I disagree with Medicare for all and single payer.
The role of govt is a catch 22 - it is by design a monopoly, and monopolies are usually inefficient, so too much govt power gets monopoly capture but too little means govt can’t break the monopolies.
The largest issue with US healthcare is lack of price-quality transparency and competition.
This means tons of middle player monopolies e.g PBMs.
I can’t go shop around for a procedure on a marketplace and pay out of pocket, the same rates an insurer would.
I can’t deal directly with service provider or the labs. It has to be intermediaries.
The # of medical licenses are capped, they’re not growing in proportion to population.
Demand-supply dynamics, the basis of capitalism is wildly inefficient in US.
Get rid of employer given insurers, make a law that insurers cannot negotiate a lower price than out of pocket price. Every procedure price should be openly put on an easily searchable marketplace.
Make it easy to start new practices, more doctors and nurses and hospitals.
The prices will come down.
Single payer is a bandaid fix. It does nothing to fix the supply problem.
this argument comes up every time and it always ignores a critical aspect of medicine: not all procedures can be “shopped for”.
If I have cancer and I need to start treatment as soon as possible I’m not going to waste precious time comparing rates of infusion centers, especially given that one may be able to take me in for treatments 2 weeks sooner. That two weeks could make all the difference
If I have a heart attack, stroke, car accident, etc, that incapacitates me, I am simply incapable of shopping around for the best price. I am going to be taken in for emergency care and treated to the point of stabilization (or better, depending on whether I have a guardian who can approve more. Said guardian could theoretically shop around at this point but it is difficult given the potential emotionality involved and danger in moving someone who is critically injured)
Increasing provider supply is certainly a huge part of fixing things, if it’s done correctly. If you merely lower standards you just increase supply with substandard practitioners that overall worsen outcomes
What percentage of the money spent on healthcare is the type of emergency you're talking about?
5%? 10%?
I'm not saying stuff like that doesn't happen but insurance for healthcare in this country is totally insane. If car insurance worked the same way Geico would be paying for my gas and oil changes. Heck they'd be paying to have the car cleaned once a month.
well my insurance company just doubled the rate on my 2009 clunker because i had the audacity to move to a low-income neighborhood, so i find these terms acceptable.
most people spend a lot of money on healthcare as they age. Many times this is emergency stuff that’s unplanned and not possible to shop for, or it’s just flat out expensive to care for. Stuff like falling at home and breaking a hip, cancer, heart attack, dementia care, etc. Once you’re admitted into the hospital it’s game over. You think someone is going to shop around while in a hospital bed connected to IV’s? That’s crazy talk.
A little boo boo or an urgent care visit can be shopped for, sure, but that’s all cheap stuff compared to emergency or end of life care! That’s the stuff people actually stress about in my opinion. So why not fix that?
Another example: a mother “shops around” to find a cheap place to deliver her baby. Great! But maybe she’s unlucky and needs emergency C-section or another emergency intervention. What good is shopping around if it’s not actually practical?
People expecting children are exactly the type of people who should be able to shop around. Even in the case of an emergency delivery it's an event that you have what, 6 months to plan for?
I see you conveniently ignored the fact that any emergency before age 65 is hard to shop around for. From a hospital bed and all that…
Anyway i simply think the idea of “shopping around” for medical care is barbaric. As a concept. We’re talking about peoples lives here. I think as a country we should have some actual pride and treat our citizens well. Not like an inconvenience.
just my opinion, as a lucky person with great health insurance.
As somebody having once "shopped for healthcare" in the US: It's pretty high on my list of all-time most frustrating and stressful situations, and that was for a relatively minor dental issue. I can't begin to imagine how it must be for somebody facing a major life-threatening (but not urgent in the emergency room sense) condition.
I'd gladly "overpay" a few (or even many) percent if that's what it takes to get systematic protection from being a pawn in a game of 10d chess between doctors needing to overtreat to recoup their enormous investments, insurers pushing back by possibly declining to pay for what I actually need to get done, and medical administration and billing companies, and industry for the size of which I have yet to hear a compelling economic argument.
It's actually easier to shop for medical care than dental. Health plans are now required to give members an online price comparison tool. You can just log on to your insurance company's member portal and search for the care you need to see prices for network providers in your area. Unfortunately, the same rule doesn't apply to dental insurance.
Still, a problem at least as big as finding various options and their prices seems to be finding somebody incentivized to give an honest evaluation of whether a given treatment is medically necessary at all.
Sometimes I wonder if it wouldn't make sense to have a doctor "on a retainer" that just gets a fixed yearly compensation for advising what to do, and what to better decline, but there's probably tons of ways this could go wrong in either direction (overtreatment vs. missing important issues) as well.
You are essentially describing "concierge medicine". This can be a good option for affluent patients who can afford the monthly fee but it's not a scalable solution for the systemic problems in the US healthcare system. A lot of the people who take advantage of it are what is known in the industry as the "worried well" — rich hypochondriacs willing to pay for personal reassurance whenever they have a tummy ache.
The role of govt is a catch 22 - it is by design a monopoly, and monopolies are usually inefficient, so too much govt power gets monopoly capture but too little means govt can’t break the monopolies.
The largest issue with US healthcare is lack of price-quality transparency and competition.
This means tons of middle player monopolies e.g PBMs.
I can’t go shop around for a procedure on a marketplace and pay out of pocket, the same rates an insurer would.
I can’t deal directly with service provider or the labs. It has to be intermediaries.
The # of medical licenses are capped, they’re not growing in proportion to population.
Demand-supply dynamics, the basis of capitalism is wildly inefficient in US.
Get rid of employer given insurers, make a law that insurers cannot negotiate a lower price than out of pocket price. Every procedure price should be openly put on an easily searchable marketplace.
Make it easy to start new practices, more doctors and nurses and hospitals.
The prices will come down.
Single payer is a bandaid fix. It does nothing to fix the supply problem.