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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#321

Post by chimeracoder »

will_brown wrote: post #297
chimeracoder wrote: post #272

Earlier quoted context omitted.

> Patients like Medicare Part D I'm talking about Medicare Advantage, not Medicare Part D. Most Medicare Advantage plans do include a Part D plan, but not all do. > not because of insurance companies or the market is privatized. People like Medicare Advantage because they are actually able to book appointments without horrendous wait times, and they're able to see a better selection of higher-quality doctors. And the…

>I'm talking about Medicare Advantage, not Medicare Part D. Most Medicare Advantage plans do include a Part D plan, but not all do. I would have thought 9 out of 10 advantage plans have part D drug coverage but its actually 82% at an average cost of $40/month. >Medicare Advantage consistently outperforms Original Medicare on medical outcomes, not just on patient satisfaction. Outcomes is a buzz word, if you want to t…

> Outcomes is a buzz word, if you want to talk Star Ratings and Quality Metrics, then we can begin to discuss what "outcomes" really mean

If you want to talk about how metrics are imperfect, fine, but you can't claim that Original Medicare is somehow better unless you actually propose some concrete metrics on which it actually does outperform Medicare Advantage. As it stands, Medicare Advantage consistently beats Original Medicare on pretty much every metric you can conceive of.

Re: YC Research: Universal Healthcare

#322

Post by refurb »

dragonwriter wrote: post #285
refurb wrote: post #284

Earlier quoted context omitted.

Nope. Medicare has 55.3M beneficiaries.[1] [1] http://www.ncpssm.org/Medicare/MedicareFastFacts

57 million, but that oncludes 17.6 million that are in third-party at-risk plans where Medicare is just paying a portion of the premiums (Medicare Advantage), not traditional "single payer" Medicare, so don't count in Medicare's negotiating power. So there's just under 40 million in traditional Medicare. http://kff.org/medicare/fact-sheet/medicare-advantage/

You need to be careful with that definition. For prescription drugs, Medicare just pays premiums to private insurers under Part D. Following your logic, Medicare has zero negotiating power for those drugs.

Re: YC Research: Universal Healthcare

#323

Post by maxerickson »

triangleman wrote: post #112
chimeracoder wrote: post #61

Earlier quoted context omitted.

> I bet making structural changes so that cost of care is more visible to patients would help a lot in the US. It would, but it would be politically infeasible. Medicare would never let it happen, because providing price transparency in the private market would undermine the convoluted system that allows them to use private insurers to subsidize the care of Medicare patients.

Explain how. I thought Medicare was rife with fraud and overbilling, so that they end up subsidizing private payers.

Medicare is about 1/6 of US healthcare spending so it obviously isn't subsidizing private payers, even if you make a ridiculous assumption like 100% of payments are fraudulent.

And then in reality fraud rates seem to be quite low, at most a few percentage points of overall Medicare spending.

Re: YC Research: Universal Healthcare

#324

Post by kybernetikos »

bjshepard wrote: post #302
Thriptic wrote: post #186

Earlier quoted context omitted.

It's much more complicated than that. Sales in the US where they can charge more are what actually offer pharma companies good ROI. Effectively the US is subsidizing R&D for the rest of the world.

This is a lie.

Saying it's a lie makes it sound like you think it's deliberately mendacious. In fact, it seems more likely that the poster believes it. It might be more constructive and interesting to say something like 'this is incorrect because/as this reference shows...'

Re: YC Research: Universal Healthcare

#325

Post by mkaziz »

dragonwriter wrote: post #106
mkaziz wrote: post #101

I really wish Congressmen didn't have federal healthcare, and they had to use the same insurance us plebeians use. That would help them fix up the system real fast.

> I really wish Congressmen didn't have federal healthcare, and they had to use the same insurance us plebeians use. They do; through 2014, like other federal employees (and most employees of large businesses) they had a choice of the private plans contracted by their employer. Since 2015, they've been limited to ACA exchange plans. http://www.factcheck.org/2009/08/health-care-for-members-of-...

Ah I didn't know that. Super cool, thanks for sharing

Re: YC Research: Universal Healthcare

#326

Post by shanusmagnus »

Thriptic wrote: post #186
Retric wrote: post #155

Earlier quoted context omitted.

Corruption. However, the line is generally described as: If companies can't discount per country then all countries end up paying high prices without discounts. However, if they can discount prices in some countries then that maximizes profits which increasing the customer base.

It's much more complicated than that. Sales in the US where they can charge more are what actually offer pharma companies good ROI. Effectively the US is subsidizing R&D for the rest of the world.

The implication of the 'subsidy' argument is that there's a certain level of profit required to drive a certain amount of product development and innovation. In other words, to get the current level of drug discovery / development / etc., pharma requires the current level of return.

The question for me is how how inelastic this relationship is. The pharma companies would have you believe that if some kind of price controls of some kind were put in place, and the total amount of profit to be had was reduced, then the inexorable result would be a scaling down of the whole process: a sinking tide lowering all ships. Is that a realistic model? I don't know. Is there way to know? I don't know that either.

It's easy to make religious claims from either side, but it would be nice to have a better sense of the system dynamics here.

Re: YC Research: Universal Healthcare

#327

Post by bluGill »

prostoalex wrote: post #296
bluGill wrote: post #198

Earlier quoted context omitted.

You forget one part: patients do not care what insurance costs because their employer chooses what they use and what price they pay. If I could buy health insurance separately from my company I'd look into it. I know my company pays at least as much as I do for my insurance, but if I go off the company plan I can't get that money to use for insurance I like. The result of this is I have incentive to not care what any…

> If I could buy health insurance separately from my company I'd look into it. You can always venture away from your employer and visit healthcare.gov or a relevant state exchange. From what you're describing I think what you're looking for is an HMO - either a branded facility like Kaiser or a "provider network" that agreed to guarantee prices to that specific insurance company. You won't gain much transparency thou…

Technically I can. However the cost to me is much more than what I pay now, even if I go with the most basic plan (which isn't even very basic - the law requires a lot of coverage that a true basic plan would exclude).

Re: YC Research: Universal Healthcare

#328

Post by athenot »

Thriptic wrote: post #186
Retric wrote: post #155

Earlier quoted context omitted.

Corruption. However, the line is generally described as: If companies can't discount per country then all countries end up paying high prices without discounts. However, if they can discount prices in some countries then that maximizes profits which increasing the customer base.

It's much more complicated than that. Sales in the US where they can charge more are what actually offer pharma companies good ROI. Effectively the US is subsidizing R&D for the rest of the world.

Not for European drug companies (and there are quite a few of them) who must negociate price in Europe, yet still cover all their R&D.

Those same comapnies then sell the same drug with pure profit (minus marketing & regulatory cost) in the US, for 4x the price because they have a monopily on it.

Re: YC Research: Universal Healthcare

#329

Post by mtrn »

Glad to live in a country that has something close to universal health care. Everybody needs to contribute a monthly share (independent of their condition) which amounts to over 200B per year in total. This seems enough for modern infrastructure, equipment, prophylaxis, medication.

That said, it's not super efficient and the incomes vary greatly between employees with strong lobby groups and laborers covered by legislation only.

Re: YC Research: Universal Healthcare

#330

Post by will_brown »

chimeracoder wrote: post #321
will_brown wrote: post #297

Earlier quoted context omitted.

>I'm talking about Medicare Advantage, not Medicare Part D. Most Medicare Advantage plans do include a Part D plan, but not all do. I would have thought 9 out of 10 advantage plans have part D drug coverage but its actually 82% at an average cost of $40/month. >Medicare Advantage consistently outperforms Original Medicare on medical outcomes, not just on patient satisfaction. Outcomes is a buzz word, if you want to t…

> Outcomes is a buzz word, if you want to talk Star Ratings and Quality Metrics, then we can begin to discuss what "outcomes" really mean If you want to talk about how metrics are imperfect, fine, but you can't claim that Original Medicare is somehow better unless you actually propose some concrete metrics on which it actually does outperform Medicare Advantage. As it stands, Medicare Advantage consistently beats Ori…

Every single Advantage patient is enrolled in "oringinal medicare" parts A and B, the only difference is those parts are administered by private insurance...and all the additional benefits and cost savings by law on these plans. That is to say the benefits and cost savings of advantage aren't there because the private market they are mandated.

Take my 1 example MTM, Medicare Advantage patients don't get that benefit because the private market is driving competition and better care, it's because by law the Avantage plans have to provide MTM under penalty of losing their Medicare contacts.

I'm not denying Avantage is better than original Medicare, but to claim the reason Advantage may be better is insurance companies and not the legally mandated benefits and costs of Advantage plans isn't good faith, especially when you already minimized >80% of the patients get mandated drug coverage. Yes it's good but is has nothing to do with insurance creating the market conditions that created the drug coverage, its law and subsidies. Though it will become clearer as the insurance continues to consolidate and Medicare patients will only be able to go to doctors, hospitals and pharmacies owned by the insurer, because that's where it's going for Medicare Avantage patients, costs will go down but I'll be damned if I call that a "good outcome".

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