Compare that to dental insurance. I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. Of course the set of possible treatments for dental work is a lot smaller, but it seems so much more straightforward.
Other times with chronic conditions where theoretically price discovery could help, the problem is that you need care badly so all the chronic care providers jack up the prices super high beyond what is needed. Treating this as a market in any way is a crazy system. If the government pays market rate, they jack it up even more. So the solution has to be that the government has to set the prices either directly or by negotiating with an entire population at its back and no competitors (i.e. monopsony in the public interest).
I have no sympathy for them whatsoever.
Had to get an MRI and the lab corporation that performed the MRIs said that it would be ~$850 if billed through insurance. This included the total cost minus what was covered by insurance so the initial cost of the procedure was in the ~$1200 range. BUT, then they said if we just paid them directly and they didn't have to bill through insurance it would only be $650. So our insurance didn't even cover the absolutely ridiculous amount of overhead that was added just to deal with our insurance provider.
Medicare didn't provide coverage for prescription drugs until the adoption of Part D. That is structured differently than other parts of Medicare. Instead of the government serving as the insurer directly, the government subsidizes premiums for a private Part D insurer. The private insurer can and does negotiate drug prices.
The fact that Medicare can't negotiate prescript drug prices is often invoked as a talking point, but Medicare prescription drug spending accounts for a relatively small proportion of. overall Medicare spending: https://www.heritage.org/medicare/commentary/good-and-bad-id... ("Consumer choice and competition have made Part D the rarest of government programs: one in which spending hasn’t spiraled out of control. In fact, government actuaries report that federal general revenue spending on the program was $67.8 billion in 2018—that’s less than what it spent in 2015 ($68.4 billion).").
A point in case is the Hep C vaccine: https://www.medicalnewstoday.com/articles/323767#drug-types-...
I'll admit that profit seeking would work better* in a society that doesn't have a strong state or other coordinating body, but given that one exists to counterpose our existing system is not reasonable.
EDIT: * In the sense that products might be produced at all. Without a strong regulatory body, the market would be flooded with snake oil medicine and the average consumer would not be able to make heads or tails of things. This is because it's much cheaper to make a fake medicine than a real one, which is what profit optimizes for: the cheapest solution with the highest payoff for the seller regardless of costs not borne by the seller (such as death and destruction writ large).
There is an issue with some old out of patent drugs that costs a lot despite being very cheap to manufacture, but that typically has to do with FDA certification deciding who can be allowed to produce what, which is also expensive to obtain.
Oh, I know. I've tried getting prices in the past. Traditional providers can't do it. One thing that has opened my eyes is using a Direct Primary Care (DPC) provider. I pay $75 a month for direct access to my doctor (email, text message, cell phone etc.). The access is great, but an unexpected side benefit is that a large percentage of their patients are un/underinsured. They can quote the prices for most common procedures from memory.
The other day I was getting a blood test and they asked if I wanted to bill my insurance or pay cash for it. I asked about the cost and they said "two-sixty". My response: "For two hundred sixty bucks we better bill the insurance. They laughed: no, $2.60 (it was an add on to another test for my physical). When I got home I googled pricing - the exact same test normally bills for around $65.
We do not have a free market. Other countries seem to have solid solutions for "socializing" medicine. I can't think of any highly functional system that is a free market. I don't even think that one is possible without people dying in the streets. Thus the best way forward is to try what has been successful elsewhere.
FTFY
People "love their health insurance" when they have it forever through their employment, and feel safe in their position.
80% of people in the US, including 50% of Republicans, support M4A precisely because they are not part of the upper-crust minority who are afforded such luxuries.
Of course, this would be mitigated by the elimination of health insurance premiums and other redundancies, but a federal taxpayer funded solution would result in a more transparent wealth transfer, whereas the employer sponsored tax deductible health insurance gimmick allows for better discrimination on who receives healthcare, and ideally reduces the amount of wealth transfer by reducing the healthcare many people receive.
Just goes to show where our "representative" democracy has gone. The number I quoted is for voters registered Republican.
My conversations are usually reminiscent of this:
The government is perfectly capable of ensuring access to a market without regulating it to death. The SNAP program (Food Stamps) is a great example of how this works in a separate market with very little elasticity in demand.
Almost every other developed country has a system that works for healthcare. It's almost always single payer or something where you definitely don't go shopping around for hospitals.
Doesn't it start to feel a bit like indoctrination when arguing for a "free market" when no other developed country has a free market for healthcare?
Is everyone else stupid? What aren't they seeing? Especially in the age of the internet?
I just can't follow this logic.
I would love to get someone who argues from the "free market" point of view do some introspection and explain the logic in a way that doesn't feel like repeating the same 2-3-4 ideas which as far as I can see, are common talking points in the US.
So, repeating the question, what is every other developed country missing?
Why aren't they all doing this, if it's obviously superior?
Even if a free market could work in the US, I have no idea how we could get from here to there without making things worse along the way.
It's all funny money til it lands in my lap, then suddenly it's real.
What baffles me the most is that most "socialized" systems functions much like a tax-paid insurance policy that covers everything and has no profit motive.
Even in a normal insurance situation you're "paying for someone else's treatment". That's the whole point of insurance.
How can you shop around when prices are that distorted?
What you don't know (unless you get 2nd/3rd/4th opinions from good dentists) is how necessary those truly are. Some dentists just work around things by recommending things you don't need. (Fill teeth, taking panorex, etc. unnecessarily)
A broken tooth is a much less complex injury than a broken arm. In many cases you don't even need to be a dentist to diagnose it. Try walking into a dentist office with a more complex injury that could involve multiple different dental specialties and severe underlying complications. You aren't going to get an immediate upfront price.
2. Dental x-rays are more often than not elective procedures. It's much easier to comparison shop elective procedures than emergency procedures. Therefore market forces frequently compel the dentist to come up with an up front cost for an x-ray.
The same market forces don't apply to hospitals because you can't wait a week or more while you shop around for treatment for a shattered hip.
She said that there's not always one "correct" treatment. Some dentists will try to nip potential problems in the bud, lest they get worse. Others have more of a wait-and-see attitude which can avoid some procedures but make others worse.
Doctors, plumbers, builders, and mechanics all do the same thing. Do you replace the brake pads now, while the wheels are off anyway, or do you squeeze another season out of them since there's still a bit left? Rebuild the whole deck, or maybe just replace the more banged up boards and wobbly railing?
Plus the huge disparity in recommended treatments is an indication some are just throwing shit at the wall to see what sticks:
https://www.theatlantic.com/magazine/archive/2019/05/the-tro...
>Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000.
https://surgerycenterok.com/pricing/
they also seem to have a lower risk of infection compared to the national average:
https://surgerycenterok.com/faqs/
i'm not sure what could account for that. i was thinking that maybe because they are incentivized to provide the procedure at the baked in rate that there's a strong incentive to get patients out of surgery successfully as best as possible (to free up another bed, etc), but i'm not sure what their demand is like.
a more macabre hypothesis is that hospitals don't care much about patients who end up in their own ICU as it's just additional billable coverage, so the precautions aren't as strict.
"I tried to find out how much my son’s birth would cost. No one would tell me." [0]
[0] https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bi...