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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

#351
post #241

Earlier quoted context omitted.

> As a Bank of America emplyee he had somewhat goog insurance that paid some. He was left with $180,000 bill. Forgive my ignorance but how is that possible? The highest out of pocket maximums for Marketplace plans is $15700 for an entire family.

In a hospital you'll likely be seen by a variety of providers some, or even many of whom are not in your network. You insurer will pay some amount out and then the provider will bill you for the rest...which can be huge. This bill is unrelated to your insurance and is unrelated to any out of pocket maximum. That maximum only relates to copays etc as part of your insurance.

When I had a kidney stone, I made sure to get to Kaiser. Not the closest hospital, but at least everyone's going to be in network.

That's the biggest benefit of Kaiser IMHO, no wacky out of network stuff at their hospitals.

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

#352
post #325

Earlier quoted context omitted.

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…

I think it's something in the American mindset. It's been said before, but Americans think of themselves as "temporarily embarrassed millionaires" when voting (hence why they consistently vote in the interests of the rich - everyone thinks they'll benefit from those tax cuts when they win the lottery/sell their startup/etc).

Same situation here; "health care costs are for those sick losers. I'm not going to get sick, so it doesn't matter to me how much it costs, and I don't want to pay more tax to reduce healthcare costs for those losers".

I exaggerate, but it does seem like there's something like this going on...

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

#353
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.

I have never been to a German doctor who didn't have some staff. It's true however that they usually do not have admin-only staff.

They have, depending on the size (and specialty) of their operation, 1-3 "Medizinischer Fachangestellte" (MFA, qualified medial employees) per doctor and maybe 1-2 "Auszubildende" (people still in training). This a qualified job which requires formal training and a diploma. Usually it's one person in charge of the appointment book and reception/waiting room and additional people helping the physicians.

They are helping during examinations, calling up people from the waiting rooms, keeping appointment books, keeping the patient files and printing out the prescriptions etc (to be signed by the doctor), and to some degree interact with the health insurers. But they also do some hands-on jobs, like they are usually allowed to apply some medications, and operate medical equipment on their own (e.g. last time I visited my dentist, the x-ray machine was operated by an MFA; she had to have a special qualification for that). They are also in charge of writing the invoices for procedures not covered by health insurance providers (e.g. additional checkups).

My GP is a single lady shop, and she hired 3 MFAs. My dentist shop has 3 dentists working there and one "technician" and has an MFA support staff of maybe 15.

So there is still a lot of admin work, after all.

>They prescribe whatever they want

Not exactly. German doctors prescribe an "active agent" (even tho a lot of times they will put a brand name). German public insurers will only pay for a max price for a given agent. So if "generics" are available, the pharmacies will likely fill prescriptions with those.

>swipe your medical card

Eh, you give your card to the doctor's MFAs and they will put it in their card reader, etc. It's not like there is a checkout line where you swipe stuff yourself.

>they're guaranteed to be paid in a week

Usually one month to four months.

It goes like this: Every physician has to be a member in the "Kassenärtzliche Vereinigung" (KV, physicians association, and KZV for dentists) of their federal state. Otherwise, you cannot be reimbursed by the public insurers. There is about 160k physicians and 60k dentists organized in the KVs and KZVs.

The physicians then report all the items (procedures, prescriptions, consolations, etc) they want to charge to the KV, which collects the information, tallies up everything and calculates the earnings based on a complicated "points" system, charges the insurers and distributes the money back to their members.

The physicians are paid once a month (usually the 15th of each month for most KVs) a progress payment, based on the estimated earnings for a quarter, estimated based on previous quarters in particular. The actual final tally is done only once a quarter where any money not yet paid through the progress payments is paid out. In the worst case, this could be a negative number, meaning a physician has to pay back some of their previously collected progress payments. That's why (AFAIK) KVs will usually underestimate the progress payments to avoid exactly this later.

>no questions asked.

The KVs will totally ask questions if your doctor starts billing a lot "funny" items (e.g. if a single doctor would charge a lot of flu vaccinations during the summer months, the KV will ask about it). And last I heard, there are spot checks/(not-so) random audits too. The KVs by law are required to make sure everything is OK, so they also dabble in fraud detection and quality control.

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

#354

Earlier quoted context omitted.

It's not that it's more expensive at one place or another for the most part. When you go in-network you are seeing providers that your insurance has a contract with. This contract includes agreed amounts for procedures. Providers will often grossly overbill (mostly because it's easier to let the billing backend resolve these limits than bill accurately in the first place) and your insurance will respond with the amou…

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.

yeah. Can you refuse treatment from an OON provider in a hospital? Because that would be my first question if approached by a doctor who could potentially bill me $100K

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

#355
post #348

Earlier quoted context omitted.

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.

Every market has information asymmetry. Software is probably the biggest one today. Yet software keeps getting better and better...

I agree there are needs for regulations--more like proper norms though and a good tort system.

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

#356

Earlier quoted context omitted.

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.

Not strictly true - we do pay a nominal fee for prescription drugs and NHS dentists (although some classes of people, eg students and retired people, are exempt).

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

#357
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.

The police would be another.

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

#358

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%?

> ultimately takes away everyone's employer-provided care

Really? Even the NHS system allows a parallel employer provided system to run alongside it, it's just only common for higher-paying jobs and those with US parent companies.

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

#359

Earlier quoted context omitted.

> 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.

Not strictly true - we do pay a nominal fee for prescription drugs and NHS dentists (although some classes of people, eg students and retired people, are exempt).

Additionally, a lot of long-term care in the UK is provided by charities (Cancer Research, Macmillan, Heart Foundation, etc) which can be expensive but IIRC doesn't appear in the NHS budget.
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