alt Hacker NewsA lot of this is an issue of insurance no longer being "insurance" in the classical sense. Insurance covers all sorts of things, my HSA pays for all sorts of things that I never would have even considered, and while that sounds great, it helps to drive up costs. It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total chaos, so I get why we don't do that. But the situatuon is a lot like student loans, colleges know they can charge more because the government will lend 5-6 figures to just about anybody, so the colleges do so. And once that person is educated, you can't just "take back" the education if they don't pay. Same deal with healthcare, government subsidizes it for most of the population in lots of ways, healthcare providers know this, they increase prices to match. And you can't just take back the surgery to fix that broken arm or undeliver the baby. There's not a single silver bullet that will fix everything, but there are definitely concrete changes that can be made to improve the situation. One of them would be to make people healthier. I know, easier said than done. But by God it would make health insurance cheaper. Same way in that if everyone was a safe driver, we'd all be paying less in car insurance. Another way would be to remove that regulation or rule or something that makes it so like a hospital can't open too close to another hospital. Another would be to just, train more doctors! What I'm trying to say is, just as the problem is multi-faceted, the solution must necessarily be as well.
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> It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total chaos, so I get why we don't do that.
But there are other things we could do that we don't.
For example, right now we have the expectation that insurers are going to "negotiate" with providers to determine the price, and then you have to use the providers your insurance has negotiated with, but who actually wants this? When you as a retail customer want to buy a pair of shoes or a piece of exercise equipment, do you call up all the manufacturers and try to haggle with them? No, they list their prices on their websites or sell them through retailers that do the same and then you choose based on who has what you want for the best price.
So make non-emergency healthcare work like that. Require them to publish their prices. Then the insurance company doesn't tell you where to go or negotiate with anybody, they only tell you how much they pay, which might be e.g. 90% of the second-lowest market price in your area, equivalent to a 10% deductible. Then you go to a website that lists every provider and their price, pick where to go and pay the difference yourself.
Suddenly they all have the incentive to publish the best price, because that's what most people are going to pick, and then you have an actual market instead of the existing opaque bureaucracy of corruption.
The majority of spend is in the last few years of life. A man dying of a stroke during the night at age 50 is much cheaper to the system than the same man living to 90 having fought cancer for 10 years.
I'm not advocating against health nor preventive care, however they don't decrease costs nearly as much as you'd expect.
Christian healthcare sharers do precisely this. By restricting services and the population addressed (your pastor or priest must sign off on your application), everything's extremely affordable. In particular, as we don't drink, do drugs, use contraceptives etc. we don't pay for coverage of them or their side effects. Obesity's also less of an issue.
There's also the trick of telling the hospital you'll pay "in cash" and getting a 10x lower bill from the hospital, then getting that reimbursed/covered by your private or alternative insurance.
> that regulation or rule or something that makes it so like a hospital can't open too close to another hospital
You're referring to certificate of need laws, but it's worth pointing out that they're not universal. More than a dozen states have repealed them (or don't have them) and everywhere I've looked, there's strong evidence that their removal has increased healthcare access, which has put downward pressure on cost of service
> Another would be to just, train more doctors!
Bill Clinton placed a cap on GME funding in the 97 Balanced Budget Act, freezing the number of residency slots that the federal government would provide funding for, so this effectively froze the number of residents there could be, which effectively limits the number of doctors possible
"If insurance covered brake pads they'd cost more" is an old mechanics quip. The principal agent problem just fucks the cost and incentive structure of anything insurance covers.
This is why it's unwise to send "routine" things through the insurance model.
"There's not a single silver bullet that will fix everything" idk, it seems like eliminating the profit motive from healthcare would resolve all kinds of problems.
Unfortunately, most of what you suggest would get in the way of many people making a lot of money.
> 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.