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markomalley
Guest
(part 2)I support Physicians for a National Healthcare Program, which advocates streamlining payment through a single nonprofit payer, which would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.
It’s not government run healthcare, it’s privately provided, publicly funded healthcare, in which medical people make a decent living and nobody makes an exorbitant profit.
I discussed, above, ad nauseum, the limits on health insurance pricing and what that does for health care availability. In summary, there are always limits as to the funds available and those limits force decisions to be made. Sometimes those decisions are unpleasant.
The second point I wish to discuss is the mechanisms of pricing in this country.
My thesis here is that unless you are paying for your own health care out of your own pocket (not by way of a third party), you don’t care what it costs. You care about the price of the premiums you pay (or the taxes that are levied upon you), you care about the co-pay (which is a set amount regardless of the price of the service), and you care about its availability. That is all.
Think about it: if you go to CVS for a 30 day prescription for a drug, it doesn’t matter to you if the drug’s overall price is $30 or $3,000. Your concern is the $10 copay that CVS exacts from you. You may not even know what CVS bills the insurance company (or the government). If you go to a neurosurgeon, you may not know that she bills the insurance company $250 or $500 for the visit, you are concerned with the $20 copay – and whether or not your referral paperwork was done properly. If you are hospitalized, you think about the $100 per day fee you have to pay and whether your insurance will pay for one overnight or 10 overnight visits. You don’t care about the $1,500 per night fee (plus $20 for the box of kleenex at your bedside) that the hospital charges the insurer on top of the copay.
Think about this for a minute: if you had to pay CVS directly for the drug, you would care if they charged $30 or $300. And if you could get the $300 CVS prescription for $250 from Rite-Aid or Walgreens, you would be more likely to go to one of those places rather than CVS, wouldn’t you? And if you had to choose a neurosurgeon who charged $250 and one that charged $500, all other factors being equal, you’d likely pick the $250 one…if it came out of your own pocket, wouldn’t you? And if enough people chose to go to the cheaper drug store and the cheaper physician, the more expensive alternatives might change their pricing strategy to stay competitive.
That is the nature of the problem. The USA’s healthcare system is not really a free market system. It is centrally controlled for pricing. Right now, the controls come from large insurance companies. In the system you advocate, the controls will come from a single nonprofit payer (that is publicly funded) – but it will still be centrally controlled.
You are probably asking yourself at this point, “what is the problem, we can just control costs by controlling how much providers get reimbursed, right?”
The problem is this: the providers, rather than trying to actually increase value for the consumer, have a psychology of trying to increase reimbursement rates from the insurers (or the government). That is profoundly different than how a marketplace actually works.
Want proof of this? Go into your files and grab a few insurance explanations of benefits. Depending upon your insurer, you will see a few different columns of numbers on there. One of them will say something along the lines of “amount billed” and another one will say something along the lines of “amount allowed.” I will wager you that, in the vast majority of cases, the “amount billed” is greater than the “amount allowed.”
Have you ever noticed this? Have you ever wondered why?
Insurance companies (or the government, in the case of Medicare or Medicaid) have set rates they pay for each type of product or service that is covered. They base those amounts upon what they determine to be a “reasonable” charge. They determine what is “reasonable” by keeping records of every claim that is made for a given service (or med or whatever), taking an average, and then applying a percentage to that average. A provider has to agree to accept that “reasonable” amount if she wants to be in that insurer’s network. And being within various insurer networks is the way that they get paid.
The way that providers increase that average (and thus the amount that they will be reimbursed) is by always charging more than what is “reasonable” – knowing full well that they won’t be reimbursed everything, but knowing that they are slowly moving the average up.
So what incentive does a provider have to increase value to the consumer in such a system? The answer: none, whatsoever.
Here’s one other example: pharmaceutical companies. When they go out and research a new pill, are they ever concerned with what the end cost of the pill will be? No, not hardly. They are concerned with whether the pill will be covered by insurers (or by Medicare / Medicaid). Because that’s where the money comes to them. And, thus, we have hyper-expensive drugs.
The problem is that a single payer insurance scheme won’t change any of that basic mentality. Can you imagine what prices would be like if cars, houses, groceries were run like health care? I shudder at the thought.