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

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

jhsph.edu

Post reply on HN
Print view View original

171–180 of 537 posts

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

#171

Post by sdrinf »

PSA: As of 2019, federal law requires all hospital & doctors to post prices in a machine-readable format.

The results are pretty striking, esp here in the Bay: eg UCSF ( https://www.ucsfhealth.org/about/pricing-transparency/ ) charges $2600 for 1-way and 2-way chest X-rays, but charges $220 (that’s two _hundred_) for 3-way chest X-ray. The difference? How many angles they take of your body -ie, a 3-way includes the 2 & 1-way; and, more notably, the 3-way was used as a chargemaster item used in pricing estimators. So eg when I went in for a routine chest x-ray, I've expected a $300-ish bill, and got charged with a $2600 one. Knowing these prices now allows me to ask specifically from my doctor to select the diagnosis&intervention with the highest benefit/cost ratio.

I’m really curious seeing consumer reactions to this, because current medical billing practices must die.

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

#172

Post by ascar »

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…

Germany has a split system between mandatory government healthcare and voluntary private healthcare, once you pass a certain income threshold (about 80% above average income) or are self-employed.

There are differences. The voluntary insurance usually pays 2x to 3x of the mandatory one and covers more treatments that are seen as optional by the government insurance. E.g. physiotherapy is covered by government insurance only for clear indications while private insurances might cover it as a precautionary measure in many more cases. Also private patients can usually skip some waiting time (e.g. days instead of a few weeks).

But (nearly) everyone is covered, government or private, and can go to the doctor without worrying about money.

Even the government insurance isn't a single entity, but you can choose between multiple providers. All charge the same 14.6% of pre-tax income (capped at ~55k income) plus an additional 0.7% to 1.x% depending on the provider. They also compete on additional services. E.g. my provider adds a free professional tooth-cleaning per year and free travel-vaccination among other things.

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

#173

Post by FiveSquared25 »

friedman23 wrote: post #120
grecy wrote: post #33

Earlier quoted context omitted.

Except that every company involved in the healthcare industry in America (drug companies, insurance companies, hospitals, etc.) make hundreds of billions (or trillions) in profit each and every year. The reason for the high prices is because healthcare in the US is an extremely, extremely lucrative for-profit industry.

> hundreds of billions (or trillions) in profit each and every year. No company makes trillions of dollars in profit.

The industry

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

#174

Post by sanjiwatsuki »

I see people saying that drugs in the US are twice as expensive as other countries in the comments. I'll summarize [0] which is one of the sources for that number.

People in the United States spend roughly 2x per capita compared to Germany, Canada, and the UK. This does not mean that drugs in the United States are twice as expensive.

The US tends to use newer molecules in the drugs that are purchased -- particularly ones that are still patented and more expensive. Other countries like Germany and the UK tend to use older drugs (e.g. molecules over 30 years old).

A naive analysis would notice that the US spends more on drugs for a lower number of sales and would conclude it's because prices are high, but that ignores the fact that US doctors tend to prescribe newer on-patent drugs which are -- drumroll -- more expensive and not necessarily more effective. I'd argue this is the fault of the doctors prescribing the drugs more than any drug company's fault.

If you examine Exhibit 6 in the study, you'll see that, yes, the United States does tend to have more expensive drugs than most other countries but it is NOT an outlier. For example, Japan and Mexico pay more than the US for the same drugs on average. Drug prices are not nearly as big of a problem as people make it out to be.

Also, to its credit, the US also has significantly cheaper generics and over-the-counter drugs.

[0] https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.1....

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

#175

Post by zanny »

nickchuck wrote: post #168
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…

From what I understand, the healthcare market isn't free at all. LOTS of regulation is what has caused this mess I believe.

Its impossible to do an apples to apples comparison but I would imagine by most standards EU health markets are less regulated than American ones, just because the organizational structure is so much simpler and oversight is so much less distributed. Instead of needing policy on every kind of machine you can use in what configuration or parameter codified in law or by an agency by formal declaration the NHS just buys the stuff they want doctors to have.

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

#176

Post by jdhn »

kodablah wrote: post #103
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 alle…

Completely agree. Someone on LinkedIn shared an article that was written by the CEO of Blue Shield of California that was basically bemoaning efforts to overturn the ACA under the guise that people would become uninsured. Never once was it mentioned how much money has been made by insurers due to the additional people who’ve signed up because of the ACA.

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

#177

Post by tathougies »

mrep wrote: post #170
jdhn wrote: post #157

Earlier quoted context omitted.

>If you don't pay your premiums, nothing happens, but if you need healthcare you're not covered until you pay your back premiums. So what happens if you don’t pay your premium but then have to use the ER? Do they refuse to take you, or are you stuck with a bill? Does that bill go away if you pay your back premiums or not!

Don't quote me, but I've read many places in the US that ER's are required to take you if you are in a life threatening situation and if you cannot pay, the hospital just ends up owning the costs and then passes those costs to everyone else through insurance fees.

Is that in Japan (where the question was asked) or the United states?

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

#178

Post by greeneggs »

jellicle wrote: post #115
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…

Most drug research is paid by the US taxpayer through research grants, not by private companies. Pharma company marketing budgets much exceed their drug research budgets.

Do you have a source for this? From what I can find, e.g., [1], the government only pays for about 1/3 of the costs. And the government funding is usually more for the underlying basic science and preliminary results, compared to the drug companies that develop drugs, test them and bring them to market. These last steps, which are ridiculously expensive, have not been a government area of expertise. (The same pattern holds for most any technology, the government supporting the basic research while more applied research and development is left to private companies.)

[1] http://thebalance.com/who-funds-biomedical-research-2663193

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

#179

Post by philwelch »

rsj_hn wrote: post #97
orangecat wrote: post #76

Earlier quoted context omitted.

Health insurers and hospitals have profit margins under 5%. Pharma margins are larger but not outrageously so. https://www.investopedia.com/ask/answers/052515/what-usual-p... https://www.advisory.com/daily-briefing/2017/05/18/moodys-re... https://www.bbc.com/news/business-28212223

That doesn't mean anything at all. The problem is dissipation of rents -- when an industry gets an economic rent, expenses will tend to increase to the maximum allowed by market discipline. This is true for all bureaucracies -- e.g. Universities are always out of money but keep charging more. Hospitals are always out of money but still charge too much. That a firm finds a way to spend the money does not mean that the…

So where does the money physically go? If I’m a rent-seeker, I still have an incentive to be stingy with my expenses. The only reason I wouldn’t would be if someone else had a monopoly and was rent-seeking on me, but who’s doing that?

I wouldn’t rule out the possibility that it’s rent-seeking all the way down, but you’d have to make that case. Suppose you say, doctors and pharma companies are rent-seeking, and I say doctors don’t really bring home the bacon and pharma has a 5% profit margin. Then you say, well, it’s the bureaucrats, and then I say, why doesn’t some pharma company just fire the bureaucrats and keep the profit margin to themselves? They can’t because of regulations? That’s not even rent-seeking anymore, it’s just over-regulation and you can fix it with deregulation.

OK, well, the doctors have their student loans and the pharma companies have some other requirements that they need universities for, so universities are the real rent-seekers. Except it’s not the universities, who are broke, it’s—well, who seeks rent from universities? I’m not ruling it out, but this is also starting to sound like it leads back to the Rothschilds somehow.

You can’t just say “Americans pay more for X therefore rent-seeking”. There are lots of things that can cause inefficiencies.

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

#180

Post by SilasX »

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…

There’s nothing innovative about cutting off someone’s health care until they can pay, and it probably wouldn’t last long as a policy here.
Post reply on HN