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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

#381

Earlier quoted context omitted.

In Canada, if it was serious, half a year is actually even quicker than I'd expect. I'd really love to try out the Japanese healthcare system. As it stands, I'm convinced that healthcare is an impossible problem to solve.

I'm convinced that healthcare is an impossible problem to solve. You need to travel more. The German system, for example, is very old, very simple and works very well.

I like the healthcare situation in Germany but normally you would have to wait months for a surgery, if it's not very critical. An appointment with a specialist can also mean waiting weeks or months.

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

#382
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…

In Canada, if it was serious, half a year is actually even quicker than I'd expect. I'd really love to try out the Japanese healthcare system. As it stands, I'm convinced that healthcare is an impossible problem to solve.

It's not though, it's solved in a lot of countries. Even - or particularly - those that are economically worse off than the US, such as Cuba.

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

#383

Earlier quoted context omitted.

He may have been traveling when he had his heart attack: https://www.wsj.com/articles/john-stockmans-medical-bills-to... He may have been attended-to by out-of-network practitioner: https://www.nbcwashington.com/news/local/Out-of-Network-ER-S...

What’s with the ‘out-of-network’ thing that gets pulled out regularly? Is healthcare really that much more expensive to an insurer if it’s done at one site or another? Sure, they’d prefer it was done in-house so that the ticket can be clipped multiple times, but it’s clearly just made up numbers that are produced currently.

It doesn't make sense, but you have to (as a patient) make sure that the provider you're getting healthcare from is covered by the insurance company's (changeable) list. Its indefensible but it's reality.

I cannot wait for reform and I hope it hits before I get old and need it often.

As an aside, even the billing system is fucked up. When I get a receipt for covered care, it often looks a lot like a bill. This has to be by design. Its bad enough that I just ignore both "receipts" and bills and wait for the collectors to call me. That's how I know which is which.

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

#384
post #364

Earlier quoted context omitted.

Absolutely true. As a doc, the US problem boils down to a cultural issue that can be summarized as: "there is no reason my money should pay for the care of others, but if I personally need care, then it should be of the absolute best quality and should be provided until my last breath no matter what" The people maintain the system themselves by insisting on that, and that is the root of every other problem. Before al…

"there is no reason my money should pay for the care of others" Isn't the cultural issue largely a idealogical issue - things like the UK NHS are avowedly socialist? In the words of Aneurin Bevan, founder of the NHS: " A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society." https://en.wikipedia.org/wiki/Aneurin_Bevan Personally, at least when it comes to healthcare, I…

Kind of. As a Brit I don't think the UK is especially socialist. Also we don't generally think of the NHS as socialist more than Americans would talk about having a socialist army or police force. The fact that the above are funded by the government from tax in my view doesn't really make them socialist. It's more just a common sense way of funding some stuff.

The dictionary has socialism as "means of production, distribution, and exchange should be owned or regulated by the community as a whole" and I've never thought of health care as a "means of production". Now if the government tries to own all the factories that's socialism.

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

#385

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.

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

> Can you refuse treatment from an OON provider in a hospital?

In most cases you will not know that it's an OON provider. You may be under sedation at the time.

The practice is outlawed in many states, as far as I know.

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

#386
post #325

Earlier quoted context omitted.

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,…

I agree with you in part, but in my opinion propaganda and lobbying are the problem because this is the source of the disconnect. When people got increased protections from the ACA, nobody complained. The insurance and hospitals deliberately shitcanned the healthcare marketplace and MOST pepole don't put much thought into why the mandated insurance became unconscionably expensinve, they just thought "Obamacare is worhtless" because that's what they were told.

I don't think it's specifically an American thing to avoid much thought about becoming really ill. It's an uncomfortable subject.

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

#387

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. 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 qualif…

tl;dr: All of my comment is basically agreeing with rndgermandude that the OP's description of German medical care is not accurate.

I co-founded a company that sells practice management software to primary care doctors in Germany. We work closely with the Hausärzteverband -- something like a union for primary care physicians -- and I speak with doctors in Germany, board members of the HAVG, and so on basically every day.

Germany has three different medical/insurance systems -- KV, HzV, and private insurance -- I worked with HzV so am most familiar with that but everyone has at least a passing understanding of KV as well since it was the only one until recent decades. HzV is more popular in certain geographies -- for instance if you work for Volkswagen you'll be in the HzV system and not the KV system under a BWQ contract.

I've never met a doctor in Germany that doesn't have staff. A quick check of the analytics of all the practices using our software doesn't show a single one.

As rndgermandude says, every single one has at least an MFA (and nowadays probably a Vera as well, since they can earn extra money that way). Our analytics shows 2-3 MFAs per doctor is the average but there are always edge cases.

>They prescribe whatever they want

This is not really true. Every insurance contract will have different rules about what can be prescribed. They can't FORCE a doctor to follow those rules but they doctor is monetarily incentivized to do so. For instance, getting a bonus every quarter so long as 80% of their prescriptions follow insurance company rules. The checks are done at run-time, every doctor knows instantly if a prescription is against insurance rules, and practice management software is REQUIRED to suggest alternatives that meet insurance requirements.

>they're guaranteed to be paid in a week

Doctors are basically NEVER paid in a week. They submit their billing at the end of the quarter (here I'm speaking primarily of HzV contracts; I'm not sure how the third option -- private insurance -- works) and then get paid a while after that.

>no questions asked.

No, this is not remotely true.

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

#388

Earlier quoted context omitted.

I'm convinced that healthcare is an impossible problem to solve. You need to travel more. The German system, for example, is very old, very simple and works very well.

I like the healthcare situation in Germany but normally you would have to wait months for a surgery, if it's not very critical. An appointment with a specialist can also mean waiting weeks or months.

Weeks is not bad... Months is. And as you said, it's for non-critical stuff.

A mixed system - government-managed for important things, with extra healthcare you can pay on top, like the one we have here in Uruguay, seems to work best.

As far as I can tell, we have the best healthcare for anything but special/rare cases which would be best served by a top specialist from the US or Germany. For the remaining 99% of cases it beats any system I know of.

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

#389

Earlier quoted context omitted.

There are interesting cases, where doctors prescribe stuff they get no valuable information from. I had this in US. Shoulder pain, that was diagnosed via an XRay... But the doctor decided he wanted an MRI. That's no unusual, but unnecessary in my case. Got charged extra $500 for the pleasure. Thankfully I was on an HDHP, so the HSA savings got hit.

That’s not an unreasonable charge for an MRI and I’d argue that you got off quite lightly. You can’t diagnose many of the potential problems shoulders have from an x-ray but a good clinical examination will catch many of them, with an MRI for confirmation. Labral tears would be an example of this.

For a second I read your comment as liberal tears, and had to do a double-take. :)

Speaking to the 500$ charge, are you saying that is a typical cost around the world for a MRI? Is there something about the machine's cost that justifies this or are you just saying that a 500$ charge is typical in the american system?

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

#390

Earlier quoted context omitted.

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,…

It is partly a cultural thing - a kind of cult of narcissism. But those attitudes are carefully cultivated by the media. They don't just happen. Congress and the Senate are full of corrupt leeches, and both parties are equally guilty. Votes make no difference. Corporate money buys political careers, and it pays for both sides. There are a few exceptions, cultivated to maintain the appearance of representative democra…

> Congress and the Senate are full of corrupt leeches, and both parties are equally guilty.

No, the Democrats and Republicans are not the same.

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