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Comment by tptacek | Hacker News Reader

The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions!

There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.

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I've got news for you... you already have government price floors on all hospital procedures.

It's not a government takeover of health care - only of pricing. The Japanese model is largely private providers, and private, employer-provided insurance.

Standardized pricing gets rid of the problem of charging different customers (slightly) different pricing, and having massive negotiations on a per-carrier basis. This sort of thing isn't a matter of "competition drives down cost". It's just stupid and inefficient.

Don't Medicare and Medicaid pay fixed prices? And aren't they generally below cost for the provider? So they have to "make up the difference" by charging private insurers and cash payers more?

I think so. My point is, government price ceilings on all health procedures are so noxious to half the polity that nobody will support it, and we'll get single payer by default.

They are generally less than what providers bill to others but Medicare doesn't pay below cost.

Medicaid varies because states have way more control and many states (especially Republican-leaning ones) have slashed their rates as part of a concerted effort to kill the program. Not that it matters - in Texas you generally can't qualify for Medicaid if you're childless or have a job. The income requirements are insanely low.

Sure, but that's why participation rate varies pretty wildly from one practice to the next on whether or not they accept Medicare or Medicaid.

If a doctor doesn't like the rates Medic[are|aid] are paying, they're free to not accept Medic[are|aid] patients.

Unless they are emergency room patients. :)

It's lower than what the provider charges other insurers, that doesn't mean it's below the provider's cost. It's also commonplace for providers to bill insurers one amount but the insurer only pays a lesser amount, it's a little game they play. Pricing of medical goods and services in the U.S. are very divorced from the actual costs of providing them.

Also, Medicare and Medicaid can't negotiate drug prices.

Fun fact: Medicare is prohibited from negotiating drug prices with suppliers, by law.

Ah, yes, Medicare Part D. That's what happened the last time the GOP got to write a health care bill.

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