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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

#451

Post by dsfyu404ed »

dragonwriter wrote: post #427
dsfyu404ed wrote: post #424

Earlier quoted context omitted.

There's plenty of industries where the customer often needs something done quickly or in an emergency and they still don't get screwed like they do in medical. Plumbers, septic pumping, auto repair, all have a substantial portion of their customers needing "emergency" services that they could charge whatever they want for. They don't though because there's price transparency and if you get screwed you'll never call t…

> If I broke my leg doing something stupid you can bet your ass I'd call around and get quotes if I could. Quotes for...what? Even with price transparency on actual services, “I broke my leg” doesn't tell you with much specificity what services you need. And that's not even to discuss, “I'm having chest pain and dizziness”.

>Quotes for...what? Even with price transparency on actual services, “I broke my leg” doesn't tell you with much specificity what services you need. And that's not even to discuss, “I'm having chest pain and dizziness”.

Sounds a lot like "my car is making a funny noise" or "my septic is backed up". Diagnosis should be cheap/free depending on how involved it is and then you get a quote for how much it will cost to fix and the quote usually includes some language like "and if X happens we'll stop work and call you/charge X to fix it as well".

Figuring out what work needs to be done based on vague descriptions by people who don't know the subject matter is what professionals do. I don't see why doctors should be held to a lower standard.

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

#452

Post by howard941 »

lostlogin wrote: post #279
roganartu wrote: post #239

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.

We're not okay with it. And it is a racket. It's not fixed because the racketeers run the place.

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

#453

Post by dragonwriter »

entity345 wrote: post #421
fsloth wrote: 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".

> "Regalian functions of the state" is a common term

It's really not; I mean, I've got a poli sci degree so I've seen it, but it's not really 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.

The pre-modern-limited-governnent prerogatives of sovereigns were much broader than law enforcement, defense, and taxation. And, in fact, the principle thing denoted by regalian power is the fundamentally ownership of all land which is superior to all private title, which is the root of all the other (essentially unlimited) powers associated with sovereignty, in a “my house, my rules” kind of way.

The term “regalian functions”, though, is most often used to refer to the three functions Adam Smith identified as essential to the sovereign in The Wealth of Nations, which are still much broader than what you suggest:

“The first duty of the sovereign, that of protecting the society from the violence and invasion of other independent societies, can be performed only by means of a military force.” [0]

“The second duty of the sovereign, that of protecting, as far as possible, every member of the society from the injustice or oppression of every other member of it, or the duty of establishing an exact administration of justice, requires two very different degrees of expense in the different periods of society.” [1]

“The third and last duty of the sovereign or commonwealth, is that of erecting and maintaining those public institutions and those public works, which though they may be in the highest degree advantageous to a great society, are, however, of such a nature, that the profit could never repay the expense to any individual, or small number of individuals; and which it, therefore, cannot be expected that any individual, or small number of individuals, should erect or maintain.” [2]

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

This is true, not in the sense of not being subsumed within “regalian functions”, but in the sense that the military is the first regalian function identified by Smith while healthcare delivery systems that broadly and effectively serve the whole population are in the third.

[0] book V, chap. 1, part 1

[1] Ibid, part 2

[2] Ibid, part 3

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

#454

Post by Shivetya »

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…

please don't foist the entirety of this issue on insurance companies, the states and federal government dictate the paper work to be done and the coverage provided. it is damn easy to mandate paying for procedures when you don't have to pay for them.

California and Vermont found this out when both determined single payer options; read : the state; were not affordable without seriously curtailing care options. As in, when you tell people no it becomes affordable, when you bend over for every little thing it suddenly becomes what we have today.

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

#455

Post by thousandautumns »

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 is there a lack of market pressure in the pharma industry?

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

#456

Post by JoeAltmaier »

thousandautumns wrote: post #455
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…

How is there a lack of market pressure in the pharma industry?

Prices are essentially fixed and heavily influenced by govt. Not a total lack of market pressure, but definitely skewed vs shoes etc.

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

#457

Post by DanBC »

laurencerowe wrote: post #305
JAlexoid wrote: post #217

Earlier quoted context omitted.

I try investing a lot in smaller pharma companies... and they are hammered by the big ones. Not on innovation, but on marketing. I disagree about NHS type system, that reduces access. A healthy mix is required, though. A lot of upfront costs are also footed by users and government/non-government funds. And a lot more of those costs are due to government regulation and essential insurance at development. Pharmaceutics…

How does an NHS type system reduce access? Everyone is covered and can go to the doctor without worrying about paying thousands in copays.

And also if people wish to pay for private care (whether out of pocket or using insurance) they're free to do that too.

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

#458

Post by entity345 »

dragonwriter wrote: post #453
entity345 wrote: post #421

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".

> "Regalian functions of the state" is a common term It's really not; I mean, I've got a poli sci degree so I've seen it, but it's not really 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. The pre-modern-limited-governnent prerogatives of sovereigns were much broader than law enforcement, defense,…

> while healthcare delivery systems that broadly and effectively serve the whole population are in the third.

That's your interpretation but that's really a political view, and indeed the definition of that third duty is highly subjective. As I wrote in another comment, the line must be drawn somewhere.

Note that my point wasn't to discuss regalian functions in general but to counter the argument that calling the British NHS 'socialist' was like calling the police or the army 'socialist'.

(Btw, I heard the term "regalian functions" in secondary school/high school...)

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

#459

Post by david927 »

egeozcan wrote: post #381
david927 wrote: post #378

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.

I don't know where this idea comes from. I'm American but my experience with healthcare in European countries where I've lived (England, France, Czech Republic and Switzerland) is unparalleled. I had my gall bladder removed (non-critical) in France; the wait was two weeks and everything about the experience was impeccable.

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

#460

Post by corebit »

matthewdgreen wrote: post #433
cteague wrote: post #344

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…

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…

Just go google "medical coding" and you'll see how your entire uninformed opinion falls apart.
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