I think if you really boil it down the most fundamental problem with medicine in the USA is there are no prices. There is no functioning market for products and services because everything is structured to insulate customers up-front from prices.
Everybody gets charged differently. Everybody ends up paying different amounts for the same thing. The numbers on bills seem to come out of an after the fact lottery ball mixer.
Probably the best reform would have been to eliminate the tax deductibility of insurance benefits. A much larger fraction of people would choose high deductible plans and be price sensitive shoppers, imposing some market discipline on the system. But of course obamacare is a move in exactly the opposite direction.
Couldn't agree more. Dr. Keith Smith describes your suggestion actually as the "Obamacare Paradox". He thinks that the ACA unintentionally created a situation where premiums and deductibles sky-rocket. It's unlikely that they designed it that way, probably hoping the subsidies would sugercoat the insurance prices or in the worst event increase pressure towards a single payer system. However, as it stands, it seems that quite a lot of people esp. in the middle class won't be able to afford the kind of insurance offered on the insurance exchange. They will HAVE to find local doctors that offer concierge memberships (very affordable) and cover themselves with a catastrophic insurance or none - because, in effect, the monthly premiums are too high, so that they take away the money people actually NEED to pay for medical situations for their kids/families.
Comments
I think if you really boil it down the most fundamental problem with medicine in the USA is there are no prices. There is no functioning market for products and services because everything is structured to insulate customers up-front from prices.
Everybody gets charged differently. Everybody ends up paying different amounts for the same thing. The numbers on bills seem to come out of an after the fact lottery ball mixer.
Probably the best reform would have been to eliminate the tax deductibility of insurance benefits. A much larger fraction of people would choose high deductible plans and be price sensitive shoppers, imposing some market discipline on the system. But of course obamacare is a move in exactly the opposite direction.
Couldn't agree more. Dr. Keith Smith describes your suggestion actually as the "Obamacare Paradox". He thinks that the ACA unintentionally created a situation where premiums and deductibles sky-rocket. It's unlikely that they designed it that way, probably hoping the subsidies would sugercoat the insurance prices or in the worst event increase pressure towards a single payer system. However, as it stands, it seems that quite a lot of people esp. in the middle class won't be able to afford the kind of insurance offered on the insurance exchange. They will HAVE to find local doctors that offer concierge memberships (very affordable) and cover themselves with a catastrophic insurance or none - because, in effect, the monthly premiums are too high, so that they take away the money people actually NEED to pay for medical situations for their kids/families.