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For context Telehealth via my workplace, with insurance "discount," costs $50 OOP. I've said it before, and I'll keep saying it: If the US insists on capitalis
by Someone1234 3y ago
For context Telehealth via my workplace, with insurance "discount," costs $50 OOP.
I've said it before, and I'll keep saying it: If the US insists on capitalist healthcare, they need to make two very specific changes to really have close to a free market system -
- Insurance discounts are banned including to Medicare and Medicaid. Everyone pays the same "cash price" (i.e. one price) and then insurance reimburse it to the patient rather than talking with medical providers at all. You get the bill, pay cash, or get insurance reimbursement, but the price is the price. There is nothing limiting your insurance company for providing tools, advice, and technology to find the most cost-effective and beneficial healthcare. But you're both working together on the same "side." The patient is the king-maker, you decide utlimately.
- Employer provided insurance is banned. Everyone, from congress through Walmart cashier buys it on an open exchange creating larger fairer pools that allows people to pick bespoke insurance based on their personal needs and finances. It also forces real competition, not for employer contracts on behalf of their employees, but for individuals and what they want/need/prioritize. It increases social mobility because you can leave one job and go to another without losing your insurance. Making insurance premiums tax-free is an easy problem to solve (we almost have the tools today).
The US either needs to lean out of capitalist healthcare completely (e.g. socialist healthcare, like Canada or multi-EU countries) or they need to lean into it. You cannot do this silly and destructive middle ground wherein people cannot pick their services, providers, or insurance then expect the "market" to be rational.
- ethbr1 3y ago110% agreed. Allowing (and requiring!) insurance companies to negotiate their own discounts over-complicates the system and distorts price transparency and signalling. And group insurance is an ideal that's outlived its utility. It made sense when there were non-trivial actuarial and administrative costs to pricing an individual, but we've got computers now. No reason the pool shouldn't be everyone.
- russdill 3y agoSean Carroll recently did a podcast with Amy Finkelstein on insurance markets. I think you'd find it interesting. A paradoxical advantage of employer health care is that it prevents people (and insurers) from choosing. https://www.preposterousuniverse.com/podcast/2023/04/10/232-amy-finkelstein-on-adverse-selection-and-hidden-information/ https://www.preposterousuniverse.com/podcast/2023/04/10/232-...
- lotsofpulp 3y agoChoosing what? Insurers are already required to accept anyone as their insured. The only thing that involving employers in the health insurance business via the tax code is it gives them more control over their employees, since it makes people more hesitant to change employers.
- russdill 3y agoIf you made one policy that was hostile to the needs of anyone with diabetes and one that caters to people with diabetes, you'd be selecting for a specific population
- lotsofpulp 3y agoBut that is already illegal, and so has nothing to do with employer chosen and subsidized health plans.
- russdill 3y agoInsurance companies are not legally required to provide the same coverage, rates, deductibles, and benefits as every other insurance company.
- lotsofpulp 3y agoYes, they are required to provide (broadly) the same "coverage" and "benefits". The things that change are network of providers, deductibles, and oop max. If you have diabetes, no matter which plan you choose from UHC/Elevance/CVS/Cigna/Humana/Centene/Molina/etc, you should be covered for all the same evidenced based care from all insurers. You should also be covered the same for a host of preventative services as required by law: https://www.healthcare.gov/coverage/preventive-care-benefits/ https://www.healthcare.gov/coverage/preventive-care-benefits...
- russdill 3y ago
- bandrami 3y agoHaving a single charge master (your first bullet point) largely removes the need for non-catastrophic insurance. The whole problem here is price discovery. As people point out, your car insurance doesn't cover day to day maintenance (generally), but it doesn't need to because AAMCO charges a single price for an oil change and that price is public. The reason you need insurance for normal day-to-day medicine is because you have no idea going into a doctor's office how much anything is going to cost, and for that matter the provider doesn't really have any idea either.
- lotsofpulp 3y agoThe provider could choose to charge by time, but they usually benefit from insurance companies being able to pay them more than their patients, hence them choosing to accept insurance rather than charge by time or something simpler. Even planned surgery can have an upfront cost: https://surgerycenterok.com https://surgerycenterok.com
- strken 3y agoReason had an article on the origins of the US system in AMA lobbying: https://reason.com/2020/04/05/how-doctors-broke-health-care/ https://reason.com/2020/04/05/how-doctors-broke-health-care/ I always wondered why medical insurance was so tightly integrated into the US. The answer is that it was done on purpose, deliberately, by doctors seeking to prevent existing institutions like unions and mutual aid societies providing healthcare as a commodity.