing as being irresponsible with the money. I do not think anyone claimed this in this discussion. >I will also point out the private insurance on this document is a plurality of spending and makes up most of the administrative cost (complete waste, on other words). The insurance portion of the business (forecasting expenses, calculating premiums, other insurance business functions) are only a waste if you are starting with the assumption that the system should be completely taxpayer funded healthcare for everyone. The managed care portion where doctors/pharmacists double check claims and monitor for waste/fraud would have to happen in a taxpayer funded healthcare too. Although it being replicated across multiple managed care organizations could be classified as waste.
- DangitBobby 5y ago
  > This does not seem relevant to a discussion about government being a party in the price negotiations for healthcare services. My apologies, I thought you were implying with a cost breakdown that the government was working with an advantage since they set prices and somehow end up paying more (meaning the government is doing a worse job than private insurers on cost metrics), especially since your cost breakdown was in response to a comment about how government intervention is needed to bring down costs. I was trying to explain how that doesn't mean government as a single payer would necessarily be more expensive. I'm glad that's not what you were trying to say. > Health insurers have been forced to offer coverage to anyone under age 65 since ACA was passed in 2010. And the government compensates them for the additional costs this incurs, yes? I will admit that the ACA has muddied the waters of this conversation. > are only a waste if you are starting with the assumption that the system should be completely taxpayer funded healthcare for everyone There's not really any other way to look at it? If it doesn't have to exist, it's waste. Both systems will generate waste, one will generate more. I think we disagree on which one, but now I'm not sure because apparently we disagree on what's even relevant to the discussion. Maybe let's take a step back. What is the takeaway you want people to have after reading the cost breakdown you shared?
  - lotsofpulp 5y ago
    >especially since your cost breakdown was in response to a comment about how government intervention is needed to bring down costs. I was trying to explain how that doesn't mean government as a single payer would necessarily be more expensive. I'm glad that's not what you were trying to say. The link I shared was to show that the government is already intervening in the market by paying for over half of all healthcare and paying at least 45% of people. >And the government compensates them for the additional costs this incurs, yes? I will admit that the ACA has muddied the waters of this conversation. Technically, yes, but not directly. All other insurance subscribers compensate for the additional costs from increased premiums. But the government does provide subsidies to lower income people to pay for those premiums. But without the subsidies and the lower income people purchasing the insurance, the system would still result in the other insurance subscribers paying higher premiums to subsidize the costlier insurance subscribers, just like in any other insurance pool. >I think we disagree on which one, but now I'm not sure because apparently we disagree on what's even relevant to the discussion. Maybe let's take a step back. What is the takeaway you want people to have after reading the cost breakdown you shared? That the government is already heavily involved in price negotiations for healthcare in the US. Therefore the problem cannot be due to private insurers. I point out in another comment in this thread that I think this is all due to politics, and being able to disguise who is getting what portion of the limited supply of healthcare there is relative to the demand. The lack of political support for broad access to healthcare for everyone, and the incentive for certain tribes to ensure their fellow tribe members are prioritized in receiving a greater than equal allocation of the available healthcare is what would have to be addressed (which is a very hairy problem, and is going to veer into classism, ageism, and racism).

lotsofpulp 5y ago

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-physician-payment-schedules https://www.ama-assn.org/practice-management/medicare-medica... https://www.ama-assn.org/about/rvs-update-committee-ruc/rbrvs-overview https://www.ama-assn.org/about/rvs-update-committee-ruc/rbrv... https://healthinformatics.uic.edu/blog/what-is-healthcare-reimbursement/ https://healthinformatics.uic.edu/blog/what-is-healthcare-re... https://www.mcknights.com/blogs/guest-columns/understanding-medicaid-reimbursement/ https://www.mcknights.com/blogs/guest-columns/understanding-... >The government also pays costs that I don't think private insurers need to worry about. For example, if you can't pay, you don't have private insurance, so private insurers don't really need to worry about paying for the long term care of people in nursing homes. I also imagine that the elderly and poor are more likely to require expensive care than the population covered by private insurers in general. This does not seem relevant to a discussion about government being a party in the price negotiations for healthcare services. >Especially since private insurers will happily say "no!" to customers that are not profitable. Health insurers have been forced to offer coverage to anyone under age 65 since ACA was passed in 2010. >So I'm not convinced that being "the majority of spending" is the same thing as being irresponsible with the money. I do not think anyone claimed this in this discussion. >I will also point out the private insurance on this document is a plurality of spending and makes up most of the administrative cost (complete waste, on other words). The insurance portion of the business (forecasting expenses, calculating premiums, other insurance business functions) are only a waste if you are starting with the assumption that the system should be completely taxpayer funded healthcare for everyone. The managed care portion where doctors/pharmacists double check claims and monitor for waste/fraud would have to happen in a taxpayer funded healthcare too. Although it being replicated across multiple managed care organizations could be classified as waste.

DangitBobby 5y ago
> This does not seem relevant to a discussion about government being a party in the price negotiations for healthcare services. My apologies, I thought you were implying with a cost breakdown that the government was working with an advantage since they set prices and somehow end up paying more (meaning the government is doing a worse job than private insurers on cost metrics), especially since your cost breakdown was in response to a comment about how government intervention is needed to bring down costs. I was trying to explain how that doesn't mean government as a single payer would necessarily be more expensive. I'm glad that's not what you were trying to say. > Health insurers have been forced to offer coverage to anyone under age 65 since ACA was passed in 2010. And the government compensates them for the additional costs this incurs, yes? I will admit that the ACA has muddied the waters of this conversation. > are only a waste if you are starting with the assumption that the system should be completely taxpayer funded healthcare for everyone There's not really any other way to look at it? If it doesn't have to exist, it's waste. Both systems will generate waste, one will generate more. I think we disagree on which one, but now I'm not sure because apparently we disagree on what's even relevant to the discussion. Maybe let's take a step back. What is the takeaway you want people to have after reading the cost breakdown you shared?
- lotsofpulp 5y ago
  >especially since your cost breakdown was in response to a comment about how government intervention is needed to bring down costs. I was trying to explain how that doesn't mean government as a single payer would necessarily be more expensive. I'm glad that's not what you were trying to say. The link I shared was to show that the government is already intervening in the market by paying for over half of all healthcare and paying at least 45% of people. >And the government compensates them for the additional costs this incurs, yes? I will admit that the ACA has muddied the waters of this conversation. Technically, yes, but not directly. All other insurance subscribers compensate for the additional costs from increased premiums. But the government does provide subsidies to lower income people to pay for those premiums. But without the subsidies and the lower income people purchasing the insurance, the system would still result in the other insurance subscribers paying higher premiums to subsidize the costlier insurance subscribers, just like in any other insurance pool. >I think we disagree on which one, but now I'm not sure because apparently we disagree on what's even relevant to the discussion. Maybe let's take a step back. What is the takeaway you want people to have after reading the cost breakdown you shared? That the government is already heavily involved in price negotiations for healthcare in the US. Therefore the problem cannot be due to private insurers. I point out in another comment in this thread that I think this is all due to politics, and being able to disguise who is getting what portion of the limited supply of healthcare there is relative to the demand. The lack of political support for broad access to healthcare for everyone, and the incentive for certain tribes to ensure their fellow tribe members are prioritized in receiving a greater than equal allocation of the available healthcare is what would have to be addressed (which is a very hairy problem, and is going to veer into classism, ageism, and racism).