Author Topic: What comes after the ACA?  (Read 690563 times)

runewell

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Re: What comes after the ACA?
« Reply #3250 on: July 20, 2017, 11:49:39 AM »
We could apply the same logic to everything else. I shouldn't pay taxes for roads I don't drive on or schools for the kids I don't have. I shouldn't pay for the library I don't use.

Nice job there comparing the private health insurance market to public infrastructure.  Until it becomes the government's job to supply us with healthcare I don't buy this comparison. 

nereo

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Re: What comes after the ACA?
« Reply #3251 on: July 20, 2017, 11:56:07 AM »
Yesterday Trump claimed his proposal to allow insurance to be sold across state lines (which is ALREADY legal) would lower premiums "60 to 70 percent" below what they currently are under the ACA.  What what?

This is like claiming we could all see 70% stock market gains if only US corporations were allowed to operate overseas.  Not only do they already do that, it's totally unrelated to delivering on the promise you are making.  I don't think you understand how these things are related.

Every time he opens his mouth to talk about health care, I get the impression he understands it less than my 11 year old daughter.  Everyone in congress musty be rolling their eyes as they try to do the hard work of identifying serious solutions while grandpa goes off on another stupid tangent.

In the NYT interview released Wednesday evening, DJT mentioned how a 21 year old could pay $12per -year for health insurance.  Whaaa??
He's so comically out of touch.  Like 3 orders of magnitude off.  What else can we get?  A new Cadillac for $300? Maybe a round of golf at a Trump Course for $1?

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So preexisting conditions are a tough deal. Because you are basically saying from the moment the insurance, you’re 21 years old, you start working and you’re paying $12 a year for insurance, and by the time you’re 70, you get a nice plan.
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runewell

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Re: What comes after the ACA?
« Reply #3252 on: July 20, 2017, 12:12:58 PM »
A new Cadillac for $300? Maybe a round of golf at a Trump Course for $1?

That's about all I would spend for those two items.

jim555

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Re: What comes after the ACA?
« Reply #3253 on: July 20, 2017, 12:22:13 PM »
Trumpcare $12 plan, covers a Band-Aid and Aspirin, nothing else. 

Dabnasty

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Re: What comes after the ACA?
« Reply #3254 on: July 20, 2017, 12:23:14 PM »
We could apply the same logic to everything else. I shouldn't pay taxes for roads I don't drive on or schools for the kids I don't have. I shouldn't pay for the library I don't use.

Nice job there comparing the private health insurance market to public infrastructure.  Until it becomes the government's job to supply us with healthcare I don't buy this comparison.
The pregnancy discussion has gotten too far from the original point and now we're just arguing about why each other's analogies are bad.

Let's go back to the beginning. You don't think your costs should help cover pregnancy because you, as a man, have no chance of becoming pregnant, correct?

But what about a woman that chooses not to have a child? What about a woman who biologically cannot have children? Should they also not pay for that coverage? How do we know who they are? Is it worth the added complication?

Back to Mr. Green's analogy, the things he listed are provided by the government and healthcare is not. However the analogy is that we all pay into a big pot and when something is needed the pot pays. So the analogy does work in that sense.

sol

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Re: What comes after the ACA?
« Reply #3255 on: July 20, 2017, 12:33:30 PM »
If it's universally available to every American, I think I would support it as a step in the right direction.  First we need to agree that America is stronger when everyone gets basic healthcare, then we can argue over how much and at what cost.

Right now, republicans don't agree with that basic premise.  They want fewer people to have healthcare.  Every single one of their proposals takes healthcare away from people, which is a wildly unpopular thing to do. 

Nice job there comparing the private health insurance market to public infrastructure.  Until it becomes the government's job to supply us with healthcare I don't buy this comparison. 

Healthcare and roads are exactly analogous benefits, so I don't see why you object to this comparison.  They can be provided publicly or privately, but they either way they both benefit everyone including the people who don't personally use them.

We all benefit from having roads, even if you don't drive, because roads allow our economy to flourish and makes emergency police and fire services available to you.  We all benefit from healthcare, even if you don't go to the doctor, because healthcare keeps our workforce healthy and prevents the spread of disease. 

Optimiser

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Re: What comes after the ACA?
« Reply #3256 on: July 20, 2017, 12:38:47 PM »
#2 - many of these costs cannot be 'planned ahead.' Everyone hopes for an easy, low-cost pregnancy. Only some

I can add a data point to this. We were planning on using a midwife to do a home birth. Total cost $3,500 for all prenatal care, delivery, and postnatal care.

My wife ended up with preeclampsia, and had to go to the hospital to give birth. The hospital bill was $26,000 for a vaginal birth with no epidural, in addition to the $3,500 midwife's fee.

A low-cost pregnancy is a great thing to shoot for, but it's nice to have insurance in case things don't go the way you planned.

partgypsy

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Re: What comes after the ACA?
« Reply #3257 on: July 20, 2017, 12:41:39 PM »
If it's universally available to every American, I think I would support it as a step in the right direction.  First we need to agree that America is stronger when everyone gets basic healthcare, then we can argue over how much and at what cost.

Right now, republicans don't agree with that basic premise.  They want fewer people to have healthcare.  Every single one of their proposals takes healthcare away from people, which is a wildly unpopular thing to do. 

Nice job there comparing the private health insurance market to public infrastructure.  Until it becomes the government's job to supply us with healthcare I don't buy this comparison. 

Healthcare and roads are exactly analogous benefits, so I don't see why you object to this comparison.  They can be provided publicly or privately, but they either way they both benefit everyone including the people who don't personally use them.

We all benefit from having roads, even if you don't drive, because roads allow our economy to flourish and makes emergency police and fire services available to you.  We all benefit from healthcare, even if you don't go to the doctor, because healthcare keeps our workforce healthy and prevents the spread of disease.

I was going to make a joke how I want my taxes back for supporting the fire department, because my house has never burned down.
Instead I will just say amen to this post. You get it. It's unbelievable how many people don't get that improving public health, benefits all of us.
« Last Edit: July 20, 2017, 12:43:11 PM by partgypsy »

runewell

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Re: What comes after the ACA?
« Reply #3258 on: July 20, 2017, 01:02:48 PM »
But what about a woman that chooses not to have a child? What about a woman who biologically cannot have children? Should they also not pay for that coverage? How do we know who they are? Is it worth the added complication?

If pregnancy coverage were a standlone purchase, this wouldn't make it any more complicated.  Those who were going to have a child would pay the $15,000 and those could not have a child would certainly not.

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Back to Mr. Green's analogy, the things he listed are provided by the government and healthcare is not. However the analogy is that we all pay into a big pot and when something is needed the pot pays. So the analogy does work in that sense.

When you buy auto insurance, you don't just get whatever you want, you decide what coverages and limits you want, and you pay more for more coverage.  The "big pot" comment is just a giant generalization that dodges the issue at hand.  Yet, insurance is a big pot that pays out when needed.  But how much you pay in depends on your risk characteristics. 
« Last Edit: July 20, 2017, 01:33:55 PM by runewell »

nereo

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Re: What comes after the ACA?
« Reply #3259 on: July 20, 2017, 01:21:03 PM »

When you buy auto insurance, you don't just get whatever you want, you decide what coverages and limits you want, and you pay more for more coverage.  The "big pot" comment is just a giant generalization that dodges the issue at hand.  Yet, insurance is a big pot that pays out when needed.  But how much you pay in depends on your risk characteristics.

I'm not sure the point you are trying to make here, and I think your analogy of auto insurance does more to refute your point than support it. Yes, drivers get to chose what level of insurance they want, but in all states I know of it must at least meet minimum requirements. How much you pay depends both on your risk factors and your level of coverage.  So it is with health insurance both before the ACA and currently; there are minimum standards a health insurance policy must cover, and then you can decide things like the size of your deductible, your coverage network and whether it covers prescription medication.  Again, how much you pay depends both on your risk characteristics and your coverage.  Because old people and sick people would pay astronomically more under these situations (along with pregnant women) we've decided to cap those and spread the cost around because it's good for society in general.

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Dabnasty

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Re: What comes after the ACA?
« Reply #3260 on: July 20, 2017, 01:41:43 PM »
But what about a woman that chooses not to have a child? What about a woman who biologically cannot have children? Should they also not pay for that coverage? How do we know who they are? Is it worth the added complication?
If pregnancy coverage were a standlone purchase, this wouldn't make it any more complicated.  Those who were going to have a child would pay the $15,000 and those could not have a child would certainly not.
This in theory may work (if you're of the mind that parents should be responsible for the costs of pregnancy - not taking a side on that here) but the discussion started with whether men should pay for that coverage given our current insurance system. I'm thinking within that constraint and I think that cost should be applied to all, not just women.

If you really think we should all pay based on risk, that's a different argument entirely.

Edit:
In a society where only pregnant families bear the entire cost of prenatal / birth, $15,000 is probably 10% of what it would cost.
Yes, and I think you are underestimating the average cost of pregnancy. Maybe $150,000 is a little high but $15,000 is definitely low.
« Last Edit: July 20, 2017, 01:49:30 PM by Dabnasty »

runewell

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Re: What comes after the ACA?
« Reply #3261 on: July 20, 2017, 01:44:58 PM »
If it's universally available to every American, I think I would support it as a step in the right direction.  First we need to agree that America is stronger when everyone gets basic healthcare, then we can argue over how much and at what cost.

Right now, republicans don't agree with that basic premise.  They want fewer people to have healthcare.  Every single one of their proposals takes healthcare away from people, which is a wildly unpopular thing to do. 
Just because republicans don't want to give away free health care as an entitlement, it does not follow that they want fewer people the have healthcare.

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because healthcare keeps our workforce healthy and prevents the spread of disease.
Debatable.  If my cubicle neighbors opted out of having health insurance, I'm not convinced I would suffer.

Quote
I was going to make a joke how I want my taxes back for supporting the fire department, because my house has never burned down.
Instead I will just say amen to this post. You get it. It's unbelievable how many people don't get that improving public health, benefits all of us.

How does paying for someone else's pregnancy provide tangible benefits to me personally?   

runewell

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Re: What comes after the ACA?
« Reply #3262 on: July 20, 2017, 01:46:35 PM »
In a society where only pregnant families bear the entire cost of prenatal / birth, $15,000 is probably 10% of what it would cost.
So you admit you don't know how much it would cost, OK.

nereo

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Re: What comes after the ACA?
« Reply #3263 on: July 20, 2017, 02:12:07 PM »
Just because republicans don't want to give away free health care as an entitlement, it does not follow that they want fewer people the have healthcare.

Quote
... because healthcare keeps our workforce healthy and prevents the spread of disease.
Debatable.  If my cubicle neighbors opted out of having health insurance, I'm not convinced I would suffer.

How does paying for someone else's pregnancy provide tangible benefits to me personally?   

I'm trying very hard to see your posts as anything other than offensive trolling.
If you are actually serious (and I'll assume you've read through the arguments made on the first 64 pages of this thread)...

Regarding your comment about Republicans not wanting fewer people to have health care: First there's the very words of the non-partisan CBO - These proposals are not about expanding affordable health-care insurance along with the scoring of the various proposals that show anywhere from 22MM to 32MM will lose health insurance.  Most of those will effectively lose access to comprehensive health care.

Second - widespread access to healthcare, particularly preventative care and vaccinations, has a straightforward correlation between the life expectancy of a population and the spread of contagious diseases. 

You seem to be only concerned with yourself, personally (how does it benefit me personally & I'm not convinced I would suffer) and your examples consider just the non-insurance of one individual (my neighbor, one pregnant woman). However we're talking about tens-of-millions of people here.  Those are people who will be less able to work, pay fewer taxes, become more likely to develop chronic conditions and have an increased risk of drug dependency. Even if you reject the notion that a society should support each other the outcome of fewer people with health insurance is a drag on entire communities.
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Mr. Green

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Re: What comes after the ACA?
« Reply #3264 on: July 20, 2017, 02:27:26 PM »
And for the record, the potential costs of a childbirth tossed around here are way too low. I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills. There is no argument anyone can make that justifies that kind of cost for a C-section and some NICU time. If you want cheaper health insurance, focus of why it's illogically expensive in the first place. Butchering coverage down to just the TP we need to wipe our butts to pay reasonable premiums is not a solution.
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tyort1

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Re: What comes after the ACA?
« Reply #3265 on: July 20, 2017, 02:41:40 PM »
And for the record, the potential costs of a childbirth tossed around here are way too low. I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills. There is no argument anyone can make that justifies that kind of cost for a C-section and some NICU time. If you want cheaper health insurance, focus of why it's illogically expensive in the first place. Butchering coverage down to just the TP we need to wipe our butts to pay reasonable premiums is not a solution.

That's a good point.  Why is it so crazy expensive in the first place?
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ixtap

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Re: What comes after the ACA?
« Reply #3266 on: July 20, 2017, 02:54:26 PM »
And for the record, the potential costs of a childbirth tossed around here are way too low. I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills. There is no argument anyone can make that justifies that kind of cost for a C-section and some NICU time. If you want cheaper health insurance, focus of why it's illogically expensive in the first place. Butchering coverage down to just the TP we need to wipe our butts to pay reasonable premiums is not a solution.

That's a good point.  Why is it so crazy expensive in the first place?

Profit and all the things designed to increase profit, rather than healthcare. This is what is happening by running universities like businesses, as well.

seattlecyclone

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Re: What comes after the ACA?
« Reply #3267 on: July 20, 2017, 03:06:25 PM »
And for the record, the potential costs of a childbirth tossed around here are way too low. I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills. There is no argument anyone can make that justifies that kind of cost for a C-section and some NICU time. If you want cheaper health insurance, focus of why it's illogically expensive in the first place. Butchering coverage down to just the TP we need to wipe our butts to pay reasonable premiums is not a solution.

That's a good point.  Why is it so crazy expensive in the first place?

An oft-cited statistic is that health care makes up one-sixth of the economy. That's a lot of people to pay, and everyone needs to get their cut. The actual hospital has doctors and nurses just like anywhere else, but they also have a much larger billing department than in most other countries, and probably more lawyers, and they need to hire a collections agency to go after the folks with no insurance. All that extra cost gets baked into the price.

Then you have the insurance companies. They have their own army of lawyers and actuaries and billing departments and whatever else, that is mostly unique to the US health care system. Pharmaceutical companies spend billions of dollars on research for new drugs. Most of this cost gets paid by Americans, because other countries are better at refusing to pay astronomical prices for new drugs than we have been thus far. The drug company is happy enough to accept half of the US price or less from other countries because that's better than nothing. If the US did that too they'd have to cut back on R&D and other expenses. Same probably goes for the companies that make the expensive, specialized equipment that ends up in the NICU. US hospitals pay through the nose for it and pass the cost along to their customers, because insurance companies will pay whatever crazy amount the hospital charges and will in turn pass the cost along to their customers.

There's a lot of potential to cut costs if there was a national takeover of this entire sector of the economy, by aggressively negotiating prices downward to what other countries pay. But all this cost cutting would come around to jobs in the end. Most folks might agree it would be better if the hospital billing department didn't need to exist, but the folks in the billing department might disagree! All told, reforming our health care system to spend like the rest of the world would cost a lot of American jobs. So far it's been politically more expedient to just subsidize the existing system through Obamacare and other things (like tax exemption for employer provided health insurance) rather than deal with the fallout of a more radical change.
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partgypsy

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Re: What comes after the ACA?
« Reply #3268 on: July 20, 2017, 03:42:05 PM »
https://www.nytimes.com/2015/03/31/upshot/income-inequality-its-also-bad-for-your-health.html

I don't know if people can read this, but there is a loss in life expectancy when you have increased income inequality. Not sure why this is, but one hypothesis is that lack of healthcare access for example disproportionately affects life expectancy, more than increased access to healthcare for the wealthy increases life expectancy. Which makes sense. That's why what was proponded through Trumpcare was directly opposite what health economists would argue one would do to increase public health.
I've noticed it seems to be much more men who are into libertarian ideals, each person goes it alone. I wonder why that is. Maybe even if a woman does not give birth, she may be more aware of the vulnerabilities that everyone goes through in one's life, from being nutured in the womb, to a helpless infant, to growing up and perhaps bearing her own young, to being an old person who again is dependent. Everyone in a sense, is dependent on other people, at some point in one's life.

runewell

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Re: What comes after the ACA?
« Reply #3269 on: July 20, 2017, 03:52:53 PM »
I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills.

Negotiated (allowed) rates can be very difference from nonnegoitated (charged) rates.  They probably paid a lot more than the typical resident would.

sol

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Re: What comes after the ACA?
« Reply #3270 on: July 20, 2017, 04:34:57 PM »
Today's news reports that the CBO points out that the republican health care bill, as currently written, is so internally inconsistent as to make itself illegal.  One part raises the deductibles cap to about $10k per year, but another part mandates 58% actuarial plans that would require $13k per year.

So they will have to either
1.  Change the actuarial value requirement to offer better coverage, which conservatives hate, or
2.  Raise the deductibles even more, which everyone hates.

It kind of looks like they just put together a random wish list of things they wanted in a health care bill, without bothering to check those wishes against each other to see if it was even possible to have them all.

nereo

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Re: What comes after the ACA?
« Reply #3271 on: July 20, 2017, 04:43:31 PM »
Today's news reports that the CBO points out that the republican health care bill, as currently written, is so internally inconsistent as to make itself illegal.  One part raises the deductibles cap to about $10k per year, but another part mandates 58% actuarial plans that would require $13k per year.

So they will have to either
1.  Change the actuarial value requirement to offer better coverage, which conservatives hate, or
2.  Raise the deductibles even more, which everyone hates.

It kind of looks like they just put together a random wish list of things they wanted in a health care bill, without bothering to check those wishes against each other to see if it was even possible to have them all.

Huh.... had not seen that analysis yet - do you have a source to link?
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brooklynguy

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Re: What comes after the ACA?
« Reply #3272 on: July 20, 2017, 05:04:50 PM »
Huh.... had not seen that analysis yet - do you have a source to link?

https://www.vox.com/policy-and-politics/2017/7/20/16004598/cbo-bcra-deductibles-obamacare

Today's news reports that the CBO points out that the republican health care bill, as currently written, is so internally inconsistent as to make itself illegal. 

Now imagine what kind of a mess of an end-product we'll wind up with if the legislation is made up completely on the fly during vote-a-rama, one of the potential paths forward currently under consideration.

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Re: What comes after the ACA?
« Reply #3273 on: July 20, 2017, 05:47:05 PM »
I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills.

Negotiated (allowed) rates can be very difference from nonnegoitated (charged) rates.  They probably paid a lot more than the typical resident would.
The point is that it shouldn't be $250,000, ever. Negotiated or nonnegotiated. It's an astronomical sum of money that has no basis in reality for the care that is provided, because if it did, that number dropping to $25,000 for "negotiated" care would put all hospitals out of business. A business can't receive the majority of their income from negotiated rates and a small percentage from "numbers-I-pulled-out-of-my-ass" rates and claim that not charging those insane rates on a tiny portion of services (the uninsured) is paramount to them staying in business. Especially a non-profit business, like so many hospitals are. It's total bullshit.

And it matters because it's the insane "retail price" rates that are used to "negotiate" the rates the most of us actually pay.
« Last Edit: July 20, 2017, 05:48:43 PM by Mr. Green »
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Mr. Green

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Re: What comes after the ACA?
« Reply #3274 on: July 20, 2017, 09:29:25 PM »
Wow. That's something else!

"Team Trump Used Obamacare Money To Run Ads Against It"

http://www.msn.com/en-us/news/politics/team-trump-used-obamacare-money-to-run-ads-against-it/ar-AAotN6G?li=BBnbcA1
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runewell

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Re: What comes after the ACA?
« Reply #3275 on: July 21, 2017, 07:38:21 AM »
The point is that it shouldn't be $250,000, ever.
And it matters because it's the insane "retail price" rates that are used to "negotiate" the rates the most of us actually pay.

In my limited experience (and I have actually worked for 3 years "setting" the rates for a single healthcare provider).   The retail price doesn't necessarily have anything to do with the negotiated price, in my sample size of 1.

Nevertheless I think the lack of competition is a big reason why the system is broken.  If everyone had a $10,000 deductible and you could get a "childbirth package" quotes could come in below that, I'd like to think that people would shop around and rates would go down.  All being equal I would consider the $8,000 package would save me two grand more than the $15,000 package would. 

runewell

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Re: What comes after the ACA?
« Reply #3276 on: July 21, 2017, 08:01:25 AM »
Profit and all the things designed to increase profit, rather than healthcare. This is what is happening by running universities like businesses, as well.

There's nothing wrong with earning a profit.  Insurance companies have to set their prices to keep their financials strong and provide a return for the stockholders if they are publicly traded, just like other stock companies.  Their financials are rate filings are subject to scrutiny by insurance departments.

The providers are also trying to earn a profit as well.  Are they performing too many tests in order to bill a lot of codes or are they just being careful.  I once did a study trying to determine which providers were billing too many codes on average.  If it's normal for a certain problem to have 4 codes billed but a particularl doctor bills 10 or 15, you have to take a closer look.

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Re: What comes after the ACA?
« Reply #3277 on: July 21, 2017, 08:47:17 AM »
Wow. That's something else!

"Team Trump Used Obamacare Money To Run Ads Against It"

http://www.msn.com/en-us/news/politics/team-trump-used-obamacare-money-to-run-ads-against-it/ar-AAotN6G?li=BBnbcA1

Oh wow, how is that not a headline around the country? Thanks for posting a link to this revealing article.

Dabnasty

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Re: What comes after the ACA?
« Reply #3278 on: July 21, 2017, 08:50:14 AM »
Profit and all the things designed to increase profit, rather than healthcare. This is what is happening by running universities like businesses, as well.

There's nothing wrong with earning a profit.  Insurance companies have to set their prices to keep their financials strong and provide a return for the stockholders if they are publicly traded, just like other stock companies.  Their financials are rate filings are subject to scrutiny by insurance departments.

The providers are also trying to earn a profit as well.  Are they performing too many tests in order to bill a lot of codes or are they just being careful.  I once did a study trying to determine which providers were billing too many codes on average.  If it's normal for a certain problem to have 4 codes billed but a particularl doctor bills 10 or 15, you have to take a closer look.
You continue to ignore the fatal flaws of free market theory in regards to healthcare. How can there be competition when so often there is no time to shop around, in rural areas there is often only one option, and even if there is competition the product can't be refused so it's not the same as a gallon of milk.

Admittedly, if prices were available costs may improve somewhat on our current situation but even providing prices is difficult because so many costs are specific to the situation. And if we paid based on results rather than inputs as some have suggested, it would disincentivize hospitals to provide costly procedures.

BTDretire

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Re: What comes after the ACA?
« Reply #3279 on: July 21, 2017, 09:06:42 AM »
And for the record, the potential costs of a childbirth tossed around here are way too low. I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills. There is no argument anyone can make that justifies that kind of cost for a C-section and some NICU time. If you want cheaper health insurance, focus of why it's illogically expensive in the first place. Butchering coverage down to just the TP we need to wipe our butts to pay reasonable premiums is not a solution.

That's a good point.  Why is it so crazy expensive in the first place?
I don't know, but I wonder how much medicaid reimburses for births. I suspect Medicaid's reimbursement is low. That would cause the rest of the payers to pay more, to make make up the real cost plus profit.
 Almost half of all births are paid for by taxpayers through medicaid. 48% in 2010, the latest year I find data on,. That number was rising every year up to 2010, so I suspect it's over 50% now in 2017, especially with the ACA adding many more to Medicaid.
http://www.cnsnews.com/news/article/terence-p-jeffrey/24-states-50-babies-born-medicaid
Just one possible cause of high costs, I'm sure there are others.

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Re: What comes after the ACA?
« Reply #3280 on: July 21, 2017, 09:13:56 AM »
Wow. That's something else!

"Team Trump Used Obamacare Money To Run Ads Against It"

http://www.msn.com/en-us/news/politics/team-trump-used-obamacare-money-to-run-ads-against-it/ar-AAotN6G?li=BBnbcA1

Oh wow, how is that not a headline around the country? Thanks for posting a link to this revealing article.

I suspect in a normal news year this would be the subject everyone would be talking about. 
Unfortunately, it's currently competing with:
Trump's inquiries about pardoning himself and his family members
Trump's secret meeting with Putin
Trump's subsequent decision to stop supporting anti-Assad rebels and basically side with Russia
The Trump team's meeting with Russian individuals who promised to give dirt on HRC
News that Trump may have met even more frequently with Putin before & after he was elected
The NYT's interview, Trump throwing Sessions under the bus and Session's decision not to step down (all about Russia!)
A sad story of a 10 year old who died from a mysterious and unintentional contact with opioids
Mar-A-Lago requesting 70 new foreign workers during DJT's self proclaimed "Made in America Week"
EPA Chief Pruitt accused of breaking the law by criticizing Paris agreement
Mueller expanding his probe to include financial dealings of Trump's businesses
THe Interior Dept ordering top scientists not to meet with Mark Zuckerberg
The GOP's "zombie bill" to repeal the ACA
OJ Simpson being granted parole
ExxonMobile fined while now-SOS Tillerson was at the helm for (wait for it) dealings with Russia
McCain's brain cancer and its impact on the GOPs already extremely narrow majority

...and those are just stories from the last three days.  Hard to keep up.  Sometimes I wonder how much of this is just stories intentinoally being added to the blaze so the networks can't figure out where to focus their attention and resources.  Of course this strategy ultimately results in a lot of things getting burned to the ground.


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Mr. Green

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Re: What comes after the ACA?
« Reply #3281 on: July 21, 2017, 09:29:51 AM »
The point is that it shouldn't be $250,000, ever.
And it matters because it's the insane "retail price" rates that are used to "negotiate" the rates the most of us actually pay.

In my limited experience (and I have actually worked for 3 years "setting" the rates for a single healthcare provider).   The retail price doesn't necessarily have anything to do with the negotiated price, in my sample size of 1.

Nevertheless I think the lack of competition is a big reason why the system is broken.  If everyone had a $10,000 deductible and you could get a "childbirth package" quotes could come in below that, I'd like to think that people would shop around and rates would go down.  All being equal I would consider the $8,000 package would save me two grand more than the $15,000 package would.
Have you ever tried to shop around a child birth? I've never received a straight answer from a medical provider (other than my dentist) about what something will cost when asking about it up front. The answer is more or less, "It costs what it costs." I would be all about shopping around to compare costs for known medical care that is coming but you pull half your hair out just trying to talk to these people.
« Last Edit: July 21, 2017, 09:32:45 AM by Mr. Green »
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radram

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Re: What comes after the ACA?
« Reply #3282 on: July 21, 2017, 09:31:09 AM »
Profit and all the things designed to increase profit, rather than healthcare. This is what is happening by running universities like businesses, as well.

There's nothing wrong with earning a profit.  Insurance companies have to set their prices to keep their financials strong and provide a return for the stockholders if they are publicly traded, just like other stock companies.  Their financials are rate filings are subject to scrutiny by insurance departments.

The providers are also trying to earn a profit as well.  Are they performing too many tests in order to bill a lot of codes or are they just being careful.  I once did a study trying to determine which providers were billing too many codes on average.  If it's normal for a certain problem to have 4 codes billed but a particularl doctor bills 10 or 15, you have to take a closer look.
You continue to ignore the fatal flaws of free market theory in regards to healthcare. How can there be competition when so often there is no time to shop around, in rural areas there is often only one option, and even if there is competition the product can't be refused so it's not the same as a gallon of milk.

Admittedly, if prices were available costs may improve somewhat on our current situation but even providing prices is difficult because so many costs are specific to the situation. And if we paid based on results rather than inputs as some have suggested, it would disincentivize hospitals to provide costly procedures.

Not to mention the fact that in a small market, there is only 1 hospital in a multi-town area, and they claim they are struggling to survive. How in the world is the solution to build ANOTHER hospital to create competition? That would just lead to 2 hospitals with no hope to survive.

Midwest

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Re: What comes after the ACA?
« Reply #3283 on: July 21, 2017, 10:11:07 AM »
The point is that it shouldn't be $250,000, ever.
And it matters because it's the insane "retail price" rates that are used to "negotiate" the rates the most of us actually pay.

In my limited experience (and I have actually worked for 3 years "setting" the rates for a single healthcare provider).   The retail price doesn't necessarily have anything to do with the negotiated price, in my sample size of 1.

Nevertheless I think the lack of competition is a big reason why the system is broken.  If everyone had a $10,000 deductible and you could get a "childbirth package" quotes could come in below that, I'd like to think that people would shop around and rates would go down.  All being equal I would consider the $8,000 package would save me two grand more than the $15,000 package would.
Have you ever tried to shop around a child birth? I've never received a straight answer from a medical provider (other than my dentist) about what something will cost when asking about it up front. The answer is more or less, "It costs what it costs." I would be all about shopping around to compare costs for known medical care that is coming but you pull half your hair out just trying to talk to these people.

I've had 2 babies in the past 4 years, and the cost is kind of irrelevant, you are basically guaranteed to max out your deductible no matter what due to the prenatal, sonograms, and postnatal visits as well as the delivery if your deductible isn't astronomical.

Insurance cost are driven by medical costs.  The cost of childbirth is irrelevant to you only because insurance has removed you from the cost of the procedure because you've already hit your deductible.  If we had catastrophic insurance and the ability to actually shop procedures, costs would fall.

Exflyboy

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Re: What comes after the ACA?
« Reply #3284 on: July 21, 2017, 10:41:55 AM »
More positive media attention for our "leaders"... NOT.

https://finance.yahoo.com/news/cbo-under-latest-senate-healthcare-144209860.html

ketchup

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Re: What comes after the ACA?
« Reply #3285 on: July 21, 2017, 10:59:05 AM »
The point is that it shouldn't be $250,000, ever.
And it matters because it's the insane "retail price" rates that are used to "negotiate" the rates the most of us actually pay.

In my limited experience (and I have actually worked for 3 years "setting" the rates for a single healthcare provider).   The retail price doesn't necessarily have anything to do with the negotiated price, in my sample size of 1.

Nevertheless I think the lack of competition is a big reason why the system is broken.  If everyone had a $10,000 deductible and you could get a "childbirth package" quotes could come in below that, I'd like to think that people would shop around and rates would go down.  All being equal I would consider the $8,000 package would save me two grand more than the $15,000 package would.
Have you ever tried to shop around a child birth? I've never received a straight answer from a medical provider (other than my dentist) about what something will cost when asking about it up front. The answer is more or less, "It costs what it costs." I would be all about shopping around to compare costs for known medical care that is coming but you pull half your hair out just trying to talk to these people.
I've noticed this too (the dental exception).  My GF recently had to get a crown put back on and she was able to call and get a straight answer about what it would cost (even given her insurance making it a little more complicated).  My SIL recently had major unexpected surgery and nobody could tell her what anything would cost (literally the only answer she got ahead of it was "a lot").  It'd ridiculous.  I wouldn't buy a house or a car or other large purchase without knowing exactly what I was in for, yet for some reason anything goes with medical stuff.

Midwest

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Re: What comes after the ACA?
« Reply #3286 on: July 21, 2017, 11:19:55 AM »
Quote from: Moustaches link=topic=66557.msg1632450#msg1632450
[/quote

I've had 2 babies in the past 4 years, and the cost is kind of irrelevant, you are basically guaranteed to max out your deductible no matter what due to the prenatal, sonograms, and postnatal visits as well as the delivery if your deductible isn't astronomical.

Insurance cost are driven by medical costs.  The cost of childbirth is irrelevant to you only because insurance has removed you from the cost of the procedure because you've already hit your deductible.  If we had catastrophic insurance and the ability to actually shop procedures, costs would fall.

If we had catastrophic insurance and people who had babies had to pay more than they can afford, there would be less people paying their bills, and more would go to collections, and costs would go up for those that actually pay.

If we could actually shop for medical costs and were incentivized to so, I suspect costs would decrease significantly.   There is such an extreme disconnect between consumers and health care costs.  On to of that, health care providers have a disincentive to provide accurate cost information.

Regarding catastrophic insurance and no pays, that would depend largely on how high the limits on catastrophic insurance were set.

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Re: What comes after the ACA?
« Reply #3287 on: July 21, 2017, 11:27:12 AM »
While we're stuck on the example of child birth, it goes without saying that making everyone who has a baby pay obsene costs is one one of the dumbest economic policies there is. A sudden drop in the birth rate due to a major shift in birth costs is a surefire way to wreck havoc on the entire system.
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runewell

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Re: What comes after the ACA?
« Reply #3288 on: July 21, 2017, 11:33:47 AM »
While we're stuck on the example of child birth, it goes without saying that making everyone who has a baby pay obsene costs is one one of the dumbest economic policies there is. A sudden drop in the birth rate due to a major shift in birth costs is a surefire way to wreck havoc on the entire system.

So we have a pyramid scheme in place then? (OK if you answer yes)

It also goes without saying that making everyone who has a baby pay for their costs could me a smart economic policy.

nereo

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Re: What comes after the ACA?
« Reply #3289 on: July 21, 2017, 11:38:39 AM »

If we could actually shop for medical costs and were incentivized to so, I suspect costs would decrease significantly.   

How would you do this? Specifically how would you incentivize people to find the lowest cost, and how could patients 'shop around' for healthcare coverage - particularly when they don't know what is wrong and can't know what a procedure might entail until after its underway?

 I agree with you that there's a great disconnect between consumers and health care costs.  I just don't see any easy solutions to these problems.
It's easy enough when the procedure is routine and known ahead of time ("I need a physical and a tetanus booster!) but what does a person do when it's more immediate or complex? ("I fell off a ladder and now my entire left side hurts, and I'm bleeding"). 

No receptionist is going to be able to give me a quote without me first being examined.  Its hard enough to know whether my injuries are life threatening or not.  Am I expected to get examined first and then shop around - or is that something the medical group ought to do on my behalf? How do we avoid situations where the examining doctor, out of an abundance of caution, might recommend immediate surgery to avoid the chance of a clot which could paralyze or kill me - simultaneously eliminating my ability to 'shop around' for a low cost option? Is it fair to ask people to make rational economic decisions while in significant pain (if yes, why is torture so effective at getting people to do things they otherwise would never do)?

These sorts of questions never seem to have satisfactory answers (to me) to suggest that a consumer-driven market-based approach would ever be effective at lowering health care costs. 
"Do not confuse complexity with superiority"

sol

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Re: What comes after the ACA?
« Reply #3290 on: July 21, 2017, 11:47:23 AM »
While we're stuck on the example of child birth, it goes without saying that making everyone who has a baby pay obsene costs is one one of the dumbest economic policies there is. A sudden drop in the birth rate due to a major shift in birth costs is a surefire way to wreck havoc on the entire system.

Great point.  Look at the other countries with declining birth rates and how much of a problem that becomes.  You need young people to pax taxes and invent things or else your country becomes a bunch of old retired people on social security / medicare.

As a corollary, look at the economic booms that have resulted every time the US has had sharply rising birth rates.  We need to make more consumers and taxpayers to at least replace the ones who are dying.  Immigration helps, since Americans are currently not making enough babies on their own.

So we have a pyramid scheme in place then? (OK if you answer yes)

It also goes without saying that making everyone who has a baby pay for their costs could me a smart economic policy.


"Pyramid scheme" suggests indefinite growth, which is not what we're shooting for by asking for more babies.  The US birth rate is currently below replacement level, and we are only growing due to immigration.  We need new people to buy the stuff our current people are making.  Declining populations lead to declining economies.

Which is exactly why your second point is so misguided.  Government should absolutely be subsidizing procreation, because paying that cost up front generates more revenue for the country over time.  Consider it an investment in our future success, like public education or highways or healthcare.  If individuals won't improve the country because the personal costs of doing so are too high, then it makes sense for government to subsidize that cost up front and then recoup it later (in this case with a lifetime of taxes).

So no, it is NOT a smart economic policy to make everyone pay the full cost of their pregnancies.  That's a profoundly backwards idea that betrays a fundamental misunderstanding of how our economy works.  Would you also tell private corporations they can't sell stock, because they should pay the full cost of their business expansions up front?
« Last Edit: July 21, 2017, 11:50:57 AM by sol »

Dabnasty

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Re: What comes after the ACA?
« Reply #3291 on: July 21, 2017, 11:54:45 AM »
So we have a pyramid scheme in place then? (OK if you answer yes)

It also goes without saying that making everyone who has a baby pay for their costs could me a smart economic policy.
More like a "stable population scheme"?

https://www.census.gov/content/dam/Census/newsroom/blogs/2016/06/americas-age-profile-told-through-population-pyramids/Chart-1.png

Midwest

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Re: What comes after the ACA?
« Reply #3292 on: July 21, 2017, 12:11:36 PM »

If we could actually shop for medical costs and were incentivized to so, I suspect costs would decrease significantly.   

How would you do this? Specifically how would you incentivize people to find the lowest cost, and how could patients 'shop around' for healthcare coverage - particularly when they don't know what is wrong and can't know what a procedure might entail until after its underway?

With regard to emergency procedures, you are absolutely correct.  You can't stop to shop.

With regard to non-emergency procedures, however, I suspect the vast majority could be shopped.  For example, orthopedic procedures, tonsils, MRI's, routine childbirth, physical therapy.....


 I agree with you that there's a great disconnect between consumers and health care costs.  I just don't see any easy solutions to these problems.
It's easy enough when the procedure is routine and known ahead of time ("I need a physical and a tetanus booster!) but what does a person do when it's more immediate or complex? ("I fell off a ladder and now my entire left side hurts, and I'm bleeding"). 

No receptionist is going to be able to give me a quote without me first being examined.  Its hard enough to know whether my injuries are life threatening or not.  Am I expected to get examined first and then shop around - or is that something the medical group ought to do on my behalf? How do we avoid situations where the examining doctor, out of an abundance of caution, might recommend immediate surgery to avoid the chance of a clot which could paralyze or kill me - simultaneously eliminating my ability to 'shop around' for a low cost option? Is it fair to ask people to make rational economic decisions while in significant pain (if yes, why is torture so effective at getting people to do things they otherwise would never do)?

These sorts of questions never seem to have satisfactory answers (to me) to suggest that a consumer-driven market-based approach would ever be effective at lowering health care costs.

I agree with you a consumer driven model is irrelevant for most emergencies.  What percentage of patient care, however, is true emergency care?  If my family is a model, emergency care is a small portion of medical care.

If we could use the consumer model to drive down the costs of non-emergency care in addition to other methods to drive down the overall costs maybe we could get somewhere.

shenlong55

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Re: What comes after the ACA?
« Reply #3293 on: July 21, 2017, 12:24:43 PM »
I agree with you a consumer driven model is irrelevant for most emergencies.  What percentage of patient care, however, is true emergency care?  If my family is a model, emergency care is a small portion of medical care.

If we could use the consumer model to drive down the costs of non-emergency care in addition to other methods to drive down the overall costs maybe we could get somewhere.

I'm not convinced that you can effectively shop around for non-emergency services in the current market.  What changes do you think we could make to get to a point where we could?

sol

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Re: What comes after the ACA?
« Reply #3294 on: July 21, 2017, 12:33:12 PM »
I agree with you a consumer driven model is irrelevant for most emergencies.  What percentage of patient care, however, is true emergency care?  If my family is a model, emergency care is a small portion of medical care.

If my family is a model, emergency care is a small portion of the care provided, but a clear majority of the cost.

Midwest

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Re: What comes after the ACA?
« Reply #3295 on: July 21, 2017, 12:35:25 PM »
I agree with you a consumer driven model is irrelevant for most emergencies.  What percentage of patient care, however, is true emergency care?  If my family is a model, emergency care is a small portion of medical care.

If we could use the consumer model to drive down the costs of non-emergency care in addition to other methods to drive down the overall costs maybe we could get somewhere.

I'm not convinced that you can effectively shop around for non-emergency services in the current market.  What changes do you think we could make to get to a point where we could?

You can't shop around, that's one of the problems. 

As far as a solution, force providers to quote prices and educate/incentivize consumers that prices vary widely. 

For example, I recently had a planned non-emergency surgery.  There were 2 surgery centers the surgery could have been performed at with the same doc.  If I were incentivized and educated, I would have picked the lower cost one (all things being equal).  Instead, I was over my deductible and didn't care nor could I have found it if I asked.

Incidentally, my 1 hour outpatient surgery cost my insurance company $20k.  That's unconscionable.
« Last Edit: July 21, 2017, 12:39:21 PM by Midwest »

Midwest

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Re: What comes after the ACA?
« Reply #3296 on: July 21, 2017, 12:37:34 PM »
I agree with you a consumer driven model is irrelevant for most emergencies.  What percentage of patient care, however, is true emergency care?  If my family is a model, emergency care is a small portion of medical care.

If my family is a model, emergency care is a small portion of the care provided, but a clear majority of the cost.

That hasn't been the case in my family.  Tonsils, planned orthopedic work and pregnancies have been the big ones.  Clearly however, informing the consumer and incentivizing is only part of the solution.

Mr. Green

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Re: What comes after the ACA?
« Reply #3297 on: July 21, 2017, 01:09:22 PM »
Government should absolutely be subsidizing procreation, because paying that cost up front generates more revenue for the country over time.  Consider it an investment in our future success, like public education or highways or healthcare.  If individuals won't improve the country because the personal costs of doing so are too high, then it makes sense for government to subsidize that cost up front and then recoup it later (in this case with a lifetime of taxes).
BINGO! The economic output new people yield grossly outperforms the cost of those births. People generate millions in revenue over their lifetimes. Their companies make money employing them. Other companies make money selling them products. Even if the real cost of birth was $250,000, which I assure you it isn't, our country still benefits hugely from new people being born.
RE in June 2016. Wife is joining me at the end of June!

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3298 on: July 21, 2017, 01:35:34 PM »
I agree with you a consumer driven model is irrelevant for most emergencies.  What percentage of patient care, however, is true emergency care?  If my family is a model, emergency care is a small portion of medical care.

If my family is a model, emergency care is a small portion of the care provided, but a clear majority of the cost.

That hasn't been the case in my family.  Tonsils, planned orthopedic work and pregnancies have been the big ones.  Clearly however, informing the consumer and incentivizing is only part of the solution.

It's not just the cost that matters, it's the quality of the care you're going to get. Different settings could have different outcomes, you could acquire an infection in a poor quality setting. A birth can be botched by a poor performance of the obstetrician.

When the asymmetry of information is large enough (with the buyer totally out of the loop of essential information), the free market system fails - econ 101

On the other hand, vaccinations, and other simple preventive procedures should be able to be shopped around, an ounce of prevention is worth a pound of cure.

Lagom

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Re: What comes after the ACA?
« Reply #3299 on: July 21, 2017, 01:45:01 PM »
I agree with you a consumer driven model is irrelevant for most emergencies.  What percentage of patient care, however, is true emergency care?  If my family is a model, emergency care is a small portion of medical care.

If my family is a model, emergency care is a small portion of the care provided, but a clear majority of the cost.

That hasn't been the case in my family.  Tonsils, planned orthopedic work and pregnancies have been the big ones.  Clearly however, informing the consumer and incentivizing is only part of the solution.

Sure it hasn't been the case in your family because you haven't had a real emergency situation occur. My wife had two recent emergency surgeries that also required around 4-5 days of recovery in the hospital. The combined bill was around 250k, which fortunately we didn't have to pay because of insurance.