3 ms·

I agree with your points, but I think there are narrower solutions. With respect to pricing, the problem seems to be the negotiations between hospitals and insu

by nickff 5y ago

I agree with your points, but I think there are narrower solutions. With respect to pricing, the problem seems to be the negotiations between hospitals and insurers, as well as hospitals' failures to institute cost-accounting. Forcing them to do better accounting, and have a clear price-list would probably help, but getting rid of the employer healthcare tax subsidy (or expanding it) would likely be a better solution. With respect to ER care, it does seem impossible to 'shop around', but these cases make up a minority of healthcare expenditures. Perhaps government should cover these cases (though this could have horrible incentive problems), or this type of insurance should be separated from the rest, and somehow priced clearly and in advance (according to level of care) by a cartel arrangement or state regulated rates.

jewayne 5y ago
> Forcing them to do better accounting, and have a clear price-list would probably help, but getting rid of the employer healthcare tax subsidy (or expanding it) would likely be a better solution. Believe it or not, it would be way easier politically to implement Medicare For All than to do piecemeal reforms.
- nickff 5y ago
  'Medicare for all' will cause a number of foreseeable and unforeseeable problems (and benefits). It would be interesting to see one or more states do it, and observe the results.
  - jewayne 5y ago
    I think the experience in Vermont suggests that it's unlikely to ever happen at the state level. It's far more likely to be a big bang at the national level.
  - dragonwriter 5y ago
    How can a state do universal single payer of its own design when there are multiple direct federal health care systems covering a substantial portion of the population, plus a huge tranch of the money states rely on for health care tied to a federal/state cooperative program with federal programmatic and eligibility constraints?
landryraccoon 5y ago
> though this could have horrible incentive problems I hear this argument, but I don't buy it. What's the incentive exactly? That people will hurt themselves, so they can go to the ER for free? That's nonsense. Nobody wants to get hurt, nobody wants to get sick, getting hurt or getting sick is not a good. The fact that they don't have to pay to "get hurt" isn't an incentive. Perhaps a few people feel this way and are insane, but those people probably need to get help at government expense either way, before the government ends up paying for them to be in prison or institutionalized anyway.

by nickff 5y ago

jewayne 5y ago

> Forcing them to do better accounting, and have a clear price-list would probably help, but getting rid of the employer healthcare tax subsidy (or expanding it) would likely be a better solution. Believe it or not, it would be way easier politically to implement Medicare For All than to do piecemeal reforms.

nickff 5y ago
'Medicare for all' will cause a number of foreseeable and unforeseeable problems (and benefits). It would be interesting to see one or more states do it, and observe the results.
- jewayne 5y ago
  I think the experience in Vermont suggests that it's unlikely to ever happen at the state level. It's far more likely to be a big bang at the national level.
- dragonwriter 5y ago
  How can a state do universal single payer of its own design when there are multiple direct federal health care systems covering a substantial portion of the population, plus a huge tranch of the money states rely on for health care tied to a federal/state cooperative program with federal programmatic and eligibility constraints?

landryraccoon 5y ago

> though this could have horrible incentive problems I hear this argument, but I don't buy it. What's the incentive exactly? That people will hurt themselves, so they can go to the ER for free? That's nonsense. Nobody wants to get hurt, nobody wants to get sick, getting hurt or getting sick is not a good. The fact that they don't have to pay to "get hurt" isn't an incentive. Perhaps a few people feel this way and are insane, but those people probably need to get help at government expense either way, before the government ends up paying for them to be in prison or institutionalized anyway.