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I'm a Brit and America, your health care system is torturing me

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Re: I'm a Brit and America, your health care system is torturing me

#21

Post by pkaye »

virusduck wrote: post #16
tomc1985 wrote: post #2

The HMO system is misery. PPOs are better but costly :/

Are you in an area where Kaiser Permenente operates? It has been, on the whole, a great healthcare provider. The level of integration of their centers is great--I can walk downstairs for an MRI or Xray or lab test (no waiting for one doctor's office to phone in authorization/orders). Electronic records are fully and usefully integrated. Costs are relatively low, and there are several options of locations in my area--…

I'm using the KP health system. Its pretty awesome. Everything in integrated. I can use the website or phone app to check any of my test results. I can message my doctor for a e-consult at no extra cost. They usually reply within half day. I can book most appointments online. If I went to a specialist, I can continue messaging them in the future. And since the doctor is gate keeper, you just need them to approve a procedure and it will happen.

Re: I'm a Brit and America, your health care system is torturing me

#22

Post by pkaye »

vivism wrote: post #5
jschwartzi wrote: post #4

Earlier quoted context omitted.

HMOs are great if you're healthy and plan to remain that way for a while. I have the same deductible and co-pays as a PPO but pay about $200 less per month. The level of care is adequate for my needs, and I actually go to the doctor now because the HMO is integrated with the provider network, so I can book appointments online. Since the HMO also owns the lab and other facilities at the clinic everything that they do…

People don't plan to remain healthy?

I'm in kidney failures (due to an auto-immune disease.) I have to do dialysis every day. I'm super careful with diet and lifestyle. But many people are not. My dietitian tells me stories of dialysis patients that go out for massive fast food meals before coming in for dialysis. Dialysis functions maybe at 10-20% of a normal kidney. Its meant to keep you alive not pull out wastes products from your excesses. It doesn't do a perfect job. These people are slowly just killing themselves.

Re: I'm a Brit and America, your health care system is torturing me

#23

Post by tptacek »

rayiner wrote: post #10

I favor nationalized health insurance, but I worry American idealism would screw up implementation. The British are aggressive about rationing care. They aim to pay around 20-30,000 pounds per quality adjusted life year: https://www.bbc.com/news/health-28983924 There was an article on HN the other day that talked about how much debt a woman had incurred for her husband’s cancer treatment after she hit her insurer’s l…

Another problem is that for a variety of reasons, some of them structural, Americans consume significantly more medical services (diagnostics, procedures, visits) than Europeans do, without improved outcomes. There are fundamental inefficiencies in our system --- for instance, incentives have led to the creation of lots of small hospitals that see poor utilization --- that lead to this, and will be baked into any single-payer system we devise.

This concerns me enough that I oppose nationalized health insurance. I think the status quo ante of the ACA was intolerable, and that the system needs dramatic improvements (high on my list would be price transparency regulations), but that the core problem we have in the US is not that health care isn't universal, but that we pay too much for it, and baking that quietly into our taxes is an alarming proposition.

Re: I'm a Brit and America, your health care system is torturing me

#24

Post by tptacek »

jjeaff wrote: post #13

This is more of a sidenote, but after having way, way more experience in healthcare system over the past few years, I thought I would share my experience. The Affordable Care act made some big changes in health insurance. Unfortunately, making it "affordable" was not one of the things. But, if you do have money, you have the option now to have absolutely great health care. For about $1300 a month, you can cover a fam…

The ACA reduced the rate of growth in health insurance premiums, but health insurance premiums continue to grow and have been for decades --- spiraling health care costs were a part of the Republican Party platform... in 1980.

Guaranteed issue, community-rated health insurance is a necessity for a private health care system, and the ACA brought those badly-needed features here. But the big problem with US health care is simply that it costs too damn much to stay healthy, and those problems are structural more than they are a function of how we fund the system.

Re: I'm a Brit and America, your health care system is torturing me

#25

Post by tptacek »

zaarn wrote: post #20
jjeaff wrote: post #13

This is more of a sidenote, but after having way, way more experience in healthcare system over the past few years, I thought I would share my experience. The Affordable Care act made some big changes in health insurance. Unfortunately, making it "affordable" was not one of the things. But, if you do have money, you have the option now to have absolutely great health care. For about $1300 a month, you can cover a fam…

In 2017, the median income of households in the US was 61'000 $. Meaning half the population has to pay half their income (maximum) into this healthcare plan. And 61'000$ income isn't being dirt poor either. In some economic models this is the lower middle class in terms of income. For people who only graduate high school and no college, this is 80% of their income. If they go to some college about 70% (14'000$ left…

The key idea in the ACA that addresses this problem is subsidies: you get tax credits and (ostensibly) CSRs to offset the cost of health insurance if you're within some multiple of the Federal poverty line. Unfortunately, this is exactly the part of the system Congressional opponents of the ACA have taken direct aim at.

Re: I'm a Brit and America, your health care system is torturing me

#26

Post by kasey_junk »

tptacek wrote: post #24
jjeaff wrote: post #13

This is more of a sidenote, but after having way, way more experience in healthcare system over the past few years, I thought I would share my experience. The Affordable Care act made some big changes in health insurance. Unfortunately, making it "affordable" was not one of the things. But, if you do have money, you have the option now to have absolutely great health care. For about $1300 a month, you can cover a fam…

The ACA reduced the rate of growth in health insurance premiums, but health insurance premiums continue to grow and have been for decades --- spiraling health care costs were a part of the Republican Party platform... in 1980. Guaranteed issue, community-rated health insurance is a necessity for a private health care system, and the ACA brought those badly-needed features here. But the big problem with US health care…

But aren't those structural problems directly caused by the way we fund the system?

Re: I'm a Brit and America, your health care system is torturing me

#27

Post by tptacek »

kasey_junk wrote: post #26
tptacek wrote: post #24

Earlier quoted context omitted.

The ACA reduced the rate of growth in health insurance premiums, but health insurance premiums continue to grow and have been for decades --- spiraling health care costs were a part of the Republican Party platform... in 1980. Guaranteed issue, community-rated health insurance is a necessity for a private health care system, and the ACA brought those badly-needed features here. But the big problem with US health care…

But aren't those structural problems directly caused by the way we fund the system?

No, I don't think that's even partially true. Medicare also overpays for care and responds to the same structural wackiness the rest of us deal with. Medicare has lower administration costs, but those costs are still higher than administration elsewhere in the world, and administration is not actually where most of our dollars go.

Re: I'm a Brit and America, your health care system is torturing me

#28

Post by tptacek »

taurath wrote: post #11
deogeo wrote: post #7

Related: https://en.wikipedia.org/wiki/Health_system#International_co...

Thats a good quick chart I can use to pull up when arguing for a single payer system. I think the biggest problem with single payer in the US is cultural, not even political - people simply don't trust the national government to do anything at an acceptable level (except when it comes to defense, the post office (74% approval rating), and the CDC).

How does this chart address the question of how we should fund our health care system? The problem is how much we're paying, not whether we pay for it in payroll taxes or out of pocket.

Re: I'm a Brit and America, your health care system is torturing me

#29

Post by kasey_junk »

tptacek wrote: post #27
kasey_junk wrote: post #26

Earlier quoted context omitted.

But aren't those structural problems directly caused by the way we fund the system?

No, I don't think that's even partially true. Medicare also overpays for care and responds to the same structural wackiness the rest of us deal with. Medicare has lower administration costs, but those costs are still higher than administration elsewhere in the world, and administration is not actually where most of our dollars go.

So maybe I don't know what you mean by structural problems. I assumed you meant agency problems, administrative costs, medical professional pay, liability costs, over care & end of life care.

All of which are directly impacted by how we fund the system.

Re: I'm a Brit and America, your health care system is torturing me

#30

Post by deogeo »

tptacek wrote: post #28
taurath wrote: post #11

Earlier quoted context omitted.

Thats a good quick chart I can use to pull up when arguing for a single payer system. I think the biggest problem with single payer in the US is cultural, not even political - people simply don't trust the national government to do anything at an acceptable level (except when it comes to defense, the post office (74% approval rating), and the CDC).

How does this chart address the question of how we should fund our health care system? The problem is how much we're paying, not whether we pay for it in payroll taxes or out of pocket.

The chart shows a strong correlation between government funded healthcare, cost-efficiency, and effectiveness - that's how.
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