Our Next President?

[dcarrigg]

Re: Our Next President?

It's also true that we haven't taken what is, in my opinion, the obvious first step: ending (or at least modifying) the employer sponsored tax break. It seems to be an issue that is mostly non-partisan, yet it doesn't get done. Presumably that's because the insurance industry, like any other, likes when there's huge tax breaks for buying their products and they lobby to maintain it.

You're not wrong. I still don't think it would have a major effect on the underlying cost structure. Even if you abolish employer sponsored healthcare and force everyone on to the exchanges, the price would remain high for all the reasons I outlined earlier. The incentives just don't work; when you need a hospital stay, there's really no good way to shop around or even determine prices ahead of time. It all just reminds me of Crassus' private sector fire brigades. When your customers are necessarily vulnerable, you can squeeze them for whatever you want.

[jk]

Re: Our Next President?

i can only see 2 possible reasonable destinations for u.s. healthcare. one is a medicare-for-all kind of single payer. people who scream about the cost seem to forget what we're already spending on our current system. the only other reasonable system i can foresee is universal coverage through kaiser-like systems. kaiser is both insurer and healthcare delivery system- they have their own clinics and hospitals, and as the insurer too the incentives are all aligned.

most places in the country will have a natural monopoly because of limited local resources. these monopoly systems, however, can be benchmarked against systems in regions dense enough to support multiple delivery systems. kaiser, for example, operates in many markets in california. the sutter system is looser and differently structured, but could easily be turned into a kaiser-like operation by incorporating the insurance function. thus there can be competitive systems to set standards and prices.

[Polish_Silver]

Re: Our Next President?

Kasier is very efficient, in my experience. So were medical services run by universities, who had a stake
in controlling costs.
Universal coverage is not necessarily expensive. It is very cost effective in Taiwan, Hong Kong, Singapore, etc.

The problem I see here is that interests are so entrenched they will rig it to keep the costs up. (pharma, insurance companies, hospitals, doctors)

[dcarrigg]

Re: Our Next President?

i can only see 2 possible reasonable destinations for u.s. healthcare. one is a medicare-for-all kind of single payer. people who scream about the cost seem to forget what we're already spending on our current system. the only other reasonable system i can foresee is universal coverage through kaiser-like systems. kaiser is both insurer and healthcare delivery system- they have their own clinics and hospitals, and as the insurer too the incentives are all aligned.

most places in the country will have a natural monopoly because of limited local resources. these monopoly systems, however, can be benchmarked against systems in regions dense enough to support multiple delivery systems. kaiser, for example, operates in many markets in california. the sutter system is looser and differently structured, but could easily be turned into a kaiser-like operation by incorporating the insurance function. thus there can be competitive systems to set standards and prices.

Kaiser seems to do some good work, and I don't have any direct experience with them. But they don't seem to really keep costs down either. In some ways, the Catholic Church and a few other university schemes have created a somewhat similar alignment around here.

But here's the thing: I think of hospitals as a natural monopoly and as something more or less like a public utility.

I mean, we live in a country where we are fine with regulated electric prices, but people scream socialism when you talk about regulating healthcare prices. People in the US don't realize what regulation does for them.

Imagine if the electric systems in the US were run like the healthcare system.

• There'd be variable opaque pricing that changed by the street and by the second. It might cost you hundreds or thousands of dollars to run the AC on that 100 degree day or run the heat when it drops to -20 degrees. And you wouldn't be able to know the price until after you used it and you got the bill. You'd just be terrified to use the heat or AC on the days when you most need it, aware that the price might ruin you and you have no control over it.

• They'd force you to buy blackout insurance, otherwise they'd shut you off at times of peak load. Some companies might not even serve you without it. Each of the power suppliers would send you bills separately from the power distributors, system operators, and transmission companies, and most people would probably want some sort of third party insurance or other negotiator to handle rate negotiations even during regular times. The bills would be confusing and outrageous.

• Likely 10% or so of the country would simply go without electricity on the regular. There would be counties in Texas with less than 50% of households having power.

• Veterans, the poorest, and the elderly might get their own special government systems of blackout insurance to try to ensure they don't freeze to death. Maybe something called Electriccare or Electriccaid. These systems would vary enormously in effectiveness and coverage by state. Electric companies would complain that the rates those systems paid were below market rates.

• Maybe in California you'd have Kaiser Electric, who managed to unify the distribution grid and the blackout insurance. But even if they did so, they'd still have to interact with other third party insurance companies and the three government systems. And they'd still have an unregulated natural monopoly at point of service. So prices would stay the highest in the world.

• Over time, tangential businesses would pop up and become standard parts of the process. Backup batteries and generators with automatic refueling delivery services would become standard parts of the insurance package, because they'd be cheaper than if the insurance company just paid the price gouging of peak rates. Soon they'd be ubiquitous for the middle class, and every household would treat having a $30k battery in the basement and a giant generator running on hot days or cold nights as normal.

• The lack of direct price regulation would lead to not only the electric sector eating up a greater share of GDP, but the strain and stress the expenses it causes would lead to ever more political solutions and insurance schemes in a futile attempt to indirectly get prices under control.

• This would lead to ever more complicated regulations on everything but the goddamn prices. Soon you wouldn't be able to screw in a lightbulb yourself legally, and you'd have to hire someone with a postgrad degree to do it for you for hundreds or thousands of dollars. And they would be encouraged to ration them to try to get prices under control. It wouldn't work, but it would result in an ever more bloated advertising and marketing budget. "Ask your certified professional engineer if LG LED lightbulbs are right for you!" Meanwhile, in every other country where they did regulate prices for electricity directly, tangential products like LG LED lightbulbs would cost $3 a pop instead of $300.

• Concierge and superlux electric services would pop up, along with vanity electric consultants even though there's a shortage of electric consultants and relatively long wait times to get a lightbulb screwed in. More and more PEs would get out of the volume game and just serve the wealthiest, offering regular home infrared scans and insulation touch-ups and other luxury services that are expensive, but mostly non-essential.

• Political movements for years would cry "Elecriccare for all!" as the system grew ever more convoluted and the costs spiraled out of control.

• Of course, people wouldn't actually care about Electriccare per se. It would all be a means to an end, and the only one people could imagine. Really the goal would be getting everyone access to electricity and lowering rates out of the stratosphere. But, since in this universe price regulation for electricity is out of the question, the best people can imagine is getting everyone on a government blackout insurance plan and hoping that price negotiations would occur that way rather than direct price regulation.

• Yet even still people would insist that if we just restructure blackout insurance and have people call into their certified professional engineers on 100 degree mornings to make $200 copayments to get a referral to an air conditioner specialist to turn the AC on, we'll reduce electric consumption, and thereby control prices. We'll literally try absolutely everything and every institutional arrangment to control prices, except actually controlling prices.

• Since we won't control prices, soon enough every blackout insurance plan and every address will have different pricing for every time of every day, leading to a massive bloated administrative staff that makes super-kludgy IT systems and builds ultra-complex smart-meters and codes and bills for all the variables.

If this sounds absurd to you, I think it should. But I also think it's pretty damned close to the reality of how the healthcare system works in the US. Pretty much an unregulated natural monopoly at the ultimate point of service. So they've got you by the shorthairs. And if you're not going to regulate prices on the natural monopoly, then it's going to eat up an ever-increasing share of national income. People will realize this and it will become a political issue. Soon this whole system's going to sprout up around it as people who can't see the forest through the trees try to solve the problem in myriad indirect ways. It will never work, because the unregulated natural monopoly's still an unregulated natural monopoly. And now all these ancillary appendages the system grew over time exist and have lobbying power.

Why doesn't this happen with electricity in the US? Because we either A) run the electric delivery system as public and municipally owned, or B) regulate prices directly in the event the system is privately owned. Either way, rates are set, usually by a quasi-judicial commission or board, and for any given 6 or 12 month period in any given municipality, the cost of a kilowatt-hour of electricity is dictated, knowable, and constant. There may be some variation. Big industrial users will probably pay less per unit than residential users, etc. But there are a limited number of combinations and rules about that stuff. Power suppliers may be deregulated too, and consumers may be able to select them. But even there, the billing is mandated to occur through the distribution company and so the negotiations are not complex. And if people don't want to do that kind of shopping, they don't have to, and the electric company will provide a standard default supply offer that everyone gets just for signing up. Even then, some of the poorer areas of the country couldn't manage the infrastructure investment, so things like the TVA pop up and are still around. And in the 30s we sent guys through rural and urban residences that were unpowered and wired them up on Uncle Sam's dime. But we basically had the makings of a universal system with affordable prices.

I suspect we will never, ever have that in healthcare the way the system is designed today, where there is no price regulation, nor a universal negotiator, nor a standard offer service, nor even broad agreement on the concept that everyone deserves access.

This is extremely weird to me. Americans collectively have come to terms with the idea that electricity is essentially a universal right of citizenship, but healthcare is not. It's a really bizarre choice, out of step with the old hierarchy of needs. But here we are. People will kick and scream and fight you tooth and nail if you suggest that healthcare delivery prices ought to be regulated. But nobody bats an eye about the fact that electric delivery prices are regulated. Nobody calls it "socialized electric." Nobody even thinks about it. They just take it for granted that electricity will be available and affordable. What a concept!

[Chris Coles]

Re: Our Next President?

Kaiser seems to do some good work, and I don't have any direct experience with them. But they don't seem to really keep costs down either. In some ways, the Catholic Church and a few other university schemes have created a somewhat similar alignment around here.

But here's the thing: I think of hospitals as a natural monopoly and as something more or less like a public utility.

I mean, we live in a country where we are fine with regulated electric prices, but people scream socialism when you talk about regulating healthcare prices. People in the US don't realize what regulation does for them.

Imagine if the electric systems in the US were run like the healthcare system.

• There'd be variable opaque pricing that changed by the street and by the second. It might cost you hundreds or thousands of dollars to run the AC on that 100 degree day or run the heat when it drops to -20 degrees. And you wouldn't be able to know the price until after you used it and you got the bill. You'd just be terrified to use the heat or AC on the days when you most need it, aware that the price might ruin you and you have no control over it.

• They'd force you to buy blackout insurance, otherwise they'd shut you off at times of peak load. Some companies might not even serve you without it. Each of the power suppliers would send you bills separately from the power distributors, system operators, and transmission companies, and most people would probably want some sort of third party insurance or other negotiator to handle rate negotiations even during regular times. The bills would be confusing and outrageous.

• Likely 10% or so of the country would simply go without electricity on the regular. There would be counties in Texas with less than 50% of households having power.

• Veterans, the poorest, and the elderly might get their own special government systems of blackout insurance to try to ensure they don't freeze to death. Maybe something called Electriccare or Electriccaid. These systems would vary enormously in effectiveness and coverage by state. Electric companies would complain that the rates those systems paid were below market rates.

• Maybe in California you'd have Kaiser Electric, who managed to unify the distribution grid and the blackout insurance. But even if they did so, they'd still have to interact with other third party insurance companies and the three government systems. And they'd still have an unregulated natural monopoly at point of service. So prices would stay the highest in the world.

• Over time, tangential businesses would pop up and become standard parts of the process. Backup batteries and generators with automatic refueling delivery services would become standard parts of the insurance package, because they'd be cheaper than if the insurance company just paid the price gouging of peak rates. Soon they'd be ubiquitous for the middle class, and every household would treat having a $30k battery in the basement and a giant generator running on hot days or cold nights as normal.

• The lack of direct price regulation would lead to not only the electric sector eating up a greater share of GDP, but the strain and stress the expenses it causes would lead to ever more political solutions and insurance schemes in a futile attempt to indirectly get prices under control.

• This would lead to ever more complicated regulations on everything but the goddamn prices. Soon you wouldn't be able to screw in a lightbulb yourself legally, and you'd have to hire someone with a postgrad degree to do it for you for hundreds or thousands of dollars. And they would be encouraged to ration them to try to get prices under control. It wouldn't work, but it would result in an ever more bloated advertising and marketing budget. "Ask your certified professional engineer if LG LED lightbulbs are right for you!" Meanwhile, in every other country where they did regulate prices for electricity directly, tangential products like LG LED lightbulbs would cost $3 a pop instead of $300.

• Concierge and superlux electric services would pop up, along with vanity electric consultants even though there's a shortage of electric consultants and relatively long wait times to get a lightbulb screwed in. More and more PEs would get out of the volume game and just serve the wealthiest, offering regular home infrared scans and insulation touch-ups and other luxury services that are expensive, but mostly non-essential.

• Political movements for years would cry "Elecriccare for all!" as the system grew ever more convoluted and the costs spiraled out of control.

• Of course, people wouldn't actually care about Electriccare per se. It would all be a means to an end, and the only one people could imagine. Really the goal would be getting everyone access to electricity and lowering rates out of the stratosphere. But, since in this universe price regulation for electricity is out of the question, the best people can imagine is getting everyone on a government blackout insurance plan and hoping that price negotiations would occur that way rather than direct price regulation.

• Yet even still people would insist that if we just restructure blackout insurance and have people call into their certified professional engineers on 100 degree mornings to make $200 copayments to get a referral to an air conditioner specialist to turn the AC on, we'll reduce electric consumption, and thereby control prices. We'll literally try absolutely everything and every institutional arrangment to control prices, except actually controlling prices.

• Since we won't control prices, soon enough every blackout insurance plan and every address will have different pricing for every time of every day, leading to a massive bloated administrative staff that makes super-kludgy IT systems and builds ultra-complex smart-meters and codes and bills for all the variables.

If this sounds absurd to you, I think it should. But I also think it's pretty damned close to the reality of how the healthcare system works in the US. Pretty much an unregulated natural monopoly at the ultimate point of service. So they've got you by the shorthairs. And if you're not going to regulate prices on the natural monopoly, then it's going to eat up an ever-increasing share of national income. People will realize this and it will become a political issue. Soon this whole system's going to sprout up around it as people who can't see the forest through the trees try to solve the problem in myriad indirect ways. It will never work, because the unregulated natural monopoly's still an unregulated natural monopoly. And now all these ancillary appendages the system grew over time exist and have lobbying power.

Why doesn't this happen with electricity in the US? Because we either A) run the electric delivery system as public and municipally owned, or B) regulate prices directly in the event the system is privately owned. Either way, rates are set, usually by a quasi-judicial commission or board, and for any given 6 or 12 month period in any given municipality, the cost of a kilowatt-hour of electricity is dictated, knowable, and constant. There may be some variation. Big industrial users will probably pay less per unit than residential users, etc. But there are a limited number of combinations and rules about that stuff. Power suppliers may be deregulated too, and consumers may be able to select them. But even there, the billing is mandated to occur through the distribution company and so the negotiations are not complex. And if people don't want to do that kind of shopping, they don't have to, and the electric company will provide a standard default supply offer that everyone gets just for signing up. Even then, some of the poorer areas of the country couldn't manage the infrastructure investment, so things like the TVA pop up and are still around. And in the 30s we sent guys through rural and urban residences that were unpowered and wired them up on Uncle Sam's dime. But we basically had the makings of a universal system with affordable prices.

I suspect we will never, ever have that in healthcare the way the system is designed today, where there is no price regulation, nor a universal negotiator, nor a standard offer service, nor even broad agreement on the concept that everyone deserves access.

This is extremely weird to me. Americans collectively have come to terms with the idea that electricity is essentially a universal right of citizenship, but healthcare is not. It's a really bizarre choice, out of step with the old hierarchy of needs. But here we are. People will kick and scream and fight you tooth and nail if you suggest that healthcare delivery prices ought to be regulated. But nobody bats an eye about the fact that electric delivery prices are regulated. Nobody calls it "socialized electric." Nobody even thinks about it. They just take it for granted that electricity will be available and affordable. What a concept!

And I always thought the solution was simple competition; that if you are faced with a powerful entity, taking more profit that necessary to achieve results, anyone could simply start up a competitor. Surely, that was always the underlying philosophy of a capital based society; the competitor was always going to have access to the necessary capital to allow them to compete. So, why not? What has changed?

[seobook]

Re: Our Next President?

And I always thought the solution was simple competition; that if you are faced with a powerful entity, taking more profit that necessary to achieve results, anyone could simply start up a competitor. Surely, that was always the underlying philosophy of a capital based society; the competitor was always going to have access to the necessary capital to allow them to compete. So, why not? What has changed?

• lack of price transparency
• heavy consolidation to scrub the market of actual competition
• non-enforcement of antitrust laws COUPLED WITH making drug reimportation illegal to juice profit margins on them
• forced purchasing of insurance
• CON laws ... you have to get DIRECT COMPETITORS (and/or those bribed by them) to approve a certificate of need for you to be able to compete with them

[dcarrigg]

Re: Our Next President?

• lack of price transparency
• heavy consolidation to scrub the market of actual competition
• non-enforcement of antitrust laws COUPLED WITH making drug reimportation illegal to juice profit margins on them
• forced purchasing of insurance
• CON laws ... you have to get DIRECT COMPETITORS (and/or those bribed by them) to approve a certificate of need for you to be able to compete with them

These are all huge factors. But even more than that, the truth is, I think, that for-profit competition never works in lots of healthcare scenarios. Even if you resolved all these, issues, nobody can shop for price when they're unconscious in the back of an ambulance. They can charge you literally whatever they want in the meanwhile. That's what I mean by natural monopoly at point of service. No time to drive an hour to the next hospital that's cheaper when you're in the middle of a heart attack. And there's only so many hospital beds any arbitrary geographic area can support. So it really does function like a natural monopoly. Worse? They can and will perform services without your consent, and you're still stuck with the bill, which you cannot know ahead of time. Worse than that? You can't always control what your doctor orders. If they put you on a brand name vs a generic or whatever when you're out, or coming to, what can you do? I've never gotten to pick what pain meds they put me on after a surgery. You can't control this stuff, but you do get billed for it.

The largest share of healthcare spending in the US still happens at hospitals. It's more money than all the retail drugs and physician and clinical services combined. If you've ever been in an ICU, you know the patients don't exactly have the luxury to "send price signals to the market." They're basically meat that's barely breathing. And the assumption is that they'll pay anything not to die. This is not a great environment into which to inject the profit motive. BUT, I still think it can be done reasonably, if prices are regulated. If they're not, as in the US, and they've got their hands on an unconscious lump of meat whom they can charge any amount they feel like charging without informed consent, then it's just a plain old extortion racket masquerading as "freedom." And people eat it up, I guess because they worship The Market®, or whatever. I always liked this scene. Who better than a crook to know when he's being shaken down?

[DSpencer]

Re: Our Next President?

You're not wrong. I still don't think it would have a major effect on the underlying cost structure. Even if you abolish employer sponsored healthcare and force everyone on to the exchanges, the price would remain high for all the reasons I outlined earlier. The incentives just don't work; when you need a hospital stay, there's really no good way to shop around or even determine prices ahead of time. It all just reminds me of Crassus' private sector fire brigades. When your customers are necessarily vulnerable, you can squeeze them for whatever you want.

I'm not sure why you say there's no good way of determining prices for a hospital stay ahead of time. The vast majority of prices are negotiated by insurance companies ahead of time. I understand the argument that you can't negotiate the price of healthcare while you bleed out in an ambulance, but the reality is that is not the real problem with US healthcare. The hospitals are already required to treat you regardless of your ability to pay. If you're broke, that's their problem. If you're not, you probably have insurance that's negotiated the price in advance. I understand there's exceptions, but those aren't what's driving the US spending levels so high.

Another easy change: let Medicare negotiate prescription drug prices. This is just self-imposed insanity that we won't let our largest healthcare payer negotiate prices for drugs.

Another easy change: allow for import of drugs from other countries. This is another scenario where the regulations hamstring us and then we decry the failure of our "free market".

The US essentially subsidizes drug innovations for the world. It's probably true that we would get less new drugs if we stopped. It also seems that we've reached the tipping point where affordability is the greater concern.

Maybe it still wouldn't be enough. But when we do everything but the obvious changes, it makes me question whether anyone is really trying.

[dcarrigg]

Re: Our Next President?

Different prices for different demos with different plans in different companies. There is no set price for an appendectomy. There are 75,000 different prices for different combinations of nonsense requiring a massive back-office (and lots of arbitrary judgement calls) just to figure out. It's like the blackout insurance all over again. Drug costs are a small fraction of hospital costs. I get that you have an instinctive aversion to regulated prices. But is the electric market really so horrible or socialist? I mean, even for free market fanatics, natural monopolies should still be a problem.

Just put ideology aside for a moment. Have you ever seen a hospital chargemaster? Here's Norton Hospital in Kentucky. Random example. It's actually a relatively cheap hospital. There are 1,567 pages of fees, each with 50 line-items on them. So you can see that I'm not making that 75,000 number up. Now compare that to Brigham and Women's here in Boston. Sorry, it's a .zip excel file. That's the only way they offer it. They have only maybe 7,000 or so charge codes. HC ASSEMBLY DRIVER PNEUM PACK #1006 costs $200,000. I have no ******* clue what that is, I can only pray to the Lord almighty in heaven I never need one.

Of course, these charges are the standard charges. Each insurance company negotiates some sort of discount off the sticker price for each individual plan. But here's the rub: You've got no way of knowing. There's literally 1,000 different codes for sterile supplies. You can't even fight these bills, because there's no way to even be sure services were rendered. All the negotiations in the world can't stop them from choosing to use one thing that's 10 times more expensive than a comparable thing in the course of treatment. And even if one hospital is cheaper than another (which matters at least for the deductible or out-of-network expenses, right?), there's no way to know or be sure. They don't even have apples-to-apples chargemaster categories. Instead of regulating prices, we turned it into the wild west, and now there's literally thousands upon thousands of pages of things you might be charged for once you step foot in the hospital, and there's no rational way to figure it out anymore.

Meanwhile, just a couple hundred miles north of me in Canada, they do it like this. A single, intelligible page of regulated prices, even for non-covered, non-residents. They even have some for-profit hospitals. It's not impossible. But if we do nothing to regulate prices, we'll continue to have this rube goldberg madness. There are over 100,000 Americans employed in just figuring out hospital charges. About one for every MD. More people than work for Alphabet worldwide. They built pages and pages of charge lines for their own services. I mean, if you hold ideology aside, and look at it like an alien being dropped on earth examining different health systems, you'd surely have to conclude that the unregulated price madness of the US system is the most ludicrous system in the world.

[DSpencer]

Re: Our Next President?

Different prices for different demos with different plans in different companies. There is no set price for an appendectomy. There are 75,000 different prices for different combinations of nonsense requiring a massive back-office (and lots of arbitrary judgement calls) just to figure out. It's like the blackout insurance all over again. Drug costs are a small fraction of hospital costs. I get that you have an instinctive aversion to regulated prices. But is the electric market really so horrible or socialist? I mean, even for free market fanatics, natural monopolies should still be a problem.

Just put ideology aside for a moment. Have you ever seen a hospital chargemaster? Here's Norton Hospital in Kentucky. Random example. It's actually a relatively cheap hospital. There are 1,567 pages of fees, each with 50 line-items on them. So you can see that I'm not making that 75,000 number up. Now compare that to Brigham and Women's here in Boston. Sorry, it's a .zip excel file. That's the only way they offer it. They have only maybe 7,000 or so charge codes. HC ASSEMBLY DRIVER PNEUM PACK #1006 costs $200,000. I have no ******* clue what that is, I can only pray to the Lord almighty in heaven I never need one.

Of course, these charges are the standard charges. Each insurance company negotiates some sort of discount off the sticker price for each individual plan. But here's the rub: You've got no way of knowing. There's literally 1,000 different codes for sterile supplies. You can't even fight these bills, because there's no way to even be sure services were rendered. All the negotiations in the world can't stop them from choosing to use one thing that's 10 times more expensive than a comparable thing in the course of treatment. And even if one hospital is cheaper than another (which matters at least for the deductible or out-of-network expenses, right?), there's no way to know or be sure. They don't even have apples-to-apples chargemaster categories. Instead of regulating prices, we turned it into the wild west, and now there's literally thousands upon thousands of pages of things you might be charged for once you step foot in the hospital, and there's no rational way to figure it out anymore.

Meanwhile, just a couple hundred miles north of me in Canada, they do it like this. A single, intelligible page of regulated prices, even for non-covered, non-residents. They even have some for-profit hospitals. It's not impossible. But if we do nothing to regulate prices, we'll continue to have this rube goldberg madness. There are over 100,000 Americans employed in just figuring out hospital charges. About one for every MD. More people than work for Alphabet worldwide. They built pages and pages of charge lines for their own services. I mean, if you hold ideology aside, and look at it like an alien being dropped on earth examining different health systems, you'd surely have to conclude that the unregulated price madness of the US system is the most ludicrous system in the world.

There is no doubt that the new transparency law is nearly worthless when the requirement allows the descriptions to be vague and cryptic to the point where they are unintelligible. Doubly so given that these prices are not the actual price for almost anyone.

Nonetheless, the complexity is not completely artificial. Sure, an electric company has a simple bill. They also sell a single product. Walmart and Lowes also have tens of thousands or more products on their price lists. Don't get me wrong, it can be simpler and it should be simpler. But, there's kind of a limit. There's thousands of medications alone, are they supposed to charge the same price for everything?

That Canadian price list is very simple. However, I find myself confused. Can you tell me how much it costs to get a total knee replacement? Or a c-section? Or a 2 level lumbar fusion? As far as I can tell, it's basically useless in determining how much something would actually cost.

The best transparency I'm aware of is probably the Surgery Center of Oklahoma:

https://surgerycenterok.com/pricing/

That's still a few hundred different prices and that's at an outpatient surgery center. And it only works because they don't take insurance and require payment in full up front.

[dcarrigg]

Re: Our Next President?

There is no doubt that the new transparency law is nearly worthless when the requirement allows the descriptions to be vague and cryptic to the point where they are unintelligible. Doubly so given that these prices are not the actual price for almost anyone.

Nonetheless, the complexity is not completely artificial. Sure, an electric company has a simple bill. They also sell a single product. Walmart and Lowes also have tens of thousands or more products on their price lists. Don't get me wrong, it can be simpler and it should be simpler. But, there's kind of a limit. There's thousands of medications alone, are they supposed to charge the same price for everything?

That Canadian price list is very simple. However, I find myself confused. Can you tell me how much it costs to get a total knee replacement? Or a c-section? Or a 2 level lumbar fusion? As far as I can tell, it's basically useless in determining how much something would actually cost.

The best transparency I'm aware of is probably the Surgery Center of Oklahoma:

https://surgerycenterok.com/pricing/

That's still a few hundred different prices and that's at an outpatient surgery center. And it only works because they don't take insurance and require payment in full up front.

Does the electric company sell a single product? Or does it appear that way thanks to regulation? I mean, if you stop and think about it off the top of your head, they're selling poles, wires, distribution lines, transmission lines, pole space for telecom use, repair services, ballasts, street lighting, transformers, ground trenches, load balancing and monitoring services, interconnection services, transfer stations and substations, power transition services, tree clearing services, preventative maintenance services, billing passthrough services for third party power providers, demand-side management programs, etc etc etc.

The regulators say, "Wrap all that stuff up into a standard kWh charge." But if they didn't, I'd bet you anything there'd be 5,000 charges for all these little things meted out. Because they could. And since they own the only grid connected to your house, they could charge you whatever. Thus is the nature of natural monopoly.

[Chris Coles]

Re: Our Next President?

So, what you need is a new mindset within the insurance industry, prepared to directly challenge the existing system. That surely comes down to leadership; so the answer is to create a completely new mindset within the insurance industry. That in turn requires someone start a debate that will show up the present lack of the required leadership.

It beggers belief that there are no professionals within the insurance industry that see the need for reform.

[vt]

Re: Our Next President?

The broken payer business model


https://www.innosight.com/insight/af...-in-new-faces/

[Chris Coles]

Re: Our Next President?

Then the way forward is to include the capability towards patient travel; towards a much more competitive location on the planet.

[Polish_Silver]

Re: Our Next President?

That is an excellent point, DC. We need either competition or price regulation. In most places, medical services are not a monopoly, except that institutions keep the prices secret and prevent
any price comparison. Japan has regulated medical prices very succesfully. The problem here is collusion, information assymetry, lack of choice etc.
Physicians are licensed by the state. So what if part of the
licensing criteria was that they had to publish prices, treatment outcomes, etc. All this stuff gets reported now to the insurance companies, but not to the consumer.

Most of the cost is chronic degenerative illness, which means there is time to plan, compare prices, switch providers. But how can you choose with no information?
I think a state or university could set up a clinic open to the general public (or to employers) and offer care at much lower prices. I am surprised larger corporations (like my own)
have not created internal medical service systems.