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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

#221

Post by cmrdporcupine »

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…

One of the problems with the Canadian system is frankly its proximity to the U.S. A large portion of our homegrown medical talent goes immediately south of the border for higher salaries (see your point about price controls on healthcare providers above).

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

#222

Post by laurentoget »

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.

It is much less free in France or Germany, and they spend considerably less for much better outcomes. You would never get an MRI for a sprained ankle in France, but on the other hand people do not die because they cannot afford insulin.

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

#223

Post by null000 »

DennisP wrote: post #135
tdhoot wrote: post #125

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

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 think a baseline requirement for these types of systems is that people don't go out of their way to be assholes for negligable gains.

My understanding of Japanese culture is that, by and large, people don't do that. Americans, meanwhile, have a pretty heaping helping of petty asshats. For exhibit A, go look up some of the asinine BS tax protesters try to get out of pretty basic civil responsibilities.

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

#224

Post by thinkcontext »

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…

The US pharma market is around $300B vs total health spending of $3T. Pharma is a big expense but certainly not amongst the biggest.

Costs for boring health issues like births, broken bones, diabetes and end of life care are what really matter. Oh, and administrative costs are way higher in the US.

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

#225

Post by JAlexoid »

pravda wrote: post #166
airstrike wrote: post #136

Earlier quoted context omitted.

> 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. That's not how this works. Volume is fixed because you effectively already know how many patients there are and COGS is minimal because drugs are generally very cheap to produce, so price and SG&A are the key drivers to determine returns

To save others the Googling: SG&A = Selling, General and Administrative Expenses. I'm not sure that you disagree with me. The higher the price the higher the returns, but price too high and you earn less money, because volume is not fixed. (I'd bet a lot less Viagra would be sold if it cost $500 per pill.) That was the genius of Martin S. He felt, correctly, that Daraprim was mispriced. That's why the price per pill…

I wrote on this above. As an investor in Gilead and a Truvada user, I really hate the fact that Gilead isn't making Truvada an effective vitamin for most of EU. It's an HIV infection prevention drug. It's priced for margin maximization at ~$1600 for 30 pills. I bet most EU countries could get on board with €20-€30 per month and have 10% of the population be on it. And EU has very low administrative costs, as many countries buy centrally.

I consider Martin to be a scumbag, but not much more than your average human being. He's a scapegoat, to the industry that would prefer a flashy Martin to scrutiny of their own actions. He should be free, as his conviction was a witch-hunt.

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

#226

Post by adventured »

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.

Legally the ER can't turn you away if you can't pay, in the US.

What they can do - specifically relevant if you're a US citizen - is send you a bill and then after you don't pay it send it off to collection agencies, which then harms your credit rating for the next five or seven years (I believe various states have different laws on when these have to drop off your credit rating, it's usually either seven years or slightly less). This has improved a bit lately, with new credit scoring updates that considerably reduce the hit from medical bill collections on your credit. However it's obviously still a ridiculous situation.

Most non-private hospitals in the US have low income programs you can sign up for (eg if you go into the ER due to an emergency and run up a big bill), that eliminate most or all of your bills if you fall under a certain income level. That's subsidized by government funding programs. Typically though if you're at that low of an income level, you should just sign up for Medicaid anyway. Those programs are usually most valuable when someone in the eg 22-50% income bracket (the most vulnerable in the US insurance system, where you're above Medicaid and below typical good paying career or job status) is caught inbetween insurance / jobs for a number of months and gets hammered by an ER visit.

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

#227

Post by null000 »

ascar wrote: post #172
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…

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 insuran…

> Also private patients can usually skip some waiting time (e.g. days instead of a few weeks).

See, now, that just really doesn't sound like a good idea to my ears. Why should someone be forced to sit through weeks of suffering while a handful of others don't, for the sole reason that they have more money to throw at the problem? I can understand buying better or more thorough treatment, or buying treatment from more expensive providers I guess, but line jumping via money just seems immoral when it comes to health care.

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

#228

Post by vasili111 »

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.

>I had this in US. Shoulder pain, that was diagnosed via an XRay... But the doctor decided he wanted an MRI.

Xray is mainly for bone problems. MRI shows well soft tissue. In medicine, if something you suspect even it has a low probability and the diagnostics are not invasive, it is better to check than to miss and regret later. Why are you so sure that MRI was not necessary in your case?

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

#229

Post by masonic »

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.

  Went to Germany got it done on the same equipment in luxury stay for 14 days at $870
A "luxury stay" in a plain hotel with no medical services should cost a lot more than $60 a day.

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

#230

Post by cpncrunch »

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…

Pharma company “bottom line” (or any other measure of pharma companies) isnt included in the OECD dataset. See link above.
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