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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#351

Post by tcbawo »

chimeracoder wrote: post #289
tcbawo wrote: post #273

Earlier quoted context omitted.

On another thread, it was explained to me that Medicare reimbursement for a vaccine doesn't even cover the cost of the vaccine itself. I'm sure there is a Byzantine reimbursement model, but something tells me that if the entire country switched over to Medicare overnight, vaccines would quickly get much more affordable.

> something tells me that if the entire country switched over to Medicare overnight, vaccines would quickly get much more affordable. Quite the opposite - if the entire country switched to Medicare overnight, Medicare would have to dramatically increase its reimbursement rates, or else hospitals would literally go out of business, and doctors would close up shop. The only reason most can afford to stay in business cu…

Medicare is a large and complex beast that typically underpays doctors and hospitals. My specific point, is that supply and demand allows the producers of vaccines to charge prices above what Medicare reimburses. In a single payer system, pricing power would force vaccine prices down. Apparently, by paying high prices, the USA is subsidizing the rest of the world.

Re: YC Research: Universal Healthcare

#352

Post by rayiner »

premium-concern wrote: post #346
rayiner wrote: post #332

Earlier quoted context omitted.

> An alternative scenario might be that drugs would get cheaper in the US, European drug prices stay the same and pharmaceutical companies somehow scrape by with lower (but still positive) profit levels. You're treating this as if it's a question of "fairness" to the drug companies, and it's not about that at all. If you could drive drug company profits to $0 with no collateral effects, it'd be unambiguously the righ…

> But if their revenue levels in the U.S. were at the level they are in Europe, they absolutely could not justify their enormous fixed costs. Maybe the public could help them substantially lower the costs by not allowing to advertise prescription drugs to laypeople? Agree with the GP. There is some massive Stockholm syndrome going on here. Some countries have well-functioning health care systems since the 18XX, not j…

> Maybe the public could help them substantially lower the costs by not allowing to advertise prescription drugs to laypeople?

That argument, though oft-repeated, is mathematically non-sensical. Unless companies are currently operating irrationally, one less dollar spent on advertising will result in more than one dollar lost in revenue.

Re: YC Research: Universal Healthcare

#353

Post by dx034 »

ameister14 wrote: post #320
dx034 wrote: post #304

Earlier quoted context omitted.

In many countries there is some element of private healthcare, but it only provides luxurious services that are in no way needed to treat health conditions (1-bed rooms in hospitals, choosing any doctor you like, shorter wait times for non-urgent treatments). Good examples here are UK and Germany. In both countries you'll get full coverage of any medical condition with public insurance. The reason that private elemen…

The UK is not a good example - it has a fairly unique nationalized system. Germany, on the other hand, has a regional and national market system with compulsive health insurance, much like the ACA attempted. It's not a public only system by any means. It's not about sharing a room, actually. It's about reducing the burden on the state, providing more efficient service for cost for everyone. Further, the main issue wi…

In Germany, it is about comfort. The public insurance is achieved via competing entities, but those are not-for-profit organizations. It's safe to say that there's no health benefit whatsoever of having private insurance in Germany. It's just nice and you can feel good getting quick appointments with any doctor you like. Necessary treatments are free for anyone else as well.

Re: YC Research: Universal Healthcare

#354

Post by ameister14 »

dx034 wrote: post #353
ameister14 wrote: post #320

Earlier quoted context omitted.

The UK is not a good example - it has a fairly unique nationalized system. Germany, on the other hand, has a regional and national market system with compulsive health insurance, much like the ACA attempted. It's not a public only system by any means. It's not about sharing a room, actually. It's about reducing the burden on the state, providing more efficient service for cost for everyone. Further, the main issue wi…

In Germany, it is about comfort. The public insurance is achieved via competing entities, but those are not-for-profit organizations. It's safe to say that there's no health benefit whatsoever of having private insurance in Germany. It's just nice and you can feel good getting quick appointments with any doctor you like. Necessary treatments are free for anyone else as well.

Hospitals in the US are also non-profits. Many insurers used to be as well.

The difference really is in who negotiates. In the US, it is usually individuals organizations or companies - in Germany it is mostly the state, though people still have choice. It's not administrated by the state, though - it's administrated through public/private partnership. Personally, I think it's a great system, and I wish the US would have implemented a version of it more successfully.

Re: YC Research: Universal Healthcare

#355

Post by premium-concern »

rayiner wrote: post #352
premium-concern wrote: post #346

Earlier quoted context omitted.

> But if their revenue levels in the U.S. were at the level they are in Europe, they absolutely could not justify their enormous fixed costs. Maybe the public could help them substantially lower the costs by not allowing to advertise prescription drugs to laypeople? Agree with the GP. There is some massive Stockholm syndrome going on here. Some countries have well-functioning health care systems since the 18XX, not j…

> Maybe the public could help them substantially lower the costs by not allowing to advertise prescription drugs to laypeople? That argument, though oft-repeated, is mathematically non-sensical. Unless companies are currently operating irrationally, one less dollar spent on advertising will result in more than one dollar lost in revenue.

Every dollar earned by advertising prescription drugs to the general population is a dollar that shouldn't have been earned in the first place.

See the Opioid epidemic that is still taking lives in the US for more than 20 years. Imagine what an economic benefit it would be for the populace if all those average middle-class Jane and John Does wouldn't have had their life shattered by addiction and instead would be holding down a steady job paying taxes.

Or imagine how much cheaper it would be if the US' reckless abuse of antibiotics in both humans and livestock wouldn't cause such a rise of multi-resistant strains of diseases.

Re: YC Research: Universal Healthcare

#356

Post by triangleman »

maxerickson wrote: post #323
triangleman wrote: post #112

Earlier quoted context omitted.

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.

What I meant by fraud, was not cases of outright fraud where someone bills Medicare for services never performed, although I'm sure that happens all the time.

I meant cases like the late night commercials "call now and get a free motor scooter! Just fill out a simple form and we will bill Medicare."

And more relevant are the cases where hospitals bill medicare huge amounts for long patient stays. Medicare always pays what they are billed, after all it's the government paying, they just write a check.

Meanwhile if you bill an insurance company they will negotiate, argue, refuse to pay, deny coverage, etc. If you bill an uninsured person they can also just decide not to pay in favor of paying more important bills like food and shelter.

So, the hospital is actually fine with this, they simply write off the unpaid amount on their taxes as a charitable expense, and increase rates, which Medicare will pay.

So, as you can see, Medicare (plus tax breaks) create a situation where the government subsidizes and distorts everyone else's health care costs.

Re: YC Research: Universal Healthcare

#357

Post by fuzzfactor »

Universal Healthcare is when a society is actually "rich" or "wealthy" in terms of truly having more than enough resources to perform essential care wholesale at no cost to patients,

and after that, when society chooses to prioritize the health care of all its citizens high enough to give equal care to all.

This doesn't usually happen, even in societies where the consistent waste of resources exceeds the total cost of universal healthcare.

Considering the resource shortage or surplus, when healing treatments are not denied to any needy members of society, that could be a fundamental marker of civilization, and an obvious measure of which societies are more advanced and which are more retarded.

Re: YC Research: Universal Healthcare

#358

Post by soperj »

markroseman wrote: post #237
soperj wrote: post #103

Earlier quoted context omitted.

What are you basing the yielded nothing on? Canada is well on it's way to Electronic Health Records.

Not so much. There are pockets, with poor interoperability between them. Multiply this by the different health systems (one per province, plus assorted others) and it's still a mess unfortunately.

The e-health standard was developed Nationally. You don't know what you're talking about.

Re: YC Research: Universal Healthcare

#359

Post by soperj »

esfandia wrote: post #138
soperj wrote: post #103

Earlier quoted context omitted.

What are you basing the yielded nothing on? Canada is well on it's way to Electronic Health Records.

It was a big time scandal in around 2009: http://www.cbc.ca/news/canada/toronto/ehealth-scandal-a-1b-w... Things may have changed since.

There was a scandal only in Ontario, doesn't mean that good work hasn't been done in that province, or other provinces.
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