351–360 of 390 posts
So my solution is until business starts making money I am going to continue to live in Mexico and get Mexican health insurance.
Earlier quoted context omitted.
It makes it inefficient in economic terms. I think you are attempting to frame it in terms of cost-shifting: making the "rich" pay for "the poor" by paying twice. But when the public hospital is 10 miles away, and the private hospital is 1 mile away, paying twice effectively lowers the access of care to the people that can't afford to pay twice. And then, proximity to public hospitals would be so valuable, that housi…
Doesn't that type of inefficiency already exist when a patient may need (or want) to go to a "network hospital", when there are multiple competing networks instead of one enormous one (that has say 95% of the "market")? > paying twice effectively lowers the access of care to the people that can't afford to pay twice My private insurance that kicks in if I e.g. need a knee surgery with 14 days wait instead of 90, will…
Not really, because all the insurers typically insure all hospitals. By having multiple insurance companies, hospitals get bargaining power and lower what insurance can ask from them. If you had only one insurance, like the state, you have 3 possible solutions: its the same, it pays more than the competing system (overly generous and thus worse for the tax payer), it pays less (uses monopoly market power and reduces hospital size/supply)
Hospitals and insurance companies are in a bargaining fight constantly, and if you look at the numbers, hospitals have won. However, hospitals are 60%+ non-profit (60% non profit, 20% public, 20% profit hospitals), so its not so clear you want hospitals to lose. Its really messy.
> My private insurance that kicks in if I e.g. need a knee surgery with 14 days wait instead of 90, will often require me to fly to a different city, likely even a different country, to get the procedure performed at a specialist private clinic. This care is something completely different to the regular care I need day-to-day for a child delivery, cancer treatment, appendectomy or whatever. As there is so very little overlap I'm also not paying twice. There isn't a private insurer that will offer me cancer treatment, child delivery etc.
The main benefit of having a single insurance company, or single payer system, is that you dont have to spend so much moeny on administrative costs. If you start getting into the rabbit hole of what will be public or private, at what cost and quality, i suspect the gains from the administrative relief will fade. Economically, maybe the best thing about having a public/private system would be that the public system is dirt cheap and effective, while the private one is simply more expensive. Thus there is some component of redistribution, but also some market forces. I think hybrid beats full state owned (I accept my own ideological bias and maybe hybrid beats fully private, though I believe it wouldnt).
> They don't exist because who would want to pay twice for that?
As an example of this, I can speak of Argentina. Argentina has had a diminishing public expenditure of public funds to public health. It has a very decaying public health system, and a thriving private one. The private one does have price controls, but not too much in effective terms: they biggest cost threat is probably that patients could choose to not have private insurance and just go to a public hospital. The reality is however crude: some public health services are of terrible quality. But its a trade-off: poor people dont pay and receive quite the tax benefit as a whole. Private is thriving and has very good quality metrics at reasonable prices. So yes, you can have a system with "double paying" that is definitely stable.
Earlier quoted context omitted.
Medicare reimbursements are below cost of care. If all insurance lowered to Medicare reimbursements, you will reduce supply.
That’s what most providers claim. In my experience (healthcare Corp finance), it’s typically closer to breaking even on Medicare. Especially if you cut out some fluff/unnecessary spending companies like to engage in. I’ve worked with Medicare and they actually try to do a bottoms up, zero based, pricing to determine what something should cost. So when a hospital is built by some award winning architect and has founta…
Earlier quoted context omitted.
It should be sustainable for patients to directly pay for the provider for the services directly for most medical care.
Yes, but that would require lower costs (prices). That we could get if pricing were more transparent. I believe that will require moving back to high-deductible 80/20 style insurance.
You cant have your cake and eat it too. If you want prices to go down you have to say there are things you wont do anymore.
Earlier quoted context omitted.
No, because it will be different for every patient (for the same treatment) and will fluctuate widely from year to year. Also there is a general ethical sense of recommending the best treatment and dealing with cost as an afterthought.
Car insurance prices vary widely from year to year, and person to person. I still expect a somewhat accurate price when I give some minimal information. Agree with the ethics, but if someone presents with a broken leg do you xray it (cheap) or mri (expensive)? For anything vaguely complicated the Dr is basically just eliminating likely culprits. Its preferable for everyone (that doesn't have a profit motive) if they…
Earlier quoted context omitted.
My wife owns and operates a private medical practice (she's an audiologist), and it's insane the way she has to do billing and accounts receivable. When a patient asks about prices she quotes them her standard price for the necessary services and calls their insurance company to confirm that the patient is covered and check what kind of copay the patient needs to pay. Assuming the patient is satisfied with the result…
In a world of pre-1990s, high-deductible, 80/20 insurance, this would happen less as the insurance company might not do the 800lb gorilla thing until the patient maxes their deductibles, and high deductibles give the consumer a strong incentive to negotiate directly with the provider.
The only downside is I don't see how it would fly politically...which is a big downside.
Earlier quoted context omitted.
> My guess is that eventually the govt will step in and start regulating prices if providers don’t. There will be a heavy pushback from industry about how that’s socialism, delivered via Fox News and other conservative outlets.
Well that is socialism. (As is our conflation of insurance and charity.) Being a form of price control, it also happens to not work very well. EDIT: and if anyone can explain why forcing doctors and hospitals to provide their services at a loss, is not socialism, then feel free to reply; as that will be assuredly more enlightening than a simple downvote.
> Well that is socialism
As indeed is provision of roads, fire trucks, police, military and so on. For some reason, people rarely call those out
> Being a form of price control, it also happens to not work very well
I think there's a strong strong case that it works very well in every rich country, because they're all doing it to some degree?
> forcing doctors and hospitals to provide their services at a loss
This assume they're not currently making super-normal profit, which I'm far from convinced by.
Earlier quoted context omitted.
Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. The idea that your access to healthcare should be linked to your own or your parents financial is crazy.
With the difference that a long-cancer treatment might cost hundreds of thousands of dollars in the US and simply bankrupt the hospital. Its easier to eat up cost if its a lot lower and has caps. The US has no apetite for those level of restrictions.
Earlier quoted context omitted.
Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. The idea that your access to healthcare should be linked to your own or your parents financial is crazy.
> Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. Then the problem is you have no pricing mechanism for determining how much the provider should actually be paid. If you offer less than what people va…
Hmm but I have the same view for food and housing. Where I live if your mother doesn't have allow money to buy proper food the government will contribute (both for food and housing).
Earlier quoted context omitted.
Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. The idea that your access to healthcare should be linked to your own or your parents financial is crazy.
I agree in principal to an extent - however economics need to be tied to the end product somewhat. Otherwise many people would opt for $100k healthcare cost (at the expense of the public) to extend their life for a few more months, this is not reasonable. Resources are finite - therefore we need appropriate allocation. In the end I agree that a basic safety net is necessary and serves a greater good - providing thing…
I disagree that failing to adhere to a certain diet should be punishable by death.