Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Why Americans Spend So Much on Health Care–In 12 Charts

wsj.com

Post reply on HN
Print view View original

111–120 of 138 posts

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#111

Post by peterwwillis »

richmarr wrote: post #65
peterwwillis wrote: post #52

Earlier quoted context omitted.

I have a reason to partly blame consumers. Recently I went in for a consult to see about an operation. Before the consult, they asked for a pee sample. After the consult I got a bill, including the lab work. I never got the operation. The doctor never needed that lab for the consult. I don't think they even performed it that day. They just threw an extra step into the procedure, knowing that most patients would just…

> The blame falls on me here because I put blind faith in the doctor's office and did not fully investigate everything being done and approve or deny things based on my questions. The thing you are describing is not the problem. In a normal healthcare system patients aren't expected to second-guess and interrogate doctors.

Sure, but we don't have a normal healthcare system, and we can't just convert it into a normal one, either.

It's a bit like big distributed systems. Before it is built, you can design it the way it should be done. After it is built, you can completely rebuild a new one from scratch, and migrate over to it over time. But it is incredibly costly, difficult, and impractical to retrofit the existing system to the point that it operates in a completely new ideal way. You can patch it, but the more patches you add, the more of a Frankenstein's Monster it becomes, getting slower, uglier, costlier, and buggier.

As much as it would be great to just upgrade the system per-state, the medical industry (as I understand it) is basically a national monolith. What I'm proposing, unfortunately, is patches. But I don't see a way around it other than rebuilding from scratch.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#112

Post by komali2 »

harryh wrote: post #100
improbable22 wrote: post #94

Earlier quoted context omitted.

Quite a few US states are bigger than EU countries which manage to run their own decent systems. (e.g. NY: 19 million, Switzerland: 8 million.) What's the argument against letting them run it? Maybe there have to be some federal ground rules. But having wider experimentation would seem like a good thing, for discovering good ways to run a system.

It could work but you'd probably have at least a moderate free loader problem with it being so easy to move from state to state. There would be nothing to prevent a healthy person from living in a low tax/no gov't health care state until they get sick and then moving to a high tax state/state paid for care.

There would be as much to prevent that as exists today. Very few people actually move from their hometowns, no matter how bad things get.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#113

Post by rayiner »

gremlinsinc wrote: post #108
rayiner wrote: post #15

Earlier quoted context omitted.

Do democratic politicians have some sort of training in maintaining the farce that more things should be handled by government, when governments in Illinois, California, New York, etc.--democratic strongholds where Republicans cannot be pointed to as the scapegoats--are on the verge of bankruptcy? I don't think, deep down, republicans think the current system is better. They just don't trust whatever replaces it won'…

We could spend a lot less money on un-needed things. For one, why are we the police of the world? What if we shut down ALL military bases abroad, docked most of our carriers except in times of war, put half the military on reserves. What if we capped politician benefits across America at what the average American's is? One big thing is-- if we ended Healthcare's ability to 'lobby' washington... made it illegal to spe…

> What if instead of single-payer hospitals would take 'subscribers' locally, they'd pay 6% of their income. Make it a requirement that every American needs to signup with a hospital, and that all hospitals need to take anyone regardless of income or lack thereof.

Unrealistic ideas are easy to throw around. In Germany, health insurance premiums are a mandatory 15.5% of income. Are we ready to impose a new 15.5% tax on everyone?

> We'd no longer be wasting ANY money on insurance CEO's, etc...

> What if we capped politician benefits across America at what the average American's is?

Feel-good moves that would save little real money, because at the end of the day what costs money are the salaries for all the middle class people involved in the health care system (doctors, nurses, administrators).

> progressive income taxes for consumption/vat instead... a vat would be paid by anyone in the country regardless of legal status, citizen or immigrant.

Except the people who want universal healthcare want the tax system to be even more progressive.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#114

Post by alphabettsy »

The common refrain that we will improve healthcare by keeping the government away and relying on the free market ignores the fact that most people are unable to shop for healthcare. Consolidation, price obscurity and immediate need makes that impossible. Even if it were possible, will there be uniform methods for describing the services and total price of services so that people can shop around?

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#115

Post by harryh »

komali2 wrote: post #112
harryh wrote: post #100

Earlier quoted context omitted.

It could work but you'd probably have at least a moderate free loader problem with it being so easy to move from state to state. There would be nothing to prevent a healthy person from living in a low tax/no gov't health care state until they get sick and then moving to a high tax state/state paid for care.

There would be as much to prevent that as exists today. Very few people actually move from their hometowns, no matter how bad things get.

The issue is that a big % of medical expenses come from a small % of people. It would only take a relatively small number of these people moving to make a big difference in expenses. And it's the people with the highest expenses who would have the most incentive to move.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#117

Post by komali2 »

harryh wrote: post #115
komali2 wrote: post #112

Earlier quoted context omitted.

There would be as much to prevent that as exists today. Very few people actually move from their hometowns, no matter how bad things get.

The issue is that a big % of medical expenses come from a small % of people. It would only take a relatively small number of these people moving to make a big difference in expenses. And it's the people with the highest expenses who would have the most incentive to move.

Sounds like, if true (I was under the impression that a big % of medical cost is due to artificial cost inflation due to the existence of insurance companies), the people costing the system the most amount of money are the least able to move, because they're, you know, dying. Or have some other debilitating condition that requires them to stay with the doctors that know what's going on.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#118

Post by improbable22 »

gremlinsinc wrote: post #104
jcadam wrote: post #81

Earlier quoted context omitted.

> Healthcare costs are by far the #1 reason why I want to move out of the U.S. as soon as possible. Hope you and your family are in perfect health if you plan to immigrate to a country with socialized healthcare. Most such countries will reject families with an autistic child, for example, based on the notion that said child will be heavily dependent on govt/health services.

What is your source for this? I know people in Canada and France with autistic kids who have never had any such issues.

Did they move there with an already-diagnosed kid?

There was a professor in the news for leaving New Zealand (I think) recently for exactly this reason. Because his kid was autistic (or something) the authorities were highly reluctant to grant him residency & hence lifelong care.

Edit: here's the story, 13-year-old stepson in fact: https://www.theguardian.com/world/2016/feb/16/prestigious-ac...

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#119

Post by dnomad »

tptacek wrote: post #107
dnomad wrote: post #49

Earlier quoted context omitted.

You're really disconnected from reality of you think California and New York, the two most dynamic and wealthiest states that actually fund directly and indirectly most of the other states, are on the verge of bankruptcy. Try coming back to the real world and examining the facts. There's a very good reason why certain states are high tax and high growth while others are welfare operations that unfortunately can lever…

California and Illinois have two of the worst fiscal conditions in the country, ranked #43 and #49 (by GMU) among states respectively, based on cash on hand vs. immediate obligations, debt to income, and liabilities to assets. California's unfunded guaranteed pension obligations alone add up to almost half its personal income. Don't even ask about Illinois. New York isn't much better. It's #39. New Jersey, home to a…

California is the 5th fastest growing state economy. This is despite already being the largest state economy by far. That is simply remarkable and to call such a state of affairs "verge of bankruptcy" is just stupid.

Further the noise around pension obligations is mostly meaningless alarmism from people who don't know any better. If California is on the verge of bankruptcy why is California's bond rating at AA-? Why is New York's bond rating is AA+? Why are investors all over the world, particularly sovereign wealth funds, in fact standing in line to loan money to these high-tax, high-growth US states? Ex-real estate and ex-China, these economies are in fact the engines of growth for pretty much the Western hemisphere.

We'll see how long it lasts though. The thesis here is that when you combine the nonsense alarmism around debt and the cherished American belief that governments can do no right you get a recipe for enormous underinvestment and malinvestment. And Americans are so disconnected from reality that they probably will vote for any idiot who starts crying about "fiscal responsibility" and cuts public investment in these economies.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#120

Post by maxxxxx »

komali2 wrote: post #96
whatok wrote: post #33

Earlier quoted context omitted.

What's the first word in the act's name?

Affordable. You opened the can of worms, now eat it. Healthcare costs were always increasing. That trend slowed under Obama. https://www.factcheck.org/2015/02/slower-premium-growth-unde... Democrats wanted a much better of the ACA, but let's not forget that Republicans were walking around talking about how they'd "oppose anything Obama did," without even reading the texts of the bills http://swampland.time.com/2012/0…

I would have much more respect for the Republicans if they had actually come up with some reality based proposals how to improve things for not wealthy patients instead of pretending that getting rid of Obamacare is the only thing needed to fix the "best healthcare system in the world".
Post reply on HN