Employer health plans are getting pricier and skimpier • Hacker News Board

Re: Employer health plans are getting pricier and skimpier

#281

Post by bluecalm » Wed, Sep 25, 2019, 9:40 PM UTC

ergothus wrote: post #181

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous I appreciate your reasonable breakdown, but I don't understand this one. I've seen many reports talking about how the costs of basic supplies and procedures are dramatically higher in the US (and vary wildly within the US). Things like X-Rays, MRIs, etc, being off by an order of magnitude or m…

MRI is like 5x cheaper here (I paid less than 300$ for both knees) without any insurance just doing it privately. The reason I think is that it's easier to open a medical business here, people can't sue for damages (or they can but will never be awarded anything substantial), there is less regulation you need to comply with and the doctors and technicians make less money. All this makes it possible to provide medical services at reasonable price.

We have public single payer healthcare. The quality is low and lines are long (it's several months at least if you would like to get free MRI using that option and then like a year or more to get actual arthroscopy). Still I think shitty but somehow working public option keeps private providers in check because they can't charge arbitrary amount as there is always shitty option to fall back on.

To give you an idea about prices here if you go private: typical doctor visit: 40$, dentist (one tooth filling): 60$, arthroscopy: 1000$, full blood panel with about everything under the sun included (hormones, vitamins, minerals, insulin response etc.): 200$. The quality of service is low but higher than in major metro areas in US (according to my sister who lives in NYC). This is Poland so low wages are surely one component that makes cheap services possible but I think not the only nor the most important one.

Re: Employer health plans are getting pricier and skimpier

#282

Post by lotsofpulp » Wed, Sep 25, 2019, 9:41 PM UTC

war1025 wrote: post #232

lotsofpulp wrote: post #62

Earlier quoted context omitted.

Source? IRS specifically states: https://www.irs.gov/taxtopics/tc502 >You may deduct only the amount of your total medical expenses that exceed 7.5% of your adjusted gross income. You figure the amount you're allowed to deduct on Form 1040, Schedule A. It’s another subsidy for big business in the US. If you work for a small employer that doesn’t offer health insurance, you’re paying with after tax money.

My reading of this [1] seems to match up with what I said: """ - If you buy health insurance through the state- or federally run health insurance marketplaces, you can deduct only the portion of the premium you pay out of your own pocket. You cannot deduct the amount of any subsidy. - If you buy an individual or family health insurance plan, either on the open market or through a marketplace, and you pay all of the c…

No, the bullet point right below the one you quoted states at least 7.5% of AGI spend is not deductible.

Re: Employer health plans are getting pricier and skimpier

#283

Post by zaroth » Wed, Sep 25, 2019, 9:42 PM UTC

throwaway_law wrote: post #115

js2 wrote: post #78

Earlier quoted context omitted.

MFA is a single-payer option but there are plenty of multi-payer healthcare systems in the world which achieve universal coverage and contain costs. Germany would be the prime example, but see also Switzerland and France.

I like single payer, but I haven't had the luxury of living under either system of universal care. I think in the US we have different issues than face Germany/Switzerland/France, and for the US to contain costs my opinion is we would have to rip private insurance out completely. Our main Government provided system (Medicare for the elderly) is a combination of government and private, and to put that system in perspe…

$375B for 82M people (~$4,500 per person) for Germany. Versus $609B for 44M people (~$13,800 per person) for Medicare.

FYI, USA currently spends about $10,800 per person on healthcare, roughly $3.5 trillion.

IMO, the discussion should revolve purely around pricing and efficiency. Negotiating power alone isn’t going to drive $1.5 trillion in costs out of the system.

I would like to see basic pricing reforms demonstrate that year-over-year price can be held constant. That would be a nice start.

Re: Employer health plans are getting pricier and skimpier

#284

Post by tempsy » Wed, Sep 25, 2019, 9:42 PM UTC

pdonis wrote: post #253

tempsy wrote: post #20

Earlier quoted context omitted.

We would do what every other country does and offer healthcare as a basic right? The whole point of "Medicare for All" is to divorce employers from their employee's healthcare. The gov't negotiates on behalf of everyone.

The government negotiating rates on behalf of all citizens is not the same as the government paying 100% of all citizens' costs. "Medicare for All" is the latter; but all we really need is the former. Basically the government could do on behalf of all citizens what it already does on behalf of government employees and elected officials: negotiate with providers to come up with a menu of plans, and then let each perso…

"Medicare for all" does not mean free healthcare. It's paid for by taxes. You taxes become your "premium" under that system. The concept of "private health insurance" outside of supplemental insurance would not exist under that system.

Re: Employer health plans are getting pricier and skimpier

#285

Post by jorblumesea » Wed, Sep 25, 2019, 9:46 PM UTC

eric_b wrote: post #204

evantahler wrote: post #201

Earlier quoted context omitted.

This episode of planet money talks about this https://www.npr.org/2019/09/04/757645741/what-medicare-for-a... Because of redundancies in the US system, there are like 5:1 administrators for each doctor. That’s a huge source of the costs. Medicare for all will likely cut a lot of those jobs to gain the savings. This show talks about if that’s good or bad for society.

It amuses me when people think that letting the government run something will make it more efficient. I do not disagree there is tremendous waste in the current system. I strongly believe that expanding the government's role will only make it worse.

You realize there multiple working examples of a national healthcare plan right? Including one very obvious example to our northern border. You're arguing like this is some huge open ended problem like climate change.

Almost every developed country has a national system that provides excellent care for far more reasonable costs. Except the US, of course.

I'm starting to realize why America will never get its shit together. Too many people without facts in the debate, believing they are correct, without any evidence at all.

Re: Employer health plans are getting pricier and skimpier

#286

Post by GreenJelloShot » Wed, Sep 25, 2019, 9:46 PM UTC

romwell wrote: post #272

simonsarris wrote: post #239

Earlier quoted context omitted.

> Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down. Why do you think this would be true? Why do you think the bargaining power would work the way you think it would? If you were correct, then cop cars must be fairly cheap compared to normal cars. Is this the case? What about other goods? Laptops? Cruise missiles? etc. Actually is it true f…

Perhaps this is a good reason: >Literally, every Industrial Nation has addressed this problem for much lower costs with better out comes.

Really? So there are zero people from other industrial nations that come into the US for health care?

Re: Employer health plans are getting pricier and skimpier

#287

Post by cma » Wed, Sep 25, 2019, 9:48 PM UTC

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous

This is not a fair comparison. Medicare/Medicaid predominantly covers the elderly. You can't compare their price spend to a mix including many more healthy people covered in single payer systems in other countries.

Re: Employer health plans are getting pricier and skimpier

#288

Post by throwaway5752 » Wed, Sep 25, 2019, 9:48 PM UTC

oarabbus_ wrote: post #280

throwaway5752 wrote: post #273

Earlier quoted context omitted.

"Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot." That is the peril of this type of analysis. Clinician cost is only 20% of total healthcare spend. Your premise is flawed so your conclusion is invalid.

His premise is not flawed; yours is. Looking only at clinican costs is akin to saying that a sandwich should only cost $1.50 because that's the cost of the ingredients. Doctor wages tie into personal health insurance, medical malpractice insurance costs, hospital system insurance costs, and more. Even if you were correct on the cost bit (you aren't), you're completely ignoring that artificially constraining the SUPPL…

You just proved my point, you know that right? It's the healthcare delivery and the markups along the way. If you paid doctors $0 tomorrow, healthcare costs would go down by 20%, at best, and probably less. Your analogy is perfect, actually. The problem in sandwich cost is rent, utilities, administrative expenses, marketing, an acceptable return on investment to the owners, etc, etc. The actual good being sold, a sandwich, probably costs 10% of what you pay retail.

Your repeated use of the phrase "cartel" is not impressive or convincing to me. In every other field: civil engineers, lawyers, real estate agents, accountants, teachers, police, and countless others have licensure, education, and training requirements.

And thanks for you concern, but I am familiar with many other global heath systems.

I notice you ignore LNPs and PAs in your analysis.

Re: Employer health plans are getting pricier and skimpier

#289

Post by GreenJelloShot » Wed, Sep 25, 2019, 9:48 PM UTC

belltaco wrote: post #207

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

>One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will occ…

Define "better".

Re: Employer health plans are getting pricier and skimpier

#290

Post by oarabbus_ » Wed, Sep 25, 2019, 9:50 PM UTC

JMTQp8lwXL wrote: post #179

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

Software Engineers in the US often make 2x as much as our European counterparts, yet we don't have any artificial limits on the number of people able to study Software Engineering. I'm not disagreeing with you the point on the AMA, but even if they removed their limits -- would many more people want to enter the field? It seems extremely intensive, not only during your education and residency, but on the job too. 12+…

>In 2011, 43,919 students applied to medical schools. However, only 20,176 of those applicants were accepted into at least one medical school. In other words, 54% of applicants got rejected to every medical school they applied to.

Even if we remove the bottom 10% or even 20% of un-accepted individuals (who we might assume, unfairly or not, are not cut out to be doctors) an absolutely significant number of people would enter the field.