We Need to Design Health Care Reform That Puts Patients Before Profits • Hacker News Board

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

#111

Post by tptacek » Fri, Oct 18, 2019, 7:00 PM UTC

ivraatiems wrote: post #106

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…

The problem is not the raw number for how much profit is made; it's how much waste is generated in pursuit of that profit. For example, the entire concept of "negotiated rates" as they apply to the US healthcare system is based around various entities trying to maximize profit, rather than maximize provision of care.[1][2][3] This results in patients being stuck with enormous bills, and services not being provided, o…

Negotiated cartel rates and lack of price insurance sure do seem like a plausible component of our health care debacle. But other countries have for-profit providers and private insurance and they don't have these problems. Why is that?

The prescription drug market is dysfunctional. But what did the last breakdown you look at say about the percentage of our health dollars swallowed by prescription drugs, compared to caregiver salaries, hospital procedures, and long-term care costs?

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

#112

Post by maximente » Fri, Oct 18, 2019, 7:00 PM UTC

tptacek wrote: post #66

The problem with US health care is that it costs too much. The elephant in the room in US health care costs is inefficiency on the provider side. Payer-side reforms have limited impact, because contrary to rhetoric from both sides of the debate, we could probably zero out administrative costs entirely and still deliver little more than a grocery store discount to American consumers. However we structure payment, we'r…

well said imo. the fact that most jobs in health care are administrative (never see a single patient) is telling that the incentives aren't good: we aren't increasing physicians per capita, we're just ... adding admins, very similar to what's going on in US universities.

for example, we know most growth in medical "jobs" are administrative in nature, and thus not helping per-capita physician rate or anything like that: https://hbr.org/2013/09/the-downside-of-health-care-job-grow...

it adds up, e.g. https://www.nejm.org/doi/full/10.1056/NEJMsa022033 where it's 3x cost of canada.

however there's a huge parasitic class of administrative jobs that exist due to this, so it's gonna be painful to excise. that pain will increase every day it's not done, unfortunately.

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

#113

Post by claudeganon » Fri, Oct 18, 2019, 7:03 PM UTC

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…

> The public rhetoric frustrates me as someone who favors universal healthcare. Demonizing corporations and rich people is red meat for partisans, but it’s not a solution. How do we pay for this system? How do we cut costs?

There are already two pieces of legislation, the Jayapal and Sanders bills, they account for their costs. Tim Faust’s new book likewise walks through all of these concerns in detail:

https://www.mhpbooks.com/books/health-justice-now/

And I don’t think people are “demonizing” corporations, so much as they are being more and more exposed to fundamental cruelty and parasitism of the American healthcare system. As costs spiral out of control and inequality compounds in the US, a far greater swathe of people are finding themselves on the receiving end of its violence and deprivation. I’d suggest you look at the work of disability activists like Ady Barkan to get a better picture.

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

#114

Post by rayiner » Fri, Oct 18, 2019, 7:03 PM UTC

bduerst wrote: post #15

kapuasuite wrote: post #4

Earlier quoted context omitted.

Other countries, yes even in Europe, have better healthcare than us with multi-payer systems. Medicare for All is a joke.

Medicare for all doesn't eliminate other payers, and is more similar to the European system than what we have now.

There is no "European system." Many European countries don't have a single payer, or even a "public option." The Netherlands has something quite close to ACA, for example. Germany has non-profit, but numerous, insurance companies.

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

#115

Post by refurb » Fri, Oct 18, 2019, 7:03 PM UTC

bduerst wrote: post #21

refurb wrote: post #14

Earlier quoted context omitted.

Umm.. a good part of Medicare is run by private insurers. Medicare Part C and D. Are you saying get rid of those too?

And why do you think that is? Part C and D have privatized options because it offers gap coverage from Part A and B, so yes, privatized Part C and D would disappear if the gaps are closed.

Coverage gaps? Medicare Part C is just another option to get coverage. So you'd take that option away?

And Medicare Part D is prescription drug coverage. You'd take that away?

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

#116

Post by ivraatiems » Fri, Oct 18, 2019, 7:03 PM UTC

tptacek wrote: post #111

ivraatiems wrote: post #106

Earlier quoted context omitted.

The problem is not the raw number for how much profit is made; it's how much waste is generated in pursuit of that profit. For example, the entire concept of "negotiated rates" as they apply to the US healthcare system is based around various entities trying to maximize profit, rather than maximize provision of care.[1][2][3] This results in patients being stuck with enormous bills, and services not being provided, o…

Negotiated cartel rates and lack of price insurance sure do seem like a plausible component of our health care debacle. But other countries have for-profit providers and private insurance and they don't have these problems. Why is that? The prescription drug market is dysfunctional. But what did the last breakdown you look at say about the percentage of our health dollars swallowed by prescription drugs, compared to…

> Negotiated cartel rates and lack of price insurance sure do seem like a plausible component of our health care debacle. But other countries have for-profit providers and private insurance and they don't have these problems. Why is that?

I'm reading your question as slightly rhetorical. If that's the case, and you have some thoughts, you should share them.

For my part, I'd start by looking at the way other privatized systems are managed and regulated, such as Sweden's: https://www.theguardian.com/society/2012/dec/18/private-heal...

> But what did the last breakdown you look at say about the percentage of our health dollars swallowed by prescription drugs, compared to caregiver salaries, hospital procedures, and long-term care costs?

I'm not making the point that prescription drugs are the largest or even a particularly substantial contributor to the overall number. I'm arguing they're an easy-to-see example of the overall problems that most facets of the current system face.

(By the way, the breakdown another user higher in the chain posted puts prescription drugs at 10% of overall costs, so that's a big chunk.)

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

#117

Post by refurb » Fri, Oct 18, 2019, 7:04 PM UTC

claudeganon wrote: post #18

refurb wrote: post #14

Earlier quoted context omitted.

Umm.. a good part of Medicare is run by private insurers. Medicare Part C and D. Are you saying get rid of those too?

Yes. Medicare for All is different from Medicare and gets rid of the hollowing out of traditional Medicare services through these side channel attacks on it. https://www.congress.gov/bill/116th-congress/house-bill/1384

Part D leverages the competitive nature of private, for profit markets.

As a result, costs for Part D have been much lower than projected.its a very successful program.

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

#118

Post by kerkeslager » Fri, Oct 18, 2019, 7:05 PM UTC

leetcrew wrote: post #89

EpicEng wrote: post #81

Earlier quoted context omitted.

>I would argue that helping many people allocate their time towards activities they actually value is just as important as saving individual lives. I think you'd pretty easily get trounced making that argument. People would much rather be alive to do something less efficiently than to... not be alive at all. This argument is a bit insane to me.

think about the people you care about. would you rather live more years or spend more time with them over a shorter life? what would they prefer? it's an inherently subjective question, and I don't think the answer is obvious. I certainly don't think one of the answers is "insane".

We live in a society where people work 40 hours a week, regardless. If people do a menial task more efficiently, the reward isn't going home and spending time with their family, it's more menial tasks. There is an exception: you might get to go home to your family if you get fired because your department is so much more efficient that you are no longer necessary. But given our society also demands that people do 40 hours a week of menial tasks to eat and live inside, it's hard to argue that's a good thing.

The only way increased productivity lets people spend more time for themselves is if it is on menial tasks outside of work, and most individual consumers won't pay for software, so then you're often into violating people's privacy to sell ads, which again is pretty hard to justify.

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

#119

Post by Zelphyr » Fri, Oct 18, 2019, 7:07 PM UTC

jcranberry wrote: post #104

aaavl2821 wrote: post #33

Earlier quoted context omitted.

Large hospitals systems have been forming regional monopolies for the last few decades. First they would buy other hospitals to increase negotiating leverage with insurers, then they started buying outpatient clinics to control patient flow. They can also increase the amount they charge at outpatient clinics once the larger hospital system buys them. Hospital spend represents 30% of US healthcare spend, and physician…

Are you sure that we should be going after hospitals rather than the insurance companies? I've been told by a doctor friend of mine that the price of treatment in hospitals are often affected by how much insurers are willing to pay. They bill an insurance company X, the insurance company only a fraction of that and the hospitals just have to deal with it. So suppose they get more leverage and they increase how much t…

Except, as I understand it, it's more like this:

Hospital bills Insurance Company $XXX,XXX.XX and Insurance Company says, "No, we'll only pay $XX,XXX.XX" so Hospital pays it. What's not mentioned is that it only cost Hospital $XXX.XX for the procedure so while they're complaining that the insurance companies only pay them a fraction of what they billed for the procedure, they're still making a massive margin.

That's not to suggest they don't have real, valid expenses. That's not even to suggest their expenses aren't high but, how would we know? They won't even tell us, the patients, how much any given procedure costs. It all seems like a wink-wink-nudge-nudge between them and the insurance companies to me while the rest of us get screwed.

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

#120

Post by tptacek » Fri, Oct 18, 2019, 7:08 PM UTC

maximente wrote: post #112

tptacek wrote: post #66

The problem with US health care is that it costs too much. The elephant in the room in US health care costs is inefficiency on the provider side. Payer-side reforms have limited impact, because contrary to rhetoric from both sides of the debate, we could probably zero out administrative costs entirely and still deliver little more than a grocery store discount to American consumers. However we structure payment, we'r…

well said imo. the fact that most jobs in health care are administrative (never see a single patient) is telling that the incentives aren't good: we aren't increasing physicians per capita, we're just ... adding admins, very similar to what's going on in US universities. for example, we know most growth in medical "jobs" are administrative in nature, and thus not helping per-capita physician rate or anything like tha…

Administration on both the provider and payer side of this system accounts for, depending on the estimates I've seen, 12-17% of total health care costs. You can't in reality zero those costs out (even Medicare's much-vaunted 2% administration cost would shoot up if it had to deal with every patient in the country), but even if you could, you wouldn't have made health care in the US affordable.