patrick.net

I think the government should provide the basic healthcare like emergency and life threatening hospitalization. Anything above that should be based on private insurance.

First step: make every non-emergency provider give the patient an exact written statement of all costs in advance of treatment.

Second step: make every provider charge everyone the same price for the same service, whether insured or not.

Third step: make every provider publish their complete price list by billing code on the internet in a standardized format.

AllTruth says

The pharmaceutical companies, medical device makers, doctors (particularly specialists), insurance companies, etc., lobby and balkanize and fragment and confuse the entire system, to enrich themselves in ways and by margins not deemed rational or in the public's interest in other advanced, developed, civilized, rational nations.

We're fucked in the U.S. six ways to Sunday because the health care lobby is giant, out-of-control, all-powerful, greedy fucking ass collusory entity that ensures monopoly-like profits and has no real cost-pressures not reasons to modernize and get efficient in the ways HAT OTHER INDUSTRIES ARE FORCED TO.

and short of changing the US political system how would this be accomplished? There are lots of giant, out-of-control, all-powerful, greedy fucking ass collusory entities that ensures monopoly-like profits in the US. The ability to put huge amounts of money into the political system has many industries using government spending, tax policy, and/or regulations as the primary profit center. Banks, aerospace, broadcasting, cable tv, railroads, banking, tobacco, sugar, oil, etc. all have profits as high or higher than hospitals, doctors, and health care facilities. Other than pharma (pure government lobbying protected profits) and health care technology (driven by the ACA medical records mandate) health care doesn't make the top 10 profitable sectors or industries. https://www.forbes.com/sites/liyanchen/2015/12/21/the-most-profitable-industries-in-2016/#65bc64435716

The US political system guarantees that single payer isn't going to happen. Fuggedaboutit.

rando says

First step: make every non-emergency provider give the patient an exact written statement of all costs in advance of treatment.

Second step: make every provider charge everyone the same price for the same service, whether insured or not.

Third step: make every provider publish their complete price list by billing code on the internet in a standardized format

Why do you keep posting this silliness time and time again. As long as people can hand their insurance card to the doctor and pay a small copay they don't care what the charges are. They go where the doctor refers them to and don't even think about the deductibles for non routine care.

None of this has any effect of any kind on where the vast majority of money is spent on health care. It can be done, it should be done, but it won't make any difference.

bob2356 says

Why do you keep posting this silliness time and time again. As long as people can hand their insurance card to the doctor and pay a small copay they don't care what the charges are.

It would make a big difference to people who have to pay a percentage of the cost and our have a big deductible. It would also make those plans more appealing. As it stands, you can not trust a health care provider to provide a service without manufacturing big charges after the fact. You can not trust health insurance companies if you don't have an hr department negotiating for you. It's a pathetic mess of a system claiming 1/6 of our gdp while providing shitty sick care.
Is even be ok suffering through Trump's narcissistic bulls hitters if he would provide Patrick's prescription for run of the mill med expenses.
It could even help with critical care of people were charged a portion of the cost.

bob2356 says

. As long as people can hand their insurance card to the doctor and pay a small copay they don't care what the charges are.

Almost nobody who works in private sector has this small copay situation. It's $5000 - $12000 annual deductible before insurance kicks in.

Single payer would have to be for citizens only. It's enactment would only serve as an added reason for illegally immigrating. Perhaps ironically, aggressive immigration control including deportation of illegals, would make single payer more palatable to the voting public.

Any Republican that can't pay CASH for all medical service,regardless of cost,
is a Great American Entrepreneurial FAILURE.
Work hard you can think of an excuse.

My problem with single payer is that we have so many dead weight people who contribute nothing to society, why should they get the same as somebody that works their ass off every day. If there must be a single payer have a two tier system, one for people that work and one for people that don't, and a bus parked in the back of the hospital to take any illegals back after we patch them up.

rpanic01 says

My problem with single payer is that we have so many dead weight people who contribute nothing to society,

A work or volunteering requirement, but who polices it?

AllTruth says

the health care lobby is giant, out-of-control, all-powerful, greedy fucking ass collusory entity that ensures monopoly-like profits and has no real cost-pressures not reasons to modernize and get efficient in the ways HAT OTHER INDUSTRIES ARE FORCED TO.

Why do you hate free enterprise and the American Way?

AllTruth says

The U.S. spends twice as much as the next-nearest expensive nation on medical care, yet has more people uninsured as a % of population, MUCH HIGHER doctor visit costs, medication, hospital charges, surgical costs, diagnostic costs, treatment costs EVERYTHING etc. costs (37% to 212% higher).

There is at least one very important stat in which we score the best. Since you have looked at the numbers and want to be fair. Please tell us where the US healthcare system scores #1 in the world today.

Booger says

Almost nobody who works in private sector has this small copay situation. It's $5000 - $12000 annual deductible before insurance kicks in.

What are you talking about? Every company I've ever worked for, my relatives have worked for, my friends have worked for, etc. ALL have copays for everything. And insurance pays a percentage of all bills until an out of pocket maximum is met.

CBOEtrader says

Please tell us where the US healthcare system scores #1 in the world today.

Highest profit margin for pharmaceutical companies?

bob2356 says

As long as people can hand their insurance card to the doctor and pay a small copay they don't care what the charges are.

That's not true. Those people are still paying higher costs in terms of premiums. Also, what you have to pay for in out-of-pocket expenses does vary considerably and you don't get to know the cost ahead of time. You cannot shop around for tests and procedures.

AllTruth says

HE INSANE HAVE DESIGNED AND IMPLEMENTED THE SYSTEM BECAUSE THEY WERE HIRED TO BY THE MEDICAL CARE COMPLEX BECAUSE IT CREATES INEFFICIENCIES AND PURE, INSANE PROFIT!!!

It's not insanity. It's capitalism. The inefficiencies you described are engineered precisely for the reason you stated. They increase profits. The managers of the system will always choose greater profit for themselves over greater wealth production and prosperity for all of society. This is called a perverse incentive and this particular one, like most others, arises from a single aspect of our economic system. That aspect is capitalism, the division of society into owners who control everything and labor who does all the work. The owners cut the pie and control who gets which piece. This creates a conflict of interest that causes almost every problem in our economy.

Dan8267 says

It's capitalism

Venezuela would be a good example of capitalism in action, right?

AllTruth says

THUNDERDOME

I thought Thunderdome was a 70's skating rink.

P N Dr Lo R says

Venezuela

There are multiple examples of what not to do. Just because running in traffic is a bad idea, doesn't mean that jumping off a cliff isn't even worse.

Dan8267 says

jumping off a cliff isn't even worse

Exactly, and Venezuela would be analagous to jumping off a cliff. Venezuela used to be one of the richest countries in South America, producing enough agricultural products through private farms to export in addition to feeding its population--once the government took over the farms to satisfy an ideology, destitution set in. It's the same result as happened during the Bolshevik Revolution--after nationalizing private farms, the country could no longer feed its population and by the early 20's America was having to supply food to the starving Russians while people in Jazz Age America were fat and happy.

rando says

First step: make every non-emergency provider give the patient an exact written statement of all costs in advance of treatment.

So we'll go around shopping for a good deal? While at the same time evaluating the quality of the provider? As though our lives are not already complicated enough as they are?

Good quality of life means free time and no worries. Just fix the price of all services and have a single payer!

Booger says

bob2356 says

. As long as people can hand their insurance card to the doctor and pay a small copay they don't care what the charges are.

Almost nobody who works in private sector has this small copay situation. It's $5000 - $12000 annual deductible before insurance kicks in.

Sure they do. Deductible and copay aren't the same. Routine health care is a copay with most plans. Deductibles only apply for non routine issues. If you have a big deductible you can certainly shop for procedures that are subject to deductibles. Nothing is stopping anyone from doing just that right now. Very few people bother. They go to whoever is in network that gets the referral. What do you believe would make people start price shopping if they don't do it now?

Where is this 5,000 to 12,000 annual deductibles number coming from? Try $1,478. average for single coverage. http://kff.org/report-section/ehbs-2016-summary-of-findings/

Dan8267 says

bob2356 says

As long as people can hand their insurance card to the doctor and pay a small copay they don't care what the charges are.

That's not true. Those people are still paying higher costs in terms of premiums. Also, what you have to pay for in out-of-pocket expenses does vary considerably and you don't get to know the cost ahead of time. You cannot shop around for tests and procedures.

What is stopping you from shopping around? You need to get the exact procedure name and codes from you doctor. Get the list of covered providers for the treatment you need in your area from your health insurance company then pick up the phone and call them. Some health insurance companies have this online, some don't. Some have the pricing on line. Consumer reports found that of policy holders that had access to online pricing only 12% used it. You can try clear health costs for online pricing, but it doesn't work that well for rural areas.

When I come to need an expensive procedure with a high deductible I will do exactly that, but I doubt it will make a difference. The first big gotcha is you have to know exactly what your policy says and understand what it means. Almost no one does. Without knowing the policy you can't price shop. The second big gotcha is the in network docs/labs for your insurance company will frequently be close in price for the same procedure. If you go out of network it is very unlikely you will get the procedure or tests for less than the in network discounted price. If you pay cash and get a big discount it won't apply to the deductible. The third big gotcha is you get what you pay for. If someone is charging half the price there is a reason. Very hard stuff to find out. The fourth big gotcha is it is impossible to know what the true price is in a lot of cases. You could be scheduled for a simple procedure that turns into a large complex procedure. Shit happens.

It's very complex and it's a lot of work. Which is why the whole idea of price shopping isn't really going to work for most people despite patricks religious faith in it. Many people simply don't get treated when they have a big deductible. which frequently turns a small problem into a big problem.

bob2356 says

which frequently turns a small problem into a big problem.

which then becomes their problem. Once you light a fire under people to take their healthcare seriously, change will happen or else people die off. It's called survival of the fittest.

rando says

Second step: make every provider charge everyone the same price for the same service, whether insured or not.

That is absolutely the best way of doing that.

I think Democrats would never allow that. Their first thing they would do is scream that outcomes have to be equal and therefore "special" people (based on race, gender, or sexual orientation) deserve a bigger subsidy because of their background and injustices that occurred in a year 1000 BC.

P N Dr Lo R says

Exactly

Wow, you really missed the point entirely.

bob2356 says

What is stopping you from shopping around? You need to get the exact procedure name and codes from you doctor.

http://www.bankrate.com/finance/insurance/health-care-costs-why-its-tough-to-get-prices-for-procedures.aspx

However, “it is not at all easy” for consumers to get accurate prices for care, says Deborah Chollet, a health insurance research leader with Mathematica Policy Research in Washington, D.C.

Whenever you contact a doctor’s office to schedule care, the first question will be about your insurance coverage — and that will determine the price, she explains.

“Then, they’re kind of at a loss to tell you what a service will cost because a service turns out to be a bundle of services,” Chollet says. “It’s not one thing.” And each service has its own medical code and price.

“It turns out to be nearly impossible to understand what that visit will cost you” beforehand, she says.

You probably already know this. 64% of consumers report that it’s very or somewhat difficult to find price info for medical treatments and procedures provided by doctors and hospitals, according to a recent Kaiser Family Foundation poll.

Dan8267 says

However, “it is not at all easy” for consumers to get accurate prices for care, says Deborah Chollet, a health insurance research leader with Mathematica Policy Research in Washington, D.C.

Whenever you contact a doctor’s office to schedule care, the first question will be about your insurance coverage — and that will determine the price, she explains.

Perfect, you made my point that doctors, labs, and hospitals can't just post a list of prices like patrick fantasizes about. The prices are negotiated with each insurance carrier plus you need to know the ins and outs of the coverage of your insurance policy. It's an insane and insanely expensive time consuming way to do things. It's a big reason more and more doctors are simply becoming employees of big health systems.

The free market just post the prices people have created a catch 22 for themselves. As long as it's a free market then it is going to be very hard to shop around because everyone sets their own prices and policies that are interdependent. If the government steps in and sets prices across the board then it's not a free market.

Dan8267 says

You cannot shop around for tests and procedures.

You most certainly can shop around. If you are paying cash you can shop very easily. Just call and ask. It's when you get into insurance policies it's complicated. There's a big difference between cannot and difficult to do.

bob2356 says

If the government steps in and sets prices across the board then it's not a free market.

It's not a free market if we have drug patents and licenses that limit the number of doctors and clinics. The free market went out the window a long time ago.

Dan8267 says

It's not a free market if we have drug patents and licenses that limit the number of doctors and clinics. The free market went out the window a long time ago.

Or a blanket ban on imported drugs from developed countries.

If we did a theoretical exercise and imagined going to a health care system whereby there was no insurance, and doctors, medications, hospitals, device makers, etc., were all paid in cash, with no middlemen (there are currently LITERALLY DOZENS OR MANY DOZENS OF MIDDLEMEN, that leech monies through bureaucracy, administration, price-fixing, etc., an example of this is 30,000 plus medical billing codes whereby there are dozens if not hundreds of different prices for same services, procedures, medications, etc. based on who is being charged and who is insured and what insurance they do or do not have), we'd get true price-discovery in medical care, with medical schools, doctors, hospitals, drug makers, device makers, etc. all having to completely revolutionize their business models and structures to become as efficient as Amazon or other such companies, and prices would fall dramatically (probably by a factor of 300% to 3,000%, depending of service, medication, device, treatment, procedure, diagnosis, care being provided/furnished).

AllTruth says

If we did a theoretical exercise and imagined going to a health care system whereby there was no insurance, and doctors, medications, hospitals, device makers, etc., were all paid in cash, with no middlemen (there are currently LITERALLY DOZENS OR MANY DOZENS OF MIDDLEMEN, that leech monies through bureaucracy, administration, price-fixing, etc., an example of this is 30,000 plus medical billing codes whereby there are dozens if not hundreds of different prices for same services, procedures, medications, etc. based on who is being charged and who is insured and what insurance they do or do not have), we'd get true price-discovery in medical care, with medical schools, doctors, hospitals, drug makers, device makers, etc. all having to completely revolutionize their business models and structures to become as efficient as Amazon or other such companies, and prices would fall dramatically (probably by a factor of 300% to 3,000%, depending of service, medication, device, treatment, proc...

We can reduce our healthcare costs by almost 80% today without changing any of that. All it takes is personal responsibility, which is severely lacking.

FortWayne says

We can reduce our healthcare costs by almost 80% today without changing any of that. All it takes is personal responsibility, which is severely lacking.

Yeah, no action is required except praying away sickness.

AllTruth says

The U.S. Should Go To A Single-Payer, Everyone Gets Medical Care, System, PERIOD

YES!!

Next can we force everyone to only be allowed to shit in their own bathroom, public toilets should be reserved for their rightful use, glory holes, and homo/bi/trans-sexual trysting.

NuttBoxer says

glory holes, and homo/bi/trans-sexual trysting.

I knew you used glory holes for punching nuts.

Check this out guys.
Warren Buffett, Bill Gates, and Charlie Munger on healthcare. 2 minute videos.

http://www.cnbc.com/2017/05/08/charlie-munger-the-amount-of-waste-from-overtreatment-of-the-dying-is-just-disgusting.html

http://www.cnbc.com/2017/05/08/forget-taxes-warren-buffett-says-the-real-problem-is-health-care.html

Dan8267 says

bob2356 says

If the government steps in and sets prices across the board then it's not a free market.

It's not a free market if we have drug patents

If we don't have drug patents, no company will bother to develop new drugs. Don't tell me governments can do the same job, because they can't, as proven by communist governments.
We probably need a single payer for health care, the ability to buy drugs from anywhere else in the world, and allow outsourcing of medical care to countries that can do the same thing at a fraction of the cost.

AllTruth says

If we did a theoretical exercise and imagined going to a health care system whereby there was no insurance, and doctors, medications, hospitals, device makers, etc., were all paid in cash, with no middlemen (there are currently LITERALLY DOZENS OR MANY DOZENS OF MIDDLEMEN, that leech monies through bureaucracy, administration, price-fixing, etc., an example of this is 30,000 plus medical billing codes whereby there are dozens if not hundreds of different prices for same services, procedures, medications, etc. based on who is being charged and who is insured and what insurance they do or do not have), we'd get true price-discovery in medical care, with medical schools, doctors, hospitals, drug makers, device makers, etc. all having to completely revolutionize their business models and structures to become as efficient as Amazon or other such companies, and prices would fall dramatically (probably by a factor of 300% to 3,000%, depending of service, medication, device, treatment, procedu...

Most people who get a major illness would end up dying.

Strategist says

Dan8267 says

bob2356 says

If the government steps in and sets prices across the board then it's not a free market.

It's not a free market if we have drug patents

If we don't have drug patents, no company will bother to develop new drugs. Don't tell me governments can do the same job, because they can't, as proven by communist governments.

We probably need a single payer for health care, the ability to buy drugs from anywhere else in the world, and allow outsourcing of medical care to countries that can do the same thing at a fraction of the cost.

If people are free to screw up their health consciously, others shouldn't be responsible. Bad outcomes are the only real deterrent to unhealthy choices.

FortWayne says

If people are free to screw up their health consciously, others shouldn't be responsible. Bad outcomes are the only real deterrent to unhealthy choices.

Those who smoke, drink too much, eat garbage would be examples, but there is no practical way to exclude them from healthcare.
What might work is tax the hell out of cigarettes, alcohol, and fattening food, and use that tax towards healthcare. So irresponsible really end up paying for their stupidity.