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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

#191

Post by beatgammit »

elipsey wrote: post #107

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 ser…

I'm confused, do you have low income and a fairly large amount of assets? I can see this if you retired early or something, and in this case the comparison with your income really isn't particularly interesting.

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

#192

Post by mikeg8 »

refurb wrote: post #165
mikeg8 wrote: post #143

Earlier quoted context omitted.

I did mean providers, I worded that poorly. US government does not set max prices for procedures, checkups, test, drugs etc as other counties have wisely chosen to do. The reason we spend so much on Medicare and Medicare is because people are less hesitant to use the service. On a per capita basis, the public payers have reduced overhead and costs compared to the private markets. If you have sources proving me wrong,…

The cost of procedures for Medicare and Medicaid is still much higher than for other countries. Yes, they reduce costs by saying “this is what we’ll pay”, but it’s still much more costly than other countries’ systems.

And I agree with those two sentences - never was arguing that we pay less (compared to other models) in our public markets. But you are not strengthening a counter-point to the conclusion I presented from the book regarding zero price control in conjunction with for-profit insurances which jacks up overall costs through coverage disputes, excess admin work etc, lack of price transparency pre-treatment etc. What is your personal hypothesis for why US healthcare is such a poor value for the price?

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

#193

Post by philwelch »

DennisP wrote: post #114
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…

Yes, but there are better ways to do it. A natural group to pay R&D for patent-free drugs is health insurance companies, who would benefit from the lower costs, and perhaps even come out ahead. But its hard for those companies to organize such an effort, because they can get the same benefit even if they don't contribute. It's a classic public goods problem. Usually we solve public goods problems with taxes, and we c…

If this was the case in the US than birth control, Plan B, and abortifacient drugs would never have been invented here.

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

#194

Post by JAlexoid »

arcticfox wrote: post #167
joering2 wrote: post #159

Earlier quoted context omitted.

Just got hemoroids frozen and cut with laser. Cost here in USA under premium insurance was $12,000. Went to Germany got it done on the same equipment in luxury stay for 14 days at $870. Plus $800 plane tickets. Meanwhile a friend of mine had a heart attack. As a Bank of America emplyee he had somewhat goog insurance that paid some. He was left with $180,000 bill.

> As a Bank of America emplyee he had somewhat goog insurance that paid some. He was left with $180,000 bill. Forgive my ignorance but how is that possible? The highest out of pocket maximums for Marketplace plans is $15700 for an entire family.

There are interesting cases, where doctors prescribe stuff they get no valuable information from.

I had this in US. Shoulder pain, that was diagnosed via an XRay... But the doctor decided he wanted an MRI. That's no unusual, but unnecessary in my case. Got charged extra $500 for the pleasure. Thankfully I was on an HDHP, so the HSA savings got hit.

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

#195

Post by beatgammit »

bedhead wrote: post #105

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…

Do you have links to those estimates or a book recommendation?

I wonder if legalizing euthanasia would help significantly. Also, perhaps more awareness for geriatric strategies that promote comfort over cures. Many elderly people spend a ton trying to fix problems that can't really be fixed and should probably just have the discomfort treated.

Also, I wonder how we stack up against the rest of the world if we ignore expenses for people over the age of 70 or so.

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

#196

Post by luckydata »

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…

Ok but why focusing on the insurance systems that are still sub-par compared to Italy, UK and Spain where the single payer system yields even better results for less money?

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

#197

Post by JAlexoid »

philwelch wrote: post #144
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…

> 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. So what happens when you go to the ER? Obviously if it's a true emergency they'll save your life and try to bill you later, but then what? Would it ever make sense to deliberately stop paying your premiums? If you can pay "out-of-pocket" for m…

I presume for people that have jobs, the premiums are withheld. So only the minority never pays up.

That's hardly unusual. I come from a similar system.

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

#198

Post by guntars »

darawk wrote: post #87
cameronh90 wrote: post #44

Earlier quoted context omitted.

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…

> Does this make us immoral for "freeloading", because we prefer putting our limited money into cost effective treatments? It doesn't make you immoral, but it is important in understanding the tradeoffs of suggesting that the US switch to an NHS-style system. > Also, is it not worth looking at why pharma R&D costs so much? The pharma industry seems to run at a very healthy profit margin compared to most other industr…

Indeed, what is the purpose of the pharma industry if not making money for the shareholders?

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

#199

Post by luckydata »

DennisP wrote: post #153
philwelch wrote: post #144

Earlier quoted context omitted.

> 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. So what happens when you go to the ER? Obviously if it's a true emergency they'll save your life and try to bill you later, but then what? Would it ever make sense to deliberately stop paying your premiums? If you can pay "out-of-pocket" for m…

Maybe there's a little interest on back premiums. Whatever the details, it's working out very well for Japan. They get great results at very low cost.

Seems completely unnecessary though, just wrap that in the taxes and be done with it.

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

#200

Post by luckydata »

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…

This has been debunked over and over again. It's just not true.
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