Why Medical Bills Are Killing Us (2013) [pdf]

I came across this last night and stayed up too late reading it. It's a fascinating exposé of where at least a good part of the money is going -- the extra money that we Americans spend on health care that doesn't bring us any better outcomes.

I think it's relevant to HN because a lot of us with families and/or in middle age can't risk quitting our jobs to start startups without assurance that we'll be able to buy adequate health insurance at a price we can afford -- and every dollar counts in a startup. I know I've seen people post here that Obamacare was an enabling factor for them, and it's now obviously at risk. So the policy discussion about what it should be replaced with is very relevant to us.

This piece, along with others I've read recently, suggests to me the following overview of the problem:

() The market for health care services is highly distorted. Not only is there no price transparency, but patients don't even have the authority to make purchase decisions on their own behalf -- that's done for them by the doctors. To the extent patients have any say in the matter, they are unlikely to be in an emotional state conducive to hard-nosed negotiating, if there is any urgency to the matter at all.

() Multiple special interest groups have gotten themselves politically entrenched. The service providers may be the most successful of these, but there are also the insurance companies and the malpractice lawyers. The amount of money flowing through the system supports armies of lobbyists, who have compromised legislators of both parties.

() There are no easy solutions here, no free lunches. You can’t have all the good parts of an unregulated insurance market (freedom to buy what you want, when you want, with market pricing) without the bad parts (steadily rising premiums and insurance that is unaffordable for people who are old and sick). At the same time, you can’t have all the good parts of a socialized system (universal coverage at affordable prices) without freedom-reducing mandates and regulations and large doses of subsidies from some people to other people. [0]

So, HNers, what's the solution? Would love to hear people's thoughts.

Personally I can't resist fantasizing that Trump will come to the same conclusion I have: single payer is the only solution. It would be like Nixon going to China. Trump (whose election I vigorously opposed) is unencumbered by considerations of who donates how much to which Congressional campaigns. And for all his flaws, he's a hell of a salesman. If he gets it into his head that this is the solution, it could really happen.

A pipe dream, I know. But would you like to see it? If not, what do you think would be better?

[0] https://www.washingtonpost.com/news/wonk/wp/2016/11/12/donal...

I'm for single payer but it will never happen until Democrats get the White House and congress. Paul Ryan is planning on privatizing Medicare asap

Routine medical care should be like food and shelter: something you are expected to pay for yourself. That would put price pressure on providers. Insurance should be a backstop for catastrophic accident or illness. It should be sold by competing local and national providers. It should be untangled from employment as a benefit. You should buy it like car insurance.

Obama, Trump, Clinton. senators, representatives -- none (or very few) of these people have any medical background and really can do little else but screw it up as badly as if the government was the single provider of all software.

The democrats couldn't do it when they had WH and Congress... they had to go with Plan B - "Obamacare".

Personally, I believe that Plan B was written to fail. Government creates problems. How do you solve the problem? More government.

Obamacare, imho, was created as the groundwork for single payer. I just don't think they expected it to fail so hard and so fast.

I have no faith in single payer... for example, look at the VA. Months of wait times for those who need the help... while those at the top get lavish bonuses.

There's hundreds of things that can be done to chip away at them.

A pet peeve of mine is certificate of need laws:

http://www.ncsl.org/research/health/con-certificate-of-need-...

The notion is to reduce capital expenditures and save costs, but they are a big part of why the hospital in the article can get away with charging so much for cat scans -- there's no competition. Of course it is going to be difficult to go to an outside imaging center during an emergency room visit, but when the outside imaging center advertises $500 prices, the patient will at least know there is something a bit fishy about the $3000 bill from the hospital.

They probably make a lot of sense for something like an ER, where there is a high up front cost and a lot of staffing costs and you can make reasonable predictions about demand. They don't make any sense for equipment that only used to be expensive.