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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

#201

Post by JAlexoid »

airstrike wrote: post #14
mikeyouse wrote: post #4

Earlier quoted context omitted.

Meh -- If this is the case, it would be far better to explicitly fund research and development in a separate appropriation rather than just mindlessly subsidizing all prescription meds. Calamities like the Valeant fraud would be much less common without the US dramatically overpaying for drugs. https://www.newyorker.com/magazine/2016/04/04/inside-the-val...

The Valeant fraud was 90% sketchy accounting and 10% price hikes, more Enron than Martin Shkreli. By anyone's standard, they are not representative of the U.S. Pharma market as a whole.

What is representative of the US market, is the cost of marketing in US.

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

#202

Post by asdff »

ekun wrote: post #77
cpncrunch wrote: post #62

Earlier quoted context omitted.

But R&D isn't included in the OECD health spending database as far as I can tell. http://www.oecd.org/els/health-systems/health-data.htm

I think it wouldn't be explicitly included, but it goes into the bottom line of big pharma companies. There is a very lengthy process of getting drugs through the FDA which makes investment's return-on-investment difficult to justify without raising already available drug prices. (edit: Having said that, our healthcare costs are out of control and it's not directly because of the R&D. It has more to do with wild over…

>There is a very lengthy process of getting drugs through the FDA which makes investment's return-on-investment difficult to justify without raising already available drug prices.

The lengthy process is there for a reason, it's not some hamper on profits just to hamper profits. Do we believe that the FDA is full of short sellers? Poor Pfizer, they won't get more money than they've spent! The logic here is sinister. ROI on drugs shouldn't be every dollar spent gets you a dollar ten and a drug, it should be you have a drug. The basic research that informs R&D spending has a ROI of zero by business metrics.

It is sad to think that the trajectory of medical advancement is dictated not by what we can achieve as scientists, but what is profitable for businessmen. When Jonas Salk was asked who owns the patent to the polio vaccine he developed, he replied, "Well, the people, I would say. There is no patent. Could you patent the sun?" In 1988 there were an estimated 350,000 cases of poliomyelitis worldwide, in 2018 there were 29 (1). The global initiative to eradicate the disease would not have been possible had the vaccination been for-profit.

(1) https://www.who.int/en/news-room/fact-sheets/detail/poliomye...

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

#203

Post by ethbro »

tdhoot wrote: post #145
DennisP wrote: post #135

Earlier quoted context omitted.

You could, but you'd have to keep the money in savings anyway, and there'd be some hassle at a time when you might not want to deal with hassle. In practice, it turns out most people just pay their premiums, at least in Japan. But if it turns out to be a problem, you could always charge interest.

I wonder what they do if someone can't pay. The system doesn't seem too different from the US to be honest, in that people with poor financial planning skills may decide to skip on insurance premiums and end up not having enough money saved to pay for medical expenses/back premiums when they occur.

Be that as it may, it sounds like the Japanese system is much more effective at keeping prices low.

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

#204

Post by nerdponx »

tdhoot wrote: post #137
nerdponx wrote: post #40

Earlier quoted context omitted.

I'm not sure this holds up to scrutiny. Why don't other rich countries (e.g. Canada, which lets you pay for your own healthcare if you want) have this problem?

Source on Canada letting you pay for your own healthcare? It's usually prohibited.

I'm probably just wrong. I was under the impression that you could pay for private health care. I'm not Canadian.

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

#205

Post by nerdponx »

vasilipupkin wrote: post #84
nerdponx wrote: post #40

Earlier quoted context omitted.

I'm not sure this holds up to scrutiny. Why don't other rich countries (e.g. Canada, which lets you pay for your own healthcare if you want) have this problem?

Canada has equivalent of Medicare for all. And Canada has at least some of these problems, for example longer wait times. These long wait times don’t ultimately affect average outcomes.

I think you misread my post. By "these problems" I meant "overspending on things that don't improve outcomes."

But if paying for extra care is illegal in Canada then my argument doesn't work.

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

#206

Post by module0000 »

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.

You cap healthcare prices for insurers because they are heavily influencing the provider prices.

Both institutions work in tandem[0] with one another to establish pricing guidelines. That's why your hospital-purchased ibuprofen is $10 per pill instead of $6 per bottle. The insurer and hospital "work out" a price that let's them achieve the profit needed to pay their administrative costs, plus margin.

In the USA(this is all from a US citizen's perspective), there are regulations that limit what percentage(15% in my state) of an insurer's income can be profit vs administrative cost. This means that a higher hospital price results in a higher profit for the insurance provider. This provides both parties an opportunity to set prices for an optimal profit. With government-mandated health insurance participation, the pool of people paying into this system has increased.

It is what is. Tell your elected official if you think it would help.

0: Anthem, Blue Cross, and UHC executives sit on the Baptist Health(hospital chain) board of directors, and vice versa.

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

#207

Post by [deleted] »

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…

[deleted]

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

#208

Post by JAlexoid »

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…

If that's the case, then don't forget that a huge part of US drug market is marketing. Those expensive pharma reps are not a usual thing outside of US, and provide no value when it comes to the healthcare system overall.

When it comes to some really interesting drugs, prices and their accessibility are really strange.

Take HIV infection preventing Truvada. The "market" price of 30 pills is $1600 in US. It's a good drug for continuous mass use for Gilead. Instead of making it pretty much ubiquitous as vitamins, they chose to target only US market for the low volume high margins. So... I'm actually annoyed with Gilead over this. I own stock and getting good deals in Europe could get up to 50mil people on daily dose of it. That would push the stock wildly up! With 0 extra marketing, as it's not high on adverse reactions with massive preventative benefits.

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

#209

Post by ethbro »

whitepoplar wrote: post #186
kenhwang wrote: post #162

Earlier quoted context omitted.

And Americans tend to be overweight and unhealthy. Access to healthcare doesn't automatically shift culture to live a healthier lifestyle (and I suspect it might even do the opposite).

It would be great if gym memberships could be made free for everyone. I bet it would even be cheaper in the long run to buy an Equinox membership for every American than it would be to do nothing.

American health care plans are starting to offer financial incentives for maintaining fitness.

Which seems a bit like a tragedy of the commons situation.

In that insurance company X is paying me for later life benefits that may be reaped by insurance company Y that I have 40 years from now.

We need to hurry up and get to baseline genetic risks, then directly rebate insured out of a central pot if they exceed their expected fitness metrics.

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

#210

Post by [deleted] »

DennisP wrote: post #149
euske wrote: post #131

Earlier quoted context omitted.

One of the main reasons why I gave up career in the States and came back to my home country (Japan) was healthcare. I had a day surgery in the US and the whole experience (i.e. bills) just scared heck out of me. I am very happy with the system here. Everything is extremely efficient compared to the US. A little while ago, I had this mysterious headache and went to an orthopedist, dentist, psychiatrist, neurosurgeon t…

That fits with what the book described. The author had a bum shoulder and saw a doctor for it, in each of the countries he covered. In Japan he got an appointment immediately and the doctor offered surgery the next day. Financially they're the most efficient of all the countries in the book.

[deleted]
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