US Health Insurers Caught Negotiating Worse Rates Than For Those With No Insurance (nytimes.com) 240
In the U.S. healthcare system, "hospitals are charging patients wildly different amounts for the same basic services," reports the New York Times — citing an investigation into medical care costs at 60 major hospitals.
This year the U.S. government ordered hospitals to publish complete lists of the prices they negotiate with private insurers, "and it provides numerous examples of major health insurers — some of the world's largest companies, with billions in annual profits — negotiating surprisingly unfavorable rates for their customers." In fact America's government-run Medicare health insurance for senior citizens is negotiating much lower rates than the privately-insured patients are getting, the Times points out — sometimes paying just 10% of what the major health plans are paying.
"In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all..." Until now, consumers had no way to know before they got the bill what prices they and their insurers would be paying. Some insurance companies have refused to provide the information when asked by patients and the employers that hired the companies to provide coverage. This secrecy has allowed hospitals to tell patients that they are getting "steep" discounts, while still charging them many times what a public program like Medicare is willing to pay. And it has left insurers with little incentive to negotiate well.
The peculiar economics of health insurance also help keep prices high. Customers judge insurance plans based on whether their preferred doctors and hospitals are covered, making it hard for an insurer to walk away from a bad deal. The insurer also may not have a strong motivation to, given that the more that is spent on care, the more an insurance company can earn. Federal regulations limit insurers' profits to a percentage of the amount they spend on care. And in some plans involving large employers, insurers are not even using their own money. The employers pay the medical bills, and give insurers a cut of the costs in exchange for administering the plan.
This year the U.S. government ordered hospitals to publish complete lists of the prices they negotiate with private insurers, "and it provides numerous examples of major health insurers — some of the world's largest companies, with billions in annual profits — negotiating surprisingly unfavorable rates for their customers." In fact America's government-run Medicare health insurance for senior citizens is negotiating much lower rates than the privately-insured patients are getting, the Times points out — sometimes paying just 10% of what the major health plans are paying.
"In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all..." Until now, consumers had no way to know before they got the bill what prices they and their insurers would be paying. Some insurance companies have refused to provide the information when asked by patients and the employers that hired the companies to provide coverage. This secrecy has allowed hospitals to tell patients that they are getting "steep" discounts, while still charging them many times what a public program like Medicare is willing to pay. And it has left insurers with little incentive to negotiate well.
The peculiar economics of health insurance also help keep prices high. Customers judge insurance plans based on whether their preferred doctors and hospitals are covered, making it hard for an insurer to walk away from a bad deal. The insurer also may not have a strong motivation to, given that the more that is spent on care, the more an insurance company can earn. Federal regulations limit insurers' profits to a percentage of the amount they spend on care. And in some plans involving large employers, insurers are not even using their own money. The employers pay the medical bills, and give insurers a cut of the costs in exchange for administering the plan.
Corrupt (Score:5, Insightful)
You couldn't end up with a worse health care system if you set out to try. Every single market force is working against the average joe.
Re: (Score:3)
A big problem is perverse incentives.
Under the ACA, insurer profits are limited to 15% of premiums. So, paradoxically, they can make more money if they pay higher prices to the providers. They can then skim off their 15% profit and pass the rest of the cost on to the customer.
Re: Corrupt (Score:2, Insightful)
Re: Corrupt (Score:5, Insightful)
"The GoP backed "single payer" alternative would have been far better..."
Kind of funny, in that now every time someone mentions single payer the entire GoP screams "Socialism!".
Re: (Score:2)
Romneycare origins (Score:5, Informative)
The Heritage Foundation memory holed it from their website, but it was their proposal.
Re: (Score:2)
The Heritage Foundation memory holed it from their website, but it was their proposal.
Here's an example I think.
https://www.heritage.org/healt... [heritage.org]
"Congressional Inaction"
Congress could simply change the federal tax code to give individuals and families tax relief for the purchase of health insurance regardless of where they work so that they can buy and own the coverage they want at competitive prices. In other words, by changing the tax code, Congress could take a dramatic step to creating a real, consumer-driven health insurance market. Going even further, if Congress allowed interstate commerce in health insurance-letting individuals and families to buy coverage across state lines from any state in the United States-it would create a single national market for insurance coverage. In this large market, with large health insurance pools, individuals and families would own and control their own health insurance. These reforms would create a robust system of consumer choice and competition.
"Enter the State Health Insurance Exchange"
I cut one or two paragraphs here after "Short of congressional action to reform the tax code, the burden to improve health coverage rests with state officials."
The best option is a health insurance market exchange. A properly designed health insurance exchange would function as a single market for all kinds of health insurance plans, including traditional insurance plans, health maintenance organizations, health savings accounts, and other new coverage options that might emerge in response to consumer demand. In principle, it would function like a stock exchange, which is a single market for all varieties of stocks and reduces the costs of buying, selling, and trading stocks. For the same reasons, other types of market transactions are also centralized, such as farmers' markets, single locations where shoppers can purchase a variety of fresh fruits and vegetables, and Carmax, where consumers can choose from among all kinds of makes and models of automobiles.
In the case of a statewide health insurance exchange, employers would designate the health insurance exchange itself as their "plan" for the purpose of the federal and state tax codes. Thus all defined contributions would be tax free, just as they would be for conventional employer-based health insurance. The major benefits of this arrangement for employers, particularly small employers, are a reduction in administrative costs and paperwork and the ability to make defined contributions to their employees' preferred plans.
It's very depressing to read, we could have had a single nationwide marketplace, and instead of just people without coverage through jobs using it, employer contributions could have go towards the marketplace, so the employer/
Re: (Score:3)
I certainly feel your sentiment, but I think capitalism has some merit in some ways. Competition can certainly inspire innovation, efficiency, productivity, etc.
I think the problem is more: lack of education. As a US citizen I went to K-12 school. Never had 1 minute of economic education. Later went to college (BSEE) and took some economics courses as elective. I did well, but the point is: I think if everyone had some solid understanding of micro and macro economics, the system would work much better.
Re: (Score:3)
Re: Romneycare origins (Score:5, Insightful)
The free market is a poor system for setting the price and supply logistics for things with inelastic demand. Health care is the big example, but basic foodstuffs, shelter, water, power, and the like all tend to have problems when they're left to the free market. On the flipside, the free market is *very* good at settling prices for elastic goods, and for driving innovation and luxury.
The free market is an excellent system when you're dealing with elastic demand, there is no collusion between any of the parties, and all the parties involved are fully informed. When you start taking away those critical elements, it very quickly breaks down, and can end up offering far worse outcomes than other systems of resource allocation.
Re: (Score:3)
Well you probably don't want to hear this but "more government" as a solution to crazy medical costs worked fine for all of the rest of the first world https://en.wikipedia.org/wiki/... [wikipedia.org] .
Personally, if the solution works I'll take it.
Re: Corrupt (Score:4, Insightful)
Mitt is in no way a RINO, he's Republican through and through, unlike Trump who was the newcomer who took the party in a 90 degree direction.
Re: (Score:3, Informative)
Well Massachusetts is decidedly liberal Blue, and has been for like, decades. So no the ACA isnâ(TM)t some Masshole GOP designed system. The only thing republican about the system in MA was Mitt signing it.. and heâ(TM)s well known as a RINO.
Is Heritage Foundation RINO now? *roflsnarts*
https://www.heritage.org/healt... [heritage.org]
In reality, those who want to create a consumer-based health system and deregulate health insurance should view Romney's plan as one of the most promising strategies out there. I know, because I've been part of the Heritage Foundation team advising the governor and his staff on the design, which builds on some of my work with officials in other states.
-- Senior Research Fellow, Heritage Foundation
Wait, what GOP backed single-payer solution? (Score:4, Insightful)
Re: (Score:2)
Re:Wait, what GOP backed single-payer solution? (Score:4, Insightful)
GOP want's you to have a choice.
The GOP wants insurers -- who donate money to them -- to get money. A single payer / public insurance option won't be making political donations ... /cynical
Re: (Score:3)
Any health care system like Romneycare that requires insurance companies to participate is a bullshit system.
If you want a single-payer system where everyone is covered but people who want special stuff can get their own insurance, fine. I don't care. But if every health insurance company in the US disappeared to
Re: (Score:2)
"facts facts" Should have been "fake facts".
Freudian slip?
Re: (Score:2)
find a politician on the Republican side that supports single-payer healthcare?
How far back are you willing to look?
Richard Nixon proposed a sorta single-payer system in February 1974.
Nixon resigned in August, Gerald Ford was less keen, and the recession of 1975 ended it.
Re: (Score:2)
Re: (Score:2)
Re: (Score:2)
So he Thought about it, but he actually signed the HMO bill? https://en.wikipedia.org/wiki/... [wikipedia.org]
No. Dick's proposal was made in 1974. It was after the HMO bill.
Re: (Score:2)
A GOP solution that had to be forced into law by the Democrats.
Re: (Score:3)
The GoP backed "single payer" alternative
The ACA *is*the GoP system. It is absolutely nothing even remotely like the first proposal from the democrats that went though congress, and heavily modified entirely to appease the GoP to the point where it was not even recognisable anymore. The democrats didn't give a fuck about private insurer profit which is precisely what lead to record medical lobbying during the Obama era.
And this fuckup was by design. The GoP members were on the record saying their single purpose was to ensure the democrat agenda ge
Re:Corrupt (Score:5, Insightful)
At least even the free market proponents are starting to wonder why we need insurance companies at all, to manage insurance that everyone is obliged to get under the same terms. In that case, just make it a government managed service.
Re:Corrupt (Score:5, Interesting)
"Under the ACA, insurer profits are limited to 15% of premiums"
No, premiums are capped at 115% of projected claims. This sounds like the same thing unless you know how actual insurance* works: since the underwriter gets your money up front, they diversify risk no just by pooling risk of their policy holders but by investing that money in other activities. Since there some variability on what the actual claims turn out to be they do get to charge that additional 15% for reinsurance, etc., but the real way they make money is by accurately assessing risk. They're not settling for the 15% over claims.
*: There is the confounding problem that much of what we call "health insurance" is actually a prepayment plan.
Re: (Score:2)
Re:Corrupt (Score:5, Interesting)
No, it's not the worst health care system possible. Believing that is dangerous, because it can *become* worse. From my own experience spending the majority of a year managing the health care of a loved one who was critically ill. She was taken to an inner city emergency room and admitted to that hospital, and eventually (after quite a bit of conflict) transferred to a Tier 3 ICU at a teaching hospital. This means I saw the best and worst of what the system has to offer.
(1) the care the working poor get is substandard for any advanced nation. It's not that the doctors start out bad; they *become* bad by having to continually rationalize substandard care.
(2) If you have a loved one trapped in a hospital that mainly treats low income working people, it is imperative you get them transferred to a hospital that treats middle class people.
(3) Once you get into that part of the system, the care is in most respects world class, but the whole system is incredibly complicated. You can't count on the hospital to always have your best interests first.
(4) The complexity and perverse incentives of the system means that you need a primary care physician whom you know personally to manage your access to services. Attempting to navigate they system without an assertive PCP is literally dangerous.
(5) The care well-to-do people after they get sick is generally very good, but very expensive, often catastrophically so. The complexity of the system is so huge, nobody feels like they can do anything about this.
(6) The people who work for the insurance company are neither interested in helping you get to a good outcome, nor even saving their employers money. Their number one concern is being the one to blame if something costs a lot of money. They will therefore refuse to authorize services that would save them money and benefit the patient if they look unusual.
(7) Insurance may simply refuse to pay certain bills after the fact. You are informed of this by something call an "Explanation of Benefits". The Explanation of benefits is a list of things that the company refuses to pay for in whole or part. There are no actual explanations, nor are you given any recourse or appeal.
(8) If you call the insurance company about a denied claim, you will not be routed to anyone who has the authority to make any decisions. The person you talk to is basically there to take up your time until you decide to go away.
Is the the *worst* system imaginable? No. But it's pretty easy to imagine a better one.
Great post - one small note on #7 (Score:3)
Just one point on #7 about the EOB docs and no recourse or appeal. The explanation of benefits docs I receive do have an appeal process you can go through documented there - usually at the end.
The problem is that it's a total pain and pretty stressful. When you and your employer are paying four digit premiums a month on healthcare, I shouldn't HAVE to be appealing because of the knotted, bureaucratic mess the insurance companies have made to protect themselves. It's not worth the stress you feel for that
Re: (Score:2)
I'm lucky with Kaiser as the hospital, doctors, and insurers are the same entity. Thus they have more incentive to provide preventative treatment to lower costs. Of course, it has its own flaws, but it's much better than the traditionally separate insurer versus doctor and deductibles.
Re: (Score:3)
Story time. In my early 20's I had to deal with wisdom teeth. lucky me I don't have four, I have six, but that's another story for another time. The point was, back then was a period of time in my life where I had a good job, got laid off and spent some time unemployed, and then got another decent job. So there was this span of time when I wasn't insured.
I had the same
Re: (Score:3)
Re: Corrupt (Score:4, Informative)
The banks do the same thing with loyal customers. (Score:2)
If you're too loyal with your bank, they do the very same thing.
You're feeling safer, they know this - so they get away with saying no to you when you want to negotiate a better deal, because they bank on that you won't leave anyway, you're too insecure and they know it.
Loyalty doesn't pay at all.
Same with work, if you get to work at home, you're more in a position to focus and think things over, when at work (at a physical location) you're stressed and psyched into believe it doesn't get better than this.
I
Re: (Score:3)
Re:The banks do the same thing with loyal customer (Score:4, Interesting)
there's really no "market."
There are some areas of medical care where the market functions well: Cosmetic surgery and LASIK.
They are generally not covered by insurance, so patients are paying out of their own pocket. Prices are publicly listed up-front. Outcomes are easy to compare.
The result? Over the last 20 years, while other healthcare costs have gone up 300%, the cost of cosmetic surgery has gone down.
Re: (Score:3)
Dental and eye-care generally insurance doesn't cover. Still both are expensive.
Re: (Score:2)
To be fair cosmetic surgery (Score:3, Insightful)
Also the results of cosmetic surgery are much easier for the layman to understand. I can look at a girl who got a boob job and tell whether it's a good or a bad boob job. I can't easily tell looking at somebody if they got a
Re: (Score:2)
That's certainly how it works with car insurance. If it's the customer paying they charge a rip-off price, if it's the insurance company they triple it.
I want LASIK but am too scared that it might screw my vision up.
Re: (Score:2)
Re: (Score:2)
Get one of those new AI wallets and see who's crazy!
Solved (Score:3)
Easy solution:
Delete: private insurers are limited to earn a profit as a certain percentage of their revenue for a given procedure
Add: private insurers are limited to earn a profit as a certain percentage of the Medicare rate for a given procedure
Solved
---
Of course there are pros and cons of even having private health insurance and using government regulation to control their profit levels. Which will not fit in the margin of this comment.
Re: (Score:3)
Re: (Score:2)
An even easier solution is to let everyone less than 65 buy medicare coverage at cost.
That was the "public option" considered by Obama in 2009 when the Democrats had 60 Senate seats.
If they weren't able to pass it then, there is no way it will happen today when they have 50 seats and really only 48 when you exclude the DINOs (Manchin and Sinema).
Re:Solved (Score:4, Insightful)
Re:Solved (Score:4, Insightful)
Re: (Score:2)
Nothing says you have to have health insurance now.
I can't opt out of my organization's health plan. I am required to have money taken from each paycheck whether I want it or not. The only thing I can do is minimize my loss by taking a once a year health exam (sugar levels, blood pressure, weight). I don't even have to be in shape or health (I am). All I have to do is spend the fifteen minutes getting looked over and I pay slightly less. But I am still required to pay.
Roll the dice if you want.
I'd be ha
Re: (Score:2)
I doubt that.
With my employer, not only can I opt out, but if I do opt out, my employer will give me $1000/month.
Re: (Score:2)
Re:Solved (Score:4, Interesting)
The real horror story of the US medical insurance system is not the fact that it costs you money to buy, its the fact that you regularly hear about people being hit with inflated bills and "out of network" charges that you cant plan for.
Personally, I like being able to rock up to any ER in the country and being dealt with for free - I had my appendix out in February of this year, cost me nothing, didn't have to worry about any bills or shock charges, just turned up to the ER, was admitted within 30 minutes, appendix out at 7am the next day, discharged 3 days later.
Re: (Score:3)
Even easier solution. Let people pay for what they use instead of being forced to pay for something they don't use. Over one's working lifetime, expect to lose, at a minimum, $100,000 paying for medical insurance you never use. That's $100,000 they will never get back. It's gone. Money poured down the drain. A complete waste.
(a) That how insurance works in general.
(b) Many (most?) people can't afford to "pay for what they use" especially for expensive medical procedures. That's why medical bankruptcy is a thing. Sure, $100k over your lifetime is a lot of money, but it's less than, for example, one heart bypass surgery [livelyme.com]:
Cardiac bypass is the most common type of heart surgery performed on adults in the US. The average cost of bypass surgery in the US in 2018 was $123,000.
And while it may be true that some (many?) reasons for cardiac bypass surgery may be patient lifestyle related, not all are nor are under the control of said patient. Some are due to genetics and/or simple bad
Re: (Score:2)
a) That how insurance works in general.
No, it does not. Insurance is when you pay, and pay, and pay, then when you need to use it, you pay even more. Need to visit a doctor? You pay for the visit. Why? You've already shelled out X thousands of dollars, why should you have to pay for something you've already paid for? Need to get a test run? You pay again.
What's the point of handing over your money if you have to pay even more? Just pay for it once when you need it.
Re:Solved (Score:4, Interesting)
Or - how about this not-so-novel idea used by every other civilised country in the western world - tax payer funded healthcare. Guess what - it's cheaper and has better out comes than the trash system America uses. By every metric, America's healthcare system sucks. Why? Because it's for profit. And it's that simple.
Re:Solved (Score:5, Informative)
a) That how insurance works in general.
No, it does not. Insurance is when you pay, and pay, and pay, then when you need to use it, you pay even more. Need to visit a doctor? You pay for the visit. Why? You've already shelled out X thousands of dollars, why should you have to pay for something you've already paid for? Need to get a test run? You pay again.
Every insurance plan -- medical, auto, home, etc... -- usually comes with deductibles, co-insurance and limitations. Those are usually inversely related to the regular premiums. Most plans have things they cover in their entirety though -- like most preventative care under the ACA, in the case of medical insurance.
What's the point of handing over your money if you have to pay even more? Just pay for it once when you need it.
As I noted in (b) most people cannot afford the cost of a major medical expense. You may not like paying $100k over your lifetime for insurance to cover most os those expenses, but do you have $123k laying around at any one moment -- all that time -- for a heart bypass? For most people, probably not.
You're either very naive, uninformed/inexperianced or trolling ...
Re: (Score:2)
Because when you need it, you can't afford it. If the system was set up that way, you couldn't afford medical care for anything more severe than a broken arm.
I'm listening to my mother-in-law bitch about that now. Didn't want to pay for long-term care insurance back when working -- why pay when I may never need it? Now that her husband needs it, she can't afford it. The cost is astronomical.
Re: (Score:2)
Add: private insurers are limited to earn a profit as a certain percentage of the Medicare rate for a given procedure ...
Better yet: private insurers are limited to earn a profit as a certain percentage of what they SAVE the insured.
For most of my life I was a runner. The last year of work, before I retired, I rode a bike to and from work regardless of the weather. Nine years after I retired I experienced Tachycardia. I had no other symptoms. My doctor took an EKG, prescribed Bistolic, and sent me to a cardiologist. He used the EGK my doctor took, because Bistolic restored normal rhythm and stopped the Tachycardia.
Seems completely messed up (Score:5, Insightful)
Probably way overdue for a full replacement with something actually modern and sane. Shame there is no political will for that in the US.
Re: (Score:2)
We could probably cut healthcare costs by at least 20% independent of the system used by eating better, getting more exercise, and cutting out the plethora of unhealthy behaviors (e.g. alcohol overconsumption) we engage in
Re: (Score:2)
And then we have a pandemic [youtu.be]. Who's covering that?
Re: (Score:3)
We can cut around 40% across the board by limiting administrative overhead in private systems to single-digit percentages, like Medicare does. Source: sec.gov.
But then the GOP and a lot of very rich people will scream "socialism !!!" as if my health is their private profit center.
Re: (Score:3)
Every other country in the world has done that, and we all get better outcomes for less money. None of it is secret.
Re: (Score:2)
You're right though. Turning your system of government into a democracy would not doubt help.
Re: (Score:2)
When has the pure market system ever actually worked?
Obfuscation is good for business (Score:2)
If you snow your customer about what you're actually doing, it's a shit ton easier to convince him you're indispensable and to make it hard for him to prove otherwise.
On the other side of the coin, this is where the old adage that "the vendor is a lying scumbag" come from.
It both mystifies me and doesn't surprise me one bit that non-profit and/or academic institutions like universities and hospitals (and university-affiliated hospitals) have managed to pull this same snow job on the general population and o
Well duh, premiums are set at payouts + percentage (Score:5, Interesting)
As part of PPACA (a law I generally supported and, if I were a congresscritter, would have voted for), insurers were required [archives.gov] to spend 80% of premiums as payouts, leaving the rest for operations & profit. Given that, the incentives are pretty clear that to make more money, you gotta spend more on care.
And that's exactly what this paper from the AEA found [aeaweb.org]. That paper is careful to say they aren't talking about whether this is a good thing (see the discussion on p74 disclaiming it) but it does have a mountain of empirical evidence and mathematical basis to say that it is happening.
The US needs a capitalist marke healthcare system (Score:2)
So many Americans act like we have a "capitalist" based health insurance system, which we most certainly do not. 49% of Americans get their healthcare through their employer [ehealthinsurance.com] which is certainly not capitalist. Only knowing the price of the service *after* you have bought it certainly isn't an element of capitalism. Being able to only enroll at a certain time of the year via either your employer or a government-based web site isn't capitalism.
The self-pay discounts that the article refers to are not a rece
Re: (Score:2)
Capitalism requires that you do not have a gun to your head. Health care by definition, always has a gun to your head. It can never work.
The world has tried lots of forms of healthcare, the US picked the worst one, by any measure.
The most liked (by people that use it) in the world is Singapore, which has a complex system which has a ton of regulations. It includes a mixture of direct government subsidies, private sector, public sector, compulsory comprehensive savings, a national healthcare insurance, a
Ever hear of ISPs? (Score:2)
We have these monopolies and duopolies in most the country called ISPs that compete to see how low they can drive prices down while providing superior service! It has worked SO well because they desperately need our business they compete against each other for it and never attempt to collude or find an unspoken "balance" in the marketplace of.... 1,2,3 companies. A monopoly always competes against itself to keep competition from moving in. /sarcasm
Re: (Score:2)
The only reason why medical insurance is tied to employment is that medical insurance provided by employers is not taxed as income. Employers found it easier to pay their employees with an insurance plan than hard cash since they could offer more to the employee without having a % taken out due to taxation.
You could start taxing medical plans or reduce taxation on other forms of compensation to solve the problem. Care to guess which option is more workable?
ban networks or make any place in XX miles of your (Score:3)
ban networks or make any place in XX miles of your home / main living area. And for people who travel for work the workplace covers an ADD on / fees to get to your home area are covered by workers comp.
Typical insurer bullshit (Score:5, Interesting)
They "claim" the price is $600, let's say you have 90% coinsurance on drugs, so that's $60 copay. In reality, Mylan was cutting a check for $300 back to the PBM later. But hey, these rebates are industry secrets and don't have to be disclosed publicly, so damn, sure does suck for anyone on the increasingly common high deductible health plans...
These practices are driving people towards prescription savings programs like GoodRX because even some generics are much cheaper on coupons then the list prices that insurers claim and then hold to as "applied toward deductible"...
Re: (Score:2)
tl;dr a lifesaving medication critical to anyone who has a severe allergy (whether it be like a bee sting or some form of food allergy) cost $34.50 for the marketing pharmaceutical company (Mylan) from the company that physically manufactured the autoinjectors (Pfizer/King Pharmaceuticals). Mylan hiked the price of an EpiPen branded autoinjector from $100 in 2007 to $600+ in 2016, which led many patients to carry expired EpiPens or to forgo havi
Um... caught? (Score:2)
What If (Score:2)
Providers had to publish one price for everyone, up front, highly visible, and insurers published the amount they covered, up front, highly visible, and you go where you want and pocket the surplus or make up the difference?
Private industry (Score:2)
In fact America's government-run Medicare health insurance for senior citizens is negotiating much lower rates than the privately-insured patients are getting, the Times points out — sometimes paying just 10% of what the major health plans are paying.
Well that's just because, as libertarians have long pointed out, private industry always does things better than gover ... oh, wait, ... never mind.
Medical Industry Totally Corrupt (Score:5, Informative)
The US medical industry is completely driven by greed. There are no limits on prices. Insurance companies work on a cost+ formula. They don't care about price. They just add their O&P. Lots of profits. Medical industry has paid off all the politicians to prevent competition, prices controls, etc. (Other countries have strong price controls and regulations.)
This gives us a system with 2 to 3 times the cost of any other developed country and the absolute worst health outcomes of any other developed country.
Re: (Score:2)
Reading your post, I would conclude that the restaurant industry should have skyrocketing prices. But it doesn't. Can you elaborate what is wrong with the healthcare industry in particular?
The US medical industry is completely driven by greed.
So is the entire rest of the economy, and this is not news to economists.
There are no limits on prices.
Most industries don't have price ceilings.
Insurance companies work on a cost+ formula. They don't care about price. They just add their O&P. Lots of profits.
Same goes for the restaurant industry, etc.
Medical industry has paid off all the politicians to prevent competition, prices controls, etc. (Other countries have strong price controls and regulations.
Do does agriculture, but we don't see skyrocketing prices there, do we? Or veterinary care, for that matter.
So what is special about healthcare?
Our third party paye
Re:Medical Industry Totally Corrupt (Score:4, Insightful)
Yes, you do have good points in that we are all victims of corporate greed.
However, some people think that health care should be different... that is should not be subject to "your money or your life" pricing. Health care is not optional, when you are ill, you must have care (or die). All of the other developed countries realize this fact and have strong regulation and price controls on health services. In spite of (or because of) these regulations, they all have better health outcomes than the US.
References:
https://www.pgpf.org/blog/2020... [pgpf.org]
https://www.americanpatient.or... [americanpatient.org]
Key Findings: The top-performing countries overall are Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes, but second on measures of care process.
Conclusion: Four features distinguish top-performing countries from the United States: 1) they provide for universal coverage and remove cost barriers; 2) they invest in primary care systems to ensure that high-value services are equitably available in all communities to all people; 3) they reduce administrative burdens that divert time, efforts, and spending from health improvement efforts; and 4) they invest in social services, especially for children and working-age adults.
https://www.commonwealthfund.o... [commonwealthfund.org]
Re: (Score:3)
> Can you elaborate what is wrong with the healthcare industry in particular?
One reason is because people can choose not to go to a restaurant, and they will continue to live perfectly fine. People can't choose not to get medical care. (Or rather, they can, but they will suffer.) When someone holds you by the balls, they can charge a lot more.
Another problem is the lack of actual competition. You can easily find prices at a restaurant, and if they're too high, go to another. With medical care, first of a
Re: (Score:3)
The US medical industry is completely driven by greed.
The entire fxxking country is completely driven by greed! That’s what capitalism is all about! It has been blatantly obvious since 2008 when the culprits got bailed out while the average homeowners got evicted.
Try naming one industry in the US that is not “completely driven by greed” if you think otherwise.
When government lawyers do deals (Score:2)
The #1 problem in the US Medical (Score:2)
Because ... (Score:5, Funny)
There's a story about two contractors on a tour of the US Capital. The tour guide mentioned that a new fence was needed and asked what they would bid. The contractor from Kentucky said $1000. The contractor from New Jersey said $10,000. The tour guide asked the N.J contractor how he ever expected to win the bid. "Simple," he says. "$4500 for me, $4500 for you. And we hire the guy from Kentucky to do the work."
My first-hand experience with the crazy system (Score:2)
I have avoided going to doctors for a very long time (which, I really should get checkups, but I have mental issues with doctors and stuff). However, I had an issue early this year (not something that could have been prevented) and ended up having to have surgery. The claims to insurance for the surgery, the surgeon, anesthesia, etc. added up to just over $215K... insurance paid a little under $13K, and I paid $12.90 (to finish my annual deductible), and everybody was okay with that.
What's the point in the
Re: (Score:2)
The claims to insurance for the surgery, the surgeon, anesthesia, etc. added up to just over $215K... insurance paid a little under $13K, and I paid $12.90 (to finish my annual deductible), and everybody was okay with that.
What's the point in the claims totalling $215K?
The premise is that is the "list" price, but insurance companies negotiate discounts with the health-care providers. The insurance companies get a reduced price and the providers get access to those insured.
Even so, I don't see why it has to be that way. For example. back in 2005, my wife was diagnosed with a brain tumor and prescribed Temodar [wikipedia.org] for her chemotherapy. The list price at the pharmacy for a one-month supply of those pills was $11,000. Using my BC/BS, the cost to me would have been $1,100 (10
Re: (Score:2)
That sucks.
15 years ago now. I suppose time heals to a certain degree. Did you re-marry?
Re: (Score:2)
That sucks. 15 years ago now. I suppose time heals to a certain degree. Did you re-marry?
Nope, not yet. My last first date was with Sue in the summer of 1985.
It costs money to get money from people (Score:2)
It is going to cost your hospital money to get money from people without insurance. If you can get some money from them right now even if it is much less than your costs you do it. In the end you would probably spend more money (money and staff time are the same thing) than you would getting trying for a large amount later. Hospitals make their money from insurance companies and insurance companies are will to do this for at least two reason. #1 Insurance companies are paid to give people access to hospita
We're doing it wrong (Score:2)
Yaneer Bar-Yam of the New England Complex Systems Institute wrote a paper a decade or so ago about the problem with the flow of funding, care, and information in the system. None of it is set up to do anything well. In looking for the link to post here, I found an even more comprehensive site that has since been put up. It is worth a look: https://necsi.edu/healthcare-c... [necsi.edu]
Best in the world! (Score:2)
The US healthcare system is the best in the world! It's privatised & loosely regulated & gets big gubbermint out of your way so you can have the healthcare, doctors & hospitals you want. Don't let these evil socialists trick you into getting health insurance properly regulated. Do you want the gubbermint telling you what you can & can't do with your own body? (Unless you're a woman, in which case the gubbermint can.) / End sarcasm
Global warming's gonna get Americans before they get meaningfu
This isn't new (Score:3)
My partner and I have a high-deductible health insurance plan. We also typically have minimal health care needs, so we have never even approached the deductible. I learned from an earlier, similar plan that often the best way to go was to ask health care providers whether they offered a cash discount. Without involving our insurance, we can often pay less than we would with insurance, and the doctor gets more money, too, because they're not getting the insurance-negotiated rate (and they save staff time, not having to submit a claim). It's a win for everyone except the insurance company, whose only role in these types of small medical transactions is to soak up money from the actual involved parties.
Here's a datapoint for you (Score:5, Insightful)
Colon cancer earlier this year. Don't know how useful this information is. Medicare Advantage Plan through Kaiser-Permanente
Hospital charged: $250,000
Insurance Paid: $25,000
I paid: $2,500.
Re: (Score:3)
What you should take away from this is that the actual cost was $25,000. The 10x markup price is a fiction.
If you are nearing retirement, remember that if the provider accepts Medicare, then they can only charge you the negotiated actual cost, not the 10x markup fictional price. This comes into play when you have to pay a co-pay percentage. You'll be paying a percentage of the real cost.
Re:Here's a datapoint for you (Score:5, Informative)
I had a unique situation a few years ago that gave me a similar datapoint though mine indicated an 8-fold difference.
There was a hospital procedure under insurance that insurance paid approximately $8,000 for. A couple of months later a mistake was made that caused retroactive loss of the insurance (never even imagined such a thing possible). The insurance company made the hospital return the money, and the hospital proceeded to bill me approximately $64,000. After about a year of fighting, I finally got the mistake reversed. At that point, the insurance company made the hospital eat the money on the basis of the technicality that it had not been billed within a year of the procedure. Total craziness.
The shocking thing to me though was the extent to which the hospital hiked the bill to an "uninsured" patient they new couldn't pay it. The only reason I can think of for that strategy is that they could have claimed a fake $64,000 loss for their business (the reality is that it was about $8,000). That loss would have netted them a greater return than the original $8,000. If that was their motivation, what a con. I'll never read stories where hospitals whine about how much the uninsured cost them in the same way again. By my experience, their claims are inflated about 8-fold.
Essentially, my experience says that the system is rampant with a form of tax fraud.
As a result, I've come to a belief that requiring medical facilities of all types to charge a flat, published rate to all customers - no special deals - could fix a lot of fraud.
Re: (Score:3)
Shattered my shoulder skiing. Needed a plate and ten screws to put the bone back together. A few months after the surgery, I get a notice from the plate manufacturer (it is notably marked 'not a bill') which says the cost of the plate is $7300. A few weeks later, I get a letter from my HMO also marked 'not a bill' which says the insurer negotiated plate cost is $1400. A few weeks after that I get another letter from my HMO, also marked 'not a bill' which is the negotiated healthcare coverage allotment -
Negotiate? (Score:3)
Negotiate what? The price should be the price. We're talking about a service. This isn't that different from getting your oil changed. (Actually horrible mechanics get outed far more quickly than horrible surgeons.) Discounts for this or that should be small. 10%. Why? Because the price is the price. Don't like it? Leave.
Re: (Score:2)
Stop posting paywalled articles. Just fuck off with this bullshit.
You wouldn't have a problem if you bought paywalled article insurance...
Re: (Score:2)
Insurance is ugly. Whether homeowners or health/medical, they always seem to try hard to stiff you 75%.
Indeed. The first week of my freshman year in college I had an emergency appendectomy. I was in the hospital seven days. The ENTIRE bill, doctor, operation and room&board was $750.50. I still had three weeks eligibility on my BCBS insurance from where I worked. BCBS paid every penny.
Today, that same operation, doctor and hospital would have costs that range across the US from $9,884 to $18,585 and with some going to $40K, $50K and one costing $180K, and the insurance would probably pay only 80%
Re: (Score:2)
I hope you understand that we already have that with Medicaid and Medicare. Everyone pays FICA (which pays into Medicare at least). Not everyone benefits from Medicare and/or Medicaid though, and of course the coverage offered by either one is really spotty.
Yet you just articulated that Medicare (you forgot Medicaid!) drove up prices in this country.
Are you proposing more of the same?
The problem is that prices are too high, period.