Author Topic: health care and the free market  (Read 526 times)

TheDrake

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health care and the free market
« on: April 02, 2019, 12:20:43 PM »
Why do we expect the free market to operate properly for health care? The free market is excellent at matching supply and demand. But a supply and demand curve means necessarily that some people just won't be able to afford that good or service.

Certainly that's how it was before insurance started getting into the act. But insurance pools only work because the risk is assessed and a determination is made to issue a policy at all and how to price it. This works well enough when we're talking about people who have a lot of accidents not getting motor vehicle insurance. But do we think it works well to raise the premiums of someone who contracts a chronic illness?

I'm speaking from a theoretical basis. I don't think that what we have right now in the US is a free market. But I hear this argument all the time, that the free market is going to be better. Certainly it could be very beneficial to young and healthy individuals.

Then there's the unlimited demand side of the equation. Lots of people are taking pills with dubious benefits because a doctor told them to. Everybody is going to pay any amount they are capable of paying to save their daughter's life.

Any system other than the free market solution also has its problems, but I'm just not sure how the market based system can work.

D.W.

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Re: health care and the free market
« Reply #1 on: April 02, 2019, 12:43:25 PM »
I think we do need the free market in practice, but it needs to be on the end of the pharmacy dealing with suppliers.  Doctors dealing with equipment manufacturers, or diagnostic testing facilities and so on.  Insurers dealing with clinics and hospitals. 

"The market" all needs to take place BEFORE it gets to the patient.  At that point, we are hostages or family of a hostage willing to pay any ransom we can to get free.

Crunch

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Re: health care and the free market
« Reply #2 on: April 02, 2019, 12:54:01 PM »
I don’t understand why this is a discussion. Six years ago healthcare was fixed by the Democrats is a straight party line vote.  Healthcare is in a golden age, cheap, accessible, and high quality.

Right?

D.W.

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Re: health care and the free market
« Reply #3 on: April 02, 2019, 12:56:46 PM »
Nah, that was a partial fix, and significantly sabotaged, and slowly degraded over time.  Catch up Crunch.   ;D

Crunch

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Re: health care and the free market
« Reply #4 on: April 02, 2019, 01:00:52 PM »
Is that what they say on Quora?

TheDrake

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Re: health care and the free market
« Reply #5 on: April 02, 2019, 01:02:49 PM »
I don’t understand why this is a discussion. Six years ago healthcare was fixed by the Democrats is a straight party line vote.  Healthcare is in a golden age, cheap, accessible, and high quality.

Right?

So I guess you don't know how free market healthcare would work either. Many Democrats then, and even more now, didn't want this highly regulated free market system but would favor a single payer system modeled after Canada. But this isn't about those systems and all their flaws, its about how this free market system I keep hearing about would work.

TheDeamon

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Re: health care and the free market
« Reply #6 on: April 02, 2019, 01:13:26 PM »
The problem with health care in the United States is it has not been anything resembling "a free market" for the past 50-ish years. It has corruption aplenty going on(price fixing schemes anyone?), it has enormous regulatory burdens(reducing competition, but hey "enhanced safety" right?), and the list goes on and on. Particularly when you consider that other aspects of the healthcare system are not very systemic at all. But rather very fragmentary as different states have differing levels of regulation and requirements in place.

We won't even get into "how bad" many of the largest consumer markets are in the United States because of state regulations in play for those locations.

Then of course, there is the matter of tort law.

D.W.

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Re: health care and the free market
« Reply #7 on: April 02, 2019, 01:25:26 PM »
Is that what they say on Quora?
I wouldn't know.  Is that where you do your shadowboxing?

TheDrake

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Re: health care and the free market
« Reply #8 on: April 02, 2019, 01:37:46 PM »
The problem with health care in the United States is it has not been anything resembling "a free market" for the past 50-ish years.

I don't disagree with any of that. But do you think that an unregulated free market would be a good healthcare system? This is largely an imaginary system, but thought experiments are useful. I can't escape the conclusion that a free market healthcare system is really one in which you accept the fact that a significant number of people are eliminated from access to health services - even in matters of life and death.

Seriati

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Re: health care and the free market
« Reply #9 on: April 02, 2019, 02:50:27 PM »
Why do we expect the free market to operate properly for health care?

Because it can and does?  The problem with looking at the "healthcare market" is that it's not one market, it's a not a dozen markets, it's not a thousand markets it's thousands and thousands of markets.

If you need knee surgery you're not going to buy a heart transplant because it's on sale.   You're not going to comparison shop at doctor's offices miles and miles away for everyday ailments.

The best "fit" for the free market is the portion of higher end procedures that are not truly life threatening.  The "worst" fit is for life and death surgery with limited service providers.

The insurance/health plan market is again even more sets of markets that are running besides and on top of the other markets. 

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The free market is excellent at matching supply and demand. But a supply and demand curve means necessarily that some people just won't be able to afford that good or service.

Which isn't a real problem for 90% of medical issues.  How much is your knee surgery worth to you?  More if you can't walk or can't work, much less if it's just an irritation.  Is it worth $100k? $1M?  or just $500?

No one really knows that answer but the consumer.  The "free market" is an attempt to make the consumer be the one that exercises that decision.  If 90% of people are only willing to pay $1k, but the surgery costs $20k, it's either not getting done that often or the price is coming down (most likely both, which is why the free market works). 

If "no price is too high" then the free is not going to work to bring prices down.

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Certainly that's how it was before insurance started getting into the act. But insurance pools only work because the risk is assessed and a determination is made to issue a policy at all and how to price it. This works well enough when we're talking about people who have a lot of accidents not getting motor vehicle insurance. But do we think it works well to raise the premiums of someone who contracts a chronic illness?

Insurance works fine, including for chronic illness, but it requires a clear agreement and the power to stick to it.

We don't have insurance, we have health plans.  The government routinely forces insurers to cover conditions that they never agreed to cover, and to pick up costs for people they never got to price in their models.

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Then there's the unlimited demand side of the equation. Lots of people are taking pills with dubious benefits because a doctor told them to.


They are taking them because the pills are subsidized.

TheDeamon

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Re: health care and the free market
« Reply #10 on: April 02, 2019, 03:21:10 PM »
The problem with health care in the United States is it has not been anything resembling "a free market" for the past 50-ish years.

I don't disagree with any of that. But do you think that an unregulated free market would be a good healthcare system? This is largely an imaginary system, but thought experiments are useful. I can't escape the conclusion that a free market healthcare system is really one in which you accept the fact that a significant number of people are eliminated from access to health services - even in matters of life and death.

Does it really require that though? I don't think so.

You're presenting a false choice scenario.

And going back to the corruption angle, when you get news reports where the Drug companies are going "Oh, the list price doesn't really matter, the consumer is not going to pay that price at the counter after the various discounts and other co-pays are factored in."

Which takes us to the point about "Nobody knows what it truly costs" and most people don't care what it costs. They like it, the want it, and want more of it, and as long as they don't have to pay for personally, they're happy as clams.

Which takes us to the Thatcher quote, "The problem with Socialism is you eventually run out of other people's money."

As it is, health care has MAJOR problems, from corruption, to regulatory overkill and inefficiency(helping drive costs up, sometimes for valid reasons, but often for no other reason than administrative delays), and of course the matter about the end user "going I don't care what it costs, because I'm not going to be the one paying for it."...at least not directly.

It's kind of like the people complaining about the Trump tax cuts because their tax returns are smaller this year, even if they paid less in taxes in 2018 than they did in 2017, despite earning as much or more money.

Are you really going to shell out $150 for that bottle of pills that only slightly help with your only slightly aggravating medical issue? Or are you instead going to say "forget that, I'm not spending $150 for a one month supply of pills that don't do all that much."

But hey, you don't need make that decision right now, because your health insurance coverage makes it so you think you're only paying $5/month for that bottle of pills.

TheDrake

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Re: health care and the free market
« Reply #11 on: April 02, 2019, 04:02:23 PM »
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We don't have insurance, we have health plans.  The government routinely forces insurers to cover conditions that they never agreed to cover, and to pick up costs for people they never got to price in their models.

I get the value of a free market to disallow coverage for certain things. In a free market you could get the reverse of catastrophic coverage in a health plan. I want to cover routine ailments, but I won't opt for the premium plan that includes organ transplants. Or you can choose your own example of exclusions. The problem with this is that this makes some kinds of coverage more expensive, yes? Maybe I'll get a health plan that doesn't cover sickle cell anemia, I'm not going to need it.

So ultimately, what this means, is that sickly people can't get insurance at all for a condition, particularly one that is pre-existing. Premiums go up the more you use the healthcare system, which is largely not under your control. Some people do have to make choices between skimping on insulin and paying the rent. I personally find that distasteful - but more importantly in the long run this is more expensive for the person (or society) when they wind up with an amputated foot after skimping too much. You could fix that problem in a free market system by turning people away from Emergency Rooms, that's how it worked prior to 1986 when Congress made it illegal.

In the ideal market system, there would indeed be full transparency and more choice. A lot of times, people only have one health plan provider in a state. They often have no visibility into choice of medical equipment. They are prevented from buying supplies on the open market - particularly the global market. Which is why we have elderly people taking buses to Mexico and Canada to get medication.

TheDeamon

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Re: health care and the free market
« Reply #12 on: April 02, 2019, 04:06:35 PM »
A lot of times, people only have one health plan provider in a state.

Which is an issue because of decisions made by state governments with regards to regulatory requirements for operating within their borders. This gets back to "we don't truly have a healthcare system in the United States."

Seriati

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Re: health care and the free market
« Reply #13 on: April 02, 2019, 04:22:41 PM »
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We don't have insurance, we have health plans.  The government routinely forces insurers to cover conditions that they never agreed to cover, and to pick up costs for people they never got to price in their models.

I get the value of a free market to disallow coverage for certain things. In a free market you could get the reverse of catastrophic coverage in a health plan. I want to cover routine ailments, but I won't opt for the premium plan that includes organ transplants. Or you can choose your own example of exclusions. The problem with this is that this makes some kinds of coverage more expensive, yes? Maybe I'll get a health plan that doesn't cover sickle cell anemia, I'm not going to need it.

Healthcare =/ insurance related to healthcare.

There are different problems in fixing two markets. 

Insurance markets needed to be reformed to be easier to understand.  There never should have been an incentive to hire adjusters and train them to deny claims.  There never should have been studies that said all claims should initially be denied because x% of people won't appeal.  Regulation of that market to ensure people understand what they are buying and get what they are paying for is completely appropriate.

Regulation to offload governmental problems onto a private market should never have been allowed.  That's exactly what "pre-existing conditions" is about.  It's not about insurance, its not about a private deal, it's not even about healthplans.  It's about government officials having to find a way to provide care to people who refused to (or were unable to) plan ahead and get coverage.  It's about having to deal with government neglect that let insurance markets make more money by hiring lawyers to defend denials than hiring analysts to make better predictions.  All of which led to a sick populace that was undercovered and facing expensive treatments (also the result of a different government failure).

What does a politician do in that circumstance?  100% of the time they find someone else to blame and try to stick it to them.  In this case, insurance companies were already largely reprehensible, so they made fairly easy targets.  Why didn't they complain?  Well that's because they spent a fortune on lobbyists to make sure that they got behind the scences payouts, cause while direct government spending is a political fight that costs a politician support from someone, behind the scenes is just "corruption" that routinely gets ignored.

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So ultimately, what this means, is that sickly people can't get insurance at all for a condition, particularly one that is pre-existing.

Can you buy car replacement insurance after you total your car?  If it were health care Congress mandated that you could.  In fact you can essentially wait until you wreck, then get insurance, then get a replacement car, then drop the insurance.  Who pays for that?  Insurance works by arbitrage, they use the premiums to invest and over time and a broad base to generate enough capital to pay claims.  If the premiums are always less than the expense and not 30 years in advance of the expense the model can not actually function.

The biggest "miss" in the debate is thinking that the healthcare prices we see today are real.  If we could unwind the impact of government influence most everyone could actually afford the care they need.  Then we could focus on those who were truly in need.

TheDrake

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Re: health care and the free market
« Reply #14 on: April 02, 2019, 04:50:02 PM »
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Can you buy car replacement insurance after you total your car?

Nope. But cars aren't human lives, and some conditions exist from birth. So following that model, anyone whose parents didn't have the foresight to have health insurance is probably out of luck? The problem is you can't replace that car. You could faithfully carry a health plan for 20 years, then get laid off and now your heart condition will only be covered if you pay a high premium - if at all. If you work for corporate, you're better off because they lump you in with other employees. If you are self-employed - not so much.

I totally agree with you about how real insurance works, including life insurance which is probably the closest analogue since it often involves evaluating the health of a person. It makes perfect sense that if you are an octogenarian with cancer that you're not going to get some life insurance, or long term care insurance.

I do agree also that costs for the people who could get healthcare would likely drop with the unraveling of legislation over the past 40 years. If nothing else, you would immediately have oversupply with all the people being turned away. I'm just not sure that's the world I'd like to live in where a homeless guy can't get treated for an emergency at an ER because he has no ability to pay.

You may be right that hospitals and insurance companies shouldn't be "back door forced" to solve a government problem. I just learned that ERs actually get paid back for their charity/bad debt by way of raising medicare/medicaid rates. There's certainly an obfuscated process there, and elsewhere.

Seriati

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Re: health care and the free market
« Reply #15 on: April 02, 2019, 05:26:49 PM »
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Can you buy car replacement insurance after you total your car?

Nope. But cars aren't human lives, and some conditions exist from birth. So following that model, anyone whose parents didn't have the foresight to have health insurance is probably out of luck?

Government problem.  What exactly do you think is stopping your government from taking care of such a luckless infant?  Any infant whose birth is covered by insurance should also be covered by that insurance.

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You could faithfully carry a health plan for 20 years, then get laid off and now your heart condition will only be covered if you pay a high premium - if at all.

Ahh.. yes, and why is your insurance though your employer in the first place?  Government manipulation.  They deliberately set the tax code to give companies buying insurance bigger deductions than individuals.  That means your insurance is not going to be portable.  They easily could have incentivized the opposite. 

So why didn't they?  Lot's of reasons, but a big one (on the good intentions side) is that they wanted to put large companies (rather than individuals) opposite insurance companies at the negotiating table.  That did result in sweetheart deals for large companies.  Unfortunately it left out the little guys and the private companies.

Easy fix?  Not really.  You could minimize some of the problems by requiring that any insurance plan offered to a corporation be offered on a mandatory basis to the public on the same terms.  But that doesn't fix the pricing problem that the government created.

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If you work for corporate, you're better off because they lump you in with other employees. If you are self-employed - not so much.

Sort of.  They could lump the whole world into a giant pool and the logic on pooling would still function, but they don't - why not?  Cause they can stick the small guys with worse deals, and the pre-existing problem would overwhelm the best plans.

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I do agree also that costs for the people who could get healthcare would likely drop with the unraveling of legislation over the past 40 years. If nothing else, you would immediately have oversupply with all the people being turned away. I'm just not sure that's the world I'd like to live in where a homeless guy can't get treated for an emergency at an ER because he has no ability to pay.

Yeah, no.  We wouldn't unwind every law regardless of utility, we'd just be looking to unwind those that broke the efficiency incentives.  Access to emergency rooms regardless of ability to pay was never about efficiency, it was about public policy, and it was funded by the government. 

Similarly, I've got little issue, and think it's a good idea to fund super conditions that involved years or decades of enormous costs directly from a government pool.  Of course that means their will be rationing and less than optimal treatments involved (the same as every socialist system today) but it will mean that healthcare and insurance costs for 95% of the populace are affordable.

Our medical system is far too big and feeds far too many people for it to just start turning away business.  In fact, if your fear was realistic, it'll almost certainly be proof that the market would immediately issue a massive price correction.  Are hospitals really going to go out of business when there are sick people with money?  No.

And it's not like they'd really be getting much less.  They currently send a bill for $20k on a knee surgery and get a co-pay of say $150 from you, and a payment of $1200 from your insurance.  Why's the bill $20k if they are willing to and profitable doing it at $1350?  Tons of things like that. 

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You may be right that hospitals and insurance companies shouldn't be "back door forced" to solve a government problem. I just learned that ERs actually get paid back for their charity/bad debt by way of raising medicare/medicaid rates. There's certainly an obfuscated process there, and elsewhere.

There's a lot wrong with what you just said.  Medicare/medicaid rates are the lowest reimbursements out there.  Hospitals that have choices almost always try to find ways to reduce their medicare/medicaid patient loads.  Heck doctors where I'm from won't even take those patients, well at least the ones that are rated as "good" won't.

You ever wonder why your doctor won't talk to you about a new issue at an appointment for something else?  They don't get paid if they do.  The bureacracy pays them based on volume of discrete events, not on quality of outcome, or happiness of patient. 

Seriati

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Re: health care and the free market
« Reply #16 on: April 03, 2019, 09:57:12 AM »
Here's a timely little piece, granted written from the right.

https://www.creators.com/read/betsy-mccaughey/04/19/better-than-obamacare

LetterRip

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Re: health care and the free market
« Reply #17 on: April 03, 2019, 01:27:17 PM »
Seriati,

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Medicare/medicaid rates are the lowest reimbursements out there.  Hospitals that have choices almost always try to find ways to reduce their medicare/medicaid patient loads.  Heck doctors where I'm from won't even take those patients, well at least the ones that are rated as "good" won't.

Medicare reimbursements are fine, medicaid are ridiculous.  After reimbursement efforts medicare is generally comparable or better to private insurance, however Medicaid is substantially less.

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According to a study from Forbes, Medicaid pays out an estimated 61 percent of what Medicare does nationally for outpatient physician services. This rate varies from state to state, but if the average is 61 percent, it is to believe that some areas are well under that mark.

https://revcycleintelligence.com/news/examining-differences-medicare-medicaid-reimbursement


Seriati

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Re: health care and the free market
« Reply #18 on: April 03, 2019, 02:12:44 PM »
Seriati,

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Medicare/medicaid rates are the lowest reimbursements out there.  Hospitals that have choices almost always try to find ways to reduce their medicare/medicaid patient loads.  Heck doctors where I'm from won't even take those patients, well at least the ones that are rated as "good" won't.

Medicare reimbursements are fine, medicaid are ridiculous.  After reimbursement efforts medicare is generally comparable or better to private insurance, however Medicaid is substantially less.

You say things that are not proven as if they were fact.  Medicare reimbursement is below the prices for private care.

Here's just one example of an analysis on the point, https://www.healthcaredive.com/news/cbo-reports-show-private-insurers-pay-physicians-hospitals-far-more-than-m/445949/.

The new scheduled approach makes it virtually impossible for a lay person to actually vet what's happening, as compared to the old formulas - which made it completely obvious how much the underpayment was.

I agree that Medicaid is even worse, but don't kid yourself, Medicare reimbursement is below market.  Now that "market" is essentially a fake market, inflated to try and grow the Medicare/Medicaid reimbursement rates, but it's still what the rest of us get stuck paying.  But there's a reason that something like 30% of physicians won't take new Medicare patients, and why you can hardly find any pyschiatrist who does so.

TheDrake

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Re: health care and the free market
« Reply #19 on: April 03, 2019, 02:29:33 PM »
One other free-market flaw in the current system is the supply of doctors. The AMA has always exercised tight control over who can provide physician services. They don't want to graduate more doctors. They fight against nurses, PAs, and other health professionals performing routine tasks - acting more like a union than a professional organization.

NobleHunter

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Re: health care and the free market
« Reply #20 on: April 03, 2019, 02:55:48 PM »
Union nothing, it's exactly like a professional organization. The history of professionalization is largely a story of excluding rival practitioners to protect the profit margins of the emerging professionals.

TheDrake

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Re: health care and the free market
« Reply #21 on: April 03, 2019, 03:17:28 PM »
Engineers are a profession, they're not throttling supply - anybody can get a PE as long as they pass the same test. Couldn't say about lawyers, but I don't perceive a shortage of them, nor have I seen them trying to limit what paralegals can do. Accountants have their professional organizations, and they do have standards in place, which has the effect of limiting entrants. It's not a full difference in goals, its a difference in how aggressive AMA is by comparison. One could say that it is just because they are more successful at the same game.

Compare to other countries, and we have fewer doctors per capita than most European countries. Great for doctors, not so good for cost control.

LetterRip

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Re: health care and the free market
« Reply #22 on: April 07, 2019, 02:34:13 PM »
You say things that are not proven as if they were fact.  Medicare reimbursement is below the prices for private care.

No it really isn't - there are 858 health insurance carriers in the US.

https://www.iii.org/fact-statistic/facts-statistics-industry-overview

Medicare pays almost the exact same (or more) as insurance carriers at the top 10th percentile of insurance carriers.  (See the figure National Price Comparisons - Commercial)

https://www.cbo.gov/system/files/115th-congress-2017-2018/presentation/52818-dp-presentation.pdf

That means there are 86 insurance carriers who pay the same or less than Medicare does.  Payment amount is proportional to size of the carrier since larger carriers can negotiate cheaper rates.  Also insurance companies follow a power law in size.

By size they are 49.5 million; 40.2 million; 22.2 million; 15.9 million; 14 million; 12.2 million; 4.4 million; 4.37 million (for the top 8  )

https://www.beckershospitalreview.com/payer-issues/america-s-largest-health-insurers-in-2018.html

So if we map that to an exponential curve, nearly all insurance payments are made by the top 10% of carriers.  The rest of those insurance carriers are simply ridiculously tiny, which is why they can sometimes have absurdly high rates - they have no negotiating power.

Also the CBO report wasn't an apples to apples comparison.  The amount calculated for what private insurance payed - included copays and deductibles payed by the person who had the insurance but didn't include what wasn't covered by medicare that the medicare recipient had to pay.

Also the CBO report ignores billing overhead and delayed payment - which are huge issues with private insurance.

Also the CBO report was only for 'professional services' (the time of doctors and nurses) - Medicare massively overpays for medication (which congress explicitly forbid them to use their size to negotiate better rates) and some other goods.

Also the CBO report fails to mention that medicare will reimburse for services that most insurance carriers won't - almost all rehab business is only because of Medicare because most carriers won't cover it, for instance.

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I agree that Medicaid is even worse, but don't kid yourself, Medicare reimbursement is below market.  Now that "market" is essentially a fake market, inflated to try and grow the Medicare/Medicaid reimbursement rates, but it's still what the rest of us get stuck paying.

See above.  The vast majority of people covered by private insurance, the insurance company pays the same or less than Medicare - essentially less in all or nearly all cases since most people have deductibles and copays.  It is only by not weighting by insurance company size when calculating 'median' and 'mean' that you have been convinced of the false belief that Medicare pays less than insurance companies.

Seriati

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Re: health care and the free market
« Reply #23 on: April 08, 2019, 06:30:48 PM »
LR, I'm confused here.  I went to your sources expecting them to back up your claims, and yet they actually back up mine.

Did you look at the conclusions on the Medicare report?  This was by the way for Medicare Advantage, though it also flagged Medicare FFS.  While I agree CBO reports are only as good as their assumptions, this pretty much showed that the Medicare payments were grossly less than commercial payments, and that's completely excluding the individual market (which is the absolute most expensive part of the commercial market). 

As a reminder, these are "conclusions" in what you cited:

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Commercial prices are (sometimes substantially) higher than Medicare FFS

Medicare Advantage prices are very close to Medicare FFS

Commercial prices vary substantially across areas and within areas; Medicare Advantage prices co-vary with Medicare FFS

Out-of-network prices are substantially higher for commercial services; Medicare Advantage prices aren’t

For most of the services Medicare Advantage (which is better reimbursing than the others), barely met the same payment as the 90th percentile paid by the commercial industry.

I'm not sure why you go into a run down on insurance carriers when the charts were based on the data from the events themselves.  It's not an average of what Aetna paid, it's every payment Aetna made for example.  Everything you imply about larger carriers conducting the vast majority of the business actually undercuts your point as they therefore would have represented the largest portion of the events that were included in the charts (and unless I'm misreading it all of the data is from 3 large carriers).  Take a look, for example, at page 19 where they do a "by provider" break down and give you a result for Medicare Advantage at the 10th and 90th percentile of providers (that's should make clear that we're not talking about "carriers" as Medicare would only be a single carrier in the model).

Look at 20, there's no service they found where Medicare FFS was not below the in network commercial price average, let alone the out of network.

So I'm kind of confused why we should reinterpret data from 3 large insurers that showed Medicare completely underpaid what they themselves pay in-network as somehow proof that large insurer rates are comparable to what Medicare pays.

I recommend people follow your second link and see for themselves, it's a direct link to a high level CBO summary.  The others are indirect links to an insurance industry group (unhelpful) and to a list of largest insurers by size (1,2 and 5 were used for the CBO report - based on their 2014 data).

I apologize but I think you've just completely misread what's going on when you are making assertions about small providers.

LetterRip

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Re: health care and the free market
« Reply #24 on: April 08, 2019, 10:09:32 PM »
LR, I'm confused here.  I went to your sources expecting them to back up your claims, and yet they actually back up mine.

[...]

I apologize but I think you've just completely misread what's going on when you are making assertions about small providers.

Hmm - on reexamination I think you are right - doh!

Fenring

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Re: health care and the free market
« Reply #25 on: April 08, 2019, 11:18:37 PM »
I wish I knew enough about health care minutiae to follow the details of this thread. Same thing I felt in the enormous thread on the topic on the old forum... 

TheDrake

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Re: health care and the free market
« Reply #26 on: April 09, 2019, 08:38:50 AM »
I recommend An American Sickness. It talks about anti competitive regulation as well as distortions of profit motive raising prices without better outcomes.