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Health care is turning into a consumer product

economist.com

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Re: Health care is turning into a consumer product

#291

Post by CraigJPerry »

DrBazza wrote: post #215
CraigJPerry wrote: post #164

Earlier quoted context omitted.

>> If the government kept funding the NHS by an extra X percent every year, we run out of public funds Lets say the uk gov allocated 10x to the nhs in the next budget - to be clear, this would put just nhs spending at more than total govt income for the year. If this were a company we’re talking about, they’d be insolvent. But we’re talking about a govt with a sovereign currency. So what would happen in this scenario…

The govt has rules for borrowing from the capital market, and that's (mostly?) for national infrastructure projects. It will never (hopefully) borrow from the capital markets to fund the NHS, and then continually pay it off. That leaves tax or private money to fund the NHS, and we can't tax people much more. So in your comment "how is the money created?" Answer, tax, and there's a maximum limit to how much we can fun…

>> The govt has rules for borrowing from the capital market

Yeah it does. The UK govt has had 6 different sets of rules in only the past 10 years.

The current rules followed by Rishi Sunak are actively opposed to what you say - he’s been celebrating beating borrowing forecasts of the OBR by £26bn, and he makes a big song and dance any time he can stating excessive public borrowing is immoral. He found the magic money tree instead…

The scope of quantitative easing has increased massively since it was introduced. On top of this, the bank of england does not publish a report on which govt bonds have matured - but we know some have already without having been sold.

So, the govt borrowed from the govt (bank of england bought out uk govt bonds held by non govt entities) then held them to maturity (so the govt paid the govt back), while remitting the coupon payments back to the govt. All while we can’t see inside the machine - none of this is available via public reporting.

It’s not quite “printing money” but it definitely qualifies as a magic money tree.

It’s how govt’s corona responses are paid for today and it’s the reason NHS funding is constrained not by tax receipts but by policy, political decision.

Re: Health care is turning into a consumer product

#292

Post by ch4s3 »

nopenopenopeno wrote: post #278
ch4s3 wrote: post #231

Earlier quoted context omitted.

> Heaven forbid “wage inflation!” I realized after double checking that it was actually a 1942 Roosevelt bill, and they were trying to figure out how to keep a lid on rising prices during the war. It's also not uniformly good if prices also rise quickly. Inflationary spirals are real, and very bad for regular people. > Was the AFL pushing for employer-based and the CIO pushing for national? I'd have to double check.…

Blaming employer-based healthcare on the stabilization act sounds suspicious to me.

It was intentionally tax incentivized via the tax code. There’s mountains of writing about it. See https://www.nytimes.com/2017/09/05/upshot/the-real-reason-th...

Re: Health care is turning into a consumer product

#293

Post by majormajor »

arethuza wrote: post #279
majormajor wrote: post #246

Earlier quoted context omitted.

This is always extra annoying because it might be a false savings to pay cash there. Let's say your MRI says you need a $5500 procedure, and your plan's deductible is $3000, 90% coverage after, and out of pocket max is $6000, and there's nothing else you've spent on the plan this year. Pay $800 for MRI with insurance, you'll then pay $2200 for the procedure to hit the deductible + 10% of the remaining $3300, so $2530…

Do you folks have to perform these calculations every time someone in your family gets sick or injured?

Usually no, most people just use doctor-suggested or in-insurance-network providers and billing because it's easier than calling multiple places and hyper-optimizing on the math.

But we have to pay the bills after the insurance company does the calculation, which often results in annoying surprises.

The better your insurance, the less nasty surprises, which largely in the US means "the better you're paid, the less you have to pay out of pocket for health expenses" which is a nasty thing because then the people most likely to be hit with a big bill are those who can least afford it.

Re: Health care is turning into a consumer product

#294

Post by alistairSH »

mumblemumble wrote: post #189
dgb23 wrote: post #76

Earlier quoted context omitted.

I agree. The "everything is a market" ideology had a good run of almost half a century, but it should be heavily criticized in hindsight. Institutions like healthcare, education, public transport, prisons(!) and so on are more efficient, less corrupt and of higher quality when they are in large parts collectively and democratically organized and funded. The "in large parts" is important here: A community should agree…

One thing to note about US healthcare is that it seems almost deliberately engineered to not be a market. I've never received significant health care in another country, so I can't say how the US system differs from others with any expertise. But I can say how US health care differs from just about anything else I spend money on: 1. I don't really get to shop for health insurance providers. My employer picks one, may…

The other side of the "market" is also not very "free". Health care facilities are heavily regulated - and I don't just mean for safety. Try opening an MRI facility or other capital-intensive facility... You'll be required to obtain a certificate of need from a state board. That board will be heavily lobbied by existing supplies to minimize competition from upstart facilities. IIRC, around 2/3 of states have these laws in place.

https://www.usnews.com/news/best-states/articles/2021-07-09/...

Re: Health care is turning into a consumer product

#295

Post by dr_orpheus »

arethuza wrote: post #279
majormajor wrote: post #246

Earlier quoted context omitted.

This is always extra annoying because it might be a false savings to pay cash there. Let's say your MRI says you need a $5500 procedure, and your plan's deductible is $3000, 90% coverage after, and out of pocket max is $6000, and there's nothing else you've spent on the plan this year. Pay $800 for MRI with insurance, you'll then pay $2200 for the procedure to hit the deductible + 10% of the remaining $3300, so $2530…

Do you folks have to perform these calculations every time someone in your family gets sick or injured?

Yes, unfortunately so. You have to play the stupid game of "expected medical expenses".

For example, am I going to do something major like have a baby this year. Then yes it probably makes more sense to get me to my deductible and pay the extra money to go with insurance. Or if you (or someone on your plan) has an ongoing medical issue where you know you will meet your deductible. Or on the flip side, I met my deductible one year and was going to physical therapy. Since I met my deductible the physical therapy visits were cheap, but going in to the next calendar year now my deductible reset. Could I have used more PT? Maybe, but the visits were about to be 5x more expensive.

But "expected medical expenses" is just the dumbest thing.

Re: Health care is turning into a consumer product

#296

Post by alistairSH »

arethuza wrote: post #267
vel0city wrote: post #265

Earlier quoted context omitted.

Many (most? I always take employer-sponsored, not an expert on all plans) health insurance plans in the US have a concept of out-of-pocket max. This is a yearly amount that is essentially your maximum yearly liability. That amount can vary from plan to plan and year to year. Usually a lower out of pocket max means higher premiums, similar to the idea of having a lower car insurance deductible usually means higher pre…

Thanks for answering - one last question! Is that a hard limit and you'll never have to pay more than that?

Trick question... - Some policies have a cap on benefits. So, your max out-of-pocket might be $10,000/person, but there's also a max benefit of $2,000,000 (made up numbers). This type of plan language was mostly banned with the ACA (Obamacare), but there are some grandfathered plans.

- Balance billing - there is no guarantee that the insurance provider will actually pay what the hospital bills. Insurance companies usually have negotiated rates with some providers. So, if you end up at an ER that's out of network (no negotiated rates), your insurance might pay what they think is reasonable and the hospital bills you the excess. Several California-based hospitals are notorious for this. It also happens with helicopter ambulance transport - frequently, they'll bill $50,000 for a ride, insurance covers $25,000, and the patient is stuck with a $25,000 balance (again, made up numbers).

Re: Health care is turning into a consumer product

#297

Post by hitpointdrew »

UnpossibleJim wrote: post #290
hitpointdrew wrote: post #276

Earlier quoted context omitted.

> the fact that healthcare is already a consumer product in the US I would strongly disagree with this. Healthcare in the US is currently a cartel system, not a consumer product/market system. If healthcare were a consumer product then: 1. It wouldn't be tied to or dependent on my employment. 2. Prices for medical treatment wouldn't be hidden/obfuscated by medical providers. 3. Insurance providers wouldn't be restric…

I only put this out there because I feel it needs to be, but we can't just put all of health-care into a single basket. Emergency medicine should be separated out of these discussions as there is no "Free Market" option, just as there is no real free market option for police or fire services. For optional surgery or cosmetic treatment, sure. You can argue a free market option, but that's why I always think there shou…

This is very fair point and distinction.

Re: Health care is turning into a consumer product

#298

Post by mindslight »

vorpalhex wrote: post #285
mindslight wrote: post #225

Earlier quoted context omitted.

This is true, but I haven't seen any coordinated efforts at market based healthcare reform. Some of the needed reforms are patently obvious (eg make arbitrary post-facto charges illegal, like every other industry), and yet there are no popular campaigns advocating for them. There are a few comments in this thread chiming in with lists of reforms, and I could write one of my own, but politically it's crickets (likely…

> make arbitrary post-facto charges illegal, Hospitals now are required to make pricing transparent and surprise bills (out of network charges) are now prohibited, both are recent reforms.

Out of network charges are only one possible surprise, and it's yet to be seen how the cartels wriggle out of the new regulation.

As far as I am aware, you're still unable to get straightforward answers for questions like "how much will this procedure cost?". Furthermore, this "transparent pricing" revolves around publishing a fake list of inflated prices that nobody actually pays and so is effectively useless.

Meanwhile in every other industry you either get a flat fee ($30 for an oil change), or at the very least an estimate and a contract that fixes the rate (the shop rate is $80/hour, we think this will take 2 hours). Materials are often overcharged (eg $140 for a part that is easily available for $100, because it's delivered from a special supplier) but still within a workable bound, unlike say fraudulent aspirin.

This is a straightforward reform - the reason healthcare doesn't operate like this is they bought laws creating the ability to charge you without needing to establish a contract.

Re: Health care is turning into a consumer product

#299

Post by dontreact »

hitpointdrew wrote: post #276
cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

> the fact that healthcare is already a consumer product in the US I would strongly disagree with this. Healthcare in the US is currently a cartel system, not a consumer product/market system. If healthcare were a consumer product then: 1. It wouldn't be tied to or dependent on my employment. 2. Prices for medical treatment wouldn't be hidden/obfuscated by medical providers. 3. Insurance providers wouldn't be restric…

The Japanese system is not a single payer healthcare system and in terms of outcomes vs. cost is one of the best in the world, so I am not so sure that single-payer is the most reasonable solution. Particularly in the US where voters are averse to giving up their private insurance.

Japanese system does have a public option and much tighter price controls, which we are missing here.

Re: Health care is turning into a consumer product

#300

Post by throwawaygh »

hitpointdrew wrote: post #276
cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

> the fact that healthcare is already a consumer product in the US I would strongly disagree with this. Healthcare in the US is currently a cartel system, not a consumer product/market system. If healthcare were a consumer product then: 1. It wouldn't be tied to or dependent on my employment. 2. Prices for medical treatment wouldn't be hidden/obfuscated by medical providers. 3. Insurance providers wouldn't be restric…

It's not (just) about whether healthcare is a human right. E.g., interstate transportation on surface roads isn't a human right, but markets lost out to collective action. Why? Because building a well-functioning market for 8 lane interstates across an entire mostly-rural country was impossible in the 20th century (and probably still is).

So, the other important question to ask is the following: how feasible is it to create a well-functioning market for this product?

So far, we don't have an existence proof that such a well-functioning market is possible to construct in the healthcare space.

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