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

jhsph.edu

431–440 of 537 posts

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

#431

Earlier quoted context omitted.

Despite Japan's aging, heavy-smoking population, Japanese people tend to be very healthy for reasons that aren't necessarily related to their healthcare system.

And Americans tend to be overweight and unhealthy. Access to healthcare doesn't automatically shift culture to live a healthier lifestyle (and I suspect it might even do the opposite).

The paper considers that hypothesis and rejects it, honing in on prices not utilization as the problem. Indeed its title is "It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt"

https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144

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

#432
post #417

Earlier quoted context omitted.

"regalian functions of the state" Sorry to nitpick, but does "regalian" mean something else than emblems or insignia of royalty? A credible sovereign state generally needs some force projection capability within it's political domain, hereditary monarchy or not. Hence military is definetly in a different category than healthcare.

The etymology of the term indeed comes from the prerogatives of the sovereign. "Regalian functions of the state" is a common term that means the basic powers of the state (monarchy or not) that used to be the prerogative of the sovereign. I.e. law & order, military, and taxation. You could also call these "inherent powers of the state".

"Hence military is definetly in a different category than healthcare."

Why is that - one is defending the citizens of the state against external threats and the other is defending the citizens against medical threats?

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

#433
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…

We know that there is an efficient model for delivering healthcare, which is a government provided/heavily-regulated healthcare market. We know this because dozens of industrialized nations successfully operate in this model, with dramatically lower costs than we have here in the US. An existence proof is usually the simplest kind of proof.

Some people talk about a hypothetical second workable model, which involves a massively de-regulated free market system. It's important to note that nobody has successfully deployed this model in an industrialized nation, and it's not clear if it can even be implemented in practice -- for political as well as practical reasons (unregulated medical providers tend to kill people, so voters enact regulations, and then you're on your way out of the sweet spot.)

Whatever your preferences, the important thing to keep in mind is that while both of these two points may exist, the points between them are highly suboptimal. Removing 10% or even 50% of the regulations on our current healthcare system is unlikely to produce a substantially more efficient system. It produces a new system with most of the weaknesses and entry-barriers of our current approach, but replete with massive new profit-taking opportunities and substantially worse protection for patients.

This is why two decades of political infighting in the US have failed to fix healthcare. There is literally zero chance that the working, de-regulated system is going to come into existence. There is some probability that we can get closer to regulated single-payer, since we already have Medicare and it's much more efficient than private insurance, even though politicians have restricted its bargaining power. There is an overwhelming probability that in the process of trying to deregulate the current system, you end up making everything substantially worse.

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

#434
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…

You: "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" Your healthcare industry: "if you personally need care, then it should be of the absolute best quality and should be provided until your last cent no matter what"

In America, cent and breath are the same. Your statements read the exact same.

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

#435

Earlier quoted context omitted.

Define true, it is true that the US spends more on medical research than the rest of the world combined, and produces more drug patents than the rest of the world combined. https://assets1b.milkeninstitute.org/assets/Publication/Rese... This btw went up fairly recently especially since Indian generics became accepted world wide in the late 90’s and early 2000’s. The US used to produce 20-30% of the world’s drug paten…

Probably has something to do with the research facilities in US becoming better and better with time. Since you don't really need to be in US to create drugs for US market.

The US always had the best facilities, biomedical research started in the US the Rockefeller University was the first one in the world iirc.

This doesn’t explain it really what could explain it is that as the cost of developing a drug became higher more and more players dropped out of the game especially as the revenues started shrinking due to Indian generics becoming popular around the world.

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

#436
It seems to me the US never outgrew it's frontier mentality.

Before, if you felt too hemmed in you could always move west and get free land, get together with other locals and form a small town.

Better to be the founder of your town than a random nobody in your previous town.

Back in the 18th-19th centuries, medical care was primitive and sometimes dispensed by the barber.

For toothaches and broken limbs, you might see a dentist or a doctor, for anything life threatening you toughed it out and died at home.

We don't do that anymore of course, but it's almost as if attitudes about self sufficiency have lagged behind.

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

#437
post #118
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…

Why would you cap healthcare prices for insurers, they don’t set prices. You mean providers? Half of US healthcare spending is public payers - Medicare and Medicaid. They do set prices for providers and still spend far more than other countries. And if you’ve been involved in US healthcare you’d realize it’s drowning in regulations already. It’s not a free market by a stretch.

Medicare is dramatically more efficient than private insurance, both in terms of actual health costs paid out and administrative overhead.

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

#438

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…

This smells like pharmaceutical industry propaganda to me.

Even if it's true, we should just fund drug research explicitly.

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

#439

Earlier quoted context omitted.

The etymology of the term indeed comes from the prerogatives of the sovereign. "Regalian functions of the state" is a common term that means the basic powers of the state (monarchy or not) that used to be the prerogative of the sovereign. I.e. law & order, military, and taxation. You could also call these "inherent powers of the state".

"Hence military is definetly in a different category than healthcare." Why is that - one is defending the citizens of the state against external threats and the other is defending the citizens against medical threats?

The military is a regalian function (and arguably its first function is to defend the state, not the citizens...), while healthcare is not usually considered a regalian function.

The line must be drawn somewhere.

You can imagine healthcare being provided fully by the private sector without state intervention (how that works for the poor is another issue) but the military has to be controlled by the state even if in fine the state hires mercenaries.

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

#440

Earlier quoted context omitted.

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.

In the UK which hospital you would go to is nearly 100% based on ease of getting there and the facilities they have on hand. The idea of driving past a hospital to get to another which is more friendly to my insurance plan completely blows my mind.

Only if you use the NHS, private insurance would require you to pay extra if you don’t live there especially for inner London Hospitals.
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