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Delivering Health
What “Narrow” Health Networks Can Tell Us About Single Payer
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  • JR

    Ain’t nothing an executive order can’t fix…

  • Andrew Allison

    The reason that “narrow networks” cost less is that they only include provides who have agreed to accept less reimbursement. This has absolutely NO relevance to single-payer insurance.Not only does Medicare cost less than private insurance but, because of the number of people participating, the network is very, very wide (I have never come across a provider which doesn’t accept Medicare). If there’s only one insurer, most practitioners have no choice but to accept it.

    • ljgude

      We have exchanged many comments about US healthcare and the Australian system in the past, but it bears repeating that the OECD average cost for healthcare is about 10% of GDP while in the US we went into the ACA at about 16% of GDP and were up to 17.1% by 2014. That’s 3 trillion dollar difference between the 10% it should be costing and 17%it is costing. $# trillion disappearing somewhere in the US healthcare system and US health outcomes are about the same or slightly worse as those in OECD countries. So we are not getting anything extra for that extra $3 trillion. For that kind of money you could buy a few congresscritters, Senators complete with toga, even a presidential candidate or two. What we have here in Australia is a universal government run system – also called Medicare – and a private system of Hospitals accessible through private insurance. The Public system has waiting lists for non urgent surgery, no choice of MD etc, but it manages in conjunction with our private system to keep people alive until 82 as opposed to 78 in the US. The key structural advantage Australia has is that if the private system gets too pricey people drop their insurance and rely on the public system. No one gets to charge $500 to $1000 for a simple test. (US hospitals have a thing called a ‘chargemaster’ or price list which sets those kind of rates for anyone not protected by a prior agreement to charge a reasonable negotiated price as in FG’s example above. Nor is US Medicare immune from this nonsense. My sister and I both suffer from Sleep Apnoea and use CPAP masks. My sister lives in the US and is on Medicare. She has a $50 co pay and the Gummint pays well over $500 for her prescription mask. I buy the same mask for $150 from an specialist online CPAP supplier and ship it out to Australia. Plus the taxpayers have to pay a bureaucrat to approve the bloodsucking company that is getting to charge an extra $400 for that mask. I’d like to that bureaucrat put to work rooting out these scams in the Medicare system and give 10% of the money he or she can save as a bonus. Then I think we could safely lower the Medicare age slowly until we have really covered the uninsured while the private side of medicine would be given an opportunity to detox slowly from their $3 Trillion Oxycontin addiction.

      • Andrew Allison

        We are largely in agreement, except that I think there’s more fraud, waste and abuse in private health care than in Medicare. Keep in mind that Medicare for all but the indigent (Medicaid) would significantly reduce the per-patient cost (by increasing the risk pool to include the young and healthy and providing greater leverage on providers) and significantly reduce the premiums for the privately insured.

  • FriendlyGoat

    My wife, in one of those “broader networks covering maybe 60%” of providers (regular Blue Cross), recently had annual blood tests for heart meds. The EOB reads like this. Retail charge: $243.41 Not covered and written off as insurance “adjustment”: $214.90 Covered Charge: $28.51 Benefits paid by insurance: $22.83 Portion paid by patient: $5.68

    This kind of absurdity in pricing has been going on and getting ever more ridiculous over 40 years that I know of. What we know in above (real) example is that a mainstream lab has contracted with a mainstream network/carrier to do this particular service for $28.51 and yet is claiming that somehow the price is $243.41

    When and if we go to single-payer, these retail price and discounting games will collapse. A few providers at the very top end will continue charging anything they want to a few patients at the top end who do not care what they pay. The vast, vast majority of providers will be reliant on the national insurance and will accept it for lack of patients who can afford to not care what they pay.

    • Ofer Imanuel

      Under the circumstances, single payer is likely better than Obamacare. At least price-wise, the government will be able to bring prices down – if they are willing to bully the healthcare providers and the trial lawyers, and bankrupt the insurance companies – all powerful lobbies.
      Of course, able to and actually doing it is not one and the same …

      • FriendlyGoat

        Single payer IS likely better than Obamacare and both are better than the situation which existed before Obamacare and FAR better than the only Republican proposed solution which is “selling insurance across state lines”.

        As for “bullying” providers and trial lawyers, I prefer the terminology of finally (finally) preventing them from bullying us. As for bankrupting insurers, we should think of our goal as simply ending one of their lines of business without putting them in bankruptcy (the situation where their liabilities exceed their assets.) There is still lots of insurance to be written on all other kinds of risks.

  • Dale Fayda

    Single payer – a nation of helpless supplicants of the failing welfare state.

    No, thanks.

  • JR

    Why are we even having this discussion? Obamacare is perfect in every way. Only Faux News watching teabagger thinks otherwise. Let’s continue with 50%+ increases and see where that takes us. Remember, it’s affordable because Obama said so.

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