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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

#321

Post by asdff »

RHSeeger wrote: post #296
asdff wrote: post #262

Earlier quoted context omitted.

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.

Yet everyone uses the roads, schools, and safety paid for by everyone to ultimately get to their advantaged economic position. Healthcare is a public effort just like any of the above, and no one should suffer unequally due to class favoritism being built into public efforts. We shouldn't compromise with people who lack the humanity to see this.

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

#322

Post by joe_the_user »

cmrdporcupine wrote: post #221
DennisP wrote: post #104

Earlier quoted context omitted.

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).

"In the World Health Organization's rankings of healthcare system performance among 191 member nations published in 2000, Canada ranked 30th and the U.S. 37th, while the overall health of Canadians was ranked 35th and Americans 72nd" [1]

So despite this problem, the Canadian health care system still manages to be superior to the US system. Perhaps in the field of health care, "top talent" is not as pressing a question as is often implied.

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

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

#323

Post by refurb »

int_19h wrote: post #276
refurb wrote: post #251

Earlier quoted context omitted.

This is correct. Canada's single payer system means doctors can't work in both the public and private systems. They have to choose one over the other. There has been plenty of efforts put into allowing private clinics outside of the public system, but they have all been shutdown.

It should also be noted that this arrangement in Canada is not typical of other countries with universal healthcare. There's more than one way to skin this particular cat; Canada just gets unduly much attention in the debate because of its proximity, and the "Canadians waiting in endless lines come to US for treatment" conservative meme. On the other hand, one thing that is usually ignored about Canadian healthcare w…

All good points.

However, I’d take issue with federalism being more developed in the US than Canada. In my experience, the federal gov’t wields much more power in Canada than the US.

However, your point stands that nothing is stopping the states from creating their own system. In fact, a few like CA and VT have proposed such arrangements, but they always fell through once the cost was apparent.

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

#324

Post by [deleted] »

monocasa wrote: post #306
tptacek wrote: post #288

Earlier quoted context omitted.

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?

As I said below: The upward pressure on prices is also from the insurers. Insurers have an "80/20 rule" from Obamacare that only 20% of their revenue can be spent on non-medical expenses (ie. profit, insurance administrative overhead, etc.). They pretty quickly hit the caps, and now only by increasing medical expenditures (the other 80%) can the pie slice that contains their profit grow year after year.

[deleted]

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

#325

Post by sbov »

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.

Not true, because people actually hate insurance companies. The best propaganda is by the hospitals because no one ever seems to complain much about them.

There's been a lot of revealing reporting over the past decade but people don't seem to care: the price of a procedure in two different hospitals in the same city can vary by 10x because they literally pull prices they charge from their asses. They tend to justify this by saying "no one ever pays that price".

But when I got a bill for my wife's surgery that included 15k for 1 hour in a recovery room, another 25k for 1 hour in a surgery room, and 9k for an overnight stay (on top of the 20k from the surgeon, 3k from the anesthesiologist, and 3-5k from random doctors we saw for a few seconds) those words sure as shit were not reassuring.

All my past attempts to get an idea of what something might cost me, even when I knew insurance wouldn't cover it, have failed. It takes days worth of time on the phone only to get the wrong answer. One even told me that I only get the cash price if I don't have insurance even if my insurance won't cover it - and I must have insurance because its illegal to not have insurance so I can't get the cash price. What the fuck man?

Hospitals can fuck off. I have no idea why they don't get more blame in this mess.

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

#326

Post by grecy »

kodablah wrote: post #106
grecy wrote: post #71

Earlier quoted context omitted.

> Are there any measures of how America does compared to Europe if you only count Americans that have good health insurance? Anecdotally, I'd say they do crap. Friends outside LA are upper-middle class. Extremely good health insurance for the last 20+ years. Had a baby, emergency C-section. Less than 12 hours later they were told they must move hospital or else pay the $60,000 per day out of pocket because their insu…

I think the commenter was asking about quality regardless of cost, especially for the upper tier.

Yes, and I was saying the quality is very low.

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

#327

Post by selestify »

monocasa wrote: post #306
tptacek wrote: post #288

Earlier quoted context omitted.

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?

As I said below: The upward pressure on prices is also from the insurers. Insurers have an "80/20 rule" from Obamacare that only 20% of their revenue can be spent on non-medical expenses (ie. profit, insurance administrative overhead, etc.). They pretty quickly hit the caps, and now only by increasing medical expenditures (the other 80%) can the pie slice that contains their profit grow year after year.

Wow, sounds like one heck of an unintended consequence for that well-meaning 80/20 rule.

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

#328

Post by ddingus »

refurb wrote: post #287
module0000 wrote: post #206

Earlier quoted context omitted.

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.

That is what networks are for.

When choice is harder, they can play the price game better.

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

#329

Post by selestify »

tptacek wrote: post #318
bshoemaker wrote: post #314

Earlier quoted context omitted.

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%?

> It leaves us overspending on health care by a huge amount

How is that the case when it reduces costs by 10%? Doesn't sound like we'll be spending any more than we already are.

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

#330

Post by max76 »

adventured wrote: post #216
DennisP wrote: post #153

Earlier quoted context omitted.

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…

Japan has a very unique healthcare crises based on it's aging population. The median age in Japan is over 9 years older than the United States and the population is continuing to get older. This crises would be very hard to deal with in any health care system, and it compounded by other pressures of taking care of an older population. Pensions programs are being stressed as the relative number of young workers are decreasing. Additionally the older population is likely to prefer economic policy that reduces inflation (to make pensions stretch further), making the working generations fight harder in international trade.

Japan's healthcare system doing so well given current stresses is a testimony to it's strength.

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