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Hospital Prices Are About To Go Public in the US (ajc.com)
Prices hospitals charge for their services will all go online Jan. 1 under a new federal requirement, but patient advocates say the realities of medical-industry pricing will make it difficult for consumers to get much out of the new data. From a report: A federal rule requires all hospitals to post online a master list of prices for the services they provide so consumers can review them starting Jan. 1. The health care industry nationally has a reputation for having little price transparency, which can make it difficult for consumers to price compare. But the hospital's master list prices, sometimes called a chargemaster, is also not a complete look, consumer advocates say. That's because the final bill a patient receives is almost never the same as the sticker price for the services they received. Insurance companies negotiate discounts on the sticker prices. Co-pays, co-insurance, deductibles also add other layers of complexity that bring discounts or increased costs before a final charge is determined.
All this "oh we can't tell you the real price" bullshit needs to come to a screeching halt. This is just cartelism, or guildism, or whatever you can call it. It's an industry screwing us over because it can, and claiming technical difficulties prevent it from changing. It was bullshit when Microsoft did it with Internet Explorer and it's bullshit with hospitals.
Shutting down free speech with violence isn't fighting fascism. It IS fascism!
That was not really an answer ...
I don't think US spending money on inefficient and unequally accessible health care help the security of other countries? Or do you think so?
Privatized medicine can work. There are clinics in the US that offer a menu of fixed-price services, and take direct payment (no insurance). No bureaucracy leads to reasonable prices - everybody wins.
The problem comes when the government intervenes too much. In the health insurance market, insisting that everyone must be covered, regardless of health problems or pre-existing conditions - that's no longer insurance, and has led to the problems the US is facing. Let the private insurance market work - it worked just fine for most people, most of the time, over many decades.
For people who cannot qualify for private insurance, the government can become the health care provider of last resort. That's basically where Medicare/Medicaid would come into play. Essential services only, no cosmetic or optional treatments. This is also where people would land, who get ill or injured, but couldn't be bothered to pay for insurance.
The situation in countries like the UK is actually not too dissimilar. The NHS provides health care for everyone, as long as you don't mind waiting months or years for anything that's not immediately life threatening. Meanwhile, there is a perfectly functional private insurance market for people who don't want to wait - the prices are reasonable, and coverage is good. As far as I can tell, the government basically ignores the private market - which is probably why it works.
Enjoy life! This is not a dress rehearsal.
But the hospital's master list prices, sometimes called a chargemaster, is also not a complete look
Correct. Because nowhere on the chargemaster is a service that says "colonoscopy". Good luck getting the average American to interpret ICD-10-PCS code descriptions. According to this website, a screening colonoscopy should receive the following three codes:
Z12.11: Encounter for screening for malignant neoplasm of the colon
Z80.0: Family history of malignant neoplasm of digestive organs
Z86.010: Personal history of colonic polyps
No word for "colonoscopy" that I can see. Furthermore, this doesn't include the anesthetist charge, recovery, the room charge (which is always charged for with surgery, inpatient or outpatient), or the food charge. Other hospitals even throw in itemized charges for IVs, needles, hoses, gowns, laundry, and tissues.
It'd be like shopping for a car, and before you go, you have to look up online the costs for all the individual parts that make up a car. Except most Americans don't know every single nut and bolt, camshaft and wiring assembly, window and panel, that goes into one. And you get to the car lot, ask how much the cost is, and the salesman says, "We have all our costs online." You get your car, you drive it home, and then you get a bill in the mail three months later for five times what it really should cost.
What health care really needs is the sticker price posted right in the window.
Just start gradually reducing medicare eligibility age from 65 to 50. Cover all children below 10, call them unborn Americans and their hosts and give pre natal care and cover child birth for free. Gradually raise it 18.
Slowly allow people to buy into medicare. Eventually we will have a single payer system.
sed -e 's/Chuck Norris/Rajnikant/g' joke > fact
First we need to build the wall. The cost alone would pay for itself in short order. The money saved from it thereafter will provide better coverage for US citizens.
http://www.fairus.org/press-re...
Life is not for the lazy.
As an outsider (living in Sweden, Europe) I am a bit curious
No you're not. This is entirely in bad faith. Yo're also leaving out a major...major cost: innovation. America basically pays for the entire world's new treatments. Your "vastly more affordable yet somehow equal" care only advances because the American market incentivizes people to create the next greatest treatment. So, I guess, if your current care is SO GREAT that you won't need any new cancer treatments ever, then enjoy your commie-med.
Are you really sure? Take Sweden for example. 10 million inhabitants, but being the source of a high amount of medical innovation, and creating a nice home market for an disproportionately large amount of biotech companies. Also, the fact that higher education is free of charge (you only pay for books) plus significant public spending on medical research is probably contributing.
When it comes to incentives, it's interesting that leaving research completely to market forces creates little incentives for products or procedures that cures diseases, but much more for products that you have to use continuously all life.
https://www.lif.se/en/about-li...
Hopefully this is the first step in getting rid of insurance companies. The hassle of all this is what the insurance companies use to stay in business.
1. Billing errors are almost always in their favor. You either spend your valuable time haggling with them to correct it, or it gets paid because you don't notice it or don't have time to deal with it.
2. The time you spend correcting their mistakes also requires people working in the insurance company to correct them. Insurance companies are regulated by the state, and so they often need to justify their rates. The customer service people serve that purpose. The rates are often negotiated such that they are allowed to make a 10-30% profit on their "service". More expenses means more profit. This behavior, which would normally kill a business, becomes something that strengthens it because of the way government has their fingers in this industry.
4. Doctors now have full time people who do nothing more than haggle with the insurance companies to get paid. This further drives up the cost of care, which again benefits the insurance companies.
5. Because we have turned healthcare into an "insurance" product, you decouple a service from its price because everything is handled in aggregate. Remember from Finance 101, insurance products are designed to "make you whole" if an unlikely event occurs. Healthcare is a certainty, so paying for it as an insurance product makes no sense. That'd be like having "food insurance" or "housing insurance" to pay for your groceries and rent/mortgage. It is unnecessary and only adds cost. Then the added cost becomes a barrier and the insurance companies sell themselves as helping to overcome the barrier that they erected.
6. Healthcare is a giant jobs program. All those people haggling over costs would be out of a job things changed significantly. This is the main reason the system won't change.
7. Individuals cannot change the market because they do not purchase the insurance. Their employers do. Therefore, health insurance companies' customers are not the people receiving the service. Insurance companies provide just enough service to entice HR directors to choose them. Employers are interested in a healthy workforce, but at the end of the day it is a dollars decision that the employee does not get to make. This serves to distort the market.
Personally, I think the solution is to eliminate health insurance, and take the premiums that companies pay and just deposit that into the employee's health savings account. Then let the employees buy whatever they need. If they want insurance they can choose the plan that is right for them. Kinda like buying car insurance They can also just save the money and pay providers directly - but they need the up-front pricing information to make those decisions. For those that need assistance, the government or charities can deposit money into people's HSA is they need assistance. Then the market will return to something more normal simply because *** the people making the decisions are the people receiving the service. ***
Remember, You are unique...just like everyone else.
Healthcare is a certainty, so paying for it as an insurance product makes no sense. That'd be like having "food insurance" or "housing insurance" to pay for your groceries and rent/mortgage.
I was with you right up until that. Healthcare is not a universal certainty. When my kid was brought into this world it popped out, cried a bit and we had it home no fuss a short while later.
When my friend's came into this world it turned blue, straight into open heart surgery due to being born with transposition of the great arteries.
Now five years later and my kid hasn't had much more than butterfly stitch at a doctor. That same friend of mine had his in the emergency room getting a custom metal plate inserted in her head to replace her shattered skull when she landed face first on a rock after dismounting a trampoline.
My wife hasn't been to the doctor in 2 years. I have endless back problems and had a hernia done. Healthcare is a perfect example of how one person's life can be completely unburdened while another's can financially bankrupt them. The latter is definitely not a certainty.
That said I live in a first world country which has socialised healthcare so the concept of using insurance to fix this problem just seems so dumb.
As an outsider (living in Sweden, Europe) I am a bit curious, but mostly alarmed how the US have got such a seemingly malfunctioning health care system. Most other 1:st world countries (in Europe, Japan, South Korea ...) have some variation on a single-payer system, where hospital visits and drugs are in most part paid by everyone via taxes, without what seems like the bureaucracy of private or employer-paid insurance.
The advantage the EU and Japan have is that they don't have a huge underclass. This is changing as the EU is now committing suicide by importing a huge underclass. In California for example 1/3 of the state, a huge chunk of that illegal or anchor babies, is on free healthcare. Free. No co-pays to visit a doctor, no cost for medicine, no monthly fee. This is supported by virtually all legally working adults paying *lots* in taxes and getting nothing in return. It's unsustainable and will bankrupt the state. Working adults however pay hundreds a month just to have insurance, and the anger grows. To say that illegal immigration is killing the state is spot on. Citation: https://www.sacbee.com/news/lo...
Car analogy: Auto insurance covers catastrophic events like collisions. But what would happen if it also included gasoline?
So every time you refuel, you fill out a form, take it to the insurance department at the gas station, sit in the waiting room for 30 minutes while they negotiate the price with your auto insurance company, and when you are finally approved, you sign more forms indicating that you understand that gasoline is flammable and contains carcinogens and should not be consumed internally or sprayed in anyone's eyes. Then they dispatch a highly trained professional to dispense the gas, which is time consuming because there is a different nozzle specified by each insurance company, and your company requires the use of a low cost nozzle that doesn't quite fit your car. Finally, you receive a binder with all the forms and receipts for your tax records.
What would this do to the cost and hassle of owning a car?
discrimination? That's what the current system is, after all. You're getting "Group Rates" negotiated by a company (your insurance company) on your behalf.
The real problem here is that you're trying to fit the square peg of healthcare into the round hole that is capitalism. Capitalism works great for things that you buy periodically, can obtain and understand all or nearly all relevant information on, lend themselves to competition and are relatively low risk for the individual. Think twinkies, soda pop, video games and even cars.
Capitalism breaks down when paying for healthcare because you can't do any of that. You can't comparison shop for a heart transplant, you'll pay anything for it since without it you die and you can't understand what makes one hospital better than another for a transplant (and no, looking at a few statistics isn't enough, how much do you know about the doctor doing the transplant? The heart being transplanted? The staff who will care for you before and after?).
Oh, and this is before we discuss how your insurance company has every incentive to try and avoid paying for your care. RE: Pre-existing conditions.
This is why folks in the know (like the doctors and nurses themselves) want single payer. But you're taught from childhood that the only answer to any problem is capitalism. When I took econ 101 in high school socialism wasn't even discussed. Capitalism was at fait accompli. A given. No other competing solutions or systems were brought into play. They didn't even try and bad mouth it, it was just capitalism rah-rah-rah for 6 months. It's tough to get out of that mindset. And I assure you, that's by design. Go look up why pubic schools were formed sometime. They're not there to teach you to be a good citizen, they're there to teach you to be a good worker. I'm not saying that's the only thing they do (don't get me wrong, I support public schools), but we need to think about where we came from and where we're going.
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You can't use the financial struggles of the British NHS as any example of socialised healthcare in a negative sense, because it's financial struggles are caused by a significant decrease in funding in real terms by the current government, plus a shift to treating its staff so badly that they are leaving NHS employment in droves.
The *entire* point of the current governments attitude to the NHS right now is *precisely* so in a few years time it can point to all the people saying "the NHS doesn't work" and use them to support a sell off to private ownership on the cheap.
It's already started - NHS bodies were recently forced to sell off "excess property" at a "three for one" sale price, which meant that a significant amount of NHS real estate was sold at firesale prices to property developers hand picked by the current government.
Why does the NHS have "excess property"? Because various services have been underfunded or defunded, meaning NHS trusts had to reduce and consolidate service provision, meaning NHS trusts now had extra wards and facilities they can't afford to provide services from. It wasn't a case of NHS trusts holding on to real estate to build an empire.
The only reason to hold the current state of the NHS up as an example of anything is as an example of deliberate mismanagement by the government.
Take for example waiting times - waiting times are an issue, so what does the government do about it? Decree that GP surgeries have to open in the evening and weekends to allow patients better access to their GPs. Does it matter that GP surgeries struggle to provide their current level of care? Not one bit. Is there extra funding for opening late and at the weekend? Not in any meaningful manner.
My wife, a GP, already worked from 7.30am to 7pm to cater for a normal 8am-6pm surgery day - 40 patient appointments a day, plus 4 home visits, plus 10 telephone consultations, plus 100 repeat prescriptions to sign for.
And now she's being told that she needs to work later and at the weekend. For no extra money.
Hospitals were told they were spending too much on locum doctors. So the government mandated a cap on locum rates. Now hospitals struggle to get locum doctors, meaning rota gaps, cancelled appointments and operations.
There are many examples of a GP practice closing and the practice partners themselves having to take second mortgages or loans out so they can pay their other staff a redundancy package.
We left and migrated to New Zealand. Not because of the NHS, but because of the governments management of the NHS.
At last count, out of the 132 people that graduated medical school with my wife, 94 now live and work outside the UK.
Every bad thing you can show about the NHS as an example of a "failing single payer system" is completely calculated by the current Conservative government, its things they have done deliberately because their end goal is to shift the UK to an insurance backed scheme like the US. This has been proven time and again.
Smokers and the obese have their routine operations cancelled? Good, they are the complex cases and raise the risks significantly even in "routine" operations. Complex cases and increased risk means it costs more to do the operation, and to insure the operation. Less money in the pot means you have to start taking responsibility for your own health - lose weight or stop smoking and your risk goes down, and your operation done.