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by 378fho 2603 days ago
The hullabaloo over "If you like your doctor, you can keep your doctor" goes a long way to explaining how health-care used to work in the US. Most simply it was a free market and free markets work.

In more detail: Independent doctors (and their staff) functioned as buyers' agents would refer patients to specialists. "Doctor-Patient Relationship" and "Referrals" were the two main components of the system. Knowing that DR. JONES referred PATIENT SMITH to them, the specialist would treat PATIENT SMITH well and charge a reasonable amount.

It was unfortunate in that you had to "get in" to the system by finding a good doctor. It was (and more now than ever is) hard to "find a good doctor." Most are no longer accepting new patients, but it served all those parties. Doctors would have repeat customers. It'd reduce their work of learning new patients. Etc.

Without such a family doctor, you would go to a provider without a referral. The provider would then know it could gouge you without risking a referral relationship.

However this system was sub-optimal for insurance company profits and large scale providers. Which is exactly who pushed Obamacare, and lead to the break-up of so many of these relationships.

As background, Health Insurance has lists of "approved providers" which they carefully curate. The most straightforward method of breaking up relationships is to exclude providers. They also put these "good doctors" (from the patients' perspective) into plans with expensive premiums. They also churn. By raising prices selectively between plans with different providers insurance companies can encourage patients to "try out" a new doctor this year. They also churn provider lists.

This means Insurance companies are now a more powerful source of referrals. They also prefer institutional providers. Between both of that, fewer providers care about where their patients are coming from. The patients often don't have much choice where they go (one of 9 different locations of the same conglomerate) and don't know enough to make an informed decision anyway (as their family doctor used to do for them).

All of this is brought about by the individual mandate. It's not a free market if you're not free to abstain. By being forced in, cash buyers became a smaller segment of the market. Cash buyers were the very people holding it all together by selecting doctors of their choosing and forming these relationships. With these doctors going out of business (largely retirement) and being replaced by institutional providers it's just getting worse.

4 comments

There was also the scare-mongering associated with "keeping your insurance plan". Failing to realize that a great many people had been diligently paying for a plan that was NEVER going to pay out for any reasonable expenses. Plans so bereft of decent coverage that it would have bordered on criminally negligent had the ACA offer something like them. But how do you make that argument? You can't keep that because it's shitty and we can't offer something worthless? They should have made this point but it was honestly not on their radar, that something so miserably bad would be out there.
In the free market what is the incentive for any doctor to take on a patient that has a condition so expensive the patient can't afford the treatment?

You are completely ignoring the insurance part of health insurance.

> All of this is brought about by the individual mandate

Some of us are old enough to remember dealing with healthcare before Obamacare, and can testify to this having been the status quo long before there was an individual mandate.

How do you negotiate with providers while having a heart attack?

Free markets depend on leverage.

I think their assumption is that you do all that thinking and negotiation while picking an insurance provider so it's covered.

But then you get carted unconscious to a hospital you are covered for but looked over by an "out of network" doctor, whatever that is.

Being an American seems like a full time job. You have to watch your back so society doesn't eat you. The frequent obsession over credit scores I see on Reddit is another one that baffles me.

Credit scores don't matter in the way it sounds. If you're trying to do tricky things like rotate through credit cards for their benefits (like airline miles), then it requires closer monitoring, and it helps to watch in case some sort of fraud is going on, but that's about it.

That said, keeping up with looking after your own back in America does feel like a full time job at times. :/

And leverage depends on clarity regarding price/performance. Neither of which is readily accessible for health providers. Way too many variables, of course, but some basic price facts would go a long way toward improving the situation.