Arguably this is true for nearly all medical conditions - prompt treatment helps, at least if there’s any effective treatment, either by avoiding a worsening condition or resolving the problem sooner and leading to better quality of life (barring edge cases like risks from over-testing for conditions you might but don’t actually have). Cancer is a very obvious case for this, but it’s true of joint replacements, organ transplants, getting your high blood pressure or diabetes under control, etc, etc.
To a large extent, all these HMOs and government run managed care programs run you through hoops to get your problem actually treated by the appropriate specialist are doing cost control at the expense of the patient’s health. Look at the VA for a classic and fairly bad example - hidden waiting lists and interminable delays before you can get seen, etc. if you were paying full price out of pocket for the whole thing, someone in a free market (or even the current US system) would be happy see you promptly. It’s only because of all these intermediaries like the government single payer provider or private insurance companies with conflicts of interest result in these imposed delays, multiple required referrals, deductibles to discourage seeking treatment, etc. none of that is good for the patient, but the party paying cares more about their profit or cost control, and doesn’t have much incentive (aside from maybe shame or a little bad PR) to get you good prompt health outcomes.
Good news for short term plans - these are going to be allowed under new HHS guidance to be up to a year and renewable without additional underwriting for up to 3 years. Yes, they have pre-existing exclusions and some limited drug benefits, but they also cost 1/3 of ACA plans and typically have decent nationwide networks.
The rule would loosen restrictions on a type of coverage known as short-term medical insurance—low-cost plans that cover a limited period with less-expansive benefit offerings, which are subject to fewer consumer protection regulations.
Such plans now can only be carried up to 90 days. The new rule would allow the plans to last for a year and be renewed for a total coverage period of 36 months.
The administration said the average monthly premium for such a plan has been about $124, less than a third the cost of an unsubsidized plan in the ACA markets.
These will be a great option for relatively healthy people in between jobs, or even those who don’t get enough subsidies to make the so-called ACA plans affordable.
Being able to buy a full year of short term coverage means you’ll be able to guarantee you’re covered until the next open enrollment period if you buy your short term coverage at the same time. This makes these plans much more attractive.
You can read his assumptions here. They seem pretty generous, for example assuming the government halves drug costs and pays only 60% of standard rates to healthcare providers. In short, it seems like it’s so crazy expensive it’s basically infeasible.
I completely agree. I was living with govt run healthcare while reading all of these stories of “horrendous” HMOs and how people were dying due to the wait times and denial of services. It seems like a lot of the coverage of govt run healthcare implies it is a panacea. It is not, and I can readily state that as fact.
And leads to further deterioration of the Marketplace risk pools, much of which gets picked up by taxpayers in higher premium subsidies (in a less efficient way than eliminating this risk pool cherry-picking nonsense with M4A). It’s sabotage, not improvement.
Looking at pharmaceutical spending in other G7 countries, the drug price reductions don’t seem unreasonable to me. Start with the NICE formulary and pricing, and make drug companies justify higher pricing than that.
On the provider reimbursements, I’d like to see a better analysis of that issue. I think simply pointing out it’s a 40% reduction is an oversimplification of the issue. A full M4A implementation would dramatically reduce providers’ administrative costs, eliminate uncompensated care, and increase current Medicaid patient reimbursements to Medicare rates. It’s possible that some increase in Medicare reimbursements is justified, but matching current private insurance reimbursement rates would amount to a windfall for providers given the other M4A advantages.
In the end, every other developed country is able to provide some form of universal care at a much lower cost than we do. I’ve not heard any convincing explanation for why such a thing would be impossible here. Some respond with anecdotes about triage-based wait lists in other systems and cost controls, but we already have wait times (if you can’t pay for something considered non-emergency, your wait time is effectively infinity, since you’re not getting the care) and utilization management by private insurers, most of which are either for-profit themselves and/or hired by a for-profit plan sponsor whose financial interest is in denying care (at least to the extent the denial wouldn’t result in higher emergency costs for them later). Some may find it strange, but I trust a government that I have at least nominal control over – a vote – more than a for-profit company who will profit more by denying care.
The overconsumption point is something else I have to take issue with. There are a few reasons “overconsumption” (whatever you want to define it as) may occur.
First, “for fun” – but I’m skeptical. I can’t speak for others, but going to any medical provider doesn’t appear anywhere on my list of favorite things to do, and I’d wager that I’m not alone in this regard. I’ve been lucky enough to have reasonably good insurance coverage (by US standards) and the means to pay for any cost-sharing, such that cost-sharing isn’t a deterrent to me seeking care, and I’ve never once been tempted to seek medical care for giggles. Is there any data showing this to be a significant issue in other systems?
Second, overusing doctors or hospitals for minor ailments (like colds) that most reasonable people would know do not require medical attention, or using higher-cost care (ER) instead of a PCP or urgent care clinic when a reasonable person would know the situation doesn’t warrant an ER visit. The first part falls into the “for fun” category I mentioned above, and I’m skeptical it presents a significant issue. For the second part, we have to consider why someone would be inclined to overuse ER care, and the biggest reason I can think of is convenience: you can walk in after work or on the weekend, when many PCPs are closed. But urgent care clinics can do the same at a lower cost. A good way to combat this is probably to prohibit ERs from feeding into it by providing and advertising wait times and wait time guarantees, which have no place in true emergency care; who would do this if they knew they were risking waiting 6 hours behind more severely ill patients? Another good way would be to encourage PCPs (with higher payments) to work around patients’ usual 9-5 M-F schedules.
Third, homeless that use the ER as a shelter – but this happens anyway and is passed onto paying patients already; for obvious reasons, these bills tend to go unpaid. M4A wouldn’t affect this behavior.
Fourth, health anxiety, Munchausen, etc. These are actual medical issues, not overconsumption, IMO, but I know some consider them overconsumption. And I’m not convinced cost-sharing deters sufferers of these conditions from seeking medical care anyway, some of which undoubtedly is uncompensated and paid for by everyone else already.
My thoughts, and I’m open to data showing otherwise: the “overconsumption” supposedly inherent in an M4A plan due to the lack of cost-sharing is mostly necessary care that wasn’t obtained in the past due to cost. That’s not overconsumption.
These are the reasons why HC will not be ‘reformed’ anytime soon and why M4A has no shot nationally. I think the Megacorps have a vested interest in maintaining the status quo knowing that they can use their HC benefits as a weapon and shield against employees looking to leave.
I know that when I retired from my Megacorp it was the #2 reason why folks wouldn’t leave even if a buyout was offered, the #1 of course being that they didn’t have enough money saved up.
Nothing serious will happen until corps get on an even playing field with HC insurance, right now as mentioned above most employees are happy to have tax-free bennies (with usually better insurance at a cheaper price than the ACA). And employers get to write all of it off etc.
So in other words nothing serious will happen, even if the Dems get control. Money will talk.
tax breaks for healthcare, esp employer tax deduction
rising drug prices, including PBMs who negotiate discounts and keep the profits
lobbying by increasingly large healthcare industry to preserve the status quo
In particular, they show the US does not consume a meaningfully different amount of healthcare per capita compared to other developed countries, it’s just that the care we do use is more expensive.
This is no way pushes for single payer. It explains how backroom deals and bilk whoops i mean bill the govt … runs amok.
If anything its the opposite … get govt OUT OF HEALTHCARE
Id like to see the govt out of all healthcare. Yes including medicare. Since weve already paid in that money should goto insurance or even cash to use at doctors offices.
You dont realize how expensive conforming to those rules n procedures is …
FW had an article on a dr who went cash only. No insurance no medicare. Fired most of his office staff and cut his prices IN HALF.
Why would this work ? Because numping thru a bunch of hoops to get a small percentage isnt worth it when u have to do real volume in order to make any kind of money.
Hospital consolidation allowing hospitals to charge monopoly rents can be solved with single-payer, antitrust enforcement, or ideally, both. In rural areas, however, there may not be enough demand to support multiple hospitals.
The inefficiencies created by numerous intermediaries can be solved with single-payer. Administrative expenses in the US are far higher than anywhere else.
Drug prices would be reduced under single-payer, provided Medicare was actually allowed to negotiate prices and establish a formulary. The WSJ article talks about Humira in particular. An NYT article about Humira from January, citing a 2015 source, says:
These are only a few high-profile overpriced drugs. There are many more.
There is also the advantage that doctors can easily familiarize themselves with a single Medicare formulary and consider cost in their prescribing decisions. In many cases, there are multiple drugs that could be used to treat a condition, with similar side effect and safety profiles. PBMs currently establish formularies, guidelines, and may require step therapy for some drugs (which requires the patient to try lower-cost drugs first, unless there is some reason not to, and step up from there if they don’t work). This is a pain for doctors to deal with because there are numerous PBM formularies out there (even from the same PBM), and different PBMs have different negotiated deals, so the lowest-cost drug to one PBM may be the highest-cost drug to another. One formulary for everyone would be easily manageable; dozens of them depending on the patient’s insurer, plan, and PBM formulary is not. Not to mention that if/when the patient switches insurers, it may be necessary to go through the entire authorization process again and potentially try different drugs if the new PBM’s requirements are different.
Suggesting that doctors could simply go cash-only to solve this problem is naive. For one, cost-sharing discourages use even when the use is medically advisable, and we shouldn’t discourage the use of primary care – it’s way cheaper to resolve something via primary care than to risk it turning into a hospital situation later. Second, it’s not a solution for catastrophic risks – e.g. a cancer diagnosis, a major accident, or any other serious condition – as most people do not have the means to self-insure for such risks. (It’s also inefficient to do so.) You could then suggest a combination system of cash-only for cheap services like PCP visits and private insurance for higher-cost services like hospitals, but then you have the same administrative bloat on the hospital side while discouraging cheap primary care use. It’s the worst of both worlds.
In general, cost-sharing works when the insured has some ability to eliminate or mitigate damages. For example, your auto deductible encourages you not to leave your car somewhere unlocked with the keys in it. Healthcare is different – things are often just random (or we later find out that something thought to be safe actually wasn’t), and the patient already has “skin in the game” by virtue of, well, their health being involved.
Do you have any clue what the VA is like. Thats 100% govt run healthcare. It will be the exact same thing under single payer. Not initially but yes it will become so.
Do you plan on having death panels ? U cannot budget without them. So yes or no. We have death panels right now. The insurance company says ur not covered if u die so what. What exactly do you think will happen when the deep pockets of uncle sam are footing the bill.
Either u have death panels … which oh by the way isnt very popular with the voters … or you will have super run away costs.
You think drug makers are going to lower their costs ? Uh no. They will just lobby n support congress candidates who support doing away with death panels.
Grandma needs medication that MAY prolong her life on avg 7 months. But it costs 100,000$ a month. Now that uncle sam is picking up the bill … why not ?
Now lets get back to the VA. Do u know why the VA sucks ? Because they are fighting with govt to fund basic shit. Why ? Because tax dollars need to goto other places so the VA only gets so much. Not multiply that by the entire nation. Yes in the very short term thing will be better. But by year three we will be in here talking about how to fix this ballooning costs in our medical care. Except when that comes … it will be of staggering proportions.
Remember. Once u go single u can never go back.
