What would you change about the Health Care System

[Potus]

There are two huge distortions in the US healthcare system: employer subsidies for health insurance and having a sizable chunk of the working age population insured by a disastrously managed, low quality health insurance program operated by a bureaucratic mess of state and federal agencies (Medicaid).

Medicaid in its current form creates a very vicious cycle. In West Virginia, medicaid reimburses at about 50 cents on the dollar and many hundreds of thousands of people are insured by it. The patient mix for a lot of these rural hospitals tends to be like 80% government payer, 15% commercial payer, 5% self payer. However, Medicaid accounts for something like 60-70% of the government payments. Taking the 50% reimbursement number, you're looking at 26% of all Medicaid bills going unpaid. That doesn't include the price controls put in place by PEIA and Medicare.

The public insurance programs pass off these exorbitant costs to the remaining 20% of hospital customers. That's why paying your own way in the healthcare system is untenable for a very large majority of the people. That also inflates the cost of private insurance very dramatically.  Government-insured patient costs are put on the private insurer, which is passed off in the form of higher deductibles and higher premiums.

This "passing off" effect costs the government more money when it comes to tax season. Higher premiums means that employers spend more on healthcare leading to a larger tax exemption. As spending on healthcare for employees increases, it crowds out wage increases for workers. I haven't done much research to back this up but a well-reasoned hunch says that healthcare inflation plays a dominant role in wage stagnation for most workers.

The means by which single payer is supposed to reduce healthcare spending is by setting prices, which advocates call "negotiating," lower than what existing insurers set them at. We already have a huge amount of price setting being done by, in my state, 80% of payers. I actually think public employee insurance is counted as employer insurance and therefore it's part of the 15%.

The price controls fail to constrain spending growth. This alone creates a pretty clear indictment of Sanderscare. The United States's incredible healthcare inflation problem is not the fault of private insurance, though something should be said about the over-utilization of healthcare that comes with a health insurance model of care.

[Potus]

The problem with American healthcare is not that Medicaid pays $10 for a box of tissues when an insurance company pays $15. It's that a box of tissues at a hospital is $15 in the first place.

Are you a single payer person? Because the "solution" that single payer proposes is to lower the medicaid number to $5, cover everyone so they have the power to set standard prices, and celebrate the newfound efficiency in our healthcare system.

[Potus]

Make doctors and patients reach more agreements on payments. For example, a major surgery. You don't want to wipe out the savings of a family or let the doctor do it for free.

lmao, are you suggesting haggling for surgery?

Yeah, let's just not do that.

You're actually describing insurance pools. When you bundle people together, you have more bargaining power to ask for lower prices.

[Potus]

I've said it before and I'll say it again.  Expand medicaid to those making under $30,000 based on the previous year's taxes and $50,000 for couples with two or more children.  Use higher taxes on the wealthiest 2% to pay for the additional costs along with repealing Obamacare.  Keep a "don't ask, don't tell policy on pre-existing conditions and allow people to remain on their parents' insurance until the age of 24. 

This is disastrous. Completely disastrous. Higher taxes, more spending, and an even more defective healthcare system. You should be looking to maximize private insurance, both as a conservative and a pragmatist.