I used to be disgusted, and now I try to be amused.

[Greedy,Greedy,Greedy]

Originally Posted by Tyrone Slothrop

You don't seem to realize that your 1. and 2. contradict each other. Also, no one requires TPAs to cover preventative care in the way that they do. If it really made things cheaper in a way that was valuable to consumers, why isn't it out there in a bigger way?



Not sure what this means or what your point is. You're suggesting the worst of both worlds -- consumer still need insurance for most health care (in spending terms), but are compelled to buy direct for preventative care.



I think the fact that you think this is true is the root of the problem. Providers have "prices" that they give to consumers, and charge people who turn out to be uninsured, and then they have the real prices that they negotiate with insurers. The "prices" are not usually the real prices. Providers don't charge $1000 to get $150 from an insurer. They know they are going to get $150 from the insurer, and they will get that $150 regardless of whether they tell you that the price is $1,000,000,000, $1000, or $150. The only people who pay $1000 are the people who have no coverage, and they get screwed because they have no bargaining power and huge information asymmetries. What you don't seem to understand is that price is a function of both supply and demand, and that buying medical care through an insurer gives you, a consumer, better bargaining power. That $1000 "price" is a reflection of what happens when the consumer doesn't have it. You think that taking consumers' bargaining leverage away and forcing them to negotiate individual with providers is going to leave them better off. For some, perhaps, which is why you have concierge services. But let's assume that people are rational, because you haven't identified any way in which people are predictably acting irrational here -- for all the people who *aren't* using concierge services right now, isn't that a pretty strong indication that they don't want to, and would be worse off if you took their first choice away?



You haven't identified an "inflating mechanism".

Of course, if one wants a model for obtaining less expensive health care, you could look and see what models that are actually out there in practice provide cheaper coverage right now.

[Hank Chinaski]

Originally Posted by Adder

That's probably grounded in mysogny.

If this is meant as a joke, okay, but if you are serious, you are crippled (or I suppose you might say "male raised challenged").

[Greedy,Greedy,Greedy]

Originally Posted by Hank Chinaski

If this is meant as a joke, okay, but if you are serious, you are crippled (or I suppose you might say "male raised challenged").

I think he meant it as a joke, but like all good jokes, it's funny because it has such a strong element of truth to it.

[Not Bob]

Originally Posted by Greedy,Greedy,Greedy

Of course, if one wants a model for obtaining less expensive health care, you could look and see what models that are actually out there in practice provide cheaper coverage right now.

I don't know anything about the macro health care issue (other than as a somewhat reasonably informed HC consumer - hence my comments to Hank about how my personal HC plans seemed to constantly reduce coverage/increase co-pays long before Barry was even a state senator), so RT has my proxy on the big picture. That said, I think you, Hank, and Sebby each have knowledge that I don't because of your respective experiences.

Anyway, I really have nothing to add. It's just that I've been working on a song parody to an REM song, and your response to Sebby brought the re line to the front of my brain.

Carry on.

[Icky Thump]

Originally Posted by Greedy,Greedy,Greedy

Of course, if one wants a model for obtaining less expensive health care, you could look and see what models that are actually out there in practice provide cheaper coverage right now.

Yep, they do it the easy way. They get rid of the expensive stuff.

Want an MRI? Sure, the next appointment is June 2018.

You're 68 and need chemo? Sorry, but here's a pain pill and a hospital bed. Call us when it's "time."

[sebastian_dangerfield]

You don't seem to realize that your 1. and 2. contradict each other.

Concierge has just started to emerge as an alternative.

Also, no one requires TPAs to cover preventative care in the way that they do. If it really made things cheaper in a way that was valuable to consumers, why isn't it out there in a bigger way?

It is out there in a big way. A TPA is the way health care is delivered for almost everyone. That's my whole argument.

Not sure what this means or what your point is. You're suggesting the worst of both worlds -- consumer still need insurance for most health care (in spending terms), but are compelled to buy direct for preventative care.

You have it backwards. If preventative costs were on the consumer, which would cause them to fall, you'd see a corresponding drop in catastrophic and chronic care costs. It's the best of both worlds. Insurance costs drop, and preventative care costs drop.

I think the fact that you think this is true is the root of the problem. Providers have "prices" that they give to consumers, and charge people who turn out to be uninsured, and then they have the real prices that they negotiate with insurers. The "prices" are not usually the real prices. Providers don't charge $1000 to get $150 from an insurer.

Incorrect. That's exactly why they do it. Why else would they? Under these circumstances, there is no business purpose achieved by an inflated price except to create bargaining power with insurers. Additionally, having managed HC debt portfolios, I can tell you providers have admitted this is exactly why they inflate the price.

They know they are going to get $150 from the insurer, and they will get that $150 regardless of whether they tell you that the price is $1,000,000,000, $1000, or $150.

Incorrect. It's bargaining leverage.

The only people who pay $1000 are the people who have no coverage, and they get screwed because they have no bargaining power and huge information asymmetries.

They pay very little, if anything. No provider is inflating the price to enhance their ability to force a little more blood from a stone.

[sebastian_dangerfield]

That $1000 "price" is a reflection of what happens when the consumer doesn't have it.

That's what an economist would say. That's not what's actually happening.

You think that taking consumers' bargaining leverage away and forcing them to negotiate individual with providers is going to leave them better off.

Yes. Market forces would compel pricing at affordable rates.

But let's assume that people are rational, because you haven't identified any way in which people are predictably acting irrational here -- for all the people who *aren't* using concierge services right now, isn't that a pretty strong indication that they don't want to, and would be worse off if you took their first choice away?

No. It's an indication that people go with the flow, and alternatives like concierge are slow to emerge. "Tyranny of tired ideas" is one way I've heard of describing the situation.

You haven't identified an "inflating mechanism".

Yes I did -- the providers' price inflation to offset bulk discounts demanded by insurers.

[Tyrone Slothrop]

Originally Posted by sebastian_dangerfield

Yes I did -- the providers' price inflation to offset bulk discounts demanded by insurers.

In the world the rest of us live in, bigger, more sophisticated purchasers have more leverage to get a better price. If you are Avis, you can buy sedans for a better price than if you are Sebby.

In your world, a car dealer gets an RFP for a fleet purchase from Avis, and has a brilliant idea -- it just tells Avis that its prices are higher, and voila! Profits!

[Greedy,Greedy,Greedy]

Originally Posted by sebastian_dangerfield

Concierge...yadda...yadda....yadda....pony!!!.....tomatoes.....cucumber.....thousand islands......yummmy.....

I trust you've gotten yourself a concierge service and have some private arrangement for when the serious stuff hits.

Good luck to you.

[Hank Chinaski]

Originally Posted by Greedy,Greedy,Greedy

I trust you've gotten yourself a concierge service and have some private arrangement for when the serious stuff hits.

Good luck to you.

I fear going to a world where we have to bid on medical services, because we have half of Ontario over here trying to get stuff done they can't get done under single payer.

[sebastian_dangerfield]

Originally Posted by Tyrone Slothrop

In the world the rest of us live in, bigger, more sophisticated purchasers have more leverage to get a better price. If you are Avis, you can buy sedans for a better price than if you are Sebby.

In your world, a car dealer gets an RFP for a fleet purchase from Avis, and has a brilliant idea -- it just tells Avis that its prices are higher, and voila! Profits!

Um... these aren't mutually exclusive scenarios. In fact, my point has been that the first in part causes the second.

I'd rather not tempt the "appeal to authority" logical fallacy, but as you raise the "rest of the world agrees with me" angle, I, uh, do live in a home with a HC provider/practice owner. I'm not just the hair club president, but also a member, so if I'm trying to refrain from going there, repay the courtesy.

Yes, I fully realize I already went there a bit when I discussed working with HC debt. That was wrong of me, and for it, I apologize.

[Greedy,Greedy,Greedy]

Originally Posted by Hank Chinaski

I fear going to a world where we have to bid on medical services, because we have half of Ontario over here trying to get stuff done they can't get done under single payer.

Well, maybe they can be customers for Sebby's concierge services.

Most of the countries with single payor systems have a modest for-pay health care system on the side. Interestingly, people usually choose to buy insurance to pay for it. I don't know how Canadians coming over are doing things - are they paying full boat, undiscounted prices for MRIs or are they buying some form of insurance that lets them use providers here in the south?

[sebastian_dangerfield]

Originally Posted by Tyrone Slothrop

In the world the rest of us live in, bigger, more sophisticated purchasers have more leverage to get a better price. If you are Avis, you can buy sedans for a better price than if you are Sebby.

In your world, a car dealer gets an RFP for a fleet purchase from Avis, and has a brilliant idea -- it just tells Avis that its prices are higher, and voila! Profits!

P. 31-35: https://www.law.uh.edu/hjhlp/volumes/Vol_14/Brown.pdf

Also happens at independent practice level.

[Tyrone Slothrop]

Originally Posted by sebastian_dangerfield

Um... these aren't mutually exclusive scenarios. In fact, my point has been that the first in part causes the second.

I'd rather not tempt the "appeal to authority" logical fallacy, but as you raise the "rest of the world agrees with me" angle, I, uh, do live in a home with a HC provider/practice owner. I'm not just the hair club president, but also a member, so if I'm trying to refrain from going there, repay the courtesy.

Yes, I fully realize I already went there a bit when I discussed working with HC debt. That was wrong of me, and for it, I apologize.

My point is that the second scenario is absurd.

[Tyrone Slothrop]

Originally Posted by sebastian_dangerfield

P. 31-35: https://www.law.uh.edu/hjhlp/volumes/Vol_14/Brown.pdf

Also happens at independent practice level.

I like the irony of your citing a medical authority from Houston here.