Comment by micaksica | Hacker News Reader

Comment by micaksica | Hacker News Reader

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> If I go see a doctor, I have no idea if I will end up with a $40, $400, $4000, or $40,000 bill until the bill comes months later and I have to pay it. NO IDEA.

This is what's really strange about the American healthcare system. For everything else in America you can either get a price up front or an estimate of total costs up front. Why should going to the doctor be any different than going to a mechanic? Pay advertised flat rates for issue diagnosis, and get estimates for the problem.

Yes, in cases of emergency you can't really shop around too much, but the majority of the time you're going to a doctor, you could at least call and get estimates of how much things will cost. It's not even possible to do this with most healthcare organizations. If you call your doctor's reception and ask "how much will it cost for this visit?" they'll tell you they don't do billing and they won't know until it's processed by insurance.

Price transparency in the healthcare market - or at least some decent estimate of it - would be a great thing to see. American healthcare is ridiculously inefficient because it appears wholly designed to be byzantine.

> This is what's really strange about the American healthcare system ...

It gets worse. Each entity in the system applies their own rules. eg a friend had an eye exam at the doctors and they took 11 months to bill[0]. The doctor group pointed out their small print says they have 12 months to bill. The insurance company had a shorter time frame and refused to pay. But it was a scam - the doctor had changed the diagnosis code to get more money, and the insurer would have refused to pay so they kept more money. My friend lost.

It is very easy to see which proposals will "fix" things. Look at which groups make less money due to the fixes (doctors, insurers, medical groups, equipment makers, drug companies etc). It is extremely rare for that to be shown, and all those groups will fight to keep what is "theirs".

> American healthcare is ridiculously inefficient because it appears wholly designed to be byzantine.

I like the word confusopoly https://en.wikipedia.org/wiki/Confusopoly

  Confusopoly is an economic and marketing term referring to a purposeful
  act by a seller or group of sellers to confuse the buyer in order to ease the sale

[0] those fortunate enough not to deal with USA healthcare are probably wondering how this could happen. The answer is that any visit now results in a blizzard of electronic and paper communication, including satisfaction surveys, "courtesy" statements with many dollar numbers all over them that don't add up, stuff telling you legal information, and more saying one party has done stuff (eg billed or paid) on your behalf but you are still liable if it doesn't all complete, co pays, deductibles, random others because of in and out network nonsense etc. And this is a superficial description - how would anyone know?

Or we could just have universal healthcare with government-set price controls, just like Japan does. The ultimate in price transparency. Everyone is healthier, lives longer, and it’s far cheaper.

I'd be fine with that, but I'm acutely aware living in the deep south that MANY people would not be happy with that. If we're talking about what's politically feasible within the US, "universal" healthcare is only really an option at the state level, or maybe with some federal maneuvering, as a multi-state regional coordination. It's simply not going to be accepted anywhere in the near-future on a national level.

For the parts of the country that are rabidly anti-universal healthcare, a more free market solution would be a nice consolation prize.

I disagree, I think they'd be extremely happy with it... as long as they were prevented from seeing the words "socialized" in any context around the program until they'd seen the benefits.

A large portion of the country working full time already has their employer offered health plans supplemented by Medicaid anyways.

There’s already tons of people on Medicare and Medicaid in red states and there hasn’t been an armed insurrection.

I think that working class people in these regions wouldn’t be adverse to Medicare being expanded to include them. I’m sure the Republican Party base of upper middle income and wealthy whites would be, but again, not so much everyone else there. It’s a matter of how and what constituencies you recruit and activate.

> I think that working class people in these regions wouldn’t be adverse to the program being expanded to include them

It’s so strange, the people who would most benefit from universal healthcare (and those that currently do, like Medicare beneficiaries) tend to be the strongest objectors to it, citing hard-to-understand ideological reasons.

> It’s so strange, the people who would most benefit from universal healthcare (and those that currently do, like Medicare beneficiaries) tend to be the strongest objectors to it, citing hard-to-understand ideological reasons.

It's not so strange if you allow yourself to question the assumption that they'd benefit from it in the first place.

Medicare is a great example. Patients can opt to receive their Medicare inpatient and outpatient coverage through a private plan instead of through the government-managed plan. Since this program was introduced, it's gained popularity rapidly, over a third of Medicare beneficiaries receive their benefits from private plans. Many private plans are the same price as Medicare or cheaper.

From the data, the private plans beat government-managed plans on the three major metrics: medical outcomes, cost, and patient satisfaction. On the last one, the difference isn't even close: the worst of the major private plans (by patient satisfaction scores) still manages higher scores than Original Medicare does.

People who haven't ever dealt with Medicare themselves directly (which includes most HN commenters) find this hard to understand, but it really isn't: dealing with Medicare is awful. I could give you my personal anecdotes, but they'd overfill the comment length on HN, and again, at the end of the day, the numbers speak for themselves. Medicare beneficiaries themselves are turning to private plans to replace their government-managed plans, so it's really not surprising if they're not the biggest advocates of expanding government-managed plans.

The private plans you refer to are mainly either simply administrators (the government pays them to administer the benefits) or supplemental providers or both. And their existence and popularity has more to do with their sponsorship by insurance funded politicians than anything else. Dealing with these administrators isn't generally better or worse than dealing with the government directly. Exceptions exist, but that goes without saying.

> The private plans you refer to are mainly either simply administrators (the government pays them to administer the benefits) or supplemental providers or both

No, they're much more than that.

> And their existence and popularity has more to do with their sponsorship by insurance funded politicians than anything else.

The programs are cheaper, provide better medical outcomes, and patients prefer them.

That doesn't mean they're perfect, but you have to bend over pretty far backwards to say that they're inferior and only popular because of "insurance-funded politicians".

> Dealing with these administrators isn't generally better or worse than dealing with the government directly. Exceptions exist, but that goes without saying.

It is monumentally easier to deal with private insurers than to deal with an Original Medicare plan.

59% of people support Medicare for All and 75% a public option. When phrased as "Medicare-for-some," support among GOP voters is 64%.

It’s a corporate-controlled media narrative that these things are unpopular.

http://www.businessinsider.com/poll-medicare-for-all-public-...

Be careful interpreting polls. Question wording bias is very powerful. If you ask them whether they’d be willing to pay higher taxes for Medicare for all, it’d much less popular. Just like how a huge majority support renewable energy in surveys, but the same overwhelming majority refuses to pay even 5% more for electricity.

Which only shows that opinion on these issues is malleable and not ideologically-fixed, as many would like to portray them. Understanding your constituency and being successfully persuasive is a fundamental part of any politics.

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