Study: When Counting Premiums, US Workers Heavily Taxed

[JimG]

In the US it often seems that nobody know what anything costs, and if they do know they won’t tell you and you are impertinent for asking.

 

[Hodos]

Is that the case or are people just forgoing eye exams and dental care? Those costs eventually catch up to you with interest.

I think you have a bit of both. People who aren’t experiencing eye trouble don’t spend a lot of time in eye exams, plus eye exams are relatively cheap, because demand is low and the cost of care is not super high. However, look at the cost of lasik eye surgery over the years. Initially, it was almost prohibitively expensive. However, as this procedure generally is considered as elective surgery, coverage of lasik is rather limited. Optometrists have had to compete for business, making pricing more transparent, and as a result over the years, the cost of lasik has come down significantly as opposed to most other health care procedures.

 

[Sarcelle]

I just saw this piece of news on CBS

$28,000 for a throat swab? This is with insurance. This doctor is running a scam. Unfortunately this is all too common in what passes for US health care. I see why people are avoiding doctor visits. They just get ripped off.

 

[blackforest]

Please educate me on the specific changes. I agree that not having insurance is not an affordable option for most Americans.

It’s more expensive. Have you heard of health care inflation? Did you read my link? Having health insurance is now getting unaffordable.

I would agree that the failure to pass health care reform between 2016 and 2017 was a legislative failure by conservatives. The issue is not that they are good with the status quo though, that would be a false narrative. The issue was over what policy changes would result in the significant decrease in health care costs.

That wasn’t my point. There’s no active movement among conservatives to overhaul the status quo.

I have yet to see where we have actually implemented a free market system in the area of healthcare.

“Profit-based” would be a better way to put it.

I haven’t seen an apples to apples comparison, so I doubt this claim stands up to scrutiny.

Despite having the highest health care spending, the U.S. has some of the worst health outcomes in the industrialized world. Do you ever wonder why this is?

$28,000 for a throat swab?

I’m pleased to see cases like this getting increased media attention. It’s scandalous what’s going on.

 

[Zzyzx_Road]

Two biggest problems with US health care that stem from the central problem: how health care has migrated from 4% of the GDP in the early 1960’s to 20% today. It is my strong belief that technology only plays a part and there is more to this issue than that:

First, no cost control is possible due to lack of price visibility. Healthcare pricing practices are extraordinarily opaque in ways Congress declared decades ago that America should not put up with in any other service industry. There are laws on the books regarding antitrust and cartel behavior with teeth in them. Sherman Antitrust Act; Robinson Patman Act; to name two. These laws are enforcible on the health care industry. The industry twice attempted to challenge those laws and were smacked down by the US Supreme Court both times. But the industry has Congress in its pockets so the laws have never been enforced on them. Removing the industry influence on Congress and sic’ing the DOJ on them would be an excellent start.

The other big problem which is kind of part of the first problem: there are far too many employees in the health care system who do not directly interface with the patients. Every last one of those employees and their manager has to get paid. Insurance companies and provider billing departments are a huge part of this issue.

Have to remember the ACA was written with all of the big health care players in the room with the Congressional staff members and with token at best representation from the people. Mark my words, any Medicare For All initiative will be worked on the same way. With no more than token representation from us. The industry will protect itself at our expense, that is all there is to it. They’ll just dress it up so it sounds good on the surface as the ACA did, but like Pelosi said about the ACA, we’ll have to read the new bill find out what’s in it. Which is to say the government will be essentially telling us: we’re screwing you, we’re just not going to be up front about that part.

 

[Theo520]

I was talking here about a system more like the NHS, where everyone pays via taxes into a system that then covers everyone (not just those deemed needy). However people can still purchase private insurance beyond what’s provided by the government. A lot of people in America don’t want to do that because they don’t want to be paying twice for coverage - they’d be paying taxes and in turn covered by public insurance, but also paying premiums for private insurance that they want to keep.

I would be OK with x2 the medicare tax and redirecting it to cover primary care for everyone. Then the working and rich can pay for additional coverage to their hearts content.

 

[DarkLight]

Yeah that I think is a major problem. The healthcare system is set up so you basically can’t guarantee what you’ll be paying until after the fact. You can even do your due diligence and still find out there’s a big problem. Plus emergency care you can end up with huge bills out of your control just because you end up somewhere out of network (since obviously in an emergency you can’t shop around).

 

[Sarcelle]

The healthcare system in the US is a big mess.

Those who think that it’s a free market are dreaming. The system is stacked against us.
It’s all about profit.

 

[Sarcelle]

Plus emergency care you can end up with huge bills out of your control just because you end up somewhere out of network (since obviously in an emergency you can’t shop around).

Especially if you’re unconscious.

 

[Hodos]

It’s more expensive. Have you heard of health care inflation? Did you read my link? Having health insurance is now getting unaffordable.

Yes, and I am saying that health care inflation is partially caused by a lack of free market principles being applied to the health care industry, not because of free market principles. The whole issue being discussed is what the cause of the high inflation of health care costs are.

“Profit-based” would be a better way to put it.

I would say free market because that implies more than just the impact of a profit motive, which is a net good in economies. Your mischaracterization seems to misunderstand that maximizing profits is done by several things, controlling costs to maximize profits, and generating demand by lowering costs to maximize economies of scale and make one more competitively priced than one’s opposition. The current model doesn’t do either of those because it forces people into the market regardless of whether they see the service as worth the cost. The result is that insurance has no incentive to provide competitive pricing, and it forces individuals to pay for services they may not even want or need even if they agree that healthcare is a beneficial service, again artificially raising demand which removes the incentive to control costs.

Despite having the highest health care spending, the U.S. has some of the worst health outcomes in the industrialized world. Do you ever wonder why this is?

It isn’t for lack of good care. The US has some of the best care in the world when it comes to wait times, services available, and medical innovation. Much of the issue is that we have one of the most culturally and racially diverse societies in the world which has an effect of increasing the types and numbers of illnesses we are treating. This is why I said you haven’t offered a like for like comparison of a society with a similar makeup as we have. We also have a culture of bad lifestyle choices which results in increased costs of health care.

 

[DarkLight]

Especially if you’re unconscious.

Even with non-emergency surgeries, there’s a big problem where medical personnel who can bill separately might not be in network. Generally you can make sure the primary doctor and the facility are in network, but you don’t have much control over the anesthesiologist or imaging tech or whoever. Nearly had that happen to me with an endoscopy, where the doctor and facility were in network but some of the other people weren’t. Fortunately that facility explained to me after, they have a policy of sending a big bill to insurance but just taking whatever insurance will give them.

 

[Zzyzx_Road]

For those yammering on and on about how this is the result of capitalist free markets, I got news for you: the current industry does not reflect free market capitalism at all where consumers are concerned. Think “corporate cronyism” and you’ll be a lot closer to the mark.

The US Congress provided legislation long ago that was aimed at keeping free markets free from monopolistic, cartel and price fixing practices. The best known of these laws are the Sherman Antitrust Act and the Robinson Patman Act. But other service pricing laws such as that for auto repair and professional services can be applied as well. But that’s not what is happening now. Hence “corporate cronyism”. That cronyism is what we need to smash apart via the defense of free markets.

We can start by taking advantage of the US Supreme Court decisions that said the health care industry is not exempt from these laws.

 

[Pattylt]

One further point she should have made…
Imagine buying a car at a specific dealership. Bob pays 40,000$ for his car but Steve pays 32,000$. And no one knows what they’ll have to pay ahead of time. Hospital and doctor bills are like this in that the amount you and your insurance pay is negotiated. This is why you can’t find out what your knee replacement will cost…it depends on your insurances negotiated price. And I’m sure not going to pay cash if I have insurance so the cash price is useless to the insured.

The uninsured are either too poor to have insurance or so wealthy they can afford costs no matter what they are. The whole system is set to be blind to the consumer.

Everyone is going to need healthcare at some or many points in their life. There is no ability to predict how much you’ll need or what type. I think there are basics we could start with. Require every health insurance company to offer a basic defined plan to cover office visits. Then, have them have to sell this plan to whomever walks in and have the government subsidize all those that make less than $XX per year…adjusted by state. Next, do something similar to catastrophic insurance plans. We all have to have one but a basic defined one is available to all and must be offered with subsidies by gov. for low/no incomes. The gap between catastrophic and basic is open market…to cover the gaps between them…the premium services, private rooms, specialty care…I don’t know, I’m just thinking as I go. But a basic level of coverage and catastrophic coverage should be available to everyone and everyone can pick their insurance company. Insurance can up sell anyone that can afford it to the level they can afford it but everyone is guaranteed a basic and catastrophic plan with government only subsidizing the low/no citizens and no more cherry picking their clients. I think this is do-able.

 

[Ridgerunner]

Despite having the highest health care spending, the U.S. has some of the worst health outcomes in the industrialized world. Do you ever wonder why this is?

I don’t know that the U.S. has the highest health care spending in the world. Many costs that are paid for at the point of service in the U.S. are paid in other ways by foreign governments, or suppressed. It is nearly impossible to compare apples to apples.

The outcomes are not the worst by any means. The U.S. has worse outcomes than some in certain things, but the best outcomes in others.

 

[blackforest]

The whole issue being discussed is what the cause of the high inflation of health care costs are.

Actually, the issue is that you’re claiming that going out-of-pocket is an option for people, as it was for your parents. But given the cost these days, it’s actually not.

I would say free market because that implies more than just the impact of a profit motive, which is a net good in economies.

The sentence before last, you said there aren’t free market principles in health care.

Your mischaracterization seems to misunderstand that maximizing profits is done by several things, controlling costs to maximize profits, and generating demand by lowering costs to maximize economies of scale and make one more competitively priced than one’s opposition.

That’s a rather loquacious sentence lacking coherence. Health care, like insurance, is a for-profit, i.e. profit-based, industry. Health care industry on track for massive profits With the insurance company in the way, it paves the way for problems cited by @DarkLight with nasty surprise bills and @Pattylt with a lack of pricing transparency.

It isn’t for lack of good care.

Actually, it is. Overall, we rank poorly. U.S. Healthcare: Most Expensive and Worst Performing - The Atlantic

https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world

The U.S. Is Failing in Infant Mortality, Starting at One Month Old - The New York Times

 

[phil3]

That’s lovely for your parents, but we live in different times now. This is not an affordable option for most Americans.

This isnt a problem with the health care system, It is a problem with dishonest people.

 

[phil3]

Despite having the highest health care spending, the U.S. has some of the worst health outcomes in the industrialized world. Do you ever wonder why this is?

The UK survival rate among the top killers is lower than the US.

 

[Dan123]

This isnt a problem with the health care system, It is a problem with dishonest people.

That bill may have been dishonest but a heart attack can set you back about $60,000. I don’t know many people with that money laying around even though heart issues are a leading cause of hospitalization and death.

 

[Sarcelle]

There’s lots of dishonest people around the world but that does not change the fact that our healthcare system is badly in need of reform.

No one should go bankrupt over an illness.

 

[phil3]

I have had 4 stents installled and a major back surgery. My out of pocket cost for all of them about $2,000 The back surgery was about $300,000 plus and the stents about $100,000.