I'm an Australian who lives in the UK, so it would be very easy for me to say something along the lines of guise you should just get the government to run the health system, it's so much better,...
I'm an Australian who lives in the UK, so it would be very easy for me to say something along the lines of guise you should just get the government to run the health system, it's so much better, but that would be boring and not terribly insightful.
The entire idea of insurance is that everyone who takes out a policy is pooling their payments and their risk together. Most people never claim as much as they pay in, but some people claim much more than they pay in, and the insurance company handles that risk. A 'socialised' public healthcare system works exactly the same way, but everyone is a policyholder, and it's funded through taxes rather than individual policyholders paying in.
Of course, Freedom and Choice and Free Markets are foundational parts of the US' national identity, so that isn't going to work for you, so instead you have private companies offering health insurance. Fine, makes sense.
But as far as I can tell, individuals in America don't take out their own health insurance policies, but instead get it as part of their workplace pay package. This is the bit that strikes me as a terrible idea. It means that instead of taking out the specific policy that meets your own needs and budget, that decision is made on your behalf by your employer. Suddenly your needs are irrelevant, and all that matters is the price. The buyer and the end-user are now different people, who have their own antagonistic relationship going on, so demand in the health insurance market has nothing to do with quality any more.
And then it gets worse, in this article. It's not entirely clear - I suspect the author doesn't know himself - but I think that Change Healthcare is a payment processing business operating between the insurance companies and the actual healthcare providers. So they're the victim of a cyberattack and can no longer deliver on their contracts, but the market has no incentive to punish them for this. The healthcare providers' solvency is now under threat, the insurers don't care because they have an excuse for not paying out, the employers don't care because they paid for a health insurance policy and that's all that matters, and the policy beneficiaries suffer but don't have a say in what happens because they're not buying anything.
I want to use your comment to also point out that when modern insurance companies as we know them today formed during the 18th and 19th century, pretty much all insurance companies were...
I want to use your comment to also point out that when modern insurance companies as we know them today formed during the 18th and 19th century, pretty much all insurance companies were cooperatively owned by the policyholders similar to how credit unions are structured, because everybody understood the naked conflict of interest involved in having a privately owned for-profit insurance company. But then private equity companies in the 20th century started basically lobbying mutual insurance company executives to initiate a process called “demutualization”, privatizing the mutual insurance company. Essentially, they run a marketing campaign and convince all the policyholders that they can just get free money if they let some random people take over the company, and for literally everyone who never actually needs to use their policy, there’s no downside. But like the whole point of insurance is that you want be able to count on it.
Anyway, it’s proof that “privatized” doesn’t actually simply mean “the government doesn’t own it” and it’s also the reason why most insurance companies have the word “mutual” in their name even though these days it’s essentially a lie.
Mutual companies are still really common today. Do you have any examples of companies claiming to be mutual companies when they're not? I would think that would be illegal.
Mutual companies are still really common today. Do you have any examples of companies claiming to be mutual companies when they're not? I would think that would be illegal.
I mean that's not really how it turned about. Much of the welfare state systems of Europe and certain countries in Asia came after WWII, and the destruction from that. When everything is...
Of course, Freedom and Choice and Free Markets are foundational parts of the US' national identity, so that isn't going to work for you, so instead you have private companies offering health insurance.
I mean that's not really how it turned about. Much of the welfare state systems of Europe and certain countries in Asia came after WWII, and the destruction from that. When everything is destroyed, and you a fresh line of credit from the Marshall Plan, then it's time when you can major rethinks about how things like insurance work.
Whereas the US was both unscathed and doing completely fine, at least for voters. People will always be resistant to change - it's the fear that in trying to do something better, you just end up in an even worse position. Why rock the boat.
As an aside, I think people have an unhealthily binary dichotomy between something like the US and something like the NHS. There's plenty of models in between, that work better than both. In particular, for the US I'd present Japan's healthcare system as a model, as it's very close to the US's, while having far better health outcomes than either the US or UK.
In Japan, too, over half of the population gets its insurance from their employer - that part is fine, and the infrastructure in the US has long been set up. To get the rest caught up, what we need is more regulations on minimum coverage standards, something which the ACA already did quite a lot of, as well as bolstering a backup insurance for the unemployed or self employed - which in the US would be Medicaid.
So the playbook in the US for getting to where Japan is, is to slowly add more coverage and/or pricing regulations on the insurance industry, and to continue to bump up the minimum medicaid income until it covers the majority of the population. As a bonus, offering a paid, but subsidized, plan for those above the threshold.
That's much less boat rocking than rip-out-everything, and each individual piece is already popular with the voting base.
The Dutch system is much closer to the American one but without the employer being a factor. Let's call it subsidized private health care. Let's also call it a horrible system. But that aside have...
The Dutch system is much closer to the American one but without the employer being a factor.
Let's call it subsidized private health care.
Let's also call it a horrible system. But that aside have a look and see how it works. You're right, it's not a dichotomy and there's plenty of systems that work in between the NHS and whatever the US has created. See how the same privatised health care system could work disconnected from employers.
Point being that I posit that it has nothing to whether it's employer related but rather that privatised health care is a blight. It's increasingly expensive and unwieldy.
Well, sure. Much of the ACA was based off of the Dutch system, after all. But not only does it empirically provide worse outcomes than Japan's metrics, the infrastructure for healthcare...
Well, sure. Much of the ACA was based off of the Dutch system, after all. But not only does it empirically provide worse outcomes than Japan's metrics, the infrastructure for healthcare disbursement is already entrenched with employment in the US; to rip that out is no small thing, and I don't think the Dutch system in practice is that similar because of that. Healthcare from employers can work perfectly fine.
It's really weird to me that healthcare through one's employer is being treated as somehow opposed to having public health insurance in this thread -- you absolutely would not need to "rip out"...
It's really weird to me that healthcare through one's employer is being treated as somehow opposed to having public health insurance in this thread -- you absolutely would not need to "rip out" anything to have a public option in the US. Public health insurance is disbursed through one's employer in Germany, but you're also provided with the exact same coverage if you're receiving it through social services -- coverage that is far better than even very good private health insurance in the US. Private health insurance exists and you can opt for it instead if you earn enough (and because the public option exists, they're obligated to offer you either better coverage or better rates or both), in which case you employer contributes their portion to that instead.
How do you square that policy of steadily increasing medicaid spending with the US’ already sky-high healthcare spending at ~20% of GDP? You throw out coverage and pricing regulations as a means...
How do you square that policy of steadily increasing medicaid spending with the US’ already sky-high healthcare spending at ~20% of GDP?
You throw out coverage and pricing regulations as a means to that end, but would you disagree with the assertion that the industry is already heavily regulated? What percentage reduction in cost of basic coverage do you think is viable from that policy route?
I’m deeply skeptical of the economic viability of simply expanding Medicare coverage to the whole US population without dire economic consequences, given how abysmal the unit-cost of basic services is. (To be clear, I’m still very much in favor of universal coverage but believe it’ll require holistic reform.)
What needs squaring? Even in a cost-neutral situation, which I think is unlikely, all that would do is shift private money to public money. The amount people spend on healthcare wouldn't change at...
What needs squaring? Even in a cost-neutral situation, which I think is unlikely, all that would do is shift private money to public money. The amount people spend on healthcare wouldn't change at all. You're just changing the color of spend.
I would disagree on a relative scale. Healthcare is more regulated than other industries, but there's obviously quite a lot more compared to other countries with mixed private/public healthcare systems. As to what you can get it down to, just look at other models. Japan is at 11% of GDP, for instance.
Additionally, there's many economies of scale factors that allow expanded medicaid to be cheaper. Just look at the actual effects of medicaid expansion
During 2014–17, Medicaid expansion was associated with a 4.4 percent to 4.7 percent reduction in state spending on traditional Medicaid. Estimates of savings outside of the Medicaid program vary significantly. Savings on mental health care, in the corrections system, and from reductions in uncompensated care range from 14 percent of the cost of expansion in Kentucky to 30 percent in Arkansas.
In many cases, it was negative increase in healthcare spending for states that expanded medicaid. I don't think the assertion that expanding medicaid will cause an uncontrollable spiral in medical costs for the nation as a whole has any grounding in reality.
I don’t follow your argument here: Isn’t the main goal of universal coverage to offer services to people who currently don’t have access to them (uninsured or insured who can’t afford OOP...
I don’t follow your argument here: Isn’t the main goal of universal coverage to offer services to people who currently don’t have access to them (uninsured or insured who can’t afford OOP components)? That’s not services that are currently being paid for privately. Also would require jacking up tax rates massively to accommodate the shift from private to public spending.
Circling back to the state Medicaid savings, I think you’re arguing my point for me: best-case scenario, there’s about 20% reduction in unit cost if we keep everything else on the same but give out universal coverage. That’d put the total cost of universal coverage well over the 30% of GDP mark, probably closer to 40%.
When we're looking at healthcare spending per GDP, we're not looking at literally how much everyone spends in insurance bills - it's ALL costs associated with medical treatment. Do the uninsured...
When we're looking at healthcare spending per GDP, we're not looking at literally how much everyone spends in insurance bills - it's ALL costs associated with medical treatment. Do the uninsured contribute zero to healthcare spending? Of course not. Everyone needs medical treatment, at least on average, the only difference is that the uninsured pay a much larger premium at the time of treatment. When someone breaks their leg and gets a $5000 hospital bill, that is healthcare spending.
Sure, with medicaid expansion, people may go to the doctor more, but that's also a good thing. That'd mostly be in preventative care, and increased preventative care is shown to decrease the net amount a country spends in health related costs. That's why the ACA made preventative care free.
Increased medicaid, or whatever the "fallback" is, not only increases coverage, but has many other effects: for one, it effectively sets a floor on what the private sector can offer for a given price, as if it's worse than the medicaid, people will just rather fallback to it. Secondly, it gives medicaid significant power, for the same reason that allowing medicare to negotiate was such a big deal. Third, there's economies of scale with healthcare, and generally the broader the coverage the cheaper the per unit costs get on average.
I'm honestly not sure where you're pulling these numbers from. Again, when states expand medicaid eligibility, their total medicaid bills goes down in many cases. I think as a whole, the US with a Japan-like model can get the nation's total health-related spending - that is, any and all medical costs across the entire country - like around 15-17% of GDP, which is less than what we spend today, and with much better outcomes and coverage.
The people impacted by marginally raising the Medicaid cutoff are people who, generally speaking, are forgoing care or don't have access to it at the moment. There's very little existing...
The people impacted by marginally raising the Medicaid cutoff are people who, generally speaking, are forgoing care or don't have access to it at the moment. There's very little existing expenditure they're burning on private insurance that'll be offsetting the marginal increase. Sure, that population gets charged absurd nominal amounts for emergent care, periodically - but in terms of what gets collected, it's literally about a dime on the dollar. That's speaking from lots of personal experience with both IP and OP claims sets.
I'm honestly not sure where you're pulling these numbers from. Again, when states expand medicaid eligibility, their total medicaid bills goes down in many cases.
E: and my 30-40% of GDP number is coming from a theoretical scenario where we don't change our existing system at all (including private insurance spend), but just suddenly extend Medicaid to the entire US population.
You are aware that the states' effective medicaid bill is going down by expanding coverage because the feds are picking up 90% of the tab, right?
I could say a lot about how monopolies and near monopolies distort and exploit markets and about the need for antitrust enforcement. I would say your comment is very much on target.
I could say a lot about how monopolies and near monopolies distort and exploit markets and about the need for antitrust enforcement.
It's definitely not, especially since most American's are hamstrung to whatever their employer provides for them. I can't choose to opt out from my employer's chosen insurer. That's not a market....
It's definitely not, especially since most American's are hamstrung to whatever their employer provides for them.
I can't choose to opt out from my employer's chosen insurer. That's not a market.
I'd say a majority Americans suffer from biblical-esq delusions about how 'good' America is and how 'bad' the rest of the world is, as well as how 'free' we are.
You can choose to opt out and use an insurance plan from the marketplace. But this isn't cheap and the coverage isn't great. Speaking from experience. My employer coverage is so astronomically...
You can choose to opt out and use an insurance plan from the marketplace. But this isn't cheap and the coverage isn't great. Speaking from experience.
My employer coverage is so astronomically awful that it's still a better choice for me.
I think that's what I meant by "you can't". It'a not a genuine choice if I can't also take my employer's share with me given how these things are priced. Unsurprisingly, it looks like most opt-out...
I think that's what I meant by "you can't". It'a not a genuine choice if I can't also take my employer's share with me given how these things are priced.
Unsurprisingly, it looks like most opt-out options are geared for the benefit of the employer, not the employee.
And it looks like my employer only allows me to opt out if I can prove my spouse provides coverage instead.
You can prove coverage from the marketplace as well. I'm only emphasizing this because there has to be at least a few other people who get a slightly better deal on the marketplace.
You can prove coverage from the marketplace as well.
I'm only emphasizing this because there has to be at least a few other people who get a slightly better deal on the marketplace.
The financials of the US healthcare system have fully devolved into a pure wealth-extraction mechanism feeding on US citizens. $200 billion USD yearly profit buys all the senators you could want,...
The financials of the US healthcare system have fully devolved into a pure wealth-extraction mechanism feeding on US citizens. $200 billion USD yearly profit buys all the senators you could want, and easily prevent any laws which would call out this blatant theft from gaining any traction.
Is it a free market? ...yes. Free from regulation and oversight, free for the strongest (in this case, the most wealthy) to solidly stand on top and freely do whatever they want, because when you make $200 billion a year, you get to write your own laws.
No, and to be clear, outside of political mouthpieces, almost no one thinks our healthcare is sane. Even the more diehard free market people (who actually know anything about markets and aren't...
Is this really a free market?
No, and to be clear, outside of political mouthpieces, almost no one thinks our healthcare is sane.
Even the more diehard free market people (who actually know anything about markets and aren't just using words they've heard) agree that healthcare as is doesn't meet those qualifications.
I'm not sure if this is a controversial take or not, but I tend to think if a health clinic doesn't have adequate cybersecurity then they probably should go out of business. Who wants to risk...
I'm not sure if this is a controversial take or not, but I tend to think if a health clinic doesn't have adequate cybersecurity then they probably should go out of business. Who wants to risk their medical records like that?
If I understand correctly, it's not that the health clinics failed. The security fail was with the company that processes insurance claims and compensation and pricing. That company is a monopoly...
If I understand correctly, it's not that the health clinics failed.
The security fail was with the company that processes insurance claims and compensation and pricing. That company is a monopoly or nearly a monopoly
I mean they're still on the hook at the end of day. Some level of planning needs to happen in case any third-party system goes down or gets disrupted since that's a known operational risk. That's...
I mean they're still on the hook at the end of day. Some level of planning needs to happen in case any third-party system goes down or gets disrupted since that's a known operational risk. That's especially true if the business signed an exclusivity contract that doesn't permit/specify a fallback service or some form of compensation adjustment/fee when the service isn't provided.
Its services allow doctors to look up patients’ insurance, pharmacies to process prescriptions, and health clinics to submit claims so they can get paid.
Phone and fax still seem to be common methods of getting this stuff done, at least at facilities I've had to deal with over the years.
I suppose this is all a bit secondary though if the core issue comes down to cash flow. Perhaps they simply weren't keeping enough in their reserves.
If the payment provider has a near monopoly across the industry, then choosing not to work with that payment provider is about the same as choosing not to work in that industry. And from the...
If the payment provider has a near monopoly across the industry, then choosing not to work with that payment provider is about the same as choosing not to work in that industry. And from the payment provider’s perspective, why would they spend money on fortifying their systems against cyber threats when they rake in just as much money without that spend, because nobody has any real choice to go to a competitor?
This is absolutely not the case, there are dozens of claims clearinghouses/healthcare clearinghouses in the US. Now, my understanding is that CHC did or does have some exclusive contracts for...
That company is a monopoly or nearly a monopoly
This is absolutely not the case, there are dozens of claims clearinghouses/healthcare clearinghouses in the US. Now, my understanding is that CHC did or does have some exclusive contracts for things like operating PBMs for some insurers/state medicaids and that kind of things, but they certainly don't have a monopoly on clearinghouse services.
That said, the cost and effort involved in switching clearinghouses or medical billing software is, as I understand it, extremely high, mostly due to the patchwork of payers that these companies have to be able to interface with, each of whom have different requirements and technologies. There have been a few efforts to standardize things, for example there is a set of standardized medical transactions, but there are also a lot of gaps and differences among payers.
I'm an Australian who lives in the UK, so it would be very easy for me to say something along the lines of guise you should just get the government to run the health system, it's so much better, but that would be boring and not terribly insightful.
The entire idea of insurance is that everyone who takes out a policy is pooling their payments and their risk together. Most people never claim as much as they pay in, but some people claim much more than they pay in, and the insurance company handles that risk. A 'socialised' public healthcare system works exactly the same way, but everyone is a policyholder, and it's funded through taxes rather than individual policyholders paying in.
Of course, Freedom and Choice and Free Markets are foundational parts of the US' national identity, so that isn't going to work for you, so instead you have private companies offering health insurance. Fine, makes sense.
But as far as I can tell, individuals in America don't take out their own health insurance policies, but instead get it as part of their workplace pay package. This is the bit that strikes me as a terrible idea. It means that instead of taking out the specific policy that meets your own needs and budget, that decision is made on your behalf by your employer. Suddenly your needs are irrelevant, and all that matters is the price. The buyer and the end-user are now different people, who have their own antagonistic relationship going on, so demand in the health insurance market has nothing to do with quality any more.
And then it gets worse, in this article. It's not entirely clear - I suspect the author doesn't know himself - but I think that Change Healthcare is a payment processing business operating between the insurance companies and the actual healthcare providers. So they're the victim of a cyberattack and can no longer deliver on their contracts, but the market has no incentive to punish them for this. The healthcare providers' solvency is now under threat, the insurers don't care because they have an excuse for not paying out, the employers don't care because they paid for a health insurance policy and that's all that matters, and the policy beneficiaries suffer but don't have a say in what happens because they're not buying anything.
Is this really a free market?
I want to use your comment to also point out that when modern insurance companies as we know them today formed during the 18th and 19th century, pretty much all insurance companies were cooperatively owned by the policyholders similar to how credit unions are structured, because everybody understood the naked conflict of interest involved in having a privately owned for-profit insurance company. But then private equity companies in the 20th century started basically lobbying mutual insurance company executives to initiate a process called “demutualization”, privatizing the mutual insurance company. Essentially, they run a marketing campaign and convince all the policyholders that they can just get free money if they let some random people take over the company, and for literally everyone who never actually needs to use their policy, there’s no downside. But like the whole point of insurance is that you want be able to count on it.
Anyway, it’s proof that “privatized” doesn’t actually simply mean “the government doesn’t own it” and it’s also the reason why most insurance companies have the word “mutual” in their name even though these days it’s essentially a lie.
Mutual companies are still really common today. Do you have any examples of companies claiming to be mutual companies when they're not? I would think that would be illegal.
I mean that's not really how it turned about. Much of the welfare state systems of Europe and certain countries in Asia came after WWII, and the destruction from that. When everything is destroyed, and you a fresh line of credit from the Marshall Plan, then it's time when you can major rethinks about how things like insurance work.
Whereas the US was both unscathed and doing completely fine, at least for voters. People will always be resistant to change - it's the fear that in trying to do something better, you just end up in an even worse position. Why rock the boat.
As an aside, I think people have an unhealthily binary dichotomy between something like the US and something like the NHS. There's plenty of models in between, that work better than both. In particular, for the US I'd present Japan's healthcare system as a model, as it's very close to the US's, while having far better health outcomes than either the US or UK.
In Japan, too, over half of the population gets its insurance from their employer - that part is fine, and the infrastructure in the US has long been set up. To get the rest caught up, what we need is more regulations on minimum coverage standards, something which the ACA already did quite a lot of, as well as bolstering a backup insurance for the unemployed or self employed - which in the US would be Medicaid.
So the playbook in the US for getting to where Japan is, is to slowly add more coverage and/or pricing regulations on the insurance industry, and to continue to bump up the minimum medicaid income until it covers the majority of the population. As a bonus, offering a paid, but subsidized, plan for those above the threshold.
That's much less boat rocking than rip-out-everything, and each individual piece is already popular with the voting base.
The Dutch system is much closer to the American one but without the employer being a factor.
Let's call it subsidized private health care.
Let's also call it a horrible system. But that aside have a look and see how it works. You're right, it's not a dichotomy and there's plenty of systems that work in between the NHS and whatever the US has created. See how the same privatised health care system could work disconnected from employers.
Point being that I posit that it has nothing to whether it's employer related but rather that privatised health care is a blight. It's increasingly expensive and unwieldy.
Can you elaborate as to why you think this is the case?
Well, sure. Much of the ACA was based off of the Dutch system, after all. But not only does it empirically provide worse outcomes than Japan's metrics, the infrastructure for healthcare disbursement is already entrenched with employment in the US; to rip that out is no small thing, and I don't think the Dutch system in practice is that similar because of that. Healthcare from employers can work perfectly fine.
It's really weird to me that healthcare through one's employer is being treated as somehow opposed to having public health insurance in this thread -- you absolutely would not need to "rip out" anything to have a public option in the US. Public health insurance is disbursed through one's employer in Germany, but you're also provided with the exact same coverage if you're receiving it through social services -- coverage that is far better than even very good private health insurance in the US. Private health insurance exists and you can opt for it instead if you earn enough (and because the public option exists, they're obligated to offer you either better coverage or better rates or both), in which case you employer contributes their portion to that instead.
How do you square that policy of steadily increasing medicaid spending with the US’ already sky-high healthcare spending at ~20% of GDP?
You throw out coverage and pricing regulations as a means to that end, but would you disagree with the assertion that the industry is already heavily regulated? What percentage reduction in cost of basic coverage do you think is viable from that policy route?
I’m deeply skeptical of the economic viability of simply expanding Medicare coverage to the whole US population without dire economic consequences, given how abysmal the unit-cost of basic services is. (To be clear, I’m still very much in favor of universal coverage but believe it’ll require holistic reform.)
What needs squaring? Even in a cost-neutral situation, which I think is unlikely, all that would do is shift private money to public money. The amount people spend on healthcare wouldn't change at all. You're just changing the color of spend.
I would disagree on a relative scale. Healthcare is more regulated than other industries, but there's obviously quite a lot more compared to other countries with mixed private/public healthcare systems. As to what you can get it down to, just look at other models. Japan is at 11% of GDP, for instance.
Additionally, there's many economies of scale factors that allow expanded medicaid to be cheaper. Just look at the actual effects of medicaid expansion
In many cases, it was negative increase in healthcare spending for states that expanded medicaid. I don't think the assertion that expanding medicaid will cause an uncontrollable spiral in medical costs for the nation as a whole has any grounding in reality.
I don’t follow your argument here: Isn’t the main goal of universal coverage to offer services to people who currently don’t have access to them (uninsured or insured who can’t afford OOP components)? That’s not services that are currently being paid for privately. Also would require jacking up tax rates massively to accommodate the shift from private to public spending.
Circling back to the state Medicaid savings, I think you’re arguing my point for me: best-case scenario, there’s about 20% reduction in unit cost if we keep everything else on the same but give out universal coverage. That’d put the total cost of universal coverage well over the 30% of GDP mark, probably closer to 40%.
When we're looking at healthcare spending per GDP, we're not looking at literally how much everyone spends in insurance bills - it's ALL costs associated with medical treatment. Do the uninsured contribute zero to healthcare spending? Of course not. Everyone needs medical treatment, at least on average, the only difference is that the uninsured pay a much larger premium at the time of treatment. When someone breaks their leg and gets a $5000 hospital bill, that is healthcare spending.
Sure, with medicaid expansion, people may go to the doctor more, but that's also a good thing. That'd mostly be in preventative care, and increased preventative care is shown to decrease the net amount a country spends in health related costs. That's why the ACA made preventative care free.
Increased medicaid, or whatever the "fallback" is, not only increases coverage, but has many other effects: for one, it effectively sets a floor on what the private sector can offer for a given price, as if it's worse than the medicaid, people will just rather fallback to it. Secondly, it gives medicaid significant power, for the same reason that allowing medicare to negotiate was such a big deal. Third, there's economies of scale with healthcare, and generally the broader the coverage the cheaper the per unit costs get on average.
I'm honestly not sure where you're pulling these numbers from. Again, when states expand medicaid eligibility, their total medicaid bills goes down in many cases. I think as a whole, the US with a Japan-like model can get the nation's total health-related spending - that is, any and all medical costs across the entire country - like around 15-17% of GDP, which is less than what we spend today, and with much better outcomes and coverage.
The people impacted by marginally raising the Medicaid cutoff are people who, generally speaking, are forgoing care or don't have access to it at the moment. There's very little existing expenditure they're burning on private insurance that'll be offsetting the marginal increase. Sure, that population gets charged absurd nominal amounts for emergent care, periodically - but in terms of what gets collected, it's literally about a dime on the dollar. That's speaking from lots of personal experience with both IP and OP claims sets.
My "20% reduction" estimate is extrapolating a best-case reduction in cost from the economy-of-scale effect, based on the source you quoted in your last comment: https://www.commonwealthfund.org/publications/issue-briefs/2020/may/impact-medicaid-expansion-states-budgets.
E: and my 30-40% of GDP number is coming from a theoretical scenario where we don't change our existing system at all (including private insurance spend), but just suddenly extend Medicaid to the entire US population.
You are aware that the states' effective medicaid bill is going down by expanding coverage because the feds are picking up 90% of the tab, right?
I could say a lot about how monopolies and near monopolies distort and exploit markets and about the need for antitrust enforcement.
I would say your comment is very much on target.
It's definitely not, especially since most American's are hamstrung to whatever their employer provides for them.
I can't choose to opt out from my employer's chosen insurer. That's not a market.
I'd say a majority Americans suffer from biblical-esq delusions about how 'good' America is and how 'bad' the rest of the world is, as well as how 'free' we are.
You can choose to opt out and use an insurance plan from the marketplace. But this isn't cheap and the coverage isn't great. Speaking from experience.
My employer coverage is so astronomically awful that it's still a better choice for me.
I think that's what I meant by "you can't". It'a not a genuine choice if I can't also take my employer's share with me given how these things are priced.
Unsurprisingly, it looks like most opt-out options are geared for the benefit of the employer, not the employee.
And it looks like my employer only allows me to opt out if I can prove my spouse provides coverage instead.
You can prove coverage from the marketplace as well.
I'm only emphasizing this because there has to be at least a few other people who get a slightly better deal on the marketplace.
The financials of the US healthcare system have fully devolved into a pure wealth-extraction mechanism feeding on US citizens. $200 billion USD yearly profit buys all the senators you could want, and easily prevent any laws which would call out this blatant theft from gaining any traction.
Is it a free market? ...yes. Free from regulation and oversight, free for the strongest (in this case, the most wealthy) to solidly stand on top and freely do whatever they want, because when you make $200 billion a year, you get to write your own laws.
No, and to be clear, outside of political mouthpieces, almost no one thinks our healthcare is sane.
Even the more diehard free market people (who actually know anything about markets and aren't just using words they've heard) agree that healthcare as is doesn't meet those qualifications.
I'm not sure if this is a controversial take or not, but I tend to think if a health clinic doesn't have adequate cybersecurity then they probably should go out of business. Who wants to risk their medical records like that?
If I understand correctly, it's not that the health clinics failed.
The security fail was with the company that processes insurance claims and compensation and pricing. That company is a monopoly or nearly a monopoly
I mean they're still on the hook at the end of day. Some level of planning needs to happen in case any third-party system goes down or gets disrupted since that's a known operational risk. That's especially true if the business signed an exclusivity contract that doesn't permit/specify a fallback service or some form of compensation adjustment/fee when the service isn't provided.
Phone and fax still seem to be common methods of getting this stuff done, at least at facilities I've had to deal with over the years.
I suppose this is all a bit secondary though if the core issue comes down to cash flow. Perhaps they simply weren't keeping enough in their reserves.
If the payment provider has a near monopoly across the industry, then choosing not to work with that payment provider is about the same as choosing not to work in that industry. And from the payment provider’s perspective, why would they spend money on fortifying their systems against cyber threats when they rake in just as much money without that spend, because nobody has any real choice to go to a competitor?
This is absolutely not the case, there are dozens of claims clearinghouses/healthcare clearinghouses in the US. Now, my understanding is that CHC did or does have some exclusive contracts for things like operating PBMs for some insurers/state medicaids and that kind of things, but they certainly don't have a monopoly on clearinghouse services.
That said, the cost and effort involved in switching clearinghouses or medical billing software is, as I understand it, extremely high, mostly due to the patchwork of payers that these companies have to be able to interface with, each of whom have different requirements and technologies. There have been a few efforts to standardize things, for example there is a set of standardized medical transactions, but there are also a lot of gaps and differences among payers.
Thanks for the explaination.