Its a first step. What people like Duffy don't get is that one of main reasons for the failure of the US medical system is the lack of transparency for customers, especially on something as critical as medical services and drugs.

Right now shopping for medical services is not easy to navigate even for a savvy consumer. Do you know where to go in your area to get the best value-for-money proposition for a broken leg? A heart-attack? Mysterious GI pain? Do you know how much you'll pay for the services? Do you know how much your drugs will cost?

Wouldn't it be nice to have a online menu of all the drugs - both brand name and generic, sold by a pharmacy and their prices? Are there alternative drug options - maybe that are 95% as effective as the "ideal" drug, but only cost 5% of the cost? Knowing that would be an important factor for many people.

Right now too many people in the US simply don't go to the doctor because they are scared they won't be able to afford the services and drugs - and they are probably right. Because the prices are inflated due to lack of transparency.

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Remember - It's important to be comfortable in your own skin... because it turns out society frowns on wearing other people's

Transparency is a problem...though far from the major one. The core problem with the American healthcare system is this idiotic belief that it can function in any way shape or form similar to any other "industry" where market forces reign supreme. Just look at the language you used in your post.

Healthcare has never been and never will be a competitive market. Give up on it or die poor trying to navigate it. That's basically it. As long as you have half of the population believing in fairly tales about "market based solutions" we are stuck with "market based solutions". The problem is that the people with 99% of the power in this market are not the consumers. Not even the savvy ones. End of story. No matter what we do around the edges, the house will always win. The house, in this case, are (in order of uselessness and margins): Insurance companies, Big Pharma, Equipment Companies, Physicians (AMA is a cartel), Specialty clinics, Hospitals (mostly administrators such as myself - certainly not the nursing staff which works insanely hard jobs for OK money). You and I as patients are at the end of this line.

It's so refreshing every time you post to hear from someone who actually knows this shit from the inside out. Funny how so many others here are convinced they know better than someone who actually gets paid to keep the merry-go-round spinning every day.

Disclaimer: married to one of the 'House' minions in your list of conspirators, so we see it from the inside every day too; just at a lower level...

That’s just it.

You shouldn’t have to FIND a price.

You should be SHOWN a price.

Hence, price tags. They are everywhere in any other industry.

My SO is a nurse practitioner. We were discussing an article where they had a study of medical people who would need treatment. The medical people, knowing the diagnosis and treatment procedures would NOT want treatment knowing the costs or further because they didn’t know their costs and out of pocket expenses. For their own health! These are people that know better.

That is telling of a broken system.

It needs to be more clear, like a broken car. Bring car in, get estimate and troubleshooting diagnosis. Make decision.

Doctor should charge diagnosis doctor visit. Provide you with written estimate of proposed treatment and costs, both if paying as a cash customer, and costs based on your insurance plan.

And you should get the info within a reasonable time, like 24 - 48hrs

I had an MRI a few years ago and paid cash because they told me if I used insurance it would cost me more out of pocket. That’s really messed up.

The bigger problem is the separation of user and payer.

If payment was better coupled to the user of the service then pricing transparency would happen on its own.

As it is now “someone else” is paying so the user is generally unconcerned with the actual cost of the service.

BTW, I was out of town recently, had to get a prescription filled and didn’t have my insurance card. Told pharmacist I’d pay out of pocket and asked him how much it cost. He punched some buttons on his computer and rang me up.

Took about 20 seconds.

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Civilize the mind, but make savage the body.

- Chinese proverb

Here we go again...you think we should shop for care...or would if only we had more skin in the game. Bogus. Fairy tales. This market does not and will not work that way. Even if you cut out all the crazy margins and got our costs back to global averages - you can't shop around for anything beyond preventative and elective care. Emergency and life saving care costs more than people can afford - even in Sweden. Maybe 10% of the population has sufficient resources to pay non-marked up prices for care without any sort of a insurance risk (and cost) transfer scheme. And I'm probably generous. The rest of us shmucks need others to subsidize our care via insurance of some sort.

If the above paragraph wasn't clear enough - I'm saying that virtually nobody could afford to pay for cancer treatment out of pocket even if our rates were more in line with the rest of the world. Not without a wholesale restructuring of the entire system...which, coincidentally, is that evil socialism boogeyman that the righties are scared of and have been preventing for decades.

And if you want to throw your hands up in the air and argue ad absurdum that singlepayer will lead to shit care - I'm happy to support a parallel for profit path for those who can afford to and want to skip to the front of the line. Also coincidentally, this all exists in other developed 'single payer' markets.

You completely misunderstood what I said.

Emergency life saving care is what insurance is for.

Check ups and treatment for the sniffles should be a more pay to play operation. Like it used to be. Like the policy I had in my 20s.

Really poor people can get in on a “single payer” system.

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Civilize the mind, but make savage the body.

- Chinese proverb

>>Emergency life saving care is what insurance is for.


So screw people with chronic conditions?

Yeah, right that’s exactly what I said!

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Civilize the mind, but make savage the body.

- Chinese proverb

OK Cool, then you are for what most of us with some experience in the actual system are advocating for. A less cluttered version of Obamacare with the public option if you will. Lieberman is a c***.

The system that existed when you were in your 20s is gone so it's probably time to give up on it. Mind you, it didn't go away because the gubmint got involved. It went away because it was ripe for the picking by those on the winning side of the information/power asymmetry in the market. And pick it they did. Woooo boy!

Bernie Sanders just offered up a medicare for all plan that bans private insurance altogether.

Honestly, from an insiders' perspective - this is a good thing. You want to lower costs or not? Nobody is going to ban you from paying directly to your expert of choice for whatever legal procedure you want done. You don't need insurance for a knee replacement. You need insurance if you can't afford a knee replacement and you want me to pitch in. Those against socialism should live what they preach ;)

But to go along with the discussion - Our current President said that he was going to replace Obamacare with something better and cheaper on day 1. If not day 1 surely by now. So...what's your point? Bernie is staking out a position that involves a solution that would, in some ways, be an improvement over status quo (and in others it would not). It's a position that would surely be negotiated back to reality before anything actually got done. Whatever it is - it involves a plan with some level of detail. It seems it would get people interested more than a promise with no details (and surprisingly, no solution...haha). It seems...of course reality has been rather weird lately so I guess I'll watch with interest as the stupid show continues.

Remember that guy who said Obamacare passed because voters were stupid? Can't believe how much shit he's taken for that. Dude's a fucking hero.

    ....another healthcare related EO that I like the sound of at first blush:

"The order calls for HHS to issue a rule requiring hospitals to disclose prices in an easy-to-read format reflecting what patients and insurers actually pay. The department will also require providers and insurers to disclose information about patients' out-of-pocket costs before they receive care.
The order also calls for a roadmap for consolidating quality metrics across all federal health care programs, expanding access to health care claims data de-identified to preserve privacy and directs the Treasury Department to expand the availability of health savings accounts to pay for more health care services."

https://www.politico.com/...transparency-1549570

I know it's the socialists but the NHS pays fixed pricing for 60m people. That pisses trump and pharma off as NHS pricing is a benchmark other countries use

It's completely insane that pricing varies by provider and insurer.

I am totally onboard with “grocery store” pricing. I am not saying that every provider charges the same price, but that the price the provider charges is the same across all people. Add in, it should be easy to see. I should be able to price shop an MRI the same way I price shop for tires.

It is ridiculous to me that if you have aetna it’s one price, but something else if you have anthem (and the myriad of sub prices per plan). And usually
If you are paying out of pocket, it’s 300% the negotiated rates. Billing is insane. If you had one price per service, the administrative overhead cost would drop significantly. And, I think providers would get paid faster. I can’t be the only one that waits until the second bill to pay. I’m still getting 10.00 checks back from being overcharged for my PT.

I like it!

And I have a hard time processing statements like this:

Because having secretive pricing that is "competitively negotiated" off an assanine made up value has done so well at pushing prices lower!