Facility Fees are Ruining Quality Care

[lonelobo]

I always find it strange that liberals never blame their city or state governments for not providing "free" services and stuff to people. The only thing they want from their local governments is to demand stuff from the federal govt.

Why don't Californians blame the governor and legislature and the San Francisco Mayor for "Letting kids die on the street because of Medicaid"? Instead people flock to and worship future gov Gavin Newsom and praise him for mocking Trump and complaining about how little money California is given by OTHER STATES. It seems pathetic to me.

Is it Ironic that a guys that sucks off the Government tit as a VA doctor, bitches about what the federal govt pays for?

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[drusso]

Nobody is entitled to healthcare at all. As I said I'd be happy to contribute my tax dollars to US citizen children in need. The inabiliy of their parents to purchase healthcare is not the child's fault.

Agree.

Medicaid Expansion Transformed a Community—Now the Bill Is Coming Due

"Whether this flood of cash can be maintained will be determined in part by whether Oregon maintains expansion and who the state decides will pay for it. “We only have so much money,” says Sen. Jeff Kruse, Republican vice chairman of the Oregon senate’s health-care committee. “Where do we draw the line?”

 

[hyperalgesia]

Is it Ironic that a guys that sucks off the Government tit as a VA doctor, bitches about what the federal govt pays for?

I also drive on federally funded highways, breath in EPA-regulated air, and enjoy USDA steak. Just as you take advantage of every cent of tax breaks you can get your wealthy 1-2% paws on and bask in the gluttonous freedom secured by the US military and local police, even while railing against these institutions. None of this is "ironic".

We all live the best we can, it's human nature, but it doesn't mean we have to agree on policy. I don't think we should take Bill Gates' money and redistribute it but if that's what was decided and that's what happened, I'm not gonna give you my share of it. I will bloody enjoy that money but still condemn the policy.

 

[MOHS_01]

I can get an all-inclusive colonoscopy (anesthesia, GI docs time, post-op visit) for right at $700. PP GI doc with his own endoscopy suite offers great cash prices.

No clue for Mohs as that's not something I refer directly to. But we do have a PP Mohs surgeon here on SDN, let's see if I can't summon @MOHS_01 and see what his prices are...

I can get a glucometer for $16 and 50 test strips for $10. Lancets, I can get a box of 100 for $2. I can get 100 insulin syringes with needles for $10.

The point I'm trying to make here is that routine health care, especially primary care, can be had for a lot less than anyone realizes. Insurance/hospitals make it more expensive than it should be, bottom line.

Prices for most procedures are tied to Medicare +/- some percentage, generally within the 20% range. Some providers enjoy pricing power while most do not... and given the nature of the demographics involved, Medicare represents the plurality of the business. I believe that my average across the board is in the neighborhood of $950 per case... but I would have to change several practice patterns before I would ever consider capitating at such a rate.


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[MOHS_01]

Really ...sounds like you need a better paying gig

Kids with all the answers - we need more of them around.

Did you happen to pick the derby winner last weekend? Or were you on TeamPatch?


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[SSdoc33]

Kids with all the answers - we need more of them around.

Did you happen to pick the derby winner last weekend? Or were you on TeamPatch?


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dems fightin' words.....

thanks for your contribution to the thread. -- very helpful info.

there are some of us who believe that the indigent can't afford a 1000 dollar Mohs surgery, and that this should be subsidized. There are others on this board who seem to think that healthcare is cheap and that that health care is not a "right".

before you pick your battles, you should know what side you are on.

 

[VA Hopeful Dr]

dems fightin' words.....

thanks for your contribution to the thread. -- very helpful info.

there are some of us who believe that the indigent can't afford a 1000 dollar Mohs surgery, and that this should be subsidized. There are others on this board who seem to think that healthcare is cheap and that that health care is not a "right".

before you pick your battles, you should know what side you are on.

I'm obviously pretty conservative and free market, but stuff that pricey is exactly what insurance is for. It's also thankfully pretty uncommon, something else insurance is good at.

My argument has always been that if you take stuff that's cheap out of the insurance game, then insurance will be more affordable and people won't have to be subsidized for things like Mohs.

 

[SSdoc33]

I'm obviously pretty conservative and free market, but stuff that pricey is exactly what insurance is for. It's also thankfully pretty uncommon, something else insurance is good at.

My argument has always been that if you take stuff that's cheap out of the insurance game, then insurance will be more affordable and people won't have to be subsidized for things like Mohs.

but its procedures like Mohs (among other things) that MAKE insurance expensive. not the 99213s and HCTZ scripts.

 

[VA Hopeful Dr]

but its procedures like Mohs (among other things) that MAKE insurance expensive. not the 99213s and HCTZ scripts.

Outside of Medicare, that's not entirely true. There's some pretty good data that for working aged patients, if you cut out primary care costs (including basic labs and meds that are ordered/prescribed by PCPs) you end up with around 20% less in overall spending. Since insurance companies aren't allowed to just keep any extra they have left at the end of the year, that would have to go into lower premiums. 20% lower premiums may not sound like much, but it takes $1000/month down to $800 or $500 down to $400.

 

[SSdoc33]

Outside of Medicare, that's not entirely true. There's some pretty good data that for working aged patients, if you cut out primary care costs (including basic labs and meds that are ordered/prescribed by PCPs) you end up with around 20% less in overall spending. Since insurance companies aren't allowed to just keep any extra they have left at the end of the year, that would have to go into lower premiums. 20% lower premiums may not sound like much, but it takes $1000/month down to $800 or $500 down to $400.

i'd like to see that data. doesnt pass the sniff test, but ill be open minded about it.

 

[VA Hopeful Dr]

i'd like to see that data. doesnt pass the sniff test, but ill be open minded about it.

So it takes some doing since there is no one source that proves every claim but rather pulling multiple sources in.

So first, primary care office visits alone are roughly 8% of total spending: https://www.google.com/url?sa=t&rct...6rBOMUtL8hHQJOfKw&sig2=QEQYJSJbdTm9bmDRk0Ad5w

Generic drugs account for around 4% of total spending: It's the new brand-name drugs driving up spending, report finds combined with this: Health Care Costs: A Primer - Report

Labs account for around 2% of spending: http://www.medpac.gov/docs/default-...th-care-spending-and-the-medicare-program.pdf

If we include inexpensive imaging (turns out that plain films, ultrasound, and echo account for 50% of spending) for an additional 2%: Health Plans Strain To Contain Rapidly Rising Cost of Imaging

So total savings of 16%, a little less than I had originally stated but pretty close.

 

[DrCommonSense]

I always find it strange that liberals never blame their city or state governments for not providing "free" services and stuff to people. The only thing they want from their local governments is to demand stuff from the federal govt.

Why don't Californians blame the governor and legislature and the San Francisco Mayor for "Letting kids die on the street because of Medicaid"? Instead people flock to and worship future gov Gavin Newsom and praise him for mocking Trump and complaining about how little money California is given by OTHER STATES. It seems pathetic to me.

Liberals are generous with OTHER people's money not their own.

Come on man that's liberalism 101

 

[SSdoc33]

So it takes some doing since there is no one source that proves every claim but rather pulling multiple sources in.

So first, primary care office visits alone are roughly 8% of total spending: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjdvpWYx-XTAhVkrVQKHeiTALAQFggnMAA&url=https://www.uhc.com/content/dam/uhcdotcom/en/ValueBasedCare/PDFs/UNH-Primary-Care-Report-Advancing-Primary-Care-Delivery.pdf&usg=AFQjCNEI4dfOONjjj6rBOMUtL8hHQJOfKw&sig2=QEQYJSJbdTm9bmDRk0Ad5w

Generic drugs account for around 4% of total spending: It's the new brand-name drugs driving up spending, report finds combined with this: Health Care Costs: A Primer - Report

Labs account for around 2% of spending: http://www.medpac.gov/docs/default-...th-care-spending-and-the-medicare-program.pdf

If we include inexpensive imaging (turns out that plain films, ultrasound, and echo account for 50% of spending) for an additional 2%: Health Plans Strain To Contain Rapidly Rising Cost of Imaging

So total savings of 16%, a little less than I had originally stated but pretty close.

so, you are saying that these costs should be out of pocket and the more expensive treatment be covered by traditional insurance? this sounds like a zero-sum game. the overall cost of healthcare is not changed. i do agree that everyone should have some "skin" in the game. where that line is drawn is the question.

 

[VA Hopeful Dr]

so, you are saying that these costs should be out of pocket and the more expensive treatment be covered by traditional insurance? this sounds like a zero-sum game. the overall cost of healthcare is not changed. i do agree that everyone should have some "skin" in the game. where that line is drawn is the question.

And that's where the cheap cash prices that I quoted earlier come into play. Insurance makes things cost more. That's well known, every layer of bureaucracy adds to cost. Remove insurance from things that should be cheap, and the prices drop.

For example: last year at my yearly physical, the routine blood work for a guy my age was paid for by Blue Cross. Total price: $140. Same exact labs using negotiated cash-pay prices: $36.

My wife's pap smear with HPV testing last year through Blue Cross: $275. Same exact testing with cash pay rates: $70.

Had a patient twist his ankle. X-Ray at the urgent care, with read: $180. Cash pay price, with read, at cash-pay rates: $30.

You get the idea. By paying for cheap things we decrease insurance costs and overall healthcare costs in one go.

 

[clubdeac]

I always find it strange that liberals never blame their city or state governments for not providing "free" services and stuff to people. The only thing they want from their local governments is to demand stuff from the federal govt.

Why don't Californians blame the governor and legislature and the San Francisco Mayor for "Letting kids die on the street because of Medicaid"? Instead people flock to and worship future gov Gavin Newsom and praise him for mocking Trump and complaining about how little money California is given by OTHER STATES. It seems pathetic to me.

Couldn't agree more! Majority of liberals live on the coasts in major metropolitan cities. Many of these issues should be decided by the local state or city gov't. For example, if you believe any and all immigrants should be allowed to come here (legally or illegally) and either work or leach off the system and you believe in the idea of sanctuary cities, your locale should hold a vote. If the liberal vote wins allowing anyone and everyone to come in, that locale should be subjected to a 5-20% tax increase to help pay for the leaches. Put your damn money where your mouth is. Don't put mine there

 

[DrCommonSense]

Couldn't agree more! Majority of liberals live on the coasts in major metropolitan cities. Many of these issues should be decided by the local state or city gov't. For example, if you believe any and all immigrants should be allowed to come here (legally or illegally) and either work or leach off the system and you believe in the idea of sanctuary cities, your locale should hold a vote. If the liberal vote wins allowing anyone and everyone to come in, that locale should be subjected to a 5-20% tax increase to help pay for the leaches. Put your damn money where your mouth is. Don't put mine there

LOL liberals want OTHERS to pay for their "generosity".

Liberalism is about taking from the productive to give to the middle man while giving crumbs to the poor.

Liberalism 101 Al Gore style

 

[Ducttape]

VA hopeful, what you are identifying is a problem with insurance and the problem with insurance reimbursement.

If the health care provider only billed for same as cash price, there is no question that the insurance company would pay just that price.

But practices know that they can charge more and get more reimbursement from insurance and insurance is willing to pay more because they recognize that by not doing so, their clients would flee to better covering insurances. The insurances then recoup their losses by increasing rates.

And the end result of what people see is that there is less money coming out of their pockets "because insurance covered it"... since most working ppl have it directly deducted.

It's a huge shell game. Think about the statins...

Why you should avoid the temptation of drug coupons

A concierge practice model that you are advocating is great for those with the capital to afford to do so, but may not work for those who cannot afford or believe they cannot afford. And it does nothing to prevent medical bankruptcies, which are rarely due to "preventative healthcare"


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[VA Hopeful Dr]

I'm actually not advocating concierge.

The cash prices work because they bypass the overhead associated with filing insurance.

 

[bedrock]

And that's where the cheap cash prices that I quoted earlier come into play. Insurance makes things cost more. That's well known, every layer of bureaucracy adds to cost. Remove insurance from things that should be cheap, and the prices drop.

For example: last year at my yearly physical, the routine blood work for a guy my age was paid for by Blue Cross. Total price: $140. Same exact labs using negotiated cash-pay prices: $36.

My wife's pap smear with HPV testing last year through Blue Cross: $275. Same exact testing with cash pay rates: $70.

Had a patient twist his ankle. X-Ray at the urgent care, with read: $180. Cash pay price, with read, at cash-pay rates: $30.

You get the idea. By paying for cheap things we decrease insurance costs and overall healthcare costs in one go.

How much did you negotiate vs what they just offer if you are willing to pay cash and know enough to say you won't pay the insurance rate?

 

[VA Hopeful Dr]

How much did you negotiate vs what they just offer if you are willing to pay cash and know enough to say you won't pay the insurance rate?

I didn't actually negotiate at all. Another doctor in town played harder ball and got about a 10% reduction in lab prices.

Wasn't worth it to me. So that CBC instead of $4.65 is now $4.12...

 

[MOHS_01]

dems fightin' words.....

thanks for your contribution to the thread. -- very helpful info.

there are some of us who believe that the indigent can't afford a 1000 dollar Mohs surgery, and that this should be subsidized. There are others on this board who seem to think that healthcare is cheap and that that health care is not a "right".

before you pick your battles, you should know what side you are on.

I see that I've been beaten to the punch, but it would appear that you need to brush up on following the argument that is actually being made -- rather than the one you would prefer to argue against. There are terms for this....

I think the problem here -- and this is not intended as a personal dig -- is that your fund of knowledge on the matter is insufficient to support these statements, whether we are speaking to the specifics of pricing, collectivized risk, etc. Pick a particular aspect and we can zero in better... Pricing? You pick a number for what you believe micrographic surgery should cost and I will explain how the current pricing is determined -- and what would happen under your proposed pricing mechanism. Perhaps you wish to take on the topic of what it means for something to be "a right" -- that should be a fun one. If you're really ambitious, try tackling the topic of the most proper and efficient way to allocate health care resources....

Okay then, go:

 

[Ducttape]

I think you are missing the big picture itself.
I see you chose to ignore all the other comments about pricing of health care.

the Mohs surgery is an example, not a definitive statement about the state of insurance coverage regarding the procedure. this discussion thread is about what healthcare should cover.

if it makes you feel better, replace the term "Mohs" with any other surgery...

 

[MOHS_01]

I think you are missing the big picture itself.
I see you chose to ignore all the other comments about pricing of health care.

the Mohs surgery is an example, not a definitive statement about the state of insurance coverage regarding the procedure. this discussion thread is about what healthcare should cover.

if it makes you feel better, replace the term "Mohs" with any other surgery...

FFS.... how do you think the lion's share of healthcare is priced? By what mechanism and under whose authority? Who controls pricing in the medical services arena? Who enjoys pricing power?

Assumptions. Try harder. Do better.


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[SSdoc33]

FFS.... how do you think the lion's share of healthcare is priced? By what mechanism and under whose authority? Who controls pricing in the medical services arena? Who enjoys pricing power?

Assumptions. Try harder. Do better.


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so far, you have made one informative post about the pricing of your surgery. thanks.

the other two were condescending and did not advance the discussion whatsoever. frankly, you are all over the place.

if you wish to contribute, read the whole thread and give us your 2 cents. otherwise, go back to popping zits and let us talk in peace.

 

[MOHS_01]

so far, you have made one informative post about the pricing of your surgery. thanks.

the other two were condescending and did not advance the discussion whatsoever. frankly, you are all over the place.

if you wish to contribute, read the whole thread and give us your 2 cents. otherwise, go back to popping zits and let us talk in peace.

They're condescending for cause; please fashion an argument so that a discussion may be had.

Let me help you out here: prices for the bulk of physician provided services are anchored to Medicare rates; Medicare calculates prices via some ridiculous Soviet styled Rube Goldberg mechanism, combining the very worst perils and evils of a political construct with the fatally flawed (and perversely incentivized) machinations of cost-of-production theory of value methods. Worse still, they double down on their ****ty policy by applying arbitrary revaluations episodically for any procedure that is either: increasing year over year in excess to the background noise or subject to the Achille's Heel political problem (small number of specialty specific providers -- look historically, they are targeted for sacrificial lamb status and redistributions). Hospital pricing is different, but I am not as intimately familiar with that process as it does not directly impact me in any way.

Bottom line is pick your poison: do you want to make the argument that healthcare prices are ridiculously high? Okay. Ask yourself why. Ask yourself who sets the prices. Ask yourself how they are set. Ask yourself what happens when the price point for a service falls below the costs incurred to provide that service. It's basic, kindergarten level economics; it's why the only places in the country someone still pumps your gas are the places where the law forces it to be so. Mandates beget mandates. We are drowning in layer upon layer of expensive bureaucracy, more layers than the best baklava you've ever eaten. The championed solution to the problems herein is the very cause of the problems presented. It's amazing, really, this willful blindspot common to the do-gooders.

 

[Ducttape]

there is no benefit in a discussion to be condescending, other than to attempt to make your argument seem more powerful. just fyi, most members of this forum don't respond positively to such, well, shenanigans.

and also, most of us are well aware of how services are priced. the vast majority of the private practice physicians have a copy of the ASIPP Fee schedule on their hard drives, know what happens when CMS meets every year, have submitted multiple comments to CMS and ASIPP regarding changes to the fee schedule, and probably knows what multiplier of those rates each insurer is billed. the hospital based ones should have this information too. some of us know not only the fee schedule per CMS but also how much we bill each and every individual insurance for each and every procedure we do, in office and at ASC/HOPD.



the original point of this thread was a discussion on the facility fees "imposed" by ASC and HOPD.

 

[MOHS_01]

there is no benefit in a discussion to be condescending, other than to attempt to make your argument seem more powerful. just fyi, most members of this forum don't respond positively to such, well, shenanigans.

and also, most of us are well aware of how services are priced. the vast majority of the private practice physicians have a copy of the ASIPP Fee schedule on their hard drives, know what happens when CMS meets every year, have submitted multiple comments to CMS and ASIPP regarding changes to the fee schedule, and probably knows what multiplier of those rates each insurer is billed. the hospital based ones should have this information too. some of us know not only the fee schedule per CMS but also how much we bill each and every individual insurance for each and every procedure we do, in office and at ASC/HOPD.



the original point of this thread was a discussion on the facility fees "imposed" by ASC and HOPD.

As someone who lives in a CON state and does not reap the benefit of facility fees, I am sure that my income suffers as a result. Let's face it -- all of third party covered healthcare services (albeit less with cosmetic, but even then the truth holds) is compulsory expropriation. I happen to be one who believes that compulsory anything is improper, expropriation for "healthcare" included. I'm no fan of hospitals, insurers, or CMS. Any "argument" presented has been poorly fleshed out and an in depth understanding of the system has not been demonstrated all that well. There has been little demonstration of the core economic, fiscal, political, social, or even the medical factors in play. You may find the response to be gruff, vulgar, or condescending... all of which may well be true... but simultaneously necessary to cut away the chaff and determine whether proper study has been devoted in order to discuss the matter in a productive way. Knowledge not demonstrated must be assumed to be absent -- particularly when direct questioning goes evaded.

I feel for the hospital based docs; they have been improperly ****ed for lack of a better term. PCP's have drawn the short stick forever as well; they provide far too many services that lack a billable CPT, E&M is underpaid, etc -- all of which adds up to poor earnings for the colossal crapfest they have to deal with daily. Subspecialists have not been immune, either; the more specialty specific your mix of provided services are, the more you are likely to have suffered at the hands of the deal makers over the past 7-8 years at least.

If you want to talk about healthcare spending in aggregate -- as most talking heads do -- you need to discuss the individual ingredients that comprise that sausage. Pricing. Utilization. Disease burden. Social traits and demands. Ultimately, this is an economic problem of scarce resource allocation. We cannot appropriately apply market principles to a system that is statutorily restricted from acting as a market. This does not represent a market failure because a market has not been allowed to form or function. This is a rationing problem... and very few on that side of the argument wish to speak in those terms.

FWIW, I do apologize for any and all hurt feelz. Not the purpose.

 

[SSdoc33]

They're condescending for cause; please fashion an argument so that a discussion may be had.

Let me help you out here: prices for the bulk of physician provided services are anchored to Medicare rates; Medicare calculates prices via some ridiculous Soviet styled Rube Goldberg mechanism, combining the very worst perils and evils of a political construct with the fatally flawed (and perversely incentivized) machinations of cost-of-production theory of value methods. Worse still, they double down on their ****ty policy by applying arbitrary revaluations episodically for any procedure that is either: increasing year over year in excess to the background noise or subject to the Achille's Heel political problem (small number of specialty specific providers -- look historically, they are targeted for sacrificial lamb status and redistributions). Hospital pricing is different, but I am not as intimately familiar with that process as it does not directly impact me in any way.

Bottom line is pick your poison: do you want to make the argument that healthcare prices are ridiculously high? Okay. Ask yourself why. Ask yourself who sets the prices. Ask yourself how they are set. Ask yourself what happens when the price point for a service falls below the costs incurred to provide that service. It's basic, kindergarten level economics; it's why the only places in the country someone still pumps your gas are the places where the law forces it to be so. Mandates beget mandates. We are drowning in layer upon layer of expensive bureaucracy, more layers than the best baklava you've ever eaten. The championed solution to the problems herein is the very cause of the problems presented. It's amazing, really, this willful blindspot common to the do-gooders.

hmmm. yeah. things are starting to come into focus a little better here.

personally, i do think that there should be a basic level of pretty crappy care that the central government provides to everyone -- similar to just about all other first world countries. then, if you want to, you can opt out and buy your own more comprehensive insurance, where you can get an MRI the next day and dont have to wait 6 months for a joint replacement and have better access to the more expensive drugs.

you seem to suggest that the reason the costs are so high is due to bureaucracy. this is certainly part of the issue, but exorbitant drug and device prices, high physician payments, hospital facility fees, and middle-man private insurance cannot be ignored.


"The championed solution to the problems herein is the very cause of the problems presented"

this is a vague statement. i assume you mean central government control/regulations. if there was a single payer -- these cost issues and a huge amount of the layers of bureaucracy just disappear. we would be able to compete on equal footing with china and europe and our businesses would not be bogged down by sky-high health care costs. single payer IS the solution to get rid of all this crap. but, you and i would get paid less and we would be told how to practice. if you take an honest look at things besides your bank account you would see that this solution is better for both the health and economics of america.

that being said, i dont want to go to a single payer. i am honest when i say that i like my money more than i care about the overall health of america. how many of us can say that?

 

[VA Hopeful Dr]

hmmm. yeah. things are starting to come into focus a little better here.

personally, i do think that there should be a basic level of pretty crappy care that the central government provides to everyone -- similar to just about all other first world countries. then, if you want to, you can opt out and buy your own more comprehensive insurance, where you can get an MRI the next day and dont have to wait 6 months for a joint replacement and have better access to the more expensive drugs.

you seem to suggest that the reason the costs are so high is due to bureaucracy. this is certainly part of the issue, but exorbitant drug and device prices, high physician payments, hospital facility fees, and middle-man private insurance cannot be ignored.


"The championed solution to the problems herein is the very cause of the problems presented"

this is a vague statement. i assume you mean central government control/regulations. if there was a single payer -- these cost issues and a huge amount of the layers of bureaucracy just disappear. we would be able to compete on equal footing with china and europe and our businesses would not be bogged down by sky-high health care costs. single payer IS the solution to get rid of all this crap. but, you and i would get paid less and we would be told how to practice. if you take an honest look at things besides your bank account you would see that this solution is better for both the health and economics of america.

that being said, i dont want to go to a single payer. i am honest when i say that i like my money more than i care about the overall health of america. how many of us can say that?

Entirely untrue
The Myth of Americans' Poor Life Expectancy

 

[MOHS_01]

hmmm. yeah. things are starting to come into focus a little better here.

personally, i do think that there should be a basic level of pretty crappy care that the central government provides to everyone -- similar to just about all other first world countries. then, if you want to, you can opt out and buy your own more comprehensive insurance, where you can get an MRI the next day and dont have to wait 6 months for a joint replacement and have better access to the more expensive drugs.

you seem to suggest that the reason the costs are so high is due to bureaucracy. this is certainly part of the issue, but exorbitant drug and device prices, high physician payments, hospital facility fees, and middle-man private insurance cannot be ignored.


"The championed solution to the problems herein is the very cause of the problems presented"

this is a vague statement. i assume you mean central government control/regulations. if there was a single payer -- these cost issues and a huge amount of the layers of bureaucracy just disappear. we would be able to compete on equal footing with china and europe and our businesses would not be bogged down by sky-high health care costs. single payer IS the solution to get rid of all this crap. but, you and i would get paid less and we would be told how to practice. if you take an honest look at things besides your bank account you would see that this solution is better for both the health and economics of america.

that being said, i dont want to go to a single payer. i am honest when i say that i like my money more than i care about the overall health of america. how many of us can say that?

Many to that last part. People do not suffer from poor health because of the healthcare system; they suffer from poor health because they eat and live like ****. True story.

As for the bolded -- sorry, dude, that's just not true. We would still have exorbitant layers of bureaucracy -- have you dealt with Medicare or Medicaid lately? It is impossible to offer an open ended check with an account funded by a defined contribution -- although they keep trying. SS. MC. MA. Pensions. This mathematical certainty precipitates a political response to the problem: price controls and bureaucratic processes. They will crush you and I before they resort to direct rationing -- they are loathe to the concept of political blowback -- and are guaranteed to over promise and under deliver. It's as predictable as the sunrise, unfortunately.

Yes, we can pull a China or wherever and hide costs via subsidies. We can lower the parasitic drag on businesses by removing from them the requirement to cover those costs. We can lower the aggregate bill by just telling the sick to go ahead and die. All of these are factually true statements.

As for the pricing problem in the US: we subsidize the rest of the world. It's that simple; we suffer in direct comparison metrics because of the fungible nature of earnings and the lack of price corrections between systems. We subsidize their defense, allowing them to redirect monies to social programs. We subsidize their social programs via the pricing mechanisms. Want to see things level out and clear the fog a little? Allow for reimportation of drugs and devices. Watch their prices rise overnight -- and ours may or may not fall, but it would not matter as no one would buy domestically if they do not. Add a public option and tell the insurance companies that their days of guaranteed commissions are over.

None of this will happen. You know why? POLITICS. Bought and paid for ****** constitute the plurality of the body politik.... they're not upsetting their apple cart.