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Repeal of Obamacare (Page 11)
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Snow-i
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Today, 02:10 PM
 
Originally Posted by Laminar View Post
I said "cost," not "price." Insurance companies currently pay whatever "price" they manage to negotiate.
Precisely. Price is a function of cost. Our problem is high costs, which leads to high prices. How does single payer fix this?
     
Laminar
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Today, 02:28 PM
 
Originally Posted by Snow-i View Post
Precisely. Price is a function of cost.
This is absolutely 100% untrue.

Price is a function of what people are willing to pay. Cost has VERY LITTLE impact on price.
     
Laminar
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Today, 02:29 PM
 
Originally Posted by subego View Post
Doesn't the entire EU have single payer?

I can dig up the master WHO rankings of healthcare systems if you want, but if you're willing to take my word, we do better than a big hunk of Eastern Europe.
Maybe I left out some qualifiers about "developed" or "first world," which would then lead to arguments about what those words mean.
     
Snow-i
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Today, 02:33 PM
 
Originally Posted by Laminar View Post
Well then let me ask you this (you may have already answered it so sorry if I'm making you repeat yourself): How does every nation with single payer achieve A) lower costs per capita and B) better outcomes. The question has two parts, and sources must be cited.
Because the costs in general are lower in those countries. Costs such as:

-Medical Wages
-Medical schools
-Medical facility construction
-Insurance for said facilities
-Property
-transportation
-emergency services such as helicopters and ambulances.
-infrastructure to support the emergency services.
-medical equipment (manufacturing to delivery)


Those things all cost considerably more in the US - single payer won't do anything to address those costs. I could cite numbers for all the above, but we'll start here (and I definitely can't be accused of bias with this source):

http://www.motherjones.com/kevin-dru...ther-countries

Single payer will not address any of the problems with costs. Our problem is costs. If you want prices to go down, you need to cut the costs. The margin is already under 3%, meaning there's nothing else really to cut besides costs. No one can connect the dots on how single payer would do a damn thing for any of these costs, aside overhead (which again, is not exactly something the government is good at AND would have no motive to keep under control). If you think that the government would come in and be more efficient than the profit motivated companies today in reducing overhead costs, well, I don't even have words for that - just a facepalm. The government has never been good at cutting costs, nor would this time be any different.

Simply dedicating less money to these things will absolutely 100% reduce the quality of care. No one has been able to connect the dots on how single payer would reduce these costs.


Your options for cutting costs are:
1. Pay less in wages and deal with the subsequent dearth of medical staff quality and quantity. Who would pay half a mil & a decade of their life to go to medical school when there is just no financial incentive to do so? You'll get what you pay for here.
2. Pay less for facilities, infrastructure. This will adversely impact the quality of care as you'll get what you pay for.
3. Pay less for medical schools - you'll get what you pay for here, and no, it won't be better care.
4. Pay less for equipment - at the same time no one will invest in developing new technologies as there is just no more ROI here. You'll see investment bottom out and the industry will not deploy new technologies as it will simply be too expensive/risky with no prospect of an ROI.



I need someone to connect the dots on how single payer can significantly reduce [i]costs[.i] in the industry. Not the price, the cost. In the US, where costs in general are higher. Hint: it won't - it'll either artificially reduce prices (which will result in quality of care/access falling to the level that the costs support), or it'll continually run at a steep deficit leading to insolvency. You can also forget about new technologies and/or cheaper treatments, since no one will invest in new tech since there is no ROI and absolutely no reason to take the risk that comes with developing new technologies.

If you want to go single payer, you've got to get costs under control. The correlation between single payer countries and lower costs is NOT causative - infact it's the reverse - lower costs all around allow for the viability of single payer.
     
Snow-i
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Today, 02:50 PM
 
Originally Posted by Laminar View Post
This is absolutely 100% untrue.

Price is a function of what people are willing to pay. Cost has VERY LITTLE impact on price.
What? You're saying cost has little impact on price? Really? The margins are under 3%, so you're saying that the costs, which are 97%+ of the price, have very little to do with the price? What are you smoking dude.? Take econ 101, costs are everything when it comes to pricing. Sure, in a market where demand far outstrips supply, you'll see the price go up - but there's nothing in our market keeping this supply down except the costs.

Healthcare is not a collectors market. The demand is more less constant (with a slight increase year over year). Supply is not being artificially or otherwise constrained, so unless you plan on the government somehow increasing the supply of medical goods and services (somehow by paying less money for it?), I'm really not sure how you came to the conclusion this would reduce prices.

It's an equation that sums to 0, so pick where you want to take from to make both sides even out. There really isn't anything to take from margin, sooo

Edited to add:

Price = Cost + Margin (<3% in this context)
( Last edited by Snow-i; Today at 03:09 PM. )
     
The Final Dakar
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Today, 02:54 PM
 
Originally Posted by subego View Post
Doesn't the entire EU have single payer?

I can dig up the master WHO rankings of healthcare systems if you want, but if you're willing to take my word, we do better than a big hunk of Eastern Europe.
You mean all the satellite states that were behind the iron curtain until 25 years ago?
     
subego
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Today, 03:09 PM
 
Originally Posted by Laminar View Post
Maybe I left out some qualifiers about "developed" or "first world," which would then lead to arguments about what those words mean.
This is a fair point, but then it circles back to whether comparing the U.S. to the paragons of Western Europe is apples to apples.

Which gets us the same old list of primary differences.

Geography
Population density
Ethnically non-homogeneous
Defense spending
Old infrastructure
     
Snow-i
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Today, 03:18 PM
 
Originally Posted by subego View Post
This is a fair point, but then it circles back to whether comparing the U.S. to the paragons of Western Europe is apples to apples.

Which gets us the same old list of primary differences.

Geography
Population density
Ethnically non-homogeneous
Defense spending
Old infrastructure
Don't forget much lower costs of living, and costs for all the ingredients that make up healthcare
     
subego
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Today, 03:21 PM
 
Originally Posted by The Final Dakar View Post
You mean all the satellite states that were behind the iron curtain until 25 years ago?
Yes.

And moreso than I thought because it looks like the paper's from 1997. My bad.

http://www.who.int/healthinfo/paper30.pdf

List is on page 18.

Though we do (did) manage to be a stone's throw from Denmark, and make New Zealand look bad.
     
subego
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Today, 03:22 PM
 
Originally Posted by Laminar View Post
Maybe I left out some qualifiers about "developed" or "first world," which would then lead to arguments about what those words mean.
Turns out my source was from 1997, so my argument takes a hit here.
     
Laminar
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Today, 03:45 PM
 
Originally Posted by Snow-i View Post
What? You're saying cost has little impact on price? Really? The margins are under 3%, so you're saying that the costs, which are 97%+ of the price, have very little to do with the price? What are you smoking dude.?
You broke the rule about citing sources.

Whose margins? The margins of the insurance companies that don't need to exist? The margins of employees whose job it is to negotiate prices between a hundred companies and a thousand providers? The billing departments of each and every hospital, clinic, and doctor's office that spend countless hours going back and forth with patients and providers trying to figure out who owes whom what percentage of what made up price? Surely you recognize the inefficiency there.

[quote]Take econ 101, costs are everything when it comes to pricing. Sure, in a market where demand far outstrips supply, you'll see the price go up - but there's nothing in our market keeping this supply down except the costs.

Take Business 101, if you're charging less than someone is willing to pay, you're undervaluing your product and missing out on money.

Why do you think the cash price that providers list are always so much cheaper than the "negotiated" insurance price? Because they will charge exactly how much the insurance company is willing to pay, and not a penny less. They'd be idiots to accept less.

Price = Cost + Margin (<3% in this context)
Waiting on that margin source and your comments on the cost of insurance overhead.

I'm beginning to see where you're coming from - you think an MRI actually costs a provider $1500 (-3%), and you'll rationalize it by assuming there's some cost of equipment and R&D and pharmaceutical research and some other stuff, without realizing that an MRI costs $1500 because insurers will pay $1500 for an MRI. Walk in and pay cash and it will run you $400.
     
Laminar
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Today, 03:52 PM
 
Originally Posted by Snow-i View Post
Because the costs in general are lower in those countries. Costs such as:

-Medical Wages
-Medical schools
You cited those, but those are easy. Let's get to citations on these:

-Medical facility construction
-Insurance for said facilities
-Property
-transportation
-emergency services such as helicopters and ambulances.
-infrastructure to support the emergency services.
-medical equipment (manufacturing to delivery)
     
Snow-i
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Today, 03:55 PM
 
Originally Posted by Laminar View Post
You broke the rule about citing sources.
To be clear, are you arguing for single payer, or are you just trying to nitpick my argument while ignoring it's main points?
Whose margins? The margins of the insurance companies that don't need to exist?
Yes - they are under 3% today. Is your argument ideological or are we trying to come up with a solution?


The margins of employees whose job it is to negotiate prices between a hundred companies and a thousand providers?
No, the margins of the insurance providers (who single provider would be replacing).

The billing departments of each and every hospital, clinic, and doctor's office that spend countless hours going back and forth with patients and providers trying to figure out who owes whom what percentage of what made up price? Surely you recognize the inefficiency there.
Nothing like a government bureaucracy to fix that

Hows the post office doing?

Lets make getting critical medicine like going to the DMV! Brilliant!
Take econ 101, costs are everything when it comes to pricing. Sure, in a market where demand far outstrips supply, you'll see the price go up - but there's nothing in our market keeping this supply down except the costs.

Take Business 101, if you're charging less than someone is willing to pay, you're undervaluing your product and missing out on money.
Are you arguing that the sub 3 percent margins are too high? Or that they should be higher? I'm really not sure - but your argument seems ideological and not grounded in how to fix the market.

Also, that someone is willing to pay the cheapest price for the same service. I.e. if someone else offers the same thing (or roughly) for cheaper, they will pick that 10/10 times. What you're describing is a monopoly, like if there were only one entity pay....wait a second!


Why do you think the cash price that providers list are always so much cheaper than the "negotiated" insurance price? Because they will charge exactly how much the insurance company is willing to pay, and not a penny less. They'd be idiots to accept less.
Yes, and at 3% margins, I'm not sure this is where the problem lies. Do you?


Waiting on that margin source and your comments on the cost of insurance overhead.
https://www.forbes.com/sites/theapot.../#6653194f3c3a

Margins for US insurance (which is what single payer would replace).

I'm beginning to see where you're coming from - you think an MRI actually costs someone $1500, and you'll rationalize it by assuming there's some cost of equipment and R&D and pharmaceutical research and some other stuff, without realizing that an MRI costs $1500 because insurers will pay $1500 for an MRI. Walk in and pay cash and it will run you $400.
\
The margins for those paying less than 3%, so it actually costs the payer $1455- if no one's looking at how much it costs, no one is going to care how much it costs. But if you are arguing for single payer, you need to describe how the MRI would be less than that $1455 something everyone else is failing to connect the dots on. Again, the margins are less than 3% - the other 97% making up costs, so you can't take anything from the margin.
( Last edited by Snow-i; Today at 04:10 PM. )
     
The Final Dakar
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Today, 04:10 PM
 
Wait, what's so bad about the post office?
     
Snow-i
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Today, 04:14 PM
 
Originally Posted by The Final Dakar View Post
Wait, what's so bad about the post office?
https://about.usps.com/news/national...6/pr16_092.htm

2016 - net loss 5.6 billion. Income, 610 million. It's insolvent.

https://lawstreetmedia.com/issues/bu...is-whats-plan/

http://www.cnsnews.com/commentary/do...-enormous-debt
     
Snow-i
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Today, 04:19 PM
 
Originally Posted by Laminar View Post
You cited those, but those are easy. Let's get to citations on these:
Well, how do you reconcile the first two? We can move down the list, but only if you participate.
     
Laminar
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Today, 05:48 PM
 
Originally Posted by Snow-i View Post
To be clear, are you arguing for single payer, or are you just trying to nitpick my argument while ignoring it's main points?
I'm not nitpicking your argument because there are no fine points to nitpick. "Single payer will never work in the US because the US is extra special." is the entirety of your argument.

Yes - they are under 3% today. Is your argument ideological or are we trying to come up with a solution?
The ACA implemented an 80/20 rule where 80% of insurance premiums had to go to to payouts and other value-added expenses. Why should I care about 3% profits when 20 or more percent of my premiums is going to overhead?

The margins for those paying less than 3%, so it actually costs the payer $1455- if no one's looking at how much it costs, no one is going to care how much it costs. But if you are arguing for single payer, you need to describe how the MRI would be less than that $1455 something everyone else is failing to connect the dots on. Again, the margins are less than 3% - the other 97% making up costs, so you can't take anything from the margin.
You're really fixated on that 3% value, so much so that I think you're getting some tunnel vision and can't see the big picture. You seem to have conveniently ignored my cash price example.

The MRI does not cost $1500 (-3%). I guarantee you the clinic is not taking a loss by charging $350 cash. The clinic knows what it costs them to do an MRI. They're able to charge $1500 because that's what the insurance company will pay. That doesn't mean the insurance company or the provider is making some giant gross profit margin, it means that a thousand dollars is wrapped up in billing, negotiations, collections, and other overhead. If a single entity always paid the cash price, how would that not save money?

Nothing like a government bureaucracy to fix that
Yet somehow every other developed nation has figured out how to spend less per capita on health care and provide better outcomes. What is so wrong with the US government that it's so far behind other nations?
     
 
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