141–150 of 537 posts
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>> Japan has a clever way to handle the mandate. If you don't pay your premiums, nothing happens, but if you need healthcare you're not covered until you pay your back premiums. Wouldn't it always be a good idea to not pay premiums until you have a major expense then?
Then they’ll add up the premiums?
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If you define single payer that broadly, ok. I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively.
> I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively. How does all of this additional overhead provide more value to the consumer at the end? How are they actually differentiated?
Japan's healthcare cost is the lowest of the three though, at 5% GDP, despite an aging population of heavy smokers. So there doesn't seem to be that much overhead.
The book The Healing of America by T.R. Reid, 2010 was a phenomenal look at this subject and the conclusion was this: we are the only developed nation whose government allows for-profit health insurance companies to exist with ZERO regulation to cap healthcare prices. Because of this, we spend 20% of every dollar on "administrative" costs compared to 3%-7% in the European and Asian countries. The goal for American he…
Why would you cap healthcare prices for insurers, they don’t set prices. You mean providers? Half of US healthcare spending is public payers - Medicare and Medicaid. They do set prices for providers and still spend far more than other countries. And if you’ve been involved in US healthcare you’d realize it’s drowning in regulations already. It’s not a free market by a stretch.
The reason we spend so much on Medicare and Medicare is because people are less hesitant to use the service. On a per capita basis, the public payers have reduced overhead and costs compared to the private markets. If you have sources proving me wrong, I’d be happy to look at them.
And while the US market my be drowong in various regulations, it is severely lacking in price control regulation - the whole reasons for this discussion.
The book The Healing of America by T.R. Reid, 2010 was a phenomenal look at this subject and the conclusion was this: we are the only developed nation whose government allows for-profit health insurance companies to exist with ZERO regulation to cap healthcare prices. Because of this, we spend 20% of every dollar on "administrative" costs compared to 3%-7% in the European and Asian countries. The goal for American he…
I read that book too, and agree it's phenomenal. It's not just about capping insurance profits. The countries doing the best also have price controls on the healthcare providers. Doctors make a lot less money. On the other hand they generally don't have to pay for medical school. France, Germany, and Japan all have similar systems, according to the book. They have private nonprofit insurance, some kind of mandate to…
So what happens when you go to the ER? Obviously if it's a true emergency they'll save your life and try to bill you later, but then what?
Would it ever make sense to deliberately stop paying your premiums? If you can pay "out-of-pocket" for medical expenses, you might be better off saving your premium money until you need medical care that's actually more expensive than the back premiums. That creates an adverse selection problem (assuming that enough of your prospective customers are devious enough to try this). Even if you can't pay out-of-pocket, you could just stop going to the doctor until something serious happened.
Earlier quoted context omitted.
>> Japan has a clever way to handle the mandate. If you don't pay your premiums, nothing happens, but if you need healthcare you're not covered until you pay your back premiums. Wouldn't it always be a good idea to not pay premiums until you have a major expense then?
You could, but you'd have to keep the money in savings anyway, and there'd be some hassle at a time when you might not want to deal with hassle. In practice, it turns out most people just pay their premiums, at least in Japan. But if it turns out to be a problem, you could always charge interest.
The system doesn't seem too different from the US to be honest, in that people with poor financial planning skills may decide to skip on insurance premiums and end up not having enough money saved to pay for medical expenses/back premiums when they occur.
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A free market would have patients and physicians reaching a supply/demand equilibrium, with facilitating brokers taking a small cut. In the US, patients go bankrupt and physicians go bankrupt — money flows to the parasites who set prices: administrators and insurers.
> A free market would have patients and physicians reaching a supply/demand equilibrium And what happens when the market is not in equilibrium? It means some services are priced out of reach for some buyers. When the market is commodities like soy beans, that's okay... it means some people don't buy soy beans. When it's healthcare, it means some people don't get healthcare and they die. Not so good.
I'm not American and I'm far from lolbertarian, but having money go straight from patients to doctors would be a vast improvent on what you folks have now. It's the same as you see in US higher education — students are charged a fortune and educators are paid peanuts.
It's worth noting that the U.S. market does pay for the lion's share of patented drugs, effectively funding a significant portion of R&D that benefits the whole world years later when generics come into market (at least for those drugs which are not costly to manufacture, which happen to be the majority). I'm not saying this model is right. I'm just saying that doing away with it will have fundamental consequences to…
This is common PhRMA talking point that needs perspective. Large pharmaceutical companies spend twice the their readers h budget on marketing, a good percentage of now is that is spent on patient oriented marketing. (e.g. “Talk your doctor about Xyzzy!”) If there would be a loss of revenue, any reduction in R & D costs lies purely with c-suite’s priorities. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p…
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> I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively. How does all of this additional overhead provide more value to the consumer at the end? How are they actually differentiated?
I'm not sure (possibly because I read the book years ago). The other two countries handle it differently. Japan's healthcare cost is the lowest of the three though, at 5% GDP, despite an aging population of heavy smokers. So there doesn't seem to be that much overhead.
Earlier quoted context omitted.
I read that book too, and agree it's phenomenal. It's not just about capping insurance profits. The countries doing the best also have price controls on the healthcare providers. Doctors make a lot less money. On the other hand they generally don't have to pay for medical school. France, Germany, and Japan all have similar systems, according to the book. They have private nonprofit insurance, some kind of mandate to…
One of the main reasons why I gave up career in the States and came back to my home country (Japan) was healthcare. I had a day surgery in the US and the whole experience (i.e. bills) just scared heck out of me. I am very happy with the system here. Everything is extremely efficient compared to the US. A little while ago, I had this mysterious headache and went to an orthopedist, dentist, psychiatrist, neurosurgeon t…
Financially they're the most efficient of all the countries in the book.
Earlier quoted context omitted.
Why would you cap healthcare prices for insurers, they don’t set prices. You mean providers? Half of US healthcare spending is public payers - Medicare and Medicaid. They do set prices for providers and still spend far more than other countries. And if you’ve been involved in US healthcare you’d realize it’s drowning in regulations already. It’s not a free market by a stretch.
It’s more complicated, the insurers essentially tell providers how to practice (ie prescribe this generic not the name brand, don’t prescribe 30 day Rx prescribe 90 day and don’t see/treat them in the meantime, etc...) and if the providers don’t listen the provider gets dropped from the network and either the patients are forced to new providers who the insurers control behind the scenes, or more and more the patient…
In terms of these insurers who control providers, can you give an example?