You are spot on with all of those points. There is nothing the government does not touch that is not poorly run, inefficient, way more expensive then it should be/advertised and impossible to navigate. Medicare/Caid the the horse that pulls much of this cart regarding pricing, coding etc. I always harken back to MASH and Radar and his forms in triplicate. Hillary Care is where much of this began to go off the rails for real. That was not successful but it moved the goal posts out further assuring us that we would end up with things like Obamacare. The left is always thinking two steps ahead and knows that is has to first fail with something, socialize it then eventually they will get it passed or slowly bleed it into the system. There is nothing that FDR touched that was not horrible in outcome.
1. Competition. The ACA gave us competition of different colors of the same dress in size small medium or large.
2. Employer spend. People need to recognize that "rich benefits" are just pre-allocated wage considerations.
3. End Mandates. Mandates are just a strong arm version of tax preferred wage allocation seen above.
4. Third party payer. Healthcare once was a B2C business. Trust is inherent in B2C transactions. Third party payor health immediately becomes B2B2C. The last 40 years has been an exercise of inserting more and more "B" middle men of no value in an attempt to artificially re-insert trust.
5. Price Transparency. Sorry but what value does a "coder" add to the patient's experience. There are some companies working to augment price transparency... but... the cartel of jumbo "insurer" and jumbo "provider" will devise new methods of obfuscating price.
Mandated Medical-Loss-Ratios might turn out to be the worst part of the ACA. It has killed new entrants into the insurance side and has led jumbo incumbent insurers to vertically integrate and become healthcare providers.
Now we see hospitals and health systems say "we can't keep people healthy because they don't have access to food and housing" - they want to control public money in those sectors in the name of managing social determinants of health.
Excellent post, and I mostly agree with the strategies outlined in the 5 points.
Here in Boston, consolidation has not been good for competition. Even only going back 20 years ago, there were multiple independent hospitals in the city. They've been slowly subsumed over the past two decades into 2 large corporations, with only a handful independents left in the region.
So incredibly important. But I guess it’s all part of the Soros/Obama Cloward-Piven strategy of creating such chaos that the system can do nothing but collapse. Se also: censorship, crime, race relations, border security, energy policies, government deficits, transgender ideology, etc. Most liberals live in a dream world where their good intentions trump reality. They end up with leaders like Obama because he stroked their go and feeds their envy. Then, like all communists and fascists, they blame the ensuing disaster on their opponents. Take a look at what’s happening in the NHS in England for a glimpse of the future of our healthcare system.
The US health care system was screwed up long before Obama. Obamacare is/was bad, but it was meant to address real issues. Fixing the issues would gore lots of oxes, including ones loved by lots of Rs
Sure it's bad. But I think it's probably less bad than I thought it was going to be. My point is that the dysfunction of the overall system is not only due to Obama. The original sin was the tax preference for employer provided care. Find more than a token R politician who is willing to invest any capital in pushing a change in that policy. Look what happened to the ACA "Cadillac Tax": repealed in an overwhelmingly bipartisan vote - 419-6 in the House.
The fact that OCare was a bill John Dingell's father scribed, nearly 100 yrs of aging doesn't make it taste any better. It's all about control and creating medical plantations of voters.
"[O]f all John's accomplishments, perhaps the most remarkable has been his tireless fight to guarantee quality, affordable health care for every American," Obama said of Dingell in a press statement on his retirement. "Decades after his father first introduced a bill for comprehensive health reform, John continued to introduce health care legislation at the beginning of every session. And as an original author of the Affordable Care Act, he helped give millions of families the peace of mind of knowing they won't lose everything if they get sick."
Obama promised: “if you like your health insurance, you get to keep it.” Wife and I had a high deductible plan with HSA at $166/mo. When Obamacare was instituted, our plan became illegal and we lost our insurance. The cheapest plan available to us was $1100/mo. Fucking huge success! If you were an insurance company executive, or a politician they buy, that is. Meanwhile health care service delivery became a hellish nightmare and has only gotten worse.
That's bad and not inconsistent with anything I've said. The only thing in addition that I've said is that nobody on the R side actually has any plans to fix any of this. As demonstrated by their actions, policy and legislating is not very high on the priority list these days for the Rs. Continuously bitching about Ds doesn't cut it.
I think when the R's want to do something, they are made into Satan. There are probably plans percolating under the surface but haven't seen the light of day. No Presidential candidate, including Trump, talks about it either.
To follow on what I said below just now. R’s have no power because they get very little money. The money they do get is mostly from business like finance, military-industry, and Pharma/healthcare. If they don’t do their masters bidding, they don’t get money, and they don’t get elected. Again I say, our government is a giant money laundering operation from the middle class to businesses that buy political influence. Play the game or sit on the sidelines and bitch. People with integrity refuse to play a rigged game. So we sit on the sidelines and bitch.
Obamacare was definitely not intended to improve health care access. As all socialist programs, It was a massive transfer of wealth from the middle class with a little to the poor and a lot to over-regulated healthcare businesses that launder their profits back to purchase politicians. It’s working just as it was designed to.
Watch the video from John Cochrane I posted above. Among other points, the right way to pay for poor people's health care is via a tax, not the crazy Rube Goldberg ACA.
And why was there an increase? Because there was a PENALTY for not buying it!!!!! (Which, BTW, was later ruled to be “unconstitutional”) And a mandate for businesses with more than 50 employees to offer it (which closed a lot of business), and allowed people to stay on their parents plans until they were 26!!!! (Insane, really). Obamacare fixed NOTHING. I know so many people whose lives were thrown into chaos because of it. Republicans did nothing about it because Paul Ryan (and many others) was bought and paid for by the medical system. Speaker of the house has to raise $300 million per year, or they don’t get the job. He wasn’t getting his money from the UAW and teachers unions.
One thing I would like to see that would benefit patients and maybe lower cost is a way to reduce the cost of becoming a doctor. More and better GPs would really help improve health care at the individual level. No one coming out of medical school with $250-$400 thousand in debt (college + med school + ) can afford to work as a GP because the pay isn't going to sustain a middle class existence with that debt burden. It is currently also a brutal job with huge responsibility, lots of bureaucracy nonsense and very, very long hours. This is why so many take the offer to sell to medical conglomerates. If new MDs could come out of school with a reasonable or no debt it would make being a GP look like a better choice.
“More like this” as the saying goes. Absolutely on the mark. Making the consumer the payer will be a difficult but necessary transition, because so few of us understand medicine and what would be a normal price for things, especially complex things like surgery. We certainly need to do things that will change the mess we’re in!
we do need more competition but it's awfully hard to ramp up this sort of drug manufacturing. The other fact is if I can only sell for $35, I have no desire to ramp up production.....at market prices I would have an incentive to do so
Looking at what's happening in Canada with MAID is a precursor to American healthcare - heck, just look at Oregon and one can predict the likelihood of the means to rein in runaway costs: eliminate the patient thru medically assisted suicide, and you eliminate the runaway costs.
-->"End Mandates. ... Right now, I pay a lot because there are federal and state mandates in place on coverage. I have to pay for stuff I don’t need which is really a tax on me benefitting someone else."<--
Mandated Obamacare coverages are how we got socialized medicine from private providers, e.g., men, post-menopausal women paying for pregnancy/maternity care, and singles/childless/grandparents paying for child/adolescent/teen dental services, et al.
Most people don't understand how insurance (catastrophic risk sharing against knowable but uncertain events) works, and what Obamacare delivers is pre-paid routine medical and healthcare spending. E.g., A fire insurance policy that covered all homeowner property maintenance and replacement costs or an auto policy that covered routine oil/filter change, irrespective of driving 5,000 or 25,000 miles per year.
I went two decades in NYS, until Medicare, going naked--without health insurance. I paid out of pocket for back surgery, receiving a steep discount as I paid cash on the spot--amounting to approximately one year's (pre-Obamacare) health insurance premium ($20k). (Not that I would recommend it for others.)
As I like to say, under Obamacare, physicians traded their patients for a paycheck, as third-party payors ("He who pays the piper calls the tune.") dictate medical treatment and healthcare services with their reimbursement policies.
The great challenge reforming Obamacare is that there are vast voting constituencies "who will die on that hill." And, of course, the Obamacare reform was based on the Big Lie ("You like your doctor, you can keep your doctor," and "savings of $2,500 per family").
The principles are a good starting point, but I won't hold my breath, sorry to say as our politics and governing institutions are in shambles.
John Cochrane is one of the clearest communicators on health care economics. A couple good ones:
General discussion https://johnhcochrane.blogspot.com/2022/07/health-policy-videopodcast.html
Cross subsidies https://johnhcochrane.blogspot.com/2018/08/the-tax-and-spend-health-care-solution.html
agree on Cochrane....clear rational easy to understand thought
You are spot on with all of those points. There is nothing the government does not touch that is not poorly run, inefficient, way more expensive then it should be/advertised and impossible to navigate. Medicare/Caid the the horse that pulls much of this cart regarding pricing, coding etc. I always harken back to MASH and Radar and his forms in triplicate. Hillary Care is where much of this began to go off the rails for real. That was not successful but it moved the goal posts out further assuring us that we would end up with things like Obamacare. The left is always thinking two steps ahead and knows that is has to first fail with something, socialize it then eventually they will get it passed or slowly bleed it into the system. There is nothing that FDR touched that was not horrible in outcome.
Great post Mr Carter. Basic competition would work wonders on this hot mess of a “system”!
1. Competition. The ACA gave us competition of different colors of the same dress in size small medium or large.
2. Employer spend. People need to recognize that "rich benefits" are just pre-allocated wage considerations.
3. End Mandates. Mandates are just a strong arm version of tax preferred wage allocation seen above.
4. Third party payer. Healthcare once was a B2C business. Trust is inherent in B2C transactions. Third party payor health immediately becomes B2B2C. The last 40 years has been an exercise of inserting more and more "B" middle men of no value in an attempt to artificially re-insert trust.
5. Price Transparency. Sorry but what value does a "coder" add to the patient's experience. There are some companies working to augment price transparency... but... the cartel of jumbo "insurer" and jumbo "provider" will devise new methods of obfuscating price.
Mandated Medical-Loss-Ratios might turn out to be the worst part of the ACA. It has killed new entrants into the insurance side and has led jumbo incumbent insurers to vertically integrate and become healthcare providers.
Now we see hospitals and health systems say "we can't keep people healthy because they don't have access to food and housing" - they want to control public money in those sectors in the name of managing social determinants of health.
Excellent post, and I mostly agree with the strategies outlined in the 5 points.
Here in Boston, consolidation has not been good for competition. Even only going back 20 years ago, there were multiple independent hospitals in the city. They've been slowly subsumed over the past two decades into 2 large corporations, with only a handful independents left in the region.
So incredibly important. But I guess it’s all part of the Soros/Obama Cloward-Piven strategy of creating such chaos that the system can do nothing but collapse. Se also: censorship, crime, race relations, border security, energy policies, government deficits, transgender ideology, etc. Most liberals live in a dream world where their good intentions trump reality. They end up with leaders like Obama because he stroked their go and feeds their envy. Then, like all communists and fascists, they blame the ensuing disaster on their opponents. Take a look at what’s happening in the NHS in England for a glimpse of the future of our healthcare system.
The US health care system was screwed up long before Obama. Obamacare is/was bad, but it was meant to address real issues. Fixing the issues would gore lots of oxes, including ones loved by lots of Rs
It was. Obamacare made it significantly worse.
Sure it's bad. But I think it's probably less bad than I thought it was going to be. My point is that the dysfunction of the overall system is not only due to Obama. The original sin was the tax preference for employer provided care. Find more than a token R politician who is willing to invest any capital in pushing a change in that policy. Look what happened to the ACA "Cadillac Tax": repealed in an overwhelmingly bipartisan vote - 419-6 in the House.
Less bad because Republicans forced some compromise....Obamacare is abysmal at best, cruel at worst.
The fact that OCare was a bill John Dingell's father scribed, nearly 100 yrs of aging doesn't make it taste any better. It's all about control and creating medical plantations of voters.
"[O]f all John's accomplishments, perhaps the most remarkable has been his tireless fight to guarantee quality, affordable health care for every American," Obama said of Dingell in a press statement on his retirement. "Decades after his father first introduced a bill for comprehensive health reform, John continued to introduce health care legislation at the beginning of every session. And as an original author of the Affordable Care Act, he helped give millions of families the peace of mind of knowing they won't lose everything if they get sick."
https://www.washingtonexaminer.com/president-obama-obamacare-is-the-best-thing-john-dingell-ever-did
Obama promised: “if you like your health insurance, you get to keep it.” Wife and I had a high deductible plan with HSA at $166/mo. When Obamacare was instituted, our plan became illegal and we lost our insurance. The cheapest plan available to us was $1100/mo. Fucking huge success! If you were an insurance company executive, or a politician they buy, that is. Meanwhile health care service delivery became a hellish nightmare and has only gotten worse.
That's bad and not inconsistent with anything I've said. The only thing in addition that I've said is that nobody on the R side actually has any plans to fix any of this. As demonstrated by their actions, policy and legislating is not very high on the priority list these days for the Rs. Continuously bitching about Ds doesn't cut it.
I think when the R's want to do something, they are made into Satan. There are probably plans percolating under the surface but haven't seen the light of day. No Presidential candidate, including Trump, talks about it either.
To follow on what I said below just now. R’s have no power because they get very little money. The money they do get is mostly from business like finance, military-industry, and Pharma/healthcare. If they don’t do their masters bidding, they don’t get money, and they don’t get elected. Again I say, our government is a giant money laundering operation from the middle class to businesses that buy political influence. Play the game or sit on the sidelines and bitch. People with integrity refuse to play a rigged game. So we sit on the sidelines and bitch.
Obamacare was definitely not intended to improve health care access. As all socialist programs, It was a massive transfer of wealth from the middle class with a little to the poor and a lot to over-regulated healthcare businesses that launder their profits back to purchase politicians. It’s working just as it was designed to.
The one thing it certainly did do was to increase the % of people insured. Even if in a very costly manner.
https://www.statista.com/statistics/200957/percentage-of-americans-without-health-insurance/
Watch the video from John Cochrane I posted above. Among other points, the right way to pay for poor people's health care is via a tax, not the crazy Rube Goldberg ACA.
And why was there an increase? Because there was a PENALTY for not buying it!!!!! (Which, BTW, was later ruled to be “unconstitutional”) And a mandate for businesses with more than 50 employees to offer it (which closed a lot of business), and allowed people to stay on their parents plans until they were 26!!!! (Insane, really). Obamacare fixed NOTHING. I know so many people whose lives were thrown into chaos because of it. Republicans did nothing about it because Paul Ryan (and many others) was bought and paid for by the medical system. Speaker of the house has to raise $300 million per year, or they don’t get the job. He wasn’t getting his money from the UAW and teachers unions.
One thing I would like to see that would benefit patients and maybe lower cost is a way to reduce the cost of becoming a doctor. More and better GPs would really help improve health care at the individual level. No one coming out of medical school with $250-$400 thousand in debt (college + med school + ) can afford to work as a GP because the pay isn't going to sustain a middle class existence with that debt burden. It is currently also a brutal job with huge responsibility, lots of bureaucracy nonsense and very, very long hours. This is why so many take the offer to sell to medical conglomerates. If new MDs could come out of school with a reasonable or no debt it would make being a GP look like a better choice.
“More like this” as the saying goes. Absolutely on the mark. Making the consumer the payer will be a difficult but necessary transition, because so few of us understand medicine and what would be a normal price for things, especially complex things like surgery. We certainly need to do things that will change the mess we’re in!
If demand for insulin at $35 exceeds supply, why can't supply be increased? Maybe we need more competition in this area.
we do need more competition but it's awfully hard to ramp up this sort of drug manufacturing. The other fact is if I can only sell for $35, I have no desire to ramp up production.....at market prices I would have an incentive to do so
It shares a common denominator. (Chart originally from Mark Perry, I believe.)
https://ritholtz.com/wp-content/uploads/2018/02/pricechanges.png
Looking at what's happening in Canada with MAID is a precursor to American healthcare - heck, just look at Oregon and one can predict the likelihood of the means to rein in runaway costs: eliminate the patient thru medically assisted suicide, and you eliminate the runaway costs.
-->"End Mandates. ... Right now, I pay a lot because there are federal and state mandates in place on coverage. I have to pay for stuff I don’t need which is really a tax on me benefitting someone else."<--
Mandated Obamacare coverages are how we got socialized medicine from private providers, e.g., men, post-menopausal women paying for pregnancy/maternity care, and singles/childless/grandparents paying for child/adolescent/teen dental services, et al.
Most people don't understand how insurance (catastrophic risk sharing against knowable but uncertain events) works, and what Obamacare delivers is pre-paid routine medical and healthcare spending. E.g., A fire insurance policy that covered all homeowner property maintenance and replacement costs or an auto policy that covered routine oil/filter change, irrespective of driving 5,000 or 25,000 miles per year.
I went two decades in NYS, until Medicare, going naked--without health insurance. I paid out of pocket for back surgery, receiving a steep discount as I paid cash on the spot--amounting to approximately one year's (pre-Obamacare) health insurance premium ($20k). (Not that I would recommend it for others.)
As I like to say, under Obamacare, physicians traded their patients for a paycheck, as third-party payors ("He who pays the piper calls the tune.") dictate medical treatment and healthcare services with their reimbursement policies.
The great challenge reforming Obamacare is that there are vast voting constituencies "who will die on that hill." And, of course, the Obamacare reform was based on the Big Lie ("You like your doctor, you can keep your doctor," and "savings of $2,500 per family").
The principles are a good starting point, but I won't hold my breath, sorry to say as our politics and governing institutions are in shambles.