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The U.S. can slash health-care costs 75% with 2 changes and no ‘Medicare for All' - 08-16-2019, 12:38 PM

When you think about it, there should only be one price.

Opinion: The U.S. can slash health-care costs 75% with 2 fundamental changes — and without ‘Medicare for All’
Published: Aug 15, 2019 3:06 p.m. ET

42
Fund the HSA deductible, as Indiana and Whole Foods do, and put real prices on everything https://www.marketwatch.com/story/th...of2&yptr=yahoo

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By

SEAN
MASAKI FLYNN
As the Democratic presidential candidates argue about “Medicare for All” versus a “public option,” two simple policy changes could slash U.S. health-care costs by 75% while increasing access and improving the quality of care.

These policies have been proven to work by ingenious companies like Whole Foods and innovative governments like the state of Indiana and Singapore. If they were rolled out nationally, the United States would save $2.4 trillion per year across individuals, businesses, and the government.

The first policy—price tags—is a necessary prerequisite for competition and efficiency. Under our current system, it’s nearly impossible for people with health insurance to find out in advance what anything covered by their insurance will end up costing. Patients have no way to comparison shop for procedures covered by insurance, and providers are under little pressure to lower costs.

By contrast, there is intense competition among the providers of medical services like LASIK eye surgery that aren’t covered by health insurance. For those procedures, providers must compete for market share and profits by figuring out ways to improve efficiency and lower prices. They must also advertise to get customers in the door, and must ensure high quality to generate customer loyalty and benefit from word of mouth.

That’s why the price of LASIK eye surgery, as just one example, has fallen so dramatically even as quality has soared. Adjusted for inflation, LASIK cost nearly $4,000 per eye when it made its debut in the 1990s. These days, the average price is around $2,000 per eye and you can get it done for as little as $1,000 on sale.

By contrast, ask yourself what a colonoscopy or knee replacement will cost you. There’s no way to tell.

Price tags also insure that everybody pays the same amount. We currently have a health-care system in which providers charge patients wildly different prices depending on their insurance. That injustice will end if we insist on legally mandated price tags and require that every patient be charged the same price.

As a side benefit, we will also see massively lower administrative costs. They are currently extremely high because once a doctor submits a bill to an insurance company, the insurance company works hard to deny or discount the claim. Thus begins a hideously costly and drawn-out negotiation that eventually yields the dollar amount that the doctor will get reimbursed. If you have price tags for every procedure and require that every patient be charged the same price, all of that bickering and chicanery goes away. As does the need for gargantuan bureaucracies to process claims.

What happened in Indiana
The second policy—deductible security—pairs an insurance policy that has an annual deductible with a health savings account (HSA) that the policy’s sponsor funds each year with an amount equal to the annual deductible.

The policy’s sponsor can be either a private employer like Whole Foods (now part of Amazon. AMZN, +0.97% ), which has been doing this since 2002, or a government entity like the state of Indiana, which has been offering deductible security to its employees since 2007.

While Indiana offers its workers a variety of health-care plans, the vast majority opt for the deductible security plan, under which the state covers the premium and then gifts $2,850 into each employee’s HSA every year.

Since that amount is equal to the annual deductible, participants have money to pay for out-of-pocket expenses. But the annual gifts do more than ensure that participants are financially secure; they give people skin in the game. Participants spend prudently because they know that any unspent HSA balances are theirs to keep. The result? Massively lower health-care spending without any decrement to health outcomes.

We know this because Indiana Gov. Mitch Daniels ordered a study that tracked health-care spending and outcomes for state employees during the 2007-to-2009 period when deductible security was first offered. Employees choosing this plan were, for example, 67% less likely to go to high-cost emergency rooms (rather than low-cost urgent care centers.) They also spent $18 less per prescription because they were vastly more likely to opt for generic equivalents rather than brand-name medicines.

Those behavioral changes resulted in 35% lower health-care spending than when the same employees were enrolled in traditional health insurance. Even better, the study found that employees enrolled in the deductible security plan were going in for mammograms, annual check ups, and other forms or preventive medicine at the same rate as when they were enrolled in traditional insurance. Thus, these cost savings are real and not due to people delaying necessary care in order to hoard their HSA balances.

By contrast, the single-payer “Medicare for All” proposal that is being pushed by Bernie Sanders and Kamala Harris would create a health-care system in which consumers never have skin in the game and in which prices are hidden for every procedure.

That lack of skin in the game will generate an expenditure explosion. We know this because when Oregon randomized 10,000 previously uninsured people into single-payer health insurance starting in 2008, the recipients’ annual health-care spending jumped 36% without any statistically significant improvements in health outcomes.

Look at Singapore
By contrast, if we were to require price tags in addition to deductible security, the combined savings would amount to about 75% of what we are paying now for health care.

We know this to be true because while price tags and deductible security were invented in the United States, only one country has had the good sense to roll them out nationwide. By doing so, Singapore is able to deliver universal coverage and the best health outcomes in the world while spending 77% less per capita than the United States and about 60% less per capita than the United Kingdom, Canada, Japan, and other advanced industrial economies.

Providers post prices in Singapore, and people have plenty of money in their HSA balances to cover out-of-pocket expenses. As in the United States, regulators set coverage standards for private insurance companies, which then accept premiums and pay for costs in excess of the annual deductible. The government also directly pays for health care for the indigent.

The result is a system in which government spending constitutes about half of all health-care spending, as is the case in the United States. But because prices are so much lower, the Singapore government spends only about 2.4% of GDP on health care. By contrast, government health-care spending in the United States runs at 8% of GDP.

With Singapore’s citizenry empowered by deductible security and price tags, competition has worked its magic, forcing providers to constantly figure out ways to lower costs and improve quality. The result is not only 77% less spending than the United States but also, as Bloomberg Businessweek reports, one of the healthiest populations in the world.

Regnery Publishing
If we are going to be serious about squashing health-care costs and improving the quality of care, we need to foster intense competition among health-care providers to win business from consumers who are informed, empowered and protected from financial surprises. Price tags and deductible security are the only polices that accomplish all of these goals.

I hope that politicians on both sides of the aisle will get behind these proven solutions. Washington should not be a place where good ideas go to die.

Sean Masaki Flynn is an associate professor of economics at Scripps College and the author of “Economics for Dummies” and, most recently, “The Cure That Works; How to have the world’s best health care — at a quarter of the price.”




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08-16-2019, 12:41 PM

I'd have to give this much more thought to decide if it makes sense and would work, but my first reaction is that it is very intriguing.


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08-16-2019, 12:49 PM

Ehhh, things are fine just the way they are


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The U.S. can slash health-care costs 75% with 2 changes and no ‘Medicare for All'
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The U.S. can slash health-care costs 75% with 2 changes and no ‘Medicare for All' - 08-16-2019, 12:57 PM

LOL!
I thought bamster-care already cut the costs?
After all, it only cost three times as much as it used to with deductibles four times higher.
The fact that there are sentient bipods (well, at least moderately sentient) who want the same kind of idiots that gave us bamster-care to do even more damage is frightening.
I can understand believing in Santa Claus and voting that way, but I can't understand being so gawdamn stupid that you actually think he can deliver on his never-ending promises to give you free shit.


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08-16-2019, 01:11 PM

Quote:
That’s why the price of LASIK eye surgery, as just one example, has fallen so dramatically even as quality has soared. Adjusted for inflation, LASIK cost nearly $4,000 per eye when it made its debut in the 1990s. These days, the average price is around $2,000 per eye and you can get it done for as little as $1,000 on sale.
There are Groupon discounts and you can clip coupons from your Sunday fliers for LASIK.

You can get it done for a few hundred bucks.

Recently, the local center was advertising $400 per eye on the radio.

Do you think I would go to a discount surgery center? For my eyes? For anything?

Nope.

And this is being presented as a positive.

A little truth mixed with a lot of misunderstanding is what I see.

.


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08-16-2019, 08:19 PM

Quote:
Originally Posted by Chopdoc View Post
There are Groupon discounts and you can clip coupons from your Sunday fliers for
LASIK.

You can get it done for a few hundred bucks.

Recently, the local center was advertising $400 per eye on the radio.

Do you think I would go to a discount surgery center? For my eyes? For anything?

Nope.

And this is being presented as a positive.

A little truth mixed with a lot of misunderstanding is what I see.


.
There is a super-duper discount possibility. The equipment sits
unused at night. So find a HS graduate who is a good reader
and set him up to do the surgeries. Bet he could do them for
$50 each. That would avoid all the overheads. Operation room,
appointment manager, equipment purchase, and insurance.

And all the advantages passed on to the blind man.


  
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08-16-2019, 09:49 PM

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Originally Posted by Slide Rule View Post
There is a super-duper discount possibility. The equipment sits
unused at night. So find a HS graduate who is a good reader
and set him up to do the surgeries. Bet he could do them for
$50 each. That would avoid all the overheads. Operation room,
appointment manager, equipment purchase, and insurance.

And all the advantages passed on to the blind man.


Even better, just get AI to do it and after simulations of a few billion procedures or so it will be able to do it far better than any doctor and you can have a lasik booth right next to the photo booth at walmart.
  
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08-16-2019, 10:17 PM

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Originally Posted by Masayoshi View Post
Even better, just get AI to do it and after simulations of a few billion procedures or so it will be able to do it far better than any doctor and you can have a lasik booth right next to the photo booth at walmart.
And then you can jump in your Tesla and let it drive you home on autopilot.
  
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medicare regulation
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medicare regulation - 08-17-2019, 04:10 AM

There is a regulation that if someone accepts medicare they are required to bill everyone at the medicare rate which medicare dictates. This is a widely ignored regulation in my experience. I have reminded more than one billing office of this to watch them squirm! Conforming to this regulation could result in huge savings. Some practices are illegally billing over a million a year. The other side of the coin, this is why you will see some practices refuse medicare.

Many years ago I visited a doctor. He charged insurance companies $100 per visit. People paying cash he charged $35. I thought this was a dishonest practice by a guy that overall I liked as a friend and thought was quite ethical. Then I replaced his entire computer network in his office including reloading all of his software and data files. When I did I found that he received 35% of what he billed insurance! "Ah, I see" said the blind Hu!

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08-17-2019, 04:11 AM

Quote:
Originally Posted by Masayoshi View Post
Even better, just get AI to do it and after simulations of a few billion procedures or so
it will be able to do it far better than any doctor and you can have a lasik booth right
next to the photo booth at Walmart.
A HS graduate could keep the costs down.

You couldn't afford me.

I suppose I would try Lasik on certain forum members
just for the benefit of their never posting again. After
punching a pencil in a few eyes, I would lose interest.

A photo booth at Walmart is a fine idea and means of
lowering the cost. Perhaps we could substitute after
photos of a client and dispense with the actual surgery.
A cost-cutting method of popularity used in medicine
today. Selling the sizzle.




  
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08-17-2019, 04:13 AM

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Originally Posted by HawaiianEye View Post
And then you can jump in your Tesla and let it drive you home on autopilot.

Yep. Autopilot would be a benefit during recovery.
  
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08-17-2019, 04:23 AM

Isn't it amazing how the mere presence of Medicare (a govt operated
Program we pay for) works in the marketplace? When you think about it works sort
of like a lobbyist. The lobbyist offers the politician money so they can charge what
they want. The doctor accepts what they pay but then he has the option to bill the
patient for the rest. When Medicare is accepted they take what Medicare pays......period.

There is no rest of the bill.

The lowest price should set the market. If one wants to pay more for care he deems
better, wonderful. He does that and leaves the rest of us out of it.



Quote:
Originally Posted by ShootingArts View Post
There is a regulation that if someone accepts medicare they are required to bill everyone at the medicare rate which medicare dictates. This is a widely ignored regulation in my experience. I have reminded more than one billing office of this to watch them squirm! Conforming to this regulation could result in huge savings. Some practices are illegally billing over a million a year. The other side of the coin, this is why you will see some practices refuse medicare.

Many years ago I visited a doctor. He charged insurance companies $100 per visit. People paying cash he charged $35. I thought this was a dishonest practice by a guy that overall I liked as a friend and thought was quite ethical. Then I replaced his entire computer network in his office including reloading all of his software and data files. When I did I found that he received 35% of what he billed insurance! "Ah, I see" said the blind Hu!

Hu


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08-17-2019, 04:29 AM

maybe i am understanding the second proposal incorrectly
you get a deep pocket to fund everyones deductible and then they get to keep what they dont use
is the cost to the deep pocket factored in??
isnt this a subsidy ??
paid for by the private sector??
  
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08-17-2019, 04:59 AM

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Originally Posted by Sofla View Post
I'd have to give this much more thought to decide if it makes sense and would work, but my first reaction is that it is very intriguing.
Remember who started this thread. All we needed was his input to slash costs 75%?
Pleeease! Trump is going to get prescription prices uniform across the globe. That is what can be done right away. As with many other things, we are paying far too much in relation to other countries. Why is that? It's bullshit.
  
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