> They make less that way. If they know you're insured they won't allow you to pay the cash price, only the much higher negotiated price.
This is not correct for all practices
My wife's practice (of plastic surgeons medical providers only in a reconstructive practice 75%, cosmetic 25%, attempting to be in-network with every insurer, with administrative front-office doubling as billing, and dedicated personnel for resubmits) vastly prefer cash paying because they get the money right then, and they don't have to haggle with insurers around things like pre-authorization, billing, etc. Insurers regularly make physicians go through the ringer to get an pre-authorization for a vital surgery. Even worse, insurers will ask for a "peer to peer" and then have some underqualified medical provider understand what a board certified surgeon is doing, based on a complex diagnosis, and not understanding the actual surgeries or procedures involved. Insurers will forget pre-auths, and then reject billing, and they have a whole bunch of shady practices around, even with in-network practices for cancer cases.
So much of this price transparency stuff is a giant racket because it helps insurers, and not the actual medical doctors, PAs, NPs and other medical providers. However, it is medical insurers & Payors which are driving all the paperwork (Horrible EMRs, ICD codes, pre-auth, auths, etc) along with growing the tsunami of administrative personnel)
Insurers try to use being out-of-network to reject medical bills, so they use it as a weapon vs practices/hospitals, very effectively unless it is an emergent case (medical emergency).
What is completely missing from this conversation is who this benefits, who this harms, and how insurers exploit the status quo.
Cash paying customers should always be the cheapest option, since there is little overhead for them.
Voters not wanting to pay for comprehensive care for everyone is a 4th head. The current system of healthcare is great for allocating different amounts of healthcare to different classes of people, so that it is great for 20 to 30% of people, okay for 20%, and not good for 50%, and that is why it persists.
There is no reason Medicare should be restricted to those over 65, or why Medicaid is implemented differently (and reimburses providers more poorly than Medicare). Or even Tricare. We have at least 3 different taxpayer funded healthcare programs specifically so not everyone can get access to equal care, but so that various classes of people can get healthcare proportional to their political power (which usually scale with money, but also votes in the case of old people).
> There is no reason Medicare should be restricted to those over 65, or why Medicaid is implemented differently (and reimburses providers more poorly than Medicare). Or even Tricare. We have at least 3 different taxpayer funded healthcare programs specifically so not everyone can get access to equal care, but so that various classes of people can get healthcare proportional to their political power (which usually scale with money, but also votes in the case of old people).
Medicare/Medicaid reimbursements are insufficient to support most medical practices. Tricare is for military & their families. Most active duty military are young & extremely healthy compared to the general population.
Medicare/Medicaid combined are the largest single item on the federal budget. More importantly, they are still growing in costs because of an aging population, and are heading towards 30% overall of the federal budget [1]
Tricare operates as an employment perk. Medicare has a cap on benefits, but is effectively mandatory for 65+, and medicaid operates as a payor of last resort, after folks have run out their lifetime benefits on medicare.
However, an argument in favor of your suggestion is that the vast majority of medical resources are spent on the last 2 years of life, often for terminally ill patients with a ton of co-morbidities that are at death's door anyways. Most medical spending happens in the latter part of life [2]
> 25% of Medicare’s annual spending is used by the 5% of patients during the last 12 months of their lives [3]
Medicare reimbursement levels are sufficient to support most medical practices. They charge more because they can, not because they have to. If reimbursement levels are cut then they'll find ways to improve efficiency, and then cut salaries.
Is there a reason that US doctors should get paid significantly more than their peers in other developed countries?
> Medicare reimbursement levels are sufficient to support most medical practices.
Big Nope.
Most practices have fairly fixed costs:
Medical malpractice
Facilities rent, or mortgage
Front office
IT & EMR
Privileging/Credentialing
Practice
CME/required education
The only highly variable cost is physician compensation, and considering the limited availability, this will merely cause the retirements and limited access to specialists.
Perhaps you have some evidence to support your extraordinary claim?
I'll provide evidence to the contrary, based on Hospitals and practices refusing to accepting Medicaid [1] patients, or, not accepting/limiting medicare patients[2], [3], [4]
The simple fact is, there is a limited supply of physicians, and many of them don't want to practice the higher volume, 5 minutes per patient, 5 minutes for notes x 12 hours a day type of practice. Not only is the higher volume more dangerous for the patient, it is also more risky for the medical provider, both in terms of quality of life, and also, the risk of an error, or inadequate information exchange.
If the AMA isn't going to fix the physician and residency pipeline, could we not offer visas to physician immigrants who meet first world medical credentialing standards to deepen the supply and therefore support demand? If supply is the issue, we should fix the supple, not destroy necessary demand.
> Basically, you are saying American trained doctors only then, as American doctors are much better trained.
Considering how much healthcare costs in the US and the quality of care received [1], I assert American doctors are not better trained, simply that they are more expensive and there are less of them per capita than other OECD countries [2] [3] [4]. I'm suggesting bypassing the undersized US doctor development pipeline until it is fully funded to produce enough doctors to meet demand and drive down costs.
https://www.ajmc.com/view/the-quality-of-us-healthcare-compa... ("A 2014 report from the Commonwealth Fund revealed continued trends that were along the same lines—despite the implementation of the Affordable Care Act (ACA) in the interim. In the report, the US “ranked last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity and healthy lives.” Significantly, the US was noted to have the highest costs while also displaying the lowest performance.")
[3] https://www.fiercehealthcare.com/practices/how-u-s-stacks-up... ("When it comes to practicing physicians, there are only two physicians for every 1,000 Americans, nearly half the ratio of countries with nationalized public healthcare. Countries with nationalized systems saw the greatest increase in the number of physicians relative to their population.")
> Voters not wanting to pay for comprehensive care for everyone is a 4th head.
M4A is overwhelmingly popular, at points taking majorities of Republicans. Also, the US government already spends as much on healthcare as Britain and the NHS; US healthcare is just allowed to cost twice as much.
Maybe now, but it was not true in 2009/2010 when ACA was being hashed out. As I saw it, lots of people said they wanted everyone to get healthcare, but when the chips were down, there was lots of balking at costs.
==We have at least 3 different taxpayer funded healthcare programs specifically so not everyone can get access to equal care==
Add in CHIP and the VA (Tricare). We've taken every vulnerable part of society (older, poor people, poor children, injured veterans) and given them government-paid, universal healthcare. This is around 100 million people.
Everyone left over is thrown into the private insurance pool. These people are typically working age population (18-60), making them both the richest and the healthiest. This is around 200 million people.
This is meaningless if the quality of healthcare is not the same. There are numerous hurdles placed for various different people to get the healthcare, effectively restricting access to healthcare itself.
No doubt. I wasn't trying to comment on the quality or access, just a point on how we have "solved" the healthcare problem over time.
Taxpayers cover the neediest, leaving the healthiest to for-profit insurers. The healthiest have no incentive to make sure the programs for the neediest actually work or are accessible.
Oh yes, I agree with you. I remember how pissed people were when ACA caused their premiums to go up, because they were now subsidizing everyone who used to simply not get healthcare.
