patrick.net

Require Medicare for all.

Patrick says

Require short clear written presentation of all non-emergency medical costs before treatment. This would give a small measure of market pressure to medical prices.

I seldom care what the total costs of a treatment are. All I care for is how much comes out of my pocket for co-pay. And I seldom know even that.

Too many hands in the till to ever be taken seriously.

Ironman says

Strategist says

I seldom care what the total costs of a treatment are. All I care for is how much comes out of my pocket for co-pay.

You and 95%+ of the population...

What you normally hear is: "If my insurance pays for it, do it". The majority could care less about the actual cost.

Exactly. If the insurance companies have to pay more, I don't care, they are crooks anyway.

Strategist says

Exactly. If the insurance companies have to pay more, I don't care, they are crooks anyway.

Yeah, but when your paying 20-100% of whatever the bloated bill is, you should care.

Ironman says

FP says

Require Medicare for all.

Not a solution.

It (or similar) is the only solution.

Just look at Patrick's figure above.

Ironman says

Price transparency and control (Patrick's plan) and a Medicare for all plan is like comparing apples to cinder blocks. Two different animals.

Yes. The first does little to solve the problem, the second goes a long way.

Ironman says

How's that working out for cost controls in the program?

You tell me.

FP says

Just look at Patrick's figure above.

here's an even more amazing image:

Patrick says

Require short clear written presentation of all non-emergency medical costs before treatment.

There is something like 70,000 icd10 codes. Most are non-emergency. That's going to make a short clear presentation pretty tough to do.

Then there is the small problem of needing a diagnoses of what is wrong to know what treatment will be before getting a price for treatment. Then most of the time treatment will be writing a prescription. How much difference is there in the cost of writing prescriptions?

People go to whatever doctor in their plan that they like or their friends recommend. Even if by some miracle people actually looked it at prices if dr x charges 20% less and your insurance doesn't cover dr. x that information is totally useless. Posting prices won't change anything no matter how much the free marketers believe it should be true.

Patrick says

Establish universally fixed costs for emergency treatment by law, because no one has any opportunity to shop in an emergency.

How exactly does one do this in the real world? The costs of a small rural hospital er that transfers a lot of people aren't comparable to the costs of running a major trauma center high level er that takes everyone and has tons of expensive specialized equipment along with lots of very expensive highly trained people . The possible variations are endless.

Patrick says

Require all providers to list all of their prices on a publicly accessible website in a standardized format by billing code, and allow public site scraping so databases can easily be collected.

and so what will that accomplish? The insurers are already know what the doctors they cover charge. The insurers set the payments.

Patrick says

Non-discrimination: all medical prices must be charged the same to everyone, whether insured or not. If a hospital charges one person $50 for a certain injection, it must charge everyone else exactly the same $50.

Won't change the cost of health care a nickle, but should definitely be the law. Overcharging the uninsured is absurd.

As Willie Sutton said (more or less) 'I rob banks because that's where the money is". If you want to make changes in the cost of health care then you need to go where the money is. Over treatment (which would require a huge cultural shift in attitudes about dying), the cost of running the insurance system, the cost of running the billing system, drug costs, and profits. Especially taking profits on every single thing done or used, like compounding interest. Pissing around with inconsequential things like posting prices is just picking up pennies on the floor.

rando says

here's an even more amazing image:

Nothing amazing about it. It's just reflects culture. Other countries don't do extending dying. They make people comfortable and let them die with dignity. I've lived in other counties a long time and talked with people about it a lot. They really are amazed and confused as to why americans would want to get so much invasive medical care when they are obviously very near dying. Many find the thought of dying in a hospital hooked up to machines pretty horrifying. Being at home or if needed hospice is much preferred Public health systems and their doctors very much support this. Doctors are careful to evaluate the costs, both financial and to the patients comfort/dignity , of procedures for the elderly. Many public systems employ their doctors so the inherent conflict of interest of fee for service doesn't exist. Even the systems that do fee for service the doctors are much more conservative about the elderly. and yes sometimes the systems simply deny care that can't be justified price wise. The "death panel" thing. But it is really rare. The patients and families are almost always on board with what the doctors recommend as being beneficial or not.

America's intensive end of life care health care fixation is very expensive. Something like 30% of medicare spending is last year of life. Far too many people demand that doctors everything they can and far to many doctors are willing to go along while billing for it.

So unless @patrick is advocating what the idiots call "death panels" the only way this is going to change is a major change in attitudes about death within american society. Without it the huge end of life costs aren't going down.

bob2356 says

rando says

here's an even more amazing image:

Nothing amazing about it. It's just reflects culture. Other countries don't do extending dying. They make people comfortable and let them die with dignity.

It's the damn lawyers who are to blame. Religion too.

rando says

here's an even more amazing image:

Yes, impressive but a bit misleading because people in their 80' and 90's are only a small fraction of the population.

The total cost is an integral over (per capita cost per age)*(number of people per age).

New subtle but important twist added to OP above:

"No one shall be charged anything at all for medical care unless they have personally signed off on the exact cost beforehand."

Ironman says

That's why it says "per capita".. doesn't matter if it's 12 people or 12 million people.

Actually it does matter. We care about the total cost.

Ironman says

Also, why does it ramp up in the senior years, lets see if you can guess???

(here's a hint: Medicare for all)

1. All the other countries on the list have Medicare for all.
2. The inflection starts above age 50.

Clearly there are other factors that explain the rise.