[costcopizza]

What, if any, alternative framework other than single payer could be put into place instead of our current hellscape?

Have health sharing plans been successful? Those require a religious affiliation IIRC.

I exclude single payer solely because it’s impossible with our current leadership.

I’m surprised there isn’t a Costco like medical group that’s nationwide, has a membership, and works solely to provide care efficiently.

[Taikonerd]

The real problem is the billing model we have, where every individual act a clinician performs is separately billable... and separately haggle-able.

One model that has shown promise is "bundled payments." For example, imagine that a certain insurance company switches to a bundled model for childbirth. They say, "we will pay a hospital $X to cover everything related to this patient's childbirth. Maybe it will be a very simple birth and the hospital will make a lot of money on it. Maybe it will be more complex/expensive, and the hospital will make less money. In some rare cases, the hospital will actually lose money."

Why is this a better model? Well, 2 reasons:

1. the hospital has an incentive to provide care efficiently, rather than trying to churn out as many procedures as possible so they can bill more

2. there's just fewer numbers for providers and payers to haggle over

[cmdli]

> I’m surprised there isn’t a Costco like medical group that’s nationwide, has a membership, and works solely to provide care efficiently.

What you are describing is an HMO, which hasn't had that much lower costs historically. Theoretically, you pay once and then they take care of you, but in practice costs haven't been that much lower.

[827a]

Where I live, we have three major hospital chains. Imagine one of them is Kaiser Permanente. My primary care is through Kaiser. When I needed to see a podiatrist to get a toenail removed, they were through Kaiser. When I went to an ER a few years ago for some abdominal pain, it was a Kaiser ER.

It is beyond me why my employer is paying an insurance company anything at this point. Kaiser should be selling me an annual plan where everything at Kaiser is covered, maybe up to a point, and then they have insurance-like network relationships with e.g. other ERs in the area, if you need them, plus out-of-area addons for when I'm traveling.

This is, fundamentally, in Kaiser's interest to sell (again, I don't live near Kaiser Permanente, I'm just using them as an example; every population center has networks of healthcare providers like this). They hate dealing with insurance as much as their patients do. But only recently have these healthcare mega-conglomerates achieved so much monopolistic integration that they could actually do this and people would be interested.

Also, interestingly: My dentist does not accept insurance; direct pay. My eye doctor also does not accept insurance. This is also a new thing; it wasn't long ago that I recall them actually asking for it, but nowadays they just bill directly. It hasn't gotten more expensive (beyond the fact that my employer is paying for useless dental and vision insurance, but at least those are only like $1-$4/paycheck).

Idk, my point is, I think things are changing and will continue to change faster than you might think. I'd love to see government-ran single-payer, but even admitting that is very unlikely to happen on the near term, there's just so much excess, waste, and bureaucracy in the medical system that some kind of short-circuiting direct-to-consumer play, by someone, will happen. Once a major healthcare provider chain can prove that this D2C model works (and it would work), the dominoes will fall.

[testing22321]

> Kaiser should be selling me an annual plan where everything at Kaiser is covered, maybe up to a point, and then they have insurance-like network relationships with e.g. other ERs in the area, if you need them, plus out-of-area addons for when I'm traveling.

If you’re trying to solve them problem, why on earth do you propose such an expensive, convoluted and strange solution?

Two dozen countTies have solved this. It works very, very well. People pay less and get better outcomes. What more do you want?

[827a]

What I want is simple: For change to actually happen. You don't need to convince me; your choice is either to convince 100M+ unreasonable people, or make a reasonable path. Direct to consumer billing is that reasonable path; that's why we're seeing it take hold in the dental, vision, and pharmaceutical industries. Core medical is next. Specialty medical will follow. Emergent medicine might never change, but that is absolutely an area where insurance does make logical sense.

[throwaway173738]

The real problem is that the insurance companies will find reasons to charge the same amount even though they have no providers in network.

[FireBeyond]

> It is beyond me why my employer is paying an insurance company anything at this point. Kaiser should be selling me an annual plan where everything at Kaiser is covered, maybe up to a point, and then they have insurance-like network relationships with e.g. other ERs in the area, if you need them, plus out-of-area addons for when I'm traveling.

Well, then you are beholden to Kaiser. Kaiser will not pay for any treatment or medication for weight loss other than gastric bypass surgery. Kaiser will not pay for many medications for mental health, especially for adolescents. Will not pay for medications that could be used for ED, even if not being prescribed for that.

And the most annoying, recently: My partner got a couple of root canals, and was in significant pain and discomfort as you'd expect. Dentist sent her prescriptions for antibiotics and pain management to Kaiser, and we go after her surgery to pick them up at the Kaiser UC/ER hybrid.

No pain meds for you. "We will only fill that through mail order - you'll get it in 5-7 business days". Very helpful for that post-surgical pain now. The irony being that they absolutely had those drugs in stock and available, they were just only for their UC/ER inpatients.

[nradov]

I don't understand your comment. Kaiser Permanente health plans already work that way. If you go to an out-of-network provider then they can still submit a claim to KP, although prior authorization may be required in some circumstances.

[Interesco]

Does your dental insurance not reimburse you? My dentist is also direct pay but submits for reimbursement on my behalf. They get paid up front and I get a check a few weeks later.