A Billionaire Pledges to Fight High Drug Prices, and the Industry Is Rattled(wsj.com)
wsj.com
A Billionaire Pledges to Fight High Drug Prices, and the Industry Is Rattled
https://www.wsj.com/articles/a-billionaire-decided-to-fight-high-drug-prices-and-the-industry-is-rattled-1540145686
298 comments
The lack of transparency is due to perverse incentives in the healthcare system stemming from overly complex legislation.
As a country, the US hasn't decided whether healthcare is a fundamental right or privilege. As a result, we constantly make political decisions that straddle the line without ever really going one way.
The biggest culprit is the "fee-for-service" model of reimbursement, where healthcare providers (physicians) are reimbursed based on the quantity of care rather than patient outcomes. Each procedure has a code (CPT) that is used to bill insurance. Billing for each of these codes is completely arbitrary and up to provider/payer negotiations. The fee-for-service model is a clear example of a perverse incentive.
Who reimburses the fee-for-service model? Either the government (Medicare/Medicaid isn't even entirely government-run, as many states rely on a for-profit Medicare Administrative Contractor) or private health insurance companies. The perverse incentives can now be seen from both the provider's side and the payer's side: hospitals and physicians negotiate to get the best reimbursement rates that they can. And of course, because these insurance companies want to make money, they make it "difficult" for providers to get paid for each procedure and will find any reasonable way to deny the claim from going through. Because of this, providers artificially raise the amount charged to the payers as high as they think they can get away with in the hopes that insurance will pay up.
Meanwhile, patients suffer greatly as there's no transparency.
As a country, the US hasn't decided whether healthcare is a fundamental right or privilege. As a result, we constantly make political decisions that straddle the line without ever really going one way.
The biggest culprit is the "fee-for-service" model of reimbursement, where healthcare providers (physicians) are reimbursed based on the quantity of care rather than patient outcomes. Each procedure has a code (CPT) that is used to bill insurance. Billing for each of these codes is completely arbitrary and up to provider/payer negotiations. The fee-for-service model is a clear example of a perverse incentive.
Who reimburses the fee-for-service model? Either the government (Medicare/Medicaid isn't even entirely government-run, as many states rely on a for-profit Medicare Administrative Contractor) or private health insurance companies. The perverse incentives can now be seen from both the provider's side and the payer's side: hospitals and physicians negotiate to get the best reimbursement rates that they can. And of course, because these insurance companies want to make money, they make it "difficult" for providers to get paid for each procedure and will find any reasonable way to deny the claim from going through. Because of this, providers artificially raise the amount charged to the payers as high as they think they can get away with in the hopes that insurance will pay up.
Meanwhile, patients suffer greatly as there's no transparency.
I cannot divulge my sources, so take it for what it is, but in talking with people at the top of several very large private insurers (as far back as 2016) they were sick of how providers weren't healing people and bleeding them out.
I've seen evidence (firsthand) that value based care can work, but it's hard to get provider networks on board when they are the ones who aren't getting paid when readmission rates are too high.
I've seen evidence (firsthand) that value based care can work, but it's hard to get provider networks on board when they are the ones who aren't getting paid when readmission rates are too high.
Insurers are part of the racket. At least that's how it feels from a consumer point of view.
Insurers essentially get a cut of the overall revenue, so they perversely win the more overall is spent.
> The biggest culprit is the "fee-for-service" model of reimbursement, where healthcare providers (physicians) are reimbursed based on the quantity of care rather than patient outcomes.
Charge a hospital based on patient outcomes? How would that work?
Charge a hospital based on patient outcomes? How would that work?
Say getting a base ammount per problem fixed or identified to some standard say $20k for solving severe stomach ulcers with bonuses for things like not having any longterm damage, minimal patient suffering and such. It doesn't matter if they use cheap antibiotics or surgery or how many screening tests were performed in that hypothetical.
Granted there would be major devils in the details especially if it causes "underwater" patients.
Granted there would be major devils in the details especially if it causes "underwater" patients.
Except not every patient can be fixed. Doctors would be incentivized not to take on really sick patients or those with mystery illnesses.
That's exactly what would happen. In a university hospital setting it's the most experienced physician
that takes on the most difficult cases.
You are way off base. The original WSJ article has links to other articles detailing how hospitals merge themselves into a monopoly that has to be accepted by the insurer. The hospital sets the prices. They also go into how these large hospital systems gobble up doctors offices and use the same leverage to increase prices and tack exhoribiant fees--just like the experience of the person you are replying to.
Not off base at all. Their description of the perverse incentives was very accurate.
I had worked as an engineer and was closely aligned to the fraud division for one of the larger insurers some time ago.
I had worked as an engineer and was closely aligned to the fraud division for one of the larger insurers some time ago.
I mean, you are both pointing out things that exist, are happening, and are problematic.
Automobile mechanics are required to provide a written estimate in advance. I don't see why health care should be any different.
Before anyone objects with "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures.
Before anyone objects with "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures.
It’s hilarious that people suggest that doctors should provide written estimates in advance, on a site full of programmers where the accepted wisdom is that its impossible for them to provide accurate estimates for the work they do.
Here's a relevant quote from a nice article [1]:
""" When you are estimating tasks that are done over and over, you can look to your historical execution time for insights. We average chopping X logs per hour.
If I hand you a Rubik's Cube and ask you to tell me how long it will take you to solve it...what is your answer going to be? If you've done it before you might have an idea. Maybe you just kept plugging away until you finally solved it? Maybe you've watched one of those videos about how to solve a Rubik's Cube, have practiced it and are confident that you could do it in 3 minutes flat? Maybe you have no idea?
Complexity and experience will dictate your answers, but then those estimates still only reflect your perception of the task...not everyone else on your team.
At best those numbers are a guess.
Every step in a software project is solving problems. You don't know how long it will take to solve the problem. You don't know how many new problems you might run into along the way. Can the new problems be solved by you or do they need to be solved by other people? """
[1]: https://www.brightball.com/articles/reality-driven-developme...
""" When you are estimating tasks that are done over and over, you can look to your historical execution time for insights. We average chopping X logs per hour.
If I hand you a Rubik's Cube and ask you to tell me how long it will take you to solve it...what is your answer going to be? If you've done it before you might have an idea. Maybe you just kept plugging away until you finally solved it? Maybe you've watched one of those videos about how to solve a Rubik's Cube, have practiced it and are confident that you could do it in 3 minutes flat? Maybe you have no idea?
Complexity and experience will dictate your answers, but then those estimates still only reflect your perception of the task...not everyone else on your team.
At best those numbers are a guess.
Every step in a software project is solving problems. You don't know how long it will take to solve the problem. You don't know how many new problems you might run into along the way. Can the new problems be solved by you or do they need to be solved by other people? """
[1]: https://www.brightball.com/articles/reality-driven-developme...
There's a big difference between not being able to provide an exact estimate because of unforeseen events[1] and not providing an estimate that includes services that are being provided to pretty much everyone visiting the health care provider for the given condition. I mean the nurse and the doctor costs quoted above are not "unforeseen".
[1] If you're going to try to say that what is "unforeseen" is relative it's not that relative, you can get an independent committee of doctors and provide a percentage based on their experience how much often that event is expected in that situation
[1] If you're going to try to say that what is "unforeseen" is relative it's not that relative, you can get an independent committee of doctors and provide a percentage based on their experience how much often that event is expected in that situation
Doctors, like auto mechanics, repeat the same tasks over and over and have a pretty good idea what something will cost. Like with automobiles, there are sometimes surprises, and those can require a new estimate to be signed off on.
Software development is inherently nonrepetitive and therefore unpredictable.
Healthcare is much closer to auto repair than software development.
Software development is inherently nonrepetitive and therefore unpredictable.
Healthcare is much closer to auto repair than software development.
Healthcare is much closer to auto repair than software development.
Sure, on a car that's running that you can't turn off, with parts you can't replace, a maintenance history you can't see, and an ECU that actively misrepresents what's going on.
Sure, on a car that's running that you can't turn off, with parts you can't replace, a maintenance history you can't see, and an ECU that actively misrepresents what's going on.
Hey now that sounds a lot like our '81 Vanagon!
Haha, if anything, software should be the most predictable. Most software just provides some screens to enter and view data. How difficult can it be to predict that? I would rate healthcare much more difficult to predict.
Most software just provides some screens to enter and view data.
That is a dangerously naive view of software. Even apps that look like simple CRUD end up riddled with specialized business logic. Apps which truly are a few screens of simple CRUD end up as spreadsheets or Microsoft Access. We've gotten pretty good at not reinventing wheels.
Say what you will about the challenge of it, doctoring is fundamentally procedural and repetitive. Patients don't really show up with whole new undiscovered diseases anymore.
That is a dangerously naive view of software. Even apps that look like simple CRUD end up riddled with specialized business logic. Apps which truly are a few screens of simple CRUD end up as spreadsheets or Microsoft Access. We've gotten pretty good at not reinventing wheels.
Say what you will about the challenge of it, doctoring is fundamentally procedural and repetitive. Patients don't really show up with whole new undiscovered diseases anymore.
> Healthcare is much closer to auto repair than software development.
O'boy. What doctor do you go to?
O'boy. What doctor do you go to?
Doctors shouldn't even have to do it. The treatment center should be able to do it. For example:
Rolled ankle
100% [of patients get charged]: Office visit: $50
58%: X-rays: $55 - $95
22%: boot/cast: $240
3%: surgery: ??
<1%: other: ??
One current problem is that even if you have insurance, and seek emergency care at a hospital that is part of the network covered by your plan, you still often end up with a huge surprise bill.
>Vox's database shows that patients are especially vulnerable to these surprise bills when out-of-network doctors work at in-network hospitals.
“It does happen quite a lot in the emergency room,” says Christopher Garmon, an assistant professor at the University of Missouri Kansas City.
Garmon published a study last year that found as many as one in five emergency room visits led to a surprise bill from an out-of-network provider involved in the care.
https://www.vox.com/2018/5/23/17353284/emergency-room-doctor...
>Vox's database shows that patients are especially vulnerable to these surprise bills when out-of-network doctors work at in-network hospitals.
“It does happen quite a lot in the emergency room,” says Christopher Garmon, an assistant professor at the University of Missouri Kansas City.
Garmon published a study last year that found as many as one in five emergency room visits led to a surprise bill from an out-of-network provider involved in the care.
https://www.vox.com/2018/5/23/17353284/emergency-room-doctor...
Anecdata: had to take spouse to ER earlier this year. She had a reasonably run-of-the-mill cold, but the cough had irritated her throat enough that everything she attempted to eat was triggering her gag reflex. She was getting pretty feeble from lack of food (and throwing what little she could get down back up).
Insurance is through her work, so I had to coax her through logging in to her account so that I could try to find an in-network ER list.
After spending ~30 minutes grumbling at the website over the complete lack of anything resembling clarity, I had a list of 3 hospitals that appeared to be in-network (and a sinking feeling that this could easily cost thousands of dollars). Set off around 2am. Arrived at first. 5+hour wait. Went to the next, no wait. They didn't manage to do much aside from giving a few tests that came up negative, administered fluids, gave her a steroid shot, and did a blood panel.
Her blood panel had one abnormal result that the doctor was willing to admit her for observation over (and had admitted people in the pass for less), but the doctor also noted that the parameter can vary a lot person to person; some people would be fine at that level. I had a sinking feeling in my stomach and decided it would be better to take her home to keep an eye on her than risk financial ruin. I think we were there 2-3 hours.
When the bill came months later, it was $2600 because the doctor was out of network.
Insurance is through her work, so I had to coax her through logging in to her account so that I could try to find an in-network ER list.
After spending ~30 minutes grumbling at the website over the complete lack of anything resembling clarity, I had a list of 3 hospitals that appeared to be in-network (and a sinking feeling that this could easily cost thousands of dollars). Set off around 2am. Arrived at first. 5+hour wait. Went to the next, no wait. They didn't manage to do much aside from giving a few tests that came up negative, administered fluids, gave her a steroid shot, and did a blood panel.
Her blood panel had one abnormal result that the doctor was willing to admit her for observation over (and had admitted people in the pass for less), but the doctor also noted that the parameter can vary a lot person to person; some people would be fine at that level. I had a sinking feeling in my stomach and decided it would be better to take her home to keep an eye on her than risk financial ruin. I think we were there 2-3 hours.
When the bill came months later, it was $2600 because the doctor was out of network.
We had a baby 4 months ago. We still get surprise bills from things we don’t even know about. Some of them could be scams but I have very little idea on how to even verify. Calls get stuck on automated helpdesk.
For all technological advancements in US, the healthcare system is quite backwards. It’s not a new problem. Tons of countries do it well “Canada, Australia, Sweden ...”
The US political and healthcare system refused to accept other models since there is sooooo much money to be made at the expense of “some-other” people dying and going bankrupt.
House insurance, car insurance, all other forms of insurance are transparent, US healthcare is the most “mafia-like money extortion” system.
For all technological advancements in US, the healthcare system is quite backwards. It’s not a new problem. Tons of countries do it well “Canada, Australia, Sweden ...”
The US political and healthcare system refused to accept other models since there is sooooo much money to be made at the expense of “some-other” people dying and going bankrupt.
House insurance, car insurance, all other forms of insurance are transparent, US healthcare is the most “mafia-like money extortion” system.
Singapore does this really well. A hospital is mandated by law to provide you financial counselling - it’s like a predictive charge sheet of what you will be charged when you’re admitted to the hospital. It’s unreasonable to expect 100% accuracy, they give you an estimate based on everything they know. if circumstances change, they are required to provide you an updated financial counsel sheet.
> "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures.
Right, as soon as the patient is admitted, it's a cardiothoracic surgery issue, or an oncology issue, or a high-risk obstetrics issue, or a critical care issue, or a neurosurgery issue, or a nephrology issue, or a general surgery issue, or an in-patient psych issue, or an ENT issue, or an opthalmology issue, or a geriatrics issue, etc.
Right, as soon as the patient is admitted, it's a cardiothoracic surgery issue, or an oncology issue, or a high-risk obstetrics issue, or a critical care issue, or a neurosurgery issue, or a nephrology issue, or a general surgery issue, or an in-patient psych issue, or an ENT issue, or an opthalmology issue, or a geriatrics issue, etc.
Doctors and the health care industry have better lobbyists than auto mechanics.
Too expensive to fix an auto issue. Oh well, let’s just dump the car and get another one.
Too expensive to fix healthcare issue. You’ll probably die or make it worse if you don’t fix it. “How much is your life worth to you?”
You can get a ton more random money by holding people’s lives over them. That is in summary the US healthcare system. Full of middlemen squeezing every penny they can out of you because they can.
Whoever campaigns for a transparent healthcare system, I’m voting for them.
Our broken healthcare system kills more people than all terrorist attacks and natural disasters combined because people can’t afford to pay the bill mafia.
That’s just a very sad state of affairs.
Too expensive to fix healthcare issue. You’ll probably die or make it worse if you don’t fix it. “How much is your life worth to you?”
You can get a ton more random money by holding people’s lives over them. That is in summary the US healthcare system. Full of middlemen squeezing every penny they can out of you because they can.
Whoever campaigns for a transparent healthcare system, I’m voting for them.
Our broken healthcare system kills more people than all terrorist attacks and natural disasters combined because people can’t afford to pay the bill mafia.
That’s just a very sad state of affairs.
> emergency care is a single-digit percentage of total health expenditures.
How does that contrast with "care provided by emergency departments?"
How does that contrast with "care provided by emergency departments?"
>>Before anyone objects with "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures.
That is true, but emergency care disproportionately results in bankruptcies compared to other forms of care.
That is true, but emergency care disproportionately results in bankruptcies compared to other forms of care.
I imagine this is directly related to the inflated costs of emergency care. A dose of ibuprofen (two tablets) costing in the $40+ range?
Well they have to pay for storage and for that very well paid employee to pass you the pills.
Moderate sarcasm.
But really that’s a deeper issue with insurance causing most of that. If you don’t have insurance, most hospitals will severely discount the costs that you are originally charged if you just work with them. It shows those prices are bullshit to begin with.
Moderate sarcasm.
But really that’s a deeper issue with insurance causing most of that. If you don’t have insurance, most hospitals will severely discount the costs that you are originally charged if you just work with them. It shows those prices are bullshit to begin with.
Even if they are willing to give you a discount if you don’t have insurance, those ibuprofen pills are still going to be charged 10x or 100x over their cost. Health industry knows nobody can shop around and get quotes and regulators are unwilling to protect patients. It’s no wonder we are in the mess we are in.
My locality has a ballot initiative up this year that would put a % cap on what hospitals can charge over their costs, and boy oh boy are the industry mouthpieces out in force to oppose it! They are having a field day with patients’ wallets, they know it, and they don’t want it to end.
My locality has a ballot initiative up this year that would put a % cap on what hospitals can charge over their costs, and boy oh boy are the industry mouthpieces out in force to oppose it! They are having a field day with patients’ wallets, they know it, and they don’t want it to end.
datavirtue(1)
The example above is essentially an estimate of the cost of parts (the strep throat test). The cost of a sick patient visit is known and could have been easily included in the estimate.
It's like being given a potentially ancient, bit-rotten code base and asked to refactor the shit out of it for a fixed price. And you can't know that upfront.
It might take a day. It may take a decade. It may take you the customer to change your entire approach.
This is not feasible. You can not disregard hidden defects and the cost of fixing them unless you do not really want reliabilty. If you do not want it, then don't complain.
In IT this requested lack of reliability is accepted. In healthcare and auto repair it is barred by law.
EDIT: i hate autocorrection.
It might take a day. It may take a decade. It may take you the customer to change your entire approach.
This is not feasible. You can not disregard hidden defects and the cost of fixing them unless you do not really want reliabilty. If you do not want it, then don't complain.
In IT this requested lack of reliability is accepted. In healthcare and auto repair it is barred by law.
EDIT: i hate autocorrection.
GP was booking an appointment for a routine procedure which has a known scope, effort, and bill of materials. There is nothing in this procedure that even remotely resembles refactoring a legacy codebase.
It's not the same. The nurse, the doctor was not a surprise. Bet you given 20 cases of people coming to check for strep, chances are their bills would have been around $400 too not $60. So they should use that amount.
GP suggested a written estimate, not a quote.
All of those fees are completely predictable. Sure if the doctor noticed a problem, they could then offer advice/treatment and the new price.
This idea that medicine is different than other fields is crazy.
This idea that medicine is different than other fields is crazy.
> i hate autocorrection. No you don't, or you'd turn it off. I'm sure there's a metaphor in there somewhere.
Yes sir, we can replace your spark plugs for only $4.00 each.
It costs $75 to pull the car into the garage, the lift fee is $105, it's $21 to open the hood, $64 to unplug the wires from the old plugs, $64 to plug the wires into the new plugs, then there's $18 to close the hood (gravity assist discount), and another $75 to put the car back in the parking lot.
Don't worry, changing your plugs is only $16.
It costs $75 to pull the car into the garage, the lift fee is $105, it's $21 to open the hood, $64 to unplug the wires from the old plugs, $64 to plug the wires into the new plugs, then there's $18 to close the hood (gravity assist discount), and another $75 to put the car back in the parking lot.
Don't worry, changing your plugs is only $16.
My (motorcycle) mechanic quotes me based on the parts and the amount of time required to do the repair. So she'll say "A new set of tires is $130, and the shop labor is $110 an hour. If you only bring in the wheels, then labor is just $50." I'm not sure what magical force is causing my mechanic to behave this way. It could be personal preference, some kind of regulatory requirement, pressure from competing shops, etc. Whatever that force is, it doesn't seem to exist in the american sickness and treatment system.
Never once in 20 years of automobile ownership has a mechanic tried a stunt like that on me.
Precisely. Yet it is completely normal in American medicine. And worse, the actual patients are rarely aware of the total amount billed or paid because their insurance company handles it.
If they didn't itemize, you would complain that all you see is a bill for $1000, at $500/hour.
You would be asking what goes into that hourly rate.
You would be asking what goes into that hourly rate.
Try to open auto shop (it is painful but doable) and hospital. I bet issue lies in that difference.
Somewhat ironically, mechanics seem to be generally considered one of the least trustworthy forms of business. I wonder why the medical profession hasn't seemed to earn a similar reputation. Maybe they will but they just haven't gotten there yet.
I'm starting to feel the same way about medical professions. Example: I go to my dentist...and as I'm sitting in the chair, hygienist tells me she's going to put on fluoride and xrays as part of routine. Alright, no problem, I have preventative coverage.
Turns out it cost $30 for flurodie and $60 for xrays. Fluoride is only covered in kids, and xrays every 2 years. I call up dentist office and you know what they tell me? They don't provide treatment based on insurance coverage.
Right...they provide treatment based on how much money they can rip you off on. Fluoride for adults is new. We have fluoride in the water and in the toothpaste.. I don't recall having it in the past and my Google search tells me where's a debate on whether it's even beneficial. I only see that it benefits the dentist's pockets.
Turns out it cost $30 for flurodie and $60 for xrays. Fluoride is only covered in kids, and xrays every 2 years. I call up dentist office and you know what they tell me? They don't provide treatment based on insurance coverage.
Right...they provide treatment based on how much money they can rip you off on. Fluoride for adults is new. We have fluoride in the water and in the toothpaste.. I don't recall having it in the past and my Google search tells me where's a debate on whether it's even beneficial. I only see that it benefits the dentist's pockets.
Similar experience for me as well. Went in to get a chipped tooth looked at before it got worse. Less than 5 min exam by the doc, and an assistant. Hygienist had to look at something... Bill for $400. How the hell is this crap legal??
Don't forget the nurse mechanics needed to transport the vehicle to the right location and the anesthesiologist mechanic to monitor the vehicle's electrical system, and the surgeon mechanic to do the procedure. And they'll also charge you fees for the tools they use.
Are you suggesting that you'd have surgery without a nurse, surgeon, or anesthesiologist? And that you shouldn't expect to have to pay for equipment used in your surgery?1
The point of the original post that the parent responded to was the fact that they got an estimate of cost for treatment that just included the cost of the strep throat test and none of the other associated costs.
The parent post expanded on that point by trying to list all the other charges for a common car service in the style that would be similar to what one would see if they were admitted to the hospital for an procedure. He then reiterated the point that the cost estimate only included the cost of parts (the 4 spark plugs).
I just expanded on that by listing the other labor related charges for the procedure that still wouldn't be included in the estimate.
In terms of car repair, you just have to know about the hourly rate of the shop and the number of hours they state a particular repair will take. In a hospital setting, you have no idea how many people will interact with you and what their charges will be (which appear to be unrelated to how much time they actually spent with your case).
The parent post expanded on that point by trying to list all the other charges for a common car service in the style that would be similar to what one would see if they were admitted to the hospital for an procedure. He then reiterated the point that the cost estimate only included the cost of parts (the 4 spark plugs).
I just expanded on that by listing the other labor related charges for the procedure that still wouldn't be included in the estimate.
In terms of car repair, you just have to know about the hourly rate of the shop and the number of hours they state a particular repair will take. In a hospital setting, you have no idea how many people will interact with you and what their charges will be (which appear to be unrelated to how much time they actually spent with your case).
I take it you have never been to a mechanic?
Because every single one I've been to also includes labor cost in the estimate.
Because every single one I've been to also includes labor cost in the estimate.
Think parent is simply illustrating what the medical case might look like in a garage. I'd say point is made.
I'm here at work, on break after taking orders for automotive work, and quoting prices... The only thing not included in the quote is the tax.
"Don't worry about it, my insurance will cover it"
If I suspect strep, I make a same-day appointment with my family doctor, show my government issued health card, get swabbed and have a result in a few minutes. I then smile at the receptionist and walk out; there is no bill for seeing your doctor or having tests run.
If I need antibiotics, my employer provided insurance covers the full cost and I pay a fixed $10 or so fee to the pharmacy.
You live a few hundred km south of me I bet, and in every way except this our world is very similar.. but you guys have far deeper problems then just transparency. Your entire view of healthcare is wrong.
If I need antibiotics, my employer provided insurance covers the full cost and I pay a fixed $10 or so fee to the pharmacy.
You live a few hundred km south of me I bet, and in every way except this our world is very similar.. but you guys have far deeper problems then just transparency. Your entire view of healthcare is wrong.
And just a reminder the US doesn’t even spend much less taxpayer money than Canada and other Western countries. The US taxpayer spends about 8-9% of GDP on healthcare, and gets this result. Other countries spend the same and get a free universal healthcare system.
For other reasons, I don't have a family doctor. All the doctors my insurance will pay for require making appointments >9 months in advance, and I fly so much with work that I can't commit to that type of lead time. Twice I've missed appointments, and both times instead of letting me reschedule the practice informed me that I was no longer allowed with them, and that missing an appointment is considered a big offense.
One day I'll figure it out but at 24 years old it's not a huge deal to me.
One day I'll figure it out but at 24 years old it's not a huge deal to me.
It is just insane to me that you have a medical issue and you're calling around for quotes. I know we have had this conversation to death for decades now but it just makes me so angry.
I was diagnosed with Oropharyngeal Cancer 39 days ago. Keeping up with the appointments alone has been bad enough. I am not sure how I would deal with this if I had to shop around for the best deal.
-I went to urgent care for some swelling on my neck that escalated quickly. 45 minutes later I was getting a MRI. This was on a Friday. They called and said it was cancer.
-Monday I was seen by a ear nose throat doctor. Yes, cancer indeed.
-Tuesday I saw a oncologist.
-At this point I decided to move to Portland since my sister lives up here. So the oncologist referred me to another ENT doctor in Portland.
-About a week later I saw a dentist and radiologist on the same day. Everyone agreed that due to the bad shape my teeth are/were in and the location of the cancer my teeth need to come out.
-A few days later another oncologist
-All my teeth removed (this has been rough)
-Tomorrow a "simulation" and PET scan to see if the cancer has spread
-Tuesday is something called a swallowing test
-Wednesday is a check up with the oral surgeon
-Friday is some intake thing for the feeding tube and a meeting with the nutritionist.
-Next Monday feeding tube installed.
-Next Tuesday another check-up with the G.I doctor.
-Next Wednesday radiation and chemo start.
So yeah.. I have no clue how much this shit is costing and I don't really care since I have Medicare. I just wish everyone had the same luxury.
-I went to urgent care for some swelling on my neck that escalated quickly. 45 minutes later I was getting a MRI. This was on a Friday. They called and said it was cancer.
-Monday I was seen by a ear nose throat doctor. Yes, cancer indeed.
-Tuesday I saw a oncologist.
-At this point I decided to move to Portland since my sister lives up here. So the oncologist referred me to another ENT doctor in Portland.
-About a week later I saw a dentist and radiologist on the same day. Everyone agreed that due to the bad shape my teeth are/were in and the location of the cancer my teeth need to come out.
-A few days later another oncologist
-All my teeth removed (this has been rough)
-Tomorrow a "simulation" and PET scan to see if the cancer has spread
-Tuesday is something called a swallowing test
-Wednesday is a check up with the oral surgeon
-Friday is some intake thing for the feeding tube and a meeting with the nutritionist.
-Next Monday feeding tube installed.
-Next Tuesday another check-up with the G.I doctor.
-Next Wednesday radiation and chemo start.
So yeah.. I have no clue how much this shit is costing and I don't really care since I have Medicare. I just wish everyone had the same luxury.
Godspeed brother, I wish you the best. You'll be in my thoughts
I hope you don’t mind, but praying for you and your treatment going forward.
Welcome to the [Cancer] club noone wants to join. Good luck w/ your treatment.
Fight the good fight, internet stranger. Don't give up. Good luck.
[deleted]
Why?
The most efficient provider should get his or her business. That way we can treat more people for strep and increase human welfare.
The most efficient provider should get his or her business. That way we can treat more people for strep and increase human welfare.
You shouldn't even need to call around, prices for routine procedures like checking for strep should be clearly posted. The bill shouldn't change if you're insured or uninsured, just the payer changes.
There's obviously some variation here, and for that an hourly rate makes sense.
Health care should be more like car repair: go in for a quote, then pay when you decide on a provider. Obviously emergencies are different, but things like strep or broken bones are pretty common, so they should have a set price.
There's obviously some variation here, and for that an hourly rate makes sense.
Health care should be more like car repair: go in for a quote, then pay when you decide on a provider. Obviously emergencies are different, but things like strep or broken bones are pretty common, so they should have a set price.
The most efficient provider should get his or her business.
That's an assertion, not an argument supported by observations. In the European countries the government sets prices for procedures, and it works well, life expectancy there isn't lower than it is in the US.
That's an assertion, not an argument supported by observations. In the European countries the government sets prices for procedures, and it works well, life expectancy there isn't lower than it is in the US.
Life expectancy is not a simple proxy for quality of health care. Exercise, diet, happiness, genetics, disaster propensity, and many cultural factors have an impact on life expectancy.
Compare specifically to the UK then - we get no exercise, have awful diets, are miserable, have a more inbred version of US genetics, fucking love self-inflicted disasters apparently, and are culturally mostly indistinguishable from the US. And yet, despite the fact that we spend a fraction of what you spend on healthcare, have a couple more years' life expectancy.
And by almost any measure we are no better than and frequently behind other western democracies in healthcare.
European countries are free riders on the American healthcare system.
Americans pay out the nose for drug prescriptions, which fund the vast majority of research and development budgets, which then benefit all people, worldwide.
Americans pay out the nose for drug prescriptions, which fund the vast majority of research and development budgets, which then benefit all people, worldwide.
Come on, the big companies are multinationals, and not all of them do all research stateside. Novartis are Swiss, GSK are British, Merck KGA are German, Novo Nordisk are Danish, Takeda are Japanese &c pp. The Yanks overpay terribly for healthcare, that's true.
It doesn't matter where they do research, it matters where they sell their drugs.
And all of those countries make more revenue selling to the US than they do any other country by a long shot.
And all of those countries make more revenue selling to the US than they do any other country by a long shot.
Of course they do. But that's not the fault of the other countries, its because US politicians allow the pharmaceutical and health care industry to get away with it. The fix is not to force others to pay the same high price for life saving medication; the solution is to bring the costs down for all. But in the US we allow corporations and lobbyists to control the narrative and people actually think its ok to force someone to choose between being able to afford their medication or food.
While I probably agree with your thesis, you have not actually addressed GP's assertion that the US subsidizes Drug Research. There is no question that we pay more for drugs than others. There is also no question that it is better for the consumer if we have cheaper drugs.
What you haven't answered is whether the research can be supported without the American market subsidizing of that research.
It is in fact, expensive to develop new drugs and something has to pay for that development.
What you haven't answered is whether the research can be supported without the American market subsidizing of that research.
It is in fact, expensive to develop new drugs and something has to pay for that development.
I think this is very self-serving propaganda by the American healthcare system. And even if it's true let's fix this by charging less in the US and see what happens to the rest of the world. .
As a European, I agree.
Americans pay out the nose for all medical care, not just drugs. So I doubt your assertion really holds water.
If the world wants and needs better drugs, there are other ways to fund research. If we give a damn, we can find such solutions.
If the world wants and needs better drugs, there are other ways to fund research. If we give a damn, we can find such solutions.
>>European countries are free riders on the American healthcare system.
Citation needed.
Citation needed.
>The most efficient provider should get his or her business.
Given that the US has this system and US healthcare is multiples more expensive with worse or similar outcomes in essentially every field, I suggest we can put that theory to rest now.
Given that the US has this system and US healthcare is multiples more expensive with worse or similar outcomes in essentially every field, I suggest we can put that theory to rest now.
What about Switzerland though?
(definitely not defending the US system)
(definitely not defending the US system)
There must be some additional variable. Be nice to know what it is.
> Given that the US has this system
The US does not have this system.
The US does not have this system.
The grand parent describes this exact process. Why would we think he was lying?
No lying is necessary, misinformation is common. People generally don't know how much the healthcare industry is regulated and how exactly.
The most efficient provider, however, might not be the best provider. If you have cancer, you want to get the best treatment and survive. But hey, this other guy might be able to do it cheaper!
Just as big a problem as the opacity in pricing, is the opacity in figuring out who the best providers even are.
There's no Yelp for healthcare because powerful groups won't let it exist.
Probably because if we had universal healthcare, you wouldn't have to call any because you would get the same service for free.
It's true that you wouldn't have to call around, because you wouldn't have to compare the cost of out-of-pocket providers. It's not true that you wouldn't have to pay. You would pay through taxes, or someone else would pay through taxes. And you would pay in terms of the waiting time, which becomes an alternative form of payment in public systems.
Interesting that everyone makes this argument for things that aren't already covered by taxes. No one sits and argues that you do have to pay for the interstate system in a discussion about the cost of using it as the turnpike.
No one thinks that no end user cost (what people usually mean when they say free) <> no money spent.
No one thinks that no end user cost (what people usually mean when they say free) <> no money spent.
Isn't the interstate system frequently blocked and the roads not really good, the speed limit low, construction way too expensive and slow, etc? I wouldn't really want to have that in my healthcare system...
My point: Let's stop comparing healthcare to road construction/maintenance. It's human lives. It works differently.
My point: Let's stop comparing healthcare to road construction/maintenance. It's human lives. It works differently.
I wasn't comparing healthcare to roads. I was commenting about how silly people sound when they say "it isn't free, taxes fund it".
Also, speed limits can be comparable to turnpike's, the interstates are rarely "blocked" unless you mean congested, which is a different issue and one that more road at that location would actually make worse. Construction costs are comparable to turnpike construction and maintenance costs and are slow because, unlike a turnpike it's most visible and most delaying in areas like cities where you can't move cars to a shoulder, something that isn't an issue for turnpikes..
Also, speed limits can be comparable to turnpike's, the interstates are rarely "blocked" unless you mean congested, which is a different issue and one that more road at that location would actually make worse. Construction costs are comparable to turnpike construction and maintenance costs and are slow because, unlike a turnpike it's most visible and most delaying in areas like cities where you can't move cars to a shoulder, something that isn't an issue for turnpikes..
>interstate frequently blocked
By whom? Traffic is just an argument for mass transit
>roads not really good
That’s an argument for more government not less. They’re fine where I live.
>speed limit low
It’s reasonable in cities and towns
>construction expensive and slow
Also high quality
You already have a beurocracy in “your” health care system. It’s just a private one and not a public one. The difference is cost involved in administrative overhead deciding who gets care and for what.
A nation needs a good health care system and a good road system to afford productive workers.
Both systems when implemented poorly cause human death and disability.
By whom? Traffic is just an argument for mass transit
>roads not really good
That’s an argument for more government not less. They’re fine where I live.
>speed limit low
It’s reasonable in cities and towns
>construction expensive and slow
Also high quality
You already have a beurocracy in “your” health care system. It’s just a private one and not a public one. The difference is cost involved in administrative overhead deciding who gets care and for what.
A nation needs a good health care system and a good road system to afford productive workers.
Both systems when implemented poorly cause human death and disability.
> By whom? Traffic is just an argument for mass transit
Huh? I don't see any argument at all. The fact is that it is, right now, blocked.
> That’s an argument for more government not less. They’re fine where I live.
Yeah, sure - I live in the Czech Republic, a place where we have more government and the worst roads you will ever see in a first world country.
It's definitely not an argument for "more government" - actually it's not an argument for either because you've provided zero arguments. Why it'd be better than it is now?
> Also high quality
The highways are definitely not high quality, it's just good enough. Visit Germany sometimes. Construction time has almost no relevance to quality, btw (if we don't talk about extremes).
> It’s reasonable in cities and towns
We are talking about interstates.
> You already have a beurocracy in “your” health care system. It’s just a private one and not a public one.
Yeah, I know. Again, what's your point? You stated facts that are well known by everyone interested in this topic. There are very clear advantages to a free market and there are very clear disadvantages of a public solution (and of course the contrary).
Have you ever thought about the fact that only people in the USA actually want a public system? Maybe a private system could work well if implemented correctly (see Switzerland, a country with one of the best healthcare in the world - that is private) - government is not a universal and definitely not always the best solution.
> The difference is cost involved in administrative overhead deciding who gets care and for what.
Is that the only difference, really? How much experience exactly do you have with public systems? Are you sure you have a complete picture? I have lived in several ones over my whole life. I prefer the US system.
BTW is there really a difference? You know the same thing needs to happen in a public system as not everyone is eligible for everything? How does it compare to waiting for 4 months until a doctor is available (in non-urgent cases)? How does it compare to generally substantially lower quality of care (not medical, but care - as in quality of food in hospitals, whether they treat you respectfully, whether you need to sleep on a hallway because all rooms are packed with 5+ people...)?
Do you know that only the most basic (we call it "medically necessary") treatments are paid and everything else needs to be paid out of pocket in full as there is no possibility to insure yourself for upper level of care (actually it's illegal)?
> Both systems when implemented poorly cause human death and disability.
Exactly. So let's stop with "hurr durr we need full government intervention" and let's focus on what's wrong, why it happened and how to fix it ASAP - and you're not going to fix anything ASAP if your way is to rebuild the whole thing and nationalize/bankrupt (or both, as is common with governments doing business) huge companies.
The USA system needs change, however I'm pretty sure that such dramatic change would leave the country in ruins (or more likely in a lot of dead bodies) simply because it's extremely hard to run such system even if you've been doing it and continuously improving it and gaining experience for the last 70 years and your country is 20x smaller - and there is no country in the world where a public system would have substantially better results than the US one.
Huh? I don't see any argument at all. The fact is that it is, right now, blocked.
> That’s an argument for more government not less. They’re fine where I live.
Yeah, sure - I live in the Czech Republic, a place where we have more government and the worst roads you will ever see in a first world country.
It's definitely not an argument for "more government" - actually it's not an argument for either because you've provided zero arguments. Why it'd be better than it is now?
> Also high quality
The highways are definitely not high quality, it's just good enough. Visit Germany sometimes. Construction time has almost no relevance to quality, btw (if we don't talk about extremes).
> It’s reasonable in cities and towns
We are talking about interstates.
> You already have a beurocracy in “your” health care system. It’s just a private one and not a public one.
Yeah, I know. Again, what's your point? You stated facts that are well known by everyone interested in this topic. There are very clear advantages to a free market and there are very clear disadvantages of a public solution (and of course the contrary).
Have you ever thought about the fact that only people in the USA actually want a public system? Maybe a private system could work well if implemented correctly (see Switzerland, a country with one of the best healthcare in the world - that is private) - government is not a universal and definitely not always the best solution.
> The difference is cost involved in administrative overhead deciding who gets care and for what.
Is that the only difference, really? How much experience exactly do you have with public systems? Are you sure you have a complete picture? I have lived in several ones over my whole life. I prefer the US system.
BTW is there really a difference? You know the same thing needs to happen in a public system as not everyone is eligible for everything? How does it compare to waiting for 4 months until a doctor is available (in non-urgent cases)? How does it compare to generally substantially lower quality of care (not medical, but care - as in quality of food in hospitals, whether they treat you respectfully, whether you need to sleep on a hallway because all rooms are packed with 5+ people...)?
Do you know that only the most basic (we call it "medically necessary") treatments are paid and everything else needs to be paid out of pocket in full as there is no possibility to insure yourself for upper level of care (actually it's illegal)?
> Both systems when implemented poorly cause human death and disability.
Exactly. So let's stop with "hurr durr we need full government intervention" and let's focus on what's wrong, why it happened and how to fix it ASAP - and you're not going to fix anything ASAP if your way is to rebuild the whole thing and nationalize/bankrupt (or both, as is common with governments doing business) huge companies.
The USA system needs change, however I'm pretty sure that such dramatic change would leave the country in ruins (or more likely in a lot of dead bodies) simply because it's extremely hard to run such system even if you've been doing it and continuously improving it and gaining experience for the last 70 years and your country is 20x smaller - and there is no country in the world where a public system would have substantially better results than the US one.
How would the universe provide healthcare?
What's the alternative? Everyone charges the same price? Who sets this price?
Calling around and shopping is what people do on practically every other service or good they buy now.
Calling around and shopping is what people do on practically every other service or good they buy now.
My guess is that this is where healthcare is headed in the US. If things stay on the current trajectory, the govt is simply going to step in set prices.
In terms of how they would be set, Medicare already spends a ton of time created a system of DRG codes for every condition along with a set payment (adjusted by COL and other things).
Of course Medicare rates are sometimes less than the cost to provide the care. But I see us just getting to the point that the govt will just say “tough shit”.
In terms of how they would be set, Medicare already spends a ton of time created a system of DRG codes for every condition along with a set payment (adjusted by COL and other things).
Of course Medicare rates are sometimes less than the cost to provide the care. But I see us just getting to the point that the govt will just say “tough shit”.
And on every other service you will get something that at least resembles a straight answer.
Do you call around and shop for different fire departments? Seems weird that such a basic need would be treated this way.
Fire departments are analogous to ambulance response — these services are entirely based on geographic location and, similarly to insurance, need to be arranged in advance by a municipality or county, or an out-of-district annual payment. Most healthcare is not summoned this way although there are an increasing number of medical practices that charge a subscription in exchange for quick access to the office and remote consultations.
If you think you're angry now you should try actually calling around for quotes. My experience is that most places you call won't even try to give you a straight answer!
>It is just insane to me that you have a medical issue and you're calling around for quotes.
You dont call around for quotes of $100+ services?
Why?
You dont call around for quotes of $100+ services?
Why?
Because you should be able to show up, get your treatment and go home without paying a dime, like in most developed countries.
That sounds unsustainable and bad capitalism.
Free services mean a few people will overuse and abuse.
Free services mean a few people will overuse and abuse.
Indeed, ever since I realized I could get medical care without paying for it I've been going out and getting cancer a couple times a week.
Countries with universal health care spend less on health care. It’s empirically proven to be cheaper.
Eventually seeking out excessive medical care will be considered a mental illness and it’s practioners hospitalized
"Drug seeking behavior" extended to antibiotics and chemotherapy lol
So you are saying poor people should just die I guess. Them and their kids.
> That sounds unsustainable
It is perfectly sustainable if you have a population that isn't ideologically opposed to taxes. You can fix that with education.
> and bad capitalism.
Good capitalism or bad capitalism, who cares? This sounds like a pointless ideological concern, again.
> Free services mean a few people will overuse and abuse.
It seems spiteful to me to deny universal healthcare to the majority because a minority might abuse it.
It is perfectly sustainable if you have a population that isn't ideologically opposed to taxes. You can fix that with education.
> and bad capitalism.
Good capitalism or bad capitalism, who cares? This sounds like a pointless ideological concern, again.
> Free services mean a few people will overuse and abuse.
It seems spiteful to me to deny universal healthcare to the majority because a minority might abuse it.
We live in a boring dystopia https://twitter.com/visakanv/status/990570131238473728
Calling for quotes is how buyers (patients) force prices down in the long run.
For example, I got a quote this summer for an outpatient MRI that was 20% the cost of a hospital MRI, faster, and would accomplish the same thing. Now I tell everyone I know about this. If enough people do this, the hospital will not be as free to increase the cost and might even lower it (or at least start providing quotes!)
This price-shopping process is slowed by all the shenanigans that keep prices and services provided confusing, and demand to improve this is hampered by insistence that patients are never in a state of mind to shop for the best healthcare provider. It’s simply untrue—and there are workarounds in the worst cases like healthcare POAs and family members donating time.
For example, I got a quote this summer for an outpatient MRI that was 20% the cost of a hospital MRI, faster, and would accomplish the same thing. Now I tell everyone I know about this. If enough people do this, the hospital will not be as free to increase the cost and might even lower it (or at least start providing quotes!)
This price-shopping process is slowed by all the shenanigans that keep prices and services provided confusing, and demand to improve this is hampered by insistence that patients are never in a state of mind to shop for the best healthcare provider. It’s simply untrue—and there are workarounds in the worst cases like healthcare POAs and family members donating time.
It’s worth noting that Kaiser does this. They post a fee schedule for just about every routine procedure in every region they operate in. There is no abiguity about what an MRI costs.
Transparency won’t fix healthcare in the US, but it is a starting point. Hell, it’s fundamental to simple free market economics. It’s silly to say we have a free market healthcare system when there is virtually no cost information about goods and services until after purchase.
Transparency won’t fix healthcare in the US, but it is a starting point. Hell, it’s fundamental to simple free market economics. It’s silly to say we have a free market healthcare system when there is virtually no cost information about goods and services until after purchase.
And Kaiser has 7 minute primary care appointments, and a high rate of physician burnout.
Do you think that's because they post their prices?
Its because of their pricing structure as a vertically integrated system.
That's pretty frustrating. I had a related experience where I needed antibiotics. As it was the weekend, I just went to a local walk in clinic. The person in front of me did not have insurance and his cost to see the doctor was $90. I had insurance and my out of pocket was initially $45, a couple weeks later I got the remainder of my bill for using out of network: $135. So in total I was charged double the individual without insurance plus the cost of my medication.
It seems that a major driver of insurance and medical costs is that doctors are allowed to charge different pricing for the same service. In this case, paying a monthly fee for insurance ended up costing me more.
It seems that a major driver of insurance and medical costs is that doctors are allowed to charge different pricing for the same service. In this case, paying a monthly fee for insurance ended up costing me more.
That sucks. The CVS Minute Clinic will quote you $99-129 for a strep throat visit, which includes the culture and the script if you actually have it. Nurse practitioners are, I think, the future of primary care.
This stuff is all bad, but it's useful to remember that primary care is actually a small fraction of the overall price of health care. Where we're really spending the money is on long-term and end-of-life care.
This stuff is all bad, but it's useful to remember that primary care is actually a small fraction of the overall price of health care. Where we're really spending the money is on long-term and end-of-life care.
> Nurse practitioners are, I think, the future of primary care.
Agreed. When I visit my PCP, I normally meet with a NP. I’ve been quite happy with the quality of care received.
> Where we're really spending the money is on long-term and end-of-life care.
With the boomers entering the end-of-life phase of their lives it will be interesting to see if we will be able to change culturally and realize the huge sums of money spent with little benefit to the economy. I’m struggling with this myself currently as my parents are aging (quickly). They don’t have unlimited savings to spend on health care. While I have ample resources, I’m not convinced shelling out $1MM is worth it for them to live with a marginal quality of life for just a couple of years. Just writing that makes me feel like a terrible person but I try to think rationally and without emotions.
Edit to add: I’m genuinely curious about your thoughts on this, @tptacek. I’ve always respected and appreciated your opinion here on HN.
Agreed. When I visit my PCP, I normally meet with a NP. I’ve been quite happy with the quality of care received.
> Where we're really spending the money is on long-term and end-of-life care.
With the boomers entering the end-of-life phase of their lives it will be interesting to see if we will be able to change culturally and realize the huge sums of money spent with little benefit to the economy. I’m struggling with this myself currently as my parents are aging (quickly). They don’t have unlimited savings to spend on health care. While I have ample resources, I’m not convinced shelling out $1MM is worth it for them to live with a marginal quality of life for just a couple of years. Just writing that makes me feel like a terrible person but I try to think rationally and without emotions.
Edit to add: I’m genuinely curious about your thoughts on this, @tptacek. I’ve always respected and appreciated your opinion here on HN.
Our unwillingness, on a national level (and perhaps on a civilizational level, though I don't know very much about other countries) to speak plainly about this issue, and address it directly, is one of the most fundamental problems in all of healthcare.
My veterinarian charges around $60 for office visits. A surgery with general anesthetic might be $1000. It's about 10x cheaper than a human doctor, maybe 100x if you go to a random emergency room. Veterinary medicine involve all the same steps as for a human patient. I can usually get appointments the same day too. It's a totally free market, where vets compete on price and service.
Same with medical procedures in the US that aren’t covered by insurance - cosmetic surgery, LASIK surgery, etc.
The free market works pretty dam well for those.
The free market works pretty dam well for those.
This is something I've been advocating for in California. Basically the equivalent to the auto repair law that guarantees that the repair is done to the quote or they tell you it will cost more and you have the right to take their quote elsewhere[1].
[1] If the technician later determines that it will take additional work and will cost more to fix your car than the original estimate, someone from the shop must contact you, describe the additional work and cost, and get your permission to proceed. -- https://www.bar.ca.gov/Consumer/Auto_Repair_Guide.html
[1] If the technician later determines that it will take additional work and will cost more to fix your car than the original estimate, someone from the shop must contact you, describe the additional work and cost, and get your permission to proceed. -- https://www.bar.ca.gov/Consumer/Auto_Repair_Guide.html
Imagine a system where you go to the GP, and just make a walk-in appointment. You sit for ten to fifteen minutes, see your GP. They check you over, direct you to go see the nurse, who checks your throat.
Then afterwards, the GP tells you that they'll phone you later on with the results.
You walk back past the reception desk, ask what the bill was, and they either say "that'll be $40 which you can claim back by taking the receipt around the corner to Medicare", or they'll say "Oh nothing to pay, it's all bulk billed".
You walk out having either spent nothing, or spent a few bucks which you get back after a five minute walk up the road.
That was my recent experience.
You walk back past the reception desk, ask what the bill was, and they either say "that'll be $40 which you can claim back by taking the receipt around the corner to Medicare", or they'll say "Oh nothing to pay, it's all bulk billed".
You walk out having either spent nothing, or spent a few bucks which you get back after a five minute walk up the road.
That was my recent experience.
At least you got a quote...I've been told by providers that they only accept insurance patients (no up front cash), and they can't tell you till they bill you...Not sure why this is the only industry like that.
You don't go to a restaurant and get the pricing after you eat. Heck when you go to a buffet you don't get billed based on how many plates you get.
You don't go to a restaurant and get the pricing after you eat. Heck when you go to a buffet you don't get billed based on how many plates you get.
I work at a small community hospital about 225 beds. They have 9 VPs, 44 directors, and 44 assistant directors. This in addition to the Medical Staff Supervisors. Seems a bit much... no.
Any time you try to define what your insurance will cover, all you can get is s nkn binding estimate, yet most places have you sign an agreement to pay in full based on that estimate, even if the estimate is wrong.
What happens if you insist on paying only the $59 that you were quoted?
They send it to a ruthless collections company and ruin your credit.
That sounds like an entirely separate uniquely American problem. Don't you have laws that prevent disputed bills from affecting credit scores?
Edit: and wouldn't this lead to lawsuits against medical practitioners for extortion if it can be proved that they make a habit of doing this to patients?
Edit: and wouldn't this lead to lawsuits against medical practitioners for extortion if it can be proved that they make a habit of doing this to patients?
No, because it is just an estimate. Every medical estimate in the US will include language that explains services other than those in the estimate may be provided, and you'll be responsible for paying for them. The provider is under no legal obligation to only perform the estimated services.
How is this legal? I mean, you can just straight up make it illegal. There's no fundamental law that says you have to allow such predatory practices.
There's a reason why health insurance companies do the amount of lobbying they do.
Also, in America, doctors will always have you sign an agreement before they see you and before the price is known, that essentially says, “you agree to be responsible for paying any amount the doctor asks for, without any limit.”
Surely goes to collections
The real issue is not a big percentage of the population care about the prices. A good chunk of them are covered by employer based insurance or government medicine. Only the poor and unemployed care about it and unfortunately they don’t have the gravity to change things in the US. Only the wealthy and entities able to fund a 301c can influence things. Point is I do t know what asking around for prices is going to do. By definition if you are asking around you don’t matter to the politicians.
Transparency is good and all, but there is anther way. In most advanced economies professional bureaucracy figures out the costs. Ordinary folks focus on getting healthy, not on costs.
> In most advanced economies professional bureaucracy figures out the costs.
This works terribly for most advanced economies, Britain and Canada in particular.
This works terribly for most advanced economies, Britain and Canada in particular.
As a Canadian living in the USA, I can say that it works less terribly than the American alternative.
Not if you have cancer.
https://www.ctvnews.ca/health/health-care-wait-times-hit-20-...
https://www.ctvnews.ca/health/health-care-wait-times-hit-20-...
Again, I have lived there, and the numbers seem on the upper end of plausible for non-essential surgery like breast reduction, but extremely bogus for anything important. A day or two was normal for routine treatments.
The official government figures, where about half of patients get care within 24 hours, and about 90% within 48, are much more in line with my experience.
The official government figures, where about half of patients get care within 24 hours, and about 90% within 48, are much more in line with my experience.
I know someone personally who had to wait months to see somebody. He said screw it and came to the states for care instead (dual citizenship). He was able to see a specialist immediately and found out he was grossly misdiagnosed.
And I know people in the USA who have gone to Canada or India for medical tourism because they could not get good care at an affordable price in the USA. But these are anecdotes.
When you look at the stats aggregated by OECD, Canada is indeed among the worst public health services in the developed world, but it still provides better care to the median earner than the US health system, at half the aggregated cost per capita.
When you look at the stats aggregated by OECD, Canada is indeed among the worst public health services in the developed world, but it still provides better care to the median earner than the US health system, at half the aggregated cost per capita.
Never once have I heard of an American going to Canada for medical tourism. I live on the Ontario/NY border and have my whole life.
I'm sorely disappointed in your arguments so far. Your stats support your point and are legitimate but mine are not. Typical liberal nonsense.
I'm sorely disappointed in your arguments so far. Your stats support your point and are legitimate but mine are not. Typical liberal nonsense.
He has data you have an anecdote. Guess which one is worth more?
And why is his data more legitimate than my data? And don't bring up the so called "bias" because of factors unrelated to the study. Every study has bias, including the numbers ori_b is touting.
Because one does not measure the quality of health care by the amount of time spent waiting for non-critical treatments such as hip replacements or breast reduction surgery, which is the only thing that your numbers are vaguely consistent with across about 10 different sources I've looked at by this point.
I challenge you to find a second source that is both consistent with your article, and breaks down the waiting times by type of treatment, including treatments that do not need follow ups with specialists.
I challenge you to find a second source that is both consistent with your article, and breaks down the waiting times by type of treatment, including treatments that do not need follow ups with specialists.
I agree, my stats are in line with what I and my family have experienced, and yours are not.
Combine that with multiple agencies such as Health Canada and OECD which have measured wait times an order of magnitude lower than you cited, I am not sure what else to say.
Combine that with multiple agencies such as Health Canada and OECD which have measured wait times an order of magnitude lower than you cited, I am not sure what else to say.
The governments stats basically have to be kept. Running the system requires all of the necessary data to already be collected for other purposes, and their stats are drawn from that.
The stats you provide are collected by an institute looking to further their ideology. They come from a far smaller data pool,and their collection method seems rather suspect. For example, they're asking the actual practitioner rather than anyone involved in scheduling.
The stats you provide are collected by an institute looking to further their ideology. They come from a far smaller data pool,and their collection method seems rather suspect. For example, they're asking the actual practitioner rather than anyone involved in scheduling.
> The stats you provide are collected by an institute looking to further their ideology.
Proof?
> The governments stats basically have to be kept. Running the system requires all of the necessary data to already be collected for other purposes, and their stats are drawn from that.
You trust a government entity to accurately report data that's not in it's best interest? When has that ever happened?
Proof?
> The governments stats basically have to be kept. Running the system requires all of the necessary data to already be collected for other purposes, and their stats are drawn from that.
You trust a government entity to accurately report data that's not in it's best interest? When has that ever happened?
> You trust a government entity to accurately report data that's not in it's best interest? When has that ever happened?
Can you explain what your criteria would be for a trustworthy source?
Can you explain what your criteria would be for a trustworthy source?
>Proof?
That's essentially the definition of a think tank. This one was founded by a libertarian and considered by many to be libertarian. Certainly cause to question their stats, and I didn't like what I saw.
>You trust a government entity to accurately report data that's not in it's best interest? When has that ever happened?
This is probably enough for you to question their stats, but you've done nothing to show they are wrong.
That's essentially the definition of a think tank. This one was founded by a libertarian and considered by many to be libertarian. Certainly cause to question their stats, and I didn't like what I saw.
>You trust a government entity to accurately report data that's not in it's best interest? When has that ever happened?
This is probably enough for you to question their stats, but you've done nothing to show they are wrong.
Just search for it on Google, you'll find dozens of news articles.
The Fraser institute, which published this study, has a right wing bias and is funded by the Koch Brothers. It seeks to displace the public system in Canada with private healthcare modelled after the US. While they claim independence and give their research away freely, one should be aware of their interests.
Proof?
https://www.cbc.ca/news/world/koch-brothers-dark-money-repub...
https://www.vancouverobserver.com/politics/charitable-fraser...
https://www.vancouverobserver.com/politics/charitable-fraser...
Neither of those links are proof that the study is invalid. So, once again, proof?
Read again. The original posters claim was that the study was funded by foreign money that pushes an agenda, not that it was invalid.
As to the invalidity:
The fact that I have never waited for more than a couple of days for treatment in over 25 years, and neither had anyone I know (with 2 exceptions, both of which were for elective surgery like breast reduction surgery) does imply that, at best, their median measurement is measuring a specific niche, rather than general treatment.
Combine that with the fact that multiple agencies have measures wait times as being an order of magnitude lower than your source, and yes, I do think your numbers are invalid.
As to the invalidity:
The fact that I have never waited for more than a couple of days for treatment in over 25 years, and neither had anyone I know (with 2 exceptions, both of which were for elective surgery like breast reduction surgery) does imply that, at best, their median measurement is measuring a specific niche, rather than general treatment.
Combine that with the fact that multiple agencies have measures wait times as being an order of magnitude lower than your source, and yes, I do think your numbers are invalid.
> The original posters claim was that the study was funded by foreign money that pushes an agenda, not that it was invalid.
Nobody's stupid enough to believe that one doesn't imply the other.
Nobody's stupid enough to believe that one doesn't imply the other.
If you believe one implies the other, then evidence of the funding should be sufficient as evidence of invalidity. If you don't believe one implies the other, then your question about the funding was answered, and you are moving goalposts.
The brass fucking neck of you saying I'm not arguing in good faith when you produce a trainwreck of a thread like this.
The fact you think Britain has a single NHS doesn't inspire confidence in your level of knowledge, but let's hear it: why is the system so poor in the UK?
> The fact you think Britain has a single NHS doesn't inspire confidence in your level of knowledge
Can you point me to where I say that? You've just killed any potential discussion by arguing in bad faith. Why should I listen to anything you have to say on the subject now that I know your intentions are hostile and that you're not open to debate?
Can you point me to where I say that? You've just killed any potential discussion by arguing in bad faith. Why should I listen to anything you have to say on the subject now that I know your intentions are hostile and that you're not open to debate?
Your inability to provide any examples has been noted.
Alternatively, socialize the costs. I've never bothered to figure out what going to the doctor would cost me, because it's so cheap here. I don't understand how it's economical to have a workforce with poor health care.
Or you know, do both! Socialize the costs, but unevenly, then inflate the costs, spread them across as many middlemen as possible, and charge left and right!
Why would you pay?
$400 for a strep test is highway robbery.
> There's no way that should be legal. I was quoted $60.
Well, part of the problem is that the state now assumes that consumers are not qualified to take care of themselves, and that the only people who are qualified are state-approved high-demand professionals. Oddly enough, opioid overdoses were not higher when you could just buy the stuff over the counter; but people have forgotten that people used to be responsible for their own well-being, and are convinced that they should not be trusted to defer to experts when they see fit.
Well, part of the problem is that the state now assumes that consumers are not qualified to take care of themselves, and that the only people who are qualified are state-approved high-demand professionals. Oddly enough, opioid overdoses were not higher when you could just buy the stuff over the counter; but people have forgotten that people used to be responsible for their own well-being, and are convinced that they should not be trusted to defer to experts when they see fit.
I'm very suspicious of that factoid, given that limiting Paracetamol purchase size was very effective at reducing overdoses in the UK.
Also, the US has seen a recent huge rise in opioid overdoses ...
Also, the US has seen a recent huge rise in opioid overdoses ...
[deleted]
Some things should simply be left to Our Betters.
After the Alfie Evans circus I'm inclined to agree. You need to be properly trained to be able to recognize what is in the best interest of the patient and that that is the only thing that matters.
It’s bizarre that “capitalism” is frequently blamed for the moral atrocity that is the American medical industry when really it’s one of the most clear cut examples of a state-mandated cartel
I'd be a great business man to if people were legally required to purchase my product.
[deleted]
That is just absurd. We accept that kings will naturally strive to uphold their power, that feudal lords will protect their privileges, and so on. But somehow, some seemingly dogmatic people firmly believe that despite the entire incentive structure pointing in that direction, genuine agents of capitalism are not furthering their own interests through the means of state power.
Of course they are. But that is not capitalism. You can't blame the free market for people "furthering their own interests through the means of state power" when the very existence of state power is antithetical to free markets. The "free" in "free market" refers specifically to the absence of legitimized and systematic aggression, of which state power is the foremost example.
This is a completely and utterly ahistorical redefinition together with selective reasoning. The theological fantasy where capitalism is freed from its state component would not differ either with regards to these incentives, the state would just be replaced by "private-property lords" which you'd stamp as legitimate and welcome the voluntary toil of the propertyless masses.
If you're going to use private and/or archaic definitions for common terms, please say so up front so we can avoid wasting our time. The term capitalism in common use today means a political and economic system which favors private ownership of the means of production, with strong implications of "laisse-faire" and "free market" policies. It is not a synonym for plutocracy, the vesting of political power in those possessing wealth. To the extent that owners of capital are effective in turning the power of the state to their own benefit, to intervene in the market on their behalf, what you have is a plutocracy, not capitalism.
Unsurprisingly, you did not address the point I made. The surgical separation of private-property, political power, and plutocracy that you're making is a fantasy in which they're somehow not deeply intertwined and interdependent from start to finish.
Also do yourself a favour and never assume that your US libertarian bubble definition is the de facto standard around the globe. Europe has a long and dark history of the kind of (neo-)feudalism that you're peddling, it's not hard to spot.
Also do yourself a favour and never assume that your US libertarian bubble definition is the de facto standard around the globe. Europe has a long and dark history of the kind of (neo-)feudalism that you're peddling, it's not hard to spot.
[deleted]
Citizens United is one such example.
It has long puzzled me that we don't have strong political constituencies for price transparency in medicine. Every medical provider ought to have a website that lists every fee and cost; this is not hard to do, yet when I call providers for cash prices, the answer is often, "I don't know" or "I can't tell you."
Agreed, it's so opaque. I feel like I've called a specialist asking what they think my copay will be given my insurance plan and they said they don't know, talk with my insurance firm. I call my insurance firm and they say they don't know, I have to submit the claim first.
Any marketplace where the buyer isn't informed of the price until after the transaction is ripe for disruption.
Any marketplace where the buyer isn't informed of the price until after the transaction is ripe for disruption.
It is complicated ( don't want to excuse it), but I am not sure I would expect the doctor to know your insurance arrangement (or even how much you would expect to pay because you would need to know how much of your deductible you have already gone through.)
And how would the Insurance company know until they are billed for the procedure?
And how would the Insurance company know until they are billed for the procedure?
This is what's so strange about the system. There is no "price sheet" because it's all funny money until the consumer gets billed. Perhaps the doctor would not know, but the hospital should have a price sheet for every routine service rendered.
Those edge cases that are not routine procedures should have estimates provided in advance.
For those edge cases that are so time sensitive that an estimate cannot be provided to the consumer in advance... well, that's what insurance is for.
Those edge cases that are not routine procedures should have estimates provided in advance.
For those edge cases that are so time sensitive that an estimate cannot be provided to the consumer in advance... well, that's what insurance is for.
Frankly, I don't see how it should be possible to buy something you're not entitled to know the price of; or rather, I don't think it should be possible to bill more for something than the quote.
I couldnt even get cvs to tell me the price of something with my insurance. They said it would take a few days.
I saw this with my girlfriend. She needed a procedure where the provider refused to even give a ballpark number, the insurance refused to tell if they would cover it or to what extent. So if you really need it, your only way forward is to get the procedure and hope for the best without even a basic idea about the costs.
"insurance refused to tell if they would cover it"
'Hey boss, I saw the schedule. Not sure I I will be able to cover any of those shifts you gave me. By the way, pay me the same weather I do my job or not. Thanks'
'Hey boss, I saw the schedule. Not sure I I will be able to cover any of those shifts you gave me. By the way, pay me the same weather I do my job or not. Thanks'
It's downright barbaric. You have a service for which you basically can't get a quote, can be collected into oblivion if you don't pay, you don't even know WHO will bill you (or even how many bills you'll get!), and you very well might be unconscious or in no position to make this kind of decision. Your life might be on the line!
It only gets some level of sanity (though not to reasonable level) if you involve insurance companies, who have some of the information necessary and the leverage to negotiate.
It only gets some level of sanity (though not to reasonable level) if you involve insurance companies, who have some of the information necessary and the leverage to negotiate.
Also don't forget that the thought of even asking for a refund on prescription medication will get you laughed at.
Right, so I'm supposed to pay $700 for some medication that has a chance of either making my heart stop or cure my condition and if it doesn't cure it, too bad.
Right, so I'm supposed to pay $700 for some medication that has a chance of either making my heart stop or cure my condition and if it doesn't cure it, too bad.
I think it was a huge mistake that this didn't get tackled during the Obamacare discussions. Price transparency and the removal of preexisting conditions would be a big step for some sanity in the US medical system. It's also pretty sad that the Republicans who are supposedly for markets don't push for price transparency.
> the removal of preexisting conditions
That happened under ACA, didn’t it?
That happened under ACA, didn’t it?
It did.
The Republicans would argue that forcing price transparency is regulation and government intervention, just like net neutrality.
Strange, in 2016 the Republicans ran on a platform of full price transparency in healthcare.
They have also historically called for a balanced budget and deceit reduction... at least when the other party is in power.
As you can very well see, I answered one very specific false claim about price transparency in healthcare.
I did not intend to suggest I am interested in otherwise discussing your personal interests in the political deceits and failures of either American party.
I did not intend to suggest I am interested in otherwise discussing your personal interests in the political deceits and failures of either American party.
I don't recall this at all. The only thing I remember is that they wanted to repeal (and less so, replace) Obamacare. I don't remember anything about price transparency.
It was a major element.
See point 5: "Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure."
https://web.archive.org/web/20161110004206/https://www.donal...
See point 5: "Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure."
https://web.archive.org/web/20161110004206/https://www.donal...
Why aren't they doing this now?
Because they didn't and don't have a sufficient majority in the Senate to repeal and replace Obamacare. And my understanding is that they would no longer have sufficient popular support to do it, either.
Huh. And they can't pass point 5 without repealing the ACA?
This is so incredibly stupid. You and a bunch of down-voters are so ideologically fixated that you can't handle a simple, factual description or chronicle without launching into sophistry.
I'm not a politician. I don't work for nor run any part of the legislative branch. I'm not a Republican, I've never even voted for them. I have zero interest in speculating about what one or another party might do in the future. But I do care about facts. Now do your worst with this.
I'm not a politician. I don't work for nor run any part of the legislative branch. I'm not a Republican, I've never even voted for them. I have zero interest in speculating about what one or another party might do in the future. But I do care about facts. Now do your worst with this.
OK, two points:
1. That point 5 seems to me to be something that in a rational universe, could get enough votes from both sides of the aisle to pass. Of course we live in a universe where neither party wants to give the other party anything they could call "a win". An the Republicans will explicitly not allow anything to come to a vote unless it has the support of the majority of republicans. They could write a bill and bring it to a vote if they wanted to.
2. It appears the real hold up is that they don't want to do anything that would make health care better unless they can first repeal the ACA. You can think about that however you like, I certainly have my opinion.
1. That point 5 seems to me to be something that in a rational universe, could get enough votes from both sides of the aisle to pass. Of course we live in a universe where neither party wants to give the other party anything they could call "a win". An the Republicans will explicitly not allow anything to come to a vote unless it has the support of the majority of republicans. They could write a bill and bring it to a vote if they wanted to.
2. It appears the real hold up is that they don't want to do anything that would make health care better unless they can first repeal the ACA. You can think about that however you like, I certainly have my opinion.
They didn't find a sufficient majority for any of their plans they voted on that night. Not AHCA. Not BCRA. Not for straight repeal nor some skinny repeal. [0]
And that's exactly the problem with politics. They don't vote for improvements, if that makes the more radical changes they want less necessary and thus appear less necessary. Especially under the shitty US election system allowing only two parties. The one who looses in the end is the citizen who just wants better healthcare.
[0] this yt channel is where I get my US healthcare news from: https://youtu.be/tMsSF2vDf6k
ps: Its funny the republicans only managed to pass repeal back when they knew obama would veto it.
And that's exactly the problem with politics. They don't vote for improvements, if that makes the more radical changes they want less necessary and thus appear less necessary. Especially under the shitty US election system allowing only two parties. The one who looses in the end is the citizen who just wants better healthcare.
[0] this yt channel is where I get my US healthcare news from: https://youtu.be/tMsSF2vDf6k
ps: Its funny the republicans only managed to pass repeal back when they knew obama would veto it.
Actually Trump and the Republicans ran on a platform of price transparency, but Senate Democrats can block and have effectively blocked (assisted by now-deceased McCain) any non-taxation-related changes to Obamacare.
Reference: https://www.politifact.com/truth-o-meter/promises/trumpomete...
Reference: https://www.politifact.com/truth-o-meter/promises/trumpomete...
> Actually Trump and the Republicans ran on a platform of price transparency, but Senate Democrats can block and have effectively blocked (assisted by now-deceased McCain) any non-taxation-related changes to Obamacare
This is a bizarre summary of the failed repeal of the ACA with a bill that wouldn't have even included the proposal they supposedly wanted.
Reference: the article you linked to
This is a bizarre summary of the failed repeal of the ACA with a bill that wouldn't have even included the proposal they supposedly wanted.
Reference: the article you linked to
It's a fact that Trump and Republicans ran on a platform of free-market healthcare and full price transparency, unlike their opponents.
The article I linked points out that this price transparency could not be achieved in the very first legislative step -- by the nature of that first bill, related exclusively to tax and revenue since it originated in the House.
Politics is an art of compromises, to achieve what is doable with sufficient majorities, as well as taking into account popular support in view of the next round of elections.
In this case, the only change that could pass was to remove the tax-shaped penalty so that people are allowed to ignore Obamacare plans. Next would have been a basic repeal of Obamacare (blocked by Senate Democrats and McCain). Finally would have been new and very different regulation, including price transparency (which could not even be attempted since step two was blocked, the consensus was that new regulations should only be passed after repealing Obamacare, and Republicans failed to build a majority around that approach).
The article I linked points out that this price transparency could not be achieved in the very first legislative step -- by the nature of that first bill, related exclusively to tax and revenue since it originated in the House.
Politics is an art of compromises, to achieve what is doable with sufficient majorities, as well as taking into account popular support in view of the next round of elections.
In this case, the only change that could pass was to remove the tax-shaped penalty so that people are allowed to ignore Obamacare plans. Next would have been a basic repeal of Obamacare (blocked by Senate Democrats and McCain). Finally would have been new and very different regulation, including price transparency (which could not even be attempted since step two was blocked, the consensus was that new regulations should only be passed after repealing Obamacare, and Republicans failed to build a majority around that approach).
But they didn't do that when they got power.
You're right, the Democrats did not require full price transparency when they had overwhelming majorities in the House and Senate, plus the Presidency. Also, the Democrats later managed to block the repeal of Obamacare, which would have been a prelude to passing new regulations including full price transparency in healthcare, thus defeating the plans of the Republicans.
You are completely wrong, the democrats didn't have an overwhelming majority in the senate. They had the minimum they needed to pass obamacare, 66. Remember that they wanted to have a single payer option and the damn democratic senator from nebraska didn't want that, and he thought if "he single-handedly stopped single payer" he'd be re-elected. So that one senator stopped single payer from being in the bill - he did vote for it after that. And that guy wasn't re-elected. Sen. Ben Nelson of Nebraska. Anywhoo, you are completely and utterly incorrect about the dems have an overwhelming majority to do whatever they wanted. In the senate they had the bare minimum, and anyone who felt they wanted a change could get it.
http://www.nbcnews.com/id/34446325/ns/politics-health_care_r...
http://www.nbcnews.com/id/34446325/ns/politics-health_care_r...
Your claims are simply erroneous and your link doesn't support them. From your own link:
> The House GOP bill that has emerged as the leading option to repeal and replace the Affordable Care Act includes no added price transparency provision.
So the bill that McCain helped defeat didn't contain improved transparency according to your own source. And the GOP hasn't introduced significant legislation since to address the problem, therefore Democrats supporting (or not supporting) it is all hypotheticals based on no actual legislation.
> The House GOP bill that has emerged as the leading option to repeal and replace the Affordable Care Act includes no added price transparency provision.
So the bill that McCain helped defeat didn't contain improved transparency according to your own source. And the GOP hasn't introduced significant legislation since to address the problem, therefore Democrats supporting (or not supporting) it is all hypotheticals based on no actual legislation.
The link I provided documents the 2016 Republican platform of full price transparency in healthcare.
You quibble about how they failed to repeal ACA and follow up with new regulation. Factually, Trump and the Rs failed with their 3-step plan, right after step 1 -- hence we remain stuck with the lack of price transparency under the Democrats' Obamacare.
So, blaming Republicans is not factual.
You quibble about how they failed to repeal ACA and follow up with new regulation. Factually, Trump and the Rs failed with their 3-step plan, right after step 1 -- hence we remain stuck with the lack of price transparency under the Democrats' Obamacare.
So, blaming Republicans is not factual.
Down-voting won't erase the fact that this was the Republican platform in 2016: "Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals." [1]
[1] Scroll down to point #5 in https://web.archive.org/web/20161110004206/https://www.donal...
[1] Scroll down to point #5 in https://web.archive.org/web/20161110004206/https://www.donal...
The Republicans control all three branches (inc. both houses of congress) of the federal government. If they wanted to bring forward legislation that addressed this issue they've had at least two years to do so (arguably more since Obama would have happily signed a pro-price transparently bill, it is an issue he spoke on).
Where is the link to the GOP's actions rather than their empty promises?
Where is the link to the GOP's actions rather than their empty promises?
Obama would have happily signed a pro-price transparently bill
Obama never had a congress that was filibuster-proof. The 110th, 111th, 112th, or 113th congress weren't. The 110th was the most favorable but wasn't filibuster proof, least of all under the filibuster rules of the time.
Plus the poster I was responding to specifically made claims about the Republican's policies and what they claimed the Republicans had tried. If the Republicans don't bring up legislation the Democrats cannot be blamed for not voting for it (or Obama for not signing it).
Plus the poster I was responding to specifically made claims about the Republican's policies and what they claimed the Republicans had tried. If the Republicans don't bring up legislation the Democrats cannot be blamed for not voting for it (or Obama for not signing it).
The 110th Congress was during the presidency of George W. Bush.
During the 111th Congress, from the appointment of Al Franken until the death of Ted Kennedy, as well as during the term of his appointed successor Paul G. Kirk, the Democratic party held 58 seats in the Senate and caucused together with 2 more senators.
https://en.wikipedia.org/wiki/111th_United_States_Congress "gave the Senate Democratic caucus sixty votes, enough to defeat a filibuster in a party-line vote."
https://www.nytimes.com/2009/07/01/us/politics/01minnesota.h... "providing Democrats with something they had long hoped for: 60 votes, and thus at least the symbolic ability to overcome filibusters."
During the 111th Congress, from the appointment of Al Franken until the death of Ted Kennedy, as well as during the term of his appointed successor Paul G. Kirk, the Democratic party held 58 seats in the Senate and caucused together with 2 more senators.
https://en.wikipedia.org/wiki/111th_United_States_Congress "gave the Senate Democratic caucus sixty votes, enough to defeat a filibuster in a party-line vote."
https://www.nytimes.com/2009/07/01/us/politics/01minnesota.h... "providing Democrats with something they had long hoped for: 60 votes, and thus at least the symbolic ability to overcome filibusters."
Bah, I'm not interested in your goalposts.
I replied to someone who falsely claimed that "Republicans who are supposedly for markets don't push for price transparency".
We all know that Democrats are the party entirely responsible for Obamacare and its lack of price transparency.
[Added for emphasis] Democrats created Obamacare without the full price transparency several people here seem to care about. Yet, you all choose to denounce Republicans -- who demonstrated in their attempt that they don't have a sufficient majority to repeal Obamacare, let alone introduce better healthcare regulation once it has been repealed.
I replied to someone who falsely claimed that "Republicans who are supposedly for markets don't push for price transparency".
We all know that Democrats are the party entirely responsible for Obamacare and its lack of price transparency.
[Added for emphasis] Democrats created Obamacare without the full price transparency several people here seem to care about. Yet, you all choose to denounce Republicans -- who demonstrated in their attempt that they don't have a sufficient majority to repeal Obamacare, let alone introduce better healthcare regulation once it has been repealed.
They're your own goalposts:
> Actually Trump and the Republicans ran on a platform of price transparency, but Senate Democrats can block and have effectively blocked
The Democrats cannot block a piece of legislation that doesn't exist. You yourself set up the criteria and you've failed to meet it.
> I replied to someone who falsely claimed that "Republicans who are supposedly for markets don't push for price transparency".
Quite correctly. You cannot link to the Republican legislation that supposedly tackles this issue while they continue to control all three branches (inc. both houses of congress) because there is no legislation. They're tried nothing and accomplished even less.
> Actually Trump and the Republicans ran on a platform of price transparency, but Senate Democrats can block and have effectively blocked
The Democrats cannot block a piece of legislation that doesn't exist. You yourself set up the criteria and you've failed to meet it.
> I replied to someone who falsely claimed that "Republicans who are supposedly for markets don't push for price transparency".
Quite correctly. You cannot link to the Republican legislation that supposedly tackles this issue while they continue to control all three branches (inc. both houses of congress) because there is no legislation. They're tried nothing and accomplished even less.
Sounds like there just hasn’t been enough money and support to create a committed movement, not when pharmaceutical companies have the means to push the narrative that it’s an intractable problem.
From the article:
> Another reason Mr. Arnold got involved: Drug pricing was an issue no other philanthropist had claimed.
This makes some intuitive sense. America’s healthcare system manages to hide its costs so well while providing modern treatment that it may not seem like the most compelling humanitarian problem for a billionaire, i.e. a first-world problem compared to providing mosquito nets to prevent malaria.
From the article:
> Another reason Mr. Arnold got involved: Drug pricing was an issue no other philanthropist had claimed.
This makes some intuitive sense. America’s healthcare system manages to hide its costs so well while providing modern treatment that it may not seem like the most compelling humanitarian problem for a billionaire, i.e. a first-world problem compared to providing mosquito nets to prevent malaria.
[deleted]
California requires hospitals to publish chargemasters (price sheets for most common procedures) and makes them available https://oshpd.ca.gov/data-and-reports/cost-transparency/hosp...
Perhaps they should be taxed on their MSRP and not be given a tax rebate on discounts. That would encourage them to keep their published prices matched to what they actually charge.
> Perhaps they should be taxed on their MSRP and not be given a tax rebate on discounts. That would encourage them to keep their published prices matched to what they actually charge.
The problem is that as there's no mandatory insurance in the US like there is in Germany, there is a very high chance that the patient may not be able to pay the bill, and so the hospital (or practice) is stuck with the costs. Which may go into six, sometimes seven digit sums. And this loss has to be eaten somewhere... in the form of everyone else having to pay way overinflated sums.
The only way to fix the US health system is to provide a national mandatory insurance for everyone which covers everything of basic healthcare, and then for the private industry they can offer insurance packages for higher-quality care (single rooms instead of shared ones, for example). Or, if that is not possible due to the insurance companies having bought off half of Congress, at the very least introduce a nationwide pricing list for medical procedures, with as few possibilities for deviation as it can be done (for example, services in the center of Manhattan can be more expensive than somewhere out in the woods because rent and staff are more expensive).
The problem is that as there's no mandatory insurance in the US like there is in Germany, there is a very high chance that the patient may not be able to pay the bill, and so the hospital (or practice) is stuck with the costs. Which may go into six, sometimes seven digit sums. And this loss has to be eaten somewhere... in the form of everyone else having to pay way overinflated sums.
The only way to fix the US health system is to provide a national mandatory insurance for everyone which covers everything of basic healthcare, and then for the private industry they can offer insurance packages for higher-quality care (single rooms instead of shared ones, for example). Or, if that is not possible due to the insurance companies having bought off half of Congress, at the very least introduce a nationwide pricing list for medical procedures, with as few possibilities for deviation as it can be done (for example, services in the center of Manhattan can be more expensive than somewhere out in the woods because rent and staff are more expensive).
mandatory insurance in the US like there is in Germany
Refugee/Asylum claimants are "insured" in the sense that such services are payed for under the Asylbewerberleistungsgesetz. Otherwise uninsured people will have to pay themselves or receive help from social services.
The idea is that you are always insured for essentials, so the question is to find out under whom at that time. No idea what specifically determines the insurer for someone entering the country. But coverage will begin back on entry and they will request membership payments for the entire time, even if you did not "use" that coverage.
As for refugees specifically, I'd expect that to be mostly a question of whom they sign on with first. The public insurance has the same rate regardless of provider, so it wouldn't make much of a difference, and governmental support will probably pay that bill anyway.
As for refugees specifically, I'd expect that to be mostly a question of whom they sign on with first. The public insurance has the same rate regardless of provider, so it wouldn't make much of a difference, and governmental support will probably pay that bill anyway.
> In Germany, what happens when an uninsured person shows up at an emergency room (say, a refugee claimant or illegal entry?)
They get treated first, payment is worked out later.
They get treated first, payment is worked out later.
> a nationwide pricing list for medical procedures, with as few possibilities for deviation
This already exists with Medicare.
This already exists with Medicare.
They aren’t taxed at all because they register as non-profits even though they act as partnerships.
It's pretty sad that we have to rely on "billionaires" because the political system is not able or willing to bring even some level of sanity into this totally perverse system.
There does seem to be some progress being made:
https://www.cnn.com/2018/10/10/politics/drug-prices-legislat...
https://www.cnn.com/2018/10/10/politics/drug-prices-legislat...
That would definitely be a good thing and may help discourage high prices, but let's see if it ever happens. The drug companies are already talking about taking it to court for violating their first amendment rights.
One thing that scares me is seeing how he's putting money into swaying how the media report on things. That one billionaire is willing to do such a thing to support the public good is great. How many are doing so for less laudable ends?
All of them? The drug company ones are...
About time an organisation started playing the same games these mega corporations do, if you don’t play how will you ever win?
I'm not sure we have to 'rely' on them. This is just a guy that made a lot of money trying to make the world a better place. I don't think there's anything to be sad about here.
I think it's very sad that the democrats system can't address issues like this. It simply shouldn't need rich guys trying to make the world a better place. I am also always skeptical of billionaire do-gooders if you consider that you rarely become a billionaire by being a nice altruistic guy.
It's a difficult and complicated issue. I don't think it's been shown that our system "can't" address it. It's just taking a while to get it sorted out. I'd like it to go faster, but generally our system works pretty well, and converges slowly on good solutions to things. While i'd like it to be faster, I don't think it ought to be rushed either. Healthcare is both important and difficult to get right.
Well no, every system requires people with power to be generally good. No system survives with only bad actors. You’re incorrectly assuming a generous billionaire isn’t a feature of capitalism / democracy.
The USA isn't democratic. And no, I don't mean it's a "Republic" either. It's a corrupt system that no longer works as originally intended.
As originally intended was a bad system, with among other things strong aristocratic tendencies—not to mention you know, legal slavery. So it’s not a bad thing that it doesn’t work as originally intended.
Even after all these years of revisionism the school systems could still do with less hagiographic depictions of the revolutionary era.
Even after all these years of revisionism the school systems could still do with less hagiographic depictions of the revolutionary era.
Our political system caused (or at the very least was complicit in causing) the problem.
> “Where it is impossible to create the conditions necessary to make competition effective, we should resort to other methods of guiding economic activity.”
- Friedrich Hayek, The Road to Serfdom, p.37
Free markets work as expected where the alternative is dying at worst: They fail completely. If you're lying unconcious in the ER and there's zero regulation in the country of unlimited capitalism worship, the hospital can charge whatever the fsck they want. And yet, there are still a few people in the US surprised they actually do so.
https://www.forbes.com/sites/chrisladd/2017/03/07/there-is-n...
- Friedrich Hayek, The Road to Serfdom, p.37
Free markets work as expected where the alternative is dying at worst: They fail completely. If you're lying unconcious in the ER and there's zero regulation in the country of unlimited capitalism worship, the hospital can charge whatever the fsck they want. And yet, there are still a few people in the US surprised they actually do so.
https://www.forbes.com/sites/chrisladd/2017/03/07/there-is-n...
I'm kind of surprised that quote is from Hayek, considering I know of him as "that Austrian Austrian economist", and mostly see him quoted in defense of radical free market ideology. I guess it just goes to show how far pro-market the Overton window's shifted recently.
Indeed!
In fact he was outright pro-Universal Healthcare, eg: "Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance, where, in short, we deal with genuinely insurable risks, the case for the state helping to organise a comprehensive system of social insurance is very strong. "
https://thinkprogress.org/hayek-on-health-care-e29ae2d600e6/
In fact he was outright pro-Universal Healthcare, eg: "Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance, where, in short, we deal with genuinely insurable risks, the case for the state helping to organise a comprehensive system of social insurance is very strong. "
https://thinkprogress.org/hayek-on-health-care-e29ae2d600e6/
It is a myth that the US has a free market in healthcare. It is a web of regulatory hell and perverse incentives.
While that's true, it's a complete non-sequitur to the parent comment.
It appears that he's trying to argue that we haven't tried hard enough to deregulate healthcare, and therefore we haven't proven it's "impossible to create the conditions necessary to make competition effective". Which imo shows a startling amount of specious reasoning or delusion.
Hayek, like Adam Smith, has been quoted to intellectual death by libertarians who haven't actually read him.
There seems to be a pretty simple solution to high drug prices: the Bayh-Dole Act.
The background to the law is this: previously if a private institution used federal grants to develop a new drug, the federal government retained patent rights. The federal government isnt particularly good at commercializing products so the Bayh-Doye act allows for private institutions to retain patents for innovations funded via government grants. The government retains certain rights to the patent (this is important).
With this situation you have a case where the American tax payer essentially pays twice for certain drugs, their taxes paid for the federal grant that discovered the drug and now they have to pay a private company to actually use the drug.
Well, the Bayh-Dole act grants the government "march-in" rights, which basically allows the government to license any patent derived using federal funds to a third party if the original partner “has not taken, or is not expected to take within a reasonable time, effective steps to achieve practical application of the … invention”.
The government has NEVER exercised it's march-in rights. I understand the hesitation to drastically change the market for a product by granting a 3rd party a patent that they would otherwise never have, but it's been made clear over the past few years that many pharmaceutical companies are acting in bad faith and abusing their market position by drastically increasing drug prices.
I think exercising Bayh-Dole on a high profile drug (EpiPen??) would shake the market back into reasonable price structures. It's a huge hammer the federal government is not wielding.
The background to the law is this: previously if a private institution used federal grants to develop a new drug, the federal government retained patent rights. The federal government isnt particularly good at commercializing products so the Bayh-Doye act allows for private institutions to retain patents for innovations funded via government grants. The government retains certain rights to the patent (this is important).
With this situation you have a case where the American tax payer essentially pays twice for certain drugs, their taxes paid for the federal grant that discovered the drug and now they have to pay a private company to actually use the drug.
Well, the Bayh-Dole act grants the government "march-in" rights, which basically allows the government to license any patent derived using federal funds to a third party if the original partner “has not taken, or is not expected to take within a reasonable time, effective steps to achieve practical application of the … invention”.
The government has NEVER exercised it's march-in rights. I understand the hesitation to drastically change the market for a product by granting a 3rd party a patent that they would otherwise never have, but it's been made clear over the past few years that many pharmaceutical companies are acting in bad faith and abusing their market position by drastically increasing drug prices.
I think exercising Bayh-Dole on a high profile drug (EpiPen??) would shake the market back into reasonable price structures. It's a huge hammer the federal government is not wielding.
Do you happen to know how many drugs are developed with federal grant money? I'm guessing that only a small percentage of high-priced drugs were developed using federal grants, and therefore your solution would be only a very partial solution, but I don't actually know. Do you?
According to Wikipedia from 2010-2016 about 200 new drugs were introduced that were partly funded by the NIH, of these drugs about 80 were significant in the fact that they worked via previously unknown mechanisms.
I've been in healthcare, pharma industry for a long time.
Healthcare isn't 'broken'. The high drug and medical prices are by design. That's the way system is designed and it's working as intended by regulators and industry leaders.
If they really wanted to 'fix' the healthcare, they can fix it. But there is no money in fixing it at this point. One guy with small amount of funding will do nothing to highly regulated space full of deeply entrenched incumbents. regulators, doctors, pharmacists, pharma, medical device, pbm, medical insurance, hospital systems, lawyers, and IT jobs at those companies.
Healthcare isn't 'broken'. The high drug and medical prices are by design. That's the way system is designed and it's working as intended by regulators and industry leaders.
If they really wanted to 'fix' the healthcare, they can fix it. But there is no money in fixing it at this point. One guy with small amount of funding will do nothing to highly regulated space full of deeply entrenched incumbents. regulators, doctors, pharmacists, pharma, medical device, pbm, medical insurance, hospital systems, lawyers, and IT jobs at those companies.
Agreed, though it seems there is a huge window for someone who charges fairly to get in
Fixed and transparent/fair costs (and promotion of it) will get a significant line in front of the clinic.
If someone's got a huge amount of money to play with this, it will be fun to see the incumbents getting trashed. In a way, it's "dumping" (but not really as it's still above cost)
Fixed and transparent/fair costs (and promotion of it) will get a significant line in front of the clinic.
If someone's got a huge amount of money to play with this, it will be fun to see the incumbents getting trashed. In a way, it's "dumping" (but not really as it's still above cost)
I think pricing transparency will help for drugs and commodified services like routine testing and procedures.
Historical though, any attempted 'fix' simply results in shifting of profit from one incumbent to another, along with even more creative ways to get around them. Mfr. copay coupons mentioned in the article is a great example.
I'm all for change, but to me, American healthcare is mainly regulatory failure.
Historical though, any attempted 'fix' simply results in shifting of profit from one incumbent to another, along with even more creative ways to get around them. Mfr. copay coupons mentioned in the article is a great example.
I'm all for change, but to me, American healthcare is mainly regulatory failure.
This, and many, many other similar issues will not be fixed until campaign finance reform gets done.
campaign finance will never be reformed, political movement needs to be able to operate in spite of money contributed
I doubt Citizens United will ever be overruled
I doubt Citizens United will ever be overruled
He [Billionaire Arnold] has spent more than $100 million in health-care-related grants since 2014. A million dollars went to Civica Rx, a nonprofit formed by seven U.S. hospital systems to make generic drugs. Up to $5.7 million is pledged to Initiative for Medicines, Access & Knowledge Inc., which files legal challenges to the validity of certain U.S. drug patents, to clear the way for lower-cost generics.
He funded research about the relationship between pharmaceutical packaging and drug costs, leading Medicare to pass new rules that took effect in 2017. The state of California, advised by an Arnold-funded group, passed a law in 2017 requiring drugmakers to justify steep price increases.
In other words, Arnold is spending money on:
- a consortium that will manufacture generics
- legal efforts to hasten the expiration of patents to provide more generics
- research on packaging
- lobbying legislatures to require justifications from drugmakers on price increases
None of this sounds like it's addressing the main problems leading to high costs:
1. The customer (patient) doesn't directly pay all costs. The economic incentive to keep prices low lies mostly with the insurance providers.
2. It takes more than a decade of research and hundreds of millions of dollars to develop a drug with a new mode of action.
3. At least 90% of these projects will fail to deliver a marketable product.
4. The amount of money spent on a drug project balloons the longer it remains viable.
5. Failure of a late-stage clinical candidate often leaves a drug company with two options: (1) kill the program; and (2) send yet another candidate through the pipeline.
6. Data on late-stage clinical failures are often tightly held in silos, preventing other companies from learning costly lessons.
He funded research about the relationship between pharmaceutical packaging and drug costs, leading Medicare to pass new rules that took effect in 2017. The state of California, advised by an Arnold-funded group, passed a law in 2017 requiring drugmakers to justify steep price increases.
In other words, Arnold is spending money on:
- a consortium that will manufacture generics
- legal efforts to hasten the expiration of patents to provide more generics
- research on packaging
- lobbying legislatures to require justifications from drugmakers on price increases
None of this sounds like it's addressing the main problems leading to high costs:
1. The customer (patient) doesn't directly pay all costs. The economic incentive to keep prices low lies mostly with the insurance providers.
2. It takes more than a decade of research and hundreds of millions of dollars to develop a drug with a new mode of action.
3. At least 90% of these projects will fail to deliver a marketable product.
4. The amount of money spent on a drug project balloons the longer it remains viable.
5. Failure of a late-stage clinical candidate often leaves a drug company with two options: (1) kill the program; and (2) send yet another candidate through the pipeline.
6. Data on late-stage clinical failures are often tightly held in silos, preventing other companies from learning costly lessons.
When I was younger and more naive I went to a surgeon to ask how much a minor surgery would cost ahead of time. They couldn’t tell me. I said fine, could you give me a ballpark estimate? And they couldn’t do that either.
Imagine going into a grocery store and not being able to check the price of your groceries before you decide to purchase them?
Why do we put up with this?
Imagine going into a grocery store and not being able to check the price of your groceries before you decide to purchase them?
Why do we put up with this?
Knew it would be John Arnold. If you find this interesting, he regularly posts content like this on his Twitter: https://twitter.com/JohnArnoldFndtn
"there should be 'compensating upside' for the few drugs that do make it to market to ensure investors continue to fund companies’ uncertain R&D efforts"
Ok, then open your books so we can see why you're pricing the way you are. Obviously, given all the recent attention this has gotten, the industry is not being very transparent about this. Why has no "outsider" been able to connect these dots and why are you (the industry) preventing them from doing so?
Ok, then open your books so we can see why you're pricing the way you are. Obviously, given all the recent attention this has gotten, the industry is not being very transparent about this. Why has no "outsider" been able to connect these dots and why are you (the industry) preventing them from doing so?
Here is a full proposal, I’d like some feedback:
http://magarshak.com/blog/?p=93
http://magarshak.com/blog/?p=93
Much rattled very startle. You'll also be AMAZED what doctors are saying about this new diet thing!
I'm feeling cranky as hell, so let me go ahead and toss out the wildly unpopular idea that the real solution here is more research etc into dietary and lifestyle changes. But I seriously doubt he's going to go in that direction.
That kind of research is really hard. You pretty much have to lock people up for long periods of time, and make sure they only eat what you give them. The current state of dietary research is pretty much a morass of contradictory associations, with no proof of any causative factors.
I’m everyone in this thread talking about price transparency for goods people need to live.
Price transparency in food seems to work alright.
Transportable commodity goods are not really the same as local, nonportable professional services.
Imagine if everything you ate had to come from the county you live in. Would it really matter how much they charged? You would have to pay it, right?
Imagine if everything you ate had to come from the county you live in. Would it really matter how much they charged? You would have to pay it, right?
We're really pretending like price transparency is the primary factor in food prices in the US and that 40 million people don't go hungry in this country?
I noticed that, too.
Free marketeers: how does price transparency improve prices for emergency room visits?
Free marketeers: how does price transparency improve prices for emergency room visits?
Perhaps it doesn't, for those weird edge cases where they have to bring the unconscious patient in and have him assessed 5 different ways. Situations like that are the domain of insurance agencies.
But most medical care (the majority of the cost) is not rendered like that. Most of it is routine and predictable, and should be priced transparently as such.
But most medical care (the majority of the cost) is not rendered like that. Most of it is routine and predictable, and should be priced transparently as such.
> Perhaps it doesn't, for those weird edge cases where they have to bring the unconscious patient in and have him assessed 5 different ways.
Does "weird edge cases" cover the 790,000 people who have a heart attack every year[1]? If not, how does price transparency improve their ambulance ride or change which hospital is their destination?
[1] https://www.cdc.gov/heartdisease/heart_attack.htm
Does "weird edge cases" cover the 790,000 people who have a heart attack every year[1]? If not, how does price transparency improve their ambulance ride or change which hospital is their destination?
[1] https://www.cdc.gov/heartdisease/heart_attack.htm
Not a necessarily a supporter of free markets, but I’d argue that more information and transparency is crucial for market efficiency. Take for example arbitrage; it disappears when enough people have access to “private information”, that in game theoretic setting, drive market price to equal the “true” price.
Why do we talk about "high drug prices" as some kind of mystical force? The cause is simple and very obvious: the medical industry is a for profit institution that puts margins and bottom line above everything else. It's a huge industry with a plethora of middlemen whose only purpose is to squeeze dollars out of the system. Delivering effective care is almost always a secondary consequence to making value for investors.
So long as healthcare has quarterly shareholder meetings, we will forever be locked in this battle.
So long as healthcare has quarterly shareholder meetings, we will forever be locked in this battle.
We are looking at the health care problem from the wrong angle. Nobody should be needing most of these drugs to begin with. But we have a food culture and system that feed civilization disease causing foods and that's where the cycle starts.
I called around, and finally settled on a facility that told me they could check for strep for just $59. I go in, get my throat culture, then get my bill.
"Well yeah, the throat culture was only $59. But the nurse had to do it and it's $120 to see a nurse. Also, the doctor has to check in before any operation is performed, and that's $200. After all other fees, your total bill is $400".
There's no way that should be legal. I was quoted $60.