Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

jhsph.edu

Post reply on HN
Print view View original

341–350 of 537 posts

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

#341

Post by simonh »

DennisP wrote: post #104
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…

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.

It seems to work that way in France too, my mother lives over there half the time. She gets medical appointments and treatment almost immediately for almost anything where in the UK she'd be in multi-month long queues. I'd take the NHS over the US system any day, but there definitely seem to be useful lessons to learn from Europe as well.

I'ma huge Maggie fan, she was our best post-war PM by far, and a good candidate for best PM ever, but her market based reforms of the NHS were utter failures.

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

#342

Post by dougmwne »

JAlexoid wrote: post #258
taormina wrote: post #220

Earlier quoted context omitted.

This is astounding. It used to be that doctors were not allowed to post their prices! Openness is needed to fix medical billing.

Why would you care, when your copay is $30 flat?

Every time I use my health insurance in the USA I peel back another layer of this onion of a scam. I've started doing most of my health care abroad even though I'm insured just so I don't have to deal with this industry. I doubt posting prices online will do much because it seems like a quick fix to a systemic issue.

1. Go for a 3 minute, 30 second ENT appointment about earwax. Think I'm just paying a co-pay. Receive an extra bill for "Charges in excess of negotiated amount"

2. Go for appointment and be told: "If you just pay us now and bypass your insurance it will be cheaper than your copays." This happened twice without any prompting.

3. Be told by another office that my insurance doesn't cover a service and that it would be better if I paid out of pocket. Learn later that that service should have been covered 100%. Struggle for months to get insurance to pay instead all the while being told by the office "we can't guarantee you won't end up paying more in the end, even if it does say 100%"

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

#343

Post by ascar »

asdff wrote: post #262
ascar wrote: 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.

No, it's not. This analogy would only apply for shorter wait times in emergency cases. And that's not true and I explicitly said that. Everyone gets the same wait time in emergencies and urgent cases. But a significant amount of cases can actually wait.

It's more like your car broke down and you have to wait longer than the guys who pay extra to get a same-day repair. But if you are a taxi driver and depend on it, they repair it anyway on the first day.

The private insured patients also sponsor better treatment for the government insured patients.

It's a good compromise (and I'm saying that as someone who is government insured) and there is law in place like a maximum of 3 weeks wait time for a specialist appointment.

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

#344

Post by cteague »

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…

American healthcare is nowhere close to a "free market".

Have you noticed how there are next to no startups disrupting the health industry? Why can't you sign up for insurance like you can sign up for a stock account on RobinHood?

There's no free market. Government licensing and regulations have created huge barriers to entry. I thought this would be more understood by those technically/entrepreneurially minded.

When things are too expensive, you need to raise the supply to get the price down. Not create price controls and socialize markets.

Read this article because it explains the problem better than I can.

https://hbr.org/2004/06/redefining-competition-in-health-car...

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

#345

Post by kieranmaine »

cameronh90 wrote: post #44
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…

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…

How does research funded by charity or governments figure in this? How do we know if research funded by these sources leads to profit making drug research?

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

#346

Post by Robin_Message »

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…

> pay as little as 110 yen ($1) out of pocket for specialist appointments

In the UK we pay nothing. I think this article is biased by American thinking.

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

#347

Post by lotsofpulp »

selestify wrote: post #327
monocasa wrote: post #306

Earlier quoted context omitted.

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.

Only because of a non functioning market due to federal and state laws.

If there was one health insurance marketplace and set of rules, and everyone, young, old, poor, rich, healthy, infirm, we’re forced to buy from it, then it would actually be possible for insurance companies to compete.

Right now, it’s basically a game of hot potato to try and not get stuck with the million dollar hemophiliacs in each state. A lot of the healthy are separated out into employer based insurance plans, and there’s not sufficient possibility of business to have more than one or two insurance offerings on healthcare.gov.

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

#348

Post by nabla9 »

cteague wrote: post #344
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…

American healthcare is nowhere close to a "free market". Have you noticed how there are next to no startups disrupting the health industry? Why can't you sign up for insurance like you can sign up for a stock account on RobinHood? There's no free market. Government licensing and regulations have created huge barriers to entry. I thought this would be more understood by those technically/entrepreneurially minded. When…

Free market and well functioning market are not synonyms.

Healthcare economy is naturally inefficient if free. Information asymmetries and other market failures emerge without good regulation and mechanism design.

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

#349

Post by pjc50 »

lostlogin wrote: post #211
joering2 wrote: post #159

Earlier quoted context omitted.

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.

How is that possible? Is the rest of the bill paid by the state?

No, it's just cheaper labour, has far fewer billing overheads, less profit, and is an actual market price rather than the oligopoly fiction the US calls prices in healthcare.

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

#350

Post by Dylan16807 »

castlecrasher2 wrote: post #259
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…

>You cap healthcare prices for insurers because they are heavily influencing the provider prices. Insurers already have an incentive to limit prices, though, which is essentially what their contracts with providers are. As in, they list how much they'll shell out for CPT codes.

They have an incentive to get discounts, which is not the same as limiting prices.
Post reply on HN