Posted on 03/25/2017 8:45:52 AM PDT by M. Dodge Thomas
"Customers in healthcare ask a different question than customers in most markets. Whether hospitals (as customers of suppliers) or individuals needing an operation, healthcare customers mostly don’t ask, “Can we afford it?” Or even, “What’s the best value for the money?” They ask, “Is it covered? Can we get reimbursed for this?” And the reimbursement or coverage is set by complex non-market mechanisms that in most parts of the market are themselves opaque to the customer. So there is no real customer and no real price signal in most relationships throughout the market."
(Excerpt) Read more at healthcareinamerica.us ...
I suggest reading him with at open mind - because a lot of what he says runs counter to what's "obviously true", and his analysis undermines a lot of what's assumed to be true - right across the political spectrum, from the presumed advantages of "single payer" on the left to the actual effects of "market competition" on the right.
In the context of healthcare, the “government is bad” vs. “government is good” argument just doesn’t fit the reality of this horrifically complex situation.
Actually, it does. Government meddling is what made this situation horrifically complex.
The problem is bureaucRATS and politicians use the words "health care" and "insurance" interchangeably.
NOPE, not buying this guys expert advice. It doesn’t start with the government trying to provide health care. IT STARTS WITH PEOPLE. People need to be able to form groups to insure themselves, and have a group of people who don’t use tobacco, curbed alcohol consumption, monogamous, committed people who don’t bring STD’s to their spouse!! People who don’t eat til they look like Hippos And folks who when they weigh 300lbs don’t get the priviledge of an electric golf cart to go up and down the aisles of Walmart to fill their baskets with marshmallows. People need to wash their private parts after sex, wash their hands after going to the bathroom, brush their teeth, and if they are addicted to Valium, make them go see their priest, rabbi or pastor and find out what internal issues are causing this. NO more payments for sexual reorientation, no more subsidies for Viagara, and no more face lifts, tummy tucks or butt perks. People should be able to form groups that allow their category who would be LESS likely to go to the hospital, get a cheaper premium. What has gotten out of hand, is the demands of people who have a hang over from drinking, and want a doctors signature on Monday that they are sick and need coverage for being absent. Listen to me... I’m telling you the truth.
I agree. :)
My 1 page profile on this forum explains how to make healthcare cheaper and better. I posted that more than a year ago.
In three SIMPLE (not easy) steps
1) Straight repeal of Obamacare. Probably the most difficult to pass as the Dems will likely filibuster. So be it. Let them deal with the voters.
2) Create a national exchange where the People can voluntarily purchase healthcare insurance and where Insurance companies can either participate in all categories of insurance or not participate at all.
Set the exchange up to have several different categories or options of insurance from high to low options / premiums / co pays etc. One option should address pre-existing by a) not include pre-existing, b) allow pre-existing with an annual cap on payments and c) an option for unlimited pre-existing conditions.
3) Change the tax code:
- for businesses so that they receive a tax deduction for any contribution to an empolyee’s health insurance (HSA account) plus small percentage (1 or 2 percent) if provided to all (full or part time) employees. Treat it like an IRA or 401k
- for individuals to create health savings accounts with pre-tax dollars
- allow for HSA’s to pay for premiums, co-pays, prescriptions, equipment, etc. And allow savings to accumulate and roll over year to year. (save for retirement years)
This will encourage
- businesses to provide a flat amount or percentage an employee receives.
- businesses to provide that payment to all employees
- individuals to participate and save
SHOP.
(See! I can make healthcare cheaper in one word.)
IMO proposals for healthcare “without Government interference” may be an entertaining exercise for newly minted Libertarians passing the bong in freshman dorms, but they are a complete of time when discussing actual healthcare systems.
If you could wave a magic wand and completely remove government involvement it health care (in fact, no such system exists anywhere in the developed world, or could) you would still face most of the problems and inefficiencies noted in the article - the healthcare “market” does not, and cannot, operate like other “competitive markets” - health care really is different.
This is why we still have “government interference” in healthcare markets in places like Singapore and New Zealand -the markets just don’t function acceptably without it.
Neither 100% government control nor 0% government involvement.
One way to reduce costs is to let people make choices up front. For example, an insurance company could offer a 20 percent discount on the understanding that a medical treatment or test has to be proven to lengthen life by an average of, say, three months before it’s covered.
it would mean the patient wouldn’t be eligible for a lot of things, such as PSA exams, annual physicals, and stents if they haven’t yet had a heart attack. But you know what? Albanians, with almost no health care infrastructure, only have an average lifespan of 16 months less than ours. If one exercises and eats right, odds are they will live a long time. And if your genes are going to give you an illness that will make you die young, odds are medical intervention would just give you a nasty extra few months anyway. The data strongly suggest people use a lot more health care than they really need.
ping
There is a solution where customers do ask what things are going to cost and how good of a value they are getting. It is because they are on the honor system and do not want to burden others in the organization. They are called Healthcare Ministries. My wife and I use Christian Healthcare Ministries in place of traditional healthcare insurance. Our group has shared over a billion dollars in healthcare expenses. It costs far less than traditional insurance and we have basically unlimited coverage. But we also have the responsibility to control the expenses and look out for the group. The people in charge including the author of this piece should be investigating how these health cost sharing ministries work and use them as a model. I am not completely sure that it would work for everyone, but it sure works well for us.
The article you posted proposes a bunch of minor modifications to a very broken system. The author recommends keeping Obamacare, and adjusting some aspects of how care is paid for. Anybody who thinks that is the solution is really just repeating what the hospitals, insurance companies, RINOS and Democrats, and drug companies want to hear.
More likely to be successful solutions to an obviously exploitative system rigged to benefit the providers will by necessity cause major dislocations in the business models of the current participants. How about thinking about real changes?
A lot of us are well informed about the nature of the health care markets, and as an example how the fake prices used by hospitals distort the market and analysis of health care costs. One simple, but radical solution would be to require hospitals to provide any service or product they sell at the same price to every customer, regardless of whether they were an individual cash payer, the government, or a private insurer. That would instantly change the entire market dynamic, as individuals would no longer need an insurance carrier to get them prices that are discounted 80 or 90 percent off the fake "list" prices. And the government could not underpay the hospitals for medicare and medicaid patients thereby forcing the actual costs of that service onto non government paid patients.
Move to Cuba.
This reads like a INSURANCE marketing piece.
bmp
Right. Karl Denniger on the market ticker writes a lot along these same lines. Direct primary care physicians lists their costs and it’s amazing the difference between them and dealing with insurance companies.
Joe evades a very basic “economic” question when it comes to “health insurance”, and it is a law and regulatory question.
It’s pretty simple. Why is health insurers and their insurance plans allowed to operate differently, as to who is customer and who is not, compared to automobile insurance of home insurance.
If your house develops a roof leak, you notify your home insurance company. They have the leak appraised and determine what they say they will pay to fix it. YOU talk to some roofers, letting them now the most your insurer will pay, creating the understanding you will be paying the rest “out of pocket”. Then YOU select your roofing company, have the repair done, get a bill from them, get your insurance company reimbursement and pay the balance of the repair bill. Your insurer WAS NOT the roofing company’s customer and did not negotiate their own price with the roofer. In the home insurance and home remain market that would be collusion.
You can see how auto insurance operates similar to home insurance. You are more “the customer” and the only customer in the relationship with the repair outfit, NOT your insurer. What has been the “premium increase” inflation rare of either auto insurance or home insurance? Nothing close to health insurance.
Why? The collusion of the health insurance with the health care providers has OBVIOUSLY not lowered the total costs being billed to you, in medical costs and insurance costs combined. Why? The author actually mentioned why, but then failed to mention the solution.
As he said, there are no incentives to the insurers to get lower costs TO YOU (in total medical + insurance costs), only costs relative to their own bottom line, in negotiations where there collude on pricing IN THEIR OWN business-to-business relationship (like a home insurer telling you only certain select roofers could be allowed to do your repairs).
The solution is to enforce anti-trust standards that removes insurers from establishing relationships of collusion that perpetuate a form of “insurance” that is only “insuring” the health care industrial complex is getting what money it demands.
The “insurer” has to be removed as the quasi-customer of the health care provider, and the health care provider has to accept YOUR INSURER’S PAYMENT, which is a matter that stands, regardless of what that means as far as anything else that will have to be paid “out of pocket”. Your auto and home insurance works that way and so should your health insurance. If it did, YOUR financial relationship with the health care providers, directly, would be driving the incentives to innovation and lower costs.
As long as the insurance premiums paid for by the employer is not treated as taxable income to the employee the cost of health care delivery will rise.
Total freedom in all marketplaces.
Internet based providers, labs, insurers, hospitals, LTACs, physical therapists, etc., all posting their prices.
Insurers inventing novel types of coverage in a million different variations.
Employers and government OUT of health care and as much as possible, OUT of our lives.
Give tax breaks to physicians, hospitals, labs, even insurers who take care of the poor and chronically ill.
No restrictions on where an insurer may offer coverage.
Let insurers compete the way GEICO competes with Progressive and Allstate.
Let everybody compete with everybody in a totally free market, allowing free association and free pricing.
Cut taxes on anyone or any business in health care, ideally to zero.
You will see innovation, quality, and savings grow like weeds.
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