Opinion: The U.S. can slash health-care costs 75% with 2 fundamental changes

[jim barclay]

https://www.marketwatch.com/story/t...and-without-medicare-for-all-2019-08-15/print

Great article, wonder why ideas like this never hit the mainstream? maybe someday?

The first policy—price tags
The second policy—deductible security

 

[Fenixgoon]

Price tags don't work when there are a million. insurance companies in the middle. Hell, that's part of the reason why we can't get a price. You have which provider? Which plan? In network or out? Is this one of your covered annual visits or not? The list goes on.

 

[Brainonska511]

Price tags don't work when there are a million. insurance companies in the middle. Hell, that's part of the reason why we can't get a price. You have which provider? Which plan? In network or out? Is this one of your covered annual visits or not? The list goes on.

Hell, I can see prices on my maintenance medication - but that doesn't exactly help, since the payer has decided that to cut costs, you can only buy from the pharmacy they control.

 

[ecogen]

Anyone that suggests price tag as a way to decrease healthcare costs is a moron, didn't read the rest.

 

[fskimospy]

Ideas like that have hit the mainstream - increasing price transparency is one of the aspects of the affordable care act, after all. It’s just not particularly effective at controlling costs.

Regardless, the author wildly, almost comically overestimates the savings available from HSAs and pricing transparency. Health spending in the US is not driven by regular purchases of routine medical services. Medical spending is overwhelmingly driven by people with serious illnesses, meaning whatever HSA someone has will be almost immediately depleted and the government insurance would take over. In addition, saying the US could achieve results like singapore despite having a population where nearly twice the percentage of people are 65 or older is nonsense.

I think the guy is trying to sell a book by making wild claims.

 

[Hayabusa Rider]

Helpful to a small degree and utterly ignores reality otherwise. In other news, 10 ways to lose 50 pounds in a week- Number 7 will shock you!

 

[glenn1]

Or the more honest change 3 that would actually save money, repeal the "emergency room must treat you regardless if you can pay" law. Unpaid ER visits as primary care both make the system suck for all the rest of us (via delays and such) while hugely driving up costs. Progressives who claim to care about "the uninsured" can fund charity clinics for them and hand out (with their own money) as much free care as they want.

 

[IronWing]

The existence of HSAs has not been lost on the insurance industry. Last year, all the HDHPs w/ HSA offered by my employer switched from set co-payments for prescriptions to a percentage based formula. Insurance companies are shifting rising costs back onto their customers with HSAs, increasing financial risk for those with HSAs so don't look to HSAs as a panacea for the future of cost control.

 

[IronWing]

Or the more honest change 3 that would actually save money, repeal the "emergency room must treat you regardless if you can pay" law. Unpaid ER visits as primary care both make the system suck for all the rest of us (via delays and such) while hugely driving up costs. Progressives who claim to care about "the uninsured" can fund charity clinics for them and hand out (with their own money) as much free care as they want.

Rather than ration ER treatment based on ability to pay, it makes much more sense to allow ERs to refuse treatment for anyone, regardless of ability to pay, for non-emergencies. If it can wait, GTFO.

 

[glenn1]

Rather than ration ER treatment based on ability to pay, it makes much more sense to allow ERs to refuse treatment for anyone, regardless of ability to pay, for non-emergencies. If it can wait, GTFO.

I'd be fine with that also. Slap a big "IDIOT" sticker on their forehead and make them walk to the Minute Clinic to get their sniffles assessed by a Medical Doctor for a malady that could have been treated by person who's had a couple hours of first aid training.

 

[Paratus]

Or the more honest change 3 that would actually save money, repeal the "emergency room must treat you regardless if you can pay" law. Unpaid ER visits as primary care both make the system suck for all the rest of us (via delays and such) while hugely driving up costs. Progressives who claim to care about "the uninsured" can fund charity clinics for them and hand out (with their own money) as much free care as they want.

Then we apply a little eminent domain under Kelo vs. New London, a little roll back of the EPA, and a liberal dollop of $peech to the local and state governments and we can then dump the bodies of the “surplus population” on Glenn’s property, while charging state and local governments to hall the bodies away for a profit.

I feel this is a strong libertarian solution.

 

[abj13]

Or the more honest change 3 that would actually save money, repeal the "emergency room must treat you regardless if you can pay" law. Unpaid ER visits as primary care both make the system suck for all the rest of us (via delays and such) while hugely driving up costs. Progressives who claim to care about "the uninsured" can fund charity clinics for them and hand out (with their own money) as much free care as they want.

Solving issues like this sound good on paper but isn't in touch with reality and would only save a minute percentage. ER encounters only account for ~12.5% of health care expenditures in the US, and a total of 2.4% of expenditures are spent on medical issues that didn't require an ER visit, but the patient did visit the ER. Many of those cases could be handled as an outpatient, which would save money, it would still require some amount of money to care for those patients. While non-emergent medical issues being evaluated in the ER is a problem, trying to fix it isn't going to rectify the US health care system.

If you want to make a major dent, 30% of health care expenditures went to administration. That's what private health care insurers are right now, middle-men who add significant bloat to the health care system, where other systems like Canada spent 16.7%.

 

[vi edit]

Or the more honest change 3 that would actually save money, repeal the "emergency room must treat you regardless if you can pay" law. Unpaid ER visits as primary care both make the system suck for all the rest of us (via delays and such) while hugely driving up costs. Progressives who claim to care about "the uninsured" can fund charity clinics for them and hand out (with their own money) as much free care as they want.

Honestly, hospitals should just slap a prompt care in front of their ER. Stick your residents and cheaper labor up there in less expensive rooms and staffing and triage. Some uninsured 20 something doesn't need to take up a $200 an hour ED docs time for their UTI. Charge a flat fee for non-insured (hell $10 is still better than $0 and the paperwork) and keep the ER's less clogged for people that really need it.

 

[senseamp]

1. Pack the Courts.
2. Repeal Citizens United which allows health corporations to legally bribe politicians to rig the system to rip off Americans.

 

[mindless1]

Or the more honest change 3 that would actually save money, repeal the "emergency room must treat you regardless if you can pay" law. Unpaid ER visits as primary care both make the system suck for all the rest of us (via delays and such) while hugely driving up costs. Progressives who claim to care about "the uninsured" can fund charity clinics for them and hand out (with their own money) as much free care as they want.

That's not the problem so much as a symptom of the problem.

A typical hospital has plenty of free space they could have devoted to a couple rooms to divert people to for a GP to take a look at them at minimal cost instead of claiming very high costs/losses associated with treating the sniffles or whatever. Even if those couple rooms are in the building next door, this could be done. Once the process is accepted it is just a matter of design and policy.

Since hospitals are incident-based treatment centers, "most" cannot make a valid argument that the space to do this is impossible. On the contrary they've been dealing with it for years and most prefer to avoid taxes by treating these people to maintain a non-profit charitable status, and claiming a very high treatment cost that can only exist because of the insurance payout structure that we have tolerated for too long.

I'm not arguing that people shouldn't go to the right treatment facility for their ailment, but I do accept there are cases where someone may not know if they just have the sniffles or something far worse. Turning away certain infectious disease carriers (so the disease spreads) could have a horrific impact on society.

 

[Lanyap]

That's not the problem so much as a symptom of the problem.

A typical hospital has plenty of free space they could have devoted to a couple rooms to divert people to for a GP to take a look at them at minimal cost instead of claiming very high costs/losses associated with treating the sniffles or whatever. Even if those couple rooms are in the building next door, this could be done. Once the process is accepted it is just a matter of design and policy.

Since hospitals are incident-based treatment centers, "most" cannot make a valid argument that the space to do this is impossible. On the contrary they've been dealing with it for years and most prefer to avoid taxes by treating these people to maintain a non-profit charitable status, and claiming a very high treatment cost that can only exist because of the insurance payout structure that we have tolerated for too long.

I'm not arguing that people shouldn't go to the right treatment facility for their ailment, but I do accept there are cases where someone may not know if they just have the sniffles or something far worse. Turning away certain infectious disease carriers (so the disease spreads) could have a horrific impact on society.

Hospitals having an urgent care facility inside or next to it sounds good except that the hospitals would want to inflate the prices like they do in the ER. The UC facility would have to be a third party like it is now.

 

[Jhhnn]

Solving issues like this sound good on paper but isn't in touch with reality and would only save a minute percentage. ER encounters only account for ~12.5% of health care expenditures in the US, and a total of 2.4% of expenditures are spent on medical issues that didn't require an ER visit, but the patient did visit the ER. Many of those cases could be handled as an outpatient, which would save money, it would still require some amount of money to care for those patients. While non-emergent medical issues being evaluated in the ER is a problem, trying to fix it isn't going to rectify the US health care system.

If you want to make a major dent, 30% of health care expenditures went to administration. That's what private health care insurers are right now, middle-men who add significant bloat to the health care system, where other systems like Canada spent 16.7%.

Well, yeh, but conservatives have alternative facts, don't you know?

 

[brycejones]

I'd be fine with that also. Slap a big "IDIOT" sticker on their forehead and make them walk to the Minute Clinic to get their sniffles assessed by a Medical Doctor for a malady that could have been treated by person who's had a couple hours of first aid training.

Even when being halfway reasonable you manage to engage dick mode. Don’t be a dick.

 

[Chromagnus]

What a terrible article. Anyone who claims that we can save 75% but doing any two things is being completely intellectually dishonest and should not be taken seriously. While there is nothing wrong with the idea of price transparency it would in no way have the impact that he says it would have. People like this do a disservice to actually legitimate conversation around health care expenses by trying to make it seem like there are such easy solutions.

 

[obidamnkenobi]

Well, yeh, but conservatives have alternative facts, don't you know?

Hey, if they "facts" don't support having poor people die on the street from easily, cheaply treatable diseases they aren't real. A sure sign of a modern, rich society is one where poor people and anyone with a case of bad luck is left to die and their corpse rotting in the street as a warning to others.

 

[glenn1]

Hey, if they "facts" don't support having poor people die on the street from easily, cheaply treatable diseases they aren't real. A sure sign of a modern, rich society is one where poor people and anyone with a case of bad luck is left to die and their corpse rotting in the street as a warning to others.

Unlike the cities run by democrats, the rest of us have the corpses picked up rather than letting them rot in the streets like you do. Must be another of those "collective action problems" you guys always talk about that prevent you from helping out yourself rather than waiting to be taxed so a bureaucrat can do it.

 

[balloonshark]

If you want to fix health care how about we start with the preventing the diseases. That would require giving capitalism the finger so the US could prosper. We start with high taxes on 80% of the crap in the grocery store and heavily subsidize the other 20%. Then we incentivize physical activity and place even higher taxes on cigarettes to phase them out altogether.

 

[Chromagnus]

If you want to fix health care how about we start with the preventing the diseases. That would require giving capitalism the finger so the US could prosper. We start with high taxes on 80% of the crap in the grocery store and heavily subsidize the other 20%. Then we incentivize physical activity and place even higher taxes on cigarettes to phase them out altogether.

You wouldn't even need to go that far. You could just stop subsidizing corn production so much. There is a reason that there is high fructose corn syrup in everything, it's cheap and delicious. It's hard to change that people think it tastes good but if you took away the production subsidies it wouldn't be used quite as much.

 

[fskimospy]

Unlike the cities run by democrats, the rest of us have the corpses picked up rather than letting them rot in the streets like you do. Must be another of those "collective action problems" you guys always talk about that prevent you from helping out yourself rather than waiting to be taxed so a bureaucrat can do it.

lolwut.

 

[Blackjack200]

lolwut.

You leave the corpses out by the curb on Mondays and Thursdays. Up to 5 corpses. For Holiday weekends, it's Tuesday instead of Monday.