The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering.
In America, price negotiation is done between providers and insurance carriers. This has a few obvious effects. First, it gives us the in-network/out-of-network distinction. Second, it introduces complexity in the math sense to pricing - providers aren't charging one price, they're charging a wide array of prices, although those prices don't really vary much.
The network thing also has the effect of reducing consumer choice in providers. I can use whatever doctors/facilities my insurance has in-network, unless I'm willing to cough up the difference out of my own pocket.
Of course, fixed prices would be that wicked socialist government control we're told is ruining everything.
I'm heading back from Japan today, and my family got a bunch of checkups and medical stuff done while we were here.
Even without insurance all our procedures cost total less than ~$100 apiece.
The most expensive thing I've ever had in japan was my full body workup last year for $500.
It included: stomach ultrasound, 5 blood tests, eye exam, MRI(brain) and barium scan. All without insurance.
By comparison, in the US I was charged $1200 to get my daughters arm cast changed (no xray, just a nurse changing the cast), and $800 for an ultrasound.
It is literally cheaper to fly to Japan and get treatment without insurance than to use my health insurance that I pay $1300/month for.
Also, as a bonus, because of the set prices of medical procedures in Japan, insurance is super cheap. For a family of 4 it was costing me around $500/month when I used to live here.
I'm in the middle of nowhere, so in my case I would need a smattering. However, almost all doctors can read/write English, even if they can't speak it. I've had 80 year old doctors proudly write down the word rheumatism, where I can barely get by with spellcheck.
In bigger cities, you'll definitely be able to find doctors who can speak English easily.
The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions!
There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.
It's not a government takeover of health care - only of pricing. The Japanese model is largely private providers, and private, employer-provided insurance.
Standardized pricing gets rid of the problem of charging different customers (slightly) different pricing, and having massive negotiations on a per-carrier basis. This sort of thing isn't a matter of "competition drives down cost". It's just stupid and inefficient.
Don't Medicare and Medicaid pay fixed prices? And aren't they generally below cost for the provider? So they have to "make up the difference" by charging private insurers and cash payers more?
It's lower than what the provider charges other insurers, that doesn't mean it's below the provider's cost. It's also commonplace for providers to bill insurers one amount but the insurer only pays a lesser amount, it's a little game they play. Pricing of medical goods and services in the U.S. are very divorced from the actual costs of providing them.
Also, Medicare and Medicaid can't negotiate drug prices.
I think so. My point is, government price ceilings on all health procedures are so noxious to half the polity that nobody will support it, and we'll get single payer by default.
They are generally less than what providers bill to others but Medicare doesn't pay below cost.
Medicaid varies because states have way more control and many states (especially Republican-leaning ones) have slashed their rates as part of a concerted effort to kill the program. Not that it matters - in Texas you generally can't qualify for Medicaid if you're childless or have a job. The income requirements are insanely low.
Yeah, based on my experience living here I don't think this kind of price control is ever going to happen in the U.S.
In the majority of the 1st world where the goverment and general population accepted the fact that healthcare is a special case outside normal economic rules. That's why get things like single payer, price controls.
That's not the prevailing belief in the US. The majority of people in power (not sure about general population) believe that healcare is like any other business subject to the same rules. Single payer is government interference into the market; price controls are definitely out of the question. Price controls might even be unconditional (if challenged, depending on context).
Also, the various lobby groups representing doctors are very powerful much like unions used to be. However unlike labor unions these groups have broader cross party relationships. These groups tent to oppose any kind of limits on pay that could directly impact their constituents.
When you put that in perspective it's obvious to understand why we end up which such convoluted solutions as the ACHA in order to expand/guarantee medical coverage to people.
Having recently had the opportunity to compare Tokyo's rail system to DC's, I'd trust the Japanese government to set prices. But here in the US I suspect prices wouldn't be set to "ensure profitability while preventing profitability." Instead, they'd go back and forth between untenable extremes.
You're not completely correct. Medicare has fixed prices that it will pay for visits, procedures etc. The prices depend on what region of the country you live in. Insurance companies then set their prices up or down from there. Independent physicians have little negotiating power and often get paid by private insurance companies less than the fixed government rate. Larger systems with more bargaining power can get significantly more.
But medicare's irrational price setting system is a big part of the problem.
It's the same thing, when it comes to the problem I'm pointing out, no matter how we describe it - medical providers charge different rates for the same products to different insurers, and insurers pay different rates for the same products to different providers. And the range of variation is not actually large, but we introduce tremendous complexity to the system in order to achieve it. It's not "competition" in the classical sense, and doesn't provide the benefits of competition to consumers, providers, or insurers.
In America, price negotiation is done between providers and insurance carriers. This has a few obvious effects. First, it gives us the in-network/out-of-network distinction. Second, it introduces complexity in the math sense to pricing - providers aren't charging one price, they're charging a wide array of prices, although those prices don't really vary much.
The network thing also has the effect of reducing consumer choice in providers. I can use whatever doctors/facilities my insurance has in-network, unless I'm willing to cough up the difference out of my own pocket.
Of course, fixed prices would be that wicked socialist government control we're told is ruining everything.