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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

#371

Post by MFLoon »

madengr wrote: post #365
oarabbus_ wrote: post #290

Earlier quoted context omitted.

>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 woul…

I wonder what’s the graduation rate for medical school? You’d think it should be difficult enough to flunk out 2/3 of the students (like engineering), but I’m guessing that is not the case.

I also used to assume it was a field full of highly intelligent people, but when I told this to my cousin who is a doctor he laughed and said something to the effect of "The medical profession selects for mediocrity", and went on to point out that being a doctor is a fairly rote profession; most of their work does not involve creative problem solving or critical thinking. It is a very challenging profession in terms of having to learn an enormous body of material, work grueling hours in dangerous and unpleasant environments, and deal with customers who are definitionally unhappy to be your customer. But it's a set of challenges that a fairly wide portion of the population can rise to.

Re: Employer health plans are getting pricier and skimpier

#372

Post by hcknwscommenter »

d1zzy wrote: post #331
adamredwoods wrote: post #307

Earlier quoted context omitted.

There is a WHY (or at least a general why): Obfuscation. - lack of clarity on competitive pricing - obfuscation by adding multiple layers in buying process (broker - insurance - claims adjuster - hospital) - obfuscation through too-many-options syndrome (Obamacare versus Medicare versus state-driven healthcare versus emergency-only healthcare) - lack of clarity when being billed (getting several bills from several di…

The typical insurance company returns are pretty small (~5%) so that alone doesn't seem to explain why prices are so high.

But that's the return (net margin, not gross cost that the insurance company is adding to the whole system). You have to look at gross, which is way higher (~5x).

Re: Employer health plans are getting pricier and skimpier

#373

Post by pmart123 »

comnetxr wrote: post #360

Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No prices are labeled in store, they just detect whatever you take and send you a bill at the end of the month. (Differing brands of the same food product are not available in store of course.) Individuals are charged 3-100x more per product than negotiated rate…

This isn't a bad analogy actually.

Re: Employer health plans are getting pricier and skimpier

#374

Post by flukus »

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.

This is what happens with corporate healthcare plans already, those costs get past onto the consumer (middle to upper middle class) and they pay a hidden healthcare tax on every purchase.

Re: Employer health plans are getting pricier and skimpier

#375

Post by jachee »

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…

> The problem is that there is not a single reason that healthcare is so expensive.

I'm recently fond of saying that the ultimate root cause of all suffering is greed.

If you follow the money, I'm sure that is exactly what you'll find.

Re: Employer health plans are getting pricier and skimpier

#376

Post by makomk »

philjohn wrote: post #303
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…

And what's more - look at the UK where we spend half as much per capita on healthcare and achieve broadly similar results. Yes, if you get a sporting injury you're going to be waiting 6-8 weeks for physio, but if you have a heart attack, cancer, are in a serious accident there is no wait.

The official NHS target for cancer treatment is that patients should get it within a month of the decision that it's necessary. The NHS has been missing that deadline quite a lot: https://www.theguardian.com/society/2019/jan/10/nhs-england-...

Re: Employer health plans are getting pricier and skimpier

#377

Post by Gibbon1 »

realitygrill wrote: post #367
madengr wrote: post #365

Earlier quoted context omitted.

I wonder what’s the graduation rate for medical school? You’d think it should be difficult enough to flunk out 2/3 of the students (like engineering), but I’m guessing that is not the case.

It's practically 100%. Once you're in, they'll do everything in their power to graduate you (legitly). Every incentive they have points at a perfect graduation rate. EDIT: In the US, anyway. Things are different in, say, Caribbean medical schools.

I read someone mention that French medical schools are easier to get into but the graduation rate is much more like engineering schools. About 1/2 to 2/3 of students drop out or fail. Said the result was French doctors were functionally better in general than US ones and happier.

Since I don't have any experience with French medical schools I don't know if that is true or still true.

I do have experience with US doctors and about half of them are just phoning it in every day.

Re: Employer health plans are getting pricier and skimpier

#378

Post by zaroth »

js2 wrote: post #308
zaroth wrote: post #283

Earlier quoted context omitted.

$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 demonstrat…

> Negotiating power alone isn’t going to drive $1.5 trillion in costs out of the system Of course it could. It works in Germany! And France! And Switzerland! Why not here? Look, I don't know how this can possibly work with our current system. It cannot be solved by the market alone. There's no transparency in the current system. Insurers can just keep passing price increases along. And many Americans want "the best"…

My point centers around two things;

1) We cannot provide the same services with the same mechanisms, processes, and infrastructure at 50% of the current price. The margin simply isn’t that high. Everything from the design of the hospital, to the regulations around the equipment provisioned in each room, to the processes followed by staff throughout a given patient visit need to change, along with the specific tools and techniques used to perform procedures, before we even get into how and what procedures are chosen to treat or manage a given symptom or disease, whether acute or chronic.

2) Even with all of the above, a system that optimizes for price will absolutely have to make trade-offs in other areas to achieve that. Understanding where, when, and how those trade-offs are made and if they are being made fairly and uniformly based on malady, procedure, patient population, etc. is not a minor detail.

These are massive structural, policy, and economic changes which will impact a double-digit percentage of GDP. Why should anyone have any faith that this will be done in any semblance of a sane, reasonable, compassionate, let alone fair, efficient, or effective manner?

If the government has shown it’s entirely incapable of passing effective legislation to manage the cost of healthcare, why should government be granted an order of magnitude greater role in the provisioning of care?

Re: Employer health plans are getting pricier and skimpier

#379

Post by pmart123 »

mullen wrote: post #218
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 oc…

Peter Attia discussed this issue pretty extensively Mart Makary on his podcast. It seems like most of the medical community agrees this would drive down costs in the near-term. The issue is what happens to care, choice, and price long-term in a single-payer system.

I think is we force the disclosure of what every company or individual pays for specific treatment or medication, this transparency alone should be a big step in the right direction to normalize costs.

Re: Employer health plans are getting pricier and skimpier

#380

Post by hardtke »

charwalker wrote: post #346
JMTQp8lwXL wrote: post #200

Earlier quoted context omitted.

Sounds like this could be solved, if the startup could offer a higher base salary, bonus, or a combination.

Yes, but that isn't the root cause is it? Even if the current employer is big enough to negotiate lower prices or deals for its coverage and that's a barrier to entry for the startup, both companies could be set one a level field in a universal healthcare system removing this cost center from both companies. Even if the cost is (partially) rolled into something like payroll or income taxes, it would still impact the…

Large employers are self insured. The insurance companies just manage the benefits. In that sense there is no negotiation, beyond a manager fee. Price is determined by health of employees and benefit level.
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