Somehow I would expect the health care industry to vigorously fight transparent pricing; led by Big Pharma. One pricing structure that needs to change, and has been opposed by the GOP, is for Medicare to pay higher prices for prescription drugs than health care insurers like Blue Cross/Blue shield. When the government pays competitive drug prices there would be more health care money available to expand the coverage expansion of ACA. For 42 years I have had the same healthcare plan provider. Two years ago UC hospitals dropped out of the group of Preferred Providers for my plan. They refused to accept the reimbursement levels the plan had negotiated with other hospital groups. UC Hospitals had been the cornerstone of hospital care for my family for over 60 years. No longer an option. I guess I am an unwanted Alumnus. It's hard to be 100% loyal when your alma mater's hospital system doesn't want you as a patient.
I remember back when the argument for plans like Romney care, which morphed into the ACA at a national level, the think tank argument presented was that the new plan would help hospitals avoid some of the ER costs of uncovered patients. The accepted mantra, was that hospitals had enormous losses due to ER costs for the uninsured that they always treated. At the same time, back in the red state of North Carolina, my best friend at the time went to the ER at a hospital in Charlotte, he had recently taken an early medical retirement but was too young for Medicare. The ER physicians told him he was very sick but that they would not treat him; he had to find other medical care. Three days later he died in his bed still waiting for a doctor's appointment. A week later police broke into his house and found his long dead body. True this was before Obama's election, but it was also proof that Hospitals did not always provide care to the uncovered (or out of plan covered) ER patients. I observed a next cubicle co-worker fall ill, be taken to a nearby ER, where his serious condition was diagnosed and emergency surgery was recommended; however he had Kaiser which demanded his transfer to a Kaiser Hospital for treatment. At Kaiser they decided against surgery and he died a couple of days later. Again just because you go to the ER, there is no guarantee of life saving or even life prolonging treatment. Finally you do not get to choose the ER if you call 911, you may request but the dispatcher may send you to a different nearby hospital that is not part of your local health care plan, as happened with my wife in Dec 2011. She got hospital care but not treatment and ultimately died as her condition declined, in part due to being sent to the "wrong" hospital group that would not communicate with her primary care and specialist physicians. Back then we could have gone to UC Med Ctr as part of our plan, but it was a hospital ER too far.
In some medically underserved states like Louisiana finding an ER in the first place can be difficult. With my in-laws they were transported to an excellent facility 15 miles away, but bypassed five hospitals that did not offer ER care. Fortunately in their cases minutes and seconds did not matter and the extra 15-20 minutes of transportation time was not a factor in their outcome. Overall I concede ER costs are a major problem, however it is a fallacy to assume that Hospitals always treat or provide ER care to everyone.
Unit2Sucks;842839594 said:
There are a few systems I can envision which would be better than ours and which don't approach single-payer. ...
I would also like to see transparent pricing for healthcare. There should be a price and the price is the same regardless of who is paying it.
A third point I would make is that under the old system it wasn't true that people without insurance were not receiving any healthcare - they were getting it through emergency room access which hospitals were required by law to provide to everyone. And of course people couldn't afford to pay those costs so they were absorbed by the system which means they were theoretically distributed to all people bearing healthcare expenses in this country. My suggestions are essentially getting back to that economic reality, but providing a higher level of care and not overburdening emergency rooms and not distributing those costs somewhat unevenly.
I'm sure there are lots of problems with what I've suggested but at a high level what I'm saying is we should have pricing transparency and the largest practical risk pools. How we get there I don't know but I do think it would do a lot to both increase access and affordability for health care as well as reducing administrative burdens.
