Live data from Hacker News

Americans Are Going Bankrupt from Getting Sick

theatlantic.com

31–40 of 133 posts

Re: Americans Are Going Bankrupt from Getting Sick

#31
post #18

Earlier quoted context omitted.

Ah, so then that's what this boils down to? The high cost of health care is a symptom of capitalism run a muck? We're being charged these exorbitant rates simply because they can get away with it? If only we had a single payer that was able to negotiate, these costs would evaporate over night? Not sure it's that simple... Although, in a way it does kind of make sense. Unlike consumer goods (television, cars, etc.), o…

> Not sure it's that simple... There aren't that many countries that pay as much as the us from public funds (two, see my previous link) or out of pocket (none). The problem is localized to the US.

Consider: - The US is much fatter, on average - Medicare's standards for reimbursement are often not based on cost effectivenes - The US government will pay around $150K/QALY vs. e.g. the UK's c. $40K/QALY.

More expensive healthcare per capita is what I'd expect given those attributes and "single payer is the only solution" does not seem to be logically linked to the problem and facts.

Re: Americans Are Going Bankrupt from Getting Sick

#32
post #20
post #5

Don't fall for the 'yes, but countries that have cheap healthcare pay for it with taxes'. The US pays more than most from taxes[0]. In Sweden we pay less per capita than americans do (from taxes) and my total _maximum_ healthcare costs for _all_ treatments, medications, surgury etc, that in the US would be paid by your employer or yourself are: $125/year max for all visits and procedures [1] + $250/year max for all p…

> In Sweden we pay less per capita than americans do (from taxes) Taxes as a percentage of GDP in Sweden is 37%, versus about 27% in the United States.

but of course that doesn't mean Sweden pays more from those taxes on Healthcare than the US.

Looking at the "Government and compulsory" figures here https://data.oecd.org/healthres/health-spending.htm the US appears to be at $8407 per person for gov. + compulsory spending and Swedent is at $4606.

Re: Americans Are Going Bankrupt from Getting Sick

#33
post #7

Earlier quoted context omitted.

Interesting logical jump from "medical facilities overcharge" to "we desperately need single-payer healthcare in this country." Single payer is certainly one possible solution, but it's not the only feasible solution, despite conclusions that availability bias might lead us to. I'm curious: what was the final price after insurance negotiated on your behalf?

You need single payer because you can overcharge anyone who can't negotiate lower rates (i.e. individuals who's personal business with the healthcare system doesn't have much if any effect on it). Compare that to a state bargaining on behalf of 10+ million customers.

There's a difference between single payer and universal coverage.There are many other systems. For example, France and Germany do not have single payer. Single payer is just well known in the US due to the proximity with Canada.

Re: Americans Are Going Bankrupt from Getting Sick

#34

Earlier quoted context omitted.

It's interesting you say that, I've heard that line of argument before but it is quite puzzling. Are you suggesting that a person on Low income in the US doesn't object to paying more than they have for their own healthcare (i.e. that they wouldn't like that healthcare to be cheaper) That seems a bit counter-intuitive, as usually people don't like being bankrupt.

Americans believe that only poor people get bankrupt... then they get cancer. It's hard to swallow an increase on taxes when you're healthy and think you will never get sick.

I can understand (although not agree with) the idea that rich people don't want to subsidise poor people's healthcare, but the argument I was responding to appeared to say that Americans don't mind paying more for their healthcare, which puzzles me.

I'd have thought that lower income Americans would be pretty happy to have a source of cheaper healthcare, even if it wasn't quite as effective as the expensive stuff.

Re: Americans Are Going Bankrupt from Getting Sick

#35

And it is entirely because the powers that be have rigged the market so that they can charge whatever they want. How have they accomplished this? First, they set strict quotas on who can be a doctor. Then, they set strict quotas on who can offer what medical goods and products. Then, they strap everyone up with student and business debt. I'm not saying it is the correct way or not, but there's a reason that in other…

Every functional society regulates who can be a doctor and who can produce medical goods and services, that really isn’t a problem. It can probably be helpful to try and look for differences between countries as opposed to just going for a libertarian end-run. Problems with the US system are an out-of-control pricing structure due to fragmentation of bargaining power, insane patenting laws which allow evergreening st…

> It can probably be helpful to try and look for differences between countries as opposed to just going for a libertarian end-run. Problems with the US system are an out-of-control pricing structure due to fragmentation of bargaining power, insane patenting laws which allow evergreening strategies, ideological opposition to functional and prove reforms, and good old fashioned cronyism.

It’s funny what “differences” people choose to fixate on. For example, patent systems are very similar between the US and Europe. And I doubt you can quantify any difference in “cronyism.” Supply of medical professionals, and doctor salaries, are quite different. So to are limits on what the state will pay for end-of-life and terminal care. (For example, when you see stories about people reaching their lifetime limit on insurance in the US, go check if the UK NHS’s death panels would have allowed anywhere near those expenses under their QALY calculations.)

I’d also love to hear your theory for how pharmaceuticals are a “natural monopoly.” EU countries lower drug prices through good old monopsony (single buyer), which has similar detrimental effects to a monopoly (single seller). They just get away with it because the US continues to resist such efforts.

Re: Americans Are Going Bankrupt from Getting Sick

#36

I accidentally stabbed myself in the finger while cutting open a package using a knife. Stupid, I know. The would was small, maybe 1 centimeter, but deep enough that it wouldn't stop bleeding on its own. My girlfriend insisted we go to the ER (urgent cares around here are closed on Sundays), so we did. I was the only one there that day. I was ushered in to see a doctor. The doctor looked at the wound, and said, "this…

You weren't paying for the glue and the five minutes. You were paying for the overhead of maintaining all the other stuff that was there that you might have needed under different circumstances but happened not to need that day.

Re: Americans Are Going Bankrupt from Getting Sick

#37
post #5

Don't fall for the 'yes, but countries that have cheap healthcare pay for it with taxes'. The US pays more than most from taxes[0]. In Sweden we pay less per capita than americans do (from taxes) and my total _maximum_ healthcare costs for _all_ treatments, medications, surgury etc, that in the US would be paid by your employer or yourself are: $125/year max for all visits and procedures [1] + $250/year max for all p…

I think most medical professionals may agree with this: the U.S. healthcare system is built on rewarding volume and doing more things. It's an especially attractive field for clinicians who specialize because they have to do special things - with highly regulated barriers to entry.

And while there has been recognition by experts in recent years to push for quality and efficiency (since doing more procedures, especially those unnecessary, raises the risk of harm), the system has been slow to both incentivize this and lower the overall costs.

Re: Americans Are Going Bankrupt from Getting Sick

#38

Earlier quoted context omitted.

Interesting logical jump from "medical facilities overcharge" to "we desperately need single-payer healthcare in this country." Single payer is certainly one possible solution, but it's not the only feasible solution, despite conclusions that availability bias might lead us to. I'm curious: what was the final price after insurance negotiated on your behalf?

I think the final amount I had to pay was around $1,150.

Thanks! That seems high, although I suspect the pricing has something to do with opportunity cost for the hospital. ER docs are limited, and he wasn't available to assist with [serious life-threatening trauma] while he was gluing your finger up.

I had something similar (knife slip, a few stitches) come out to like $350 at urgent care. I paid with (literal) cash.

Re: Americans Are Going Bankrupt from Getting Sick

#39
post #5

Don't fall for the 'yes, but countries that have cheap healthcare pay for it with taxes'. The US pays more than most from taxes[0]. In Sweden we pay less per capita than americans do (from taxes) and my total _maximum_ healthcare costs for _all_ treatments, medications, surgury etc, that in the US would be paid by your employer or yourself are: $125/year max for all visits and procedures [1] + $250/year max for all p…

>>Don't fall for the 'yes, but countries that have cheap healthcare pay for it with taxes'. The US pays more than most from taxes[0]. Americans don't actually have an objection to paying more for healthcare. What they do have an objection to is paying for other people's healthcare. America is a deeply individualistic society, and the idea of one's tax dollars being spent to benefit others lies at the root of most peo…

All this leads to is less people going in for annual checkups and preventative health care which leads to people becoming catastrophically sick ($40k medical bills) vs. preventing that situation from happening at all if it can be prevented; or catching it early on so it can be mitigated.

It's been a long time since I've worked in retail where I had no employee provided healthcare but back then I'd only go to the doctor if my arm was falling off. Everything else was "this feels weird, I'll wait it out, hopefully it goes away because I don't have $150-200 for a checkup if it turns out to be nothing."

A simple example is dental care. Yearly checkups, cleanings, etc and actively working to prevent major issues leads to far less diseases (blood, etc). But when you don't have decent insurance knowing that you might go in and get told you've got a $400 cavity or need a $1500 root canal out of pocket dissuades a lot of people from even going in. Thankfully I have generally healthy teeth but I hadn't gone to a dentist since my teens (parents insurance) until a few years ago. And once you tell someone that you might be shocked by the number of people who come out of the woodwork to tell you they haven't gone either.

I generally thought I was incredibly healthy and invincible until 28 when out of the blue I got appendicitis, which was $35k. I still had my "only go if my arms falling off" mentality back then but eventually the pain was so unbearable that I drove myself to the ER as I knew something serious was going on. Thankfully I had insurance. That really taught me that there's a lot of things in my body that I have no control over regardless of how healthy and active I am and having a fall back plan to help when catastrophe happens is critical.

Re: Americans Are Going Bankrupt from Getting Sick

#40
post #5

Don't fall for the 'yes, but countries that have cheap healthcare pay for it with taxes'. The US pays more than most from taxes[0]. In Sweden we pay less per capita than americans do (from taxes) and my total _maximum_ healthcare costs for _all_ treatments, medications, surgury etc, that in the US would be paid by your employer or yourself are: $125/year max for all visits and procedures [1] + $250/year max for all p…

>>Don't fall for the 'yes, but countries that have cheap healthcare pay for it with taxes'. The US pays more than most from taxes[0]. Americans don't actually have an objection to paying more for healthcare. What they do have an objection to is paying for other people's healthcare. America is a deeply individualistic society, and the idea of one's tax dollars being spent to benefit others lies at the root of most peo…

Ironically, I support single payer healthcare (or at least a dramatic restructuring that decouples pricing from employment) specifically because of individualism.

Right now, you need to work at a corporation to get collective bargaining for healthcare prices. This presents a huge disadvantage to people wanting to be contractors, self-employed artists, people wanting to start small businesses, people who only want to work every other year for whatever reason, etc.

Your options are limited because you need to be part of a corporate collective to get reasonable healthcare options.

Post reply on HN