5 ms·

These types of studies, and the goals they aim to support, always frustrate me as solving a surface-level problem rather than root cause. The problem with US h

These types of studies, and the goals they aim to support, always frustrate me as solving a surface-level problem rather than root cause. The problem with US healthcare isn't who pays for it, its how damn expensive it is. As always there are multiple factors at play, my list would include corruption, lack of legal accountability/responsibility, and a population that is much less healthy than reasonable. Go after any one of those and we'd make a lot more headway than trying to ram through a universal, government-run healthcare or insurance program. And yes, such a program could impact the above topics, but it doesn't have to and could make any of them worse.

loeg 2mo ago
Americans just consume a lot of healthcare services. Any substantial cost savings requires providing less healthcare service.
- quacked 2mo ago
  That's not necessarily true; fewer limitations on who is allowed to provide health service and manufacture medicine and health technologies would also drop prices. Competition in healthcare is very, very difficult because it's often illegal to compete.
  - whimsicalism 2mo ago
    You're actually talking about the same problem. Competition in healthcare is heavily restricted by stuff like certificates of need because there is little cost-sharing with utilizers so you get overutilization & induced demand. This is Roemer's law [0]. A large part of the reason for competition restrictions is because of a hacky attempt to control overutilization without direct cost-sharing. 0: https://en.wikipedia.org/wiki/Roemer%27s_law https://en.wikipedia.org/wiki/Roemer%27s_law
- t-writescode 2mo ago
  Citation needed (per capita please). Given that people constantly, literally AVOID care because they can’t pay for it until it’s such an absurd problem that it’s very, very expensive, I struggle to believe this, at all. And money amount doesn’t matter in this evidence because, again, Americans regularly avoid care until it’s catastrophic because they literally can’t afford it and/or have to wait for insurance to meet a certain harm level threshold where it literally can no longer be argued (emergency care)
  - SoftTalker 2mo ago
    I think a citation is needed for "Americans regularly avoid care ... because they can’t afford it." I think there are other reasons, e.g. they don't like doctors, or it's too inconvenient, or waiting times are too long. I have good insurance and haven't seen a doctor in probably 20 years. I know people who are visiting the doctor for every sore throat, ache and pain or sneeze and sniffle, and that's not me at all.
    - TimorousBestie 2mo ago
      Here you go, a recent survey: https://www.jgwentworth.com/resources/medical-emergency https://www.jgwentworth.com/resources/medical-emergency > The survey showed that over nine in ten (92%) of insured respondents had delayed or avoided medical care because of concern about cost. > In fact, 95% of those surveyed said a medical emergency would likely put them into serious debt even with insurance.
      - SoftTalker 2mo ago
        An unexpected car replacement would put most people into serious debt. And there's no insurance for that. People get so hung up on the idea that they should have to pay for health care, when you have to pay for every other necessity in life.
        TimorousBestie 2mo ago
        So you didn’t want a citation after all. Alas.
        sjsdaiuasgdia 2mo ago
        [dead]
        pythonaut_16 2mo ago
        Why are you moving the goal posts? You asked for a citation and were given one and now you just change to a different argument.
- dboreham 2mo ago
  In some cases they are provided healthcare services without a choice, so they're not really "consuming" those services. E.g. tests that don't change outcome but do cover a provider from a legal risk.
- nradov 2mo ago
  Something like 20% of healthcare services are "low value care" which aren't justified by evidence-based medicine criteria and may even harm the patient. Regardless of the financing system we could free up a lot of capacity and slash costs by eliminating that low value care. Of course in practice it's difficult to do that at scale. https://www.bloomsbury.com/us/price-we-pay-9781635575910/ https://www.bloomsbury.com/us/price-we-pay-9781635575910/
hx8 2mo ago
> The problem with US healthcare isn't who pays for it, its how damn expensive it is Saving $1,000,000,000,000/yr is directly addressing how damn expensive it is.
- _heimdall 2mo ago
  (1) we don't know the claims of the study will be accurate if implemented and (2) we would need studies modelling cost savings of alternative approaches to actually compare anything. Obamacare made wild claims about cost savings as well. That didn't work out for many reasons that could show up again with another universal healthcare push.
  - hx8 2mo ago
    1. Do any of the cost savings recommendations you address come close to $1T/yr impact? This is the scale we should be aiming for. 2. If you think this modeling is inaccurate or incomplete you can directly discuss that. That would be a much more interesting discussion than "it might be incorrect."
    - _heimdall 2mo ago
      That's a great question, and one that should receive similar funding and attention to properly compare. My hunch is that (a) this study over estimates on the cost reduction side and would not pan out, and (b) improving health should always be a better cost savings than reducing corporate overhead (especially given how piss poor our average health is today).
  - dmschulman 2mo ago
    There's a multitude of evidence that points to the success of the ACA from a cost perspective (among other things). Cost of healthcare for individuals is not a good metric to judge by. The ecosystem of hospitals, patients, doctors, insurers, health systems, and the federal government is complex and you're not going to get a clear picture of the overall impact of the ACA by looking as something as simple as cost savings. One example, hospitals are required to treat patients whether or not they hold insurance. The hospital foots the bill for that care and it's a major reason why hospitals shut down (especially in underserved communities). Getting more people on insurance plans was a direct factor is keeping many struggling hospitals and health systems afloat. https://www.statnews.com/2019/03/22/affordable-care-act-controls-costs/ https://www.statnews.com/2019/03/22/affordable-care-act-cont... https://www.networkforphl.org/news-insights/the-affordable-care-act-reflections-on-10-years/ https://www.networkforphl.org/news-insights/the-affordable-c... https://www.cbpp.org/research/health/chart-book-accomplishments-of-affordable-care-act https://www.cbpp.org/research/health/chart-book-accomplishme...
nsxwolf 2mo ago
We never attempted to solve the issue of distorted price signals that occur when customers aren't the ones paying for something. We're still charging $600 for a bag of saline.
- jtbayly 2mo ago
  Especially when the buyer and seller are the same huge monopoly entity, but the payer is “somebody else,” the incentives are completely perverse.
Retric 2mo ago
No, it’s not a question of who pays for it but who benefits. You could have universal health with zero additional spending by the US government, but all that administrative overhead is someone’s income.
- QuercusMax 2mo ago
  Companies don't hesitate to lay people off when their jobs aren't needed. I don't see why these parasitic insurance companies need to stay in business.
- _heimdall 2mo ago
  No one benefits when there's a single player in an industry. When that single player also owns your taxes and military, its a risk we should at least avoid if at all possible.
  - Retric 2mo ago
    Let’s try and deal with actual facts here. If you disagree then you should be able to post some actual data in terms of lifespans or costs that says otherwise. There’s multiple healthcare systems around the world, single payer results in vastly less administrative and thus overall spending and equal or better outcomes overall. So by objective criteria the average person massively benefits from single payer healthcare.
hnlmorg 2mo ago
The point of nationalisation is to address those underlying concerns. But it’s fair to say that in practice, nationalisation doesn’t always solve those problems. The problem is you either need to regular or nationalise. And neither of those are particularly “American”.
- _heimdall 2mo ago
  I don't think our problem is a lack of regulation though. If anything its a lack of market competition, and that is caused by over regulation and legal protections that make holding companies responsible difficult or impossible.
  - mindslight 2mo ago
    It's also caused by absurd nonsense like how doctors can't tell you how much anything they're proposing to do actually will cost (a necessary condition for entering into a contract!), but then the system makes up arbitrary bills after the fact - with fraudulent amounts that nobody actually pays! No other industry works like that, as it's not the foundation of a market in the first place. Imagine if going to the grocery store involved "paying" some token amount at the cashier for their time to put your items in bags, then for the food you received shakedown bills for years afterwards, that you had to spend time going through your old documentation to refute and bargain down. Absurd. Regardless of "insurance", who is ultimately paying, or subsidies to provide a baseline of care - there needs to be reform that mandates simple up-front prices, constant per-provider regardless who is paying, and ruling out any other theory of billing. Doctors throw up their hands and act like they're dealing with some special problems, but there are plenty of other industries we can look at for the dynamics of how to handle routine procedures versus emergencies (and knowns vs unknowns) in a consensual and market-responsive manner.
    - nradov 2mo ago
      That's all true, but from a practical standpoint providers really have no way to accurately estimate a patient's out-of-pocket financial responsibility in advance. The current HIPAA adopted standard transactions don't allow for sending a prospective claim. So all they can realistically do is perform the procedure, submit a claim to the patient's health plan, wait for it to (maybe) be paid, and then send a bill to the patient for the balance. https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/adopted-standards-operating-rules https://www.cms.gov/priorities/key-initiatives/burden-reduct... The good news is that CMS is working on an update to those standards which will at least make prospective claims technically possible. Although it may take years until that functionality is widely implemented.
giantg2 2mo ago
"The problem with US healthcare isn't who pays for it, its how damn expensive it is." And also how much is required. I bet a study investigating how much money and lives could be saved by reducing obesity would have 2x numbers
- _heimdall 2mo ago
  Exactly. I'd at least want to see similarly funded studies comparing solves for underlying causes beyond just insurance companies not being nationalized. Similarly we could look into the likely cost of over medicating our people, and the atrocities we call food in grocery stores.
larkost 2mo ago
I agree that this proposal would not solve all of the problems; absent more changes you would still see the creep up of healthcare costs at too high a rate. But slashing $1 trillion off of a $5.3 trillion costs is a pretty big bite of the apple. Even if you go with the more conservative $663 number, that is still a great first step. And both of those numbers are after adding the costs of covering currency uncovered people. So we are collectively getting more for significantly less money. It does this by eliminating a very inefficient layer of our current system (insurance companies), and by having there replacement for that (the government) negotiate on drug prices (how much savings there is the reason there are two estimates). Currently insurance companies almost have a negative incentive to push down drug prices (their profits are limited to a percentage of total spending, and most large companies are pushing against that limit). Most of the cost control pressures in our current system come out of Medicare/Medicade, and this would widen that out to the whole system. That in turn would wedge open the door to pushing on the other drivers of the cost spirals: hospital administration, new expensive drugs that are not worth the additional costs, doctor salaries ballooning, and the broken system between malpractice insurance and dysfunctional enforcement against malpractice.
- _heimdall 2mo ago
  I understand that theres an argument for removing private insurance companies in favor of thr government can cut costs. It can also increase them. I'd argue that the primary issue with insurance costs today is the lack of market competition, obscurity of what costs and prices are, and government protections that prevent insurance companies from being legally liable for many of the problems they cause. Corruption and monopolistic practices is a big deal in healthcare, for example. We'd be better off, in my opinion, by solving that rather than killing an entire private industry and hoping our government can continue to do it better indefinitely.
  - onraglanroad 2mo ago
    >theres an argument for removing private insurance companies in favor of thr government I don't see why you'd need to do that. Just expand medicare to everyone and if people want to also buy private insurance they can. They'd just need to be more competitive and add significant value, which they don't currently do.
SpicyLemonZest 2mo ago
It's extremely challenging to go after high costs in the current system, because the doctors who charge them are popular and the insurance companies who pay them are hated. There was a 2024 story that stuck in my mind (https://www.npr.org/2024/12/05/nx-s1-5217617/blue-cross-blue-shield-anesthesia-anthem https://www.npr.org/2024/12/05/nx-s1-5217617/blue-cross-blue...) when Anthem tried to negotiate down the rate of certain anesthesia procedures; the public was absolutely outraged, successfully demanding that Anthem must back down and accept whatever the doctors feel is the appropriate pricing model.
- _heimdall 2mo ago
  The disconnect between prices and end consumers is itself a huge problem. I should know what care costs before I get it, and I should know how much my instance company is paying on my behalf before I get care. For prices to be sane we need people being able to compare prices, decide what care they want and can afford, etc. Our prices are so high because its a closed market acting as though it were a free/open market being driven in part by customer decisions.
  - SpicyLemonZest 2mo ago
    I think that’s a reasonable model to want, but it’s what we call “preauthorization”, and many patients along with most doctors absolutely hate it. In order to know with certainty what your care will cost and how much your insurance company will pay, the doctor has to contact them in between deciding what treatment you should have and giving you the treatment. You can and I do solve that annoyance with an HMO, where the doctors and insurance can communicate more effectively because they’re part of the same organization. But that also means it’s difficult or impossible for me to get the kind of care that a normal insurance company would hesitate to approve.
    - _heimdall 2mo ago
      Preauthorization is a bit different, and yes I can see care providers hating it. Its possible for a provider to know ahead of time that providing a saline IV costs $60, for example. Its also possible to have health care policies that approve any treatment deemed necessary at any healthcare provider, or at any healthcare provider in network if that concept was still a thing. We don't have to have a preauthorisation step where doctors are expected to ask insurance companies if they will approve a certain treatment for a certain patient before it can be done. That is a particularly terrible implementation if you ask me.
bcrosby95 2mo ago
I have a strong dislike for the industry as a whole. There's too many ridiculous situations I've been subject to, along with hearing of some from my friends. My favorite was a friend who had to deliver her baby, alone, in a hallway, because they forgot about her. And the hospital billed her for it. LOL.
hintymad 2mo ago
> The problem with US healthcare isn't who pays for it, its how damn expensive it is Exactly! There's so much paperwork that a doctor sometimes need two assistants just for the paper work. There's so much cost for independent practice that increasingly more doctors end up joining big hospitals. Charges with and without insurance have a huge difference. Just to name a few.
- autoexec 2mo ago
  Universal healthcare would cut down on the paperwork needed and provide opportunities to simplify it
- HDThoreaun 2mo ago
  medicare is basically the biggest culprit for the "too much paperwork" stuff. A m4a plan that doesnt involve capitation would have even more paperwork than the current system does.
tptacek 2mo ago
This paper is based on numbers from the CMS NHE. Here are those numbers summarized (up to 2023): https://nationalhealthspending.org/ https://nationalhealthspending.org/ I haven't finished reading the paper and have no opinions on it (other than that most successful universal systems aren't single-payer) but if we start from actual numbers the discussion will be better.

loeg 2mo ago

Americans just consume a lot of healthcare services. Any substantial cost savings requires providing less healthcare service.

quacked 2mo ago
That's not necessarily true; fewer limitations on who is allowed to provide health service and manufacture medicine and health technologies would also drop prices. Competition in healthcare is very, very difficult because it's often illegal to compete.
- whimsicalism 2mo ago
  You're actually talking about the same problem. Competition in healthcare is heavily restricted by stuff like certificates of need because there is little cost-sharing with utilizers so you get overutilization & induced demand. This is Roemer's law [0]. A large part of the reason for competition restrictions is because of a hacky attempt to control overutilization without direct cost-sharing. 0: https://en.wikipedia.org/wiki/Roemer%27s_law https://en.wikipedia.org/wiki/Roemer%27s_law
t-writescode 2mo ago
Citation needed (per capita please). Given that people constantly, literally AVOID care because they can’t pay for it until it’s such an absurd problem that it’s very, very expensive, I struggle to believe this, at all. And money amount doesn’t matter in this evidence because, again, Americans regularly avoid care until it’s catastrophic because they literally can’t afford it and/or have to wait for insurance to meet a certain harm level threshold where it literally can no longer be argued (emergency care)
- SoftTalker 2mo ago
  I think a citation is needed for "Americans regularly avoid care ... because they can’t afford it." I think there are other reasons, e.g. they don't like doctors, or it's too inconvenient, or waiting times are too long. I have good insurance and haven't seen a doctor in probably 20 years. I know people who are visiting the doctor for every sore throat, ache and pain or sneeze and sniffle, and that's not me at all.
  - TimorousBestie 2mo ago
    Here you go, a recent survey: https://www.jgwentworth.com/resources/medical-emergency https://www.jgwentworth.com/resources/medical-emergency > The survey showed that over nine in ten (92%) of insured respondents had delayed or avoided medical care because of concern about cost. > In fact, 95% of those surveyed said a medical emergency would likely put them into serious debt even with insurance.
    - SoftTalker 2mo ago
      An unexpected car replacement would put most people into serious debt. And there's no insurance for that. People get so hung up on the idea that they should have to pay for health care, when you have to pay for every other necessity in life.
      - TimorousBestie 2mo ago
        So you didn’t want a citation after all. Alas.
      - sjsdaiuasgdia 2mo ago
        [dead]
      - pythonaut_16 2mo ago
        Why are you moving the goal posts? You asked for a citation and were given one and now you just change to a different argument.
dboreham 2mo ago
In some cases they are provided healthcare services without a choice, so they're not really "consuming" those services. E.g. tests that don't change outcome but do cover a provider from a legal risk.
nradov 2mo ago
Something like 20% of healthcare services are "low value care" which aren't justified by evidence-based medicine criteria and may even harm the patient. Regardless of the financing system we could free up a lot of capacity and slash costs by eliminating that low value care. Of course in practice it's difficult to do that at scale. https://www.bloomsbury.com/us/price-we-pay-9781635575910/ https://www.bloomsbury.com/us/price-we-pay-9781635575910/

hx8 2mo ago

> The problem with US healthcare isn't who pays for it, its how damn expensive it is Saving $1,000,000,000,000/yr is directly addressing how damn expensive it is.

_heimdall 2mo ago
(1) we don't know the claims of the study will be accurate if implemented and (2) we would need studies modelling cost savings of alternative approaches to actually compare anything. Obamacare made wild claims about cost savings as well. That didn't work out for many reasons that could show up again with another universal healthcare push.
- hx8 2mo ago
  1. Do any of the cost savings recommendations you address come close to $1T/yr impact? This is the scale we should be aiming for. 2. If you think this modeling is inaccurate or incomplete you can directly discuss that. That would be a much more interesting discussion than "it might be incorrect."
  - _heimdall 2mo ago
    That's a great question, and one that should receive similar funding and attention to properly compare. My hunch is that (a) this study over estimates on the cost reduction side and would not pan out, and (b) improving health should always be a better cost savings than reducing corporate overhead (especially given how piss poor our average health is today).
- dmschulman 2mo ago
  There's a multitude of evidence that points to the success of the ACA from a cost perspective (among other things). Cost of healthcare for individuals is not a good metric to judge by. The ecosystem of hospitals, patients, doctors, insurers, health systems, and the federal government is complex and you're not going to get a clear picture of the overall impact of the ACA by looking as something as simple as cost savings. One example, hospitals are required to treat patients whether or not they hold insurance. The hospital foots the bill for that care and it's a major reason why hospitals shut down (especially in underserved communities). Getting more people on insurance plans was a direct factor is keeping many struggling hospitals and health systems afloat. https://www.statnews.com/2019/03/22/affordable-care-act-controls-costs/ https://www.statnews.com/2019/03/22/affordable-care-act-cont... https://www.networkforphl.org/news-insights/the-affordable-care-act-reflections-on-10-years/ https://www.networkforphl.org/news-insights/the-affordable-c... https://www.cbpp.org/research/health/chart-book-accomplishments-of-affordable-care-act https://www.cbpp.org/research/health/chart-book-accomplishme...

nsxwolf 2mo ago

We never attempted to solve the issue of distorted price signals that occur when customers aren't the ones paying for something. We're still charging $600 for a bag of saline.

jtbayly 2mo ago
Especially when the buyer and seller are the same huge monopoly entity, but the payer is “somebody else,” the incentives are completely perverse.

Retric 2mo ago

No, it’s not a question of who pays for it but who benefits. You could have universal health with zero additional spending by the US government, but all that administrative overhead is someone’s income.

QuercusMax 2mo ago
Companies don't hesitate to lay people off when their jobs aren't needed. I don't see why these parasitic insurance companies need to stay in business.
_heimdall 2mo ago
No one benefits when there's a single player in an industry. When that single player also owns your taxes and military, its a risk we should at least avoid if at all possible.
- Retric 2mo ago
  Let’s try and deal with actual facts here. If you disagree then you should be able to post some actual data in terms of lifespans or costs that says otherwise. There’s multiple healthcare systems around the world, single payer results in vastly less administrative and thus overall spending and equal or better outcomes overall. So by objective criteria the average person massively benefits from single payer healthcare.

hnlmorg 2mo ago

The point of nationalisation is to address those underlying concerns. But it’s fair to say that in practice, nationalisation doesn’t always solve those problems. The problem is you either need to regular or nationalise. And neither of those are particularly “American”.

_heimdall 2mo ago
I don't think our problem is a lack of regulation though. If anything its a lack of market competition, and that is caused by over regulation and legal protections that make holding companies responsible difficult or impossible.
- mindslight 2mo ago
  It's also caused by absurd nonsense like how doctors can't tell you how much anything they're proposing to do actually will cost (a necessary condition for entering into a contract!), but then the system makes up arbitrary bills after the fact - with fraudulent amounts that nobody actually pays! No other industry works like that, as it's not the foundation of a market in the first place. Imagine if going to the grocery store involved "paying" some token amount at the cashier for their time to put your items in bags, then for the food you received shakedown bills for years afterwards, that you had to spend time going through your old documentation to refute and bargain down. Absurd. Regardless of "insurance", who is ultimately paying, or subsidies to provide a baseline of care - there needs to be reform that mandates simple up-front prices, constant per-provider regardless who is paying, and ruling out any other theory of billing. Doctors throw up their hands and act like they're dealing with some special problems, but there are plenty of other industries we can look at for the dynamics of how to handle routine procedures versus emergencies (and knowns vs unknowns) in a consensual and market-responsive manner.
  - nradov 2mo ago
    That's all true, but from a practical standpoint providers really have no way to accurately estimate a patient's out-of-pocket financial responsibility in advance. The current HIPAA adopted standard transactions don't allow for sending a prospective claim. So all they can realistically do is perform the procedure, submit a claim to the patient's health plan, wait for it to (maybe) be paid, and then send a bill to the patient for the balance. https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/adopted-standards-operating-rules https://www.cms.gov/priorities/key-initiatives/burden-reduct... The good news is that CMS is working on an update to those standards which will at least make prospective claims technically possible. Although it may take years until that functionality is widely implemented.

giantg2 2mo ago

"The problem with US healthcare isn't who pays for it, its how damn expensive it is." And also how much is required. I bet a study investigating how much money and lives could be saved by reducing obesity would have 2x numbers

_heimdall 2mo ago
Exactly. I'd at least want to see similarly funded studies comparing solves for underlying causes beyond just insurance companies not being nationalized. Similarly we could look into the likely cost of over medicating our people, and the atrocities we call food in grocery stores.

larkost 2mo ago

I agree that this proposal would not solve all of the problems; absent more changes you would still see the creep up of healthcare costs at too high a rate. But slashing $1 trillion off of a $5.3 trillion costs is a pretty big bite of the apple. Even if you go with the more conservative $663 number, that is still a great first step. And both of those numbers are after adding the costs of covering currency uncovered people. So we are collectively getting more for significantly less money. It does this by eliminating a very inefficient layer of our current system (insurance companies), and by having there replacement for that (the government) negotiate on drug prices (how much savings there is the reason there are two estimates). Currently insurance companies almost have a negative incentive to push down drug prices (their profits are limited to a percentage of total spending, and most large companies are pushing against that limit). Most of the cost control pressures in our current system come out of Medicare/Medicade, and this would widen that out to the whole system. That in turn would wedge open the door to pushing on the other drivers of the cost spirals: hospital administration, new expensive drugs that are not worth the additional costs, doctor salaries ballooning, and the broken system between malpractice insurance and dysfunctional enforcement against malpractice.

_heimdall 2mo ago
I understand that theres an argument for removing private insurance companies in favor of thr government can cut costs. It can also increase them. I'd argue that the primary issue with insurance costs today is the lack of market competition, obscurity of what costs and prices are, and government protections that prevent insurance companies from being legally liable for many of the problems they cause. Corruption and monopolistic practices is a big deal in healthcare, for example. We'd be better off, in my opinion, by solving that rather than killing an entire private industry and hoping our government can continue to do it better indefinitely.
- onraglanroad 2mo ago
  >theres an argument for removing private insurance companies in favor of thr government I don't see why you'd need to do that. Just expand medicare to everyone and if people want to also buy private insurance they can. They'd just need to be more competitive and add significant value, which they don't currently do.

SpicyLemonZest 2mo ago

It's extremely challenging to go after high costs in the current system, because the doctors who charge them are popular and the insurance companies who pay them are hated. There was a 2024 story that stuck in my mind (https://www.npr.org/2024/12/05/nx-s1-5217617/blue-cross-blue-shield-anesthesia-anthem https://www.npr.org/2024/12/05/nx-s1-5217617/blue-cross-blue...) when Anthem tried to negotiate down the rate of certain anesthesia procedures; the public was absolutely outraged, successfully demanding that Anthem must back down and accept whatever the doctors feel is the appropriate pricing model.

_heimdall 2mo ago
The disconnect between prices and end consumers is itself a huge problem. I should know what care costs before I get it, and I should know how much my instance company is paying on my behalf before I get care. For prices to be sane we need people being able to compare prices, decide what care they want and can afford, etc. Our prices are so high because its a closed market acting as though it were a free/open market being driven in part by customer decisions.
- SpicyLemonZest 2mo ago
  I think that’s a reasonable model to want, but it’s what we call “preauthorization”, and many patients along with most doctors absolutely hate it. In order to know with certainty what your care will cost and how much your insurance company will pay, the doctor has to contact them in between deciding what treatment you should have and giving you the treatment. You can and I do solve that annoyance with an HMO, where the doctors and insurance can communicate more effectively because they’re part of the same organization. But that also means it’s difficult or impossible for me to get the kind of care that a normal insurance company would hesitate to approve.
  - _heimdall 2mo ago
    Preauthorization is a bit different, and yes I can see care providers hating it. Its possible for a provider to know ahead of time that providing a saline IV costs $60, for example. Its also possible to have health care policies that approve any treatment deemed necessary at any healthcare provider, or at any healthcare provider in network if that concept was still a thing. We don't have to have a preauthorisation step where doctors are expected to ask insurance companies if they will approve a certain treatment for a certain patient before it can be done. That is a particularly terrible implementation if you ask me.

bcrosby95 2mo ago

I have a strong dislike for the industry as a whole. There's too many ridiculous situations I've been subject to, along with hearing of some from my friends. My favorite was a friend who had to deliver her baby, alone, in a hallway, because they forgot about her. And the hospital billed her for it. LOL.

hintymad 2mo ago

> The problem with US healthcare isn't who pays for it, its how damn expensive it is Exactly! There's so much paperwork that a doctor sometimes need two assistants just for the paper work. There's so much cost for independent practice that increasingly more doctors end up joining big hospitals. Charges with and without insurance have a huge difference. Just to name a few.

autoexec 2mo ago
Universal healthcare would cut down on the paperwork needed and provide opportunities to simplify it
HDThoreaun 2mo ago
medicare is basically the biggest culprit for the "too much paperwork" stuff. A m4a plan that doesnt involve capitation would have even more paperwork than the current system does.

tptacek 2mo ago

This paper is based on numbers from the CMS NHE. Here are those numbers summarized (up to 2023): https://nationalhealthspending.org/ https://nationalhealthspending.org/ I haven't finished reading the paper and have no opinions on it (other than that most successful universal systems aren't single-payer) but if we start from actual numbers the discussion will be better.