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Subject:  Re: Single Payer Series Date:  1/23/2020  3:30 PM
Author:  tjscott0 Number:  576202 of 592401

Vox look at the state of Maryland.

Maryland is the site of two big experiments in containing health care costs. The first: Since the 1970s, the state has set the prices hospitals can charge for medical care, known as all-payer rate setting.

The second experiment: Since 2014, it’s also capped how much health spending can grow overall, including how much revenue each hospital can take in.

These kinds of regulations are common abroad — France, Japan, Switzerland, the Netherlands, and Germany all have some variation of rate setting and set budgets for health care spending. But here in the United States, Maryland stands alone.

Hospitals’ budgets are fixed, as are the rates they can charge for procedures. Once they hit their revenue caps, they don’t make more money on having patients in the hospital — and there is a carrot-and-stick system to ensure hospitals don’t exceed those caps.

Obviously concentrating on preventative is necessary to make such a system work.

Readmission rates at the hospital dropped 26 percent between 2011 and 2018
emergency department visits dropped nearly 20 percent.

The rates Maryland set aren't draconian. Maryland goals are to cut the increase in healthcare costs to 4% increase a year.

There is one big problem with the Maryland system. While Marylanders are paying among the lowest rates for healthcare; their insurance premiums do not decline. Insurers are laughing all the way to the bank. And there is no mandatory coverage requirement in the state.

In France, Germany, & Switzerland insurance is mandatory. And the basic coverage provided by the insurer is required to be on a nonprofit basis. Insurers make their profit on the supplement coverages sold to the public.
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