It isn't really a free market though, it is a fixed market. If it was true free market it would be individual to service, that is why prices are all over the place. We just need to return to individual health care plans, paid for by employees individually (or give them cash health benefits). If your employer paid your auto insurance we'd have the same problem.
Not sure how you fix it, maybe by temporarily making it illegal to allow a company to provide health benefits through insurers to fix this. Employers should only be allowed to give you the money for an individual plan (most startups sometimes do this instead). Employers don't pay your auto insurance, home insurance or other insurance. Maybe a one time convert of employer groups to individual groups managed for risk, then, for privacy, for business, for better health care the individual has that (also probably a back up plan for those in need).
Why should employers know about your health? This is ancient thinking where you stayed with a company forever. It's also a privacy thing. I think it would also combat ageism. It will also make starting companies and competing much easier with less friction. It would also allow employees to more easily go from job to job, when you have an employer plan it is a scary predicament sometimes.
Cost can only be competitive if they are seen, they will be seen if it is moved away from employer provided.
Possibly, but you can't make that leap directly, people/industries don't move that fast. First step is move away from company provided, I am sure there would be renewed interest for it in many against it now, or some workable private and public system where prices are known, more direct.
Only after we have explored every other possible solution. This is America, and no socialism is possible; unless you are a homeland security contractor.
Yes, those are all socialist. That's not a bad thing.
Any government is, at its core, socialist. Rather than everyone funding their own private army, the state socialises the cost and provides national defence.
For other parts of society, it may also make sense to have everyone pay in to provide service which is to the public good. Police, fire, postal services are canonical examples.
In most countries, health care is also socialised. As is garbage collection, libraries, and road building.
The question - for most reasonable people - is where do you draw the line? Buses are socialised - what about taxis? Doctors are socialised - what about Lawyers, or accountants?
Describe "national healthcare". I see people who like to bitch about the US throwing this term around a lot, but what do you mean by it? One single, state-organized health care provider that gets funded 100% by other taxes or a flat-fee contribution that is the same for everybody? State-set price controls? Price controls on what - costs of procedure or insurance plan? What about coverage of those plans, determined by the state?
State organized and owned healthcare. You pay for it as a taxpayer and don't have to worry about going bankrupt because of a disease that can happen to anybody. For an example, the UK's NHS.
Private healthcare is still perfectly legal and fine, as is private health insurance, if you deem the state services are not suitable for you.
Hospitals should be helping people, not ripping them off >.<
You don't even have to make it illegal for your employer to pay your insurance premium, just take away the tax deduction and watch how fast your employer stops paying.
I suspect they still would provide it, because it would be a competitive advantage. I get better rates on health insurance through my employer than I could get on my own, presumably because the average working person is cheaper to care for than the average person. So, my company (and most companies) would still find an advantage in hiring if they offered health care. (I'm assuming above that you're talking about taking away the employee tax advantage for this insurance (the avoidance of personal income tax on it). It occurs to me at the end of my reply that you might consider treating it as a non-business expense and that the company would have to pay corporate income tax on the money they use to buy health insurance. I agree that doing that is a big hammer, but it also seems like a terrible idea. If the company has a legitimate business purpose in spending its money that way, namely to better compete for employees, then it's a legitimate business expense, IMO. Trying to enforce social change via the tax code rarely results in precisely the "clean" outcome that people lobbying for those changes intend, or purport to intend.)
I blame employer-provided health insurance. It leads to people thinking "hey, it's free!".
The story I've heard is that at some point (WW2-ish?) there was some sort of government-induced cap on wages, so employers couldn't compete for employees merely on a cash salary.
So, as an unintended consequence to the original government action, employers started offering health insurance as a non-cash benefit.
(Please correct me if I'm wrong, I am admittedly going on hearsay.)
Why aren't the insurance companies working to drive prices down?
I understand the theory: People buy insurance; the insurance companies 'police' medical providers and regulate (through the market) the pricing of services.
From the outside it doesn't look like that works. From the outside it looks like very many more (often unneeded) tests are conducted. And it looks like the insurance companies are not squeezing the providers of health care, but are squeezing the patients.
Most private health insurance in the US is provided by employers. Thus, the people paying for the services are not the patients but insurance companies, and the insurance companies are selected by employers not the patients.
But that says nothing about why insurance companies are not pushing prices down.
They get paid by employers, but they'd make more profit if the health care they buy is cheaper. Since I regularly hear that prices are cheaper if you negotiate with the doctors it seems that insurance companies are not doing that negotiation.
So, given that they appear to be losing out on some profit, why? Why aren't they pushing the costs down?
They are pushing costs down. That's why when you get a bill from your insurance and it says "Procedure X - $5000" followed by "Negotiated rate - $1000 accepted".
Insurance companies figure out what stuff should actually cost, then enter into contracts with providers that says "Hey I know you're still making a decent profit if I only pay you $100 instead of $150, so take $100 and you'll make it up on volume when you become one of my preferred providers."
The insurance companies are going to "negotiate" with the hospitals in which the hospital's bargaining position will be to offer fewer services, or the reduce the level of service provided. That's what it looks like from the inside. The insurers put as much money in their pockets. And the hospitals do the same. The patient gets hit with a large bill and fewer sub-par services. Everyone wins. Except the patient.
This is one of the many sad points about the health system. Luck should have absolutely NO relation to whether you can afford reasonable health care. Reasonable health care should be available to Joe Blow who is earning minimum wage at your local city council and to Mr. Burns who is earning 20x more than Joe Blow.
The nice thing about making something mandatory is that their is then outrage when people can't afford what they must have. Society can't ignore the problem anymore and must attack it head on.
Can't afford insurance? Well, here is a subsidy, or why not just go on medicaid? Can't afford insurance and make $60K a year; well, maybe individual plans should be more affordable...single payer is looking more desirable. Oh, you make $100K a year and STILL can't afford insurance (let's say no family is involved). Well how the f*ck are you spending your money? Oh, you just don't want to buy it because you are young and invincible? That's not how insurance works.
Yeh for America; they are finally catching up with the rest of the developed world!
What about the unemployed who cannot afford the mandatory insurance - and won't get assistance unless they trek 20 miles across the county (without a car) EACH WEEK to prove they are still unemployed yet looking for work? Seem right?
Basically they didn't solve health care costs, they just dumped the cost onto the entire taxpayer base, the same way walmart keeps low prices by keeping their employees on food stamps.
Like I said: single payer begins to look good. We've fixed problem (A), that everyone should have health insurance. This is what we were able to get passed. Now we have problem (B): how to get everyone insured?
The republicans fought tooth and nail against this because they know that viable solutions to problem (B) are very narrow, and Americans aren't going to want to go back to the have/have not insurance previous state.
But ya, it sucks to have all this political intrigue and drawn-out plans, but that's what happens when the country is so divided on the issue.
The country is not divided on the issue. There are some very powerful people paying media organizations and elderly people who already enjoy single-payer healthcare to say that the rest of the population shouldn't have it, and conditioning political contributions on speaking out against it.
> Oh, you just don't want to buy it because you are young and invincible? That's not how insurance works.
In the US it does. It will be much more cost-effective for healthy people to pay the penalty each year than to buy insurance. When they need care, they can buy insurance at the normal rate, since it will be illegal to deny them coverage based on a pre-existing condition. This is more than a little bit like shopping for fire insurance after your house has burned down. The primary difference is that politicians have not spent great amounts of effort telling me that I should be entitled to place bets on past events relating to burning houses.
Not sustainable to game the system like that. I think the whole system will strain at the contradictions in place, but that is what was politically viable. Now that we have to live with a new reality, the contradictions will be solved eventually.
This kind of system works very well in Switzerland, but the swiss system is much more mature and they've figured out all the kinks (the people are also responsible enough to vote for it directly).
Just like the old law against unemployment back in what was known as the Socblock and the soviets ran the country. Too many people unemployed? No problem - being unemployed is now against the law and a criminal offence.
The weird thing about having an HSA is that because I pay essentially 75% of a lot of things out of pocket (as long as I'm below my deductible), it often makes sense for me to negotiate and "pay cash" rather than running through my insurance. And yes, the doctors, pharmacies, etc. drop the prices a lot.
One of the weird things going on right now is that Doxycycline (a common antibiotic) has gone up in price 10-20x in the past couple months. A bottle which used to cost me $12 generic is now...$350! (due to a crazy FDA recertification process for the manufacturers)
My local pharmacist laid in a huge supply at the old price, and when I told him I was on an HSA (and where he saw my insurance deductible of around $250), he sold me the prescription for cash for $30.
Still covered for anything serious (essentially any ER visit, cancer, serious illness, imaging, etc.), but for anything else, I'm highly incented to negotiate like I would for any other product. Best of both worlds.
That still sounds like a terrible deal to me. In the UK, I pay around 10% of my salary for national health care and get free care for any problem I might have (and so does my girlfriend, of course). Medication is always exactly £7 (or similar, it might have changed slightly recently) regardless of what it's for.
So my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage. (I also think the top US care, if you are in the right place, is better than the top NHS care, but only for cancer or very rare diseases; for everything common they're comparable, but NHS covers everyone, so the average quality of care in the UK is better than the average in the US (rather, the 25th percentile care in the US is horrible, whereas the 25th percentile in the NHS is pretty comparable to any NHS care)
(and, with an HSA, if I spend less than $3-5k/yr, I get to put that money pre-tax into a Roth IRA equivalent retirement account. I generally spend $200-1000/yr on medical care, so this tends to work out well for me; I don't think I've ever spent more than $1500 in a year. A lot of employers will just give you that money (and pay your premium) if you pick an HSA plan vs. a PPO plan, since it saves them approximately that much in premium)
I'd be willing to pay some premium to cover everyone in the country vs. just myself, and to ensure I would have full coverage regardless of income. I don't think I'd want to pay a flat 10% on all of my income without limit for that, on top of taxes, though. (although, between medicare and 3.8% obamacare surcharge on income and capital gains, it's already nearly 10% up to 100k)
In addition to HSA, what I'd really like is truly universal minimum standard of care -- not quite where the NHS is, but maybe 20% of that -- to cover preventive and "very cost effective" treatments. The problem is while the NHS is able to use QALYs in making decisions, I don't think the US government would be so rational; we'd end up over-covering dramatic diseases and under-covering less dramatic diseases. I don't believe a $500k intervention for an indigent old person with limited benefit should be paid by taxes, since that same $500k could cover childhood immunizations or preventive care for 5-10k people.
> my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage
You're not comparing like with like. Comparing a figure (presumably) calculated by taking the GP's effective tax contributions and multiplying by the proportion of UK public spending that goes to health (~19%)[1], with a figure of the direct cost of insurance, is not an accurate way of comparing healthcare costs between countries.
Most actual comparisons I can find between effective cost of healthcare between the US and UK, e.g. [2], seem to conclude that the US pays just over twice as much as the UK per capita (~$7k vs ~3k).
(Also, it's not a "flat 10% on all your income", you misunderstand the GP. Our income tax system is progressive, just like the US's. The NHS is funded from general taxation (including NI payments)).
Apparently the variation across regions in the US (controlled for all other factors like race, income, etc.) almost half as much as the variation between the US and UK, even though the entire US has the same financial structure.
And that leads to perverse incentives; If you have no incentive to help control costs, then it falls upon the NHS to control costs through delays and denial of service.
Empirically, this is false. Perverse incentives and perverse pricing pervades the US system. Whereas the UK system provides equivalent health at half the cost.
Certainly your thought is a common one, the idea that individuals can be incentivized to cut costs was the motivation behind high-deductible plans. High-deductible plans were initially priced much lower than they are now, because the insurance companies thought that individuals on those plans would control their costs much better. However, that was not observed, and the insurance companies have raised rates faster than with other plan types, and HDHPs are now not nearly as good deal as they once were. (At least in my area.)
Didn't exactly that also happen with HMOs from 1973 onward (once they had a federal regulatory framework)?
It seems like an underlying problem is that whenever a "cover somewhat less, save money, charge a huge amount less" plan is put in place, there are incentives in individual cases (through lobbying or whatever) to add coverage, killing the cost savings.
This is the precise opposite of how it works for a lot of people in the US. I've been on both sides of this, with two incidents a few days apart on either side of student insurance expiring.
Hospitals charge uninsured people a ridiculous amount, then mark it down anywhere from 50-98% (Yes, I had a bill that was adjusted 98%) based on negotiations with insurance companies.
Uninsured people get hit with the full, absurd inflated costs as bills. They then have the privilege of begging the hospital for a markdown or a payment plan (turned down completely in my case as an unemployed graduate student because I couldn't afford my own place and lived with parents).
The bills don't show up for anywhere from three weeks to three months, and there is no indication of what is owed until they end; Nobody's able to tell you on command what things cost before 'coding' things at their leisure. One hospital visit that does any nontrivial diagnostic work may incur dozens of separately billed "services" running through different providers and individual doctors. That begging the hospital for a markdown only applies to them, three-quarters of the others won't accept anything short of the full amount.
I thought this system was a bad compromise, but then I got sick. The system is absolutely ridiculous, the victim is given an open-ended debt("If we think of anything else you owe us we'll call you", & "No, we can't give you an itemized bill for 'services'") in dozens of segments with little room for argument or inspection, and threatened monthly with destruction of his financial livelihood.
Don't support single payer healthcare? Try a major acute illness on for size and see if your opinions change. This system of "insurance", whatever it was supposed to solve, is utterly broken unless you happen to be healthy.
PS: My state is apparently recognized as one of the best in the nation on this topic, I can only imagine what it's like in North Dakota. A lot of people's lives have been ruined by a medical system that makes it downright impossible for the average person to tolerate getting sick.
PPS: I think of hospitals as somewhat predatorial now because this will fall worst on an honest, ignorant, unemployed person who attempts to pay his debts - the way one is advised by financial experts to deal with it is to either declare bankruptcy, or make small monthly payments, an option which appears nowhere on your bills (which demand payment immediately), and which the hospital will not either volunteer or agree to when requested. Token payments above some undefined percentage of the debt will prevent them from sending the bill to the collections agency. So if you know this, a major illness might be roughly equivalent to an unexpected student loan, but with the stress of destroying one's health and future health insurance. If you don't, or if you acquire a chronic illness which requires extended care, you acquire a permanent black cloud raining down acid on your financial future.
My locale has a relatively high degree of consumer-centric regulation in healthcare and is apparently held up as a success story for the results in terms of cost inflation.
This is why the ACA is such a boon for people that thonk health care should be a free market. It takes the free market ideals and embraces them; the accusations of socialism are more telling of the accuser than the accused. That's not to say that I think health care should be a free market, just that its the goal of the ACA, and the current situation in the US is much less free a market, and due to employer provided insurance, barely a market at all. No price information is communicated to consumers, and the ACA will start to do that.
One good aspect doesn't make it a boon. In my personal experience, the law has made insurance less affordable. I'm in between jobs and bought an inexpensive short-term, high-deductible plan. However, the plan has been deprecated (no renewals after a certain date) because it does not meet all provisions of the ACA.
My long-term HDHP went from $80/mo to $118/mo, which is high in percentage terms, but still not a big deal IMO. In the process they gave me unlimited lifetime coverage, added free preventive care, etc. -- which IMO seems actuarially impossible, but I'm on the buy side of this transaction.
It really varies by state. I went to an online insurance comparison app (I should promote Leaky or SimplyInsured here, but at the time in 2010, I used ehealthinsurance), searched for HDHPs, then picked based on reputation. I picked a Blue Shield provider with no lifetime cap (or a $6mm lifetime cap, I forget).
The only states I know are WA and CA. In WA, I like Regence Blue Shield; plans seem to be in the $100-150/mo range now.
In CA, there are also a lot of HDHPs in the $100-150/mo range. I'd specifically avoid Kaiser as an employer giving coverage, as some people really dislike Kaiser since you must use a Kaiser doctor, hospital, or other facility, but if you're an individual and like a Kaiser doctor, it might be a good choice. Otherwise a lot of people I know use Health Net, Anthem, etc.
I'm not a lawyer nor am I a licensed insurance agent so I'm hesitant to recommend specific plans.
I think these rates are low due to being HDHPs and the "best" patient group; 26-35 year old single male. Those are exactly the people who don't get individual insurance unless they're cautious people who join AAA, change oil on time, buy fire extinguishers, look both ways before crossing the street, etc. (and thus exceptionally good risks), and even then seek to minimize contact with doctors. I suspect the unhealthy ones are particularly likely to take jobs with insurance, or be on medicaid/prison/etc., in that bracket, or are so irresponsible as to have no insurance (because hey, even $120/mo is better spent on beer).
Rates don't seem that much worse for women (which is weird, since I'd assume most women get enough extra covered services covered now by an HSA to destroy the actuarial model for a $100/mo plan). The rates 4x once you add children, though. I tried also plugging in numbers for people born in 1969, 1959, 1950, and rates do go up, but only maybe 4x, too. So the prices are generally within a 10x range per insured, at least for healthy people or in places where there is no medical underwriting, tops, and under ACA, that will converge to 4x (although I'm sure by raising the low end by 50-150% and only lowering the top end by a trivial amount.) I always assumed all insurance was $500+/mo/insured, since that's what the group rates for small businesses seem to be, but that's due to adverse selection and inefficiency I think.
The real problem seems to be if you're unhealthy when looking for insurance, or have children (particularly with high medical costs), or have an acute high-cost event, or are poor enough that $100-200/mo is a hardship (even though I think $100-200/mo for health insurance, whether paid by the individual or the government, is pretty reasonable), or are, worst case, so unhealthy that you're also poor and thus doubly screwed.
Wow, this is insanity: I priced some NY (10024) and MA (02139) zip codes on ehealthinsurance and the coverage looked approximately 5x CA or WA rates. I'm not sure if that's specific to the site and their mix of carriers, or if insurance really is that much more expensive on the East Coast.
>In my personal experience, the law has made insurance less affordable.
Last year I had a PPO insurance plan at work that cost $216 per month for a family plan and had very tiny out of pocket expenses. This year my employer dropped the PPO as being unaffordable and switched to a HDHP that costs the same $216 per month for my family plan. Now the plan pays literally nothing for the first $3,000. And then 80/20 up to the first $7,000.
The ACA benefited a lot of people. If you're an older student living at home. If you have a pre-existing condition. If you develop a catastrophic illness. But if you're not in one of those benefited groups then you are paying for those benefited groups.
$216 sounds like only your part of the payment. Do you know how your employer's contribution (the bulk of the total cost) changed? Sounds like they saved a lot of money.
This is exactly it. The company I work for is fairly open, and I know how much they pay every pay period for my health insurance, and it is about 3x as much as I pay for the plan.
This guy's company sounds like they changed providers, pushed almost all the cost to the employee (under the mask that it costs the employee the same), is saving a ton of money, but tells the employees to blame the ACA.
While I work for a decent company, they even tried to blame some crap on the ACA trying to explain why the premiums went up this year. Except, they went up the same amount the year before, and the one before that also.
The sickest among us are by far the most expensive to provide healthcare to: the dying, the elderly, the disabled, the chronically ill. The ACA does a lot to limit costs for those age groups through mandating coverage for pre-existing conditions, introducing caps on premiums, and removing dollar limits on how much coverage an individual is entitled to (both annually and over a lifetime).
You can argue that those are beneficial steps, but they certainly distort the economics of making healthcare decisions.
The other distortion is that there's not much in the way of preventative health care.
Diabetes is expensive and has a bunch of complications, yet obesity and excess sugar consumption is a serious problem that doesn't get much help.
Some mental health problems respond much better to early intervention. Leaving them means the person drifts along, not thriving, sometimes leaving work or staying at minimum wage. (Or, in England, on disability benefits). Getting treatment early (which can be as little as 14 sessions of 1 hour per week of talking therapy) can effectively cure some people, and provides remission and resilience for others. But, again, this kind of stuff isn't as widespread as it needs to be.
Note this isn't any kind of human rights argument for better healthcare. It's firmly financial benefit.
I have to admit I was against ACA for a variety of reasons, but if the first step is increased price transparency and exposing that data, it will do a lot of good.
The best reform I can think of would be a combination of individually purchased (vs. employer) HSAs, where poor people get grants of up to the the full deductible per year in some kind of special account IFF they sign up for HSAs, and price transparency. Employers who currency pay for your entire insurance could give you an equivalent amount (plus deductible) which goes into your Health Savings Account.
You're then effectively paying an army of 300 million to constantly search for the best prices (or rather, to find third party organizations to search for the best prices for them). $3-5k/person is actually not that unreasonable for the poorest 30mm people and those covered by medicare/va/medicare-for-kids/etc.
I'm confident this could drop the prices of procedures by >10x, comparable to other countries. Americans are really good at driving down costs when they know the costs and are paying them out of pocket; look at how much cheaper it is to buy an iPhone in the USA vs. where it's made.
That's not a political reality. Since healthcare bought by an employer counts as an tax-deductible expense and healthcare bought by an individual gets no such breaks, there is a huge incentive (equal to the marginal tax rate) for individuals to have someone else write the checks for the bulk of their healthcare costs.
Before market-based healthcare will work, either 1) employer-provided health insurance benefits must be taxed as income or 2) individual healthcare purchases must be tax-free.
1) is an obvious political non-starter. 2) is a huge new loophole in the tax code and an accounting nightmare.
Individual healthcare purchases (not insurance) can be deducted from your taxes, either explicitly if you're filing a long form, or implicitly if you're claiming the standard deduction.
I don't see why it would be a huge burden to make individual health insurance tax deductible.
Only healthcare expenses over 7.5% of adjusted gross income are tax deductible. Plus, the poor and lower-middle class don't tend to much in income taxes (if any), so they wouldn't qualify for the discount.
In contrast, corporations always write off employee healthcare premiums on their taxes. The issue isn't just the fairness of who pay taxes when, it's also about the distortions in healthcare markets caused by these policies.
HSAs are not deductions. HSAs are pre-tax money which is essentially tax exempt when saved/invested (including gains) or when spent on a medical purchase. So you can still use one fully even if you take the standard deduction.
You cannot pay insurance premiums from an HSA. HSAs have annual caps. Small business owners still have to pay some taxes on HSA contributions. The poor have no use for tax deductions because they don't pay income taxes. HSAs are a partial answer at best.
All that being said, I think my original point about employer-provided insurance incentives distorting the healthcare market stands empirically. It just costs more if you buy your own health insurance. If taxes aren't the reason, what is? And what should be done about that, if anything?
Yes, your out of pocket is premium + out of pocket maximum.
No, HSAs no longer have caps (at least policies signed after a certain date, or in some states; I think pretty soon they'll have no annual or lifetime maximums at all); they're essentially "you're at risk based on your deductible for non-preventive services up to the out of pocket maximum, but excellent essentially-free care for the rest of the year once you hit that cap"). (there are some weird edge cases, like Rx drugs outside the hospital, potentially non-covered services, etc., but essentially a $500k hospital bill for some serious trauma would all be covered after you've paid the $5-7k out of pocket maximum (probably met on the way to the hospital or within seconds of entering the ER, if it's a serious trauma)
You can solve the "poor have no use for tax deductions" by giving them the out of pocket maximum into the HSA; it's free money in a personal allocated account. Or by making some deductions refundable or credits (similar to the EIC, which is most of why Puerto Rico wants to become a state now...most citizens would earn a federal tax rebate!)
The quick fix is probably to make personal purchases of health insurance also deductible, rather than removing employer health insurance deductibility. And push people into HSAs, with some people getting HSA account filling by the government. No one should be against this (except I guess "any tax decreases are bad, since we're already operating at a deficit")
"The quick fix is probably to make personal purchases of health insurance also deductible, rather than removing employer health insurance deductibility."
I'm glad we agree. That's what I said a few comments ago. Though once you make insurance deductible, you might as well close all healthcare purchase loopholes.
I also said it amounts to a huge tax break, and I don't see a revenue-neutral way of getting that passed. And I don't see Congress hiking up the national deficit that much right now.
I wonder, since we strangely expect employers to provide healthcare insurance in the US, what if employers just decided to provided actual healthcare.
Imagine taking all of the health premiums Google pays for its employees, and instead of feeding it in to a broken system, you build a world class health facility in Mountain View that's free to employees.
Larger employers (including Google probably) already under-write their own schemes, the "insurance" company actually only manages billing in those cases.
But then what happens when they need care when they're not near the company hospital? You'd need to set up company run hospitals all around the state and the country to manage the costs. And suddenly, you've reinvented Kaiser.
Yeah - they're basically the outgrowth of Kaiser Shipyards doing exactly what nostromo proposed back in the 40s, and then letting other people buy in to their network.
I would not recommend Kaiser. I herniated a disc in my back, fairly severely, 6 weeks ago. I've seen 5 doctors & a physical therapist so far & have yet to get the treatment several have said I need. For the past 6 weeks I've been able to stand for 5-10 minutes, top and can't sit at all.
Whereas an insurance facility has incentive to try not to pay, because Kaiser is integrated, they incentive not to provide the service at all.
Each time you get a referral to a different department the sequence is 2-3 days to schedule the appointment. The first appointment has to be a consult, the next available being in 1-2 weeks. Then the treatment they want to try (if any), being 2-4 weeks out.
I believe there are employers who do that. (it's really hard to google for right now). It's done in cooperation with some kind of integrated organizations like Cleveland Clinic or something I think.
Says Walmart, Boeing, and Lowes have this for certain things (heart care, which is expensive and fairly predictable demand and common enough to be worthwhile)
One of the least known factors in American health care is that many large employers operate the health insurance directly, and at a profit.
Many large corporations are the health insurance provider for their employees, and then contract the administration of the insurance to one of the known brands like AETNA or Blue Cross or whatever.
So, they are one step ahead of you. Not exactly what you meant, but a more profitable version.
8000 USD for a hospital treatment does not seem insanely expensive for me. Hospitals are by definition expensive - 24/7 on-site staff, highly trained experts (doctors), lots of expensive machines. A simple bed in a hospital is far more complicated and expensive than your standard home mattress. Hospitals need to overprovision on a constant basis since the can't just return a "503 Retry Later" in case of emergencies.
There's certainly ways to save money on the lowest price, but the spread is far more interesting - given that you should get a solid treatment in each of the hospitals, why does one manage to offer you a fifth of the highest price?
As I understand the history, during the wage freeze of WWII, companies used medical insurance as a form of compensation. This also helped the companies because the men left behind tended to be not as healthy as those who were conscripted.
Once you think of it as compensation, you can see why the benefits are tied to the employer. "Join us; we have good healthcare."
It started as a legacy of wage controls during WW2 (they added a bunch of fringe benefits to compete without technically breaking the law), but continues because medical insurance is tax deductible for an employer who buys it for his employees, but NOT for an individual who buys it for himself or his own family. So it essentially costs an individual 20-55% more than it could cost an employer.
(There's also the risk-pooling aspect; an employer can get a group rate with guaranteed issuance because it's assumed they will be selecting employees for moderate to good health (or else they'd be disabled vs. working), or at worst randomly, with only random-in-population odds of high-cost dependents. There's an adverse selection with voluntary individual insurance; healthy people would rationally not get insurance if it were really expensive relative to their expected utilization, whereas someone with a chronic condition or high risk actually would get insurance even at a relatively high cost. Which in turn drives up the costs per insured, which drives up the rate...eventually becoming uneconomic. In practice, a lot of people with chronic conditions in their families actually do seek out stable jobs with big employers with good insurance to cover it, vs. doing startups or whatever, which imposes a loss on the economy if they would otherwise have been the next Elon Musk.)
The Republicans in 2008 (McCain?) were actually arguing for making medical insurance non-deductible for employers and I think deductible for individuals, which was then seized upon as "taking away your health insurance". Ironically that position of moving insurance away from employers seems to be a long-term goal of the ACA/ObamaCare.
I do not understand why there is no public list online with the basic costs of operations (including all the variables). With price transparency a lot of this unequal treatment and prices would surface. I understand there are a lot of variables, but not like it wouldn't be possible. (I understand a treatment at Hopkins would be more expensive than say at your local hospital, but at the very least it would be clear how much more expensive it actually is.
EDIT: One way to do it nationwide would be to ask people to send in their bills (anonymized).
Operations are one type of unknown cost, but the problem extends to all parts of medical treatment. I know of at least one company (SnapHealth [1]) trying to solve this problem, from one small angle: tests and doc visits, as opposed to operations. But what I think you're asking for (and I would agree with) is a public list ala some regulatory mandate to publish costs of specific treatments?
Yes. The minimum cost for a standard operation/procedure (without complications). X people doing the check-in, X-doctors for the procedure, X time in hospital bed to get well again, X time with checkups afterwards... You get the idea... EDIT: Forgot the link you send in. Looks good!
I think that healthcare providers would have to start this process. The bills and statements are far too opaque for the end user to properly decipher.
As an anecdote, I was treated for cancer several years ago; trying to wade through the morass of bills, statements, treatments, third/fourth/fifth levels of providers, was simply unfeasible.
And hospitals naturally have a desire for this type of billing info to remain opaque since it dissuades any criticism of fee schedules.
There's a much easier way: get Medicaid's reimbursement data. Contrary to popular belief, hospitals do not lose money on Medicaid patients. They just lose a whole lot of profit margin.
Price transparency wouldn't help in most cases. If my deductible is the same whether I get the $8,000 procedure or the $38,000 (same) procedure, why should I care? I bet the $38,000 one is better.
That's not my specific take, but I bet the majority of Americans would take that argument.
You're right. User will definitely benefit, but not directly. Perhaps the energy for transparancy should be directed at the insurance companies? Or would they not care as well?
Here's a link to the guide that Ontario doctors use to figure out how much to charge for health care provided to the uninsured (i.e. non-Canadians): http://oscarresourceplone.oscartools.org/OntarioBilling/omat.... It's not a price list, but it gives you a breakdown and shows you what the variables are that are taken into account. This is provided by the Ontario Medical Association.
So great I now know that hospitals charge different fees which is still pointless since my federally mandated heath insurance will pay either one of those prices at no difference in cost to me. In reality I can get my hip replaced at any institution and pay nothing more then the $300 a month I pay for my health insurance. So in the real world the price of all those procedures _to me_ is $300 a month.
This is not a free market. Making these prices public isn't going to make it a free market. No problems have been fixed. Only new and novel problems have been introduced.
You're completely missing the bigger picture. You may be paying a fixed rate for your care, but if healthcare costs continue to rise unabated then you won't be paying $300/month next year, you may be paying $500/month. In addition the mandate to get everyone into the coverage pool plays a factor in helping keep your costs low.
If hospitals can charge rates set seemingly at random, and the "customer" has little or no opportunity to understand what the cost of their choices are, or even make a choice of where to go, then the system will likely continue to spiral out of control. And it is out of control.
My company, with 50 employees, will paying in excess of $500k for healthcare benefits this year. That doesn't even include the contribution required from the employees. That cost has risen ~12% every year. You are deluded if you see recent attempts to control these costs as only introducing new problems. Something has to be done.
No your deluded if you think people will shop around for something that has no direct influence on their finances. Your absolutely correct that ideally everyone would do the "right thing" and make the financially prudent decision that benefits society and shop around for a good price on a procedure. However no one will do that. Most people don't care because like I said it doesn't influence me and even if I did the "right thing" I am bound by both my fellow employees ( via our small pool ) and US tax law ( by medicare and insurance subsidies ) to split the cost of _everyone's_ actions so unless a majority of society gets on board my actions matter little.
In effect I will continue to go to the nice hospital for elective surgery because its nice there, ya so what they charge someone else 300% more for the same stuff, the food is better and I get free TV in my room.
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[ 3.0 ms ] story [ 173 ms ] threadNot sure how you fix it, maybe by temporarily making it illegal to allow a company to provide health benefits through insurers to fix this. Employers should only be allowed to give you the money for an individual plan (most startups sometimes do this instead). Employers don't pay your auto insurance, home insurance or other insurance. Maybe a one time convert of employer groups to individual groups managed for risk, then, for privacy, for business, for better health care the individual has that (also probably a back up plan for those in need).
Why should employers know about your health? This is ancient thinking where you stayed with a company forever. It's also a privacy thing. I think it would also combat ageism. It will also make starting companies and competing much easier with less friction. It would also allow employees to more easily go from job to job, when you have an employer plan it is a scary predicament sometimes.
Cost can only be competitive if they are seen, they will be seen if it is moved away from employer provided.
What about the police department? Or the fire department? Or the post office?
Any government is, at its core, socialist. Rather than everyone funding their own private army, the state socialises the cost and provides national defence.
For other parts of society, it may also make sense to have everyone pay in to provide service which is to the public good. Police, fire, postal services are canonical examples.
In most countries, health care is also socialised. As is garbage collection, libraries, and road building.
The question - for most reasonable people - is where do you draw the line? Buses are socialised - what about taxis? Doctors are socialised - what about Lawyers, or accountants?
Private healthcare is still perfectly legal and fine, as is private health insurance, if you deem the state services are not suitable for you.
Hospitals should be helping people, not ripping them off >.<
you mean you can't afford to not _have_ the service? you can certainly be unable to pay!
The story I've heard is that at some point (WW2-ish?) there was some sort of government-induced cap on wages, so employers couldn't compete for employees merely on a cash salary.
So, as an unintended consequence to the original government action, employers started offering health insurance as a non-cash benefit.
(Please correct me if I'm wrong, I am admittedly going on hearsay.)
Here is some history regarding health insurance in the US that backs up that story: http://www.ebri.org/publications/facts/index.cfm?fa=0302fact
I understand the theory: People buy insurance; the insurance companies 'police' medical providers and regulate (through the market) the pricing of services.
From the outside it doesn't look like that works. From the outside it looks like very many more (often unneeded) tests are conducted. And it looks like the insurance companies are not squeezing the providers of health care, but are squeezing the patients.
They get paid by employers, but they'd make more profit if the health care they buy is cheaper. Since I regularly hear that prices are cheaper if you negotiate with the doctors it seems that insurance companies are not doing that negotiation.
So, given that they appear to be losing out on some profit, why? Why aren't they pushing the costs down?
Insurance companies figure out what stuff should actually cost, then enter into contracts with providers that says "Hey I know you're still making a decent profit if I only pay you $100 instead of $150, so take $100 and you'll make it up on volume when you become one of my preferred providers."
Hey no, I want to go to Hospital B.
Take bill home and sumbit to insurance if you are lucky enough to have insurance.
You just saved the system at least 75% of the cost.
This is one of the many sad points about the health system. Luck should have absolutely NO relation to whether you can afford reasonable health care. Reasonable health care should be available to Joe Blow who is earning minimum wage at your local city council and to Mr. Burns who is earning 20x more than Joe Blow.
In a few years it will literally be a crime to not have insurance. So cannot afford it? Not their problem - YOUR problem.
Yay 'murica.
Can't afford insurance? Well, here is a subsidy, or why not just go on medicaid? Can't afford insurance and make $60K a year; well, maybe individual plans should be more affordable...single payer is looking more desirable. Oh, you make $100K a year and STILL can't afford insurance (let's say no family is involved). Well how the f*ck are you spending your money? Oh, you just don't want to buy it because you are young and invincible? That's not how insurance works.
Yeh for America; they are finally catching up with the rest of the developed world!
Basically they didn't solve health care costs, they just dumped the cost onto the entire taxpayer base, the same way walmart keeps low prices by keeping their employees on food stamps.
The republicans fought tooth and nail against this because they know that viable solutions to problem (B) are very narrow, and Americans aren't going to want to go back to the have/have not insurance previous state.
But ya, it sucks to have all this political intrigue and drawn-out plans, but that's what happens when the country is so divided on the issue.
http://pnhp.org/blog/2009/12/09/two-thirds-support-3/
In the US it does. It will be much more cost-effective for healthy people to pay the penalty each year than to buy insurance. When they need care, they can buy insurance at the normal rate, since it will be illegal to deny them coverage based on a pre-existing condition. This is more than a little bit like shopping for fire insurance after your house has burned down. The primary difference is that politicians have not spent great amounts of effort telling me that I should be entitled to place bets on past events relating to burning houses.
This kind of system works very well in Switzerland, but the swiss system is much more mature and they've figured out all the kinks (the people are also responsible enough to vote for it directly).
Clearly he is undercompensated.
One of the weird things going on right now is that Doxycycline (a common antibiotic) has gone up in price 10-20x in the past couple months. A bottle which used to cost me $12 generic is now...$350! (due to a crazy FDA recertification process for the manufacturers)
My local pharmacist laid in a huge supply at the old price, and when I told him I was on an HSA (and where he saw my insurance deductible of around $250), he sold me the prescription for cash for $30.
Still covered for anything serious (essentially any ER visit, cancer, serious illness, imaging, etc.), but for anything else, I'm highly incented to negotiate like I would for any other product. Best of both worlds.
(and, with an HSA, if I spend less than $3-5k/yr, I get to put that money pre-tax into a Roth IRA equivalent retirement account. I generally spend $200-1000/yr on medical care, so this tends to work out well for me; I don't think I've ever spent more than $1500 in a year. A lot of employers will just give you that money (and pay your premium) if you pick an HSA plan vs. a PPO plan, since it saves them approximately that much in premium)
I'd be willing to pay some premium to cover everyone in the country vs. just myself, and to ensure I would have full coverage regardless of income. I don't think I'd want to pay a flat 10% on all of my income without limit for that, on top of taxes, though. (although, between medicare and 3.8% obamacare surcharge on income and capital gains, it's already nearly 10% up to 100k)
In addition to HSA, what I'd really like is truly universal minimum standard of care -- not quite where the NHS is, but maybe 20% of that -- to cover preventive and "very cost effective" treatments. The problem is while the NHS is able to use QALYs in making decisions, I don't think the US government would be so rational; we'd end up over-covering dramatic diseases and under-covering less dramatic diseases. I don't believe a $500k intervention for an indigent old person with limited benefit should be paid by taxes, since that same $500k could cover childhood immunizations or preventive care for 5-10k people.
You're not comparing like with like. Comparing a figure (presumably) calculated by taking the GP's effective tax contributions and multiplying by the proportion of UK public spending that goes to health (~19%)[1], with a figure of the direct cost of insurance, is not an accurate way of comparing healthcare costs between countries.
Most actual comparisons I can find between effective cost of healthcare between the US and UK, e.g. [2], seem to conclude that the US pays just over twice as much as the UK per capita (~$7k vs ~3k).
(Also, it's not a "flat 10% on all your income", you misunderstand the GP. Our income tax system is progressive, just like the US's. The NHS is funded from general taxation (including NI payments)).
[1] http://www.guardian.co.uk/news/datablog/2013/mar/20/budget-2...
[2] http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s...
Apparently the variation across regions in the US (controlled for all other factors like race, income, etc.) almost half as much as the variation between the US and UK, even though the entire US has the same financial structure.
Except in Scotland, Northern Ireland and Wales where since 2011 it is always exactly £0
http://www.bbc.co.uk/news/uk-12928485
Certainly your thought is a common one, the idea that individuals can be incentivized to cut costs was the motivation behind high-deductible plans. High-deductible plans were initially priced much lower than they are now, because the insurance companies thought that individuals on those plans would control their costs much better. However, that was not observed, and the insurance companies have raised rates faster than with other plan types, and HDHPs are now not nearly as good deal as they once were. (At least in my area.)
It seems like an underlying problem is that whenever a "cover somewhat less, save money, charge a huge amount less" plan is put in place, there are incentives in individual cases (through lobbying or whatever) to add coverage, killing the cost savings.
Hospitals charge uninsured people a ridiculous amount, then mark it down anywhere from 50-98% (Yes, I had a bill that was adjusted 98%) based on negotiations with insurance companies.
Uninsured people get hit with the full, absurd inflated costs as bills. They then have the privilege of begging the hospital for a markdown or a payment plan (turned down completely in my case as an unemployed graduate student because I couldn't afford my own place and lived with parents).
The bills don't show up for anywhere from three weeks to three months, and there is no indication of what is owed until they end; Nobody's able to tell you on command what things cost before 'coding' things at their leisure. One hospital visit that does any nontrivial diagnostic work may incur dozens of separately billed "services" running through different providers and individual doctors. That begging the hospital for a markdown only applies to them, three-quarters of the others won't accept anything short of the full amount.
I thought this system was a bad compromise, but then I got sick. The system is absolutely ridiculous, the victim is given an open-ended debt("If we think of anything else you owe us we'll call you", & "No, we can't give you an itemized bill for 'services'") in dozens of segments with little room for argument or inspection, and threatened monthly with destruction of his financial livelihood.
Don't support single payer healthcare? Try a major acute illness on for size and see if your opinions change. This system of "insurance", whatever it was supposed to solve, is utterly broken unless you happen to be healthy.
PS: My state is apparently recognized as one of the best in the nation on this topic, I can only imagine what it's like in North Dakota. A lot of people's lives have been ruined by a medical system that makes it downright impossible for the average person to tolerate getting sick.
PPS: I think of hospitals as somewhat predatorial now because this will fall worst on an honest, ignorant, unemployed person who attempts to pay his debts - the way one is advised by financial experts to deal with it is to either declare bankruptcy, or make small monthly payments, an option which appears nowhere on your bills (which demand payment immediately), and which the hospital will not either volunteer or agree to when requested. Token payments above some undefined percentage of the debt will prevent them from sending the bill to the collections agency. So if you know this, a major illness might be roughly equivalent to an unexpected student loan, but with the stress of destroying one's health and future health insurance. If you don't, or if you acquire a chronic illness which requires extended care, you acquire a permanent black cloud raining down acid on your financial future.
The only states I know are WA and CA. In WA, I like Regence Blue Shield; plans seem to be in the $100-150/mo range now.
In CA, there are also a lot of HDHPs in the $100-150/mo range. I'd specifically avoid Kaiser as an employer giving coverage, as some people really dislike Kaiser since you must use a Kaiser doctor, hospital, or other facility, but if you're an individual and like a Kaiser doctor, it might be a good choice. Otherwise a lot of people I know use Health Net, Anthem, etc.
I'm not a lawyer nor am I a licensed insurance agent so I'm hesitant to recommend specific plans.
I think these rates are low due to being HDHPs and the "best" patient group; 26-35 year old single male. Those are exactly the people who don't get individual insurance unless they're cautious people who join AAA, change oil on time, buy fire extinguishers, look both ways before crossing the street, etc. (and thus exceptionally good risks), and even then seek to minimize contact with doctors. I suspect the unhealthy ones are particularly likely to take jobs with insurance, or be on medicaid/prison/etc., in that bracket, or are so irresponsible as to have no insurance (because hey, even $120/mo is better spent on beer).
Rates don't seem that much worse for women (which is weird, since I'd assume most women get enough extra covered services covered now by an HSA to destroy the actuarial model for a $100/mo plan). The rates 4x once you add children, though. I tried also plugging in numbers for people born in 1969, 1959, 1950, and rates do go up, but only maybe 4x, too. So the prices are generally within a 10x range per insured, at least for healthy people or in places where there is no medical underwriting, tops, and under ACA, that will converge to 4x (although I'm sure by raising the low end by 50-150% and only lowering the top end by a trivial amount.) I always assumed all insurance was $500+/mo/insured, since that's what the group rates for small businesses seem to be, but that's due to adverse selection and inefficiency I think.
The real problem seems to be if you're unhealthy when looking for insurance, or have children (particularly with high medical costs), or have an acute high-cost event, or are poor enough that $100-200/mo is a hardship (even though I think $100-200/mo for health insurance, whether paid by the individual or the government, is pretty reasonable), or are, worst case, so unhealthy that you're also poor and thus doubly screwed.
Last year I had a PPO insurance plan at work that cost $216 per month for a family plan and had very tiny out of pocket expenses. This year my employer dropped the PPO as being unaffordable and switched to a HDHP that costs the same $216 per month for my family plan. Now the plan pays literally nothing for the first $3,000. And then 80/20 up to the first $7,000.
The ACA benefited a lot of people. If you're an older student living at home. If you have a pre-existing condition. If you develop a catastrophic illness. But if you're not in one of those benefited groups then you are paying for those benefited groups.
This guy's company sounds like they changed providers, pushed almost all the cost to the employee (under the mask that it costs the employee the same), is saving a ton of money, but tells the employees to blame the ACA.
While I work for a decent company, they even tried to blame some crap on the ACA trying to explain why the premiums went up this year. Except, they went up the same amount the year before, and the one before that also.
You can argue that those are beneficial steps, but they certainly distort the economics of making healthcare decisions.
Diabetes is expensive and has a bunch of complications, yet obesity and excess sugar consumption is a serious problem that doesn't get much help.
Some mental health problems respond much better to early intervention. Leaving them means the person drifts along, not thriving, sometimes leaving work or staying at minimum wage. (Or, in England, on disability benefits). Getting treatment early (which can be as little as 14 sessions of 1 hour per week of talking therapy) can effectively cure some people, and provides remission and resilience for others. But, again, this kind of stuff isn't as widespread as it needs to be.
Note this isn't any kind of human rights argument for better healthcare. It's firmly financial benefit.
The best reform I can think of would be a combination of individually purchased (vs. employer) HSAs, where poor people get grants of up to the the full deductible per year in some kind of special account IFF they sign up for HSAs, and price transparency. Employers who currency pay for your entire insurance could give you an equivalent amount (plus deductible) which goes into your Health Savings Account.
You're then effectively paying an army of 300 million to constantly search for the best prices (or rather, to find third party organizations to search for the best prices for them). $3-5k/person is actually not that unreasonable for the poorest 30mm people and those covered by medicare/va/medicare-for-kids/etc.
I'm confident this could drop the prices of procedures by >10x, comparable to other countries. Americans are really good at driving down costs when they know the costs and are paying them out of pocket; look at how much cheaper it is to buy an iPhone in the USA vs. where it's made.
Before market-based healthcare will work, either 1) employer-provided health insurance benefits must be taxed as income or 2) individual healthcare purchases must be tax-free.
1) is an obvious political non-starter. 2) is a huge new loophole in the tax code and an accounting nightmare.
I don't see why it would be a huge burden to make individual health insurance tax deductible.
In contrast, corporations always write off employee healthcare premiums on their taxes. The issue isn't just the fairness of who pay taxes when, it's also about the distortions in healthcare markets caused by these policies.
All that being said, I think my original point about employer-provided insurance incentives distorting the healthcare market stands empirically. It just costs more if you buy your own health insurance. If taxes aren't the reason, what is? And what should be done about that, if anything?
No, HSAs no longer have caps (at least policies signed after a certain date, or in some states; I think pretty soon they'll have no annual or lifetime maximums at all); they're essentially "you're at risk based on your deductible for non-preventive services up to the out of pocket maximum, but excellent essentially-free care for the rest of the year once you hit that cap"). (there are some weird edge cases, like Rx drugs outside the hospital, potentially non-covered services, etc., but essentially a $500k hospital bill for some serious trauma would all be covered after you've paid the $5-7k out of pocket maximum (probably met on the way to the hospital or within seconds of entering the ER, if it's a serious trauma)
You can solve the "poor have no use for tax deductions" by giving them the out of pocket maximum into the HSA; it's free money in a personal allocated account. Or by making some deductions refundable or credits (similar to the EIC, which is most of why Puerto Rico wants to become a state now...most citizens would earn a federal tax rebate!)
The quick fix is probably to make personal purchases of health insurance also deductible, rather than removing employer health insurance deductibility. And push people into HSAs, with some people getting HSA account filling by the government. No one should be against this (except I guess "any tax decreases are bad, since we're already operating at a deficit")
I'm glad we agree. That's what I said a few comments ago. Though once you make insurance deductible, you might as well close all healthcare purchase loopholes.
I also said it amounts to a huge tax break, and I don't see a revenue-neutral way of getting that passed. And I don't see Congress hiking up the national deficit that much right now.
Imagine taking all of the health premiums Google pays for its employees, and instead of feeding it in to a broken system, you build a world class health facility in Mountain View that's free to employees.
Whereas an insurance facility has incentive to try not to pay, because Kaiser is integrated, they incentive not to provide the service at all.
Each time you get a referral to a different department the sequence is 2-3 days to schedule the appointment. The first appointment has to be a consult, the next available being in 1-2 weeks. Then the treatment they want to try (if any), being 2-4 weeks out.
http://www.fiercehealthcare.com/story/cleveland-clinic-wal-m...
Says Walmart, Boeing, and Lowes have this for certain things (heart care, which is expensive and fairly predictable demand and common enough to be worthwhile)
http://www.employerdirecthealthcare.com/solutions/employers seems to be one model -- for employers that self-insure, they have negotiated cheaper case rates for common planned procedures.
Many large corporations are the health insurance provider for their employees, and then contract the administration of the insurance to one of the known brands like AETNA or Blue Cross or whatever.
So, they are one step ahead of you. Not exactly what you meant, but a more profitable version.
There's certainly ways to save money on the lowest price, but the spread is far more interesting - given that you should get a solid treatment in each of the hospitals, why does one manage to offer you a fifth of the highest price?
may be because those higher charges are more bureaucracy than actual value adding?
Isn't that the same with the doctors? Isn't that the same with the equipment?
Isn't that the same with the medication?
Who cares if they can kill you on the cheap? The point is to save lives no matter what the cost.
Once you think of it as compensation, you can see why the benefits are tied to the employer. "Join us; we have good healthcare."
(There's also the risk-pooling aspect; an employer can get a group rate with guaranteed issuance because it's assumed they will be selecting employees for moderate to good health (or else they'd be disabled vs. working), or at worst randomly, with only random-in-population odds of high-cost dependents. There's an adverse selection with voluntary individual insurance; healthy people would rationally not get insurance if it were really expensive relative to their expected utilization, whereas someone with a chronic condition or high risk actually would get insurance even at a relatively high cost. Which in turn drives up the costs per insured, which drives up the rate...eventually becoming uneconomic. In practice, a lot of people with chronic conditions in their families actually do seek out stable jobs with big employers with good insurance to cover it, vs. doing startups or whatever, which imposes a loss on the economy if they would otherwise have been the next Elon Musk.)
The Republicans in 2008 (McCain?) were actually arguing for making medical insurance non-deductible for employers and I think deductible for individuals, which was then seized upon as "taking away your health insurance". Ironically that position of moving insurance away from employers seems to be a long-term goal of the ACA/ObamaCare.
EDIT: One way to do it nationwide would be to ask people to send in their bills (anonymized).
[1] - https://www.snaphealth.com/
Not sure if it would make money, but I bet a lot of people would like it and benefit from it.
Anybody up for it?
Does it already exist?
As an anecdote, I was treated for cancer several years ago; trying to wade through the morass of bills, statements, treatments, third/fourth/fifth levels of providers, was simply unfeasible.
And hospitals naturally have a desire for this type of billing info to remain opaque since it dissuades any criticism of fee schedules.
That's not my specific take, but I bet the majority of Americans would take that argument.
https://www.google.com/fusiontables/DataSource?docid=1VlO_qd...
This is not a free market. Making these prices public isn't going to make it a free market. No problems have been fixed. Only new and novel problems have been introduced.
If hospitals can charge rates set seemingly at random, and the "customer" has little or no opportunity to understand what the cost of their choices are, or even make a choice of where to go, then the system will likely continue to spiral out of control. And it is out of control.
My company, with 50 employees, will paying in excess of $500k for healthcare benefits this year. That doesn't even include the contribution required from the employees. That cost has risen ~12% every year. You are deluded if you see recent attempts to control these costs as only introducing new problems. Something has to be done.
In effect I will continue to go to the nice hospital for elective surgery because its nice there, ya so what they charge someone else 300% more for the same stuff, the food is better and I get free TV in my room.