re: What’s a real conservative solution to fix healthcare?

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The very likely answer will be: "Oh, your co-pay is $30".

"That's not what I'm asking. What is the actual price of this service?"

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To which their first question will be... who is your insurance with.

Also allow insurance to be sold across State lines. Allow people to shop their insurance across state lines.

Competition
Cross state lines

It shouldnt be used to cover every little expense. It really should be for serious or major testing and treatments.

-You don't need it to pay for Dr visits and blood work each year.
-You don't need to cover specialist visits
-Serious procedures and such could be covered as a percentage
-Prevention could be covered as a percentage

Let people decide what they want to buy, choice is the key. If somebody wants to roll the dice and not be covered, that is they risk. If you want to just pay for catastrophic/emergency insurance, then go for it.
If you want to pay 2000/month to cover any and everything....so be it.

Paying $4k/month for a family on a private plan with $7500 deductible is not working for the producers. It works great for the free-loaders and subsidized.

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I think if we would increase copays to a minimum of $200 or maybe even $500 then maybe you would think about it before getting a doctor because you had a small rash or headache. I know poor folks will squeal on this but that would cut out a lot of the BS visits. Most of us pay a lot more insurance to cover costs for the poor that don't pay hardly anything. And then you might think about getting a cheaper service like a doc-in-a-box or teledoc.


Poor people don’t have co pays

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You make my point. Why should they get it for free. Make the minimum $200-$500 and they'll stop showing up for every little thing.

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Bring in foreign physicians and nurses.

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Force drug companies to stop subsidizing cheap overseas costs w high prices here.

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Love these two. Also:

1. Repeal Obamacare entitlements and replace them with grants to states would reduce premiums for individual coverage by as much as 32 percent, according to an analysis by the Center for Health and Economy. Heritage Foundation.

2. Increases Price Transparency Throughout the Health Care System for Patients

Empowers patients and employers to shop for health care and make informed health care decisions by providing timely and accurate information about the cost of care, treatment, and services
Makes health care price information public by ensuring hospitals, insurance companies, labs, imaging providers, and ambulatory surgical centers publicly list the prices they charge patients
Lowers costs for patients and employers by requiring health insurers and pharmacy benefit managers (PBMs) to disclose negotiated drug rebates and discounts, revealing the true costs of prescription drugs
Addresses the Cost of Prescription Drugs

Lowers out-of-pocket costs for seniors who receive medication at a hospital-owned outpatient facility
Expands access to more affordable generic drugs
Equips employer health plans with the drug price information they need to get the best deal possible for their employees Energy and Commerce

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Business types have been running hospitals long before the ACA showed up. Maybe the ratio increased after that?

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From my knowledge

My mother worked at charity it was ran but Drs and Nurses. After LSU opened its entirely ran by businesses

Increased competition.

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Now how to fix it?

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That's a lot more difficult than people think, and not for the reasons almost anyone reading this is going to expect.

It would be relatively simple to just get rid of 3rd party pay for routine and elective care, have insurance only for rare and catastrophic situations (which is what insurance is supposed to be), and have everyone pay cash for everything under that threshold.

If you want to subsidize poor people's health care, fine, but don't do it with 3rd party pay. Give them an HSA that taxpayer money gets deposited in at the beginning of the year that can only be used for approved health care expenses and give them an incentive to not waste it, such as they get to withdraw a portion of any unused amount at the end of the year in cash.

The details can be quibbled about, but some version of the above would be easy and simple and would in fact cause routine and elective care costs to drop through the floor relative to where they are now.

But there are at least two unintended consequences of doing that that most people don't think about and at least one that some people do think about.

In reverse order...

1. A cash model would reduce the number of physicians available for routine and elective care. When people think about this model, they're thinking about primary care or similar care that revolves mostly around a physician's advice and prescriptive ability and not on specialized equipment or other personnel. Primary care, endocrinology, those sorts of things.

Within that space, every practice would likely be some form of concierge/boutique practice. Either that, or they would be a few hundred bucks a visit if you weren't doing some sort of subscription plan.

That part could work, although what would end up happening is that there would be a sizeable chunk of the population that couldn't afford cash at the time of service like that, but would make too much money to qualify for assistance.

It could work, but there would be fewer physicians, more mid-level providers, and more people not getting routine care or elective care. To the degree that physicians started to experience lower salaries, and to the degree that we're talking about elective procedures that include surgery (knee replacements, for example) this would be especially true.

But it could work. Except for...

The bigger problems are:

2. When I got started in health care I observed some strange stuff that didn't make sense until I came to a couple of conclusions. The first thing I noticed is that our system resists any attempts to bring down the cost of medication. After years of observation I have come to the conclusion that this is because US Big Pharma is responsible for funding almost all of the clinical medical research in the world.

The only way I can see to bring down medication costs is to stop protecting the patents that Big Pharma owns for their meds and let generic versions be produced right away. That's what other countries do, and it's why their medication costs are so much lower than ours.

But then the incentive to develop new drugs (and procedures, at least to some degree) goes away. The reason almost all of that research is done here is because this is where the incentive lives. Take it away and our research drops off just like every other country.

Basically, we stop moving forward medically. And by "we," I mean the whole world. Basically American citizens are paying for the entire worlds R&D, which sucks.

But the only alternative is to stop paying for it and let the research stop as well.

3. Hospitals. One of the first things I noticed that was strange in our system was right after I started in health care, in 2005. A few years earlier one of the first blind controlled studies was done on arthroscopic knee surgeries, and the results were shocking. The researchers found that the success rates did not differ from a control group that didn't receive the surgery (but thought they did...the surgeon put them under and made an incision and then stitched it right back up.). So basically the surgery was no more effective than a placebo. (Look it up; it's easy to find).

This experiment has been repeated a few time since then with the same results, so that wasn't a fluke. And keep in mind that as far as I know there are no studies that show otherwise, either. As far as I am aware, every time this procedure has been subjected to a blind controlled study this has been the result.

And since then they have also subjected more surgical procedures to this sort of test with similar results...a lot of the surgeries that health insurance pays out LOTS of money for are simply not very effective.

So I'm watching this thinking, "Well, it may take a little while, but surely insurance companies are going to stop paying for that."

But over 20 years after the first study, we're doing more of those than ever, and insurance keeps right on paying for it. Paying for a procedure that we've known for over 20 years is no more effective than a placebo. And we now know there are others like it with similarly ineffective results—spinal fusion surgery barely has a 50% success rate, for example—but insurance keeps paying.

Why?

I thought about that question for years. For over a decade.

Then when COVID hit I arrived at my answer. When all of the elective procedures (such as these orthopedic procedures) were cancelled due to COVID, many hospitals struggled to survive.

Ah-ha!

I think just like we're protecting medical R&D by resisting bringing drug prices down, I think we're protecting hospitals by continuing to pay for surgeries and procedures that are popular, but that have been proven ineffective by research.

That sounds rancid at first glance, but if the alternative is that the hospital goes under and has to close its doors, where do you go when you've been in a car accident or are having a heart attack?

If I am right about that, that means that a cash system radically changes hospitals. When that spinal fusion surgery that right now brings in $60,000 to a hospital only brings in $7,000-$10,000, a lot of the rural ones probably go under. The ones in more populated areas will be transformed and have to radically streamline.

So a lot of things that people take for granted now about their health care experience will go away or look very different. It's not going to be the same, just cheaper. It's going to be a whole different enchilada.

Now none of what I just typed necessarily means we shouldn't do it or that we wouldn't be better off that way. If we can find some way of getting clinical research done (clinical research as opposed to basic research) if everyone is o.k. with the new streamlined, bare-bones version of routine and elective care, sure.

But people need to understand that under that model a LOT of the time that they see a physician now, they'll see a PA or NP. Getting Grammy's knee replacement surgery is going to be a pretty bare bones (no pun intended) affair, in and out, and while the surgery itself might become way more affordable, rehab therapy is still going to add expense. Like primary care, that's a service that right now doesn't have nearly the room to become more affordable than the surgery does. It's probably not going to be much cheaper than it already is now. And going to the primary care is either going to be a similar experience, or you're going to pay a monthly subscription fee which only covers that physician. So referrals to specialists are still going to be an additional out of pocket expense on top of the monthly subscription to the PCP.

You get the idea.

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Bring in foreign physicians and nurses.

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You do realize most nurses live paycheck to paycheck huh? Costs $14K per night in the ICU and a RN might take home about $450 of that (before taxes).

Many of the bs in-hospital interventions that you all pay for are purported as “necessary” under the guise of infection control or safety. X company does a trial showing their product “reduces in-hospital infection by 2 percent” and boom, now every patient gets it. See it all the time.

And who do you think pays for those artificial heart valves for IV drug users..? Or their month long ICU stays?

You bring back basic and affordable hospital plans for the major stuff,

and free market the rest.

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Many say trust the free market

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What free market? There is no free market in American healthcare and there hasn't been in 50+ years.

You could argue that a supposed free market that is controlled by the government is the worst option of all.