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“If we want to make America great again, we’re gonna have to make healthcare well again.” — Katy Talento
God bless him.
He really is the Conservative president they told us we didn’t need. And could never have.
It seems the last few years the left has found ways to make winning happen even if it’s not close. If we don’t stop ballot harvesting, they won’t need two hundred ballots found in the trunk of someone’s car . . .
“Leave it for the states to figure out, with the Federal Government stepping in only to resolve cross-border disputes. ”
– My Answer To Everything
I’d be curious to learn what the target time to treatment actually is. Maybe that tidbit is reported in the part of the article that’s hidden behind the pay wall?
When or how does any of this actually go into effect? If the President can unilaterally effect price transparency, when will we see those prices? If the President cannot accomplish this unilaterally, why should we expect it to proceed?
I don’t know what Ryan, McConnell, and company were telling Trump behind closed doors in that first year of his presidency, but we heard diddly squat from him about repealing Obamacare after the election. He did not publicly pressure the Republican-dominated Congress and Senate for results.
Sounds familiar. We’ll see if Trump can actually get something done.
https://www.commonwealthfund.org/publications/newsletter-article/bush-hints-legislation-price-transparency
I think any efforts on price transparency should be focused on common, non-emergency procedures, like childbirth services. If we can’t get consumers shopping for that, then its hopeless to think they’ll do it for surgeries. Also need employers to change their plan designs to make it worth it to shop.
If free market surgery center in Oklahoma can post prices, it seems that hospitals full of MBA’s can figure out how to do it. https://surgerycenterok.com/pricing/
Russ Roberts interviewed the owner on Econtalk. It was a good program.
Great article on the health care fleecing of Americans.
It is no surprise to me when Candace Owens and Katie, her guest discuss how one out of every five American households is in collections due to the health care bills.
In 2017, when I had to max out my credit cards to pay health cost bills, I was overwhelmed over how billing is allowed in this day and age. The first time that a person gets a bill, it gives the date of service, and the provider and what the care was. (An X ray, or Cat Scan, or doctor visit.)
But the second time the bill is sent, there is no date, no info about what or who or how I was seen, it was now just an amount. You have to hope that the billing people did not make a mistake, and that you are now paying what you should be.
I have the leisure time as a semi retired person to spend lots of time on this. One thing that happened after I collated all my bills and invoices: one month, Invoice to me designated as 12ABC was for $ 484. And Invoice 34DEF was for $ 1,112.
The next month, Invoice 12ABC was now $ 1,112 and Invoice 34CDEF was now $ 484.
When I called the billing dept to tell them of the mix up – the supervisor just laughed at me. It was like, “So what?”
Because that is how sloppily this billing situation is handled!
Here is a clue about what Trump was told: Big Pharma and Big Medical now occupy the Number One spot in the economy. They are now ahead of Defense Contractors and the Military.
And it will stay this way. Vaccine mandates for children are just the beginning. Right now in many states, if you don’t vaccinate yr kid according to the new and insane schedule of vaccinations, the kid can’t go to day care or school. It will happen soon that if you don’t get the vaccines required, no Social Security or MediCare.
One single vaccination for a newborn – the hep vaccine – costs over $ 400. And think about it: if they can mandate a totally unnecesary and possibly the riskiest vaccine most normal people have ever had to have to brand spanking new newborns, who due to not swapping sex partners or sharing needles don’t get hepatitis, then Big Pharma can soon be telling people that due to the DNA record that Big Pharma has assembled, Citizen A must have a $ 12,000 a year anti-cancer genetic tinkering procedure, as that person’s genetic records determine it is absolutely necessary. (And the necessity is based on their arranging their studies and statistics to be able to convince doctors to tell citizens that these are totally necessary.)
The problem is, the state legislatures are totally owned by Big Medical and Big Pharma. So it won’t get done in the states, just as it has not gotten done in Washington.
Lobbyists rule.
It’s not hopeless at all but it does take courage and innovation. Check out the Oklahoma Surgery Center to see real price transparency. You can also hear a good explanation of how and why this is the correct approach on a recent Econtalk podcast where the OSC director is interviewed. The system is currently a mishmash of ways to hide real costs in order to inflate billing and scam patients as to costs and ‘savings’. Unscrupulous providers as well as insurance companies are the beneficiaries. Patients and taxpayers get the bill.
There’s a major element missing to this conversation: the primary reason we have such horrible opacity (and worse, huge discrepancies) in the pricing of patient-reimbursed medical care is due to the structure of our healthcare system. Over the decades, we have set up a convoluted, internally-contradictory Rube-Goldberg contraption that provides major incentives – one could even say requires – providers to be very secretive about their prices and to monkey with them in a seeming arbitrary and capricious manner.
In other words, the root cause of undesirable phenomena like price opacity is government policy, not private sector corruption. That corruption absolutely does exist, but it’s a natural and inevitable result of the incentives in place. It’s like leaving dirty dishes in a wet sink for a week and then blaming the bacteria for the fact that everything is slimy and putrid.
To provide but one of millions of examples: Medicare pricing. Medicare typically pays a fixed percent deduction from hospital’s list prices. So the obvious incentive is for hospitals to jack their list prices to astronomic levels, but then they also have an obvious disincentive to publishing those prices. So forcing them to publish their list prices could very well lead to fewer clinics accepting Medicare patients. That may be good or bad, but it’s certainly an unintended consequence that would likely have major political effects.
I’m fine with some sort of government-mandated price disclosure, so this isn’t an argument against the current efforts. My arguments are rather: a) there will definitely be unintended consequences which may be worse than the benefits of this change, and b) without changes to the underlying structure of our healthcare payment systems and the incentives it creates, changes like this won’t solve anything, they’ll just shift the problems from one place to another.
This sentiment gets to the root of my issue with conservative health care debates.
One unanimous (and correct) complaint from the right about Obamacare was that it was far too long and complicated for any one person to understand. “You have to pass the bill to find out what’s in the bill” was prophetically true and rightly criticized by every Republican voter as fundamentally undemocratic.
But here’s my problem: the same voters who acknowledge that our health care system is too complex for even the professionals to understand then turn around and become insulted when someone (like myself) says “there are no easy solutions to our health care mess.” There’s a huge inherent contradiction between saying the system is too complex for even the experts yet ordinary folk are capable of knowing what’s good and bad for the system. Same for those who think there are simple solutions to repairing our health care system.
The reason that neither Paul Ryan nor Donald Trump nor Ted “I shut down the government over Obamacare funding” Cruz made a full-throated call for comprehensive reform after the 2016 election is because Republican voters aren’t yet willing to accept the fact that any meaningful reform will be a) dreadfully complicated and in many ways only understandable to experts, b) require eliminating features of our current health care system that many voters (including Republican voters) like, and c) still probably end up with a fairly unsatisfying final product.
TL;DR: The primary reason why Republicans can’t enact meaningful health care reform isn’t because of our elected officials or lobbyists, it’s Republican voters.
Of course, those same teams of MBAs at big hospitals will also quickly find out a way to game the new price transparency regime just as well as they are gaming the current regulations.
Yeah that’s their job.
The same way that rich people hire accountants to minimize their tax liabilities.
The second one isn’t a bill, it’s a statement of your account. Every vendor I’ve ever dealt with in any industry does it the same exact way. It’s not their fault you didn’t look at your first bill. And you can call at any time and get the original detailed bill I’ve done it a million times.
It surprises me. If they have a bill they can’t pay, why don’t they call and make arrangements? I’ve done it. My grown daughter just recently had a bill from Children’s Hospital she couldn’t pay. I said “Call them, tell them you are out of work, and can you pay $25 a month until it is paid off.” She did, they said ok.
It’s tough when you can’t fit 10 pounds of manure in a 5 pound bag. I’ve been there. But you only go in to collections because you ignored the manure.
For the majority of people who have insurance through their employer there is something else to consider. YOU are not their customer, but the “end user”. Their customer is your employer, and that is whom they (hospital, doctors, etc.) need to satisfy. Your employer is who does the shopping, not you. You are confined, mostly, to the providers within the network specified by the insurance company chosen by your employer.
Shopping around is easier for those with a high-deductible health plan, but if you don’t know the actual cash price for a service, it’s pretty hard to shop around!
Economics is so simple until you complicate it with needless bureaucracy. Medical care and insurance is no different than any other industry and operates on the same principles – supply, demand and competition. I always like to refer to the LASIK eye surgery example. A procedure not covered by most insurance carriers, therefore it isn’t caught up in their Ponzi scheme. Doctors who perform this work need to be competitive. They also need to tell you how much it will cost. Surprise, surprise – prices for LASIK have dropped drastically in the past 20 years.
Every time an outside party forces its way into free market exchange, prices rise, regardless of what the product is.
Which is one antidote to the typical, “If a little government interference in society doesn’t work, then keep doubling it until the government has complete control.”
“The target relating to the first part of a patient’s journey states that following an urgent GP referral for suspected cancer, at least 93% of patients should be seen by a specialist within two weeks. The standard is the same for patients with breast symptoms (where cancer is not initially suspected).
Between 2009 and 2014, the percentage of people with suspected cancer having their first consultant appointment within two weeks of an urgent GP referral fluctuated at around 95%. After this, performance dropped slightly to about 94%, until the most recent year where it declined further. The two-week standard has been missed for the last five quarters. In quarter one (Q1) 2019/20, only 90.2% of patients had their first consultant appointment within two weeks.
Waiting times for patients with breast symptoms were similar to those with suspected cancer between 2010 and 2014. However, over the last four years performance has declined at a faster rate, especially in Q1 of each financial year (April to June). In Q1 2018/19, only 77.5% of patients with breast symptoms had their first consultant appointment within two weeks of an urgent GP referral.”
It’s not the providers. We almost never know what the charge or compensation for a procedure is going to be. The problem is insurance. Our employers ( and most of no longer work as individual practitioners) negotiate rates with all the insurance companies and it’s an incredibly arcane process. Commercial insurance usually pays on a percentage of the Medicare reimbursement rate. Thats based on averages across an area. Then Medicaid pays whatever the hell they want to pay.
It’s as stupid as the cost for drugs. When I have patients ask me what a drug is going to cost I have no idea. It’s all dependent on their insurance.
A) And they don’t rule in D.C.?
B) All it takes is one state to figure out something that works, and a few other states will start to emulate it. I mean, you’ve got 50 friggin’ states to choose from.
So that’s just the wait time until their first consultation, and not the wait time until their first actual treatment?
Wow.
To be fair to the NHS, the fact that wait times were so good up until 2014 suggests that something other than “public health care doesn’t work” happened in the meantime to make the wait times get so bad in 2019.
What other trends started to happen around 2014 that could have effected wait times?
It could be just the normal working of the Tragedy of the Commons. Some things that don’t work in the long term might work in the short term.
At least states have the fiscal restraint of having to balance their budgets. Thats the biggest limit on lobbyists going. The Feds otoh will always prefer runnning up more debt over upsetting a lobbyist or a voter. Which is why the Left won’t do single payer on a state level.
I would hope that everyone in the US is fine with price disclosure. The system we have now reeks of illegal price fixing.
One of the more popular graphics relating to US med pricing indicates what affluent people know & take advantage of all the time: medical tourism. A person can have a hip replacement procedure here, or travel to Madrid Spain, have a hip replacement procedure there, stay for six months & learn the language while there. All while enjoying a decent vacation. They will still save money.
The average American cannot do that as they don’t have a way to be insured for their medical excursion to Spain. Employer paid insurance keeps us inside the oppressive loop of local hospitals.
It is all insider trading done in a way most Americans do not understand. I watched a local Big Wig at one of the major insurance firm HQ in Marin County trade his position at the insurance firm for an Executive position at the local hospital. What came with him, and was probably the reason he received the new position at the hospital was that he brought with him an agreement that the insurance firms’ employees would now be exclusively treated at that hospital.
Yep, really good Econtalk episode about the Oklahoma surgery center and the sources of murky health care pricing. It touched on the fiction of the size of “discounts” on health care services that insurance plans/firms claim they can procure for employers and individuals.
What struck me most from the episode was the surgery center’s example of the synthesis of professional competence, integrity, and transparent pricing. The center expects its partner doctors to be competent at determining exactly the type of treatment required and thus estimating its cost, so it can spell out prices exactly to patients. If the surgery turned out to be more complicated later on, the center would expect the doctor (and itself) to swallow the extra costs of dealing with complications–and not charge the patient more than what was originally specified. The owner added that the center would simply stop working with doctors who had neither the honesty nor competence needed to be clear to patients how much their treatments cost.