[ChemicalWarfare]

Before something like this happens we need to address the costs. There are ridiculous situations where you can pay $X in cash but when using insurance the charge against the policy will be $X*4 or higher.

Or the fact that ~half of what your provider charges goes towards their own insurance they have to keep to cover lawsuits against them etc.

Also, not sure what the breakdown is outside of the US - here about 50% of the population (the "bottom 50%") effectively don't pay any taxes so the burden on the rest of the population can be significant if there's any movement towards using taxation to pay for universal healthcare.

[athenot]

Before, or while. If the health agency is the final player stuck with the bill, you can bet there will be a strong push and leverage) to contain costs.

CMS already applies downward pressure for many things; drugs are the one area where they can't because someone thought it was a good idea to pass a law forbidding them to negociate drug prices.

[grasshopperpurp]

... because someone thought it was a good idea to pass a law forbidding them to negociate drug prices.

Good post. Just want to highlight that it's not so much that someone thought it was a good idea as someone lobbied so that they/their company would make more money.

[chimeracoder]

> Before, or while. If the health agency is the final player stuck with the bill, you can bet there will be a strong push and leverage) to contain costs.

Not really - in fact, the current pricing situation is exacerbated by Medicare, not alleviated by it.

Medicare sets its reimbursement rates at whatever level it decides to pay (there isn't really any "negotiation" that happens), and providers are required, by law, to charge insurers and uninsured patients more than what Medicare pays. Unsurprisingly, this results in Medicare paying rates that are below COGS (and therefore literally unsustainable), and private insurers and uninsured patients make up for the difference.

The situation is so bad that Medicare has not one but two special programs to compensate providers who mostly or exclusively treat Medicare patients, because otherwise they would literally go out of business because they couldn't pay for their supplies, let alone rent and staff wages.

[wingspar]

My experience is the opposite. Cash payer gets list price, insurance gets a much lower negotiated price. I always thought an 'insurance plan' with zero actual coverage but the negotiated prices could be ideal for self employed (with separate catastrophic policy)

[maxerickson]

That's effectively what a high deductible plan is. The ACA bronze plans are essentially high deductible catastrophic plans with some bundled services (but those services represent a small fraction of the plan cost).

The bills for simple services can still be pretty large.

[maxerickson]

Everyone already pays into Medicare, it isn't part of the income tax brackets. Not nearly enough to cover their own health care costs, but let's not conflate no federal income taxes with no taxes.

[kgwgk]

> Medicare is funded primarily from three sources: general revenues (45 percent), payroll taxes (36 percent), and beneficiary premiums (13 percent)

http://www.kff.org/medicare/issue-brief/the-facts-on-medicar...

[swagtricker]

Not to mention those $35 bags of saline...