Is health care a natural monopoly?

[o_mlly]

Is health care a natural monopsony? And is a monopsony ever good? No.

 

[BT3241]

There is no free health care out there unless you are unemployed - all tax payers are in the pool thats how it works anyone who says there is free health care does not know what they are talking about other countries take care of their unemployed thats the difference. Does it make it cheaper I don’t know government corruption and wasteful spending come with it.How is it socialism when every working person pays for it , just like everyone else a premium is paid.

 

[dochawk]

The idea is that if Americans have to pay for their own care out of their own pockets they’ll be wiser about what care they get.

generally speaking, for “efficient” allocation, it is ideal for the last dollar spent on something to cost that person exactly a dollar. If he only pays, say, fifty cents, he will use resources that are not worth a dollar to him. (similarly, if he has to pay more than a dollar to spend, he won’t consume something that was worth a dollar to him).

So if someone is looking at $15,000 in medical expenses, for example, it really isn’t that important for allocation who pays the first $14,000 (assuming it gets paid), just that last thousand.

The HSA accounts are wonderful for allocation. When I first got one, the savings compared to a traditional policy was more than the out of pocket cap! (and then, after being on it for a decade, it got obamacared out of existence, and I had to buy an inferior policy at just shy of four times the price . . .)

My wife also gave birth almost two years ago and we’re paying down our $8,000 in medical bills.

Almost three decades ago, after my first spectacular month practicing law, I looked at my bank accounts. Hey, wait! I cleared $10k this month; why are my accounts all empty? Oh, c-section . . .

 

[dochawk]

Anyway, my own pet proposal for the system is to start with price transparency, such that each provider who wants to receive any type of insurance reimbursement must post an actual price for each service [there will be some specialties or circumstances for which this is not possible].

Everything within a standard deviation of the mean price is covered by insurance/copayment/deductible. If a physician thinks he is enough more skilled to charge more than that, he can, but it must be disclosed ahead of time, and the insurance treats it as the maximum cost.

The second step is to create a single standard base policy (or perhaps up to three). You may sell any other health insurance you want, but only as riders to the base policy (and we probably want to standardize common riders). Even lower deductibles should be a rider.

At the same time, we make acquiring a pre-existing condition an insured event. E.g., if you blow a knee in a way that has $250k in present value of actuarially anticipated future expenses, that is a current “charge” to the policy of $250k, rather than charging you a higher premium in the future to reflect this. [and, yes, this would increase current premiums for the healthy]. You could not be removed from a plan for acquiring such a condition, and if you change policies, your old insurance pays that much to the new insurance. If you skipped insurance, but want it now that it will pay big expenses, you get the base price for the policy, but either the knee is excluded, or you pay the expected future cost as a buy-in.

By standardizing the policies, they could be put out for bid by the government. For example, for low income families, it could put out a bid for ten thousand class A policies for a specified age.

This plan keeps competition and the efficiencies it brings, while preserving individual freedoms and choices.

[sidenote: there was a transparency and disclosure order by rule from the current US administration. It doesn’t go as far as the one I would impose, but the hospitals are fighting it tooth and nail . . . “but . . . it makes us tell people prices before we charge them, and they might go somewhere else!”]

 

[Angel_Gabriel]

[sidenote: there was a transparency and disclosure order by rule from the current US administration. It doesn’t go as far as the one I would impose, but the hospitals are fighting it tooth and nail . . . “but . . . it makes us tell people prices before we charge them, and they might go somewhere else!”]

I recently had gallbladder surgery…in order to figure out my expected bill (and to avoid the shock that often comes with seeing that large bill) I called the hospital and jumped through a bazillion hoops to find out what the cost was and what I would have to pay. We also have a HSA high deductible plan ($4k for family)…that surgery was estimated at $43k! my cost was about $3k…that b/c of the deductible and that wasn’t included lab work and the surgeon and anesthesia bills… Hospitals are ruthless and they will simply have to accept our payment plan b/c we don’t have $3k in savings. Thankfully our HSA has a decent chunk but it won’t cover all of it.

I’m grateful that there is now a law that will make these places tell you how much a procedure costs.

 

[Peeps]

I think that one reason why healthcare is so expensive is that there is a shortage of healthcare workers in almost all areas, including doctors. People have to pay us a lot because we are working short and working exhausted, and especially during this pandemic, time-off is often denied because of the short staffing.

But if they hired more people, those hires would want an equivalent high salary, and that would drive the cost of healthcare up, too.

To quote Ricky Ricardo, “Ai yi yi!”

 

[JerryZ]

Having seen first hand what governments actually do with the “natural monopolies” the verdict is; Thanks but No Thanks!!!

If you want to have poor service from a service entity give it to the government to run. If you want to squander wealth then hell yeah give it to the government. They will spend it and come for more. Until there is no more.

Peace!