I have a simple solution that would fix American health care

Here it is...

We limit what health care providers can charge to aggregates of what it costs in other countries. For example, if you break your arm here, we look at how much it would cost to have it treated in every other developed country, average those totals, and restrict health care providers from charging anymore than 10% more than that aggregate price.

Now if you are asking why that would fix the American health care system then I invite you to watch these two colorful videos which do a great job explaining why it is broken in very simple terms.





There you have it. We need to get the private costs down and since the heath care providers and insurance companies are in cahoots to keep prices inflated, we need to use controls on pricing so that the free market actually has a chance to function as it should. This is actually a legitimate antitrust issue because if the markets were functioning as they should, competition would naturally drive down prices as people would actually know the cost of their health care and would have more opportunity to shop around for better deals or at least make informed decisions about their own care.

Here is an added benefit...it would also drive down the costs of Medicare and Medicaid substantially, which would lead to big cuts to government costs.

CriticalThought said:

Here it is...

We limit what health care providers can charge to aggregates of what it costs in other countries. For example, if you break your arm here, we look at how much it would cost to have it treated in every other developed country, average those totals, and restrict health care providers from charging anymore than 10% more than that aggregate price.

Now if you are asking why that would fix the American health care system then I invite you to watch these two colorful videos which do a great job explaining why it is broken in very simple terms.





There you have it. We need to get the private costs down and since the heath care providers and insurance companies are in cahoots to keep prices inflated, we need to use controls on pricing so that the free market actually has a chance to function as it should. This is actually a legitimate antitrust issue because if the markets were functioning as they should, competition would naturally drive down prices as people would actually know the cost of their health care and would have more opportunity to shop around for better deals or at least make informed decisions about their own care.

Here is an added benefit...it would also drive down the costs of Medicare and Medicaid substantially, which would lead to big cuts to government costs.

Click to expand...

Switching off the motor for medical research would certainly shake up the global pharmaceutical industry.

CriticalThought said:

Here it is...

We limit what health care providers can charge to aggregates of what it costs in other countries. For example, if you break your arm here, we look at how much it would cost to have it treated in every other developed country, average those totals, and restrict health care providers from charging anymore than 10% more than that aggregate price.

Click to expand...

Why should the price we pay be based on the price other people pay, especially other people far away receiving a different product from the one we're getting?

Instead, our price should bear at least some relationship to our cost. Basing it on other people's prices is not a fix, but a sure way to cripple the health system with completely random ass price ceilings that have nothing to do with the actual costs incurred in providing healthcare.

I invite you to watch these two colorful videos ...

Click to expand...

No, thanks.

... heath care providers and insurance companies are in cahoots to keep prices inflated...

Click to expand...

Why would insurance companies want healthcare to cost more?

... we need to use controls on pricing so that the free market actually has a chance to function as it should.

Click to expand...

The free market and healthcare have nothing to do with each other - nothing.

...competition would naturally drive down prices as people would actually know the cost of their health care and would have more opportunity to shop around for better deals or at least make informed decisions about their own care.

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Competition plays no role in healthcare costs. By the nature of the healthcare market it cannot.

Here is an added benefit...it would also drive down the costs of Medicare and Medicaid substantially, which would lead to big cuts to government costs.

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Both programs largely set their own prices already and enforce them through a system of "our beneficiaries represent a huge share of your market, so if you want to have access to that market, you're gonna take whatever the **** we pay you and be happy with it".

Some aspects of the programs are affected by high prices, but that's largely a result of government inaction in regards to those programs, not healthcare as a whole.

Lets be clear the reason that health care is been surging in price is not rocket science. You have a situation with these companies on Wall Street they have to show cash flow and profit increases to the tune 3-5% annually to placate their share holders. The answer is simple...first decouple the current employment health care model away from employers. Then eliminate the capitalistic nature of the health care industry. Why? Because it is not working. Have a bipartisan Congressional delegation and a branch of the Executive offices do a detailed 1-2 year study of all the medical programs around the world pick one and tweak it and there you go. Capitalism works wonders in business we have to come to the conclusion it does not work in this industry. The cost from 1970 to now has strangled growth in this country ....especially in the arena of wages for the average American.

CriticalThought said:

Here it is...

We limit what health care providers can charge to aggregates of what it costs in other countries. For example, if you break your arm here, we look at how much it would cost to have it treated in every other developed country, average those totals, and restrict health care providers from charging anymore than 10% more than that aggregate price.

Click to expand...

That gives me a similar idea for getting the costs of my Boston rent down. We pass a law saying rents here can be no higher than the costs of rent in Topeka, Kansas.

Problem solved!

1. United States

> Health expenditure per capita: $8,713
> Expenditure as a pct. of GDP: 16.4%
> Obesity rate: 35.3%
> Life expectancy: 78.8

While higher health care spending generally leads to better health outcomes, this is famously not the case in the United States. The country, which is one of the world's wealthiest, spends by far the most on health care. The United States spends around $8,700 per capita each year on health care, more than double the OECD average and well more than second place Switzerland.

Despite the high spending, Americans are not anywhere near the world's healthiest. More than 35% of Americans are obese, one of the highest rate in the world, and exceptionally high compared with other countries spending the most on health. The United States is also the only top 10 country for health spending where the life expectancy does not exceed 80 years. Also, perhaps as a consequence of poor economic and social factors as well as the inefficient spending, adverse health outcomes such as infant mortality have increased in the United States. While in 2000, the incidence of infant mortality in the United States was lower than the OECD average, today it is higher.

Best (and Worst) Countries for Business
2. Switzerland

> Health expenditure per capita: $6,325
> Expenditure as a pct. of GDP: 11.1%
> Obesity rate: 10.3%
> Life expectancy: 82.9

With universal health care for every citizen, Switzerland spends more on health care per capita than every country except for the United States. Higher spending in Switzerland is accompanied by better health outcomes. The national obesity rate of 10.3% is one of the lowest worldwide. A relatively low obesity rate likely contributes to the Swiss' perception of their own health. Nearly 81% of Swiss adults report being in good or very good health, a higher share than in all but six of the countries reviewed.

With more than 17 nurses for every 1,000 citizens, no country in the world is home to a larger concentration of practicing nurses than Switzerland. Switzerland also has a relatively high doctor to patient ratio with about four practicing doctors for every 1,000 residents. With a low obesity rate and plenty of health care providers, people in Switzerland can expect to live to be about 83, a higher life expectancy than in all but two of the 43 countries examined by the OECD.

3. Norway

> Health expenditure per capita: $5,862
> Expenditure as a pct. of GDP: 8.9%
> Obesity rate: 10.0%
> Life expectancy: 81.8

As in a number of other European nations, health care is universal in Norway. Through an agreement with the European Union (EU), all EU citizens are covered by the system, and undocumented immigrants are permitted free emergency treatment only. Due largely to Norway's centralized medical system, $4,981 of the $5,862 total per capita annual health spending comes from public sources — the highest public contribution of all OECD nations. The high health care spending in Norway means more health practitioners. There are approximately four doctors and 17 nurses per 1,000 Norwegians, the fourth and second highest concentrations among countries reviewed.

As in other prosperous nations, Norway has a relatively high incidence of cancer at 318 cases per 100,000 people each year. However, this is largely due to the long life expectancy. Norway has one of the longest life expectancies in the world, at 81.8 years. Despite the high incidence, Norwegian cancer patients have relatively high survival rates.

Countries With the Best (and Worst) Jobs
4. Netherlands

> Health expenditure per capita: $5,131
> Expenditure as a pct. of GDP: 11.1%
> Obesity rate: 11.1%
> Life expectancy: 81.4

Residents of the Netherlands, except for conscientious objectors and members of the military, are required to purchase health care by a government mandate implemented in 2006. Only around 1% of country residents do not have insurance. The country's health care expenditure, which at $5,131 per capita trails only three other OECD nations, amounts to 11.1% of GDP, the second largest share after the United States. While residents are required to purchase health insurance, the cost is mostly covered by the government. Out-of-pocket expenses account for just 5.2% of the overall cost, the lowest such share among countries reviewed by the OECD.



10 Cities Where You Don't Want to Get Sick
5. Sweden

> Health expenditure per capita: $4,904
> Expenditure as a pct. of GDP: 11.0%
> Obesity rate: 11.7%
> Life expectancy: 82.0

we should study what other first world nations are doing, pick the best parts of each system, and create a custom fit solution for the US. having your health care tied to where you work is a poor system.

CriticalThought said:

Here it is...

We limit what health care providers can charge to aggregates of what it costs in other countries. For example, if you break your arm here, we look at how much it would cost to have it treated in every other developed country, average those totals, and restrict health care providers from charging anymore than 10% more than that aggregate price.

Now if you are asking why that would fix the American health care system then I invite you to watch these two colorful videos which do a great job explaining why it is broken in very simple terms.





There you have it. We need to get the private costs down and since the heath care providers and insurance companies are in cahoots to keep prices inflated, we need to use controls on pricing so that the free market actually has a chance to function as it should. This is actually a legitimate antitrust issue because if the markets were functioning as they should, competition would naturally drive down prices as people would actually know the cost of their health care and would have more opportunity to shop around for better deals or at least make informed decisions about their own care.

Here is an added benefit...it would also drive down the costs of Medicare and Medicaid substantially, which would lead to big cuts to government costs.

Click to expand...

Read this:
https://www.npr.org/templates/story/story.php?storyId=123421684

I don't think they should have an exemption, but maybe I just don't understand their maga benevolence.

Helix said:

we should study what other first world nations are doing, pick the best parts of each system, and create a custom fit solution for the US. having your health care tied to where you work is a poor system.

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That can't happen here, because we can't possibly cut into the profits of the pharma, hospital and insurance industries.

<alt>doxygen said:

That can't happen here, because we can't possibly cut into the profits of the pharma, hospital and insurance industries.

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the public support for it isn't quite where it needs to be yet. we have a lot of people who are still covered by legacy insurance plans at their jobs. these are real insurance plans that actually pay for most of the costs when you get sick, so of course they are reluctant to try something else. workers who started their careers after the late 90s, however, have experienced a different system. as legacy plans become more rare and jobs are eliminated through automation, even Republicans will be forced to embrace single payer or a solution like it. this will take a couple decades, or it might happen more quickly if those currently in charge cause another massive economic crash / recession.

Helix said:

the public support for it isn't quite where it needs to be yet. we have a lot of people who are still covered by legacy insurance plans at their jobs. these are real insurance plans that actually pay for most of the costs when you get sick, so of course they are reluctant to try something else. workers who started their careers after the late 90s, however, have experienced a different system. as legacy plans become more rare and jobs are eliminated through automation, even Republicans will be forced to embrace single payer or a solution like it. this will take a couple decades, or it might happen more quickly if those currently in charge cause another massive economic crash / recession.

Click to expand...

The problem with getting a "medicare for all" or other single payer through is that it doesn't address the root problem - insane costs and far too many leeches in the system that add absolutely no value. Those need to be removed, and that in and of itself would cause economic upheaval. Hospitals, pharma and insurance employ many people.

<alt>doxygen said:

The problem with getting a "medicare for all" or other single payer through is that it doesn't address the root problem - insane costs and far too many leeches in the system that add absolutely no value. Those need to be removed, and that in and of itself would cause economic upheaval. Hospitals, pharma and insurance employ many people.

Click to expand...

that's the flipside. a lot of people are employed by the current system or are in fields related to it, including me. at some point, though, you just have to look at the system and realize how inefficient and unsustainable it is. we can do better.

<alt>doxygen said:

That can't happen here

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If we've decided to benchmark ourselves to other nations, perhaps we need to close some of our hospitals.

The smaller average size of US hospitals and relatively lower hospital utilization also play a role in driving up US inpatient costs. The United States has 23 percent fewer beds per hospital than the OECD average, reflecting the fact that capacity is distributed over more hospitals in the United States than it is in other countries. Because many fixed costs, such as high-cost machinery and administrative functions, must be incurred in each hospital regardless of size, being subscale increases US fixed costs per bed.

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We may need to cut pay.

Why are costs [of hospital stays] roughly 50% higher?

• Most input prices are roughly 50% higher in the U.S.
  • Medicare pays physicians roughly 50% more than physician labor costs in comparable countries
  • Nurses make about 50% more in the U.S.
  • The literature suggests that drugs and devices also cost about 50% more
• Some other smaller categories of cost are not more expensive (e.g., utilities)

Why are input prices higher?

• Individuals with higher education tend to make relatively higher salaries in the U.S., but the wage premium is even higher for health care workers
• Financial pressure on hospitals can affect wages of employees
  • Insurers have less leverage over hospitals in the U.S.
  • Higher hospital revenues can lead to higher wages in the U.S.
• Drug and device prices are higher in the U.S.

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We may need to deliver fewer services people have come to expect and get rid of some of our "excess" capacity.

Compared with the average OECD country, the U.S. delivers (population adjusted) almost three times as many mammograms, two-and-a-half times the number of MRI scans, and 31 percent more C-sections. Also, the U.S. has more stand-by equipment, for example, 1.66 MRI machines per 6,000 annual scans vs. 1.06 machines. The extra machines provide easier access for Americans, but add to cost. Similarly, occupancy rates in U.S. acute care hospitals are much lower than in OECD countries, reducing the likelihood of delays in admissions, but building that extra capacity adds to cost. Aggressive treatment of very sick elderly also makes the mix expensive. In the U.S. many elderly patients are treated in intensive care units (ICUs), but in other countries they would receive only palliative care. More amenities such as privacy and space in hospitals and more attractive clinics also add to U.S. costs.

While the U.S. mix of services is disproportionately tilted toward more expensive interventions, the other OECD countries emphasize a “plain vanilla” mix. Compared with the U.S., the average OECD country has 30 percent more physician visits and more than 30 percent more hospital days per capita.

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We may need to cut back on our use of new medicines and technologies--or at least wait longer for them.

Overall, Americans use more medicines than people in other developed countries. They rank first for their use of antipsychotics as well as drugs for dementia, respiratory problems and rheumatoid arthritis. This is partly explained by medical needs: The burden of disease in the U.S. — as measured in “years of life lost” — is higher than in many OECD countries for the most common forms of heart disease, chronic obstructive pulmonary diseases, diabetes, and Alzheimer’s. Several factors may explain this, including high levels of obesity and high rates of diagnosis.

Americans also have faster access to new drugs than patients in many other countries. That’s in part because the U.S. has always been a very attractive market for pharmaceutical companies: It’s big, accounting for 34 percent of the world market; has low levels of price regulation; and offers few barriers to market entry once FDA approval has been secured. (By contrast, in some other countries there may be a time lag between clinical approval of a drug and the point when it is added to official lists of reimbursable drugs.)

The result is that companies often choose the U.S. to launch new products. And, because the US market is so big and profitable, investments in research and development have long been steered towards meeting its clinical needs.

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Greenbeard said:

If we've decided to benchmark ourselves to other nations, perhaps we need to close some of our hospitals.


We may need to cut pay.


We may need to deliver fewer services people have come to expect and get rid of some of our "excess" capacity.


We may need to cut back on our use of new medicines and technologies--or at least wait longer for them.

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That makes some sense, but...
There are powerful, very entrenched interests that are raking in the money from the current system. I don't see a congress/WH in the foreseeable future that will have the balls to pry them from the trough.

<alt>doxygen said:

That makes some sense, but...
There are powerful, very entrenched interests that are raking in the money from the current system. I don't see a congress/WH in the foreseeable future that will have the balls to pry them from the trough.

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Made more difficult by the fact that one of those entrenched interests is the public itself.

<alt>doxygen said:

The problem with getting a "medicare for all" or other single payer through is that it doesn't address the root problem - insane costs and far too many leeches in the system that add absolutely no value. Those need to be removed, and that in and of itself would cause economic upheaval. Hospitals, pharma and insurance employ many people.

Click to expand...

The third party payer system is the root of insane prices. Costs aren't really all that high, but when you add unregulated profits to the actual cost, you end up with insane prices.

In most industries, the free market mechanism of price competition is what "regulates profits", that mechanism doesn't work well in third party payer system (unless of course the third party payer system itself establishes reasonable prices).

Medicare actually does regulate prices, so medicare for all would solve the price problem.

imagep said:

Medicare actually does regulate prices, so medicare for all would solve the price problem.

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Even Medicare's prices tend to be a lot higher than the rest of the world, and that's because costs here are higher.

Having only a single fee schedule would eliminate the price discrimination across different payers we have today, if that's what you mean, but it wouldn't remake the cost structure of the American health system overnight. The single-payer would have to have higher prices than Medicare does today, which adds to the challenges of financing it.

Greenbeard said:

Even Medicare's prices tend to be a lot higher than the rest of the world, and that's because costs here are higher.

Having only a single fee schedule would eliminate the price discrimination across different payers we have today, if that's what you mean, but it wouldn't remake the cost structure of the American health system overnight. The single-payer would have to have higher prices than Medicare does today, which adds to the challenges of financing it.

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Prices are often many times higher than what they have to be. I don't have insurance, I shop for healthcare based upon price. Nearly two years ago I detached my triceps from my elbow and needed sugery. The cost of a MRI varied from $500 to over $4,000 depending on who I called. I was quoted a price for the use of an operating room of $36,000 by one provider, and $5k by a different provider. The anesthesiologist wanted $2500 for a nerve block I said no thank you, that's a procedure that can be done for less than $100, it just involves locating the nerve with an ultrasound and then giving a shot.

I really don't think that people realize the degree that they are getting screwed, it's not by ten percent or twenty percent, it's more like 90+%.

imagep said:

Prices are often many times higher than what they have to be. I don't have insurance, I shop for healthcare based upon price. Nearly two years ago I detached my triceps from my elbow and needed sugery. The cost of a MRI varied from $500 to over $4,000 depending on who I called. I was quoted a price for the use of an operating room of $36,000 by one provider, and $5k by a different provider. The anesthesiologist wanted $2500 for a nerve block I said no thank you, that's a procedure that can be done for less than $100, it just involves locating the nerve with an ultrasound and then giving a shot.

I really don't think that people realize the degree that they are getting screwed, it's not by ten percent or twenty percent, it's more like 90+%.

Click to expand...

You just don;t understand the pricing structure and why it occurs.

I already addressed your example on another thread

CriticalThought said:

Here it is...

We limit what health care providers can charge to aggregates of what it costs in other countries. For example, if you break your arm here, we look at how much it would cost to have it treated in every other developed country, average those totals, and restrict health care providers from charging anymore than 10% more than that aggregate price.

Now if you are asking why that would fix the American health care system then I invite you to watch these two colorful videos which do a great job explaining why it is broken in very simple terms.





There you have it. We need to get the private costs down and since the heath care providers and insurance companies are in cahoots to keep prices inflated, we need to use controls on pricing so that the free market actually has a chance to function as it should. This is actually a legitimate antitrust issue because if the markets were functioning as they should, competition would naturally drive down prices as people would actually know the cost of their health care and would have more opportunity to shop around for better deals or at least make informed decisions about their own care.

Here is an added benefit...it would also drive down the costs of Medicare and Medicaid substantially, which would lead to big cuts to government costs.

Click to expand...

I appreciate your concern, but you will bankrupt every private doctor in NYC within 6 months.

<alt>doxygen said:

The problem with getting a "medicare for all" or other single payer through is that it doesn't address the root problem - insane costs and far too many leeches in the system that add absolutely no value. Those need to be removed, and that in and of itself would cause economic upheaval. Hospitals, pharma and insurance employ many people.

Click to expand...

We should start executing the handicapped and sick the elderly and those who work full time at bargain prices?

jaeger19 said:

You just don;t understand the pricing structure and why it occurs.

I already addressed your example on another thread

Click to expand...

Yes I do. It's almost random. When one company charges $36k and another $5k for the exact same service, then it isn't "cost" that the $36K company is using for setting their price, it's the stupidity of people who don't bother to price shop for services, combined with the fact that they have no real incentive to price shop because they have "good insurance".

imagep said:

Yes I do. It's almost random. When one company charges $36k and another $5k for the exact same service, then it isn't "cost" that the $36K company is using for setting their price, it's the stupidity of people who don't bother to price shop for services, combined with the fact that they have no real incentive to price shop because they have "good insurance".

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Yeah see.. you just demonstrated that you don't know.. and no.. its not random.

So... let me try to explain.

One company say company A charges 36k

the other company B charges 5k.. for the same service.

First.. it can be cost.. for charging the 36k.

1. Company A.. also provides way more services.. than Company B. Services that are very necessary to the community.. and to you.. but that are not in high demand. So they can do not just outpatient surgery.. but the full gamet of surgery right down to the most difficult trauma surgery.

Company B? Company B only provides easier surgeries.. done maybe on an outpatient basis. They do not have the costs associated with being able to provide ANY needed surgery that comes in.. they only provide those surgeries that are easier and in high demand.

SO.. Company A.. they have to shift the cost of having all that equipment available and staff.. to provide those rare surgeries.. onto surgeries that have higher demand. (this is called cost shifting".) and thus they charge 36k

While company B? They do not have costs they have to shift over.. and thus they can charge 5k.

Has nothing to do with price shopping.

Another reason?

1. Company A charges 36k for procedure X because that's the allowable from the insurance is 35K. Meanwhile for procedure Y.. they charge 5k because that's the allowable from the insurance company.

2. Company B charges 5k for procedure x because that's whats allowable from insurance companies.. but for procedure Y? They charge 36K because that's whats allowable.

Since both Company A and Company B are often dealing with bundled charges from the insurance company.. their are different prices because of what the insurance companies will allow.

Again.. this has nothing to do with price shopping. Price shopping doesn't change this one bit.

imagep said:

Prices are often many times higher than what they have to be. I don't have insurance, I shop for healthcare based upon price. Nearly two years ago I detached my triceps from my elbow and needed sugery. The cost of a MRI varied from $500 to over $4,000 depending on who I called. I was quoted a price for the use of an operating room of $36,000 by one provider, and $5k by a different provider. The anesthesiologist wanted $2500 for a nerve block I said no thank you, that's a procedure that can be done for less than $100, it just involves locating the nerve with an ultrasound and then giving a shot.

I really don't think that people realize the degree that they are getting screwed, it's not by ten percent or twenty percent, it's more like 90+%.

Click to expand...

A couple quick points:

First, the uninsured often do get screwed, particularly if they're not eligible for some of the financial aid non-profit systems offer. And that's because the system isn't really designed for there to be uninsured people. That's part of why universal coverage is a goal of so many, including health care providers. You may be getting hit with full charges, but charges aren't really intended to be 'the price' and the vast majority of patients (or their insurers) don't pay prices anywhere near full charges. So extrapolating from the point of view of an uninsured person is not really indicative of the general experience in our system or the price a health care provider would expect to get paid.

Second, even when you take into account actual negotiated prices (not charges), some service lines generate good margins and others don't for any given provider. So there's a degree of cross-subsidization that happens across services. In many cases, these services aren't really priced like commodities to be shopped for by individual consumers--that's why the growth in high deductible plans and direct price exposure has been rocky. When it comes to pricing, to some degree the system has historically been more focused on whether the total financial package makes sense in aggregate and less on whether the pricing of each individual service makes sense in isolation.

We're in sort of an in-between place right now where we can't quite decide whether we want to fix pricing so that (where possible) consumers can shop for health services as a commodity, or go in the exact opposite direction and remove any financial liability for consumers at the point of care. Most single-payer advocates tend to lean toward the latter.

CriticalThought said:

Here it is...

We limit what health care providers can charge to aggregates of what it costs in other countries. For example, if you break your arm here, we look at how much it would cost to have it treated in every other developed country, average those totals, and restrict health care providers from charging anymore than 10% more than that aggregate price.

Now if you are asking why that would fix the American health care system then I invite you to watch these two colorful videos which do a great job explaining why it is broken in very simple terms.





There you have it. We need to get the private costs down and since the heath care providers and insurance companies are in cahoots to keep prices inflated, we need to use controls on pricing so that the free market actually has a chance to function as it should. This is actually a legitimate antitrust issue because if the markets were functioning as they should, competition would naturally drive down prices as people would actually know the cost of their health care and would have more opportunity to shop around for better deals or at least make informed decisions about their own care.

Here is an added benefit...it would also drive down the costs of Medicare and Medicaid substantially, which would lead to big cuts to government costs.

Click to expand...

"Organized medicine"