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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

#281

Post by tptacek »

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…

If health insurance companies are the problem, why are administrative expenses --- which we overspend on, to be sure --- not the dominant factor in our health care expenses? They aren't; they're not even in the top 3.

If Medicare managed all of US health care and nothing else changed (that is, if we relied on Medicare for funding and kept the rest of the system we had intact), we'd reduce prices by something in the low teens percentage points. Families upset about the cost to insure their families on the ACA markets would not be mollified by that level of price relief.

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

#282

Post by JAlexoid »

pytyper2 wrote: post #119

They spend more on healthcare because a corporation presented a bill with a larger total at the bottom. NO human goes to the hospital and says, "...please charge me 37 dollars more than last visit for that generic aspirin..." All you international geniuses, help us out, stop investing in the for profit US healthcare system. Sell your holdings today, don't invest your retirement in funds that invest in for profit heal…

We will not. USA is the global piggy bank.

Honestly - it is.

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

#283

Post by Fej »

Judging by the comments, there are a lot of us here who already know this. So what are we going to do about it, now? The system is broken but there are a number of entrenched interests who want to keep it that way and an electorate willing to buy whatever they say.

I am short on hope.

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

#284

Post by samatman »

vasili111 wrote: post #235
cmrdporcupine wrote: post #221

Earlier quoted context omitted.

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).

If you need talents to stay in your country then you need to pay them more.

I think that misses the point.

Germany pays doctors less, and can, because the switching cost is far higher. Canadians get to keep their first language (most of them do at least), stay on the same continent, which reduces travel to see old friends and extended family, and otherwise have fewer culture shocks to adjust to.

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

#285

Post by interlocutor »

The reason healthcare costs so much more in the US than other countries, is health insurance. When insurance pays for everything patients don't care how much the medical providers are charging, or whether they are providing unnecessary services. When somebody else (i.e., insurance) is paying, the individual consumer is encouraged to consume without any restraint. When all consumers behave this way, healthcare providers are able to charge sky-high prices and unnecessary services, which in turn causes insurance premiums to go up. (Look up "tragedy of the commons").

The solution is to make the consumer participate in driving costs down. One employer I know of has an excellent solution to the problem: Make employees pay 100% of the bill up to a certain amount, such as $6000. That's a large amount, but the employer then contributes a large amount to your Health Savings Account (HSA), such as $4000. This amount is for you to keep regardless of whether you have any health bills or not. (This money can be used for medical expenses only, but can be used any time, including after retirement). So the maximum you will spend out of pocket per year is $2000. How does this encourage the consumer to scrutinize and control medical expenditure? Because the first $6000 of medical spending in a year is "your money". This is money you'd be able to keep in your HSA if you didn't have any medical expenses. This gives the consumer a strong incentive to reduce costs, question charges, avoid unnecessary services, and so on.

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

#286

Post by analog31 »

nickhalfasleep wrote: post #271

I wonder how long other industries will let the healthcare companies get away with this. The first Fortune 500 company to give it's employees free travel to Mexico, Canada, or Cuba for affordable care will cause quite a few waves. Or a smart country could open up "embassy clinics" throughout America, offering affordable healthcare and taking the profits back home.

I've thought about a similar arrangement, where a state could contract its entire health care system to a smart country.

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

#287

Post by refurb »

module0000 wrote: post #206
refurb wrote: post #118

Earlier quoted context omitted.

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…

Health insurers and providers negotiate payments for healthcare. They sit on the opposite side of the table - insurers want the lowest price and providers want the highest price.

The only benefit an insurer would have from a higher price is if they have a monopoly position - no other insurer. Otherwise the other insurers will pay less, charge a lower premium and grab all the customers.

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

#288

Post by tptacek »

will_brown wrote: post #124
refurb wrote: post #118

Earlier quoted context omitted.

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.

It’s more complicated, the insurers essentially tell providers how to practice (ie prescribe this generic not the name brand, don’t prescribe 30 day Rx prescribe 90 day and don’t see/treat them in the meantime, etc...) and if the providers don’t listen the provider gets dropped from the network and either the patients are forced to new providers who the insurers control behind the scenes, or more and more the patient…

Ok, but Americans overconsume health care and are prescribed more procedures than other countries --- that's a dominant factor in our health care costs, unlike prescription drugs and admin costs. How do insurers, which have a direct financial incentive not to fund care, own that problem?

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

#289

Post by int_19h »

nerdponx wrote: post #204
tdhoot wrote: post #137

Earlier quoted context omitted.

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.

You can pay for private care for things that aren't covered by the public system.

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

#290

Post by komali2 »

lostlogin wrote: post #279
roganartu wrote: post #239

Earlier quoted context omitted.

It's not that it's more expensive at one place or another for the most part. When you go in-network you are seeing providers that your insurance has a contract with. This contract includes agreed amounts for procedures. Providers will often grossly overbill (mostly because it's easier to let the billing backend resolve these limits than bill accurately in the first place) and your insurance will respond with the amou…

I understand this, but don’t understand why millions of people are ok with the system. It has a lot more in common with a protection racket than with patient care in my view.

Propaganda and lobbying by the insurance companies ensure that the will of the people doesn't turn against them.
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