4 ms·

We also need to start acknowledging most medical care is urgent and not a choice. Happy to see some movement on at least price transparency though.

by diob 4y ago

Eleison23 4y ago
mwerd 4y ago
Sure, that makes sense. We should also acknowledge that it costs money to deliver and we live in a resource constrained world.
- EMIRELADERO 4y ago
  That doesn't seem to have stopped most other countries from having free or near-free healthcare. You shouldn't even have to think about money when dealing with hospitals.
  - gwright 4y ago
    This language isn't very helpful. It is likely paid for from general tax revenue. That might be a better implementation but it certainly isn't "free". And if it isn't explicitly paid for via tax revenue it will end up being paid for via inflation if the government spending is out of line with its revenue.
    - EMIRELADERO 4y ago
      By "free" I meant "free at the time of treatment". Of course nothing is free. Traffic lights aren't free. Road maintenance isn't free.
      - gwright 4y ago
        Many people really don't connect the dots between tax policies and health care insurance/payment policies. Saying that health care/insurance is "free" makes it difficult to have a coherent policy discussion. I know the ship has sailed on this but it I continue to see people truly believe that they are not paying for health care and that sort of misguided understanding of economics shouldn't be encouraged as it makes it difficult to have coherent discussions about many different public policies. College education should be free... College loans should be free (even when they weren't when the loan was taken out)... Income should be free (UBI schemes)... If you switch to "subsidized" from "free" the list expands exponentially.
    - olddustytrail 4y ago
      The language is fine because that's what the word "free" means. Do you complain that a cloud provider's free tier isn't really free because it's paid for by other customers? It seems it's only with healthcare people forget the meaning of the word.
  - coredog64 4y ago
    As is common in these discussions, I’ll reference the French system as I experienced it. If you have to go to the hospital, that’s not billed to you. If you see your GP, they charge you up front. There’s no copay as in the US system, the doctor just charges what they want. The doctor doesn’t keep any significant medicine on prem. If you need a vaccine, they write a script that you take to the pharmacy and return with. In either case, you submit your paperwork after the fact and get reimbursed. For office visits it’s 80% of the “reasonable and customary” changes. For medicine it’s usually 50-60%. You can purchase additional insurance that covers more of these costs, but I didn’t see any value in it for my situation. When I left, French insurance companies were setting up US style networks with doctors. If you saw an in-network provider, you were reimbursed more. Only the truly indigent get “free” healthcare under the French system.
- ealexhudson 4y ago
  The cost of the thing is effectively irrelevant if you both need it and don't get the bills for weeks/months. If patients are expected to self-ration, they need the info up front...
- maxerickson 4y ago
  Government restricts the resources available for health care with the idea that it costs to much to have extra. So my local hospital just does whatever and charges Medicare their CAH rates, doesn't matter a lot if they suck or could be cheaper, no one else can open a hospital (both by state law and because Medicare probably wouldn't agree to pay them).
nickff 4y ago
Is most medical care urgent? I dislike asking for citations, but that is quite the claim! Are you saying the majority of patient-practitioner encounters are emergency visits, or that the majority of spending is on emergency care, or something else?
- yamtaddle 4y ago
  I'd expect the majority of people's encounters with big medical bills from hospitals before old age are either emergency, or childbirth related, so those are the two things you'll see young and middle-aged people complain about. But the biggest bills are probably near end-of-life, and mostly not emergency care.
adam_arthur 4y ago
Most medical care is not urgent. In fact, emergency care is a tiny fraction of all medical spending. Thus the ability to "shop around" and thus subjectivity of medical care to price competition definitely exists in the majority of cases. If the system were setup to incentivize and support this. But due to lack of price transparency and skin in the game, there is no competitive pressure on pricing in practice. https://www.politifact.com/factchecks/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/#:~:text=Emergency%20rooms%20account%20for%20%222,of%20all%20health%20care%20spending.%22 https://www.politifact.com/factchecks/2013/oct/28/nick-gille...
- three_seagrass 4y ago
  Your link doesn't support your claim about shopping around. Most health insured patients can "shop around" in their network, which is a list of pre-negotiated priced providers that the insurance company has approved. Providers that are already vetted to be the lower cost for insurance, created through purchase power. And that's assuming it isn't an HMO, for which there is no shopping around. There are not enough options for real market competition in healthcare.
  - adam_arthur 4y ago
    My comment's point was that it's theoretically possible for healthcare to allow for shopping around, but in practice it's not. Due to lack of price transparency and lack of incentives for consumers to care (max out of pocket)
    - diob 4y ago
      I love how we go to theory instead of looking at other nations where healthcare works, like Australia. American exceptionalism at it's finest.
      - adam_arthur 4y ago
        America didn’t become great by copying Europe. Or Australia. There are obvious flaws in the healthcare system that are apparent from first principles. No need to blindly copy others. Removing incentives for people to use the system efficiently leads to poor outcomes in different ways

We also need to start acknowledging most medical care is urgent and not a choice. Happy to see some movement on at least price transparency though.

by diob 4y ago

We also need to start acknowledging most medical care is urgent and not a choice. Happy to see some movement on at least price transparency though.

Eleison23 4y ago

mwerd 4y ago

Sure, that makes sense. We should also acknowledge that it costs money to deliver and we live in a resource constrained world.

EMIRELADERO 4y ago
That doesn't seem to have stopped most other countries from having free or near-free healthcare. You shouldn't even have to think about money when dealing with hospitals.
- gwright 4y ago
  This language isn't very helpful. It is likely paid for from general tax revenue. That might be a better implementation but it certainly isn't "free". And if it isn't explicitly paid for via tax revenue it will end up being paid for via inflation if the government spending is out of line with its revenue.
  - EMIRELADERO 4y ago
    By "free" I meant "free at the time of treatment". Of course nothing is free. Traffic lights aren't free. Road maintenance isn't free.
    - gwright 4y ago
      Many people really don't connect the dots between tax policies and health care insurance/payment policies. Saying that health care/insurance is "free" makes it difficult to have a coherent policy discussion. I know the ship has sailed on this but it I continue to see people truly believe that they are not paying for health care and that sort of misguided understanding of economics shouldn't be encouraged as it makes it difficult to have coherent discussions about many different public policies. College education should be free... College loans should be free (even when they weren't when the loan was taken out)... Income should be free (UBI schemes)... If you switch to "subsidized" from "free" the list expands exponentially.
  - olddustytrail 4y ago
    The language is fine because that's what the word "free" means. Do you complain that a cloud provider's free tier isn't really free because it's paid for by other customers? It seems it's only with healthcare people forget the meaning of the word.
- coredog64 4y ago
  As is common in these discussions, I’ll reference the French system as I experienced it. If you have to go to the hospital, that’s not billed to you. If you see your GP, they charge you up front. There’s no copay as in the US system, the doctor just charges what they want. The doctor doesn’t keep any significant medicine on prem. If you need a vaccine, they write a script that you take to the pharmacy and return with. In either case, you submit your paperwork after the fact and get reimbursed. For office visits it’s 80% of the “reasonable and customary” changes. For medicine it’s usually 50-60%. You can purchase additional insurance that covers more of these costs, but I didn’t see any value in it for my situation. When I left, French insurance companies were setting up US style networks with doctors. If you saw an in-network provider, you were reimbursed more. Only the truly indigent get “free” healthcare under the French system.
ealexhudson 4y ago
The cost of the thing is effectively irrelevant if you both need it and don't get the bills for weeks/months. If patients are expected to self-ration, they need the info up front...
maxerickson 4y ago
Government restricts the resources available for health care with the idea that it costs to much to have extra. So my local hospital just does whatever and charges Medicare their CAH rates, doesn't matter a lot if they suck or could be cheaper, no one else can open a hospital (both by state law and because Medicare probably wouldn't agree to pay them).

nickff 4y ago

Is most medical care urgent? I dislike asking for citations, but that is quite the claim! Are you saying the majority of patient-practitioner encounters are emergency visits, or that the majority of spending is on emergency care, or something else?

yamtaddle 4y ago
I'd expect the majority of people's encounters with big medical bills from hospitals before old age are either emergency, or childbirth related, so those are the two things you'll see young and middle-aged people complain about. But the biggest bills are probably near end-of-life, and mostly not emergency care.

adam_arthur 4y ago

Most medical care is not urgent. In fact, emergency care is a tiny fraction of all medical spending. Thus the ability to "shop around" and thus subjectivity of medical care to price competition definitely exists in the majority of cases. If the system were setup to incentivize and support this. But due to lack of price transparency and skin in the game, there is no competitive pressure on pricing in practice. https://www.politifact.com/factchecks/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/#:~:text=Emergency%20rooms%20account%20for%20%222,of%20all%20health%20care%20spending.%22 https://www.politifact.com/factchecks/2013/oct/28/nick-gille...

three_seagrass 4y ago
Your link doesn't support your claim about shopping around. Most health insured patients can "shop around" in their network, which is a list of pre-negotiated priced providers that the insurance company has approved. Providers that are already vetted to be the lower cost for insurance, created through purchase power. And that's assuming it isn't an HMO, for which there is no shopping around. There are not enough options for real market competition in healthcare.
- adam_arthur 4y ago
  My comment's point was that it's theoretically possible for healthcare to allow for shopping around, but in practice it's not. Due to lack of price transparency and lack of incentives for consumers to care (max out of pocket)
  - diob 4y ago
    I love how we go to theory instead of looking at other nations where healthcare works, like Australia. American exceptionalism at it's finest.
    - adam_arthur 4y ago
      America didn’t become great by copying Europe. Or Australia. There are obvious flaws in the healthcare system that are apparent from first principles. No need to blindly copy others. Removing incentives for people to use the system efficiently leads to poor outcomes in different ways