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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

#121

Post by rsj_hn »

d--b wrote: post #46
airstrike wrote: post #27

Earlier quoted context omitted.

As a U.S. immigrant who struggles to find truly healthy food choices in Manhattan of all places, I couldn't agree more.

Whole Foods is pretty healthy. Fresh direct is not bad at all. Fairway market...

Whole Foods has expensive food, together with a lot of outrageous health claims, but it's the industry black sheep in terms of health and sanitation.

Most supermarkets, for example require basic things like bathrooms and hand washing stations separated from food handling areas on agricultural farms that supply them with product. Not Whole Foods. There also have lots of issues with sanitation in their stores, especially given the volume they move from their salad bars.

I'd check them out a bit more:

https://www.barfblog.com/tags/whole-foods/

https://www.ajc.com/news/national/fda-letter-says-whole-food...

https://twitter.com/sarahtaber_bww/status/101318470059948851...

I'm hoping that the Amazon acquisition will lead to some much needed professionalization and normalization of their supplier requirements and processes, but we'll see.

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

#122

Post by DennisP »

jellicle wrote: post #111
DennisP wrote: post #104

Earlier quoted context omitted.

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…

Sufficiently advanced regulation is indistinguishable from single-payer - insurance is completely reliable, covers everything, and is completely fungible. Who cares what name is on the card? The easiest way to accomplish that is just to have a single government insurer. But you can finagle your way in the back door by regulating the shit out of insurance companies too. One-third of the US population is on a US single…

If you define single payer that broadly, ok. I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively.

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

#123

Post by refurb »

pjmorris wrote: post #101
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

Prescription drugs account for about 10% of all healthcare spending. It’s been pretty steady over the years.

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

#124

Post by will_brown »

refurb wrote: post #118
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…

Why would you cap healthcare prices for insurers, they don’t set prices. You mean providers? Half of US healthcare spending is public payers - Medicare and Medicaid. They do set prices for providers and still spend far more than other countries. And if you’ve been involved in US healthcare you’d realize it’s drowning in regulations already. It’s not a free market by a stretch.

It’s more complicated, the insurers essentially tell providers how to practice (ie prescribe this generic not the name brand, don’t prescribe 30 day Rx prescribe 90 day and don’t see/treat them in the meantime, etc...) and if the providers don’t listen the provider gets dropped from the network and either the patients are forced to new providers who the insurers control behind the scenes, or more and more the patients are forced to providers the insurers actually own.

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

#125

Post by tdhoot »

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…

>> 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.

Wouldn't it always be a good idea to not pay premiums until you have a major expense then?

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

#126

Post by PakG1 »

braythwayt wrote: post #99
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…

"Never confuse an unregulated market with a free market." --- (Yes, yes, I understand that to an economist, a "free market" is free of regulation, a product of laissez-faire economics. But to the lay person, a "free market" is one where prices are set by perfect competition, which requires a balance of power, the prevention of monopolization, and information symmetry.)

Really? I thought it was the other way around.

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

#127

Post by kaibee »

DennisP wrote: post #122
jellicle wrote: post #111

Earlier quoted context omitted.

Sufficiently advanced regulation is indistinguishable from single-payer - insurance is completely reliable, covers everything, and is completely fungible. Who cares what name is on the card? The easiest way to accomplish that is just to have a single government insurer. But you can finagle your way in the back door by regulating the shit out of insurance companies too. One-third of the US population is on a US single…

If you define single payer that broadly, ok. I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively.

> I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively.

How does all of this additional overhead provide more value to the consumer at the end? How are they actually differentiated?

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

#128

Post by MichaelApproved »

bluetwo wrote: post #83
MichaelApproved wrote: post #49

Earlier quoted context omitted.

> Let the free market work Respectfully, enough with this free market garbage. The healthcare industry is not a free market, it can never be. It's not possible for the consumer to be educated. Even if you put emergencies aside, when an unconscious person can't start price shopping emergency rooms, you still have regular office visits that are impossible to price shop. Ask yourself when the last time you asked your ph…

Free markets and regulations can co-exist. It doesn't have to be one or the other. The most successful markets are a careful balance of well crafted regulations. Healthcare in the US is not carefully balanced. BTW, hospitals in the US begin publishing their pricing data online this year. By law.

> Free markets and regulations can co-exist. It doesn't have to be one or the other.

Name one country on this or any other planet where this exists. Anywhere, except some bullshit theoretical textbook funded by a think-tank with obvious conflicts of interest.

> BTW, hospitals in the US begin publishing their pricing data online this year. By law.

More garbage. Those aren't real prices being published, they're approximations. And good luck calculating your service or trying to price shop while sick in bed.

I'll edit the comment and add a source for that soon. Found it[1].

The most ridiculous part is that some would call those published prices a good start. As if continuing down the road of an "educated consumer" is the right path.

IT IS IMPOSSIBLE FOR THE CONSUMER TO BE EDUCATED IN HEALTHCARE.

Prices are just a small part of it of the impossibility.

Doctors and nurses go through years of school. They go through all that because medicine is hard. Even the basic aspect of pronouncing the words is hard.

If you can't pronounce the words, how can you be expected to remember them and shop around, while sick...

EMS: You have a broken leg and a concussion. Which hospital do you want us to take you to?

Me: can you pull over for a few minutes while I lookup some prices? Actually, my service in the area is terrible. Does this ambulance have wifi?

EMS: Sure.

Me: Is it free?

EMS: No but you'll be happy to know the prices are published on our website.

Edit: [1] https://www.newsweek.com/end-hidden-costs-january-1st-all-us...

The prices listed are the retail prices while is not what the hospital usually charges. It's still not possible to know what price will end up on your bill. How much of a discount will you get at one hospital VS. another? Who knows...

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

#129

Post by pravda »

cameronh90 wrote: post #44
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…

It does appear to be the case that the US funds most pharma R&D due to Americans overpaying relative to the rest of the word. In some cases (China, India) this is due to weak IP protection, but in other cases (Canada, UK, Europe) it's more to do with our governments having a stronger negotiating position and setting hard limits on what they'll spend for a given benefit to patients. Some characterise this as freeloadi…

The "freeloading" meme is the creation of public relations groups employed by the pharma industry.

Drugs in the US are priced at the profit-maximizing price. That profit-maximizing price has nothing to do with how much pharma earns in other countries.

And it has absolutely nothing to do with the cost of R&D. R&D is a sunk cost, has no effect on drug pricing.

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

#130

Post by HillaryBriss »

one of the mysteries for me is always: economists love it when the government spends more money because of money multiplier effects (the old Keynesian idea of burying wads of hundred dollar bills in millions of bottles and then pay someone to dig them up and spend it).

but then, when you have this HUGE industry which literally spends hundreds and hundreds of billions on all kinds of nonsense like wasteful billing administration, unnecessary defensive medical tests, overpriced drugs, etc, the same economists are unhappy.

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