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The US spends more on healthcare for no gain says new report from Johns Hopkins

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Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#101

Post by pjmorris »

airstrike wrote: post #2

It's worth noting that the U.S. market does pay for the lion's share of patented drugs, effectively funding a significant portion of R&D that benefits the whole world years later when generics come into market (at least for those drugs which are not costly to manufacture, which happen to be the majority). I'm not saying this model is right. I'm just saying that doing away with it will have fundamental consequences to…

US GDP is ~19 Trillion. If US Health care spending is 18% of GDP, that's about 3.5 Trillion annually. Pfizer's (largest drug co) net income in 2017 was ~21 Billion [0], less than one percent of health care spending. I didn't tally the rest of the industry up, but I'd be surprised if it hit 10% of total costs.

[0] https://en.wikipedia.org/wiki/Pfizer

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#102

Post by tomlock »

kodablah wrote: post #94
tomlock wrote: post #54

Earlier quoted context omitted.

I think it is also worth noting that number of drugs patented is not necessarily the best metric for measuring healthcare success. I think one of the best is perhaps life expectancy - and that's dropping in America, patents or no.

I don't think anyone was arguing it is a success, so not worth debating that non argument. The commenter simply pointed out something that exists.

I am similarly pointing out something that exists, the falling life expectancy in America. I am also pointing out that patents are not a good metric for healthcare success, whether or not the OP intended that it be used that way.

I'm not debating anyone with my comment.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#103

Post by kodablah »

bluetwo wrote: post #22

Like the article says, previous research has come to the same conclusion. We pay much more, and are ranked nowhere near the top for lifespan, childhood mortality, and other measures. Obamacare was a great first step. Define what basic healthcare is and form markets that encourage apples-to-apples comparison. Let the free market work. Sucks that one party used this as a weapon to wrestle power. Oh well. Not going to a…

> Obamacare was a great first step

Disagree, it was a horrible first step directed at the demand instead of the supply. In fact, I couldn't think of a worse step of reducing provider-driven costs than heaping rules on the payers (insurers and their customers) to force paying into the system without equally significant rules controlling the suppliers. Obamacare has entrenched the ones charging all this money, not alleviated it.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#104

Post by DennisP »

mikeg8 wrote: post #81

The book The Healing of America by T.R. Reid, 2010 was a phenomenal look at this subject and the conclusion was this: we are the only developed nation whose government allows for-profit health insurance companies to exist with ZERO regulation to cap healthcare prices. Because of this, we spend 20% of every dollar on "administrative" costs compared to 3%-7% in the European and Asian countries. The goal for American he…

I read that book too, and agree it's phenomenal. It's not just about capping insurance profits. The countries doing the best also have price controls on the healthcare providers. Doctors make a lot less money. On the other hand they generally don't have to pay for medical school.

France, Germany, and Japan all have similar systems, according to the book. They have private nonprofit insurance, some kind of mandate to purchase it, a government price list on services, guaranteed coverage of anything on the list, and digital medical records.

A lot of German primary care doctors don't even hire office staff. They prescribe whatever they want, swipe your medical card, and they're guaranteed to be paid in a week, no questions asked.

Japan has a clever way to handle the mandate. If you don't pay your premiums, nothing happens, but if you need healthcare you're not covered until you pay your back premiums.

I wish all the Americans who think the rest of the developed world runs on single payer would read this book. None of the three countries I just mentioned use single payer. The book also covers Canada and the UK, both of which are single payer (and single provider in the UK), and while their results are pretty good, they're not as good as the other three.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#105

Post by bedhead »

Where does the money go? Aside from the waste and fraud, two places. First, we pay for convenience. We want to see a doctor now. We want immediate access to all the best equipment, and specialists, and drugs, and we don't want to wait around or travel far. And we increasingly want it for every citizen. Second, over treatment of the dying - no subject is more uncomfortable. When asked what the biggest problem Kaiser Permanente faced, Charlie Munger, board member, responded over treatment of the dying. Various estimates are half of all healthcare spending takes place in the final two years of peoples' lives. In both cases, we've essentially deemed care as "cost no object", and when that happens, things get sideways fast.

I'm not saying what is right or wrong, just what the problem is. Fast, cheap, good - you can always only pick two.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#106

Post by kodablah »

grecy wrote: post #71
harimau777 wrote: post #48

Are there any measures of how America does compared to Europe if you only count Americans that have good health insurance? It seems to me that many people who are opposed to socialized medicine don't necessarily disagree that it would give the poor better care; rather they fear that it will result in them receiving worse care.

> Are there any measures of how America does compared to Europe if you only count Americans that have good health insurance? Anecdotally, I'd say they do crap. Friends outside LA are upper-middle class. Extremely good health insurance for the last 20+ years. Had a baby, emergency C-section. Less than 12 hours later they were told they must move hospital or else pay the $60,000 per day out of pocket because their insu…

I think the commenter was asking about quality regardless of cost, especially for the upper tier.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#107

Post by elipsey »

I think it would be worthwhile to discuss more than just per capita cost. The way that these costs are distributed is important and, I believe, problematic. The problem here is not just that per capita cost is high, it’s that for reasons that are partly structural, and partly demographic, healthy young payers with lower incomes can be burdened with the full, un-subsidised, costs of insurance, while others consume services without seeing the price. Some people have tax subsidized employer sponsored health care, some people have socialized health care, some people pay for insurance out of pocket with post-tax income, and some people have nothing and have to negotiate costs under duress after they have already consumed services. Doctors will not commit to a price in writing in advance. If you think will, try it sometime ;)

I’m currently paying more then %100 of my annual income into an insurance pool, because I need insurance to protect my assets. (It’s complicated...) Moreover, the cost is not tax exempt because it is not employer sponsored. I’m healthy and don’t really consume much in the way of services. Meanwhile, others in the same insurance pool I’m paying into never see the price of their premiums, and don’t pay taxes on them. I understand that the point of insurance is to pool risk for insurable events, but how can we ever have an efficient market without price information?

As Milton Friedman put it “No one is as careful with other people’s money, as he is with his own.”

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#108

Post by gerdesj »

mikeg8 wrote: post #81

The book The Healing of America by T.R. Reid, 2010 was a phenomenal look at this subject and the conclusion was this: we are the only developed nation whose government allows for-profit health insurance companies to exist with ZERO regulation to cap healthcare prices. Because of this, we spend 20% of every dollar on "administrative" costs compared to 3%-7% in the European and Asian countries. The goal for American he…

we are the only developed nation whose government allows for-profit health insurance companies to exist with ZERO regulation to cap healthcare prices.

So what are you going to do about it?

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#109

Post by mikeg8 »

DennisP wrote: post #104
mikeg8 wrote: post #81

The book The Healing of America by T.R. Reid, 2010 was a phenomenal look at this subject and the conclusion was this: we are the only developed nation whose government allows for-profit health insurance companies to exist with ZERO regulation to cap healthcare prices. Because of this, we spend 20% of every dollar on "administrative" costs compared to 3%-7% in the European and Asian countries. The goal for American he…

I read that book too, and agree it's phenomenal. It's not just about capping insurance profits. The countries doing the best also have price controls on the healthcare providers. Doctors make a lot less money. On the other hand they generally don't have to pay for medical school. France, Germany, and Japan all have similar systems, according to the book. They have private nonprofit insurance, some kind of mandate to…

Thanks for your great comment and I agree especially with your last paragraph. While reading the book, I was so frustrated with how poorly my county has handled such an important issue, probably the most important.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#110

Post by jeromeparadis »

harimau777 wrote: post #48

Are there any measures of how America does compared to Europe if you only count Americans that have good health insurance? It seems to me that many people who are opposed to socialized medicine don't necessarily disagree that it would give the poor better care; rather they fear that it will result in them receiving worse care.

> ...rather they fear that it will result in them receiving worse care.

In Canada, we have free healthcare. If you have the money you still can go private if you think you'll get a better care.

But I guarantee you won't go private for hearth surgery. There's not market for it because the care you get is already the best in the public sector.

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