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I'm wondering what it will take to stop this, it's basically institutionalized loan sharking across a giant chunk of the economy critical to society. The entire

• poidos 5y ago
  Either socialized or nationalized medicine. Removing the insurance companies entirely removes the price-gouging they do from the equation. On the non-insurance front, every hospital and care provider is then required to either - negotiate with the government on prices, or - work for the government, charging their rates.
  • dontcare007 5y ago
    And then waste and graft moves from a semi-accountable company to a group that has the use of force to enforce their policies. No thanks.
    • jatone 5y ago
      the fact you think insurance companies are accountable is laughable. last I checked I never could decide on what insurance provider my employer offered. I see no difference between private insurance and government run except the government is constantly lambasted for overspending and medicare seems to have the lowest operating costs and payouts to healthcare providers. which seems to be the exact metric you want. edit: just move to a public option system and watch shit hit the fan in the market.
      • handrous 5y ago
        > I see no difference between private insurance and government run except the government is constantly lambasted for overspending and medicare seems to have the lowest operating costs and payouts to healthcare providers. Contrary to popular understanding, relatively low (sometimes impressively low) overhead & even fraud rates is the norm for US government social programs. This is one case where pop-culture "common knowledge" diverges wildly from reality.
        • jatone 5y ago
          Indeed!
      • throwaway0a5e 5y ago
        >the fact you think insurance companies are accountable is laughable. Accountable is obviously relative. BigCo at least wants one thing you know about, money, and that makes them far less capricious and far easier to deal with than government where you don't know any of the incentives that the people who (with several layers of indirection) set the KPIs for the person you are actually dealing with. As evil as they are I'll take Comcast over some random state org any day. Having a public option as a backstop would probably be good but I don't think I want a public option that covers routine stuff, GP visits, a broken bone. Stuff with a well bounded upper limit like that tends to be handled well by private insurance so long as there's competition (see auto insurance for example).
        • jatone 5y ago
          then you're ideological driven instead of results driven.
  • user1980 5y ago
    I live in Saskatoon, Saskatchewan, Canada. If I want to find a family doctor, there is a list of 3 clinics with doctors taking patients, in a metro area of 325,000. Older people have "the good doctors" and those doctors aren't taking on new patients. Waiting lists for specialists are ridiculous, unless it's something extremely urgent. It quickly becomes about "who you know" and queues can be jumped if you have the inside track. I've never been encouraged or "nudged" to get a physical or even blood work done. Quite frankly, the system is under so much strain that getting everyone a physical would push it over the brink. So they mandate them for commercial drivers and other high-risk occupations, and everyone else just goes to medi-clinics and sees a walk-in doctor. Zero continuity of care. Canada is great at treating the dying, terrible at treating the healthy. I'm self-employed. Dental, prescription drugs, glasses, mental health: this is all out of pocket. My impression is that if you have a reasonably good job in the United States, you have access to reasonable health care. Is that a fair assessment?
• _jal 5y ago
  > I'm wondering what it will take to stop this Single payer.
  • tastyfreeze 5y ago
    Single payer is not really a solution to the healthcare cost problem. All it does is give government more power that it doesn't have Constitional authorization to posses. A real solution to healthcare cost is making healthcare a functioning market where the buyer knows prices before they purchase.
    • paxys 5y ago
      A free market solution will never work in healthcare because neither side has the ability to say no and walk away when they can't come to an agreement on price. A consumer cannot price shop and delay an appointment or procedure when it is a matter of life and death. A hospital or insurance company cannot say no to someone who they are 100% sure will never be able to pay the bill.
      • tastyfreeze 5y ago
        That is what insurance is supposed to be for. Medical insurance should be more like home or auto insurance. My home and auto policies do not cover maintenance and improvement but they do cover rare catastrophic events. My medical insurance covers every damn thing that has to do with medicine. If I go to the doctor for an annual check up there is no reason that insurance should be involved as that is a regular and elective cost. If I break my arm that is unexpected and probably costly so I would have insurance to cover something like that. Insurance is for uncommon events that you have little to no control over. The policy you choose should reflect how you want to mitigate your own risk of uncommon events happening.
        • paxys 5y ago
          Insurance companies actually want to pay for your regular, non-emergency medical costs because it is way cheaper for them to do so vs letting conditions go undetected and then paying orders of magnitudes more for surgeries, prescriptions and expert visits. Your annual checkup visits aren't what is causing ballooning healthcare costs, but actually lowering them.
• jedberg 5y ago
  Most countries solve this by requiring hospitals to be non-profits and making insurance non-existent or also non-profit.
  • ceejayoz 5y ago
    Non-profit doesn't mean you can't make a profit, just that you can't distribute it to shareholders. Big salaries, perks, and bonuses to executives is just fine.
    • jedberg 5y ago
      They usually tie it to caps on executive salary and bonus, but even without it's still better than for-profit.
      • whatthesmack 5y ago
        Why is it better? Non-profits don't have the efficiency incentive that for-profits do, as far as I understand it. I've read a few things that indicate non-profit hospitals are full of fiscal bloat, because there's no incentive to act otherwise. On mobile now, but can search for a few sources.
        • ceejayoz 5y ago
          > Non-profits don't have the efficiency incentive that for-profits do, as far as I understand it. Sure they do. They have revenue and expenses to manage just like a for-profit business does. > I've read a few things that indicate non-profit hospitals are full of fiscal bloat, because there's no incentive to act otherwise. This is not unique to non-profit ones.
  • jdminhbg 5y ago
    More than half of US hospitals are non-profits, and Obamacare capped the profit % for insurance companies.
    • 5y ago
• tastyfreeze 5y ago
  The normal market pricing feedback that is present in other markets is broken in medical markets. This is mostly because prices aren't known and the recipient of services often isn't directly the payer. Publishing prices so people can shop around like any other product is a good starting point. Hospitals do not have to compete on price because insurance covers it in most cases and in many places they have a local monopoly. Also the more people pay out of pocket for medical the more they care about what the price is.
• willcipriano 5y ago
  > And why aren't there startups out there coming to compete for this gigantic money pool by offering a mere 400% markup? Regulation. If you wanted to start a service that drives elderly patients to get their medicine, in some justictions you need the permission of the local ambulance company to make sure you don't cut into their profits. This process is called a certificate of need[0] and if you dont have one, you can't operate. It's like this with virtually everything medical related. If you try to compete they have ways to shut you down or stop you from starting all together. [0]https://www.usnews.com/news/best-states/articles/2021-07-09/on-the-heels-of-the-pandemic-states-should-get-rid-of-certificate-of-need-laws https://www.usnews.com/news/best-states/articles/2021-07-09/... See also: Controlling the supply of doctors by limiting residency slots (https://www.aamc.org/news-insights/medical-school-enrollments-grow-residency-slots-haven-t-kept-pace https://www.aamc.org/news-insights/medical-school-enrollment...) Banning the reimportation of drugs produced in the US back from Canada at lower prices. Keeping older, safe, and well known drugs behind the counter (albuterol is a good example) to drive office visits and keep pharmacy revenues up. In other countries you can just buy many common drugs like that over the counter, cheaply.
• handrous 5y ago
  The single tool that AFAIK every other advanced-economy state (OECD, if you like, but even some outside that) uses, despite all the different approaches in the wild, is: price controls. The more-free-market ones simply dictate prices on some things and services (with, for the more-free-market ones like Singapore, the very real implicit threat of dictating even more of them if the market gets too greedy, with the less-free-market ones dictating more prices from the outset), and at the less-free-market end of the spectrum you have state monopsony (single-payer) or even direct state control of healthcare service providers, so the price controls are more de facto. I'm not aware of a single system outside the US [EDIT: in a developed state, that is—I've not looked into developing-world systems] that doesn't achieve their results with price controls. Even the relatively "free market" ones—again, Singapore is usually the prime example people bring out for that, and they use some price controls and a very credible threat of further intervention to make their system work. Given this, I don't have much hope of success for any reform that doesn't either directly set at least some prices and threaten to set even more, or take even more control over price-setting (monopsony power, or nationalizing providers), given how universal that element seems to be.
  • SomewhatLikely 5y ago
    Are there any examples where a public option is available at a reasonable price so any private practices have to compete on price?
    • huitzitziltzin 5y ago
      Not exactly as you may be thinking, but in many countries there is a parallel, private health care sector. The fact that patients have the choice to go to the public sector instead of the private likely keeps prices in the private sector down, but if there is literature on the extent and magnitude of those effects, I’m not familiar with it. Mexico is an example of such a country.
    • handrous 5y ago
      None that I'm aware of. My guess would be that this is because if you do it poorly, it doesn't help a damn thing, and if you do it well, it's just single-payer with extra steps. This is because to do it right you'd effectively have to dictate that ~all providers take the public option insurance, and at that point you may as well do single-payer. Otherwise, there's no reason to expect a public option, as in just another insurer that happens to be government-run, would be able to compete when providers can just refuse to take them unless they raise compensation to roughly match everyone else. At best it would apply only light downward pressure on prices. There are some systems that have private (though, perhaps, non-profit only) insurance and a public insurer as a kind of public option, as an insurer of last resort, but they place all kinds of restrictions on this, like standardizing basic-coverage plans and dictating that all insurers offer them, mandating that providers all accept these plans (including the government one) and so on, and often still having other price controls on top of it.
• Jansen312 5y ago
  Same issue as college degree inflation. Clue : free money from Uncle Sam. At the end of the day, we all need to accept healthcare is never meant universal. It is limited just like a Gucci bag or a Ferrari. You can't make everyone have a Tesla, even if you try, the price will just go up. The only way to democratize the access it to build more and not to give more free money. If government build more hospitals, finance tons of MDs graduate, conduct all the pharmaceutical researches, hospital bills will reduce significantly. But alas, we all want coverage. We all believe every Tom Dick and Harry or Jane Jill or Jenny should be guaranteed with healthcare access. See Barry nonsense Barrycare. We all need to learn from handphone market. There will always be many tiers models to fit different budgets. We shouldn't restrict doctors and care only within USA. Let other countries healthcare acceptable to USA insurance and medicaid claims. If every handset is made in USA, sure Motorola will still be the Apple iPhone today. See when China able to crank out segway and phones cheaper, many gets to enjoyed it.
• 908B64B197 5y ago
  > And why aren't there startups out there coming to compete for this gigantic money pool by offering a mere 400% markup? You are thinking like someone from an industry that went from a $5,543 (2020 dollars) Apple ][ in 1977 to a $999 MacBook Air in 2021. That's all thanks to solid engineering, innovation and a competitive landscape. Now, for anything touching healthcare, you'll have to deal with The Cartel. You are going to get every legal challenge thrown at you by every instance of government (and The Cartel itself) before you can even think of helping your first patient. You'll basically need a member of The Cartel to vouch for you, or train as one. To even get a chance of getting in, you need to accumulate at least 6 figures of debts and try to squeeze in one of the limited spots The Cartel opens up for new recruits. Then, after about a decade of classes (4 of them completely useless to you) and a few years of pointless hazing, you'll be given the privilege to price gouge yourself. By then, I'm not so sure you'll want to democratize access, sadly.