[HN Gopher] Why conventional wisdom on health care is wrong (a p...
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Why conventional wisdom on health care is wrong (a primer) (2020)
Author : jeffreyrogers
Score : 51 points
Date : 2024-10-17 15:57 UTC (1 days ago)
(HTM) web link (randomcriticalanalysis.com)
(TXT) w3m dump (randomcriticalanalysis.com)
| psd1 wrote:
| Well, that was interesting.
|
| What I'm unclear on is whether "health spending", in this
| analysis, is defined as money paid to care providers such as
| hospitals and dentists, or money paid by citizens for healthcare.
| Because you've got insurers and PBMs taking profit.
|
| The ratio of those two numbers is the efficiency of the American
| insurance model. How does it compare to the administration of a
| single-payer system such as the NHS?
|
| Until I see some data indicating otherwise, I'm going to look at
| my PS200pcm national insurance and my PS9.90 prescriptions and my
| free ambulances, and Americans' $500pcm insurance and their
| unlimited prescription costs and their four-figure bills even
| when insured, and I'm going to continue to believe that Americans
| are punching themselves in the face.
| xvedejas wrote:
| Well, there's also the rate of new drug and procedure
| discovery. I've heard it quipped that Americans are subsidizing
| the discovery of new medical techniques for the rest of the
| world. Whether that's worth a higher cost is arguable but I
| think the effect is there.
| bozhark wrote:
| Exactly this, example: biologics.
|
| I am currently prescribed a medication that is over $30,000
| per injection every 12 weeks.
|
| Because we have absolutely atrocious health organization.
| Pharmaceutical companies can set their prices regardless of
| anything but their profit.
| nradov wrote:
| How should pharmaceutical prices be set?
| BobaFloutist wrote:
| In general, anything that's mandatory for life/basic
| quality of life but still needs to be produced by
| industry should should be regulated to artificially
| reduce prices in order to compensate for inelastic demand
| and prevent price gouging. This regulation should include
| supply-side subsidies _and_ dynamic, carefully considered
| price controls.
|
| This should apply to food, water, housing, health care,
| transportation, internet; all those good things that you
| can't do without and are extremely vulnerable to market
| manipulation.
| claytongulick wrote:
| It's worth researching the inevitable consequences of
| price controls, it's a predictable outcome that's been
| tested many times.
|
| Price controls are Hobson's choice: Would you prefer
| expensive bread, or _no bread_?
| ElevenLathe wrote:
| That's right, which is why basic healthcare (including
| production of normal, well-characterized, non-
| experimental drugs) should be taken out of the price
| system altogether and run directly by the government.
| AnthonyMouse wrote:
| Normal off-patent drugs are already pretty cheap. You can
| get a bottle of ibuprofen for like $5. Drugs still under
| patent are, of course, expensive on purpose.
| BobaFloutist wrote:
| By price controls I literally just mean "anti-gouging
| regulation", not "you can't charge more than exactly $5
| for x"
| AnthonyMouse wrote:
| Describe the operation of "anti-gouging regulation" that
| isn't just a price ceiling or a cap on how much the price
| can increase in response to a sudden supply constraint
| that would otherwise result in a shortage.
| michaelje wrote:
| Every other country appears to have the "bread" at a
| reasonable price. Ironically, it's the US which has the
| same bread for 100x the cost.
| dgfitz wrote:
| Did you know Russian citizens spend half their take home
| pay on food? Wanna keep running with that point of yours?
| jltsiren wrote:
| One model is that a government pays a license fee that
| allows them to produce the drug in unlimited quantities
| for their country. (In practice, they could buy the drug
| from the manufacturer at the marginal cost, or they could
| use another pharmaceutical company as a subcontractor.)
| Sometimes there is a deal, and the country may get orders
| of magnitude higher health benefits for a marginally
| higher price. And sometimes the company refuses, because
| the deal would interfere with their business model in
| other countries.
| AnthonyMouse wrote:
| > One model is that a government pays a license fee that
| allows them to produce the drug in unlimited quantities
| for their country.
|
| How does this determine how much the license fee should
| be?
| vundercind wrote:
| When this gets brought up as a _positive_ to our high
| healthcare spending (which you 're not exactly doing, more
| just making note of the existence of the argument) it's such
| a head-scratcher for me.
|
| 1) OK... maybe we should stop, then? Like, that seems like a
| terrible deal? How is that a justification at all? It seems
| like just a description of something very stupid we're doing.
|
| 2) This _would_ be a good deal if we were getting _other
| countries_ to also pay high prices and bringing that money
| "home", but basically the exact opposite is happening. WTF.
|
| 3) More often than not, the side of the issue that raises
| this as a _good_ thing is also the side full of folks who
| think we should e.g. reduce spending on foreign aid, so it 's
| _especially_ weird that they 're bringing it up.
|
| Plus, I'm very skeptical that the idea that drug development
| would dramatically slow down if the US stopped over-spending
| to the tune of 2x-100x on lots of drugs is even true. But
| setting that aside, it's still just a bizarre line of
| argument, to me.
| AStonesThrow wrote:
| You see, development of new drugs, devices, and treatments
| is definitely something that we must continue at breakneck
| pace, by any means necessary, because people keep
| discovering how awful and harmful the existing ones are, so
| we need to make consistent progress beyond the _status
| quo_.
|
| If you move faster than the science and the lawsuits, then
| you can keep selling deadly crap to a naive and trusting
| populace.
|
| https://en.wikipedia.org/wiki/Reye_syndrome
|
| https://en.wikipedia.org/wiki/Thalidomide
|
| https://en.wikipedia.org/wiki/Tardive_dyskinesia
|
| https://en.m.wikipedia.org/wiki/Fenfluramine/phentermine
| AnthonyMouse wrote:
| > OK... maybe we should stop, then? Like, that seems like a
| terrible deal? How is that a justification at all? It seems
| like just a description of something very stupid we're
| doing.
|
| The US pays for drug development and then the rest of the
| world caps prices and gets the drugs cheaper. If the US
| stops then the money for drug development goes down, which
| is not great. What you really want is to get the other
| countries to pay their share, but how do you propose to do
| that?
| BurningFrog wrote:
| Yeah, it's unfortunate for the US, but since no one else is
| stepping up to pay for the medical research that benefits all
| of humanity, we have to do it.
|
| The recent "negotiated prices" for Medicare drugs could be
| the beginning of the end for this system though.
| saulrh wrote:
| Wouldn't it be _even better_ to explicitly funnel our money
| to R &D, rather than hoping that it gets there eventually
| after insurers and paperwork maximizers and intentionally-
| inefficient providers all take their cuts?
| basementcat wrote:
| Which researchers do you funnel money to?
|
| The majority of basic research is done in academic research
| laboratories which are predominantly funded by government
| research grants. If one of these studies pans out and
| something can be patented, a business or investor group may
| license the patent and fund an applied R&D program with the
| goal of getting through FDA trials. This effort is either
| funded by investor capital or internal company funds
| (likely from revenues from the sales of FDA approved
| medications or other products). Presumably if a business or
| investor group has a track record of bringing treatments to
| market (e.g. having a revenue stream from a previously
| economically successful product) they are entitled with the
| option to invest more funds, etc.
| doctorpangloss wrote:
| High interest rates have stopped way more drug development
| than lower or higher drug prices ever have.
|
| Between 2019 and 2022 there were like 88 biotech IPO lockup
| expirations and only 3 were trading higher than post lockup
| for any period of time.
|
| Macro determines the rate of risk taking. Not "details." You
| simply 100% cannot have drug discovery without risk, and risk
| wants returns.
|
| Should we have low rates and high inflation for the sake of
| more "discovery of medical techniques?" Inflation and high
| costs: dude, they are exactly the same thing!
| nradov wrote:
| Profit margins for insurers are pretty low on a percentage
| basis. The Affordable Care Act (Obamacare) imposed a minimum
| medical loss ratio on commercial payers. You can read the
| financial statements for those that are publicly traded. Some
| of the largest insurers such as Blue Cross Blue Shield
| Association members are non-profit.
|
| The NHS isn't really a "single-payer system" in any meaningful
| sense. In the UK, most healthcare providers are employed
| directly by the government and their wages are fixed below the
| market rate to control costs. There are internal financial
| transfers but there aren't really arms-length negotiations and
| payments between separate payer and provider organizations.
|
| If the USA was to adopt a single-payer system like the various
| "Medicare for All" proposals that politicians have floated that
| wouldn't do much to reduce costs. Any meaningful cost reduction
| for the system as a whole would require driving down provider
| wages, rationing care, and ending the way that we subsidize
| drug development costs for the rest of the world. Those
| measures might be good things to do on balance, but they aren't
| politically popular.
| bozhark wrote:
| For profit non profits exist. There is no "metric" for how
| much a 501(c)(3) must ratio in order to be considered tax
| exempt.
|
| They must follow their own discipline set in their founding
| documents.
|
| Calling blue cross blue shield nonprofit is disingenuous as
| they made $749,000,000 in 2022.
|
| Per their 990's: https://www.causeiq.com/organizations/view_9
| 90/135656874/101...
| wahern wrote:
| $749 million is revenue. Revenue less expenses (i.e.
| profit) was $57 million, which admittedly is a decent 7.5%.
| But as a nonprofit there are no shareholders or partners to
| siphon off that profit. The common argument is that
| management siphons off that money through salaries, and I
| can't say they don't, but if you look at their assets &
| liabilities it seems like some significant amount of their
| profit is going into savings.
|
| Anyhow, the Blue Cross/Blue Shield system has a very
| complex structure so if you're looking to find where the
| real money is being siphoned off it's unlikely to be at the
| top. BC/BS affiliates are independent, that's why the org
| at the top for a system insuring over a hundred million
| people pulls in less than a billion dollars in revenue.
| abound wrote:
| "Nonprofit", at least in the US, is usually shorthand for
| having received a 501c3 (or similar) designation from the
| IRS. It has little bearing on your ability to make money as
| an organization (with caveats like the public support
| calculations)
|
| Source: Ran a nonprofit for a few years that made money
| doing software consulting
| _DeadFred_ wrote:
| This is so misleading. What you are saying it technically
| true, but also why our system is broken.
|
| If I can only make 10% profit (or whatever the law is), what
| is my incentive to keep healthcare costs down? The ONLY way I
| can grow my income if it healthcare costs go up. 10% profit
| on a $100 medication is way less than 10% profit on a
| $1,000,000 medication. The road to hell is paved with good
| intentions.
|
| Another disingenuous argument on non-profits. Is all of Blue
| Cross Blue Shield non-profit or only the certain parts you
| want us to look at? A 'Pay no attention to the man behind the
| curtain' argument.
|
| Final disingenuous argument is you just asserting 'meaningful
| cost reduction'. There is no way ambulance rides went from
| $200 to $10,000 because of EMT pay.
| FireBeyond wrote:
| > There is no way ambulance rides went from $200 to $10,000
| because of EMT pay.
|
| Absolutely not. EMT pay can be as low as $12 an hour.
| wahern wrote:
| > If I can only make 10% profit (or whatever the law is),
| what is my incentive to keep healthcare costs down? The
| ONLY way I can grow my income if it healthcare costs go up.
|
| You're missing the step where you also have to increase
| premiums, i.e. price. And what normally keeps any seller
| from increasing their prices whenever they want is
| competition--some other insurer will get your business.
|
| That begs the question of how competitive the insurance
| market is. Let's assume it's woefully uncompetitive. But in
| that case I don't see how the ACA 80/20 rule on
| administrative overhead changes incentives and the
| evolution of price inflation one way or another. At best it
| temporarily disrupted existing inflationary schemes, at
| worst it does nothing.
| nradov wrote:
| I'm not asking you to look at anything. Many US healthcare
| payers are private non-profit corporations. That includes
| some (but not all) Blue Cross Blue Shield Association
| licensees. The BCBSA isn't a payer itself and merely
| provides some shared services to their independent
| licensees. Outside of the Blues system there are other
| large non-profit payers such as Kaiser Permanente, HCSC,
| Geisinger, EmblemHealth, etc. This isn't secret
| information, you can just go look it up instead of arguing.
|
| Commercial health plans have conflicting financial
| incentives. Most of them no longer provide much insurance
| (in terms of bearing financial risk) but rather primarily
| act as administrators for self-insured employers. So while
| payers can potentially boost short-term profits by paying
| out higher claims, employers comparison shop between
| competing health plans every year. Your HR department would
| happily switch from Aetna to Cigna (or whatever) next year
| if their analytics forecast shows that would save a few
| dollars on expected claims.
|
| Ambulance fees are a mess but those represent a tiny
| fraction of overall US healthcare spending. Some reform
| there would be a good idea but that wouldn't do much to
| reduce costs.
|
| Significant systemic cost reductions will require some mix
| of lower provider wages, care rationing, and reduced
| spending on new drug and device development. Countries with
| more socialized healthcare systems are more financially
| efficient in some ways but they also just do less stuff:
| less drug development, longer queues for advanced
| treatments, underpaid doctors (relative to market wages),
| care restrictions based on QALYs (or similar metrics).
| Complaints about payer profits, while perhaps somewhat
| legitimate in certain cases, are largely a distraction from
| more fundamental problems. That's just basic math dictated
| by the cashflows. There are no simple solutions and we're
| eventually going to have to make hard choices. No one wants
| to face this reality.
| _DeadFred_ wrote:
| Edited out frustration.
|
| I wrote hospital medical software for 20 years passing on
| way better pay because I wanted to make a difference. And
| I gave up because the system WANTS to be how it is today.
| Everyone in medical is CHOOSING to make it this way, then
| claiming 'ah it's too big, it's too complicated, we can't
| change it'. Americans being to scared to call an
| ambulance means emergency care has completely failed
| them, not a small little thing to be brushed off.
| Americans are making hard choices about medical care
| every day already.
| nradov wrote:
| We're all frustrated. No one is happy with their
| available choices. Join the club.
|
| The system can't want anything. It isn't even really a
| "system" in any meaningful way, in the sense of being a
| unified entity working towards a common goal. US
| healthcare is just a bunch of disconnected people and
| organizations pursuing their own interests, often in
| conflict with each other. Any major improvements will
| require changes at the federal policy level to better
| align incentives with desired outcomes. This is hard
| because we collectively can't even agree on the desired
| outcomes or how to measure them. I mean at a high level
| most people think that everyone should have convenient,
| affordable access to high-quality care but once you get
| into specifics everything gets complicated and making
| trade-offs which disadvantage some voters is unpopular.
| Like should we spend $100K to give a terminal cancer
| patient another month of life? Should surgeons make $700K
| per year?
|
| It's easy to complain and cast blame. And we should
| certainly cut out waste and abuse where we find it. But
| that won't significantly move the needle on overall
| system costs. The problems are much more fundamental.
| selimthegrim wrote:
| Good Lord I wonder what the unexpurgated version was like
| whoitwas wrote:
| This is nonsense. Health care costs about twice as much in US
| as everywhere else and only the rich can afford it. Health
| insurance companies fight against doctors and patients to
| subvert health and profit as much as possible.
| nradov wrote:
| 92% of Americans have health plan coverage, so we're not
| talking only about the rich here. There are certainly
| problems that we should fix but spreading misinformation
| about basic facts doesn't help anything.
|
| https://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_E
| s...
|
| It's easy for populists to demonize health insurance
| companies. But even if we somehow magically cut all payer
| profits to zero that would only marginally reduce total
| system costs. Much of what they do in fighting against
| doctors by negotiating lower reimbursement rates and
| denying claims that don't meet coverage rules actually
| helps to control costs for their main customers, the large
| self-insured employers that purchase health plans for their
| employees. At the national policy level, one change that
| would probably help would be breaking the linkage between
| employment and health plan coverage in order to better
| align incentives.
|
| Other countries that spend less on healthcare also have
| lower provider wages, longer queues for advanced
| treatments, rationed care based on QALYs (or similar
| metrics), and less innovation in drugs and medical devices.
| Maybe that would be better overall but let's not pretend
| that there aren't severe trade-offs. You can't have your
| cake and eat it too.
| vundercind wrote:
| We spend even more money on healthcare administration than
| what's directly spent on it. HR departments screwing around
| with insurance. Various government benefits & other agencies
| having to mess with private health insurance issues. Attorneys
| general offices and state rep offices spending time to get
| insurers' and hospital billing departments' heads out of their
| asses (they do a _lot_ of this).
|
| There are also untold hours lost in unpaid labor on the part of
| "clients" messing with insurance and hospital billing
| departments. It's not uncommon for someone who is, or is
| connected to a person who is, seriously sick for even a few
| days to spend a work-week or more of time that year messing
| with the billing from the incident. This can include uneventful
| pregnancies and births.
| frsoafdslfdlsa wrote:
| Have you tried phoning a GP or for an ambulance recently?
| sarah_eu wrote:
| Americans look at their 9k a month salary and don't care about
| loosing an extra 300 USD on health insurance. I've experienced
| the British and Swiss systems - Swiss is like the American -
| pay roughly 600 CHF a month - and it's way better than the NHS.
| You can see a specialist the next day, get a scan the next day
| etc.
| psd1 wrote:
| Is medical bankruptcy common in Switzerland?
|
| 600chf sounds like passable value for money, as long as you
| get excellent care and as long as that's all you pay.
|
| But my concern is always what happens to the poor. Yeah,
| yeah, the Swiss are rich - but not literally every Swiss, I
| presume.
| TMWNN wrote:
| >Is medical bankruptcy common in Switzerland?
|
| Only 4% of US bankruptcies are because of medical bills
| <https://www.washingtonpost.com/blogs/post-
| partisan/wp/2018/0...>. A tipoff that _[insert large
| percentage here]_ of bankruptcies aren 't actually because
| of medical costs is that only 6% of bankruptcies by those
| without health insurance are because of that cause. The
| biggest cause of bankruptcies is lack of income, which
| health insurance doesn't affect in any country.
| Loudergood wrote:
| 9k a month is not typical for sure.
| DaveExeter wrote:
| $300x12 = $3,600/year for US health insurance?
|
| I think it costs more than that!
| nonameiguess wrote:
| It is surprisingly hard to track down what is meant exactly. It
| is not either of the options you listed here, but closer to the
| first. Chasing a very long chain of citations to other
| citations, it appears this paper contains the original
| explanation of where the data come from: https://sci-
| hub.st/10.1007/s11205-015-1196-y.
|
| They survey all of the possible healthcare goods and services
| available across OECD nations, make their best attempt to
| select a representative basket that is both available across
| all nations and reasonably similar, then estimate what they
| call a "quasi-price" per unit of good and/or service, to
| account for the fact that the actual charged price is often
| artificially suppressed or set to zero by government fiat. This
| seems to be done by scouring management accounting databases to
| figure out what the payers and providers consider to be
| reasonable reimbursement rates for accounting purposes, whether
| or not that is what they actually receive.
|
| I get what they're trying to do, but this probably explains
| some of the counterintuive results, because mostly people are
| probably thinking more along the lines of "add up all premiums
| paid to insurers, out of pocket expenses paid directly by
| consumers to providers, and all government outlays classified
| as healthcare" and that's how much your country spends on
| healthcare.
|
| That's a reasonable comparison to make, but as the blog and the
| OECD report both point out, it does nothing to account for
| differences in quantity and quality of healthcare goods being
| paid for. The problem is this discourse then inevitably leads
| to "well the US gets worse outcomes," but to what extent is
| that fair? The only reason I can walk today is because of US
| healthcare. If you incur a musculoskeletal injury that requires
| intervention in various different countries, how likely are you
| to fully recover? If you get cancer, how likely are you to go
| into remission? I don't necessarily know exactly what _should_
| be measured, but I know that when the discussion goes straight
| to lifespan, that is heavily confounded. Americans drive more,
| own more guns, are fatter. There has been tremendous industrial
| pollution in various places, though I don 't know how that
| compares to the rest of the OECD. I wouldn't be surprised if we
| have more backyard pools. There are many, many reasons we might
| live shorter lives that have nothing at all to do with the
| quality of the healthcare we receive.
| AnthonyMouse wrote:
| > What I'm unclear on is whether "health spending", in this
| analysis, is defined as money paid to care providers such as
| hospitals and dentists, or money paid by citizens for
| healthcare. Because you've got insurers and PBMs taking profit.
|
| > The ratio of those two numbers is the efficiency of the
| American insurance model.
|
| The ratio of those two numbers is quite divorced from the
| efficiency of an insurance model.
|
| On the one side, this would count wasteful spending on
| unnecessary tests or overpriced services as an efficiency
| _improvement_ because proportionally more money is going to
| providers. On the other side, if insurers better at preventing
| fraud have lower premiums and therefore get more customers and
| make more money, that would count as "inefficiency" and the
| fraud _prevented_ would _also_ count as inefficiency (because
| that money went to "providers"), even if the net result is
| less fraud and lower premiums.
|
| That isn't to say that the US system is efficient. It's clearly
| quite broken. But its brokenness is because the government has
| been thoroughly captured by the industry -- which is the
| providers as much as the insurers -- and they oppose any
| measures that would improve actual efficiency because the
| inefficiency is their profit. Which is why the US system costs
| more than the systems in other countries regardless of whether
| the other countries use public or private systems.
|
| An efficient regulatory system for a private insurance market
| would be something like, a schedule of service codes where each
| provider is required to publish a fee schedule representing the
| uniform fee paid by all institutional insurers, eliminating the
| overhead of "negotiating prices" (a major source of
| inefficiency) in favor of price transparency and allowing
| patients and insurers to choose a provider on the basis of
| price and distance, while still subjecting providers to
| competitive pressure because people would naturally favor
| providers with lower fees. But the existing US system doesn't
| do that at all.
| nradov wrote:
| I generally agree with your points, but the US healthcare
| system does now have pretty much the level of price
| transparency that you want. Commercial health plans have been
| required to publish their negotiated network provider fee
| schedules since 2022. You can just download the files and
| take a look. Of course as an individual health plan member
| that won't tell you your out-of-pocket cost for a particular
| service, but it is useful to self-insured employers
| comparison shopping between health plans.
|
| https://www.cms.gov/healthplan-price-transparency/plans-
| and-...
|
| Longer term though we should move away from the fee-for-
| service model based on providers submitting claims for
| service codes. A value-based care model where provider
| organizations bear at least some financial risk and are
| accountable for patient outcomes will probably work better
| for everyone.
| AnthonyMouse wrote:
| > the US healthcare system does now have pretty much the
| level of price transparency that you want.
|
| They made a little progress toward it but the providers are
| fighting it every way they can. Apparently one of the
| methods is to use many different codes for the same thing
| so they can't easily be compared. You need to get to the
| point where it's like a price comparison service; your
| doctor tells you to get a scan and you get a list of every
| service in the country that offers it, sortable by both
| price to you and distance from your house. They should also
| eliminate the premise of "in-network" and just have all
| providers publish their prices and insurers publish the
| amount they cover in your region.
|
| > A value-based care model where provider organizations
| bear at least some financial risk and are accountable for
| patient outcomes will probably work better for everyone.
|
| It would probably be better to combine them, i.e. you get
| primary care your way but when primary care wants you to
| get a scan or take a medication you have competing
| providers. Lumping the entire network into one entity is
| likely to lead to market consolidation and then
| inefficiency.
| TMWNN wrote:
| Studies have found that Kaiser Permanente (an integrated health
| insurance/care provider--basically a non-governmental
| equivalent of the NHS in comprehensiveness--that is available
| in many US states) is more efficient and effective than the NHS
| for about the same cost.
|
| Examples:
|
| * <https://www.bmj.com/content/324/7330/135>
|
| * <https://www.bmj.com/content/327/7426/1257>
| zaptheimpaler wrote:
| Anecdotally anyone can talk to a few doctors and find out just
| how much time they spend on updating charts/documenting
| information that's not directly relevant to the care, its just
| to protect against liability or work with insurance. Or how
| many hours they spend on phone calls fighting with insurance
| companies. The people who actually understand medicine wasting
| hours with some clueless rep with 0 understanding and a
| flowchart who's only job is to deny claims. Dr. Glaucomflecken
| on youtube has many videos about that too.
|
| So on the ground level, it's already clear some of our highest
| paid most valuable people spend 20-30% of their time on a
| flavor of administrative junk which isn't necessary in a
| single-payer system. I'm skeptical of claims that this waste
| doesn't translate into the higher level metrics.
| akira2501 wrote:
| > I'm unclear on is whether "health spending",
|
| They list their source as 2017 OECD data. OECD seems to define
| this as:
|
| "Health spending is the final consumption of health care goods
| and services including personal health care and collective
| services."
|
| Their charts are also drawn in a standard and more
| understandable way.[0]
|
| > Americans are punching themselves in the face.
|
| Hurtful, but okay, I do hope you realize it's the rampant
| monopolization of health care that is the problem in this
| country. Yours solved it by simply creating a single publicly
| held monopoly.
|
| It's not as if either system is perfect and doesn't create it's
| own share and particular style of inhumane healthcare outcomes.
| Prescription label prices are noticeably different but are they
| meaningfully different where outcomes are concerned?
|
| [0]: https://www.oecd.org/en/data/indicators/health-
| spending.html
| WalterBright wrote:
| Health care prices in the US were reasonable until the
| government got involved in it.
| keldaris wrote:
| If that's true, how are they so much more reasonable in most
| developed countries with far greater government involvement
| still? Is the US government just uniquely bad at healthcare
| somehow? Why?
| throwme0827349 wrote:
| This is fine as a high level economic discussion, but I think it
| misses the point of the complaints from actually US consumers:
| when I consume healthcare as an individual I am paying with a
| blank check, and I am therefore likely to be tricked into
| consuming more health care than I would otherwise choose to
| afford, perhaps to a ruinous degree.
|
| I think ordinary consumers care much less about whether their
| country spends a nominal share of GDP on the heath sector, than
| about whether they will be unexpectedly bankrupt by consuming
| health services, and this is why people are actually mad.
| kcsavvy wrote:
| I started and sold a company in the industry, and agree that
| macro level analysis misses this. In the us healthcare as a
| "product" has an AWFUL customer experience. On so many levels.
| And the worse it gets the more people want to "burn it all
| down", despite the fact that it might not be as dire as we
| think when we do the high level analysis. Whether or not that's
| a good thing is up for debate.
| darth_avocado wrote:
| > The claim that US health care prices are inexplicably high
| was never well-evidenced
|
| I can provide anecdotal evidence that prices inexplicably high.
| A primary care physician will charge anywhere between $200-$500
| for a visit. If you have good insurance, you don't pay out of
| pocket. In the same city, I once had to go to a PCP who would
| only work without insurance. I had to wait a lot because of how
| many people were lined up in front of the office, but I paid
| $50 for the visit. I'm already paying 4-10x in a comprable
| market for the same services.
|
| When I was abroad, I had to visit a doctor's office for food
| poisoning. I paid 200 in the local currency. I could have gone
| to a hospital and they would charged me 500 in the local
| currency. But what's important to know is that the median
| monthly wages in the country were 25000 in the local currency.
| So all in all, you'd pay a smaller portion of your wages for a
| simple checkup.
|
| And that tbh is why people are actually mad.
| _DeadFred_ wrote:
| I recently had skin cancer surgery. I was offered a 20%
| discount to self pay. Because of my deductible I would have
| paid more if I used insurance than if I just paid. We are now
| to the point where it's not cost effective to use our private
| insurance for cancer surgery. How anyone is defending this
| system is crazy to me.
| BirAdam wrote:
| My wife had a kidney transplant. Two of her medicines cost
| hundreds each per month with insurance, but without
| insurance are under one hundred each for three months.
| pessimist wrote:
| This analysis in the end doesn't show what it claims to show and
| actually proves the reverse - US Health care spending _is_ much
| larger than other countries, it eats up _significant_ fraction of
| productivity gains in other sectors (rises faster than income as
| shown by the 1.8 slope in the very first graph), and _does not_
| lead to better health outcomes. It actually proves we would be
| better off if we spent less and focused on lifestyle.
| YetAnotherNick wrote:
| What was it claiming exactly that it proved to be reverse?
|
| > we would be better off if we spent less and focused on
| lifestyle.
|
| I didn't see any claim opposite of this.
| betaby wrote:
| > US Health care spending is much larger than other countries
|
| The thing is that in USA (and Canada) radiologist compensation
| went from 300k/yer to 500k/year over the last 10 yeas. It's the
| same radiologist. While spending is growing quantity of doctor
| per population is diminishing.
|
| In USA/Canada there is cartel enforced cap on how many new
| doctors can be minted per year, and this cap is not even
| scaling up with the population growth.
| nradov wrote:
| The immediate limit is a government (Medicare) funding cap on
| the number of residency (graduate medical education) program
| slots. At one time the American Medical Association lobbied
| to put that cap in place but they reversed course years ago.
| Congress still hasn't acted, and so every year there are some
| students who graduate from medical school but are unable to
| practice.
|
| https://savegme.org/
| neves wrote:
| A quick reading of the summary shows a lot of debunking and just
| one item that explains the bad health of North Americans:
|
| Diminishing returns to spending and worse lifestyle factors
| explain America's mediocre health outcomes
|
| https://randomcriticalanalysis.com/why-conventional-wisdom-o...
| firejake308 wrote:
| As an armchair economist, this is my personal favorite theory.
| With one of the most obese populations in the world, I think
| it's obvious that we'll also be the most sick and we'll have to
| spend a lot to try to dig ourselves out.
| pessimizer wrote:
| How does people being fat make asthma inhalers from the 50s
| cost $70 when they're $5-$10 everywhere else in the world?
| nickpsecurity wrote:
| I skimmed what I can while on break. What I didn't see is
| something I've heard from doctors but can't verify. It's that
| insurance companies require them to do extra procedures or have
| extra employees they don't think they need. Some who didn't take
| insurance say it keeps their cost down.
|
| One told me the insurance companies incentivize him to treat
| patients like an assembly line where cash only lets him spend one
| on one time with customers. He also might treat people for
| several things on the same bill which he claimed he'd have to
| itemize and charge separately for with insurance.
|
| So, do people here have specific examples (esp links) to support
| or refute those anecdotes? If they were true, it would mean
| insurance rules were driving much of the cost. Looking at their
| causes, my first guess would be how they respond to losses from
| both real malpractice and greed-driven lawsuits. I can't imagine
| that costs aren't impacted by this with all the lawyer ads I see
| for suing insurance companies. ;)
| aDyslecticCrow wrote:
| GDP per capita and other "per capita" metrics are also unreliable
| metrics for household income, as they suffer from the same issue
| as averages. This is a common trap that is done in population
| statistics, as mean and averages are always easier to calculate
| and reduce the complexity of the calculations.
|
| Large wealth inequality makes GDP per capita and average
| household spending not representative of a real-world median
| household. If healthcare costs have outpaced median income but
| kept up with mean income, that is a MASSIVE societal issue.
|
| Most of the plots and arguments in the article overlook this, so
| I don't trust the arguments much.
|
| However, it is still interesting how strong the correlations are.
| It gives some interesting insights into what goes into the cost
| of running hospitals, I suppose.
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