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I write about America’s health care system, and I got caught up in it

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Re: I write about America’s health care system, and I got caught up in it

#121

Post by BobbyJo »

jatone wrote: post #104
BobbyJo wrote: post #72

Earlier quoted context omitted.

> The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand) Changing housing situations is exactly as easy as changing hospitals and emergency rooms no? Since the lat…

You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated. markets don't deal with this situation well. changing hospitals don't change the baseline costs for providing health care in a significant manner for there to be competition nor are many hospitals in a competitive market (often there is only one hospital for an entire rural region). that's before even getting into ph…

> You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated

This account, or at least should account, for a very small minority of interactions with healthcare facilities. Saying that's why the whole market is defunct is recklessly reductionist.

> markets don't deal with this situation well.

They don't deal with it at all. Imagine if some people needed bread or they'd die, would that change the price on the shelf? No, because the bread didn't get there because of that niche market, it got there because most people eat it. It is the same with healthcare. If a hospital exists because people routinely visit the doctor, some people needing their life saved isn't going to suddenly change prices.

> that's before even getting into pharma. which can charge millions of dollars for life saving/changing drugs for single course treatments. hell take a look at what happened with epipens. there is no protection against profiteering via nebulous 'markets' when your choices are 'purchase or die'.

Totally agree. The issue there is regulation and how we allow companies to be a position of no competition. If the government stepped in and payed those prices for you, it wouldn't solve the problem.

Re: I write about America’s health care system, and I got caught up in it

#122

Post by syki »

BobbyJo wrote: post #119
syki wrote: post #112

Earlier quoted context omitted.

Of course healthcare isn’t and can’t be free. Unless by free you mean free at the point of usage. I support government provided healthcare and government runs off of tax revenue. Denying a person cancer treatment for no other reason than because they can’t pay $x at the point of usage is an immoral system. An analogous situation occurs with federal courts. Those who can’t afford filing fees have those fees waived and…

That's a bad comparison. The filing fee is small compared medical treatment, and it's in support of the government itself. The cost of doing that for people is tiny and doesn't really take away from anyone else. Medicine is a scarce resource at this point, and, generally speaking, giving care to X often means Y won't get it. The fundamental problem with medical care is supply, lowering barriers for demand isn't a sol…

The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage. In the U.S. system denials of care by insurance companies are not done so another person can get said care. They are done to increase profit margins and profiting from denying someone care is immoral.

Re: I write about America’s health care system, and I got caught up in it

#123

Post by mantas »

syki wrote: post #116
mantas wrote: post #86

Earlier quoted context omitted.

In countries with public healthcare it’s still based on ability to pay. You pay out of pocket and cut the queue, have decent time allotment with the doctor, get best medication available without money-saving algorithms etc.

In Canada private health clinics can not legally provide care that is covered by the Canada Health Act. EDIT: After further reading it appears that private health care is a murky area in some provinces. My above stated belief appears to be wrong at least in terms of how things actually work there. Here is my view. Private medical care should be banned.

Here in backwater Europe we had no private medicine for a long time. The outcome was massive healthcare black market. Semi-official price list you've to pay to nurses/doctors/etc to „premium“ care.

On top of that, official medical staff wages were crap. People were forced either work for peanuts (IMO nurses and doctors jobs are damn hard and they have to be paid well), take money under table or... emigrate.

Now we have mixed system and it's definitely better than it was before. Doctors gets paid well. Elite doctors tend to work 2-3 days in private clinics and then 2-3 days in public hospitals so you can still get hold of them for free. Those who have an inch for premium services can pay local&legal, so local economy wins.

Re: I write about America’s health care system, and I got caught up in it

#124

Post by BobbyJo »

syki wrote: post #122
BobbyJo wrote: post #119

Earlier quoted context omitted.

That's a bad comparison. The filing fee is small compared medical treatment, and it's in support of the government itself. The cost of doing that for people is tiny and doesn't really take away from anyone else. Medicine is a scarce resource at this point, and, generally speaking, giving care to X often means Y won't get it. The fundamental problem with medical care is supply, lowering barriers for demand isn't a sol…

The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage. In the U.S. system denials of care by insurance companies are not done so another person can get said care. They are done to increase profit margins and profiting from denying someone care is immoral.

> The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage

That last bit is exactly what we're in disagreement about, and I haven't seen a good case for it yet.

> In the U.S. system denials of care by insurance companies are not done so another person can get said care

True.

> They are done to increase profit margins

Indirectly, sure. Its a business where money out must be less than money in.

> and profiting from denying someone care is immoral.

Again, this is the disagreement, and I'm not really seeing a good argument for that being the case. Some people should be denied care. I don't see why performing a necessary function shouldn't be profitable, especially when it's beneficial to everyone in times of scarcity, like now.

Re: I write about America’s health care system, and I got caught up in it

#125

Post by jatone »

BobbyJo wrote: post #121
jatone wrote: post #104

Earlier quoted context omitted.

You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated. markets don't deal with this situation well. changing hospitals don't change the baseline costs for providing health care in a significant manner for there to be competition nor are many hospitals in a competitive market (often there is only one hospital for an entire rural region). that's before even getting into ph…

> You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated This account, or at least should account, for a very small minority of interactions with healthcare facilities. Saying that's why the whole market is defunct is recklessly reductionist. > markets don't deal with this situation well. They don't deal with it at all. Imagine if some people needed bread or they'd die, w…

> This account, or at least should account, for a very small minority of interactions with healthcare facilities.

sadly its not. you're in pain? you need to visit a medical facility to figure out whats wrong. without knowing how serious it is it can lead to a life long issue. again you don't really have choices here. pay the healthcare tax or risk long term issues.

there is a reason preventative medicine is cheaper (overall) than delaying care until a condition has progressed.

the capitalists idea of a market simply doesn't apply to healthcare.

> If a hospital exists because people routinely visit the doctor.

this isn't true. we fund hospitals in rural areas because there literally isnt enough people to keep one operating via patient care.

you're also asserting that if the populace can't sustain the healthcare system then it shouldn't be available to people. which is fairly cruel and immoral.

Re: I write about America’s health care system, and I got caught up in it

#126

Post by syki »

BobbyJo wrote: post #124
syki wrote: post #122

Earlier quoted context omitted.

The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage. In the U.S. system denials of care by insurance companies are not done so another person can get said care. They are done to increase profit margins and profiting from denying someone care is immoral.

> The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage That last bit is exactly what we're in disagreement about, and I haven't seen a good case for it yet. > In the U.S. system denials of care by insurance companies are not done so another person can get said care True. > They…

Police, most roads, and certain aspects of the legal system are free at the point of usage. It’s bad to have for profit police, court system, and Air Force. Some things ought not be profit driven. It’s quite disconcerting that someone sees no problem with a person profiting from denying healthcare. I should not be able to enrich myself by denying you health care. Tough decisions need to be made and the motive for the decision should not be profit.

I am not more important than you or anyone else. I don’t deserve health care before you just because I have more money. That’s a perverse idea. Unfortunately too many Americans embody the Bible’s warning regarding the love of money.

Re: I write about America’s health care system, and I got caught up in it

#127

Post by soneil »

tryptophan wrote: post #70
andi999 wrote: post #65

Earlier quoted context omitted.

The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand) If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give…

> If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give me all you have'. Yes it can... there is more than one oncologist in the world. Competition exists. As for if youre talking about the chemo drugs, you don't have to use the latest-and-greatest on-patent treatment. There are now decades of drugs that are off patent. They may not be as good, but then again, it…

The first covid vaccines came out of the UK and Germany. Whoever told you we're just stealing from the US has their head firmly in the sand.

Re: I write about America’s health care system, and I got caught up in it

#128

Post by refurb »

koenigdavidmj wrote: post #48
refurb wrote: post #31

Earlier quoted context omitted.

Why is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

My insurance did this for my kid’s eczema. Except the $5 one was an immune suppressant. For my toddler. For eczema. During a pandemic. The only sane response to that is “okay, I won’t give my kid either of those; we’ll just stick with OTC lotions”. Which is exactly what they intended.

A topical steroid I assume? Sure it’s an immune suppressant, since eczema is an immune condition. Topical steroids are standard of care.

Re: I write about America’s health care system, and I got caught up in it

#129

Post by refurb »

beerandt wrote: post #100
andi999 wrote: post #65

Earlier quoted context omitted.

The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand) If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give…

Medical prices being inelastic (to the extent they are) has much more to do with medicare/medicaid/FDA regulations, govt & insurance allowable reimbursement rate lists, and costly govt requirements to even participate in a govt funded plan (like electronic medical records). Proof? Services not typically covered, like plastic surgery or cosmetic dermatology. Clearly listed and even advertised prices for their services…

Your last comment is the reason for the massive gap between list price versus net price in the US system.

The US has a rule about “usual & customary price”. That’s a legal definition and providers can’t charge any customer more than that.

If you’re looking to price discriminate, you set your U&C price as high as possible, maybe 2-5x what you’d accept. That way if you find a customer willing to pay 4X, you’re not running afoul of the law.

For everyone else, you negotiate a much more reasonable net price, typically through insurance.

The people who get screwed in the end are ones without insurance. They get billed the imaginary number nobody ever intended anyone to pay.

Re: I write about America’s health care system, and I got caught up in it

#130

Post by refurb »

civilized wrote: post #78
lotsofpulp wrote: post #77

Earlier quoted context omitted.

The relatively new surprise billing and emergency care from out of network providers to be treated as in network providers legislation changes that: https://www.cms.gov/nosurprises https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule... For non emergency care, it should be easy to login to insurance company’s website and see if doctor or doctor group is in network or out of network.

Sort of. You get to initiate a fight with the insurer through an unaccountable arbiter. Insurer websites have lied to us in the past, claiming X was in network (zero cost!) and then sending us a denial resulting in a giant out of network bill for that exact X. Same service, same provider. Truly incompetent and evil system. Fills me with rage.

This is the problem with the US system, all the crap falls to the patient to deal with in the end.

It won’t help you now, but before any expensive visit, you should call your insurer and confirm they are in-network (doctor and clinic). A note will be made in your file as proof.

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