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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

#311

Post by sdrinf »

tptacek wrote: post #291
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…

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.

List prices, like chargemaster. Yes, on one hand, insurance negotiates %x0 discount on it (but eg in the above case, my insurer, Anthem was -ostensibly- charged full price on it) . OTOH, see example above, whereby simple intervention of designating what specific service I will be taking upfront makes a 10x difference in prices. So, regardless of insurance, this transparency gives a serious lever for informed decision-making (whenever that's possible), and can be used additionally to price negotiation.

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

#312

Post by RHSeeger »

laurentoget wrote: post #222
nickchuck wrote: post #168

Earlier quoted context omitted.

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.

Ugh. I hate this story. In every popular story I've seen of "this person died because they couldn't afford insulin", it's really been a case of "this person died because they couldn't afford the most expensive insulin, and they weren't willing to switch to the DRASTICALLY cheaper insulins available".

- The story I'm looking at now had someone complaining he couldn't afford his Lantus.

- Lantus is pretty much the most expensive 24 hour insulin available. Last I checked it was something like $275 per bottle.

- Walmart has cheaper insulins R, N(PH) for somewhere in the range of $20-25. They're older insulins and don't work as well, but they are an option for any diabetic that can't afford the newer insulins. (Note, I can't find it on Walmart's web site but, as I understand it, you can't but it online, so that may be why)

For context:

- My insurance doesn't cover Lantus either. I take a generic (to be fair, I don't believe that generic was available at the time of the story) version of it.

- I used to take R and N insulin

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

#313

Post by dzhiurgis »

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.

Should have treated yourself with business class seats...

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

#314

Post by bshoemaker »

tptacek wrote: post #293
rohanshah wrote: post #100

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.

Because it covers millions more, while spending less. Is this difficult to understand?

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

#315

Post by foepys »

null000 wrote: post #227
ascar wrote: post #172

Earlier quoted context omitted.

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…

It is already illegal, yet practiced widely because the burden of proof is on the patient that cannot look into the doctor's records because of privacy.

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

#316

Post by atombender »

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…

> "biosynthetics"

You're probably thinking of biologics [1]. These include immunosuppressant monoclonal antibodies such as adalimumab (Humira) and secukinumab (Cosentyx), used in treating autoimmune diseases such as psoriasis, ankylosing spondylitis, psoriatic arthritis, MS, Crohn's, etc. They are derived from biological sources such as Chinese hamster ovary cells [2]. They are also extremely expensive -- often several thousands of dollars per month [3].

[1] https://en.wikipedia.org/wiki/Biopharmaceutical

[2] https://en.wikipedia.org/wiki/Chinese_hamster_ovary_cell

[3] https://health.usnews.com/health-news/health-wellness/articl...

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

#317

Post by RHSeeger »

dragontamer wrote: post #302
zzleeper wrote: post #63

Earlier quoted context omitted.

You don't have to pay dividends, you can just do a stock repurchase. Regarding investor preferences, they only want the money spent if it gives them a positive NPV. Pharma companies are already paying dividends, which means they have funds in excess of their NPV>0 projects, which is why they return them to shareholders. Hell, half of the shareholder activism literature and the policy payout literature is about CEOs o…

> Regarding investor preferences, they only want the money spent if it gives them a positive NPV. Precisely. And cash rarely gives the best NPV. You put money into companies with the expectation that they make MORE money in the future. > Pharma companies are already paying dividends, which means they have funds in excess of their NPV>0 projects, which is why they return them to shareholders. And there you have it. It…

To be fair, the master in that story was a bit of a jerk.

> You knew that I reap where I have not sown and gather where I scattered no seed?

He took what belonged to others. And, had the servant with 2 talents lost money instead of making it, I doubt the master would have responded to him with "Well, you tried. Good on you."

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

#318

Post by tptacek »

bshoemaker wrote: post #314
tptacek wrote: post #293

Earlier quoted context omitted.

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.

Because it covers millions more, while spending less. Is this difficult to understand?

It leaves us overspending on health care by a huge amount, raises everyone's insurance, and ultimately takes away everyone's employer-provided care, which the majority of Americans who have it like. If it was cutting our expenses in half, the cost savings might sell it. But 10%?

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

#319

Post by [deleted] »

komali2 wrote: post #290
lostlogin wrote: post #279

Earlier quoted context omitted.

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.

[deleted]

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

#320

Post by [deleted] »

komali2 wrote: post #290
lostlogin wrote: post #279

Earlier quoted context omitted.

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.

[deleted]
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