The over-regulation, in fact, is what has caused prices to skyrocket and be unrealistic, unsustainable.

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So-called "single payer" has been proven to be a failure.

In reality, the single payer is the patient.  It's the patient's responsibility alone.  Your care, your responsibility.  How you meet it that obligation (through insurance and out of pocket) is up to you to navigate and decide how to approach.

I don't find, and you haven't offered, evidence in support of either claim that you make above.
The British and Canadian systems are both stressed, yes, but are still doing better than us in terms of prices (including the part that government pays) and outcomes.  

My claim is that a low supply of doctors and insufficient competition between hospitals is driving costs up.  As evidence I can refer you to WHO statistics on the number of physicians per capita. In Western Europe they have twice as many as we do.

Well, when we can't agree on facts, then there's no point in a discussion with you.  The US healthcare system was (and still is, despite the damage 0bamacare did) the best in the world.  You can't get the level of care you get here in rationed nations.  Innovation has brought down cost as well.  So, if you can't accept important truths then there's no point.  You're in a different reality.  Our care and value cannot be matched, though it's closer than it used to be due to 0bamacare.

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"You do your own thing in your own time. You should be proud."

I don't find, and you haven't offered, evidence in support of either claim that you make above.
The British and Canadian systems are both stressed, yes, but are still doing better than us in terms of prices (including the part that government pays) and outcomes.  

My claim is that a low supply of doctors and insufficient competition between hospitals is driving costs up.  As evidence I can refer you to WHO statistics on the number of physicians per capita. In Western Europe they have twice as many as we do.

Well, when we can't agree on facts, then there's no point in a discussion with you.  The US healthcare system was (and still is, despite the damage 0bamacare did) the best in the world.  You can't get the level of care you get here in rationed nations.  Innovation has brought down cost as well.  So, if you can't accept important truths then there's no point.  You're in a different reality.  Our care and value cannot be matched, though it's closer than it used to be due to 0bamacare.

now you've introduced a new claim about the superiority of our system in terms of prices and outcomes and no evidence to support it.  Where is your evidence? how do you measure these things? who measures them?

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My fellow southpaw Mark Brunell will probably always be my favorite Jaguar.

Well, when we can't agree on facts, then there's no point in a discussion with you.  The US healthcare system was (and still is, despite the damage 0bamacare did) the best in the world.  You can't get the level of care you get here in rationed nations.  Innovation has brought down cost as well.  So, if you can't accept important truths then there's no point.  You're in a different reality.  Our care and value cannot be matched, though it's closer than it used to be due to 0bamacare.

now you've introduced a new claim about the superiority of our system in terms of prices and outcomes and no evidence to support it.  Where is your evidence? how do you measure these things? who measures them?

So you don't know it all.  I never would have guessed from the attitude.  Otherwise, you'd be showing me.

---

"You do your own thing in your own time. You should be proud."

now you've introduced a new claim about the superiority of our system in terms of prices and outcomes and no evidence to support it.  Where is your evidence? how do you measure these things? who measures them?

So you don't know it all.  I never would have guessed from the attitude.  Otherwise, you'd be showing me.

I never claimed to know it all.  
But I do have some evidence.  I claimed that we have fewer doctors per population than other countries:
http://www.who.int/gho/health_workforce/...ensity/en/
Could be one reason that our costs are higher.  

You claimed that we pay more because we have too many regulations.  Many countries have more regulations, and nearly all of them pay less than us.  I could show you the cost data, but regulations are hard to quantify.  I think you'd agree that a system with state-owned hospitals is more regulated than ours, as is a single payer system.  

If you want to show that somehow we pay more because we get better stuff, I'd like to see the evidence.

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My fellow southpaw Mark Brunell will probably always be my favorite Jaguar.

Pricing isn't arbitrary, even in our overly regulated health care system.

Governments can provide superior healthcare at a much reduced cost which means private insurers can't price gouge. That's the answer.

LOL! Tell that to Venzuela, price controls don't matter if no one will sell you anything at that price.

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Yes, it's improvement, but it's Blaine Gabbert 2012 level improvement. - Pirkster

http://youtu.be/ouGM3NWpjxk The Home Hypnotist!

http://youtu.be/XQRFkn0Ly3A Media on the Brain Link!
 

Peyton must store oxygen in that forehead of his. No way I'd still be alive after all that choking.

 

Congress passes legislation that sets the price factors, CMS develops the fee schedule that Medicare pays, all contracts with private insurers are based on the Medicare fee schedule. Just this calendar year Congress changed the price factors twice resulting in millions of dollars of work reprocessing claims when they backdated the fee schedule updates after the fact. Here in Florida the changes resulted in a roughly 3.5% overall change in reimbursement from January 1 to March 15 that we still haven't completely worked through.

And politics is so deeply engrained in that legislative process as doctors, hospitals, insurance companies, nonprofits, health care corporations, retail stores and patient advocacy groups all lobby their [BLEEP] off to get their share of the health care dollar that the single payer model would be just as ineffective. See the Massachusetts, Tennessee, and VA plan scandals for how our government can screw it up in different ways.No, we need market based health care with fewer government friction points and reduced administrative costs, not more government control with cockamamie schemes thought up by accounting nerds who know spreadsheets better than medicine.

There's no reason to assume that a major reform of health insurance would maintain the same rules and relationships of Medicare today.

You're right that, from the perspective of individual provider organizations, Medicare reimbursement rates seem to be dictated from on high.

However those who do the "dictating" in government do not see themselves as powerful; they are very scared of losing any significant number of providers. They try to listen to the "market forces" as much as possible and err on the side of higher prices. When a large, allegedly nonprofitt hospital organization comes to them with a biased accounting presentation alleging that Medicare reimbursements are already too low, they get scared.

Then the government has a rule that says nobody is allowed to pay a lower price than Medicare, except Medicaid. This rule triggers all sorts of voodoo accounting, but it also alters the playing field for negotiations between providers and insurers. The providers come to the table knowing that they will never have to accept less than Medicare pays. The private insurers at that point are just determining how much they are going to get shafted, not if.

Even as some Democrats are using "Medicare for all" as shorthand for what they hope to accomplish, it's not clear if or how their reforms would touch these types of problems, and what the impact on prices might be.

At the end of the day, medicine is not a free market activity to the user: each of us would pay any price to extend our health, and few of us have the medical knowledge to meaningfully dispute a doctor's recommendations. Robust regulations will always be needed to control prices.

That said, it is a [font=Arial Black]free market activity to the provider.[/font]  The providers have the best information about the value of their time, how many hours they want to work, and the products and services patients need. The most effective way to lower costs starts with simply having more doctors, more nursing home beds, and more hospital beds.  With higher supply, lower prices are likely.  The AMA in particular has been very effective at needlessly restricting the number of residency positions that exists, and this in turn makes it needlessly hard to get into medical school.  In Florida, the nursing home lobbyists have been very effective at blocking new nursing home construction. They don't have America's health at heart, only their own paychecks.

You got to be kidding me. The only way its a free market to a provider is to opt out of insurance completely and go direct or concierge. Theres only so many rich people around to do that with. Or do Derm, of course. In a free market the one getting the service (patient) would be the one paying the provider. That just isn't what happens in the US.

---

Yes, it's improvement, but it's Blaine Gabbert 2012 level improvement. - Pirkster

http://youtu.be/ouGM3NWpjxk The Home Hypnotist!

http://youtu.be/XQRFkn0Ly3A Media on the Brain Link!
 

Peyton must store oxygen in that forehead of his. No way I'd still be alive after all that choking.

 

Governments can provide superior healthcare at a much reduced cost which means private insurers can't price gouge. That's the answer.

LOL! Tell that to Venzuela, price controls don't matter if no one will sell you anything at that price.

I see your Venezuela and raise you a Canada + every Western European country + Mexico.

---

My fellow southpaw Mark Brunell will probably always be my favorite Jaguar.

There's no reason to assume that a major reform of health insurance would maintain the same rules and relationships of Medicare today.

You're right that, from the perspective of individual provider organizations, Medicare reimbursement rates seem to be dictated from on high.

However those who do the "dictating" in government do not see themselves as powerful; they are very scared of losing any significant number of providers. They try to listen to the "market forces" as much as possible and err on the side of higher prices. When a large, allegedly nonprofitt hospital organization comes to them with a biased accounting presentation alleging that Medicare reimbursements are already too low, they get scared.

Then the government has a rule that says nobody is allowed to pay a lower price than Medicare, except Medicaid. This rule triggers all sorts of voodoo accounting, but it also alters the playing field for negotiations between providers and insurers. The providers come to the table knowing that they will never have to accept less than Medicare pays. The private insurers at that point are just determining how much they are going to get shafted, not if.

Even as some Democrats are using "Medicare for all" as shorthand for what they hope to accomplish, it's not clear if or how their reforms would touch these types of problems, and what the impact on prices might be.

At the end of the day, medicine is not a free market activity to the user: each of us would pay any price to extend our health, and few of us have the medical knowledge to meaningfully dispute a doctor's recommendations. Robust regulations will always be needed to control prices.

That said, it is a [font=Arial Black]free market activity to the provider.[/font]  The providers have the best information about the value of their time, how many hours they want to work, and the products and services patients need. The most effective way to lower costs starts with simply having more doctors, more nursing home beds, and more hospital beds.  With higher supply, lower prices are likely.  The AMA in particular has been very effective at needlessly restricting the number of residency positions that exists, and this in turn makes it needlessly hard to get into medical school.  In Florida, the nursing home lobbyists have been very effective at blocking new nursing home construction. They don't have America's health at heart, only their own paychecks.

You got to be kidding me. The only way its a free market to a provider is to opt out of insurance completely and go direct or concierge. Theres only so many rich people around to do that with. Or do Derm, of course. In a free market the one getting the service (patient) would be the one paying the provider. That just isn't what happens in the US.

it's still up to you whether to take Medicaid or not, whether to take Medicare or not, and whether to take any of the private insurances or not. sometimes a private insurer will offer you some sort of incentive and a promise that you'll be the only provider of that type for their members in the area. If that sounds like a good deal you are free to take it.
that's a lot more choices than the patients have, and there's no life or death implications to them.

---

My fellow southpaw Mark Brunell will probably always be my favorite Jaguar.

You got to be kidding me. The only way its a free market to a provider is to opt out of insurance completely and go direct or concierge. Theres only so many rich people around to do that with. Or do Derm, of course. In a free market the one getting the service (patient) would be the one paying the provider. That just isn't what happens in the US.

it's still up to you whether to take Medicaid or not, whether to take Medicare or not, and whether to take any of the private insurances or not. sometimes a private insurer will offer you some sort of incentive and a promise that you'll be the only provider of that type for their members in the area. If that sounds like a good deal you are free to take it.
that's a lot more choices than the patients have, and there's no life or death implications to them.

Since you like questions so much, how many carrier/physician contracts have you read in your life?

---

“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

it's still up to you whether to take Medicaid or not, whether to take Medicare or not, and whether to take any of the private insurances or not. sometimes a private insurer will offer you some sort of incentive and a promise that you'll be the only provider of that type for their members in the area. If that sounds like a good deal you are free to take it.
that's a lot more choices than the patients have, and there's no life or death implications to them.

Since you like questions so much, how many carrier/physician contracts have you read in your life?

Zero. But I have processed Medicaid claims in an earlier life. My wife is a doctor and she used to take Medicaid but now she does not. We have a friend who takes Medicaid. trust personal experience with the fact that her doctor is free to choose to take Medicaid or not take it.

---

My fellow southpaw Mark Brunell will probably always be my favorite Jaguar.

Since you like questions so much, how many carrier/physician contracts have you read in your life?

Zero. But I have processed Medicaid claims in an earlier life. My wife is a doctor and she used to take Medicaid but now she does not. We have a friend who takes Medicaid. trust personal experience with the fact that her doctor is free to choose to take Medicaid or not take it.

Ah, so you have some limited exposure, that explains your perceptions. It also explains why you think plan participation constitutes a free market. You're still not right but I understand your reasoning.

Would you care to elaborate on this statement from earlier, maybe provide a reference? I'm interested in your explanation.

"Then the government has a rule that says nobody is allowed to pay a lower price than Medicare, except Medicaid."

---

“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Zero. But I have processed Medicaid claims in an earlier life. My wife is a doctor and she used to take Medicaid but now she does not. We have a friend who takes Medicaid. trust personal experience with the fact that her doctor is free to choose to take Medicaid or not take it.

Ah, so you have some limited exposure, that explains your perceptions. It also explains why you think plan participation constitutes a free market. You're still not right but I understand your reasoning.

Would you care to elaborate on this statement from earlier, maybe provide a reference? I'm interested in your explanation.

"Then the government has a rule that says nobody is allowed to pay a lower price than Medicare, except Medicaid."

Some doctors in my wife's field provide free consultations.
Others bill insurance for their consultations.
Her experience is that if you take private insurance, you can bill private insurance for the consultation and also let customers who don't have insurance, be on the "free consultation" or "the cost of the consultation is included in the cost of treatment if you choose to accept the treatment" aka bundled cost program. But it is not that way with Medicare. If Medicare finds out that you're letting some of your clients have a free consultation, they're going to say well gosh I guess the cost for consultation $0, $0 is what you get from us too." And Medicare in general does not do bundled costs.

---

My fellow southpaw Mark Brunell will probably always be my favorite Jaguar.

Since you like questions so much, how many carrier/physician contracts have you read in your life?

Zero. But I have processed Medicaid claims in an earlier life. My wife is a doctor and she used to take Medicaid but now she does not. We have a friend who takes Medicaid. trust personal experience with the fact that her doctor is free to choose to take Medicaid or not take it.

Unless your a pediatrician and literally over half the kids in America have only medicaid. Can you afford to cut off half of your potential clients? Can you afford to keep them in a capitation model where you get $2.13 per a kid per a month (not a joke, go look up Alabamas rate).

Maybe you could try and sue the government since the mandate for the states is that medicaid will pay enough to provide the same level of access to physicians that non-medicaid patients have. But then you would find out that was already done, and the government just gets to do what it wants.

But be my guest and have universal healthcare just like Russia, Venzuela, Cuba etc. Just don't come crying to me that you have to bring your own gloves to the hospital because the nurse won't change them otherwise.

---

Yes, it's improvement, but it's Blaine Gabbert 2012 level improvement. - Pirkster

http://youtu.be/ouGM3NWpjxk The Home Hypnotist!

http://youtu.be/XQRFkn0Ly3A Media on the Brain Link!
 

Peyton must store oxygen in that forehead of his. No way I'd still be alive after all that choking.

 

Ah, so you have some limited exposure, that explains your perceptions. It also explains why you think plan participation constitutes a free market. You're still not right but I understand your reasoning.

Would you care to elaborate on this statement from earlier, maybe provide a reference? I'm interested in your explanation.

"Then the government has a rule that says nobody is allowed to pay a lower price than Medicare, except Medicaid."

Some doctors in my wife's field provide free consultations.
Others bill insurance for their consultations.
Her experience is that if you take private insurance, you can bill private insurance for the consultation and also let customers who don't have insurance, be on the "free consultation" or "the cost of the consultation is included in the cost of treatment if you choose to accept the treatment" aka bundled cost program. But it is not that way with Medicare. If Medicare finds out that you're letting some of your clients have a free consultation, they're going to say well gosh I guess the cost for consultation $0, $0 is what you get from us too." And Medicare in general does not do bundled costs.

Interesting, what specialty is your wife practicing? Medicare hasn't paid for consultations since 2010, and United, Blue, Aetna, and Cigna (roughly 85% of the commercial market in NE FLorida) stopped doing so immediately thereafter as well. I'd like to know the reimbursements that you're getting though I'm sure you can't share. And Medicare isn't the only payer who audits based on the fee for service activities of their participating physicians. Blue and United are both interviewing in the NFL region looking for de facto fee schedules; once they find one they start recouping almost immediately. And maybe you aren't up on the current payment model changes, but Medicare is going to be bundling payments almost exclusively in the next 3 years.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato