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This is Why Healthcare Costs So Much! Thanks AMA and Big Insurance.

ttwtt78640 said:
Folks do not spend 7 years (or more) in extra schooling, while foregooing income, to prevent "starving". I agree that in single payer it is take it or leave it. Doctors, like other highly skilled professionals, are not fools and realize that there is an international demand for their skills and they also tend to be very bright and thus have many opportunities to switch career study fields to a more profitbale major (or medical specialty).

Canadian doctors still make dramatically less than U.S. counterparts: study | National Post
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And yet Canadian doctors are not pouring over the border. They seem quite happy
 
ttwtt78640 said:
Folks do not spend 7 years (or more) in extra schooling, while foregooing income, to prevent "starving". I agree that in single payer it is take it or leave it. Doctors, like other highly skilled professionals, are not fools and realize that there is an international demand for their skills and they also tend to be very bright and thus have many opportunities to switch career study fields to a more profitbale major (or medical specialty).

Canadian doctors still make dramatically less than U.S. counterparts: study | National Post
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And yet, doctors still exist in Canada.
 
vegas giants said:
And yet Canadian doctors are not pouring over the border. They seem quite happy
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While that may be true of Canadian doctors (for the time being) I see plenty of foreign born doctors in the US - if you were a doctor and going to relocate overseas to North America would you choose Canada or the US? ;)
 
ttwtt78640 said:
While that may be true of Canadian doctors (for the time being) I see plenty of foreign born doctors in the US - if you were a doctor and going to relocate overseas to North America would you choose Canada or the US? ;)
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Canada seems to do quite well in the number of doctors it has. If anything we have the doctor shortage
 
Free market depends somewhat on competition. There's never ever going to be competition in Health Care. Even if by some miracle we could get the government out of HC, there would still be NO competition.

No one is ever going to shop around for cheaper prices when their health, or their child's health is on the line.
 
Deuce said:
And yet, doctors still exist in Canada.
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Doctors exist in many nations yet they seem to thrive in the US. ;)

This is not by accident as we see extremely heavy lobbying from the medical, pharmaceutical and medical care insurance associations. Congress critters seem much more concerned about preserving their all important campaign cash than about reducing medical care costs. Even the 100% demorat PPACA has no "public option" or meaningful cost controls - that speaks volumes as to what even (super duper compassionate?) demorat congress critters are willing to personally sacrifice in order to lower medical care costs. ;)
 
vegas giants said:
We can change all that. Doctors fight against it too because they don't want the competition
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Yep, it is usually as simple as follow the money. Of course, the insurance industry does not want costs to go down - they operate on a percentage basis (like real estate agents) so the more the cost then the bigger their cut of it is.
 
ttwtt78640 said:
Yep, it is usually as simple as follow the money. Of course, the insurance industry does not want costs to go down - they operate on a percentage basis (like real estate agents) so the more the cost then the bigger their cut of it is.
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That's why the government needs to run it
 
vegas giants said:
That's why the government needs to run it
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The only things stopping UHC appear to be 1) the reluctance of congress critters to forego campaign cash, 2) the need to squeeze the people even more to get the tax revenue required and 3) general distrust in turning over ever more power to the government (remember that $2,500/year we all saved with PPACA?).
 
ttwtt78640 said:
The only things stopping UHC appear to be 1) the reluctance of congress critters to forego campaign cash, 2) the need to squeeze the people even more to get the tax revenue required and 3) general distrust in turning over ever more power to the government (remember that $2,500/year we all saved with PPACA?).
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It will have to happen eventually. For profit care is imploding
 
ttwtt78640 said:
Yep, we see lots of once prosperous medical care providers now homeless and begging on the streets. ;)
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No you see healthcare costs soaring and people wanting a better system. And people vote
 
ttwtt78640 said:
Doctors exist in many nations yet they seem to thrive in the US. ;)

This is not by accident as we see extremely heavy lobbying from the medical, pharmaceutical and medical care insurance associations. Congress critters seem much more concerned about preserving their all important campaign cash than about reducing medical care costs. Even the 100% demorat PPACA has no "public option" or meaningful cost controls - that speaks volumes as to what even (super duper compassionate?) demorat congress critters are willing to personally sacrifice in order to lower medical care costs. ;)
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This post presents zero arguments supporting the idea that single payer is more expensive.
 
ttwtt78640 said:
Indeed they do vote - and the winners, after all of that voting, do not want UHC.
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We shall see. I think it is inevitable that we get single payer. But who knows...maybe I am wrong
 
Captain Adverse said:
I was just cruising YouTube and found this interesting video about American healthcare costs.

It talks about hospitals but I believe it applies to pretty much any medical practice thanks to a need to qualify for inclusion as a medical provider in Insurance coverage plans.



I think it's humorously entertaining and informative at the same time.

Essentially, in order to afford discounts on services demanded by Big Insurance, medical facilities create extreme prices for medicine and services in order to discount those prices and still make major profits for both.

I've known (and sensed) it was something like this that had to be in play.

IMO it's a travesty affecting us all; especially now with the government compelled requirements of the ACA which depends on such Healthcare Insurers and medical providers.

Congress addressing such inflated pricing might go a long way to alleviating problems with public healthcare expenses.

THAT would be a real healthcare initiative. :yes:

Thoughts?
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I like Adam ruins Everything.. but in this episode he left a lot of things out.. like that hospitals are not paid the way he described.. they are usually paid on a DRG system..

He left out that the pricing reflects care that is not profit making in other areas.. etc.
 
vegas giants said:
We shall see. I think it is inevitable that we get single payer. But who knows...maybe I am wrong
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When the party for a bigger federal government compromises with (or loses power to) the party for a huge federal government then maybe that will happen. The last shot at it resulted in PPACA.
 
ttwtt78640 said:
When the party for a bigger federal government compromises with (or loses power to) the party for a huge federal government then maybe that will happen. The last shot at it resulted in PPACA.
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Which was a huge step in the right direction. The US is a big country and moves slowly ....but it gets there.

The US always does the right thing......after it has tried everything else first. ---Winston Churchill
 
vegas giants said:
Which was a huge step in the right direction. The US is a big country and moves slowly ....but it gets there.

The US always does the right thing......after it has tried everything else first. ---Winston Churchill
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Hmm.. a few posts ago (#37?) much of the resulting system was imploding (collapsing?). ;)

Perhaps Pelosi should have said "we have to break it so that we can fix it properly". ;)
 
ttwtt78640 said:
Hmm.. a few posts ago (#37?) much of the resulting system was imploding (collapsing?). ;)
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More people are covered now than ever before. But costs are still out of control. Time to cover everyone under single payer
 
Visbek said:
I have a tough time seeing major benefits for profit motives in health care.
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Are you asking what the benefit of competition between different actors is?

Perhaps. However, even if we cleared out some of those issues, we'd end up with a system where millions will be priced out of care, pharmaceuticals will abuse their monopoly positions, and patients might be forced to select less effective treatments based on pricing.
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I'm not in general talking about direct price exposure. In most cases that isn't particularly feasible. More importantly relative price by itself doesn't necessarily tell you what you need to know to make a decision. One of the areas where payers can add value in the future is in using smarter plan designs--i.e., the financial incentives you face in accessing benefits--to provide the choice architecture people need to make decisions. That means where possible encoding the relative value of different providers and treatments into the plan's cost sharing. We've seen some tinkering with tiered networks or value-based insurance design to date but I'd like to see a much more concerted effort to build meaningful signals into the incentives people face.

This can be done in ways that scale to income so that the incentives are there without unduly causing hardship, and certainly they can be done in plans where some part of the premium is subsidized if necessary.

Medicaid basically sets prices, by saying "we'll pay X for procedure Y." It isn't perfect, but it works quite well.
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States have turned over most of their Medicaid populations to private insurers. The state pays the insurers a premium for each enrollee, and the insurer is generally responsible for negotiating reimbursements with its provider network. Similar to how things work in the commercial space.

The trend has been distinctly away from the model you're describing, not towards it. It's possible that Maryland and Vermont's recent all-payer innovations will lead more states into all-payer approaches and perhaps even direct rate-setting but I wouldn't necessarily count on that.

Another issue is that insurance plans are sticky -- most people are reluctant to change plans once they've switched.
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And yet the exchanges have seen more willingness on the part of consumers to defect to competitors than previous public marketplaces. The NYTimes picked up on this back in late '14: People Are Shopping for Health Insurance, Surprisingly.

That has held up in subsequent open enrollment periods:

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The threat of shoppers voting with their feet is the source of the large degree of price (premium) competition we've seen in the exchanges.

What you're proposing is pretty much what the Exchanges offer. It puts the insurers in direct competition; it gives the potential insured a lot of information about the plans; it offers a variety of plans; it is up-front about pricing. It still doesn't work great, because the mandate is too weak to force healthier people into the system. That's why prices went up so much in a handful of states. Forcing employees to use the same systems wouldn't make it any easier, or more transparent, it would just change the lineup of plan offerings.
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I'm talking exactly about what the exchanges offer. We've seen more price (premium) competition in the exchanges than anticipated, which has put downward pressure on provider prices. When we saw the first-ever drop in hospital prices two years ago, commercial insurance pressures on hospital pricing was one of the main culprits. We've even seen a proliferation of provider-sponsored plans, allowing provider systems to essentially price their suite of services (via a single premium) directly to consumers. There's a reason comparable coverage is significantly cheaper in a competitive exchange than in a non-competitive employer-based plan.

The point of moving more people from the less-competitive private insurance space that's ~14 times bigger by enrollment and into more competitive marketplaces is not simply to "change the lineup of plan offerings," it's to spread the incentives encouraging cost containment to the rest of the market. Really make the exchanges market-movers and you'll see that greater enrollment doesn't simply make them more stable and more attractive to potential sellers, the managed care competition for the most favorable provider contracts will be significant.
 
Greenbeard said:
Are you asking what the benefit of competition between different actors is?



I'm not in general talking about direct price exposure. In most cases that isn't particularly feasible. More importantly relative price by itself doesn't necessarily tell you what you need to know to make a decision. One of the areas where payers can add value in the future is in using smarter plan designs--i.e., the financial incentives you face in accessing benefits--to provide the choice architecture people need to make decisions. That means where possible encoding the relative value of different providers and treatments into the plan's cost sharing. We've seen some tinkering with tiered networks or value-based insurance design to date but I'd like to see a much more concerted effort to build meaningful signals into the incentives people face.

This can be done in ways that scale to income so that the incentives are there without unduly causing hardship, and certainly they can be done in plans where some part of the premium is subsidized if necessary.



States have turned over most of their Medicaid populations to private insurers. The state pays the insurers a premium for each enrollee, and the insurer is generally responsible for negotiating reimbursements with its provider network. Similar to how things work in the commercial space.

The trend has been distinctly away from the model you're describing, not towards it. It's possible that Maryland and Vermont's recent all-payer innovations will lead more states into all-payer approaches and perhaps even direct rate-setting but I wouldn't necessarily count on that.



And yet the exchanges have seen more willingness on the part of consumers to defect to competitors than previous public marketplaces. The NYTimes picked up on this back in late '14: People Are Shopping for Health Insurance, Surprisingly.

That has held up in subsequent open enrollment periods:

blog1.png


The threat of shoppers voting with their feet is the source of the large degree of price (premium) competition we've seen in the exchanges.



I'm talking exactly about what the exchanges offer. We've seen more price (premium) competition in the exchanges than anticipated, which has put downward pressure on provider prices. When we saw the first-ever drop in hospital prices two years ago, commercial insurance pressures on hospital pricing was one of the main culprits. We've even seen a proliferation of provider-sponsored plans, allowing provider systems to essentially price their suite of services (via a single premium) directly to consumers. There's a reason comparable coverage is significantly cheaper in a competitive exchange than in a non-competitive employer-based plan.

The point of moving more people from the less-competitive private insurance space that's ~14 times bigger by enrollment and into more competitive marketplaces is not simply to "change the lineup of plan offerings," it's to spread the incentives encouraging cost containment to the rest of the market. Really make the exchanges market-movers and you'll see that greater enrollment doesn't simply make them more stable and more attractive to potential sellers, the managed care competition for the most favorable provider contracts will be significant.
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Whats sad is that one of the best ideas of the ACA was the exchanges. It was unfortunate that they did not carry this idea out more fully. And what's really sad is that the republican party has done whatever they can to kill one of the best ideas in the ACA.
 
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