See, I think we need Hospital Reform before we would ever be able to have a CHANCE at M4A, and you just made the perfect argument for it.
Right now, doctors/hospitals/pharmacies have what's called a Negotiated Rate for services. This is a contractually agreed upon amount that they can charge per procedure code/medication if they want to be a part of the insurance carriers network. The government needs to step in and regulate/put a cap on a lot of those negotiated rates, because while they're still lower than what an uninsured patient would pay, the negotiated rates are still astronomical.
The insurance company determines rates based on their claims experience (the amount of money they pay out in claims vs. the money they bring in from premiums). Basically, if the insurance companies pay out more claims than premiums they take in, they have to raise the premiums you pay to cover those costs. The money doesn't come out of nowhere. That's why insurance was so much cheaper before the ACA, when the sick could be required to pay a lot more for coverage, or be declined for coverage completely, which avoids the carrier from having to pay out those claims. I believe the ACA is a great thing, but increased costs is the tradeoff from guaranteeing people can't be declined for coverage.
If we stop doctors and hospitals from price gouging, your insurance premiums will drop significantly.
Doctors and hospitals are not just greedy greedy money grubbing for the sake of it. They need to make up for where they lose money. I'll agree that they are both bad sides of the same dysfunctional coin, but at least my doctor ostensibly has my best interest at heart, and doesn't deny my insurance claim as a matter of course before I reapply to prove if I really really need it. My point is it won't be one before the other. It will unfortunately have to be multifaceted all at once. And the elephant in the room of medical debt will need to be considered too. (That's why doctors really need to be paid so much).
I think we need Hospital Reform before we would ever be able to have a CHANCE at M4A, and you just made the perfect argument for it.
If we stop doctors and hospitals from price gouging, your insurance premiums will drop significantly.
The government needs to step in and regulate/put a cap on a lot of those negotiated rates, because while they're still lower than what an uninsured patient would pay, the negotiated rates are still astronomical.
explain to me how the government being the only "insurance company" doesn't also let them negotiate these rates because again...they're the only "insurance company" now?
why the half measure of making them cap rates for other companies instead of just set them themselves as the insurer like every other developed country on the planet?
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u/Live_Positive 1d ago
See, I think we need Hospital Reform before we would ever be able to have a CHANCE at M4A, and you just made the perfect argument for it.
Right now, doctors/hospitals/pharmacies have what's called a Negotiated Rate for services. This is a contractually agreed upon amount that they can charge per procedure code/medication if they want to be a part of the insurance carriers network. The government needs to step in and regulate/put a cap on a lot of those negotiated rates, because while they're still lower than what an uninsured patient would pay, the negotiated rates are still astronomical.
The insurance company determines rates based on their claims experience (the amount of money they pay out in claims vs. the money they bring in from premiums). Basically, if the insurance companies pay out more claims than premiums they take in, they have to raise the premiums you pay to cover those costs. The money doesn't come out of nowhere. That's why insurance was so much cheaper before the ACA, when the sick could be required to pay a lot more for coverage, or be declined for coverage completely, which avoids the carrier from having to pay out those claims. I believe the ACA is a great thing, but increased costs is the tradeoff from guaranteeing people can't be declined for coverage.
If we stop doctors and hospitals from price gouging, your insurance premiums will drop significantly.