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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

#291
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…

Are those the list prices, or the negotiated prices the providers pay insurers? From my understanding and in my limited experience there is virtually no relationship between the two, and, in reality, even the uninsured don't end up paying list.

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

#292
post #254

Earlier quoted context omitted.

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 negative MRI result can be just as informative as a positive one. Maybe your XRay gave the doc only 80% confidence in the diagnosis, and the MRI was to rule out a larger issue. Like an engineer, doctors work deductively to rule out potential diagnoses, so all that is left is the correct one. Inductive logic brings in subconscious bias and assumptions.

Nope. He ordered MRI immediately with the XRay... and he didn't even look at it, as I was informed by the assistant.

I checked if he needed to do that with my other doctor - he said that only one was needed, not the other.

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

#293

It's worth noting that a recent analysis of S.1804, the Medicare for All Act, "could reduce total health care spending in the U.S. by nearly 10 percent" [1]. Even conservative analysis [2] has the program project to save in the trillions over a decade. All while providing comprehensive, universal healthcare, free at the point-of-service. Also, Medicare For All would theoretically be able to command substantially lowe…

Why would I be excited about a proposal to totally restructure an industry that every American comes into contact with and that represents something approaching 20% of our economy just for the prospect of a ten percent savings? Take any family complaining today about the cost of a Silver plan on an ACA exchange, offer them a 10% savings, and see if they're OK with what they're paying.

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

#294

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.

Fortune 500 companies already frequently self-insure their employees.

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

#295

Earlier quoted context omitted.

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.

No it's not an unreasonable charge. The amount I had to go through and the necessity of it was the question.

I got charged with two things - XRay and MRI. One was enough, apparently... And I wasn't in any critical condition to an XRay immediately.

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

#296
post #262
post #236

Earlier quoted context omitted.

Why do you think line-jumping is more immoral than getting worse treatment? In one case you just have to wait in non life-threatening and non-urgent cases (you only have to wait if you actually can wait). In the other case you are actually in a worse physical or mental position.

This is like if the whole town is on fire, but you have enough money to pay the fireman to save your house first. Priority access to universal needs shouldn't be given based on personal wealth. I wonder if the people who wrote this line jumping into law qualified for the public or private insurance.

> universal needs

Not everyone agrees Person A's needs should be paid for by other people. The system described (that pays for everyone, but treats people that can afford it better) may be a reasonable compromise to those people.

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

#297

Earlier quoted context omitted.

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?

I saw my other doctor, slightly more decorated orthopaedic surgeon, that literally told me that I was blasted with XRay for no reason or my MRI wasn't necessary.

I have an irritating bone spur in the shoulder, that's the only problem.

The doctor ordered both Xray and MRI at the same time, while there was literally no need for one of them.

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

#298
post #97

Earlier quoted context omitted.

That doesn't mean anything at all. The problem is dissipation of rents -- when an industry gets an economic rent, expenses will tend to increase to the maximum allowed by market discipline. This is true for all bureaucracies -- e.g. Universities are always out of money but keep charging more. Hospitals are always out of money but still charge too much. That a firm finds a way to spend the money does not mean that the…

So where does the money physically go? If I’m a rent-seeker, I still have an incentive to be stingy with my expenses. The only reason I wouldn’t would be if someone else had a monopoly and was rent-seeking on me, but who’s doing that? I wouldn’t rule out the possibility that it’s rent-seeking all the way down, but you’d have to make that case. Suppose you say, doctors and pharma companies are rent-seeking, and I say…

Yes, you, personally have an incentive to be stingy.

But when you are talking about a big organization, they find ways of spending money because the managers of the organization are not aligned with the shareholders. Every organization has pressure to keep expanding because there is always more stuff that could be done, and you can hire people to do that stuff up until the total earnings are in line with the market return irrespective of the above average earnings that could be had without all the extra activity. They will keep spending on marginal expenses to "defend" their rents up until no rents are to be had. This is called rent dissipation.

A good example would be education, and count the number of educational administrators, gold plated dorm rooms, activity centers, weird classes, etc. Then go look at hospital spending. Instead of the nurse giving you a tylenol, they invest in a prescription dispensing vending machine that costs $$$, and they hire more administrators. Then take a look at your standard corporation and look at all the odd positions they have that a "lean" smaller company or a start up would never have. Compliance officers, marketing staff, assistant to the marketing staff, support services, travel support, real estate management services, etc.

So you can think of this as a law of bureaucracy, unless there is someone imposing discipline on the cost side, the managers of a bureaucracy are going to grow that bureaucracy until they run out of money. This is how ATT ends up funding basic research and discovering the cosmic microwave background radiation. Because they have all this money to spend. And I guarantee you that at its halcyon days when it was obviously a monopoly and thus earning monopoly rents, ATT was not earning more than the average market return on their investment because they kept "investing" in hiring more staff and more resources up until the total return fell to the market required return.

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

#299

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.

No, the US needs to stop over-paying their doctors.

And doctors need to stop being corrupt by reducing supply of doctors through restrictive medical school entry.

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

#300

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…

We don’t pay for that drug research via insurance though—even worse it’s our taxes that fund big pharma’s research and we give them tax breaks. So it’s even worse that we subsidize them and then allow them extort the public.
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