The prices hospitals negotiate with private insurers for patient services

If a workplace or insurer says to a hospital “if all these people come for a checkup, what can you do in pricing?” Is that something that should be blocked?

A friend of mine used to work as an independent advocate for sick people in NYC. Basically people who were getting screwed by some aspect of the American healthcare system would pay her to do nothing but deal with bureaucratic red tape and bullshit. Like a healthcare lawyer almost. And of course she saved people more money than she cost, so she was constantly getting new clients. She only stopped because it was soul sucking work and incredibly depressing.

Now let's imagine a system that's so broken with bureaucratic BS that it makes sense to hire someone for this. All of the 'healthcare workers' that my friend would speak with on the phone for her clients were essentially overhead and only necessary because the system is geared more towards ripping people off than actually helping anyone.

We don't need any of these bureaucrats. They can all be fired.

The point is that there’s no magic bullet here. There’s no mustache twirling trillionare villain that we can shut down and get the UK’s spending numbers.

Cutting healthcare spending significantly, which I think we should do, would cause hardship for a huge number of people and entire regions on the country.

$2T/yr divided by just the 9.8 million = 204,081, which puts average comp in the 160s. Sounds right; around here your average nurse makes about $80k/yr with excellent benefits, and they are sort of the median employee.

And that's just the employees providing care. There's also an enormous bureaucracy.

It could be this - plenty of nurses make well over $100k, plenty of doctors make well over $500k. It varies a lot based on location, specialty, overtime, but there are some good livings being made.

What does this look like? Is there money going into the system that’s not going to anyone / any company at all?

At a naive look, if insurance cost would be less than 10% of the final cost of a service (assuming that a generic service can represent health cost in general), one would expect the difference to be in that range - but the article shows a much higher variance.

I think what we have there is a very expensive medical school system. And things snow ball. Especially given a doctor role. A doctor studies and goes through practical training a good 8 years. That's college/uni + health center fees that stack up with interest over a long period of time.

Doc then needs to make a living in accordance to his past effort, more than a living, get enough to earn the status he deserves. Now the thing is, taxes accounts for a lot given the high band income. So we could say the doctors are earning too much, but reality is 70% of their gross income goes to multiple tax tiers. 1/ income tax 2/ debt pay back 3/ insurer, continous training fees and other things that are sort of imposed on medical professional.

I'm not a doctor, but I couldn't figure out how even a surgeon could justify such high pay, in the million dollar per year in many US positions. But looking comprehensively as the taxes imposed on them, everything makes sense, all they have left is 200k per year. Cashiers and other clerks earn a quarter this amount, but that's for any less than what doctors are making not many would go through all these hops and be privileged enough to even take the risk of such a financial investment.

The argument that many doctors come from wealthy families doesn't invalidate the simple fact debt still exists and somehow needs to be paid back, and in most cases it does get paid back.

Solution? Get rid of income taxes, make medical schools optional to practice, just make exams open to any participant, affordable education channels will pop up by themselves. Don't regulate medical malpractice, practicians should rather have their lives ruined instead, it's actually a stronger incentive to proper practice than having a big insurer paying the millions in settlement cases.

The medical sector is far more tied to other industries and regulating costs than it looks. I only included 3 obvious contributors to high staff cost, there are numerous supply chains to look at to also account for other spendings that seem unavoidable but in reality pointless for health care.

However my wife is a doctor who is fellowship trained, so she didn’t start making real money until she was 32. But she made a good bit above the median salary for many years before that. She also doesn’t feel like she sacrificed her 20s. She had plenty of fun, although she says med school was much harder than her engineering degree.

And now she makes much more than I do as a principal engineer, and she works less than 30 hours a week.

She doesn’t have to worry about interview prep or job hopping. She has absolute job security in any economy. She gets paid for continuing education. She is highly respected (people are much more impressed that I married a doctor than that I’m a principal engineer lol).

There is a legal framework protecting her autonomy and decision making at work. Not even the CEO of the hospital can overrule her.

In short, she is almost completely above the rat race, and is a true professional in ways that we (software engineers ) are not.

I would 100% recommend our children become doctors.

I deal with surgeons from time to time through work. Maybe their training is hard but being a surgeon is pretty much an almost guaranteed ticket to becoming a multi-multi-millionaire. These guys are extremely well paid.

I am not sure how to fix this but an important first step would be to mandate full transparency of all pricing. In addition the same service should cost the same for uninsured and insured patients. Same for in- and out-of-network billing.

Right now a patient basically has no way of navigating this. Even if you are insured there is a much greater than zero probability that you will get hit with some random charges you could not have anticipated. You just have to hope for the best when you go to a hospital.

Don’t look to us for any ideas how to do your healthcare!

And since no other country with a huge diversified economy is willing to run external deficits large enough to meet foreign demand for reserves, the dollar is pretty much the only good choice. There just isn’t enough gold to clear trade in a $80+ trillion global economy.

Technically social security covers 70% of the state set price and insurance must at a minimum cover the other 30% but that's the general idea.

https://www.ama-assn.org/practice-management/medicare-medica...

https://www.ama-assn.org/about/rvs-update-committee-ruc/rbrv...

https://healthinformatics.uic.edu/blog/what-is-healthcare-re...

https://www.mcknights.com/blogs/guest-columns/understanding-...

>The government also pays costs that I don't think private insurers need to worry about. For example, if you can't pay, you don't have private insurance, so private insurers don't really need to worry about paying for the long term care of people in nursing homes. I also imagine that the elderly and poor are more likely to require expensive care than the population covered by private insurers in general.

This does not seem relevant to a discussion about government being a party in the price negotiations for healthcare services.

>Especially since private insurers will happily say "no!" to customers that are not profitable.

Health insurers have been forced to offer coverage to anyone under age 65 since ACA was passed in 2010.

>So I'm not convinced that being "the majority of spending" is the same thing as being irresponsible with the money.

I do not think anyone claimed this in this discussion.

>I will also point out the private insurance on this document is a plurality of spending and makes up most of the administrative cost (complete waste, on other words).

The insurance portion of the business (forecasting expenses, calculating premiums, other insurance business functions) are only a waste if you are starting with the assumption that the system should be completely taxpayer funded healthcare for everyone.

The managed care portion where doctors/pharmacists double check claims and monitor for waste/fraud would have to happen in a taxpayer funded healthcare too. Although it being replicated across multiple managed care organizations could be classified as waste.

A vet is risking a lot to do that. If you find one, pay well.

Single shot isn't enough, 2 or 3 at one or two week intervals is what i've been told.

You say "the problem with that". Pitched another way, we could say "the benefit of that"...

when it's an extra cost

Would it necessarily be an extra cost? I understand that the amount typically paid in the US on health insurance, by the individual and employers, compares badly with the amount paid in many other systems that provide better healthcare for less money.

I do not exactly see all my work from home friends who I know are working less than 40 hours a week Mon to Fri 9 to 5 clamoring to go help at the hospital right now even at current nurse's pay.