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

211–220 of 537 posts

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

#211

Post by lostlogin »

joering2 wrote: post #159
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…

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.

How is that possible? Is the rest of the bill paid by the state?

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

#212

Post by lostlogin »

JAlexoid wrote: post #194
arcticfox wrote: post #167

Earlier quoted context omitted.

> 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.

That’s not an unreasonable charge for an MRI and I’d argue that you got off quite lightly. You can’t diagnose many of the potential problems shoulders have from an x-ray but a good clinical examination will catch many of them, with an MRI for confirmation. Labral tears would be an example of this.

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

#214

Post by minikites »

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.)

Both are about as real in practice as the Easter Bunny, so it's a distinction without a difference.

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

#215

Post by jorblumesea »

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…

Not really, most of the costs go straight to shareholders. 25% of our spending is "Administrative costs" aka profits for investors. The issues of American healthcare are well documented and not a mystery.

It boils down to two clear facts:

1) The US has no price controls whatsoever

2) The US has a for-profit system where your health is a business.

It's not that complicated. The rest of the world has it figured out for the most part.

https://www.commonwealthfund.org/publications/journal-articl...

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

#216

Post by adventured »

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.

It's about to stop working out very well for Japan. The costs in their system are exploding higher rapidly and putting everything at risk. Their system won't remain intact for much longer at the rate healthcare costs are outpacing economic growth.

Here's the relevant chart: https://i.imgur.com/s97bp9R.jpg

"Health-Care Paradox Threatens to Add to Japan’s Debt Problems"

"Japanese seniors, who enjoy the world’s longest life expectancy, pay as little as 110 yen ($1) out of pocket for specialist appointments. While these visits may help prevent expensive-to-treat diseases, they’re becoming unaffordable in a country where almost 1 in 7 people is 75 years or older, and annual health-care expenditure grew at a pace 40 times faster than the economy from 2000 to 2016."

https://www.bloomberg.com/news/articles/2018-12-13/health-ca...

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

#217

Post by JAlexoid »

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…

I try investing a lot in smaller pharma companies... and they are hammered by the big ones. Not on innovation, but on marketing.

I disagree about NHS type system, that reduces access. A healthy mix is required, though.

A lot of upfront costs are also footed by users and government/non-government funds. And a lot more of those costs are due to government regulation and essential insurance at development.

Pharmaceutics researchers aren't exactly rich, btw. Your dentist probably makes more than many researchers of life saving drugs.

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

#218

Post by lostlogin »

EvanAnderson wrote: post #183
arcticfox wrote: post #167

Earlier quoted context omitted.

> 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.

He may have been traveling when he had his heart attack: https://www.wsj.com/articles/john-stockmans-medical-bills-to... He may have been attended-to by out-of-network practitioner: https://www.nbcwashington.com/news/local/Out-of-Network-ER-S...

What’s with the ‘out-of-network’ thing that gets pulled out regularly? Is healthcare really that much more expensive to an insurer if it’s done at one site or another? Sure, they’d prefer it was done in-house so that the ticket can be clipped multiple times, but it’s clearly just made up numbers that are produced currently.

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

#219

Post by skwb »

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…

A good summary of the political economy that surrounds the US healthcare system is that people want healthcare that's: - fast - efficient - no restrictions on hospitals, doctors, or treatment - financed by taxes on the rich (defined in whoever is in a tax bracket higher than themselves)

Now this is obviously untenable. In my professional estimation (ex-health policy analyst) I think you CAN have a public option be viable. But financing it will likely have to be done by expanding revenue through middle class tax hikes (not just millionaires), which never fend very well in our current political climate.

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

#220

Post by taormina »

sdrinf wrote: post #171

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…

This is astounding. It used to be that doctors were not allowed to post their prices! Openness is needed to fix medical billing.
Post reply on HN