Which firms profit most from America’s health-care system (2018) • Hacker News Board

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

#61

Post by Auracle » Sat, Jul 04, 2020, 3:19 PM UTC

vertbhrtn wrote: post #30

bluedino wrote: post #12

Earlier quoted context omitted.

If we fixed our diet problems, I’m not sure if we’d either have e or healthcare costs, or if the industry would find other ways to fill in the gap

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.

Vegetables are cheap. Beans are cheap. Chicken and turkey are cheap.

McDonalds is not cheap, but it’s easy. It astounds me how many people eat out almost every meal.

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

#62

Post by war1025 » Sat, Jul 04, 2020, 3:23 PM UTC

throwawayiionqz wrote: post #60

knubie wrote: 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.

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

Maybe I'm misremembering, but we had a ridiculous high deductible ($10k?) when we had our first kid, and I don't think we met it.

That said, I complain about the price of healthcare and insurance to anyone who will listen, and I hope someday it gets sorted out. So far the only solution I've found is to get a better paying job, which isn't a solution for most people.

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

#63

Post by dan-robertson » Sat, Jul 04, 2020, 3:23 PM UTC

grecy wrote: post #15

dan-robertson wrote: post #9

Earlier quoted context omitted.

A counter argument I see sometimes is that the reason Americans spend more on healthcare compared to other rich countries is that American consumers spend more on just about everything than most other rich countries (and also earn more money). I don’t really know how much merit the argument has.

> American consumers spend more on just about everything than most other rich countries Do you have a source for that? In my experience living and working in a slew of countries around the world, the USA has the cheapest alcohol, cigarettes, cars, electricity, clothing, electronics, gas (and diesel), food at the supermarket, food at the restaurant and many other things of any developed country. Because taxes are so l…

I’m not saying things are more expensive but that the total spent is more. What do you think Americans do with their relatively higher incomes? Evidence would suggest that for the most part they aren’t just putting the difference straight into their savings accounts.

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

#64

Post by boublepop » Sat, Jul 04, 2020, 3:23 PM UTC

sytelus wrote: post #19

In the case of health care, consolidation has probably made things worse by muting competition. There are now five big insurance companies, three big wholesalers, three large pharmacy chains and three big benefit managers. In the case of health care, consolidation has probably made things worse by muting competition. There are now five big insurance companies, three big wholesalers, three large pharmacy chains and th…

As I see it consolidation isn’t the root cause. The central problem is that pharmacy benefits manager have been allowed to invert the normal market. Normally for someone arranging the “resale” of a product from a producer to costumers would make more money if the price got negotiated down. But since PBMs have forced rebates of 70%+ that means that they are making most of the money on a drug sale. So even thought they are representing the buyers at the negotiation table, they want the prices as high as they can be. Producers are sitting down at the table and outbitting each other not on how low the price could be, but how high they are willing to make it, it’s absurd. And you’d think the insurance companies or pharmacies would object, but often they are owned by the same group so they all just share the proceeds from ripping of the people.

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

#65

Post by tryptophan » Sat, Jul 04, 2020, 3:23 PM UTC

lotsofpulp wrote: post #43

sytelus wrote: post #19

In the case of health care, consolidation has probably made things worse by muting competition. There are now five big insurance companies, three big wholesalers, three large pharmacy chains and three big benefit managers. In the case of health care, consolidation has probably made things worse by muting competition. There are now five big insurance companies, three big wholesalers, three large pharmacy chains and th…

That is the situation I see with pretty much all businesses. 2 to 3, maybe 5 large organizations who can outcompete everyone due to economies of scale, especially due to advancements in technology.

Healthcare administration isn't really a high tech business though.

I think the culprit here is obamacare; after all it was written by the insurance companies. Who's surprised that it benefits them the most? Insurance stocks absolutely took off after it was passed.

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

#66

Post by take_a_breath » Sat, Jul 04, 2020, 3:24 PM UTC

knubie wrote: 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…

Colonoscopies in the US cost about $2,500 out-of-pocket, even with insurance. Most other countries are under $1,000 for the same procedure.

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

#67

Post by lotsofpulp » Sat, Jul 04, 2020, 3:25 PM UTC

ianleeclark wrote: post #57

Taek wrote: post #36

Earlier quoted context omitted.

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.

There are plenty of healthcare related things that one can shop for, such as this COVID test. The price could easily be advertised on the healthcare facilities website. But it’s not because it would hurt revenue since price transparency benefits buyers, and price obfuscation benefits sellers by allowing them to price discriminate and charge each seller the most each seller is able to pay.

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

#68

Post by satyrnein » Sat, Jul 04, 2020, 3:26 PM UTC

DougWebb wrote: post #18

saddlerustle wrote: post #11

Earlier quoted context omitted.

Why do you think that'll make drugs significantly cheaper? Drug companies are only about as profitable as other science-heavy industries.

Pharmaceutical companies have massive advertising/marketing budgets, which a nationalized drug R&D program would not need. That lowers overall costs. The R&D and manufacturing costs would also be spread across all Americans instead of only the patients who need the drugs, so the costs would be much lower for the patients as well.

At least some of those marketing costs would still be needed, they'd just be called "education" or "outreach" or "access" programs. Patients and doctors still need to be informed of new advancements to improve outcomes.

For the second point, cost spreading helps particular people in particular circumstances, but doesn't lower overall cost. You're just running a wealth transfer or insurance program in addition at that point.

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

#69

Post by lotsofpulp » Sat, Jul 04, 2020, 3:27 PM UTC

epistasis wrote: post #58

Taek wrote: post #42

Earlier quoted context omitted.

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 woul…

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

US taxpayers seem to be able to find hundreds billions for R&D of fighter jets and aircraft carriers. Perhaps this is not as necessary as developing medicine. Or not invading and occupying random countries.

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

#70

Post by barrenko » Sat, Jul 04, 2020, 3:27 PM UTC

mobilefriendly wrote: post #41

vertbhrtn wrote: post #30

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.

Milk is not healthy, rice barely can qualify but I guess it's food. Beans are.