This exchange on twitter was surreal:
So, first of all, let me say for the record that there are a lot of drugs that cost more than $4 out of pocket. This is in a market with very little price transparency. There are going to be a few cases you encounter where an insurance plan charges for a medication than self-pay. But the effort to identify them is likely to be extremely hard.
The other issue is costs in the US are very high, in general. I had to self-pay for a medical appointment in Canada recently and it was $50 CAD. Fifteen years ago when I did this in Seattle it was $275 USD. For precisely the same reason: getting an antibiotic for an infection with about 10 minutes of medical contact. There is a reason people are terrified of having a major exposure to health care costs.
It is also the case that I don't think an open market in health care has ever been tried in the United States in the modern era. Licensing and immigration rules mean that foreign and self trained medical doctors cannot rush into this lucrative market. Prescriptions are held by gate-keepers. Nobody can self-treat an infection, even if they manage to guess correctly what is required. Hospital emergency rooms are closing and there is not an emerging low cost substitute (a sign of a market that is not open). Those that remain are now handing out "surprise bills", even to those with insurance.
This is not to say that single payer is a miracle solution. In a system like this it insures big losers all over the place and I don't think that can be overlooked. But the idea that the problem with the current system is "insurance" seems like a bad one unless there is a very radical libertarian reform. I would be interested in seeing such an approach, but I suspect that market forces would be crueler to the health care industry profits than any government regulated approach.
Anyway, a tweet strength that brought me back from retirement.
I think there are a lot of routine healthcare expenses that could easily be robust, fairly priced markets if we didn't insist on having insurance cover everything. That's not to say that insurance for large expenses isn't both necessary and good, but there's a reason we don't pool our food expenses or routine household product expenses.
ReplyDeleteThe reason why they don't exist and can't exist in the current system is adverse selection. People who don't have insurance are WAY worse customers than people who do. I agree that there are other barriers from the various other middlemen and rentseekers running around, but solving the adverse selection problem is by far the biggest barrier.
See cosmetic surgery, LASIK, etc. as an example of how costs can come substantially down for non-emergency care when there is no insurance involved.
Not long ago I went to one of those "urgent care" places---it's kinda like a doctor's office where you don't need to have a membership, you can just show up without making an appointment, but not like an emergency room where you'd have to wait for hours. Anyway, the cost was reasonable and the service was fine. The staff didn't seem like the most competent doctors in the world---but, hey, most of the time what a doctor does is pretty routine anyway.
ReplyDeleteI have a health plan and a usual doctor, but urgent care was more convenient in this case for getting quick treatment with an injury.
Anyway, this urgent care thing seems relatively recent. Ten years ago or more, I think it was pretty much doctor's office or emergency room. Which meant that if you weren't lucky enough to get injured or sick between 9 and 5 on a weekday, you'd have to wait 5 hours in an emergency room to get seen by a doctor for 5 minutes, and then later get that bill for $500.
This is a good time to remind everyone to check out the extraordinary work Sarah Kliff did on ER bills while at Vox
Deletehttps://www.vox.com/2018/2/27/16936638/er-bills-emergency-room-hospital-fees-health-care-costs