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Quote:How is this not true? If Wal-Mart was the only store that sold household goods, would the prices be like they are?


Whatever was mandated if comparing to a public system.


You don't have a free market because the insurers start having networks of doctors etc. The private system works better in Australia but still not great.
Quote:Whatever was mandated if comparing to a public system.


You don't have a free market because the insurers start having networks of doctors etc. The private system works better in Australia but still not great.
But free markets decrease costs to the consumer no matter what the product or service, right? That seems to be the argument here.
Quote:Whatever was mandated if comparing to a public system.


You don't have a free market because the insurers start having networks of doctors etc. The private system works better in Australia but still not great.
 

I don't disagree, the system here is far too hampered by the middle men of insurance. If you want to win the war against over-utilization you have to start with price pain for the consumer.
Quote:But free markets decrease costs to the consumer no matter what the product or service, right? That seems to be the argument here.


Possibly if you can make it an actual free market. Unfortunately with patents on drugs and the fact that healthcare is more of a necessity than a choice I'm not sure it works.
Quote:How dare you insinuate that something as simple as the free market could better manage the limited resources of our world than our governmental superiors.


Hail bernie
Quote:99.5% of Swiss citizens have health insurance. Because they can choose between plans from nearly 100 different private insurance companies, insurers must compete on price and service, helping to curb health care inflation. Most beneficiaries have complete freedom to choose their doctor, and appointment waiting times are almost as low as those in the U.S., the world leader.
Thanks for proving my point. The fee schedules are established by the government. BTW, did you get this from the Forbes article without reading the nest paragraph? Just wondering how you got the info you did without catching the government setting the reimbursements.
Quote:You really think the US and the Swiss are a reasonable comparison when you factor in population, climate, culture and geography?
Are you serious here? climate? geography? You have yet to rebut that every other major democracy has a cheaper system that provides better coverage, and that they all use government price controls, and you resort to climate? Hey, I like the idea of free competition, but what we have now, and what has been proposed recently doesn't even come close. So far in this thread no one has seriously addressed that without the transparency in pricing there is no viable way to set the competition up, and the balkanization of doctors into networks diminishes competition. So far we are 13 pages into this thread, and while I appreciate the contributions that you, Rob, and a few others have made, I have to admit, I am a bit disappointed that most of what we get in terms of a plan is a paean to competition without the slightest idea of how that competition would be successful. Previously I pointed out the disparity in the price of procedures. I have mentioned that several times, and yet you steadfastly ignore that discrepancy that has absolutely nothing with the climate or how much junk food folks eat. 
Unfortunately ideology is more important than the facts to many people.


Apparently Scottish want an American system... good luck finding many Brit's who want that.
Quote:Thanks for proving my point. The fee schedules are established by the government. BTW, did you get this from the Forbes article without reading the nest paragraph? Just wondering how you got the info you did without catching the government setting the reimbursements.
 

1.) I never stated that the Swiss system was perfect. 

2.) As we have stated above, Medicare already acts as a defacto government benchmark for fee schedules.  We still have the same challenges. 

3.) We've already talked about the importance of cost transparency and consumer choice. 

4.) Just as an aside, we currently have more than 150% of the entire population of Switzerland living in the country as undocumented aliens. 

5.) The Labor force participation rate in Switzerland is over 80% here its just over 60%,  They have conversations about how best to deliver care within their communal values and not as much about half the country trying to piggy back the other half. 
Earlier, Stround mentioned that it was impossible to cut out the middle man.  Increasingly, there is a chance (in some sectors) that this may not be the case.  As stated earlier, the problem with massive bureaucracies is that they themselves cost money and the cost of compliance.  Some Care providers are finding that it is much easier to manage their own risk pool in house through concierge care than having to wait on a reimbursment from an insurance company.  This both dramatically decreases overhead cost to the insured and dramatically increases access and choice.  Health Savings accounts, Direct risk managed basic and preventative care coupled with catastrophic major health insurance could be a winning combination moving forward. 

 

As another aside, it is my responsibility to again point out the blind absurdity of having the US government trying to manage risk pools.  How's the VA working out?  They are about to bankrupt the country with a failed Old Age insurance scheme.  They last two major health entitlement programs they created are heading towards insolvency.  The last regulation/entitlement/debacle was  a lesson in mal practice.  If a CEO of a health insurance company went on television and ensured that all of his policy holders would be able to keep their network doctors and then that turned out to be a calculated lie, they would have been thrown in jail.  IF they lied about policy decreases instead of policy increases they would be thrown in jail.  IF they had a negative debt to income ratio of nearly 6 to 1 then they would be rejected by every insurance commission in all 50 states!  The idea that more regulation and more intervention is going to make things CHEAPER is absurd. 

Quote:1.) I never stated that the Swiss system was perfect. 

No system is perfect. But the others are significantly better.


2.) As we have stated above, Medicare already acts as a defacto government benchmark for fee schedules.  We still have the same challenges. 

Medicare in no way limits charges made by our private health systems.


3.) We've already talked about the importance of cost transparency and consumer choice. 

So you agree all of this talk of competition is pretty pointless if we can't know what everyone is charging? If not, how do you solve the problem and guarantee competition?


4.) Just as an aside, we currently have more than 150% of the entire population of Switzerland living in the country as undocumented aliens. 

Yes, and they are a bit of a drag due to emergency care. If emergency care is 2% of spending, and undocmented aliens are 3% of the population, it matters, but ins nowhere near the bulk of the costs.


5.) The Labor force participation rate in Switzerland is over 80% here its just over 60%,  They have conversations about how best to deliver care within their communal values and not as much about half the country trying to piggy back the other half. 

Yeah, or maybe it is the fact that all of the other countries use the government to actually do something useful like get decent rates on procedures and medicine.
Quote:Are you serious here? climate? geography? You have yet to rebut that every other major democracy has a cheaper system that provides better coverage, and that they all use government price controls, and you resort to climate? Hey, I like the idea of free competition, but what we have now, and what has been proposed recently doesn't even come close. So far in this thread no one has seriously addressed that without the transparency in pricing there is no viable way to set the competition up, and the balkanization of doctors into networks diminishes competition. So far we are 13 pages into this thread, and while I appreciate the contributions that you, Rob, and a few others have made, I have to admit, I am a bit disappointed that most of what we get in terms of a plan is a paean to competition without the slightest idea of how that competition would be successful. Previously I pointed out the disparity in the price of procedures. I have mentioned that several times, and yet you steadfastly ignore that discrepancy that has absolutely nothing with the climate or how much junk food folks eat.


I'm sorry, I didn't realize we were arguing. I can't and don't defend our system as you seem to want, and have no real interest in doing so. I hopefully gave you some information about how prices are set that you can use or not, I don't really care if you're disappointed. The facts is simply that we have a choice between more government control and less government control of the healthcare sector and I will always favor less. If you are incapable of recognizing that your thoughts are much more complex than a comparison of prices among unlike environments then you should expand your thinking.
We have more government control here and cheaper private health insurance. They try and price gouge too much and people will also ditch the coverage for the public system.
Quote:<blockquote class="ipsBlockquote" data-author="jj82284" data-cid="971117" data-time="1488330402">
1.) I never stated that the Swiss system was perfect. 
No system is perfect. But the others are significantly better.


2.) As we have stated above, Medicare already acts as a defacto government benchmark for fee schedules.  We still have the same challenges. 
Medicare in no way limits charges made by our private health systems.


3.) We've already talked about the importance of cost transparency and consumer choice. 
So you agree all of this talk of competition is pretty pointless if we can't know what everyone is charging? If not, how do you solve the problem and guarantee competition?


4.) Just as an aside, we currently have more than 150% of the entire population of Switzerland living in the country as undocumented aliens. 
Yes, and they are a bit of a drag due to emergency care. If emergency care is 2% of spending, and undocmented aliens are 3% of the population, it matters, but ins nowhere near the bulk of the costs.


5.) The Labor force participation rate in Switzerland is over 80% here its just over 60%,  They have conversations about how best to deliver care within their communal values and not as much about half the country trying to piggy back the other half. 
Yeah, or maybe it is the fact that all of the other countries use the government to actually do something useful like get decent rates on procedures and medicine.
</blockquote>


Regarding #2, how many contracts have you negotiated with an insurance company, what conversion factor did you use to set your fee schedule, and how did you assign credit to the physicians to compensate them for their labor while insuring adequate margin for non-production overhead?
Quote:We have more government control here and cheaper private health insurance. They try and price gouge too much and people will also ditch the coverage for the public system.


Aside from the government aspect I think that's great, I wish we were putting our resources into developing a robust individual market here.
Quote: 

<blockquote class="ipsBlockquote" data-author="jj82284" data-cid="971117" data-time="1488330402">
<div>
1.) I never stated that the Swiss system was perfect. 

No system is perfect. But the others are significantly better.


2.) As we have stated above, Medicare already acts as a defacto government benchmark for fee schedules.  We still have the same challenges. 

Medicare in no way limits charges made by our private health systems.


3.) We've already talked about the importance of cost transparency and consumer choice. 

So you agree all of this talk of competition is pretty pointless if we can't know what everyone is charging? If not, how do you solve the problem and guarantee competition?


4.) Just as an aside, we currently have more than 150% of the entire population of Switzerland living in the country as undocumented aliens. 

Yes, and they are a bit of a drag due to emergency care. If emergency care is 2% of spending, and undocmented aliens are 3% of the population, it matters, but ins nowhere near the bulk of the costs.


5.) The Labor force participation rate in Switzerland is over 80% here its just over 60%,  They have conversations about how best to deliver care within their communal values and not as much about half the country trying to piggy back the other half. 

Yeah, or maybe it is the fact that all of the other countries use the government to actually do something useful like get decent rates on procedures and medicine.
 

</div>
</blockquote>
 

1.)Significantly is a relative term.  As the Forbes article stated, we are essentially the world Leader in speed getting people to Treatment.  My wife for instance has had a routine check up at 10:00 and been in for a diagnostic referral before the close of business.  That creates value vs. a system that would make her wait 6 months for government approval.  Also, you have to make adjustments for other economic conditions.  Per Capita GDP in Britain is 38k and per Capita GDP in the US is nearly 60k then there is a built in difference in how that correlates to wages and thus the cost of delivering health care. 

 

There are certain features that other countries have tried that may add value to our overall health care market and I think it makes sense to consider adopting some of them. 

 

2.) Medicare Might not make statutory requirements of health care providers, but generally costs and reimbursements are based on the direction Medicare Takes.

 

3.) Agree, I am the one who bought it up.  When you walk into the average Doctors office, even if you ask what a procedure will cost they can't give you an answer.  More over, we bundle our catastrophic risk, preventative prepayment, incidental care risk, collective purchasing power, etc. all in the same financial instrument (current health insurance).  We should be looking at ways to take preventative and incidental care away from major insurance and have risk pools managed by care providers.  Also, we should be able to create groups to allow banding and collective purchasing that are a.) not tied to employment, b.) able to allow each individual policy owner to own their own policy. 

 

4.) You missed it.  at current about 71% of undocumented immigrants are on some form of government assistance.  The vast majority will not be covered or be receiving their care through some form of a government program.  That means that we are already subsidizing a population greater than that of most of the ALTERNATIVES That most people point to.  This is a contributing factor to why Switzerland actually spends about 1/3rd the money we do as a percentage of GDP on Healthcare expenses. 

 

5.) Why do you keep pointing to other countries that have longer wait times and less choice as better options?  more over, why don't you point to the VA as the system that you want to participate in?  Why don't you tout the actuarial solvency of Social Security as the Gold standard in Modern government run insurance?  Why don't you tout the transparency of the Obama Care deliberations, and the promises made to the American people as the clear winner over Public Insurance companies and their requirements to tell the Truth? 

 

Instead we just get the standard answer of "all other industrialized Democracies"  When we point out that our current employer based system is the byproduct of failed price controls what's your response? 

 

As FL pointed out, the basic principle of economics is Scarcity.  That Scarcity will manifest itself in some way, be it through price or lack of supply.  We could pass a law that says every laptop only costs 5 dollars.  Guess how many laptops will get produced?  Allow people to see their own costs, make their decisions and hold providers accountable to provide more options to the public to do things more efficiently while getting barriers out of their way! 
Quote:Aside from the government aspect I think that's great, I wish we were putting our resources into developing a robust individual market here.
 

Exactly.  Companies don't invest time or money in the individual market (10% of the population) because the money is in the group markets (85% of the population)  IT's a bigger piece of the pie, the persistency of premium payments is going to be exponentially higher because you are dealing with corporate officers and not just random people.  Moreover, people are only going to be employed there for 3-5 years on average.  That creates and ARTIFICIAL TERM in the actuarial calculations that means that there is theoretically less risk insuring that pool. 

 

IF we truly had a free market where there wasn't a double blind between patients and Doctors (their employer and the insurance companies) then we would have much better options as consumers.
But wages aren't high in the US? So not sure how GDP per capita comes into it.


Irish richer than British? I don't think so.
Quote:But wages aren't high in the US? So not sure how GDP per capita comes into it.


Irish richer than British? I don't think so.


Better looking too
Quote:My HSA runs me $80 a pay period in premiums and I contribute an additional $150 per pay period. The $460 a month is much better than the $600 premium for my old plan that still had a $3500 deductible.
 

A health savings account is not health insurance.   What you are doing is self-insuring at least a portion of the costs that are not covered by your regular health insurance policy.   So you really can't equate what you call the "premium" on your HSA with the premium on your health insurance policy.   They are not the same thing.  
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