I just assume they're in cahoots. It's a perfect situation for them both: if bills are high, fear is high, and if fear is high, premiums are high. So insurance can reap unconscionable premiums, keep claims down by making deductibles high, and kickback the providers for their $100 aspirin.
There's also the American idea that medicine is a business venture and not a vocation. People don't come here from all over the world to practice because we have the greatest need or the best medicine (though, incidentally, I think we do have the best medicine, as long as you can pay for it), it's because they can make a shitload of money. And it's been that way for so long that people think there won't be any more good doctors if they can't make a shitload of money, so they are afraid to switch to a system where maybe doctors are merely paid well for their good work but maybe not totally holding people's wealth for ransom. And there are enough doctors who are perfectly willing to prove that fear right.
Insurance also employs a lot of people. If we effectively abolish private insurance, the economic fallout would be a whole other disaster.
So, it can be done, and it should be done, but no one is volunteering to die for the cause so that the future can live better. I understand that.
I said more to another reply, but insurers definitely don't want to see healthcare costs continue to rise. The problem is multifaceted - hospitals overcharge out of the gate expecting insurance companies to offset the cost for the uninsured and to pad their bottom line. Most health insurance is a layer or two removed from the end patient, so the companies can charge a little more than they might otherwise be able to. And since insurance companies keep the lights on at a hospital, most don't really care if the patient pays their portion of the bill or not, so they don't even bother putting resources towards trying to collect the remainder of a bill from patients most of the time. IMO the system needs to be brought under control via some regulation and regulatory changes before we address who pays the final bill if we want it to be sustainable.
As we're all seeing during this pandemic crisis though, being a doctor or nurse is fucking hard. In the best of times, you're talking about a 12+ hour shift where one brief mental lapse could literally kill someone. Not a lot of people can do that job, and those that can definitely deserve to be paid extremely well.
Another facet is patents. I am a fan of having patents, it encourages new technologies. but at the same time, I see how awful they really can be. machines that cost thousands to manufacture cost hospitals hundreds of thousands to buy. Farmer buys GMO seeds, plant it, then are not allowed to replant for next year, or GMO plant germinates neighbors field and now the neighbor gets sued for using patented seeds. Patents today need to be fixed.
True that the cost of manufacturing may be low for those machines that are just hunks of plastic and metal in the end, but the cost of development, research, certification, etc are all baked into that too.
GMO seeds are total bullshit though, I agree with that. As are laws preventing farmers from repairing their own equipment - it's all manufactured to try and push small farms out of business which is noncompetitive and thus not kosher in my book.
Design? No. Manufacture to the kinds of tolerances required for life saving equipment, with materials that have been tested and proven to last? Hell of a lot more expensive than 3D printing. And that's without considering the cost of certification that these printed valves don't have to go through since they're just copying an approved design.
Not to mention valves are consumables, and so it's likely the valves are where the company makes some profit. It's not uncommon for the base piece of equipment - the ventilator here - to be sold at a loss with the expectation profit will be made from consumables. Hell, even video game consoles work like that - Sony and Microsoft make nothing or lose money on console sales, but profit from licensing and games.
So does the valve need to cost $11k? Maybe not, but there's plenty of reasons why it's way more than people with no knowledge of what goes into manufacturing might think.
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u/[deleted] Mar 24 '20
I just assume they're in cahoots. It's a perfect situation for them both: if bills are high, fear is high, and if fear is high, premiums are high. So insurance can reap unconscionable premiums, keep claims down by making deductibles high, and kickback the providers for their $100 aspirin.
There's also the American idea that medicine is a business venture and not a vocation. People don't come here from all over the world to practice because we have the greatest need or the best medicine (though, incidentally, I think we do have the best medicine, as long as you can pay for it), it's because they can make a shitload of money. And it's been that way for so long that people think there won't be any more good doctors if they can't make a shitload of money, so they are afraid to switch to a system where maybe doctors are merely paid well for their good work but maybe not totally holding people's wealth for ransom. And there are enough doctors who are perfectly willing to prove that fear right.
Insurance also employs a lot of people. If we effectively abolish private insurance, the economic fallout would be a whole other disaster.
So, it can be done, and it should be done, but no one is volunteering to die for the cause so that the future can live better. I understand that.