The Chosen One’s demand to drop interest rates
- Thread starter IUclover
- Start date
Only someone with the IQ of Rashida Tlaib would advocate that political parties should have control of such an institution.
And consumers have let them. Why?
Consumers are downright ruthless in keeping prices down. Why does WalMart exist? Why does Southwest Airlines exist? Why does Aldi exist?
These companies have thrived by figuring out ways to get people the things they want and need at low prices.
We’ve removed consumers from their normal place at the table in healthcare. Why should they care how much anything costs? For that matter, why should an incoming college student care how much college costs…relative to what their future earnings might be?
These are actually very similar problems.
Consumers have let them under the guise of un affordability. Which isn’t true. They are told they need “insurance”. Well…without “insurance” those artificially increased costs are not there. What they need is very targeted catastrophic coverage. We also need a Medicaid program only ran by the states that covers roughly 1/3 of the population for the non-catastrophic events.
The costs to the consumer would plummet.
Affordability, yes. But the guiding principle is that healthcare is a right.
Except it can’t be a right. And that incongruence sits at the heart of not just our problems with healthcare, but everybody’s…very much including those who believe that right has been formally conferred.
Let's all agree, you are correct. Was the issue myself and other's are talking about better or worse in 1990? 2000? 2020? Will it be worse in 2033?
How has the issue you're describing above changed over time?
Yes, it's worse today than it was in the past and will probably continue getting worse over time. I've said as much already.
What you're suggesting would likely just trade one problem for another one -- which is one form or another of tightened supply. That's because you don't address the core problem. Reimbursement rates exceeding CPI is a symptom of the problem.
You're assuming that everybody involved in the supply of healthcare goods and services would more or less continue operating as they have. And I think that's a flawed assumption.
"I agree with your 3rd party assignment. I guess I'm coming from a, "well, if we don't want to blow it all up" approach.
If you allow public reimbursement rates to climb at CPI-1, and you set private reimbursements at CPI-1.25, over time both cost curves would bend and start coming back together. Additionally, the % to gdp ratio would drop. Prices would continue to increase, but at lower rate of growth. We should have done it 20 years ago, and we wouldn't be discussing it now.
Let those rates run their course until you get to the desired % of gdp. Say 15%. Then peg the rates to cpi."
How does it make the problem worse? Specifically.
What is your specific proposal?
Because scarcity is a real thing -- which is to say that there are more healthcare goods/services demanded than there is the supply to satisfy them -- what capping prices will do is redound to tightened supplies.
You've bristled at the idea that what you're proposing are price controls. But I don't know why. That's precisely what this is. Here, I'll just read you back your own words from above:
Who exactly is "you"? And what are they "allowing" and "setting"?
Everybody always thinks that their attempt at price controls will somehow be different. But they all fall prey to the same basic fault: they assume no (or minimal) changes on the supply side of the ledger.
I think we should make policies that are aimed at increasing out-of-pocket healthcare expenditures and reducing 3rd party payments. There's a reason that providers of elective procedures openly compete with one another, especially when they aren't utilizing any/many resources that are utilized by the insured marketplace. We should want to see providers competing with each other on price (and everything else).
Medical tourism offers us some big clues on this. If you want, say, a bariatric procedure done, you can get it for a third of the price elsewhere than you can here. And even the procedures here are far cheaper than comparable procedures that are covered by insurance.
Put the consumer in his rightful seat -- and we will see the kinds of market shifts we want to see. But we can't really do that until we give up on thwe idea that healthcare is a right. And I'm not sure that's possible at this point.
Do you notice that we never have to have these kinds of conversations ("What's your specific proposal?") for things we don't consider basic human rights? It's only for things like healthcare and education.
Did you ever address @twenty02 claim about doctor quotas?
If my idea is price control, how would you describe what we have now? I'm simply using the same formulas that are currently being used.
Edit: Which by the way, is a problem. That is going to be addressed one way or another.
I haven't. But it's yet another example of government intervention giving us perverted results.
It's a bad thing -- don't get me wrong. But it's not our primary culprit. Supply has been filling in those gaps with foreign physicians and APPs.
Still, if what you're arguing is that we should get lawmakers out of trying to manage the healthcare marketplace with moves like this, I heartily agree.
There absolutely is an element of price control in our current system. And it's caused all kinds of problems. We should get away from it.
You asking me this question is like me saying to you "Don't pour that kerosene on the fire. It will make a bigger fire." And you answering me by saying "Why are you defending the fire?"
I'm not defending the fire. The healthcare system we have is a Frankenstein's monster, put together over many decades of misguided healthcare policy.....pretty much all of which has been furthering the search of that elusive goddam unicorn.
And I have agreed third parties are the ultimately culprit. But if you can’t convince CMS and Congress to quit giving providers unnecessary and unsustainable raises. If you can't convince them to bend the cost curve that's artificially high, how are you going to convince them to eliminate the health insurance industry, Medicaid, and Medicare?
It's not like that at all.
And in my defense, I made a claim that there was a problem with the way the FFS schedules were calculated and you told me I was wrong before you knew how they were calculated. And you've proven post after post that you aren't grasping the concept. Spartans and twenty have. Maybe the y can help? I'm done trying.
Have I ever given you any indication that I'm hopeful?
But the problem isn't them, it's us. Politicians are ultimately only interested in the preservation of their offices and power. So they tell people what they want to hear. And what do they want to hear? That if you elect them, they'll make sure we all have ready access to high quality affordable healthcare. In other words: I have the unicorn...don't believe those people who say he doesn't exist.
Yes, it's cynical. I have to imagine most of these people are smart enough to know they're peddling a fantasy. But whether they do or don't, they're still peddling it. And we continue to demand it. And on and on the cycle goes....despite never quite catching up to the unicorn. Maybe next session...vote for me again and we'll keep trying.
And where has this gotten us?
It's not exactly rocket science, Digressions.
And the problem with price controls isn't the algorithm. It's that people can and do react -- usually in ways the price controllers don't intend or even anticipate.
But these efforts have failed to produce the intended results going at least all the way back to Diocletian:
Edictum de Pretiis Rerum Venalium, "Edict Concerning the Sale Price of Goods"
And that's feasible how? Half of all health care expenditures are paid by the govt. Unless you plan to eliminate Medicare and Medicaid, how do you propose the govt operate pricing?
Speaking of Diocletian's Edict, @snarlcakes you won't be surprised to learn that the primary impetus behind its issuance was the debasement of Roman Denarius. A succession of Roman emperors needed more money for more armies. I'll give you one guess as to how they got the money to pay for these.
There's a pretty good infographic on what led up to this here.
Mark Twain never actually said "History doesn't repeat itself, but it often rhymes." But he should have!
The best ways to fix the problem aren't politically feasible. I agree with you. It's not even worth suggesting them -- they would even sound far-fetched to people who more or less concede that I'm not wrong about the core problem.
As such, I usually point to Singapore as the place to look for the best ideas. I think they've done a better job than virtually anybody else at establishing a workable balance between these competing forces.
Doing something like this would basically replace Medicaid. Low income people use HSAs to pay for the vast majority of their healthcare transactions, just like everybody else. The only difference is that their accounts are subsidized.
I know a lot of people say a plan like that isn't workable in the US. But I don't really know why they'd say that. Most of the complex parts are offloaded to where they most belong: between consumers and providers.
Also, I'd be remiss if I didn't mention that I think AI will likely have a bigger positive impact on healthcare than any other single sector of our economy.
You forgot the ones that bitch incessantly about the debt, but don't have the balls to tell doctors and insurance companies, No. And their supporters who incessantly bitch about the debt, and don’t have the economic chops or reading capacity to know what could be done.
Do nothing and blame others.
Good day.
