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

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

#141

Post by jcranberry »

jostmey wrote: post #9
helpPeople wrote: post #6

Until Americans find Physicians (and Pharmacists) as the enemy, it will never happen. They(AMA and APA) are top lobbyists that entrench themselves using monopolistic practices. Sure school can cost 500k, but with 200 to 300k+ per year salaries, they can kill that debt. (This is their common defense)

I think you're stumbling on a root cause of America's healthcare crisis. I think most American's don't understand just how much physicians make--and where did you get those figures because clinicians I know make a good deal more than 200-300k

Average salary of physicians from the bureau of labor statistics [1]:

Anesthesiologists $267,020 Surgeons 255,110 Obstetricians and gynecologists 238,320 Psychiatrists 220,380 Family and general practitioners 211,780 Physicians and surgeons, all other 203,880 Internists, general 196,490 Pediatricians, general 183,240

Doctors go through 4 extra years of school and then 5-7 years as a resident where they are paid an average of 60k and work ridiculous hours. During that period they're always on call, work twice as much as average workers in other industries, and don't get regular holidays. I have a surgical resident friend who regularly works over 100 hours a week, sometimes having as much as three 24 shifts in a week--and frequently he'll have I just don't see how doctors are overpaid considering the amount of training they have to go through, their work conditions, and the risks involved.

1. https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...

2. https://www.gallaghermalpractice.com/blog/post/how-much-does...

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

#142

Post by tptacek »

ska wrote: post #13
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.

Other countries have better healthcare with single payer systems also.

Doesn't that strongly suggest that the structure of the payer side is not as outcome-determinative as advocates (for M4A, or for conservative reforms like across-state-lines insurance) make it out to be? What if payer structure really is a sideshow? What if we can make single payer work, or make private insurance work, but doing either job perfectly doesn't make care affordable in the US?

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

#143

Post by tptacek »

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.

At the point where you're saying we simply "close the gaps" in existing Medicare, you're really not talking about Medicare anymore; you're just using it as a synonym for a hypothetical US NHS. That's fine, but you should be up front about it if you do; you're not just expanding Medicare to new customers, but building a fundamentally new system and giving it the old Medicare name.

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

#144

Post by disabled »

Scoundreller wrote: post #123
disabled wrote: post #75

As an American with 2 rare immune-mediated neurological diseases, that affect my peripheral nervous system, I can almost guarantee you that decent health care reform will not happen in the foreseeable future. By the way, both of these diseases are in pharmaceutical remission, due to taking a blood product that has immunomodulatory properties. I will have to take it for life. My medical insurance literally pays hundre…

Do be sure to check that any new country will pay for the same thing. Single-payer/socialized healthcare can mean “Just Saying No” to expensive interventions.

Yes, and this is one of the main issues. Overall it is a logistical disaster. But, I have to say that engineering school helps you tackle logistical nightmares like this.

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

#145

Post by awinder »

tptacek wrote: post #96
awinder wrote: post #91

Earlier quoted context omitted.

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 probl…

I mean I'm at 20% in 2 cost centers (ill give you back 3 single digits but not a digit more), and there's more math on how you actually save money in a single payer system than just those 2 things. I don't know where the average family low-deductible plan costs $500 (maybe with employer subsidies? again, not a fair comparison), but 20% is a lot more than the 5% the parent discussed.

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

#146

Post by claudeganon »

tptacek wrote: post #138
claudeganon wrote: post #136

Earlier quoted context omitted.

As I mentioned to Raiyner, you should really read Tim Faust’s book to understand how single-payer can drive down costs, but I’ll highlight this from one of his articles: “ As the sole purchaser, the federal government is immediately able to set just prices for health care services (for example, by negotiating the cost of drugs). With the weight of the full cost of health care falling squarely on its shoulders, it has…

I'm very familiar with this argument, but it's unpersuasive, because we already have a national health insurance system for the (huge) most expensive cohort of Americans, and it has been unable to contain these costs, despite playing a powerful role in the structure of the system itself. Why aren't private health insurance systems incentivized to create evidence-based care plans? Wouldn't they, if anything, be more i…

If you’re referring to Medicare, it does control costs through its fee schedule, but is limited in efficacy because it doesn’t cover everyone. Nevertheless, the Trump administration is currently trying to jack up how much it pays out to non-Medicare levels to prevent even this downward pressure. And of course it’s barred from negotiating drug prices for the same reasons.

As to why insurance companies don’t pursue evidence-based treatment plans, it’s cheaper and easier in the US to just deny care and profit from it. Why do something more difficult, requiring additional investment, when they can just deny more claims. ACA plans already deny 1 in 5 claims.

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

#147

Post by 4ntonius8lock »

aaavl2821 wrote: post #93
4ntonius8lock wrote: post #64

Earlier quoted context omitted.

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

I don't have much experience with Think Tanks, but I've found the ones I've looked at to be highly partial to those funding them.

This country is very capable of smart, logical thinking. We've basically eradicated the issues of flooding. If we apply that type of thinking/organization, the issue could be tackled. But both sides, left and right, would have to want truth over vindication. We need to demand commissions to investigate, instead of trying to validate pre-conceived ideological notions.

If people reading the article asked for it, politicians would take note and would likely commission a good study. That's the beauty of our system (despite it's glaring flaws)

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

#148

Post by 4ntonius8lock »

dsfyu404ed wrote: post #105
4ntonius8lock wrote: post #61

Earlier quoted context omitted.

Except it isn't only about winning. Otherwise, we'd have no objective advancements in medicine. Saying it's ONLY about winning is just as absurd as thinking it's only about solving the problem. It's about solving problems within the system. That includes winning and a lot of other elements.

I didn't say that was the only goal. The politicians, the newspaper editors, the online trolls, etc. are all people too and probably want to see everyone get good healthcare at good prices but they're so busy advancing their vision of how that should happen that we can't actually have productive discourse because nobody can change their opinion on any detail.

> The politicians, the newspaper editors, the online trolls, etc. are all people too and probably want to see everyone get good healthcare at good prices

So then it's a good idea to remind people of the absurd, as in the post you answered. Dismissing the absurd as merely being a consequence of not 'thinking about winning' is an oversimplification.

To me such a dismissive, one liner post is designed for ego-gratification, rather than real in depth discussion. No offense, we all do it. Just saying my perspective.

Maybe I'm missing the in depth part though.

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

#149

Post by tptacek »

awinder wrote: post #145
tptacek wrote: post #96

Earlier quoted context omitted.

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 probl…

I mean I'm at 20% in 2 cost centers (ill give you back 3 single digits but not a digit more), and there's more math on how you actually save money in a single payer system than just those 2 things. I don't know where the average family low-deductible plan costs $500 (maybe with employer subsidies? again, not a fair comparison), but 20% is a lot more than the 5% the parent discussed.

I'm going to hold you to your own 17% number just to keep things simple.

In Chicago, for a family of four, the lowest-priced ACA bronze plan, Blue Cross with a restricted network ("FocusCare") and a $15,000 family deductible, after zeroing out 17% of expenses, you are paying $976/mo. I think health insurance is very valuable, but can say confidently that the average family in Chicago does not view $976/mo with a $15k deductible and a limited network as "affordable". The numbers get even harder if you select a more reasonable plan.

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

#150

Post by tptacek »

claudeganon wrote: post #146
tptacek wrote: post #138

Earlier quoted context omitted.

I'm very familiar with this argument, but it's unpersuasive, because we already have a national health insurance system for the (huge) most expensive cohort of Americans, and it has been unable to contain these costs, despite playing a powerful role in the structure of the system itself. Why aren't private health insurance systems incentivized to create evidence-based care plans? Wouldn't they, if anything, be more i…

If you’re referring to Medicare, it does control costs through its fee schedule, but is limited in efficacy because it doesn’t cover everyone. Nevertheless, the Trump administration is currently trying to jack up how much it pays out to non-Medicare levels to prevent even this downward pressure. And of course it’s barred from negotiating drug prices for the same reasons. As to why insurance companies don’t pursue evi…

Wait, Medicare covers the most expensive cohort of patients in the country, which you'll easily see in any breakdown of health costs by age. It already has responsibility and authority for prices in the most important segment of the market. Why hasn't it controlled their costs?

I think your answer on evidence-based care is superficial and a little bit facile. For instance, a major component of evidence based care is in fact the denial of procedures with limited demonstrated efficacy; see, for instance, the story about cardiac stents for otherwise stable patients. If anything, both private insurance and Medicare are allowing too many of these kinds of procedures. Why?

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