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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

#331

Post by grecy »

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.

You literally just said "It's not perfect, so I don't want it".

Don't let perfect be the enemy of improvement.

Constant improvement is what the system needs, and anything that improves it is good and should be done.

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

#332

Post by dmitriy_ko »

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.

This issue existed before Obamacare 80/20 rule. In a free market the way for a profitable insurer to grow is by growing marketshare -- whether 80/20 rule exists or not. And the way to grow marketshare is to offer cheaper insurance. To offer cheaper insurance insurers have to push service prices down. Somehow this is not happening.

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

#333

Post by max76 »

int_19h wrote: post #260
cameronh90 wrote: post #44

Earlier quoted context omitted.

It does appear to be the case that the US funds most pharma R&D due to Americans overpaying relative to the rest of the word. In some cases (China, India) this is due to weak IP protection, but in other cases (Canada, UK, Europe) it's more to do with our governments having a stronger negotiating position and setting hard limits on what they'll spend for a given benefit to patients. Some characterise this as freeloadi…

> Does this make us immoral for "freeloading", because we prefer putting our limited money into cost effective treatments? It depends on whether some drugs that your system considers affordable today as generics, would have not existed without being funded by US taxpayers, I suppose.

> without being funded by US taxpayers

It's not US taxpayers that are footing the R&D bill, but United States based customers of non-generic prescription drugs. These are technically two different sets of people.

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

#334

Post by slx26 »

I speak for myself, but I'm pretty sure many people would share the thought: healthcare is the number one reason for which I'd never move to America.

And there are a billion things for which you might want/not want to move to another country. And I'm healthy, and there are many other things that might seem crazy about America. I don't know, maybe I'm just paranoid, but I do seriously hope for the sake of everyone (and I don't mean to be meddlesome), that US citizens stop accepting this as normal and the situation changes soon.

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

#335

Post by Gibbon1 »

refurb wrote: post #249
Gibbon1 wrote: post #66

Earlier quoted context omitted.

> Respectfully, enough with this free market garbage. Kenneth Arrow pretty much proved in 1963 that 'the free market' doesn't work for healthcare. Nothing since has produced a shred of evidence that he was wrong.

Seems to work pretty well for vision correction and cosmetic surgery though. So Kenneth Arrow's hypothesis can't be correct.

> work pretty well for vision correction

Now that's extremely amusing.

> cosmetic surgery

When elective an ordinary consumer good.

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

#337

Post by halfjoking »

The title is inaccurate.

It shouldn't be "spends more for no gain"... it should be "spends more for worse healthcare."

"No gain" implies that we are getting the same level of healthcare as other countries, when in fact we have worse outcomes, less nurses/doctors, worse wait times, and always get stuck with the bill. Only in America do people regularly end up in bankruptcy for medical expenses.

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

#338

Post by DanBC »

darawk wrote: post #87
cameronh90 wrote: post #44

Earlier quoted context omitted.

It does appear to be the case that the US funds most pharma R&D due to Americans overpaying relative to the rest of the word. In some cases (China, India) this is due to weak IP protection, but in other cases (Canada, UK, Europe) it's more to do with our governments having a stronger negotiating position and setting hard limits on what they'll spend for a given benefit to patients. Some characterise this as freeloadi…

> Does this make us immoral for "freeloading", because we prefer putting our limited money into cost effective treatments? It doesn't make you immoral, but it is important in understanding the tradeoffs of suggesting that the US switch to an NHS-style system. > Also, is it not worth looking at why pharma R&D costs so much? The pharma industry seems to run at a very healthy profit margin compared to most other industr…

Too often these drugs are hugely expensive and provide marginal benefit over existing treatment. Sometimes they're even worse than existing treatment.

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

#339

Post by ropable »

slx26 wrote: post #334

I speak for myself, but I'm pretty sure many people would share the thought: healthcare is the number one reason for which I'd never move to America. And there are a billion things for which you might want/not want to move to another country. And I'm healthy, and there are many other things that might seem crazy about America. I don't know, maybe I'm just paranoid, but I do seriously hope for the sake of everyone (an…

Yep. Healthcare, and gun culture.

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

#340

Post by ThePhysicist »

icelancer wrote: post #273
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…

> A lot of German primary care doctors don't even hire office staff. They prescribe whatever they want, swipe your medical card, and they're guaranteed to be paid in a week, no questions asked. Any sort of change towards this in the United States (and I agree, it's a good one) will be spun as losing jobs and crushing the economy, which is a very hard argument to defeat.

I haven’t come across a single doctor in Germany who didn’t have at least one office assistant to handle incoming patients, schedule appointments and do the bookkeeping. Most doctors seem to have more though these days as the administrative burden has increased. There’s also a trend for doctors to share office space and have a joint office and reception (also to reduce cost).
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