I have been doing medical billing for over 10 yrs. I believe the healthcare system in America is broken. Mark Cuban recently created a way to make pharmaceutical costs considerably more affordable, why can't the same be done with medical services? It won't be the same strategy because it's a different puzzle. Before you say it can't be done, hear me out.
Ambulance companies make up their own prices because they're privately owned, hospital bills seem to be inconsistent depending on where you go and insurance premiums can be as high as $700-$1000/Mo if you don't have access to your own personal coverage through employment or other means. The price of medical services are high because of insurance based contracted rates that determine what percentage will be paid. To understand this better, pretend you sold shirts and I tell you I'll buy all of them, but I will only pay you 30% of your asking price. Not to mention I will sometimes not pay you if I deem the shirt not fit to my liking, but I still keep the shirt. You would benefit from raising your price to make up for the percentage lost. This creates a cycle of higher costs from medical providers and as a reaction, the insurance makes it even more difficult for services to be proven payable or "medically necessary". The patient ends up bearing the burden.
And then there is Medicare. Why is it that we have to wait until we're 65 to finally get assistance from the government? FYI it's not entirely government assistance, you pay your whole life for Medicare, just check your paycheck stubs. Even when you do get Medicare it's not free, you still pay monthly premiums. Depending on your plan they will range from $170/Mo for part B (outpatient services) and if you don't meet the free requirements for Medicare taxes paid during your lifetime, $274-$499 for part A (inpatient services). Medicare is a decent concept, but it doesn't kick in until age 65 and the benefits eventually run out! This means a lot of families are forced to make difficult end of life decisions because Medicare only pays for so many inpatient days in the hospital. They have the option of skilled nursing facilities, but those can be extremely expensive. That is a different conversation altogether. The affordable healthcare government insurance can also be expensive depending on income level. Not only that, most medical facilities are not in network with these insurances, so this means you could end up being responsible for the entire bill.
Now if we had the option to pay the hospital a monthly premium (as an example we'll say $200/Mo), it would create competition with insurance companies forcing them to lower their premiums, and it would generate revenue for medical providers which would allow them to lower prices on medical services for premium paying members. It would still be called insurance, but it would be through the hospital. They are after all selling a service. Why bring a 3rd party into this? Some hospitals do offer their own programs that help with payments, but you have to meet low income requirements. Surgeries and other high cost services can be resolved with this issue, given my previous statement of a medical provider being able to lower costs if they are generating additional revenue through their own insurance plan. You would still be responsible for a portion of these costs, they would just be considerably lower. There will still be free routine preventive visits as well. However, deductibles and out of pockets may become a thing of the past if we can get services at an affordable price.
Insurance companies are becoming bigger, greedier and too powerful. Without competition there is no reason for things to change.
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