Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

We Need to Design Health Care Reform That Puts Patients Before Profits

rooseveltinstitute.org

Post reply on HN
Print view View original

91–100 of 206 posts

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#91

Post by awinder »

rayiner wrote: post #34

The U.S. spends $3.5 trillion annually on healthcare. Worldwide profits for the 112 publicly traded healthcare industry companies amount to $50 billion per quarter: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar... . Even if all those profits are allocated to the U.S., that's about 5.7% of healthcare spending. (And completely consistent with most other industries.) Hyper-focusing on profits is misguided…

So there’s the profits, and there’s the costs of the profit system. Which is why you have to look in places like administrative costs which are something like 17% in private insurance. Profit is the money over revenue - costs, so yes the profit is a center of waste, but there’s a ton of waste in the costs department that would not be necessary in a universal system.

There’s also a lot of makework jobs wrapped in there too, so it’s no doubt a complicated problem.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#92

Post by lotsofpulp »

DonnyV wrote: post #84
rayiner wrote: post #34

The U.S. spends $3.5 trillion annually on healthcare. Worldwide profits for the 112 publicly traded healthcare industry companies amount to $50 billion per quarter: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar... . Even if all those profits are allocated to the U.S., that's about 5.7% of healthcare spending. (And completely consistent with most other industries.) Hyper-focusing on profits is misguided…

First of all I don't trust profit numbers of any large corporation. There are so many ways that large corporations can hide profit. So lets pay attention to revenue. UnitedHealth alone generated $200 billion in 2017. https://www.modernhealthcare.com/article/20180116/NEWS/18011... Yeah there might be some fat there.

There is at most 20% of "fat" there, by law (ACA).

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#93

Post by aaavl2821 »

4ntonius8lock wrote: post #64
aaavl2821 wrote: post #37

Earlier quoted context omitted.

There is plenty of data on this available. It isn't perfect but it's there. The problem isn't lack of data, its lack of awareness of the data. Most people learn about the healthcare system by reading newspapers and other media, and from what I've seen coverage of healthcare in most US media is very political and seldom data-driven Check out here to start, there are plenty of other resources: https://data.oecd.org/hea…

Raw data there is. I'm talking about a report that says: After analyzing the health care systems of X, Y and Z countries, a commission suggest A, B and C changes to the US healthcare system. A major commission organized and created by an organization that has proven capable of developing long term, large scale plans for the greater good of the country (think the army corp of engineers, but it doesn't have to be them,…

That's fair, there are think tanks that do this sort of work, but I think it is a hard problem.

Yes even on HN I find that most people are pretty dogmatic about healthcare. People tend to react rationally to the data when presented, but are also happy to make aggressive statements that are unsupported by data

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#94

Post by TaylorAlexander »

tptacek wrote: post #79
TaylorAlexander wrote: post #72

Earlier quoted context omitted.

There’s always room for critique, but millions of Americans need something to change. How can we get coverage to the poorest people effectively?

I think it's easy to misread what I wrote as saying that the current system is OK, or there aren't giant, urgent problems that need to be addressed. There are huge problems. The concern I have is that payer-side reforms are a sideshow.

Sorry, I didn’t mean to suggest that you had taken this position. I just really want to move the conversation forward. So there are problems with Medicare, but you seem to know about this so I’m curious what you would suggest we do to provide coverage to millions of poor Americans currently going without. I’m no policy expert and I thought M4A is a great idea. Thanks!

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#95

Post by AimForTheBushes »

DonnyV wrote: post #84
rayiner wrote: post #34

The U.S. spends $3.5 trillion annually on healthcare. Worldwide profits for the 112 publicly traded healthcare industry companies amount to $50 billion per quarter: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar... . Even if all those profits are allocated to the U.S., that's about 5.7% of healthcare spending. (And completely consistent with most other industries.) Hyper-focusing on profits is misguided…

First of all I don't trust profit numbers of any large corporation. There are so many ways that large corporations can hide profit. So lets pay attention to revenue. UnitedHealth alone generated $200 billion in 2017. https://www.modernhealthcare.com/article/20180116/NEWS/18011... Yeah there might be some fat there.

Assuming your distrust is true then the article's point of attacking profits is futile.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#96

Post by tptacek »

awinder wrote: post #91
rayiner wrote: post #34

The U.S. spends $3.5 trillion annually on healthcare. Worldwide profits for the 112 publicly traded healthcare industry companies amount to $50 billion per quarter: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar... . Even if all those profits are allocated to the U.S., that's about 5.7% of healthcare spending. (And completely consistent with most other industries.) Hyper-focusing on profits is misguided…

So there’s the profits, and there’s the costs of the profit system. Which is why you have to look in places like administrative costs which are something like 17% in private insurance. Profit is the money over revenue - costs, so yes the profit is a center of waste, but there’s a ton of waste in the costs department that would not be necessary in a universal system. There’s also a lot of makework jobs wrapped in ther…

By the numbers you just cited --- higher than the numbers I found, but only by single digits --- if you zeroed out administrative costs, eliminating not just insurance but any money paid anywhere to administer health benefits --- you would bring the cost of a low-deductible family health plan down by about $100/month. That is simply not enough, not nearly enough, to address the problem. Our national health care problem is not that plans cost $100 too much.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#97

Post by Matticus_Rex »

c0nducktr wrote: post #86
tptacek wrote: post #67

Earlier quoted context omitted.

Your argument is that a nonprofit Japanese restaurant could have delivered a better experience to me?

I'd wager a nonprofit Japanese restaurant could have provided your meal at a lower cost.

Would it have been the same meal, cooked by people with the same level of talent, served with the same care? "Profit" is not just a disposable line item.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#98

Post by OliverJones »

The situation is slightly more complex than this article recognizes.

1. When a hospital, either for-profit or not-for-profit, must provide free care to a patient, it comes out of their hide. Enough of this free care can force the hospital to demand higher rates. See https://hmsa.com/portal/provider/zav_pel.fh.DIA.650.htm Medicare and Medicaid foots part of the free care bill. And, yes, patients who turn up at emergency departments get some free care. It makes the news when a hospital kicks patients to the curb because they can't pay.

2. Enough free care can bankrupt a hospital or force it to close. In under-served areas (rural) this is, umm, not good for the community served by the hospital.

3. Corporations -- hey fellow HN readers, our employers -- must offer private health insurance. This is a HUGE pain in the neck for executives (some HN readers, that's you and me). They have to scare up health plans their companies and employees can afford, so they must waste their time doing that instead of, I dunno, designing products or calling on prospective customers. Sure, we get entrepreneurs trying to help with this. Zenefits. Need I say more? It's time-wasting madness.

4. Corporations must pay insane amounts of money for health plans for their people. And it's compound insanity. That's like compound interest, but worse.

5. Employees (that's you and me, HN readers) have to waste our time and spend our money on our part of health insurance costs.

6. "Medicare for all" invokes a health-care payment system that's proven to work at scale, and is reasonably accountable to all its stakeholders. (Except for part D / drugs / the subject of another rant for another day.)

My point: in the long run, being business-centric is the SAME THING as being patient-centric. In this area, Mitt Romney was right: "corporations are people."

I am baffled by politicians' complaints that some kind of government option for paying for health care is bad because it will raise taxes. Don't they know what we know? Paying for health care is already a massive tax on both employers and employees.

It's just hidden by a shell game. It's not actually a tax, it's a tax deduction. If you believe this, maybe I can rent you a some space in the huge dirigible hangar at Moffett Field. Cheap. Send me your bitcoin.

Can you imagine how much more successful a YC company might be if they didn't have to sweat this health-insurance stuff? Can you imagine how much more successful GM and Tesla would be if they knew their workers' health care was covered?

How come captains of industry and bigshot VCs aren't demanding better?

Yeah, some companies will suffer when this changes. But almost all companies suffer now.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#99

Post by zarro »

Contrarian viewpoint: NOT focusing on the profits is the cause of the problem.

Hypothesis: Prices are high because of inefficiencies in the markets caused by bad laws attempting to subsidize one class of people by another. Hospitals aren't able to refuse treatment by law to those that can't afford to pay for their services and insurance companies are coerced to insure unprofitable people by law and the net effect is to try and coerce people into a redistribution of money from people that require more care from those that require less care to cover these expenditures.

Because there is no mechanism to coerce people to do this willingly that's efficient enough for the increasing demands of those requiring care, both industries to give the invoices to the government (who created the problem) thereby getting rid of the requirement to think about how they will fund their expenditures - making it the governments problem to figure out.

This thereby allows them to continue uncontrolled expenditure resulting in exuberant prices in an ever increasing downward spiral to catastrophe as in effect they are spending 'other peoples money' in the hopes that "eventually these invoices will be paid" through some sort of government sponsored coercion mechanism forcing socialized heath care or some other such method with the same result.

Its really quite simple and clever and funny how it still works.

-5% of the population accounts for more than half of all health spending.

-50% of the population with the lowest spending accounts for only 3% of all total health spending.

Edit: Anytime I share this viewpoint, a bunch of either misguided or prejudiced people downvote me. I'm guessing its because they don't understand the argument completely, or see its logic, but disagree with its implications.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#100

Post by tptacek »

TaylorAlexander wrote: post #94
tptacek wrote: post #79

Earlier quoted context omitted.

I think it's easy to misread what I wrote as saying that the current system is OK, or there aren't giant, urgent problems that need to be addressed. There are huge problems. The concern I have is that payer-side reforms are a sideshow.

Sorry, I didn’t mean to suggest that you had taken this position. I just really want to move the conversation forward. So there are problems with Medicare, but you seem to know about this so I’m curious what you would suggest we do to provide coverage to millions of poor Americans currently going without. I’m no policy expert and I thought M4A is a great idea. Thanks!

I don't know. What I'm advocating is that any discussion of the US health care problem start with a breakdown of where the money is going in our system. There are competing breakdowns, but any of them would be better than the default presumption we seem to have that the problem with health care is "insurance companies and prescription drugs". No breakdown I've seen on any side of this debate shows that either of those things are the true driver of costs in our system.

I'm not defending either the current private health insurance system, which I think needs drastic reform, or the market for prescription drugs, which is dysfunctional in a bunch of ways. But I am unconvinced that the public intuition about the overall health care problem is well informed.

Post reply on HN