[b9a2cab5]

No, the article says exactly why:

> Texas-based Christus Health early this year said on its website it planned to defy the rules because its comprehensive list of prices “will only be useful for our competitors.”

Because publishing prices leads to actual competition.

[mc32]

Price transparency in medical care should have been a thing since the 80s when we deregulated telecomms and aviation. There should be price transparency and WYSIWYG billing, no hidden fees, or bait and switch, etc. No $50 tylenols and such shenanigans.

[koolba]

I’d take it a step further and mandate a single price for everybody. Let insurance cover whatever the actual is going to be for paying in cash and not some voodoo accounting that generates a cash price backwards from the maximum negotiated rates.

Insurance should be to cover unforeseen events. Baking in the cost of trivial things like a “fee flu shot” just acts as a way to obscure the true costs.

[arcticbull]

Let's take it one step further and everyone pays for health insurance out of their taxes according to their means, and the state handles all the billing, negotiation and pricing on their end - and the individual never has to care who's paying and how much. Socialized medicine already covers 40% of Americans between Medicare, Medicaid and the VA. Time to get it to 100%.

The Canada Health Act is a great model. The Feds mandate that the Provinces figure out how to provide everyone a minimum standard of care, and each Province administers a public health insurance program that covers everyone. This would map perfectly to the states.

[mc32]

I'm not sure I would want to go there. "People of means" already pay greater taxes which support government programs. If you think they are not paying enough, raise their taxes, but avoid double taxation.

In other words, I don't think just because I would pay $1000 for a broken arm means I would agree that Bezos should pay $100,000,000 for the same. It would make no sense. It would make sense to close his tax loopholes. Sure.

[arcticbull]

Sorry for the unintentionally charged and hence confusing language there. I just meant via progressive taxation. Something like the Ontario Health Premium [1] which ranges from $0 per year if your taxable income is $20,000 or less, to $900 per year if your taxable income is more than $200,600.

I agree and also do not want what you outlined! :)

I strongly suspect that a socialized medical program in the US would not actually cost individuals any more than they're paying now - it's just that the cost they're paying is hidden behind employer paid premiums. That's just a private tax.

[1] https://www.ontario.ca/page/health-premium

[b9a2cab5]

> I strongly suspect that a socialized medical program in the US would not actually cost individuals any more than they're paying now

The definition of progressive taxation means this is not the case for anyone making more than 100-150k, given current tax brackets.

Medicare already is 1/3 of the federal budget and I can assure you someone making low 6 figures definitely pays more in tax than 3x $900.

[kwhitefoot]

> a socialized medical program in the US would not actually cost individuals any more than they're paying now

But think of all those insurance company employees who would be out of work!

[zaroth]

I think a great way to do this would be for the government to enter the market with a fixed enrollment and a lottery system.

They can run the program for 3 years for 100,000 people and transparently report all their findings and we can see how it went.

[mc32]

Ok. Yes, that makes sense.

[Karunamon]

Anyone who's had extensive dealings with the VA would be glad to share why they are not interested in single payer. Making that switch will not remove the incompetence, poor staffing lack of care, lack of accountability, and so forth.

Some sane standards need to be drafted and then enforced, hard and fast, before we start mandating how healthcare is paid for.

[arcticbull]

And anyone who has dealt with socialized medicine in the OECD will tell you the exact opposite :) Wholesale reform is needed, and that can certainly be part of the package. However, parceling it out is a great way to achieve absolutely nothing as evidenced by the current morass.

[xyzzyz]

Huh? I have experience with “socialized medicine” in Poland, and, in short, it’s shit.

[yes_really]

> and the individual never has to care who's paying and how much

But then nobody cares about how much the government is paying, and you end up with more and more taxes and inflation.

Taxes are increasing. Government debt and inflation are skyrocketing. Can't we put an end to it?

Also the government can't even build passenger rail without wasting absurd amounts of money and having "unexpected delays" in all projects. Why should we trust it to manage everyone's healthcare?

[lmm]

Because every comparable country that has a government-run healthcare system has somehow ends up with it being ~twice as efficient. I get that there's theory that says a private healthcare system should be better at keeping costs under control, but it's not borne out by the evidence.

[yes_really]

"~twice as efficient" is a stretch. They might cost half the price, but they are not necessarily twice as efficient.

Medical treatments and equipments in the US are the best in the world (discounting super small countries). Americans have the highest life expectancy in the world (discounting homicides and transit deaths). Americans can get treatments fast while people in Canada or the UK have to wait for months because the government is rationing treatments.

And we should consider other reasons that explain the costs besides "private system inefficiency": American companies carry the world on medical innovation (so other countries are benefitting from the Free-Rider Problem, and Americans are paying for it). American regulation requires doctors to spend several more years in training than at other countries (in other countries the medical school is usually merged with undergrad). And, finally, Americans just earn more than people in other countries. GDP per capita is 60k in the US, 40k in other developed countries.

[Consultant32452]

When you are imagining single payer in the US, are you imagining it being designed and run by the people who created the current system?

[arcticbull]

People seem to be big fans of Medicare. Of those covered by Medicare 75% say the system is working well, only 22% say it is working poorly. [1]

[1] https://www.kff.org/medicaid/poll-finding/medicare-and-medic...

[Consultant32452]

Thank you for the thoughtful response to my question.

[technofiend]

Unfortunately as one example Medicare Part D price negotiation has been blocked since 2003. When some drugs were moved to Part B, insurance companies were furious because it allowed price negotiation for those.

This is from 2016, so nothing has changed AFAIK. https://www.healthaffairs.org/do/10.1377/forefront.20160919....

Despite this election season’s divisiveness, both major parties’ presidential candidates have embraced the idea of authorizing Medicare Part D to negotiate directly with drug companies to set prescription drug prices. The Medicare Modernization Act of 2003 (MMA), which established Medicare Part D, included a ban on such negotiation.

Apparently both sides of the aisle pander to voters with the idea they'll help with healthcare costs and then don't once safely elected to office.

[refurb]

Your summary doesn’t make much sense.

Part D plans are administered by private insurance, who do negotiate prices.

Part B drugs aren’t negotiated even today. Government has a formula for what they will pay, but there is no negotiation.

[spaetzleesser]

Totally agree. Charge the same price for everybody no matter how they are paying.

[refurb]

Why mandate a single price? Don’t we want prices to be competitive? As a young doctor I may want to bill at a 10% discount?

[HarryHirsch]

Medicine is very much standardized, so you want to bill the same per procedure, but for complicated cases you want to allow upcharges.

[refurb]

So a fresh out of residency eye surgeon should get paid the same as a 20 year old doctor who has done 1,000s of the procedures?

[HarryHirsch]

The patient should pay the same, no matter who does it. Compensation of healthcare staff is an internal matter and frankly not relevant to the patient.

That's how it works in Germany.

[daniel-cussen]

I don't understand, are you being sarcastic? Which is preferable?

[JumpCrisscross]

What would be the difficult-to-foresee challenges this, for practitioners and consumers, would raise?

[R0b0t1]

Price transparency is a thing. NY (and I think other states by now) have ruled that surprise billing was never enforceable.

[JumpCrisscross]

Given “no hospitals have been penalized as of late December, according to the Centers for Medicare and Medicaid Services, which is responsible for enforcing the rules,” this comes close to dereliction of duty by CMMS. That said, that hospital’s spokesperson said they will be in compliance by the New Year, so maybe this is just a work in progress.

[tastyfreeze]

The price transparency rules became effective on January 1st 2021. A change like this will always take time for everybody to implement. But, I agree. If CMMS doesn't penalize non-compliance hospitals will drag their feet indefinitely.