Political debate on Health Care

Coffee
1

Not sure if this should be a carved-out thread? I have a bit a different view on where Health Cost go wrong. Health Services are (for valid reason) provided by both Regulated Industries and Regulated Professions. These Regulations however imply a natural Monopoloy. These Days, the “Guild” of Doctors monetizes on their Monopoly Position. Clearly, there are other places as well where we are not good but the biggest cost-driver (in Switzerland) is the fact that the consumption of Medical Services heavily increases.

The interesting thing there is that Prices of the Medical Services are well controlled and remain flat. What happens however is that Doctors just drive up their profit by ordering and billing more and more services. What a few years back used to be 4-5 different TarMed Items, is now another 1 or 2 extra and when you have a look at how many “first 5 mins, second 5 mins, last 5 mins” a doctor charges a day - you will feel sorry for their overtime (not).

Doctors themselve are not the problem either. A General Practicioner doesn’t earn excessively but they showcase the problem. It trully starts to hurt with Specialists that for the sake of improving their P&L start to order and bill more and more very expensive services. This drives up Salaries and Quantity of Medical Specialists. A few years ago, there was an interesting NZZ article about a 90+ something patent that was clearly dying. The hospital had put him on palliative care and two days later, he then passed away. Even though it was just aging, 10+ different doctors managed to book some “materials review, consulting, advicing, …” bills - and this without even seeing the patient.

Even though I am not a big fan of regulations, Economics 1:1 tells us that whenever there was a monopoly, it calls for regulation. Therefore, I would favor a relatively simple regulation - namely:

  1. Capped Salaries: Doctors, (regulated) Medical Professions and Employees to Service Providers that perform regulated Medical Services MUST NOT earn more than e.g. 2x the Bundesratslohn
  2. No Side-Income & Kickbacks: Full ban for side-jobs, side-benefits, perks, free education trips and other kickbacks (e.g. as currently paid by Big Pharma). Employement capped to 100% and in case of part-time employed, the side-job must not exceed the (percentage adjusted) compensation of the main job. Or alternatively - a simple ban to take on any side-job (for both regulated professions and Management within a Medical Service Provider).
  3. Separate Legal Entities: Full segregation of regulated vs. Non-Regulated Service Providers (two legal entities); Other than Non-Regulated Services are offered to the public and make up no more than 10% of total revenues
  4. Audit & Financial Transparency: Full Financial Audit on Service Providers that perform Regulated Medical Services; Books to be annually reviewed by external auditors and to be reported to BAG
  5. Market Priced Subcontractors & Suppliers: Suppliers and Outsourcers to regulated Medical Service Providers must be procured through the BAG and/or a procurement organization that is jointly owned by at least three major (top 20) health insurance providers; No Intra-Group services regulated and non-regulated Entities
  6. Capped RoE: 100% tax on Medical Service Providers’ Return on Equity greater 10% + SARON; Obligation to unwind Excessive Equity Level (don’t ask me how to implement this; e.g. Short/Long-Term Liquidity must not exceed X% of annual Revenue?)

Once we are there, we can as a next step look at Hospital and Expensive Infrastructure investment optimization and then at overall Insurance Incentives. But at first, we need to break the monopoly. I know, this is a nightmare for any liberal mindset but if we don’t act now - society will run into a major problem (maybe 10 years down the line).

5 Likes
2

Your proposals are not ever the way a market economy deals with monopolies, and you should be shamed for advocating this in a forum that makes a point of retiring early through capital acquisition.

3

@_MP FYI: This article was reported a while back already but your Admins so far tolerate this hate speech. Just that you are aware.

4

Sarcasm detector malfunctioning?

5

In the line of the TeaGhost post I would say that it is better to provide arguments for the discussion rather than shaming someone for his/her opinions (sarcasm or not…).

That said, even If I don’t fully agree I see the point of TeaGhost and I will add that, ideally, most professions should have capped salaries, specially those related to public services as health care should be and more importantly, public services should be independant and have no influence from private companies (Pharma). Theory and practice is another thing…

FIRE is about capital acquision, true, but the point is whether this should be done in expense of other people’s wealth? In the case of health care this often have a detrimental impact on the most vulnerable populations that have a limited affordability to overcome the increases in health care costs…

We are anyway deviating from the main topic of NW progression…

1 Like
6

The FIRE relevant conclusion from the past ~20 posts might be: budget for health care costs growing by >CPI

7

x2-5 :grin:
My premium certainly went up by more than ~2-3% p.a. over the past few years.

8

We’re getting pretty off topic here.

6 Likes
9

Can confirm this, make sure to check your medical bills carefully. I’ve had to file complaints twice, one resulting in -50% charges. They charged me double the time in Tarmed, quite shamelessly. Their excuse was along the lines of: just forward it to your insurance, what do you care anyway? As if honesty wasn’t even an issue…

10

Its a sobering thought for a liberal mindset like I have it myself to ask for brutal hard regulation and controlled compensation. The alternative would be either a full state takeover (like in the UK) or alternatively a deregulation that allows for Insurance Companies that decide what network of Hospitals they want to work with. Both are terrible alternatives. Bit if we don‘t act, we will have a major public Problem - a few years down the line…

But why should I keep discussing these things if Hate Speak is ignored and if Forum members are (without consequences) asked to shame me. This community is great but the administration is terrible.

11

I’m not @xmj , so I can’t say for sure, but I believe you @TeaGhost are misunderstanding that bit, because of a small english error on @xmj 's part?

For me it makes sense, that @xmj meant to write you should be ashamed…, which doesn’t quite mean that he is advocating that others actively “shame you”. It’s “just” a way of saying he feels what you wrote is inappropriate.
“You should be ashamed” is really not such a “hard” saying/expression, in my language use, that would need escalation to resolve.

Just my 2 cents :blush:

1 Like
12

And it is not hate speech by any stretch of the imagination. Let’s get real here!

2 Likes
14

For what it’s worth - I did mean “you should be shamed for this”. That’s what should happen to people arguing for socialism on a forum devoted to capital accumulation.

15

Way to keep the drama going :wink:

2 Likes
16

Ah well, my apologies & my empathy to you, @TeaGhost .

1 Like
17

Mustachianism, and thus this forum, is at least as much about frugalism as about capital accumulation. Should we shame everybody who buys a car (at all, not even thinking about a Mr./Ms. Fancypants expensive one), a more expensive than the most frugal phones or calls a plumber instead of doing their own repairs themselves as is the mustachian way?

Capitalism can be unbridled, or regulated, or crony, or many other variants of it. Opinions may differ, asking for more regulation in the healthcare sector doesn’t run opposed to what mustachianism stands for.

3 Likes
18

By their own admission, this is a nightmare.

I’ve lived in places where healthcare is provided by the state with more regulation than what they propose – and it entails all the known features of socialism:

  • decaying quality,
  • months- if not years-long waiting lists
  • inability to even get a medical service provider to reply to phone calls if not emails (“try again next quarter; we’re full”) if you do not have ‘pull’…

In a country such as this, where highly qualified doctors come from all over the world because of the better regulation and higher pay, the above proposals are akin to declaring “we do not want you”. This is dangerous in a country which does not even educate enough doctors to provide for the current quality of service.

What’s more, these types of proposals open the door to crippling Switzerland’s main exports: pharmaceutical goods (and, by extension, my own stock market gains from it :wink: )

You can argue for this, and I’ll defend your right to do so, but I’ll also note that doing so will incur a terrifyingly high cost. The social cost of me shaming you for it is just the tiniest bit of it.

The analogy you’re proposing should, more appropriately, be “we don’t like fancy sports cars so we’ll cap all car companies’ profits, and their suppliers’ profits, even if there are plenty of people wanting to buy these services.”

Which is not something that in any way yields well to net worth progression.

BTW: Much easier if we spin this into a separate post “Health care cost and ways to reform it politically”, this might attract some more interesting discussions.