HealthCare

[lejend]

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[lejend]

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[Goodspeed]

@lejend Valeant took it too far, but they are a great example because what happened there shows the problem so clearly. R&D departments were gutted and prices hiked, and the people who relied on this medication had no choice but to keep buying. Many of them were forced to stop buying. Whatever research R&D was in the middle of was cut short. It's an extreme example to illustrate a point, which is that predatory pricing IS an issue. And it's still widespread. https://www.marketwatch.com/story/big-p ... 2016-12-19

I do agree that the government can make health care more affordable. But that can only be accomplished by getting out of the market.

The contrary is proven by history and, honestly, common sense. For businesses, it's an absolute no brainer to hike prices when demand is inelastic and there is no competition. Not all drugs have viable alternatives. It doesn't take a genius to see that while patents exist, the free market is never going to have a solution for this. And without patents, R&D is a waste of money. So please, enlighten me about how your precious free market is going to solve this problem.

It's disappointing to see that there are STILL people who consider the free market this magical thing that, despite being "survival of the fittest" by design, will magically have solutions for poverty and inequality of opportunity, and for basic human needs like health care being out of financial reach of poor people. The free market, in many ways, is like evolution. Those who were born in the wrong place, or don't have the ability to adapt, will likely not survive and/or procreate (because they can't afford it). And natural ecosystems even have a leg up on the market: every resource that is put in is eventually rotated back to the bottom of the food chain. In the market, money accumulates at the top instead.

It's okay to be opposed to government regulation because you don't want equal opportunity, and you do want the poor to have to fight for basic human needs all their lives. Makes you an asshole in my view, but sure. Just don't pretend the free market is ever going to work for these people.

[thomasgreen6]

The rich don't have as much as you'd think though.

Correct me if I'm wrong, but according to wikipedia, in 2014 the top 1% of the United States population possed 40% of its wealth

Wealth and money aren't the same thing, however. I can have a T-shirt worth, say, $200, and say that my worth is $200, but that $200 in assets can't really be used to fund government programs, can it? Unless you're calling for confiscation and nationalization of the property of wealthy people, (which would be counterproductive), you are not going to fund anything with their trillions of dollars of assets.

Even taxing income would be counterproductive. The rich don't just sit there; they react by reducing investment, firing employees, raising prices, and moving to other countries.

So in terms of taxable income, the wealthy don't have anywhere near enough of it to fund a welfare state. That's why most socialist countries impose fairly high taxes on the poor and the middle class.

Apparently, Bill Gates as an example earns about $10 billion a year. Furthermore according to Wikipedia, (again), the top 8% of people in the USA earned 28.5% of the toal income which is approximately $2 trillion (per year). To put this in perspective, in the UK the budgest for the NHS is about £125 million per year. I don't see how your point stands using these statistics.

[Bucknasty]

Using Wikipedia as a source

[spanky4ever]

survival of the fittest, is when you take care of your offsping, and each other. Look it up

[bigsmoke]

Show hidden quotes

The rich don't have as much as you'd think though.

Correct me if I'm wrong, but according to wikipedia, in 2014 the top 1% of the United States population possed 40% of its wealth

Wealth and money aren't the same thing, however. I can have a T-shirt worth, say, $200, and say that my worth is $200, but that $200 in assets can't really be used to fund government programs, can it? Unless you're calling for confiscation and nationalization of the property of wealthy people, (which would be counterproductive), you are not going to fund anything with their trillions of dollars of assets.

Even taxing income would be counterproductive. The rich don't just sit there; they react by reducing investment, firing employees, raising prices, and moving to other countries.

So in terms of taxable income, the wealthy don't have anywhere near enough of it to fund a welfare state. That's why most socialist countries impose fairly high taxes on the poor and the middle class.

Apparently, Bill Gates as an example earns about $10 billion a year. Furthermore according to Wikipedia, (again), the top 8% of people in the USA earned 28.5% of the toal income which is approximately $2 trillion (per year). To put this in perspective, in the UK the budgest for the NHS is about £125 million per year. I don't see how your point stands using these statistics.

Taxable income. If you are rich you tend not to want people to take it away, so you invest in the best investment for your money i.e. in NZ real estate is hardly taxed so there is a large market for it. You can't use a house to pay for things, its not actual currency. If the government begin taxing it, they will just move their assets elsewhere.

Now its already established that the US health system has a fairly large expenditure already (compared to other countries), so money really is not the issue if the system is bad.

[lejend]

@lejend Valeant took it too far, but they are a great example because what happened there shows the problem so clearly. R&D departments were gutted and prices hiked, and the people who relied on this medication had no choice but to keep buying. Many of them were forced to stop buying. Whatever research R&D was in the middle of was cut short. It's an extreme example to illustrate a point, which is that predatory pricing IS an issue. And it's still widespread. https://www.marketwatch.com/story/big-p ... 2016-12-19

They're a great example if your company's goal is bankruptcy - clearly. In a free market, you're free to make choices, but you're not spared the consequences of those choices. Valeant and co. can make terrible business decisions to their heart's content, their competitors won't be so stupid.

I am not sure if people will be affected much by these drug price hikes, though. Insurers and employers cover most of the costs. That's one reason pharmaceutical companies and health care providers charge so much. People rely on their health insurance to pay for everything. The true cost of care is hidden from them.

You can trace virtually all flaws of the market back to government intervention. Such as government regulations artificially inflating the cost of R&D, thus incentivizing pharmaceutical companies to impose high prices in order to make a profit.

It seems that in your view, the US health care industry is this laissez-faire paradise, where any failure can be attributed to the free market. You're really ignoring the fact that the government heavily intervenes in the market. It is hardly laissez-faire; it's actually an incredibly distorted market.

The contrary is proven by history and, honestly, common sense. For businesses, it's an absolute no brainer to hike prices when demand is inelastic and there is no competition. Not all drugs have viable alternatives. It doesn't take a genius to see that while patents exist, the free market is never going to have a solution for this. And without patents, R&D is a waste of money. So please, enlighten me about how your precious free market is going to solve this problem.

Never heard of a business that looks to sell their product to the fewest people possible. Have you?

Businesses often hike prices but that's not their purpose. Their purpose is to make a profit, and hiking prices is only one method of accomplishing that. Other times it is counterproductive. You want your prices high but not so high that few people can afford them. Oftentimes, you can make a higher profit by decreasing your prices.

We can see this trend in all sorts of markets. For instance prices of common goods, and luxuries previously attainable only to the very rich, have significantly decreased over the years. The few markets where prices don't always decrease are ones heavily distorted by government intervention: education, housing and health care, to name a few.

No matter how well-intentioned, government interventions always have unintended consequences, and cause way more problems than they solve.

You would never want the government to have a monopoly on, say, video game development. It's obvious to you that millions of people making their own choices in a free market, are more efficient and innovative than government bean-counters. Yet when it comes to a product that you deem "essential", your judgement is clouded, you start arguing that the same laws of economics that apply in every other market, stop applying in this particular market. That's caused by fear, not empirically-verified reality.

It's disappointing to see that there are STILL people who consider the free market this magical thing that, despite being "survival of the fittest" by design, will magically have solutions for poverty and inequality of opportunity, and for basic human needs like health care being out of financial reach of poor people. The free market, in many ways, is like evolution. Those who were born in the wrong place, or don't have the ability to adapt, will likely not survive and/or procreate (because they can't afford it). And natural ecosystems even have a leg up on the market: every resource that is put in is eventually rotated back to the bottom of the food chain. In the market, money accumulates at the top instead

It's okay to be opposed to government regulation because you don't want equal opportunity, and you do want the poor to have to fight for basic human needs all their lives. Makes you an asshole in my view, but sure. Just don't pretend the free market is ever going to work for these people.

Even more disappointing is that despite decades of complete failure, famine, poverty and hundreds of millions of deaths, there are still people who believe central planning beats a market economy.

There is nothing magical about markets. Economic freedom is based on an understanding of basic laws of economics, that humans naturally adhere to when left to their own devices. In fact, even in socialist dictatorships, markets still exist secretly. Again, human nature.

No one wants people to suffer, that's ridiculous. I can tell you, though, that, firstly, my beliefs are fundamentally grounded in the idea of individual liberty, whereas you are arguing for eliminating individual choice and imposing a top-down directive on everyone. The beauty of my system is that my preferences are irrelevant; every person is free to do whatever they please without violating any other person's rights. Your beliefs are based on the idea that people can't be expected to fare for themselves; they must be forced by government into organizing in a certain way. Their personal preferences are meaningless.

Secondly, whenever economic freedom has been implemented, it has resulted in increased prosperity, without exception. Whereas whenever socialism has been implemented, poverty and misery followed, without exception.

Socialist ideology is predicated on force, and consistently results in astounding misery. So I don't understand how leftists have the moral highground here. I'm a bad person for wanting people to be free and prosperous, whereas leftists are saints for wanting to eliminate individual choice and implement a notoriously failed system. Apparently.

That was a bit ramble-y, but I hope I explained well enough that my beliefs are more complex than "kill children."

[lejend]

Apparently, Bill Gates as an example earns about $10 billion a year. Furthermore according to Wikipedia, (again), the top 8% of people in the USA earned 28.5% of the toal income which is approximately $2 trillion (per year). To put this in perspective, in the UK the budgest for the NHS is about £125 million per year. I don't see how your point stands using these statistics.

Okay let's accept those figures for the sake of argument. Even if you managed to funnel literally all that $2 trillion into the government's coffers, that's still a deficit of $2 trillion per year; federal spending is $4 trillion per year. You're still going to have to tax the poor and middle-class and borrow heavily.

[thomasgreen6]

Apparently, Bill Gates as an example earns about $10 billion a year. Furthermore according to Wikipedia, (again), the top 8% of people in the USA earned 28.5% of the toal income which is approximately $2 trillion (per year). To put this in perspective, in the UK the budgest for the NHS is about £125 million per year. I don't see how your point stands using these statistics.

Okay let's accept those figures for the sake of argument. Even if you managed to funnel literally all that $2 trillion into the government's coffers, that's still a deficit of $2 trillion per year; federal spending is $4 trillion per year. You're still going to have to tax the poor and middle-class and borrow heavily.

I accept that I got these figures from wikipedia and if you have a more relaibe source then the figures from there might be more accurate. I understand your point and perhaps suggesting that taxing the rich can fund your entire federal budget (or its equivilent) is naive. However, it is clear that the very richest band of the population in the USA can contribute proprtionaly a lot more (i.e the top 8% can theoretically contribute to 50% of the federal budget for example). My point related to the the context of health care and I was demonstrating that to fund a public healthcare system free at the point of entry, similar to the UK, then the richest group of people in the USA seem to earn more then enough to at least partially fund a sytem like this.

[gibson]

wikipedia is a reliable source.

[Goodspeed]

@lejend Valeant took it too far, but they are a great example because what happened there shows the problem so clearly. R&D departments were gutted and prices hiked, and the people who relied on this medication had no choice but to keep buying. Many of them were forced to stop buying. Whatever research R&D was in the middle of was cut short. It's an extreme example to illustrate a point, which is that predatory pricing IS an issue. And it's still widespread. https://www.marketwatch.com/story/big-p ... 2016-12-19

They're a great example if your company's goal is bankruptcy - clearly. In a free market, you're free to make choices, but you're not spared the consequences of those choices. Valeant and co. can make terrible business decisions to their heart's content, their competitors won't be so stupid.

Again, they took it too far, but price hikes are still widespread. You don't need to look far to find controversies about predatory pricing in US pharma. I linked you an article already, so I've done my part. If you're interested you can do some googling yourself.

I am not sure if people will be affected much by these drug price hikes, though. Insurers and employers cover most of the costs. That's one reason pharmaceutical companies and health care providers charge so much. People rely on their health insurance to pay for everything. The true cost of care is hidden from them.

If insurance companies face high costs because medicine got more expensive, then they will have to increase premiums. So no, the cost of care is not "hidden" to people.
Pharma and health care providers can hike prices all they want because they are going to get paid anyway. That's why insurance is so much more expensive in the US than here, which in turn is why a lot of people in the US aren't insured at all. They have to take the risk because they can't afford insurance. And sometimes they get sick and then they are completely fucked.

You can trace virtually all flaws of the market back to government intervention. Such as government regulations artificially inflating the cost of R&D, thus incentivizing pharmaceutical companies to impose high prices in order to make a profit.

What?

It seems that in your view, the US health care industry is this laissez-faire paradise, where any failure can be attributed to the free market.

Not at all. I am only noticing a problem. A very simple one: Without government intervention, inelastic demand and patents set the stage for predatory pricing. And this is exactly what we see happen.
I agree with you that government intervention in US pharma hasn't been the most effective. But that doesn't mean it can't be done, just means it has to be done right. Probably hard to do it right immediately given that the US is an oligarchy, meaning price regulation is effectively off the table. They're trying, or tried, which is better than nothing.

Never heard of a business that looks to sell their product to the fewest people possible. Have you?

Businesses often hike prices but that's not their purpose. Their purpose is to make a profit, and hiking prices is only one method of accomplishing that. Other times it is counterproductive. You want your prices high but not so high that few people can afford them. Oftentimes, you can make a higher profit by decreasing your prices.

We can see this trend in all sorts of markets. For instance prices of common goods, and luxuries previously attainable only to the very rich, have significantly decreased over the years. The few markets where prices don't always decrease are ones heavily distorted by government intervention: education, housing and health care, to name a few.

You don't seem to understand the concept of inelastic demand.

You would never want the government to have a monopoly on, say, video game development. It's obvious to you that millions of people making their own choices in a free market, are more efficient and innovative than government bean-counters. Yet when it comes to a product that you deem "essential", your judgement is clouded, you start arguing that the same laws of economics that apply in every other market, stop applying in this particular market. That's caused by fear, not empirically-verified reality.

No, it's not. Unequivocally, a market of essential products is very different from other markets. This is because people will continue buying no matter how high the price is. They need the product. And because of patents, often enough there are no alternatives to certain medicine. That's what inelastic demand is, and I can't believe I have to explain that to you after mentioning the concept at least 5 times ITT. How hard is it to google things?
And yes, a market behaves very differently in such situations as we can clearly observe.

Even more disappointing is that despite decades of complete failure, famine, poverty and hundreds of millions of deaths, there are still people who believe central planning beats a market economy.

It's not either or. A free market is great as long as it's regulated. There needs to be protection for the lower end of the food chain, or they will be exploited. And rules need to be in place to prevent economic crises like the one in 2008, where unchecked greed and stupidity allowed the housing market to become a ticking time bomb.

[lejend]

I accept that I got these figures from wikipedia and if you have a more relaibe source then the figures from there might be more accurate. I understand your point and perhaps suggesting that taxing the rich can fund your entire federal budget (or its equivilent) is naive. However, it is clear that the very richest band of the population in the USA can contribute proprtionaly a lot more (i.e the top 8% can theoretically contribute to 50% of the federal budget for example). My point related to the the context of health care and I was demonstrating that to fund a public healthcare system free at the point of entry, similar to the UK, then the richest group of people in the USA seem to earn more then enough to at least partially fund a sytem like this.

Let's say the rich make 2 trillion a year. Number 1, you are not going to be able to tax much of it. The rich react to taxes by reducing investment, cutting jobs, and often using illegal methods of evading taxes. They are the class most able to evade taxation. But for the sake of argument, let's say you successfully tax 100% of the income and they somehow accept it without reacting. That's still nowhere near enough to fund the government.

Of course the rich can partially fund it, but that's not nearly enough. I mean nobody wants to deal with constant cost-cutting and budget cuts, which I constantly hear the NHS is always facing. Is that right?

As I said earlier, the US taxation system is progressive, which means the rich already pay a disproportionate amount of taxes.

The Internal Revenue Service has recently released new data on individual income taxes for calendar year 2014, showing the number of taxpayers, adjusted gross income, and income tax shares by income percentiles.[1]

The data demonstrates that the U.S. individual income tax continues to be very progressive, borne mainly by the highest income earners.

In 2014, 139.6 million taxpayers reported earning $9.71 trillion in adjusted gross income and paid $1.37 trillion in individual income taxes.

The share of income earned by the top 1 percent of taxpayers rose to 20.6 percent in 2014. Their share of federal individual income taxes also rose, to 39.5 percent.

In 2014, the top 50 percent of all taxpayers paid 97.3 percent of all individual income taxes while the bottom 50 percent paid the remaining 2.7 percent.

The top 1 percent paid a greater share of individual income taxes (39.5 percent) than the bottom 90 percent combined (29.1 percent).

The top 1 percent of taxpayers paid a 27.1 percent individual income tax rate, which is more than seven times higher than taxpayers in the bottom 50 percent (3.5 percent).

https://taxfoundation.org/summary-lates ... 16-update/

[lejend]

Again, they took it too far, but price hikes are still widespread. You don't need to look far to find controversies about predatory pricing in US pharma. I linked you an article already, so I've done my part. If you're interested you can do some googling yourself.

If insurance companies face high costs because medicine got more expensive, then they will have to increase premiums. So no, the cost of care is not "hidden" to people. Pharma and health care providers can hike prices all they want because they are going to get paid anyway. That's why insurance is so much more expensive in the US than here, which in turn is why a lot of people in the US aren't insured at all. They have to take the risk because they can't afford insurance. And sometimes they get sick and then they are completely fucked.

The point of health insurance is to pool risk. It's true health care might be expensive, but health insurance, by definition, will be cheaper. People typically pay the premium and maybe the deductible and some small expenses, anything beyond that is paid for by the insurer. That incentivizes care providers to ask for absurdly high prices, because insurers can afford it and almost everyone relies on insurance to cover health care expenses. People mostly pay their insurance company, as opposed to the care provider. They are divorced from the true cost of health care.

You are operating from the assumption that insurance is necessary to receive care, which is not true. You can look at care providers who only accept cash and see how care prices drop. Over-reliance on health insurance most definitely deserves much of the blame for skyrocketing care prices.

Some choice quotes:

http://time.com/4649914/why-the-doctor-takes-only-cash/

[spoiler=.]

When Art Villa found out, after one too many boating accidents, that he needed a total knee replacement, he began asking around to see how much it would cost. The hospital near his home in Helena, Mont., would charge $40,000 for the procedure, he says. But that didn't include the anesthesiologist's fee, physical therapy or a stay at a rehabilitation center afterward. A 2015 Blue Cross Blue Shield study found that one hospital in Dallas billed $16,772 for a knee replacement while another in the same area charged $61,585.

It was in the midst of this confounding research that Villa, who's 68, heard about the Surgery Center of Oklahoma, whose business model is different from that of most hospitals. There, the all-inclusive price for every operation is listed on the website. A rotator-cuff repair for the shoulder costs $8,260. A surgical procedure for carpal tunnel syndrome is $2,750. Setting and casting a basic broken leg: $1,925.

The catch is that the whole facility is cash-based. It doesn't take insurance of any kind. Not Aetna. Not Cigna. Not Medicare or Medicaid. Patients or their employers pay whatever price is listed online, period. There are no negotiated rates, no third-party reimbursements and almost no paperwork. "We say, 'Here's the price. Here's what you're getting. Here's your bill,'" says Keith Smith, who co-founded the Surgery Center in 1997 with fellow anesthesiologist Steven Lantier. "It's as simple as that."

To Villa, the model seemed refreshingly subversive. The Surgery Center would charge $19,000 for his whole-knee replacement, a discount of nearly 50% on what Villa expected to be charged at his local hospital. And that price would include everything from airfare to the organization's only facility, in Oklahoma City, to medications and physical therapy. If unforeseen complications arose during or after the procedure, the Surgery Center would cover those costs. Villa wouldn't see another bill.

Sometimes called direct pay, and closely related to concierge care, this sort of business model was once seen as the perquisite of rich folks and medical tourists from foreign lands. But nowadays many of the people seeking cash-based care are middle-class Americans with high-deductible insurance plans. For a patient with an $11,000 family deductible, for example, it might make more sense to seek out a cash-based center like the Premier Medical Imaging facility in Minneapolis, which offers a basic MRI for $499, than to cough up the several thousand dollars that the same procedure generally costs at a traditional hospital. Cash payments don't count toward a patient's deductible, but for some it's worth the gamble.

Self-insured companies, like the trucking and storage firm where Villa is the chief administrative officer, are also fueling the trend. Because such companies pay their employees' medical bills out of their operating budget, it's in their interest to steer everybody to the cheapest option. Villa, for example, says his decision to go to the Surgery Center saved his company money, since his $19,000 bill is less than it would have been charged, even with a negotiated discount, by a traditional hospital. The Oklahoma state public employees' insurance fund, which covers 183,000 people, recently did similar math. In 2015 it announced a new rule: If patients go to a traditional hospital, they pay their deductible and co-payment. If they go to a cash-based provider that meets the fund's criteria, including the Surgery Center of Oklahoma, they pay nothing at all.

...

This trend may accelerate nationally. With the Affordable Care Act on the chopping block, many experts expect the free-market model to take off. While congressional Republicans have yet to produce a viable replacement for the Obama Administration's health care law, almost any change is likely to result in more Americans' choosing high-deductible insurance plans, which would help fuel the cash-based marketplace for years to come.

A few days after Villa's knee-replacement operation was completed on Jan. 17, his daughter captured a video of the happy patient, in headphones, "boogying down the hallway," as he put it, of the Marriott Residence Inn in Oklahoma City, where he stayed for a week and a half to recover. After the surgery a physical therapist and a nurse visited Villa in his hotel room, bearing gifts: an ice machine, pain medication, a thermometer and detailed, hands-on instructions for his recovery, all of which were included in his original bill. "I've really never experienced this quality of care," Villa says.

[/spoiler]

https://www.healthline.com/health-news/ ... ly-cash#12

[spoiler=.]

To make ends meet, many primary care practices squeeze more patient visits into their week.

As they do, the length of each visit shrinks, giving doctors barely enough time to assess a patient’s main concern, let alone connect with them.

“Patients become herded through the cattle gates and physicians become hamsters in the wheel,” Bartlett told Healthline. “And it doesn’t make for a good relationship for anybody.”

So Bartlett did what a small but increasing number of physicians are doing — ditching insurance companies altogether.

Instead they are setting up cash-only medical practices where doctors deal directly with patients on financial matters.

This immediately shifts the doctor-patient relationship.

“The main benefit of not billing through insurance is that you no longer work for the insurance company. You work directly for the patient,” Dr. Carmela Mancini, an internal medicine doctor who has a direct primary care practice in Massachusetts told Healthline.

What is ‘cash only?’

The cash only model is known as direct care or direct primary care.

Patients pay an annual or monthly fee for access to their doctor. This covers most primary care procedures — things like physicals, tests for strep throat, EKGs, and stitches.

Patients also get 24/7 access to their doctors, longer office visits, and often same-day appointments...

According to the John Locke Foundation, the average monthly payment for direct primary care is $25 to $85...

With only 800 to 1,000 patients — or fewer — direct primary care practices are smaller than typical primary care practices, which may have 2,000 to 3,000 patients.

This allows time during the day for longer office visits — and lets doctors maintain better work-life balance.

Typical primary care doctors may spend no more than 10 to 15 minutes with each patient.

A direct primary care doctor may spend at least 20 minutes with a patient. Or more.

A follow-up visit with Mancini is 30 minutes. For people with multiple chronic conditions, she’ll book one-and-a-half hours.

This hearkens back to your great-grandparents’ time.

“This is how it used to be back in the day before you had back-to-back patients,” said Bartlett, “before insurance became the norm for outpatient care around the 1950s.”...

Direct primary care doctors also have more control over how they interact with patients. Phone consultations, text messages, and Skype are common.

Most insurance companies will only reimburse a doctor when a patient comes into the office.

“I don’t need to force people to come into my office for things that don’t need to be handled that way,” said Bartlett. “Telemedicine is booming. There’s a reason for that.”

With telemedicine, patients can avoid unnecessary trips to the doctor — and hours away from work or having to pay for a babysitter — just to find out the results of a lab test or to ask a simple question about a rash or a cold.

And because doctors are accessible around-the-clock, patients may be less likely to put off seeking help.

After talking to a patient on the phone or getting a text, a doctor can write a prescription, refer a patient to the emergency room, or just ease their concerns.

“There are so many patients that have so much anxiety,” said Bartlett. “A lot of anxiety is triggered by a concern that there’s something wrong with them.”

Quicker care can also keep small problems from turning into larger ones — like a cat scratch becoming a major infection or symptoms of a heart attack or stroke going untreated.

People get urgent care when it’s needed and avoid it when it’s not.

“With three of us in the office getting to know patients, we can save so many ER visits, so many unnecessary urgent care visits,” said Dr. Jeffrey Gold, a family practice doctor at Gold Direct Care, a direct primary care practice in Massachusetts...

Many advocates of direct primary care say these benefits result from no longer dealing with insurance companies.

Part of this is that insurance companies don’t reimburse doctors enough to cover the cost of longer visits.

And there are many hoops for doctors to jump through to get reimbursed, including the use of electronic medical records for billing purposes.

“Most of us chose primary care to build relationships with people and take care of people,” said Gold. “How do you do that in an eight-minute visit, where 75 percent of it you’re standing at a computer checking boxes and typing stuff in?”

Cutting out insurance billing also cuts costs.

“[This model] definitely is sustainable, and what makes it sustainable is my overhead is really low,” said Mancini. “When you’re not billing through insurance, you don’t need 10 people doing coding and billing for you.”

Although direct primary care physicians have fewer patients, the monthly membership fees plus lower overhead means that their practices can still be financially viable.

...

A big part of the direct primary care model is price transparency, which puts more control back in the hands of consumers.

“How do you become a consumer if you don’t have the right tools?” said Gold. “The biggest thing we’re bringing to light is transparency in pricing, which does not exist.”

Practices list membership fees on their website and clearly explain what patients get for their money — no surprise bills when an insurance company says a doctor’s visit wasn’t covered.

Direct primary care practices can also offer inexpensive medications to patients.

“You can have a small wholesale pharmacy in your office and dispense noncontrolled and noncompounded medications at amazing prices,” said Bartlett.

[/spoiler]

https://reason.com/blog/2017/01/27/what ... -take-cash

[spoiler=.]

Anyone who has ever tried to shop around for prices on medical care knows how dysfunctional the market is. It's not because huge amounts of money isn't changing hands; it's that nobody really knows what anything costs at any given moment in time.

When I first moved to Los Angeles from Buffalo, my then-wife was pregnant with our first child and we were on a grad-student plan that didn't travel far beyond Western New York. Reason's benefits might not kick in until after our son was born, so I called around to area hospitals to try and find out what things cost. Four hospitals refused to give me any information, saying that they could not (and would not) price out anything. Part of that's understandable—what if something went seriously wrong?—but the people I spoke to refused to even say what basic charges were for things like delivery room time, anesthetics, and the like. Of course they have rate sheets for all that but share them with potential customers? Go fuck yourself, buddy.

For good reason: These costs are completely contingent on a wide variety of factors, especially what insurance plan you have or whether you have insurance at all. More recently, I've had the same problem trying to price out basic blood tests (a lipid panel) in southwestern Ohio, as simple and mechanical a procedure as exists. Without clear pricing, we'll never get far in radically improving the cost and quality of care for non-emergency services. In areas that are not traditionally covered by insurance—think Lasik surgery, cosmetic dentistry, and plastic surgery—a very different model obtains and you see exactly the sort of market-driven efficiencies that we see in virtually every other part of our commercial lives. The surgeon Jeffrey Singer has written about how various insurance contracts bar him from even discussing discounted cash payments with patients who announce they have insurance.

Time has a great story about bringing basic market forces to medicine. Titled "What Happens When Doctors Only Take Cash," the article uses the Oklahoma City Surgery Center as a model for a different way of doing business. Co-founded by the outspoken libertarian Keith Smith and Steven Lantier, two anesthesiologists, the center takes no insurance whatsoever. Instead, they take cash only and advertise and guarantee their prices and services. The result is pretty goddamned amazing:

...

At the heart of this are the price signals that help us guide decisions in all parts of our lives. If you don't know what things cost at a given point in time, there's really no way to make an informed decision...

With about half of all medical dollars being spent by the government and much of the rest covered by completely inscrutable insurance-company payment systems, good luck figuring out what anything costs at any given point in time. Ironically, Smith notes that Obamacare's forced march toward high-deductible plans (still a rarity among insured people) is actually fueling more cost-consciousness among patients (who should be called customers! enough with the mystifying of medical care as something more than other types of services!). After all, if your deductible is $6,000 or $15,000 or something you're unlikely to reach in a given year, you have more incentive to track your costs.

Indeed. I started this post with anecdotes about the difficulty of finding medical prices and I'll end with another. A few years back I had switched to a high-deductible plan and was prescribed something—a statin or antidepressant, I can't remember which, but it was a drug for which many brand names and many generics exist. My doctor prescribed a name brand and I asked him how much it would cost per month. He replied, I have no idea. I pressed him a bit and he had his staff call my insurer and find out. It turned out it would be something on the order of $80 a month while a generic drug would do basically the same thing for about $8.00 a month. He prescribed the latter and said we could always switch if it wasn't getting the job done.

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What?

Not at all. I am only noticing a problem. A very simple one: Without government intervention, inelastic demand and patents set the stage for predatory pricing. And this is exactly what we see happen.
I agree with you that government intervention in US pharma hasn't been the most effective. But that doesn't mean it can't be done, just means it has to be done right. Probably hard to do it right immediately given that the US is an oligarchy, meaning price regulation is effectively off the table. They're trying, or tried, which is better than nothing.

You don't seem to understand the concept of inelastic demand.

No, it's not. Unequivocally, a market of essential products is very different from other markets. This is because people will continue buying no matter how high the price is. They need the product. And because of patents, often enough there are no alternatives to certain medicine. That's what inelastic demand is, and I can't believe I have to explain that to you after mentioning the concept at least 5 times ITT. How hard is it to google things?
And yes, a market behaves very differently in such situations as we can clearly observe.

It's not either or. A free market is great as long as it's regulated. There needs to be protection for the lower end of the food chain, or they will be exploited. And rules need to be in place to prevent economic crises like the one in 2008, where unchecked greed and stupidity allowed the housing market to become a ticking time bomb.

All right, let's accept purely for the sake of argument that your diagnosis of the problem is true. How, precisely, do you suggest government reduce drug prices? Without any trade-offs in innovation, etc.?

[Goodspeed]

I don't know, I'm not an expert, but there are plenty of other countries who are doing this right that one could use for inspiration. I want to say make agreements with health care providers about maximum prices. Question and investigate their R&D cost figures, because pharma companies have a habit of manipulating these numbers in order to justify higher prices. Compare them with similar companies or even EU-based pharma companies. Then subsidize R&D if necessary.

[lejend]

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