This is beyond fictional - it's delusional. Insurance (public or private) is a risk-pooling system - and w/o it, too many people would face financial ruin. Median balance in transaction accounts (savings, checking, MM, etc.) is around $8,000. Cost of 1 surgery w/ 3-day hospital stay is ~$100K.
One more. If median balance is 8k, 25 pct of people not on Medicaid have how much available ? Can we agree the those people will choose lower premium, higher deductible ? And few if any can afford to pay up to the deductible? Commercial insurance doesn’t work for the people who need it the most
Why are you defending Ballmer? Makes me wonder what wild shit the Mavs doing?
#medicareforAll works for America. Hey Mark, I see a Big Short setting up, and I know we've had our differences, but if I could have a small loan of several million dollars, I can make enough money for you and for me to change things here. You know it's a bought game. You need players on-side. 🤙😁📲
No. #medicareforAll doesn't work for America b/c it doesn't address pricing - and the evidence is clear that Medicare PRICING won't work. This. Isn't. Trivial. We need SINGLE pricing. No one cares how many payers there are. hc4.us/oneprice
... which is one of the arguments for UHC. How UHC is FINANCED is highly variable - but Germany (pop 80M) does it pretty well. Employers/employees have an almost 50/50 split of the tax - which would be FAR less than the uncapped commercial rates we load onto employers/employees today.
... we need EMPLOYERS out of the healthcare business. Here's 11 reasons why - there are more. hc4.us/esi20 #Medsky
The government secures transactions across many different industries Dan. They just don't do it for individuals in healthcare. What they do is subsidize insurance premiums. That's a mistake and leads to inflated healthcare pricing and effectively subsidizing big insurance companies
But ins companies take advantage of this approach by cross subsidizing their own lines of business and gaming the rules. We will never see them put patients over economics Dan They need to be disaggregated. Which means self insured employers getting smarter
And the feds getting a lot smarter. It's more effective for taxpayers to guarantee healthcare transactions (within limits) than for insurance companies to do what they do today. All without insurance premiums or raising taxes
Almost got there
And to answer the inevitable question of "how are we gonna pay for it?" We can pay for it the same way we pay for the defense department. Or maybe we can cut the defense department a little bit to pay for it?
About 30% of health case is waste, fraud and abuse. That turns medical waste fraud and abuse into a trillion dollar business. Start looking there and the funding gets easier.
Feds getting smarter: 1) FTC: bust up UHG & the rest. Vertical integration is killing us. 2) FDA: dump interchangeability hurdle for biosims. Just a gift to pharma. 3) FTC & FDA: Limit limited distribution to REMS & ultra orphan indications only 4) CMS: Negotiate pricing on all drugs 4 Medicare
What are the odds of the current administration “getting smarter?”
Who am I to doubt the guy running things.
Mark, you mention self insured emploYERS. What do you make of connecting insurance to employment. It’s baffling that this is the aspirational default of every employee. Wouldn’t it be much easier to weed out the worse insurers if users got to choose their insurance. Not their employers
Amen!
So what's the solo ins companies? They have the money and political clout to stop any reform
I don't agree with your view on everything, but that's not necessary for me to appreciate you're trying and getting tangible results. That's more than most in your status circle, so, thank you for that.
So I need to add data to this statement. Both the Kaiser Family Foundation and myself (I was able to recreate this data using a small subset of historical data) have found that commercial insurance companies are paying 250% above Medicare/Medicaid payments.
However the net profit margin of hospitals is about inline with Medicare/Medicaid expected net profits. We need a multi-industry approach with physicians, finance, legal and communications, etc.
Or a reform of the DRG system to what it originally was (hospital and physician payments are lumped together).
The RAND study also verified that Nat'l avg (~250%). Which is insane. My surgery could easily be 2.5X my neighbors simply b/c we're in different coverage tiers. Just nuts. But that's what commercial rates (mostly thru ESI) supports: hc4.us/esi20
So when they’re looking at the costs it’s dependent on the itemized invoice. Most hospitals you need to call in to get the real bill through the mail. My company uses specialized physicians to review and renegotiate these claims. Medicare/Medicaid are capped through an CMS software application.
... and we can/should absolutely use that CMS software more broadly! We'd have to change the pricing (Medicare/Medicaid/VA are all too low) - but let's have THAT debate. Not who's covered. hc4.us/oneprice
bsky.app/profile/rbre...
My medicine used to cost me 50 a month and now it’s only 7 - while those aren’t big numbers, percentage wise it’s like 85% cheaper Getting something at an 85% discount is unheard of
Everyone bickering Over the proper way to run a broken system. Funny….
The ins. industry is purely predatory ATP. It makes no sense for them to have/ pay shareholders. They have to fuck people that pay in to make profits for investors. It isn't there to help. It's there to kick people when down Mark, if you cared at all you'd do something meaningful with your $
What baffles me is that the US spends more per capita on health care than any other country by a considerable margin. This means they could have free healthcare and potentially save money at the same time. Yet the people seem happy with the current situation as it has been like that forever.
GOP keeps selling the status quo successfully ;-( In fairness - polls do indicate a majority in favor of UHC - but it's a complicated debate so that's as far as we get ;-(
This is a political POV - NOT an economic or HC one. Payers ARE heavily regulated. They do make a profit - but they also adhere to the MLR regs - AND there are state insurance commissioners that review/approve rate increases annually. The systemic flaw is TIERED commercial coverage by employer.
Thank you for helping do the right thing!
How does it work everywhere else in the world outside of the United States, Dan?
Universal Health Coverage. We're the only country w/o it. We're the outlier - and the metrics prove it. We spend way MORE than other countries and the results show that we've built a sickcare system (for profit) - not a healthcare system. How UHC is financed is variable - but it's still UHC.
That's. My. Point. Now, why I should pay 2-50 times more for a script if I have insurance than if I don't? Why not make the "negotiated" price the price for everyone? Who loses if the negotiated price becomes the price? PBMs mostly.
PBMs is the wrong argument. Yea - they profit - BUT the systemic flaw is TIERED coverage - which we've tied (as an accident of history) to employment. These rates are accurate - and destined to do one thing. Always go higher. Why? Because commercial rates for HC delivery are uncapped.
Inflation is why it goes up. But you didn't answer my question. Why do PBMs need to exist when our government has already negotiated The Price, for the VA? Why not make the VA price, The Price? There can't be that much in profit in ripping off the uninsured.
Why is The Price for Flomax $20 for The Insured, when Cuban sells it for $6? Why not make The Price $6?
Mark's CPD is great at EXPOSING highly variable pricing - but it's not a solution b/c the variable pricing applies to every aspect of healthcare not just Rx - and the cost of one surgery w/ a 3-day hospital stay can easily eclipse $100K. Billionaires can afford to self-fund that - can you?
I'm not trying to fix the whole problem, I'm just trying to fix this specific one. Still don't understand why PBMs need to exist when the VA (e.g. the federal government) has already negotiated The Price. Generic Flomax starts at $20, and goes down to as low as $6.32 from there. Why?
PBMs are a reflection of the whole problem. Tiered coverage to support tiered pricing. For commercial Rx coverage - PBMs do that. BUT. Generics = high volume/low margin. Branded+Specialty Rx is the real elephant in the Rx room and direct pay can't solve patent protected pricing.
Right, but since The Floor has already been negotiated, why not do bottom up, by % instead of top down/roll the dice? About 90% are covered by some kind of drug plan, it should be easy. We could cut the PBMs out immediately. And if you're uninsured, you should get the VA price by default 😀
Generic Rx = subset of a subset and we need to stop carving out slices of HC to force into a cash/consumer model b/c it has a consequence on coverage rates - and you can't ELIMINATE pooled risk. We've already done that with dental, vision - now we're aiming to do that w/ Primary Care & Rx. Dumb.
Specifically addressing the price of prescriptions. Healthcare - the physician and hospital are an entirely different kettle of worms. Last 5 years of life need to be addressed...specific example: Why TF did a physician try to order a colonoscopy for my 88 year old dad?
I agree - b/c we've designed a "for-profit" system w/ uncapped commercial pricing - and the system is working as designed. We need to change the design. UHC is that system design change. But this is also an 80yr battle going back to the Truman administration. The HC INDUSTRY keeps winning ;-(
... why not VA4ALL? That's UHC - which I absolutely support/lobby for. Pricing would need to be debated (VA and Medicare pricing are too low), but we should have THAT debate. Not who's covered. We don't need single-payer healthcare - but we absolutely need single-pricing. hc4.us/oneprice