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This cant be said enough... When i had a doctor come to my door asking if i had any masks to donate I had some choice words for that schmuck.
@Raccoon Sure they do, they decide who they work for, ergo they decide what companies remain in business. If they work for only companies that operate ethically then these hospitals would never thrive.
Nah thats a short sighted view. No the answer to that is you start your own small one person clinic and work independently, as many doctors do. They certainly can afford it.
Not at all, they just need to work for a office without predatory practices for a little while. Doctors make astronomical amounts even in private practice.
@freemo Do those exist?
Or are the issues with insurance so systemic that not buying into the system ends up shortchanging the practice, making such honest practices unprofitable in a broken system?
I.e. if prices are inflated because insurance companies insist on spending more resources bartering than paying out, wouldn't an honest doctor practice that gives up-front pricing still have to deal with that and end up taking a loss as a result?
@freemo I think that banning health insurance could get rid of this problem overnight.
Ya know I never considered banning health insurance... and I was about to say that sounds idiotic... but as I try to type it i just keep going "he aint wrong".. if everyone had to pay cash people would be pissed as fuck at the rip off prices and might actually demand some change.
The problem is people dont know how to fix problems. So while they would demand change that demand would be "make it free for everyone!" and then we are right back at having insurance again.
@freemo It'd be the health care companies that'd actually need to make the change. They only charge so much because insurance covers 80% of costs. The vast majority of people can't afford the MSRPs of health care, so they'd either go without care or go to another country for care, greatly decreasing revenues in the health care sector. To turn things around, they would then need to bring down their prices so that they can get those customers back.
The proper change, of course, is that health companies actually come to meet a supply-demand curve... there are a few problems though.
1) as I pointed out people will demand the wrong kind of change, they wont hold healthcare responsible, they will just demand insurance back
2) Supply-demand and free market works great for anything where there is a reasonable supply-demand force. However the demand in healthcare is infinite because a person will (usually) give everything he owns to live just one more day. So healthcare is the one area where a free-market with minimal regulations or price fixing simply will not work against a supply-demand curve in any reasonable fashion.
@freemo Part of me feels like that's what they're doing, they're selling products at the price that most customers + their health care providers are willing to pay.
I agree with you though that price fixing isn't the solution. I wasn't a fan of #Trump's #Insulin price caps when he instituted them, no matter how positive the effects of them were (although I was certainly happy for my friends who could get #Insulin at lower prices)
Another problem that drives up costs is underpayments. We have laws on the books that any hospital that takes any federal money has to see everyone through the ER regardless of whether the person can pay or not. And they can’t just release someone to the streets after treatment. So many hospitals have agreements with local motels to set people (usually homeless) for 1 night to release them “safely”. Those costs can add up. Our medical tort system which is very litigious runs up the insurance costs of providers, especially certain specialists like obstetricians. Ironically one of worst payers in insurance is the Federal Government with Medicaid being one of the worst.
While it‘s good that people can be seen, those losses have to be made up somehow. And they do this by having really high list prices.
@icedquinn @freemo Well not right now, no, but that's because of the business model my proposal seeks to break.
The issue with supply-demand market mentality in healthcare is that the supply in limited and demand is infinite. You can always pay more to live longer, with diminishing returns, and most people will give everything they own to live just one more peaceful day.
You simply cant use supply and demand in that sort of dynamic without reaching extortion level prices quicky, as we have already seen.
@freemo @icedquinn I suppose? I'd guess in many cases it depends on the types of care we're talking about. Taking care of a broken bone or a pregnant lady isn't comparable to end-of-life care, or something like #insulin.
Even so, a rich person will spend a lot of money getting exorbanant care for a broken bone if they are scared of long-term function. People can be quite irrational about their health.
@freemo @icedquinn A rich person will spend $375k on a #McLaren too...that doesn't mean that cars for everyone will cost that same amount
its not about how much they will spend, its about the fact that any person of any amount of money will spend all their disposable income and much of their indisposable income to get it.
A rich person wouldnt spend their last 500K on a car if it meant they were homeless. They would spend that on a treatment if they knew it would bive them a happier and or longer life.
@freemo @icedquinn I guess my point is that most people don't have $50k or $100k is disposable income
It's the "money is relative" thing. For Bill Gates, $50k is a small amount, like a $20 to the rest of us.
No thats my point... most people dont have it, yet spend it anyway, thats the point.
@freemo @icedquinn How can people spend what they don't have? They're not the #USA government, nor do most people have absurdly high lines of credit on their credit cards.
> How can people spend what they don't have?
Debt. You go in, get treated, get a bill, dont have the money to pay, you just spent money you dont have. Its very common.
@freemo @icedquinn It's that easy to get an absurdly high loan like that, for everyday people?
Its not even a loan, you dont even know what your spending till you walk out most of the time.
Many years ago i had asthema, fairly severe. My insurance had lapsed and I spent a day or two in the hospital. Cost me almost 100K by the time I left, didnt have a penny to my name.
@freemo @icedquinn Ah, I don't disagree with you that $100k can easily be out-of-pocket healthcare costs w/o insurance at the moment, for sure
the regulators suffocate the supply of goods. some small amount of that might be for the best, but when you crack open the literature the USA is on the extremely hostile side of the curve compared to saner places like Switzerland
but that's not what the USA does. the USA puts up massive financial and regulatory walls to just straight up suffocate small labs out of the market.
@freemo @realcaseyrollins The other problem with that is that, even with reduced prices, most people still wouldn't be able to afford emergency care. That leads us to a place where laborers end up disabled for life because they can't get a broken arm treated promptly.
Making it free up-front would likely be more economically viable than dealing with the long-term systemic effects of people not getting the care they need (similar to how we deal with homelessness and drugs: just endlessly throwing money at enforcement instead of prevention).
Fair point. I would say the middle class could afford emergency care if appropriately prices (after all insurance costs more than paying out of pocket **on average)... but your right that the poor would be left in the dust and rely on charity.
@freemo @realcaseyrollins So, it looks like the overall median savings for Americans is something like $8,000, but when you look at Americans under 35, it drops to $5,000.
That means half the population has less than that.
I agree that losing insurance would drive prices down (modern insurance is definitely a scam), but I think you're underestimating the number of people who would be able to handle a serious unexpected medical expense on their own... more likely, a new industry of loan sharks would crop up around the void.
Savings based on what? Insurance is there to make money, it **cant** provide any savings on average unless it operates at a loss.
Now if you are talking about the savings that is created because insurance companies negotiate lower prices, that is the very thing outlawing insurance is intending to get rid of, to make sure the prices the average person gets is the same as the "real" price insurance gets. The fact that they scam you into insurance by charing individuals astronomically higher prices is the very thing that needs to be illegal.
@freemo @realcaseyrollins No, no, I'm talking about how much the average American has saved up, i.e. how much they have in their bank account to pay for emergencies sans insurance.
> even with reduced prices, most people still wouldn't be able to afford emergency care.
What makes you say that?
@freemo @realcaseyrollins Maybe a happy middle ground is higher deductibles. A lot of people don't need insurance for things that cost a couple hundred, they need insurance for something that costs thousands.
In this way, a lot of people would shop around for a lot of medical purchases, but you'd avoid financial ruin for a huge thing.
Not sure how a higher deductible would fix the extortion pricing that ultimately drives up either your medical bill or your monthly insurance bill.
To me the solution is clear, there is really only one. Co-op only healthcare. By making all healthcare (especially insurance) co-op you retaint he group bargaining, institute supply-demand pressures to improve service and pricing, and eliminate the greed element by ensuring the customers are the owners. This allows insurance to remain free market (addressing the issues with universal healthcare) while also removing the greed and exploirtation factor (a problem with unregulated free market healthcare).
Health insurance is fine. But it needs to be actual insurance and not a payment plan. Think of it like car or homeowners insurance. It’s there to handle unexpected big ticket things, not routine maintenance.
I‘m a fan of HSAs on steroids. Tie a high deductible policy to a tax- free savings account that I own entirely. I say on steroids because I’d like the option to raise the deductible even higher and allow me to save as much as I want in that account. But the current HSA model is a good start. I can keep everything I put in there for life, it’s tax free as long as it’s spent on medical expenses. At retirement age it’s eligible to be pulled out for any other reason but doing so mesns it will be taxed (no additional penalties, just regular income). And I can make money on the balance over time.
> Health insurance is fine. But it needs to be actual insurance and not a payment plan. Think of it like car or homeowners insurance. It’s there to handle unexpected big ticket things, not routine maintenance.
I think many responsible people see insurance as a good idea, to each their own. I am of the opinion that statistically your better off just taking that same money and putting it into a bank account. Statistically the bank account will reach much higher values than you will ever need to spend on healthcare (assuming you paid the same as an individual as insurance pays, but even if not this tends to be true).
While this can be risky at first (and really you have to get a savings going before you go off health insurance), once you get there and especially if you keep it multi-generational, then there is no need for healthcare, even with big ticket items.
@realcaseyrollins @freemo You are absolutely correct.
@realcaseyrollins @freemo
Pet insurance works on reimbursement. People pay the veterinary hospitals and then their pet insurance reimburses them for whatever percent they signed up for. Our hospital does zero paperwork. As a result, our prices are not overly inflated by insurance payout. Interesting concept.
@Zennagain @freemo Well I bet your pet insurance also isn't funded by government subsidies, is it
@realcaseyrollins @freemo
Absolutely not! That would kill it for sure! Sad that inflation due to Putin and Trump and global warming, has cased animal care to become unaffordable without insurance. 💩
@freemo
...I'm not sure the average doctor is really part of that decision process, or really directly benefits from it...