The more-free-market ones simply dictate prices on some things and services (with, for the more-free-market ones like Singapore, the very real implicit threat of dictating even more of them if the market gets too greedy, with the less-free-market ones dictating more prices from the outset), and at the less-free-market end of the spectrum you have state monopsony (single-payer) or even direct state control of healthcare service providers, so the price controls are more de facto.
I'm not aware of a single system outside the US [EDIT: in a developed state, that is—I've not looked into developing-world systems] that doesn't achieve their results with price controls. Even the relatively "free market" ones—again, Singapore is usually the prime example people bring out for that, and they use some price controls and a very credible threat of further intervention to make their system work. Given this, I don't have much hope of success for any reform that doesn't either directly set at least some prices and threaten to set even more, or take even more control over price-setting (monopsony power, or nationalizing providers), given how universal that element seems to be.
The fact that patients have the choice to go to the public sector instead of the private likely keeps prices in the private sector down, but if there is literature on the extent and magnitude of those effects, I’m not familiar with it. Mexico is an example of such a country.
There are some systems that have private (though, perhaps, non-profit only) insurance and a public insurer as a kind of public option, as an insurer of last resort, but they place all kinds of restrictions on this, like standardizing basic-coverage plans and dictating that all insurers offer them, mandating that providers all accept these plans (including the government one) and so on, and often still having other price controls on top of it.
[EDIT] To clarify, "public option" proposals in the US involve a government-run insurer operating on the same market as private insurers, not any kind of universal or default coverage. There are lots of systems with private components or additions or even that are primarily private (with heavy regulation and price controls, typically) but I'm not aware of any that do what US public option proposals have called for. US public option proposals that have made it as far as bills have also come with restrictions, like only allowing those without employer-sponsored insurance options available to choose to pay for a public option, which would almost certainly have done weird and undesirable things to the risk pools for the public plans.
- negotiate with the government on prices, or
- work for the government, charging their rates.
I see no difference between private insurance and government run except the government is constantly lambasted for overspending and medicare seems to have the lowest operating costs and payouts to healthcare providers.
which seems to be the exact metric you want.
edit: just move to a public option system and watch shit hit the fan in the market.
Contrary to popular understanding, relatively low (sometimes impressively low) overhead & even fraud rates is the norm for US government social programs. This is one case where pop-culture "common knowledge" diverges wildly from reality.
Accountable is obviously relative.
BigCo at least wants one thing you know about, money, and that makes them far less capricious and far easier to deal with than government where you don't know any of the incentives that the people who (with several layers of indirection) set the KPIs for the person you are actually dealing with.
As evil as they are I'll take Comcast over some random state org any day.
Having a public option as a backstop would probably be good but I don't think I want a public option that covers routine stuff, GP visits, a broken bone. Stuff with a well bounded upper limit like that tends to be handled well by private insurance so long as there's competition (see auto insurance for example).
Waiting lists for specialists are ridiculous, unless it's something extremely urgent. It quickly becomes about "who you know" and queues can be jumped if you have the inside track.
I've never been encouraged or "nudged" to get a physical or even blood work done. Quite frankly, the system is under so much strain that getting everyone a physical would push it over the brink. So they mandate them for commercial drivers and other high-risk occupations, and everyone else just goes to medi-clinics and sees a walk-in doctor. Zero continuity of care.
Canada is great at treating the dying, terrible at treating the healthy.
I'm self-employed. Dental, prescription drugs, glasses, mental health: this is all out of pocket.
My impression is that if you have a reasonably good job in the United States, you have access to reasonable health care. Is that a fair assessment?
Regulation. If you wanted to start a service that drives elderly patients to get their medicine, in some justictions you need the permission of the local ambulance company to make sure you don't cut into their profits. This process is called a certificate of need[0] and if you dont have one, you can't operate.
It's like this with virtually everything medical related. If you try to compete they have ways to shut you down or stop you from starting all together.
[0]https://www.usnews.com/news/best-states/articles/2021-07-09/...
See also:
Controlling the supply of doctors by limiting residency slots (https://www.aamc.org/news-insights/medical-school-enrollment...)
Banning the reimportation of drugs produced in the US back from Canada at lower prices.
Keeping older, safe, and well known drugs behind the counter (albuterol is a good example) to drive office visits and keep pharmacy revenues up. In other countries you can just buy many common drugs like that over the counter, cheaply.
Publishing prices so people can shop around like any other product is a good starting point. Hospitals do not have to compete on price because insurance covers it in most cases and in many places they have a local monopoly.
Also the more people pay out of pocket for medical the more they care about what the price is.
Single payer.
A real solution to healthcare cost is making healthcare a functioning market where the buyer knows prices before they purchase.
A consumer cannot price shop and delay an appointment or procedure when it is a matter of life and death.
A hospital or insurance company cannot say no to someone who they are 100% sure will never be able to pay the bill.
Insurance is for uncommon events that you have little to no control over. The policy you choose should reflect how you want to mitigate your own risk of uncommon events happening.
Rule changes like this take time to be implemented and effective. You cant very well expect current practices to change when effectively very little has changed in price transparency yet.
I'm asserting even if it was implemented fully it won't do shit. I have insurance why would I give a shit about the prices? my employer pays the majority of the costs. its only going to incentives the uninsured to go shopping and they're a very small market.
thats precisely the problem. lack of choices in the insurance market where the incentives are not aligned.
So, after price transparency what is the next step to reach the goal of a healthcare free-market? I say it would be competition. Once prices are known publicly then it becomes easier for independent doctors to compete on price. There may be barriers to competition like limits on number of medical doctors that are granted licenses or something to that effect.
price transparency does jack shit in such a market where the stakes are literally your health.
healthcare services do not compete on price they compete on quality of service.
the next step and what should have been the first step is a public option with a mandate that employers must offer it as one of the insurance coverages available. I'd even go further and say employers must offer public + 3 other private insurances and to opt out for an increase in base pay equal to what the employer contributes to the most expensive plan.
the natural pressures on the government to minimize wasteful spending on social services will take care of the rest as suddenly private insurance will have to compete with cheaper to you public insurance.
Now, for anything touching healthcare, you'll have to deal with The Cartel. You are going to get every legal challenge thrown at you by every instance of government (and The Cartel itself) before you can even think of helping your first patient.
You'll basically need a member of The Cartel to vouch for you, or train as one. To even get a chance of getting in, you need to accumulate at least 6 figures of debts and try to squeeze in one of the limited spots The Cartel opens up for new recruits. Then, after about a decade of classes (4 of them completely useless to you) and a few years of pointless hazing, you'll be given the privilege to price gouge yourself.
By then, I'm not so sure you'll want to democratize access, sadly.
Big salaries, perks, and bonuses to executives is just fine.
Sure they do. They have revenue and expenses to manage just like a for-profit business does.
> I've read a few things that indicate non-profit hospitals are full of fiscal bloat, because there's no incentive to act otherwise.
This is not unique to non-profit ones.
Source: https://www.kff.org/other/state-indicator/hospitals-by-owner...
All this ends up meaning is that any revenue above their expenses is plowed into hiring more and more administrative staff and building new facilities.