Mmm. We actually have quite a bit of research including controlled experiments in multiple countries that show cost sharing can dramatically reduce overall costs without affecting health by reducing unnecessary utilization.
We also have research that if they are too high or applied willy nilly, they can end up raising costs and negatively affect health.
Rand Paul and his defenders have made a big deal of the fact that the Shouldice Clinic is a privately run hospital (grandfathered in when the provincial health plan (OHIP) was set up). What they don’t say is that Shouldice is funded through OHIP. I could go there for the same procedure at no charge except for a semi-private room, and I know two people who have, one of whom could never have afforded to pay out-of-pocket. If I didn’t want to spend three days there, I could have the operation done at any public hospital as a same-day procedure, but Shouldice has the reputation as a world-class clinic, possibly no longer deserved.
Paul will have paid cash, about $6000-$8000 US, about average for the US, although it can go much higher.
That’s a partially circular argument. I big part of the inequality in the US is lack of affordable health care. Seriously, there are families living in cars because they lost their homes due to lack of adequate health insurance. It’s a blight on the country.
Like other very wealthy people, they can afford to go to the very top end specialists for a particular procedure. In this case, cardiac, probably either the Mayo Clinic or the Cleveland Clinic. The private floor of the Cleveland Clinic is like a 5 star hotel and caters to the international jet-set. They are seen by some of the top 5 or so physicians (at least by reputation) in the world.
You or I might be able to go to those hospitals, but we’ll never get a defibrilator implant from Bruce Wilkoff. He has fellows for that.
Roughly $435/minute.
I might as well take a stab at this since I’ve done entirely too much research on various national health care systems.
Financial incentives and disincentives seems to be the way most do it - aimed at providers and patients.
Provider financial incentives are straightforward. Bonuses for coordinated care, efficient health outcomes, nurse/doctor ratios, following recommended treatment protocols, etc. are used all over the place.
Provider financial disincentives seem to be less frequently used, but it is basically the same as above but inverted.
Patient financial incentives don’t seem to be in use much, but France, for instance, provides financial incentives to assign a primary care physician.
Patient financial disincentives are easier with coinsurance since one can simply charge a patient more based on cost/benefit to steer them. Without it though, well, the only other option I can think of is simply not covering ineffective treatments and allowing them to pay for it as an elective if they choose.
Canada for instance, uses private health insurance for vision and dental care, prescription drugs, rehabilitation services, home care, and private rooms in hospitals.
Australia’s private insurance offers more choice of providers (particularly in hospitals), faster access for nonemergency services, and rebates for selected services.
France’s private insurance covers copayments (or co-insurance) and actually helps get private insurers to push the government to negotiate lower reimbursement rates.
i’m a little bit confused by your line of argument. relying on private insurance will somehow help reduce inequality? because that seems to be what you’re saying.
do we need to tackle racism and structural inequality?
yes.
will medicare for all stop us from doing so?
no.
will socialized medicine improve the lot of all citizens?
yes.
medicare for all is one part of fixing things. it’s not “the” solution - but to pretend it’s not part of the solution? that i don’t get.
Did you read the story you posted? It was a private hospital outside the canadian social cate system.
*care (edit)
My issue with the term Medicare for all" is that it is not so much a good starting point but rather a deception. Kind of like Brexit was a nicely branded concept meant to elicit an idea that was far from any reality any proponent could deliver since none of them had actually thought it through. Medicare is a specific program that people like, calling this Medicare for all is a bold faced bait and switch. I expect nothing less from politicians but do try to call them out when I see it.
Did paul go there because of the cost/program or because the best doctor/team for his procedure was there?
When my kid was born the neo tried to charge us $1700 for a 2 minute checkup. We were uninsured and paying for everything ourselves so I asked them to explain the charge, they refused so I told them that if they could not justify the charge I would not pay it. After a few back and forths I told them to come back to me with a reasonable amount or I simply won’t pay it and they sent me a new bill for $378. I also negotiated the hospital before the birth and everything down to the sono tech but missed the neo. My total cost, including that charge was about the same I would have paid with insurance. If we got insurance schemes out of the equation between the doctor and the patient the costs would plummet spectacularly.
As was pointed out in another reply, Shouldice is funded through the province.
Therefore not entirely “outside the system”. The WaPo description of it as such is an oversimplification. As I said, it has nothing to do with private or public and everything to do with rich people doing whatever they think will give them an advantage.
Personally, I much prefer living in a system that gives me, my neighbour and the guy working for minimum wage part-time at Walmart equal ability to go see a doctor, not just the one of us whose employer bought a good plan. I like living where I don’t have to worry about ending up bankrupt or homeless if I get sick, and where Gord down at the mill is just as entitled to care as Chad at the investment bank.
Funny how Americans keep coming up with all these horror stories about our system and yet I haven’t met a single person who knows anyone whose experienced them. Not even their cousin’s friend’s college roommate. Yet every day there’s another gofundme for basic medical care for someone in the States.
We’re not perfect here, but you aren’t going to find many people willing to trade it for the mess that is the USA. Sure, one or two outliers, but that’s true everywhere. You sure as hell aren’t going to convince me, so you might as well stop trying.
In contrast, I was recently hospitalised in Australia for a C5/6 Anterior Cervical Discectomy and Fusion.
About a week in hospital, including a couple of days in intensive care after the surgery. Lots of MRIs and X-rays, assorted medication, etc.
Total cost to me: $0.
What gave you the impression that I wanted to convince you that the system here is good? I was merely trying to understand the OPs statement that “Rich Americans” are flocking outside the US for care.
It has been my experience that the US produces some of the best doctors and medical tech along with some of the worst insurance schemes. I just don’t want to be forced at gunpoint to participate in any insurance scheme, privately funded or publicly funded. I would rather have options of what insurance, if any, fits my budget and lifestyle, I’m pro choice in life bud.
Though its not really the point. The real question is that if you pay the full cost of a procedure in both Australia and the US, why does the US version cost so much more?
TLDW: because every sector of the profit-driven healthcare industry is ripping Americans off to a spectacular degree.
Collective bargaining works. United we bargain, divided we beg.
I think we might have had this exact debate about a year ago, including a discussion of the same video.
New Zealand gets better prices than most of the US because they apparently negotiate better. But many of the little health care organizations in the US must be bigger than the NZ health care system. So why don’t US health care organizations negotiate?
My first thought would be to investigate how often the insurance companies and medical providers are owned by the same people.
No reason to bargain hard when you’re dealing with yourself.
