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

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Health insurance companies post record profits almost every year.

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Two (dumb) people downvoted this.

You two, do you not know that the above quoted statement is true? It's an easy Google search away, if so.

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Basic healthcare should be menu price. Insurance shouldn't be involved. Got the sniffles? 50 bucks. Tummy hurts? 50 bucks. Simple things should be eliminated from insurance.

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Only it won't be $50.

Not if you want to see a physician. You might be able to see an NP for $50.


If you're o.k, with that, have at it.

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Beyond basic healthcare you should pay insurance for things that you couldn't pay for normally.

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Where is that line, exactly?

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2nd step, disallow insurance companies from questioning the doctor's advice and trying to influence care.

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What insurance companies? I thought we were all cash now. You mean for the catastrophic care?

O.k., but that drives costs up. If the insurance company has no ability to push back, doctors will over treat. Guaranteed.

It's already happened once. Ever hear of the "Mercedes 80s?" That's what happened then because insurance companies weren't questioning anything.

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Impossible under the current system. Because your price will depend upon what insurance policy you have. People think that's a simple as, "I have BC/BS." But there are over 50,000 different policies just within BC/BS. People think this is something that hospitals ad doctors do to try to hide something. It's not. They do it because it's impossible to not do it. They don't tell you b/c they don't know. Not until someone spends 20-30 minutes on the phone verifying your benefits. Which they can't even do until/unless they know what procedures you need to have verified.

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Respectfully disagree, every procedure has a price and it can be posted. What you have described is the problem, or at least one of them.

Just an anecdote.
My mom was a nurse - she worked for a single doctor who was part of a 3-doctor specialized practice. When I was little, I remember spending a lot of time at her office (she was a single mom). I was just 3 doctors, 3 nurses, a receptionist, and a part-time office type person, i guess did the bills and stuff.

Sometime in the early to mid 80s I remember their practice moved to a much bigger office. Still just 3 doctors, though. But all of the sudden there were a lot more people working, not nurses - each doc still had one nurse, but the number of people working at the new place was more than triple from what I remember. And there was an "Office Manager" I remember being confused by this dude, asking my mom questions about him. He was essentially the boss but wasn't a doctor - which made no sense at all to me. I was told the move had to do with Medicare regulations - if the practice wanted to see Medicare patients there were all these requirements they had to go through to be a Medicare provider

In a nutshell - doctors lost control, administration - not care - increased exponentially, and costs for the practice skyrocketed along with, i presume - patients' bills.

You were already in the office so she was getting paid for the office visit already. That's what covers her time, her office staff's time, etc. The $300 cash price for the botox is for the botox ONLY, since you were already there. You didn't mention what was billed and paid for that visit.

Everyone needs to get it out of their heads that charges mean anything at all. They do not. There is only a very, very small % of insurances or potentially a self pay that pay a % of charges. Everything is not driven at all by that doctor or hospital. The payments and copays are completely driven by the insurance companies, Medicare, or Medicaid.

Payments are either a per diem (so much per day for a hospital stay, no matter what happens while you are in the hospital) or a per stay payment (a chunk of money based on your diagnosis no matter how long or short your stay and not matter what happens while you are there).

Once you get this in your head, pricing makes more sense. Charges don't mean anything. Insurance company contracts do. Our countries healthcare is mostly driven by insurance companies and drug companies.

Any entity that receives Medicaid as payment must grant the lowest price to the government. There is no incentive to keep the price low.

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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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You are correct about these things, generally. What our much older model used to be, when healthcare was somewhat affordable, was that all hospitals didn't do all the things. There would be 1-2 very large medical centers in a city of 200-250k population. These would handle all the more intense cases. All the major surgeries, the heart bypasses, the neuro surgeries, etc. People needing even more intense things would travel to other places. As a child in the 60s and 70s, I remember frequently people going to Houston for medical care and not just cancer treatment. A very good friend of mine had scoliosis and needed back surgery when we were 13-14. She went to Houston. A city this size would also have a few more "local" hospitals" that would handle basic surgeries, older people with the flu, COPD exacerbations, all kinds of general med stuff. There would be small hospitals in smaller cities (like a hospital in Minden, near where I grew up.) They also only handled basic stuff.

Just like the rest of our consumer driven society, people didn't want to travel or go to certain hospitals for their healthcare. Instead, all the hospitals started to get more expensive equipment. This increased the cost of our whole healthcare system. Part of the cost is driven by what the consumer wants. They want all the technology everywhere, easily accessible. Hospitals make money on this and are more than willing to comply. We want it all, but we also want it to be cheap. You just can't have it that way.

Another big drug issue that goes along with the R&D problems is that we allow advertising. There are plenty perfectly good, older drugs that are cheap. Physicians are willing to prescribe them. However, patients see the ads and think newer must mean better. Lots of the time, newer means slightly different and much more expensive. Patients go to the doc asking for the new drug they saw on TV. Doc has trouble convincing them they are doing fine on what they currently take. Doc eventually caves and writes a scrip for the new, pricy drug.

It's all a cycle and until consumers have to pay at the pump instead of having it taken out of their check every month, consumers won't change their behaviors.

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Respectfully disagree, every procedure has a price and it can be posted.

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But what you're going to be responsible for paying as the patient is different with each policy.

So of what use is it to post the fee charged when the fee charged is nothing more than three times the highest allowed amount of any policy you have come across?

Because that's what the fee is going to be.

And that fee is different if you are on Medicare or Medicaid. And it may bear no resemblance to what you as the patient will actually be responsible for paying.

So how exactly does that help you to know any of that?

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Social Security system, Singapore takes mandatory deductions from workers' paychecks—around 20 percent of wages—

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So the government can use the 20% in the general budget like they raided the SS Trust and now the Medicare Trust? No thanks!

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Why can't we do what Singapore or Switzerland do?

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Public canings and hot cocoa? I support.