There must be a pony in here somewhere.

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Aresen
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Re: There must be a pony in here somewhere.

Post by Aresen » 26 Jul 2018, 16:13

In a way, medical costs are like the Uber economy: Because your choices are often limited at the time, you have little opportunity to negotiate.

The one advantage insurers ought to have - ability to average demand over many individual purchases - doesn't seem to work in the US. In countries with single payer, the monopsony can dictate prices.
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JD
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Re: There must be a pony in here somewhere.

Post by JD » 26 Jul 2018, 16:18

Aresen wrote:
26 Jul 2018, 16:13
In a way, medical costs are like the Uber economy: Because your choices are often limited at the time, you have little opportunity to negotiate.

The one advantage insurers ought to have - ability to average demand over many individual purchases - doesn't seem to work in the US. In countries with single payer, the monopsony can dictate prices.
From what I understand, the insurers' advantage does work that way, in that the amount an insurer pays the provider is invariably less than the rack rate. The issue is that you, the actual patient, are not the customer of the insurer; your employer is.
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Jadagul
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Re: There must be a pony in here somewhere.

Post by Jadagul » 26 Jul 2018, 16:37

Jennifer wrote:
26 Jul 2018, 15:52
What would actually have to change about the current legal/social/insurance status quo, to make price transparency a thing? Such incidents as Welch's "This will be 800 bucks -- [procedure is done, so it's now too late for Welch to back out] -- wait, did I say eight hundred? Nope, I actually meant eighty-seven thousand because ha ha fuck you" -- and of course there have been many other examples mentioned/posted on this forum and even this thread, though none involving people any of us actually know -- in most service industries, this would be thoroughly illegal fraud: if you check in to a hotel room for $100 and they try charging you $1,000 or $10,000 at checkout the next morning, they would never get away with that (although, since IANAL, I don't know which specific laws or regulations they'd be violating there). Same thing if you go to a restaurant and then, only after you've finished eating and it's too late to change your mind about accepting their service, they give you a bill orders of magnitude higher than the originally agreed-upon price. But obviously, no such rules apply to the medical field -- or perhaps it is more accurate to say, the medical field is granted exemptions to the rules other industries must face.

What are the actual rules or regs causing this problem, and how intertwined are they with "our medical system" as a whole? Obviously, given the realities of medicine, it is not always possible for hospitals to completely, accurately judge a final bill in advance -- there might genuinely be complications which arise -- but the overbilling medical stories causing the problem are not examples of good-faith wiggle-room where setting prices is concerned.
I'm sure a lot of what's going on is that the actual services being provided can change unpredictably in the middle of a lot of medical care.

Like, if you go under the table for routine surgery and things go very badly and they need to do extreme and expensive things, they're not going to wake you up in the middle to okay the add-on purchase.

Now, the reasonable way to handle this is probably to price it in to the beginning: the average operation is $500 but the price is $2000 because some fraction of them are super crazy expensive.

But the way we actually do it is to bill for the services consumed, rather than the services purchased. In the hotel metaphor, it's like they stock the minibar with drinks way more expensive than the actual room---and sometimes you have to drink them or you'll die.

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JasonL
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Re: There must be a pony in here somewhere.

Post by JasonL » 26 Jul 2018, 16:44

Was playing around and found this pretty good dashboard. Couple of interesting findings including that historically price has been primary driver of total expenditures but now total usage is increasing at rate exceeding cost increases.

https://www.healthsystemtracker.org/dashboard/

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thoreau
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Re: There must be a pony in here somewhere.

Post by thoreau » 26 Jul 2018, 17:52

How much of that is increased usage due to the population aging? I'm curious if patterns have changed within age groups, or if age groups are remaining more or less the same but the age profile of the population is changing.
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Mo
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Re: There must be a pony in here somewhere.

Post by Mo » 30 Nov 2018, 02:56

FFS, health insurance companies are now advising people to start GoFundMes to pay for bills.
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Re: There must be a pony in here somewhere.

Post by Jasper » 30 Nov 2018, 11:49

Mo wrote:
30 Nov 2018, 02:56
FFS, health insurance companies are now advising people to start GoFundMes to pay for bills.
If you're talking about that letter making it's way across social media, it's from the transplant review board of the hospital, and there's some medicare regulation that says you have to be able to afford the immuno-suppressant drugs required for a transplant operation before medicare will even look at your application.

Caveat - I read this in a twitter thread.
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JD
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Re: There must be a pony in here somewhere.

Post by JD » 13 Dec 2018, 12:16

The Democrats are gearing up for another run at "universal healthcare", which can mean nearly anything when you look at the various proposals...except that they all agree that it means that the government should set prices.

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Re: There must be a pony in here somewhere.

Post by Warren » 13 Dec 2018, 12:49

What could possibly go wrong?
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JasonL
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Re: There must be a pony in here somewhere.

Post by JasonL » 13 Dec 2018, 16:46

Time to go cross eyed staring at our future so I can choose the least destructive among them. There's a lot of fantasy in funding I can see that already. Team Bernie doesn't even try "let's get our policy right then talk about funding." Sure. The Urban Institute one seems the most funding plausible and the most repectful of the ongoing fact that most employees are happy with their employee plans.

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Re: There must be a pony in here somewhere.

Post by JasonL » 13 Dec 2018, 16:49

I'm out on anything that doesn't involve patient skin in the game for most patients. I'm okay with a layer at the bottom for the lowest income to evade such, but I think you are in real trouble if you don't have people feel something at point of the event that in some sense is proportional to real costs.

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Re: There must be a pony in here somewhere.

Post by Aresen » 13 Dec 2018, 16:52

In the Senate, there are a lot more Red seats up than Blue seats in 2020. The Blues could win control of both houses. If they get a Blue president, I think some form of Universal Plan is inevitable.

The only question is "How big will the bill be?" I am sure that the Blues will indulge in a lot of hand-waving about how the US is a huge outlier in per capita and % of gdp spending on health care, promising that their 'universal' plan will reduce costs. Personally, I can't see how a universal plan will do anything but increase total spending, especially as everyone will demand Mayo Clinic service instead of Dr. Sue's Strip Mall Clinic service.
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thoreau
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Re: There must be a pony in here somewhere.

Post by thoreau » 13 Dec 2018, 19:21

I'd like to see a Venn diagram of those who think it's unconscionable to deny Mayo Clinic service to everyone and those who believe that Western Medicine is not tuned in with what really matters to the health of the whole individual.
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Re: There must be a pony in here somewhere.

Post by Warren » 13 Dec 2018, 20:20

JasonL wrote:
13 Dec 2018, 16:49
I'm out on anything that doesn't involve patient skin in the game for most patients.
Then you're out period. That's the starting point of every discussion.
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Re: There must be a pony in here somewhere.

Post by Warren » 13 Dec 2018, 20:22

thoreau wrote:
13 Dec 2018, 19:21
I'd like to see a Venn diagram of those who think it's unconscionable to deny Mayo Clinic service to everyone and those who believe that Western Medicine is not tuned in with what really matters to the health of the whole individual.
That would be interesting. I have no idea what the overlap would be. I'm not sure what to make of it, but it would be interesting.
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Mo
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Re: There must be a pony in here somewhere.

Post by Mo » 13 Dec 2018, 21:56

Aresen wrote:In the Senate, there are a lot more Red seats up than Blue seats in 2020. The Blues could win control of both houses. If they get a Blue president, I think some form of Universal Plan is inevitable.

The only question is "How big will the bill be?" I am sure that the Blues will indulge in a lot of hand-waving about how the US is a huge outlier in per capita and % of gdp spending on health care, promising that their 'universal' plan will reduce costs. Personally, I can't see how a universal plan will do anything but increase total spending, especially as everyone will demand Mayo Clinic service instead of Dr. Sue's Strip Mall Clinic service.
Best case is adding a public option to buy into Medicaid/Medicare/something similar. It would also allow those programs to have income level phase-ins as a price will be set.
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Re: There must be a pony in here somewhere.

Post by JasonL » 13 Dec 2018, 22:22

I think one of the most significant binding constraints is the willingness of providers to accept enough less money to make given programs affordable. You are dealing with powerful loss aversion forces there.

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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 13 Dec 2018, 22:52

Single payer is coming. There is no stopping it, I think.
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Re: There must be a pony in here somewhere.

Post by thoreau » 13 Dec 2018, 22:55

We cannot have single-payer AND a bunch of aircraft carriers AND anything remotely resembling a tax rate that Americans will accept. Maybe, JUST MAYBE, we can have two of those things, but we cannot have all three.

Not for very long, at least.
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JasonL
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Re: There must be a pony in here somewhere.

Post by JasonL » 13 Dec 2018, 22:56

I agree. The biggest problem relative to international systems is provider rates. How many people you know would continue on their career path if someone said they were regulatorily capped at 60% of current wages.

It’s going to be interesting.

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Eric the .5b
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Re: There must be a pony in here somewhere.

Post by Eric the .5b » 13 Dec 2018, 23:03

JasonL wrote:
13 Dec 2018, 16:46
Time to go cross eyed staring at our future so I can choose the least destructive among them.
At some point, you don't need to look too close, because the actual thing imposed (if any) is going to fought over (and fought against) by people who don't give a shit what we think.
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Aresen
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Re: There must be a pony in here somewhere.

Post by Aresen » 13 Dec 2018, 23:06

Blues have convinced themselves that Single Payer will be affordable because the profit motive will be taken out of the equation and suddenly prices and costs will fall to levels like those in Canada. While there may be better cost control in Canada and the wait list issue in Canada is overstated, the simple fact is US practitioners do a hell of a lot more defensive medicine and malpractice premiums are far lower in Canada.
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Pham Nuwen
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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 13 Dec 2018, 23:07

Eric the .5b wrote:
13 Dec 2018, 23:03
JasonL wrote:
13 Dec 2018, 16:46
Time to go cross eyed staring at our future so I can choose the least destructive among them.
At some point, you don't need to look too close, because the actual thing imposed (if any) is going to fought over (and fought against) by people who don't give a shit what we think.
That is my understanding as well. That and things like the $350 bill i received for about 10 minutes of an NP's time for Tim. Then being charged just today for $370 for the NP herself. That shit just isn't going to fly these days I feel. Single payer draws near ...
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Aresen
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Re: There must be a pony in here somewhere.

Post by Aresen » 13 Dec 2018, 23:09

Eric the .5b wrote:
13 Dec 2018, 23:03
JasonL wrote:
13 Dec 2018, 16:46
Time to go cross eyed staring at our future so I can choose the least destructive among them.
At some point, you don't need to look too close, because the actual thing imposed (if any) is going to fought over (and fought against) by people who don't give a shit what we think.
Plus both sides will tell their supporters horror stories about the other side and half-truths about their own side. (Or less than half-truths. Remember "You can keep your existing plan?")
If Trump supporters wanted a tough guy, why did they elect such a whiny bitch? - Mo

Those who know history are doomed to deja vu. - the innominate one

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Pham Nuwen
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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 13 Dec 2018, 23:11

Also. I really don't think things like cost to taxpayers is a concern. Call it a hunch.
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