Kady M. Spends an awful lot of time <snip>
My position can be more concisely expressed:
- I prefer free market solutions to problems, but I’ve been quite clear on Medium that the free market horse has left the barn some decades ago. You can’t put that genie back in the bottle. The only way forward for us now is some sort of hybrid national insurance solution.
- The way the insurance market has developed in the US, both private and public (Medicare, mostly) removes financial incentives from the actors (doctors, patients, hospitals, equipment suppliers, pharmas, etc.) to shop price and minimize cost.
- Ergo, I support solutions which re-institute those incentives to shop price and minimize cost. Pretty simple, that. (You and I often get hung up on whether the solution is “socialized” or not. I support a hybrid solution where everyone does what they’re good at, and the government has a role in keeping coverage and cost in balance between the actors. If that’s “socialized”, so be it. I’m not as afraid of the term as you seem to think.)
gxorlando is not wrong when he points out that government actions over the last few decades have contributed to cost inflation. If you look back at the history of health care cost inflation over time, inflation moved to a higher orbit after Medicare removed 50% of the total nation’s health care billing away from any free market price controls. The architects of that program simply didn’t consider how removing any concern for thriftiness from our heaviest users of health care would affect the entire system
Doctors make bank in the US because there is a firewall between the end consumer and the price that is set, called the insurance industry. The individual consumer doesn’t know or care what the doctor charges, as long as the insurance company will pay it.
Well, they also make bank because Medicare and private insurance users have no incentive to NOT be a heavy user of services. If my cost to see a doctor is $25 bucks and a hundred a month, shit, I’ll go to the doctor for a hangnail. The higher the copay, the more I’m deterred from using the service casually. That’s an imperfect approach, but it does work to control costs. Japan’s single payer system uses substantial copays to deter overuseage, for example.
The insurance company doesn’t care what the doctor charges either, since they are passing all costs on in premiums. So doctors make bank, because no one is forcing them to compete for business on price.
Agreed. So let’s make them compete for business on price.
So, assuming we maintain, approximately, our current system using health insurance as the primary payer, you actually need additional regulation, to force the companies to keep an eye on cost, potentially by capping their charges to users.
Well, what you need is the patient to become cost conscious. If that happens, everything else falls into place.
A better plan would be to scrap the insurance system as it currently exists, and follow the lead of, you know, every other modern country, in which doctors salaries are lower than the US,
That’s true, but chasing our best and brightest out of the medical field is not a great solution. Restore cost consciousness throughout the system, and you have a chance for everything to fall into place.
“Every other modern country” is also struggling with rising health care costs, you know. That should tell you something.