Why doctors pay millions in fees that could be spent on care
text.npr.org
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One way to avoid this in the US is to go with an HMO, since they can be wildly profitable and still be much more efficient than an insurance company + independent providers. Of course, the problem with that is that non-emergency care from third-party doctors isn't covered by the HMO.
A better way to solve the problem is to go with a single-payer healthcare system, such as the one the progressives was proposing during the Obamacare negotiations. (As every other first-world country has done at this point.)
This is simply not true, and there is another option that deserves to at least be mentioned:
I'm not sure. Switzerland seems to spend about the same as Germany in the last couple of years (of course the German system is also privatized to a significant degree) but Swiss GDP per capita is much higher.
If we look at spending as % of GDP Switzerland is actually below both Germany and France and about on par with Britain (~11%) while US spend more than 16.5%.
Netherlands where IIRC the system is also almost entirely private just with heavily regulated pricing is even a bit lower than all of the countries I mentioned.
Then again Switzerland and the Netherlands has a quite a bit younger population than Germany (median is lower by about 5 years) which must also play a part.
I wouldn’t dismiss a comparison vs percentage GDP, but it is a little different than absolute expenditure and abstracts the some aspects out differently. Absolute per capita expenditures if nothing else seems a little less volatile.
https://data.oecd.org/chart/79Yf
But I don't agree about comparing absolute spending. Of course there are caveats when using GDP but you really can't expect countries where salaries and other costs are much higher like Switzerland to not spend quite a bit more than poorer countries (and this doesn't really say much about the system itself). So we should at least adjust the absolute per capita spending by PPP.
Better for who, and under what circumstances?
Possibly. But there are countries in Europe where healthcare is primarily or to a large degree (or even entirely like in Switzerland, they don't even have any Medicare/Medicaid equivalents) financed through private insurance systems. Yet they manage to keep prices from spiraling through effective regulation.
I don't know Swiss politics but I also assume there isn't a bickering back-and-forth by party lines that end up distorting/underfunding any sort of healthcare.
True, however US spends huge amounts on MedicAid which sort of tries to do the same just seemingly way less efficiently and also less equitably. Capping insurance premiums at 10%(?) of income seems like a better idea than having a byzantine style system which discourages people from ever trying increase their incomes.
> I don't know Swiss politics but I also assume there isn't a bickering back-and-forth by party lines
Yeah, of course that's the real problem since we already know that any system ranging from fully private (with government subsidies) to single payer can work with proper regulation.
Source: The Healing of America by T.R. Reid.
What’s the angle here? Classic rent seeking because they can? Profiteering collecting interest on the float? Banking on doctors being slow to cash physical checks?
There’s some heavy stickiness to using one of these paperwork handlers for doctors. The switching costs are significant. But you’d still think there’s enough money there for someone to step up and offer the service without the fees. There’s enough money in fee per service to eat the big guys’ lunches.
It’s ridiculously close to the payroll business and we all know what happened there over the past 5-10 years.
Btw, don't give the Food industry these ideas :). It would suck if we now have "Food Insurance"
The root problem is the tail end of healthcare is enormously expensive, into the millions of dollars. Insuring a car is a minor expense, max $50k for the vast majority. It is the healthcare, that could require years of therapy and work done by extremely highly qualified people in short supply, using patented medicines, all wrapped up in liability protection, because if someone makes a mistake, you are eligible for up to millions of dollars in damages.
And also, if you are under age 50 and/or healthy, you are not just paying to insure your health in this calendar year, you are paying for healthcare older and/or sicker people are receiving. Health insurance premiums are more similar to a tax than an insurance premium.
People hated them b/c: - you couldn't use a meal twice in the lunch period e.g. have a late breakfast at 11am and and early dinner at 3pm
- you lost all of your meals at the end of the week
They then switched to "Y meals per semester" and people loved it.
- you could get an extra takeout meal for later (or a friend)
- you could eat three times a day on the weeks you were at school and less if you were away for a trip etc
- they actually released a price for lunch($6) and dinner($11( so you could arbitrage getting a cheap lunch vs buying dinner somewhere else
I feel there’s a ton of room for that in healthcare.
This kind of already exists with insurance and car repair.
If I damage my car, I take it to an approved repair shop and they give me an estimate. It's in the car repair shop's best interest to provide a quick estimate and good repair. If they don't, I can raise the issue with my insurer who might even lose me as a customer. The repair shop would then potentially lose out on repeat business from the insurance company.
Granted, this is a better example of a not-so-free market working vs the "locked in market" of healthcare but I think it's good to provide some counter examples to "it's ALWAYS bad to have insurers with preferred vendors"
This is what being American means. Capitalism and rent seeking to the max!
Endless possibilities!
Because multiple parties in the system are both making money and control the standards of practice. This makes real competition incredibly difficult.
2. Would their customer be the insurer or the doctor? If it's the doctor, I can't see insurers wanting to reimburse anyone other than the doctor. If it's the insurer, why would they farm out their billing to this third party when they already have the capability, and it's clearly lucrative?
3. Medicine in general is ripe for disruption, but it's so heavily regulated that eats into a lot of the potential profits from any service provider. Everything is an enterprise contract negotiation and the technical talent leaves pretty quickly when they see how slow everything moves. I've worked with large hospital systems that were still running Windows 7. Recently.
demand scaling prices and share doctoring.
* Start from scratch with a new system.
* Keep trying to make the current mess work. When it only came into existence as a way of evading price controls in WW2. And it's hopelessly wasteful and expensive and ineffective.
But the US system is institutionally opposed to reform.
I am always baffled by fees for electronic delivery of anything.
"Marginal cost of delivery for an electronic ticket is essentially zero so if we can get $5 of marginal revenue then our MR/MC ratio approaches infinity!"
The insurance companies are the ones paying for care. The hospital systems are the ones charging for care. The entity that pays for care has every incentive to keep costs _low_. The entity that charges for care has every incentive to charge as much as possible. i.e. The ire of consumers should be directed at hospital systems rather than insurance companies.
Edit: here’s an article on the topic https://www.npr.org/sections/health-shots/2018/05/25/6136857...
In fact it's often in the insurance companies interests to make premiums generally go up, because they make more actual money for taking the same percentage.
The insane paperwork we've built-up thanks to the industry isn't really serving our colletive best interests.
Of course, there are people who are very afraid of what might happen if they don't take HIPAA seriously even at smaller companies. I suppose those companies turn into big expensive companies pretty quickly.
Not sure how big rsync.net is, and no I'm not advertising, but their pricing is reasonable and I trust that they really are HIPAA compliant in the way that I'm willing to accept. So this isn't a strict rule, but I do think that there are a lot of situations where you have a non-compliant product that is more compliant than the "HIPAA-compliant" product.
HIPAA tends to create a situation where you have the minimum possible compliance (e.g. the most basic encryption that hasn't been broken or just disk-based encryption rather than doing something like individual record encryption and using a a pepper) for the highest possible cost. Companies who would provide more robust protection tend not to because of the legal risk, so you have companies that fill in the space with lower quality software but are willing to put their name on a business associate agreement.
The focus then becomes the advertising of the product as HIPAA compliant rather than making it more compliant.
You do have larger companies who seemingly have better compliance, but I remember someone telling me they had to pay $700 a month for Tiger Connect for example. There is more competition in this area today, so prices have gone down, but I remember a few years back it being pretty rough on what you could get where people would stamp their product as compliant. The least expensive options seemed like there was a "messages.php" file somewhere leaking all the secure messages.
It kind of stifles innovation in a way as well. For example, there is no secure messaging product that I know of that uses the methods that Signal uses to encrypt messages. Notwithstanding the location of Signal's data, no one in compliance is going to allow use of the app without a business associate agreement. So the less-secure apps win.
The Europeans were doing just fine without HIPAA right up until the GDPR anyway. I seriously doubt people would choose HIPAA over the savings they could have if it was to evaporate.
Government breaks up managed care organizations so that they are small enough such that their counterparties (e.g. smaller doctor organizations) can tell them to pound sand when asked for ludicrous fees.
Government legislated that electronic ACH payments or transactions have to be offered free of charge.
Government operates electronic money accounts and electronic money transfers as infrastructure.
The fees aren't pure profit for financial institutions. Its used to subsidize consumer protections like fraud prevention and reversal.
> This is one angle where I actually respect a portion of the crypto community
Is there a portion of crypto platforms that don't take in fees?
[0] https://www.wsj.com/articles/crypto-and-its-many-fees-what-t...
[1] https://www.investopedia.com/tech/how-much-does-it-cost-buy-...
[2] https://www.makeuseof.com/crypto-exchange-fees-explained/