Comment by autoexec

Comment by autoexec 2 days ago

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> but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper.

I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance.

The best thing we could do is ditch the private healthcare industry to the extent that the rest of the first world has and cover everyone with government plans. Those plans can then negotiate for much better prices and refuse the kinds of insane charges we're seeing. The cost of plans would also drop because prices would be spread out over every taxpayer. Having primarily a single provider for insurance would make everything easier and less expensive for hospitals and doctors offices too.

The billions in profits private healthcare companies rake in all comes at the expense of everyone else one way or another and they have every incentive to make as much money in profit as they can. Without that excess fortune in profits being skimmed off and stuffed into pockets a government funded insurance plan which covered everyone could get the job done taking in closer to what it actually costs to deliver the services we want and no more.

potato3732842 2 days ago

You don't need the insurance industry sticking their dick in most of the business they do. Insurance is for the foreseeable but unforecastable, not for routine things.

The additional overhead is substantial and adds huge marginal cost for routine things and say nothing of the principal-agent problem

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  • tptacek 2 days ago

    You could zero out every dollar American insurers make and not materially alter consumer health care economics; their share of the health care pie is almost literally a rounding error.

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    • csa 20 hours ago

      > You could zero out every dollar American insurers make and not materially alter consumer health care economics; their share of the health care pie is almost literally a rounding error.

      What are you implying with this comment?

      I generally enjoy reading your comments, as they provide some interesting and often unique insight.

      But this one…

      Either it’s something I don’t understand, or it has the potential to be incredibly misleading in its implications.

      The impact of American insurers on direct costs, indirect costs, and opportunity costs of healthcare is much more than a rounding error. The incentives amongst various actors, with insurers in the middle, are massively misaligned. I’m sure you know this.

      Ask patio11 about insurance in Japan. It’s incredibly affordable, it’s quite good, and there are both public and private options. It’s not perfect by any means, but I miss the healthcare options in terms of both cost and quality that I had in Japan.

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      • tptacek 20 hours ago

        I think people mistake me for saying that the American status quo is acceptable. It isn't. We overpay (and overprescribe) wildly above peer countries. It's very bad. The only point I'm making here is that the two most common villains in these narratives --- insurers and pharma companies --- mathematically account for only a small portion of spending. Insurers in particular act as sin-eaters for the providers, who dwarf them in size.

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      • Aloisius 19 hours ago

        The primary reason Japan's healthcare is affordable is because the government institutes strict price controls on healthcare providers. Every procedure, every service, every medical device and every drug has a price fixed nationally and those prices are below even what Medicaid pays.

        Normally, price controls would lead to shortages, but with healthcare, there's always shortages with or without price controls and every country has to, in some way or another, ration care anyway.

        If you tried to implement that here, doctors would riot (read: use their ridiculously powerful lobby to kill it or get the fee schedule increased - which they did every year for a decade when medicare dared to institute cost controls. see: medicare doc fix).

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    • potato3732842 2 days ago

      The magic of the system is that it's structured so that people like you can say things like that and not even be lying in any provable way.

      Sure, it's not the actual insuring that's costing that much but the massive breakdown of incentives from increasingly vertically integrated healthcare companies (some of whom are insurers, some of whom own insurers) owning increasingly large shares of everything is clearly causing cost to spiral. The industry is making work for itself at out expense. Whether that work happens in the insurer's office or the billing office of the clinic that's owned by the insurer isn't really material. And of course everyone in the process gets a cut so they fight for their bit of it. Doctors used to drive the same crappy cars and live in the same modest houses as the rest of us. Nurse didn't used to be the "made it in life" job for people who come from poor backgrounds.

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      • tptacek 2 days ago

        Dial it back a bit. I just made an extremely banal and citable claim about US health care. I agree with you (trivially verifiable from the search bar at the bottom of this page) about the practitioner compensation racket.

        https://nationalhealthspending.org/

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    • franktankbank a day ago

      They add costs in the form of hospital administration which wouldn't be their books.

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      • tptacek a day ago

        In that it represents dollars that don't go to their business, yes, you're right.

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phil21 2 days ago

> Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it

It’s more they know insurance won’t pay for it, and negotiate discounts based off the “retail” price. Although at this point it’s gotten so ridiculously convoluted and cross-subsidized that I doubt even the insurance company or hospital knows what the actual paid amount for a Tylenol will end up being until months after the fact.

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  • teeray 2 days ago

    Meanwhile, I hand my credit card to the vet for a bottle of Gabapentin and I’m out the door.

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    • SlightlyLeftPad a day ago

      That will be uhm, <checks register> $15. Have a fantastic holiday!

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      • teeray a day ago

        My point being that healthcare costs for pets are immediately calculable, where it’s a big damn mystery for months on end about how much equivalent human healthcare will end up costing. Clearly, if the former is possible, the latter should be too.

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        • SlightlyLeftPad 19 hours ago

          Totally agree there. I was simply demonstrating that interaction directly. For a human, it’s “we’ll bill your insurance for that Gabapentin. We’ll need pre-authorization first, assuming it’s covered, you’re out of pocket cost will be your copay of $25 plus 20% coinsurance of whatever number the insurance company decided it should cost assuming you’ve met your deductible.” Me: “what’s the cash price without insurance?” Cashier: “$30”

          It’s basically the Kohl’s pricing model except there’s no hope of ever finding out what that single bottle of meds will cost until you’ve completely forgotten it 6 months later and you get a bill for $600.

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SlightlyLeftPad a day ago

> I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance.

Did we discover a new kind of monopoly perhaps? It’s not quite full blown corruption as there still (for now) exists a somewhat adversarial relationship between insurance and hospitals. However, at the same time, they seem to be pulling each other into the abyss, and our society is the victim.

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  • kmeisthax 20 hours ago

    Pretty much every healthcare business unit - hospitals, pharma, insurance, and so on - are deeply consolidated. It spread like contagion, as anyone who didn't consolidate got their margin eaten. The sum of all those different vectors pulling on the same market is one unified message: "rape the consumer for all they're worth"! Because that's the only source of margin left, and everyone's got hungry shareholders who only make money when the business accelerates profit.

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