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Which firms profit most from America’s health-care system (2018)

economist.com

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Re: Which firms profit most from America’s health-care system (2018)

#51

Earlier quoted context omitted.

I'd argue it's unfixable for low income workers. Excessive sugar in all the cheap food is a trap they can't avoid. They don't have money to buy better food and don't have time to shop and cook for themselves. That's assuming they recognize this problem at all.

More than 40 million Americans are on food stamps (govt food support). In reality, many food basics like milk, rice and beans are healthy and affordable.

Affordable, yes, but require more time and skill to cook a meal that hits the same reward centers as the edible junk sold in cheap restaurant chains... often both short in supply among those on food stamps.

Re: Which firms profit most from America’s health-care system (2018)

#52

Earlier quoted context omitted.

> B It was tried and rolled back in chicago because it was deemed as unfairly targeting the poor.

Did Chicago stop corn subsidies in the US?

no? but wouldn't it have the same effect of burdening the poor more?

Re: Which firms profit most from America’s health-care system (2018)

#53

Earlier quoted context omitted.

I'd argue it's unfixable for low income workers. Excessive sugar in all the cheap food is a trap they can't avoid. They don't have money to buy better food and don't have time to shop and cook for themselves. That's assuming they recognize this problem at all.

More than 40 million Americans are on food stamps (govt food support). In reality, many food basics like milk, rice and beans are healthy and affordable.

Plenty of people are low income or otherwise cash poor by reasonable standards, but not low enough to qualify for food stamps.

Re: Which firms profit most from America’s health-care system (2018)

#54
post #21
post #2

from Wikipedia: The classic example of rent-seeking, according to Robert Shiller, is that of a feudal lord who installs a chain across a river that flows through his land and then hires a collector to charge passing boats a fee to lower the chain. There is nothing productive about the chain or the collector. The lord has made no improvements to the river and is not adding value in any way, directly or indirectly, exc…

This feudal lord probably have invested in an upkeep of few knights who enforce that chains stays in place. And then lobbied at the court against complaints from merchants and peasants. He might have also have to bribe few judges. Also historically feudal lords had been constantly in debt spending more on representation then they have earned. Some moneylenders might have taken all this rent from river chain. Or the f…

Just because rent seekers spend their money does not make them productive members of society. In nature parasites have their own parasites, which can again have their own parasites. I suppose in a zero sum economy rent seeking doesn't hurt the economy (just certain members of the economy), but in a positive sum economy, if non-productive rent seekers are taking money from productive people this will cause the economy to be worse than it could have been. If people who would otherwise be productive are lured into rent seeking by the potential profits then it's a double loss. Not only are they taking capital from productive people that could have been used to create more wealth, but they themselves could have been producing wealth instead of being a drag on wealth creation.

There are certainly situations where organizations that seem like rent seekers are not entirely rent seekers, though. Government is the main example. Taxes can seem like a drag on wealth creation, and sometimes they are, but they also fund infrastructure, education, and stability, which are wealth multipliers.

The issue is also complicated by the fact that the world economy is very connected, but economic growth is often measured on a per country, corporation, or even individual basis. Also, aggregate wealth is not the be-all end-all metric. Wealth redistribution can sometimes lead to greater aggregate happiness, even if the amount of wealth stays the same or even decreases.

Overall, though, I think that the majority of rent seeking hurts the economy and the people in the economy more than it helps, but I would be very interested to see empirical data showing otherwise.

Re: Which firms profit most from America’s health-care system (2018)

#55

Just got the bill yesterday for my "free" Covid test. $250, insurance pays $105, you owe $145. (The test was free, the office visit was not.)

Who is to blame? The government for not collecting taxes from you and using that money to pay the doctor? The doctor for billing too high for the visit? The insurance company for not covering more of the price? Personally I would seek to understand why the doctor is billing so much and how that can become more fair for everyone involved.

For who to blame, I think it is shared. The govt could have set a price ceiling for testing so people actually get tested. Yes, I think the bill was too high for the service provided, which was the test and checking vitals. For me I essentially had to get tested because I had a fever and my wife was not allowed to go back to work until I was cleared. Maybe I could have shopped around better.

Re: Which firms profit most from America’s health-care system (2018)

#56

Earlier quoted context omitted.

And as a result we have bigger homes, bigger cars, bigger TVs.... but worse healthcare outcomes? Seems like some of that excess spending yields us more returns than others.

The things you mentioned are almost all inversely related to better healthcare outcomes, to grossly oversimplify a contributing factor. * Bigger homes means you feel more comfortable being lazy and spending all your time indoors * Bigger cars means you are incentivized to drive 20 miles to a restaurant in comfort instead of walking over to a closer one * Bigger TVs means you spend all day "watching the game" instead…

> Bigger cars means you are incentivized to drive 20 miles to a restaurant in comfort instead of walking over to a closer one

For many (most?) people in the US, the idea of walking anywhere of consequence from their home is simply ludicrous. Restaurant, convenience store, grocery store, all are completely inaccessible except by car.

Suburb planning has explicitly disallowed that sort of living for most people. It has also made it nearly impossible to serve neighborhoods with any sort of reasonable public transit.

Re: Which firms profit most from America’s health-care system (2018)

#57
post #36

Earlier quoted context omitted.

Who is to blame? The government for not collecting taxes from you and using that money to pay the doctor? The doctor for billing too high for the visit? The insurance company for not covering more of the price? Personally I would seek to understand why the doctor is billing so much and how that can become more fair for everyone involved.

A big element here is that the free market is being choked out. Consumers walk into healthcare facilities without any idea what they will be paying when they walk out, and therefore have no ability to choose one facility over another based on price. Because that ability doesn't exist, there is no downwards price pressure anywhere at the consumer level for medical services. I think we'd see a lot more results if we as…

> Because that ability doesn't exist, there is no downwards price pressure anywhere at the consumer level for medical services.

It's important to note that the downward pressure you'd see here is only for elastic goods which most healthcare-related things likely aren't.

Re: Which firms profit most from America’s health-care system (2018)

#58
post #42
post #29

Earlier quoted context omitted.

Developing new drugs takes over a decade and costs billions. European countries are free loading of US drug research. https://www.wsj.com/amp/articles/how-other-countries-freeloa...

Do we have good data on what happens if you change the IP laws around drugs to reduce the moat that the developers get? A common claim by big-pharma defenders is that if you take away the gouging aspect, drug development will stop. Is there some way we can test this experimentally on a subset of the drug market?

One way to do that would be to publicly fund research for clinical trials in drugs that do not have that moat.

It is totally possible to develop drugs without that moat, it just requires getting the money from somewhere.

I have no idea which method would produce better outcomes. Back when there was more science leadership at large pharma, I thought they would be more likely to take crazy bets that work out, that wouldn't necessarily happen at an NIH grant review panel. But last I checked most upper management in pharma are people that tout a PhD on their name, but it's for a field outside of a relevant science.

Re: Which firms profit most from America’s health-care system (2018)

#59

Earlier quoted context omitted.

Personally I'm way more inclined to believe Americans are unhealthy because their health care system is too expensive, rather than the other way around. Obesity is treatable.

> Obesity is treatable. How?

By fixing nutrition and adding some physical exercises. Though it’s slow, count 1 kg weight loss/week in average.

Re: Which firms profit most from America’s health-care system (2018)

#60
post #5

> Every year America spends about $5,000 more per person on health care than other rich countries do. Yet its people are not any healthier. I think part of the reason Americans spend more on healthcare is precisely because they're unhealthy. According to the American CDC the obesity rate has reached a staggering 42.4% of adults[0], which brings with it a slew of health problems. This accounts for an additional $147 b…

2 nights at the hospital for delivering a healthy baby may cost $50k-$100k to the insurance for healthy baby and mom.

The fact that hospital/physicians charge as much and insurance accepts to pay is not due to some unhealthy habits or chronic diseases in the US.

Edit: of course your point stands and the higher rate of chronic diseases makes it worse.

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