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Employer health plans are getting pricier and skimpier

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Re: Employer health plans are getting pricier and skimpier

#291

Post by oarabbus_ »

notadoc wrote: post #240
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…

> 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 sounds like a strange conspiracy, do you have evidence to support that? Keep in mind 20+ years ago that insurance was much cheaper, deductibles were almost nonexistent, and care networks were giant. Talk to your US parents or grandparents ab…

The AMA quite literally fits the definition of a cartel. It's quite absurd to use the term "conspiracy".

Academic papers going back to (at least) 1977 have suggested this: https://www.jstor.org/stable/2352286?seq=1#page_scan_tab_con...

Here are some other reading links.

http://www.jparksmd.com/blog/a-massively-overpaid-cartel (this doctor attempts to refute that the AMA isn't a cartel by making the point that doctors are "overpaid" in the US as compared to Europe by the same factor as for many other professions. He however intentionally avoids the point of the restricted supply, which is the root cause of the issue, the artificially high salaries are simply a symptom of the disease)

https://wallstreetpit.com/5769-medical-cartel-md-salaries-hi...

https://www.washingtonexaminer.com/thanks-to-doctors-there-a...

https://fee.org/articles/the-medical-cartel-is-keeping-healt...

Re: Employer health plans are getting pricier and skimpier

#292

Post by cwbrandsma »

KoftaBob wrote: post #12

This is why I feel the "most Americans like their health insurance" cliche is complete garbage.

I felt this is something that politicians say to two groups: the insurance companies and the "anti-socialism" libertarian crowd (who have injected themselves into the republican party).

Re: Employer health plans are getting pricier and skimpier

#293

Post by harryh »

Frondo wrote: post #250
HarryHirsch wrote: post #119

Earlier quoted context omitted.

The difference between Switzerland and the US is that in Switzerland pricing is regulated. The free market does not work when your life is at stake. You can shop around as much as you like for a butt enlargement and skip it if it's too expensive, but if you find a bat in the bedroom you need a physician straightaway, and then he will overcharge you.

There are some procedures where shopping around is conceivably an option. Once you're in desperate need (say, when it's bad enough that you're calling an ambulance), or unconscious, it's not realistic to suggest price-shopping. Markets of the mostly-free sort work well enough for commodity products, like the kind of peanut butter you're buying a jar of every few weeks (though even that's regulated, from things to foo…

The vast majority of health care is a commodity product. Unless you have some super rare condition, whatever your problem happens to be it's extremely likely to receive more or less the same treatment from a large number of potential providers.

Re: Employer health plans are getting pricier and skimpier

#294

Post by jandrese »

GreenJelloShot wrote: post #286
romwell wrote: post #272

Earlier quoted context omitted.

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?

Zero people from other nations come to the US to save money on health care. The ones that do come are looking for specialists for some exotic condition, not because they love the level of care or the price tags.

Re: Employer health plans are getting pricier and skimpier

#295

Post by simonsarris »

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.

But why those nations have lower costs isn't so simple. If you remove all profit and admin overhead from the US system, its still something like $5000/person more expensive than other countries (I think that that was vs Canada).

A large component of healthcare cost in the US is simply healthcare use. We are deeply, deeply unhealthy with 75% overweight rates and absurd levels of pre/diabetes, which are the largest comorbidities of all, and comorbidities of each other. Costs will never be comparable until overweight/obesity rates and usage are comparable too. They are not.

High prices in the US are very unfortunately largely explained by usage, and no amount of profit-reducing or cost cutting will work unless you are cutting usage itself:

https://randomcriticalanalysis.com/2016/09/25/high-us-health...

Re: Employer health plans are getting pricier and skimpier

#296

Post by madengr »

Turing_Machine wrote: post #219
MuffinFlavored wrote: post #170

Earlier quoted context omitted.

> An entire generation is draining their savings to keep up with premium costs. Knock on wood but, myself and pretty much everybody I know has insurance covered ~75% through our full time employers. I think my portion of my insurance is about... $100/mo? I've never had to use it way/shape/form in the past... 5-10 years. Isn't the truth that the most unhealthy people are what drives health care costs? It'd be interest…

> Knock on wood but, myself and pretty much everybody I know has insurance covered ~75% through our full time employers. That is money that would otherwise be given to you in the form of salary, so, yeah, you're paying for it even if it doesn't seem like it. Historically, the main reason for employer-provided health insurance in the U.S. is that it provided a loophole to increase effective employee compensation in a…

My employer dropped dental insurance a few years ago. They never gave me a pay bump to compensate. Now I spend $1,600/year on cleanings for a family of 4. At least it is out of my HSA, so pre-tax.

Re: Employer health plans are getting pricier and skimpier

#297

Post by jandrese »

baq wrote: post #188
geddy wrote: post #180

Earlier quoted context omitted.

> Doctor's are paid too much... why? You can also branch off here: because malpractice insurance is insanely expensive. Why? Because people sue over absolutely everything. Why? Because lawyers in this country are vultures. If anything is overly expensive, you can usually track it back to insurance costs somewhere, which can typically be tracked back to the fact that we live in a litigious society.

they sue and get awarded insane damages, which is probably something that could be regulated more strictly, but then what do i know.

This is compounded by our high medical costs. People who sue often have chronic medical conditions as a result of the malpractice, and the settlement is basically paying them for their extortionately expensive medical care.

Re: Employer health plans are getting pricier and skimpier

#298

Post by wonnage »

geddy wrote: post #193
MuffinFlavored wrote: post #170

Earlier quoted context omitted.

> An entire generation is draining their savings to keep up with premium costs. Knock on wood but, myself and pretty much everybody I know has insurance covered ~75% through our full time employers. I think my portion of my insurance is about... $100/mo? I've never had to use it way/shape/form in the past... 5-10 years. Isn't the truth that the most unhealthy people are what drives health care costs? It'd be interest…

Yeah, I really wonder where that $10,000/person figure comes from when you remove obesity and smoking related illnesses, so, the two highest and most preventable causes of death in this country. I always believed you should be able to qualify for lower costs (or be charged higher) depending on how you take care of yourself. Annual physical fitness test. I'm a little sick and tired of paying high premiums for people t…

HN, where you can find paranoid vegans blaming people for getting sick

Re: Employer health plans are getting pricier and skimpier

#299

Post by oarabbus_ »

throwaway5752 wrote: post #288
oarabbus_ wrote: post #280

Earlier quoted context omitted.

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 san…

On the contrary, you proved mine. I worked in medical devices and hospitals for a significant portion of my career, and I really don't care that you aren't impressed by the term "cartel", that's your prerogative to turn a blind eye to the facts. It's a combination of inflated salaries plus numerical shortage of doctors (the two are related) causing the root issues here. You claim to be familiar with other health systems; care to explain why in every other developed nation where doctors are not so overpaid, health care costs are reasonable?

NPs and PAs are not allowed to perform a significant number of medical procedures; I see you ignore that, conveniently, and bringing it up isn't much other than a red herring.

The "cartel" term has been used both colloquially and in academic literature for quite some time:

https://www.jstor.org/stable/2352286?seq=1#page_scan_tab_con...

Here are some other reading links.

http://www.jparksmd.com/blog/a-massively-overpaid-cartel

https://wallstreetpit.com/5769-medical-cartel-md-salaries-hi...

https://www.forbes.com/sites/timworstall/2017/06/04/milton-f...

https://fee.org/articles/the-medical-cartel-is-keeping-healt...

Re: Employer health plans are getting pricier and skimpier

#300

Post by ceejayoz »

GreenJelloShot wrote: post #289
belltaco wrote: post #207

Earlier quoted context omitted.

>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".

Substantially cheaper, with similar patient outcomes.
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