patrick.net

Single payer isn’t that simple. I’d love it to be simple, but it’s not. Single payer Obamacare just pushes cost onto taxpayers, it doesn’t address them.

It still doesn’t address the damn emergency room racket. They won’t tell me the price even if I pay cash.

marcus says

Fortwaynemobile says

was told by everyone who works there that they can’t possibly tell me the price.

THat's the OPs point.

I don't think publishing prices is the solution. The solution is single payer. MAking that payer our representative. But the transition no matter what is going to be tough, because of entrenched investment interests in hospitals and health insurance companies, big pharma etc. In fact the transitions away from what we have is so difficult, that it explains the reason for the ACA.

Sadly, at the federal level our government couldn't work together, becasue that might have made Obama a hugely successful President. And we couldn't have that.!

And yes, of course lobbyists, campaign finance and corruption in general are also at the heart of the problem.

Corporations are people ! Got to love those right wing SCOTUS'.

Yet illegals can visit ER with impunity.

marcus says

Sadly, at the federal level our government couldn't work together, becasue that might have made Obama a hugely successful President. And we couldn't have that.!

Normal people don't care about who gets called a hugely succesful president...That's the domain of fanatics and special needs people...People care about what is good for themselves.

marcus says

It's almost as if free market capitalism isn't working in this case. Is it possible, that there are some things, such as health care that shouldn't be left to the "market."

The pricing system isn't capitalist, which is the problem.

There is another problem with over-regulation, resulting in the shut down of tons of smaller, charity hospitals and many areas only have one corporate hospital with secret pricing and no reasonable alternative.

theoakman says

You certainly can't be of the position that publishing prices would be a bad thing. It can only help.

I don't think it's the root of the problem. Right now we have a system where most people either have health insrance or an HMO like Kaiser, through their employer, or they buy their own health insurance.

People who buy their own are often going to opt for a major medical plan that covers mostly huge or catastrphic costs, and then they pay for smaller things themselves. Where as people with socalled cadilac plans or HMOS have plans that cover more, and then they have a copay of something like $20 - $30.

From the doctors point of view, it depends on which of these types of providers she caters to, but the billing aspect of it is already a nightmare.

So what would listing prices even mean ? IF it's an independent doctor that offers services to various insurance companies and also connected to a medical school and hospital, how does she list her price ?

The only thing I can imagine is something like this:

Here's is my price for this procedure: $ X

These following insurers pay X, these other insurers pay .70X, medicare pays .60X , the following MAGA insurers don't cover this procedure at all, and I am not currently taking uncovered patients, but if the hospital assigns me uncovered patients a payment plan for price .60X will be negotiated.

So sure, we could have a HUGE battle in congress about listing prices, and what we would get is probably some mess like that. AS long as different insurers have different deals, and corporate hospitals are playing various complex games to keep the system running as it does, I don't see that listing prices is a solution.

But, I can understand that if someone is an independent contractor, buying cheap major medical insurance for themselves and choosing to pay for everything non major out of pocket, that then they would like prices listed.

But we have a royally messed up health system that is not directed towards these patients/customers and their interests. But if we put in place a single payer system, where everyone had more or less the same coverage, with supplemental plans covering the difference for many procedures and out of system doctors, then I could see that listing prices makes sense.

First things first. The way the system is now, what would requiring prices be listed even mean ?

zzyzzx says

This is why Trump wants published prices for common medical procedures.

Sadly, I have not heard Trump mention anything about publishing medical prices since the election.

Someone please remind him about this campaign issue.

OR you could have a price list for people with policies that don't cover that particular procedure. That would be easier to implement. But even then, it messes things up. If they have a lower price that brings in more uncovered patients, do they then have to charge more of a premium to insurance companies to offset. OR if they can't, what is this going to mean? Presumably they have a deal for being in their "Network" that they have to be able to treat up to X number of patients from that insurer. So they can't lower prices so much for non-covered people to cause a problem with that deal. Also, doctors hate having to track down patients to pay their bills.

Don't you see ? Unless there is standardization among insurance companies as to what the insurance costs and what it covers(spreading the cost of people with preexisting conditions among the pools), then price lists can't really be done.

IT's a complex mess, that I don't claim to nearly comprehend. But I can see that listing prices may simply not be doable in the current system.

marcus says

It's almost as if free market capitalism isn't working in this case. Is it possible, that there are some things, such as health care that shouldn't be left to the "market."

There are instances when capitalism fails. Emergency room is one of them.
The huge bills people receive really goes to pay for those who have no insurance.

Strategist says

The huge bills people receive really goes to pay for those who have no insurance.

Well that and the overhead of being staffed to handle much more than what they are typically tasked with. Right ? Think about it. THey don't know when those busiest days or nights are going to be. But they have to be ready for them. Only part of that can be handled with the "on call" system. Also, let's not forget about coverage for malpractice suits.

marcus says

Strategist says

The huge bills people receive really goes to pay for those who have no insurance.

Well that and the overhead of being staffed to handle much more than what they are typically tasked with. Right ? Think about it. THey don't know when those busiest days or nights are going to be. But they have to be ready for them. Only part of that can be handled with the "on call" system. Also, let's not forget about coverage for malpractice suits.

The medical system is fucked up. You can lose your life savings with a single accident or illness in the family.
My dog was in the emergency room twice for a total of 5 days, just a few months ago. The total cost including follow ups and meds was about $8,000. We even had insurance, but they only paid $1,350. Even insurance rips you off. You just can't win.

Single payer pretends to be the silver bullet for this issue, but it's not. Its proponents don't understand the law of unintended consequences: poorer quality doctors, less innovation, less choice, no competition, more gov't bureaucracy/corruption/cost. This country CANNOT afford single payer, period. My belief is that it can only work when you have very tight borders, a very large majority of makers (not takers), and a SMALLER, HEALTHIER and more homogeneous population (like Denmark).

The solution is the integrated health system or HMO like Kaiser, where they own the health plan and provider sides of the house, and there's health competition with others. They're motivated to provide the best care for the money, and the patient is "taken care of" for a predictable cost to their budget.

Kaiser isn't much cheaper than being on a ppo plan. Kaiser is nothing more than an example of the expensive health care we already have.

It doesn't take that much thought to see that single payer can work. In spite of the fact that those enemies, those damn liberals, like it. That alone doesn't make it wrong. IT already fucking works (medicare) for all of the expensive stuff (for pretty much everyone) when old people are dying without even bringing race or work ethic in to it.

Adding on major medical for the rest of us to medicare has got to be cheaper than the current mess, even if it does deprive an entire industry of a fortume it is skimming off of the top.

Don't worry, Kaiser takes medicare.

AS with energy related issues, I really wish this weren't a democrat issue. If the solution to any problem implies that democrats win, we simply CAN NOT HAVE THAT !!!!!!!!!!!!

There isn't any mystery as to what procedures cost, it's kept deliberately opaque by hospitals and insurers who benefit greatly by concealing costs.

Hospitals gouge, which give insurers a reason to raise premiums which they claim they can't avoid because the hospitals gouge.

Be very suspicious of an extremely widespread service that has easily statistically measurable sets of numbers in a capitalist society where the costs are skyrocketing near double digits every year.

This is easily proven: Compare the change in health care costs in Japan or Singapore, versus the United States. The former two experience health care inflation about the same as general inflation. The latter is often 200-300% higher than CPI. And Japan has an incredibly large aging population and a much smaller successive population of young people. Something ain't right.

Medical costs should be more predictable and less varied than Haircuts or Fast Food Hamburgers.

HMOs failed in most states FYI.

marcus says

Kaiser isn't much cheaper than being on a ppo plan. Kaiser is nothing more than an example of the expensive health care we already have.

It doesn't take that much thought to see that single payer can work. In spite of the fact that those enemies, those damn liberals, like it. That alone doesn't make it wrong. IT already fucking works (medicare) for all of the expensive stuff (for pretty much everyone) when old people are dying without even bringing race or work ethic in to it.

Adding on major medical for the rest of us to medicare has got to be cheaper than the current mess, even if it does deprive an entire industry of a fortume it is skimming off of the top.

Don't worry, Kaiser takes medicare.

AS with energy related issues, I really wish this weren't a democrat issue. If the solution to any problem implies that democrats win, we simply CAN NOT HAVE THAT !!!!!!!!!!!!

marcus says

The solution is single payer.

My mother in law is on single payer Medicare. She’s into her third unnecessary surgery and getting ready for two more. She switched doctors a couple years ago and the new guy wanted to get paid for some procedures so convinced her that surgery would take care of her various aches and pains.
Wonder who is paying for all that? It’s free for her!

If people had some skin in the game, they’d be less likely to abuse the medical care. But then we’d need fewer surgeons and medical personnel. Can’t have that.

theoakman says

You certainly can't be of the position that publishing prices would be a bad thing. It can only help.

Anything that fixes our medical system is bad to a socialist.

What's your take on Laser Eye surgery? Those prices are posted regularly and the cost has gone down. Not sure if it's still the case but for a good 10 years, insurance didn't cover it either.

marcus says

Kaiser isn't much cheaper than being on a ppo plan.

.

Where I work, Kaiser costs the same as a PPO plan, but offers way cheaper co-pays and deductables. Now if there were competitive HMO's to Kaiser, we might get a break. But all anyone has to compare to is expensive PPO's.

theoakman says

What's your take on Laser Eye surgery? Those prices are posted regularly and the cost has gone down. Not sure if it's still the case but for a good 10 years, insurance didn't cover it either

Clearly there’s a strong correlation between procedures insurance doesn’t cover and reasonable pricing.
I paid for that procedure out of pocket back when it cost $4000. Worth every penny.

theoakman says

What's your take on Laser Eye surgery? Those prices are posted regularly and the cost has gone down. Not sure if it's still the case but for a good 10 years, insurance didn't cover it either.

Great point. Capitalism works in medical care when it's not in the rotten system.

Patrick says

The other big problem is the daily masturbation to racial issues by the lefties who run the media. They are just going to keep stroking themselves because they love the discord it causes. They absolutely do not want national unity.

Yup. Both Islam and the Radical Left know that Western Civilization, Enlightenment and "Pre-Post Modernity", Rationalism, Communitarianism, and Civic Nationalism have to be defeated to usher in the "Perfect Civilization". Traditional Liberals, Classic Liberals, etc. stand in the way of Progress. Why, we could have Utopia if we could just start from the Year Zero and/or convert all the Kaffirs!

The Siblinghood of Man (Brotherhood being Patriarchal) can be had here on Earth, Gentlemen! It only takes a kindly, guiding, elder Uncle Hand, like that of Jeremy Corbyn, and this could be an Earthly Paradise, with Equity and Social Justice (Equality under the Law and regular Justice being Bourgeois, Capitalist, Patriarchy). It will be the Maternal State of Nature, with all Property in Common, healthy Vegan Dinners, Regular Yoga Exercise, and mandatory Recycling for all!

lostand confused says

Yet illegals can visit ER with impunity.

I think anyone can if you don't care about your credit rating and don't have a legit job.

theoakman says

What's your take on Laser Eye surgery? Those prices are posted regularly and the cost has gone down. Not sure if it's still the case but for a good 10 years, insurance didn't cover it either.

Absolutely lasik and invisalign are perfect examples of capitalism working its magic in medicine. The insurance/hospital/MD/big pharma racket system is socialism, not much to blame capitalism for.

Invisalign now costs less than one month rent for a 2-3 bedroom in SF. Lasik less than a week's rent.

In New Jersey, there's a chain of physical surgery centers and they've opened 10 or 12 locations already. I've been in and out for about 16 months for various injuries. My insurance covers it, fortunately. But if you are having chronic pain and have no insurance, they'll set up a 3 month plan for you for $600. They run EPAT ultrasound to break up the scar tissue, work on you manually via massage/muscle release and have you work on specific exercises to strengthen. I've been to physical therapy 6 different times in my life. They were the best I went to and they are offering services for cash at reasonable prices.

In New York years ago, physicians tried to align themselves with each other. They formed groups of general practitioners and several specialists. They were going to offer unlimited services for a flat fee per person each year...something like $2500. The state shut down their system claiming they were running their own insurance. The reality is, the insurance company saw this as a threat and lobbied to have them shut down.

Insurance companies are the evil within the system and the sooner we stop acting like people need to be insured to obtain care, the quicker we can work these aholes out of the system. It won't happen because 50% of the population equate insurance with the ability to see a doctor.

Patrick says

Well, yes and no. We CAN afford single payer because we already spend the most in the world per person on health care, by a large amount:

What I meant is that we CANNOT afford single payer as our country exists realistically today. If we changed a bunch of foundational things like you later mention in your post, then it's more possible.

Many years ago, they built a state of the art private hospital in Pittsburg, CA in a beautiful, modern building. At that time, the State of California deemed in it's infinite wisdom that no hospital could legally operate unless they included an emergency room. The hospital never opened, it just sat idle, because they knew that the emergency room in a welfare type population would quickly bankrupt the hospital, so they abandoned it.

PrivilegedtobeWhite says

we CANNOT afford single payer as our country exists realistically today

OK, agreed.

My point there was that we already pay more per person than any country with single-payer.

MY take is that single payer could definitely be done in a way that would actually bring down costs over time.

It's too complicated for someone with as little expertise as I have in the field to realistically even speculate, but based on what I know, it seems like it could work as medicare for all, except that for people below 65, it would only cover major medical catastrophic stuff. Not even preventative care such as colonoscopys or breast cancer screening.

(note: I use the term major medical to refer to the type of care that requires a hospital stay, such as surgery. Not the preventative and maintenance care)

Then the insurance industry could compete for policies that cover all the things that this type of major medical does not, with a health care savings plans as an option, and sure listed prices for the many people that would opt for the health savings accounts. Possibly some law requiring people to put away at least $1500 per year in a health savings plan would be a good idea, since otherwise all the people that live paycheck to paycheck would have no money for preventative care.

But yes, the obstacle to medicare for all being done well is insurance industry.

IF we weren't all so divided by political ideology, and gullible to providers of propaganda, then the internet age might have been a vehicle for bringing a new political party together that could solve so many problems, including this one. But alas propaganda works, and corporations are people. So even if such a group rose up, their leaders would quickly be bought off, while massive amounts of money was spent discrediting them to the idiot masses.

You have single payer in America, it's just expensive. It can't be cheap, because of how expensive healthcare is.

Government is trying to address it through insurance, insurance is a fraction of it. When Hospital charges someone a million (yes 1M) for ICU because their kids were born pre term, that's not insurance fault. That's just how expensive it is these days. Single payer isn't going to change that.

Why can't I know in advance what things cost, why can't we have a system that promotes efficiency instead of monopoly? Costs are astronomical. Than there are social issues, like homeless and illegals who still get healthcare but that cost is passed onto everyone else, thanks Democrats for creating this homeless paradise in CA.

Patrick says

The other big problem is the daily masturbation to racial issues by the lefties who run the media. They are just going to keep stroking themselves because they love the discord it causes. They absolutely do not want national unity.

Patriotism is a threat to Multinational Corporations. it's the only force with enough legitimacy and power to oppose them.

Multinats are also playing with fire. The combination of mass immigration + support to "End Whiteness" (aka stoking Racial Tension with the bad actor always Whites) is dangerous, and the replacement regimes of Socialism and/or Islam will be far less considerate of Multinational's needs.

Quigley says

If people had some skin in the game, they’d be less likely to abuse the medical care. But then we’d need fewer surgeons and medical personnel. Can’t have that.

Mandatory Catastrophic Coverage.and mandatory MSAs is a great balance between Socialized Healthcare and the Secretive, Opaque Hospital-Insurance Bureaucratic Fake Market of today.