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)

#91

Post by hef19898 » Sat, Jul 04, 2020, 3:55 PM UTC

phaemon wrote: post #78

enaaem wrote: 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...

(I'm using 2015 figures because they were the latest available the last time I challenged this bullshit) Nope, drugs sales in the EU alone are enough to cover pharmaceutical R&D costs worldwide. What they aren't enough to cover is Marketing costs, but that's OK since most EU countries don't allow direct marketing of drugs. That's what the US covers. Not quite so noble sounding that you're covering the cost of adverti…

Thanks for these numbers!

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

#92

Post by dragonwriter » Sat, Jul 04, 2020, 3:57 PM UTC

Taek wrote: post #36

sushshshsh wrote: post #25

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…

> A big element here is that the free market is being choked out.

Given that every developed country has much lower per capita and per GDP costs, and pretty much none have more of a free market in health than the US, I'm pretty sure that's not the problem driving US prices high. I get that free market fundamentalism is one of the most influential religions in the US, but it's popularity doesn't make it contentions true any more than the popularity of Christian fundamentalism does for young earth creationism.

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

#93

Post by nazgulsenpai » Sat, Jul 04, 2020, 3:59 PM UTC

boublepop wrote: post #64

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…

Pharmacies, PBMs and insurance companies being owned by the same group is all an effect of consolidation.

Source: worked for an independent specialty pharmacy that was purchased by a PBM that in turn merged with a major national insurer

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

#94

Post by rgblambda » Sat, Jul 04, 2020, 4:02 PM UTC

vishnugupta wrote: post #72

epistasis wrote: post #56

Earlier quoted context omitted.

> 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…

> Restaurant, convenience store, grocery store, all are completely inaccessible except by car. This particular aspect of USA struck me as quite bizarre whenever I visited on business trips. More so as I’m from India where it’s almost a given that things that you need on a day to day basis (grocery, bakery, pharmacy, convenience store etc.,) are available within walking distance. Apart from an opportunity to get some…

Initially U.S cities were built according to a grid plan (grids being the most efficient means of urban planning at the time). This also made public transport easier. Grids however do not work well for cars. In response to increasing car ownership, T junctions were introduced to improve flow of traffic. The car also made it possible for people to live far from their place of work, thus the popularisation of suburbs. Other countries followed suit.

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

#95

Post by nazgulsenpai » Sat, Jul 04, 2020, 4:03 PM UTC

guerrilla wrote: post #24

ntsplnkv2 wrote: post #6

> Everyone hates pharmaceutical firms, but their share of health-care rent-seeking is relatively trivial, especially once you include the many midsized and small firms that are investing heavily. This article misses the point. People hate pharmaceuticals because of ridiculously high drug costs, and that's about it. If they can't produce drugs at profit without gouging potential end users then it should be nationalize…

Subsidizing doesn't stop the price gouging though, it only distributes the cost and in fact may increase the incentive for price gouging since payment would be nearly guaranteed. Why not free the intellectual property here instead?

Because without patents and exclusivity, the return on the massive R&D involved doesn't exist. Naturally that removes the incentive for R&D (in the market as it exists today.)

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

#96

Post by perl4ever » Sat, Jul 04, 2020, 4:05 PM UTC

tkeAmarktinClss wrote: post #45

I didn't see anyone mention physicians. The base rate of the profession is around 250k per year. Specialities are not included in that calculation. Specialities are closer to 400k to 500k per year. This is not natural. This is 130+ years of regulatory capture. Other countries pay their physicians half as much. Not to mention outcomes are basically the same.

It's my perception, not saying it's necessarily universally applicable to the US or all types of doctors, that nobody sees a doctor any more. You see a nurse practitioner or a physicians assistant. There might be one actual doctor per practice.

So talking about what doctors make might be misleading.

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

#97

Post by specialist » Sat, Jul 04, 2020, 4:08 PM UTC

This paper says 4% of cost goes towards "excess profits". I accept this without reservation.

But it remains unsatisfying.

What about the other overheads? Marketing, customer acquisition and retention? Health plan negotiators? Payment processing? Executive compensation? Etc, etc.

Many others have guesstimated USA healthcare costs 50% more per capita than Canada. So eliminating administrative overhead would whack 1/3rd of the costs, right?

Advocates for single payer could better emphasize all the unnecessary inefficiencies of our Freedom Markets™ health care system. All those "bullshit jobs" David Graeber has been telling us about.

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

#98

Post by specialist » Sat, Jul 04, 2020, 4:10 PM UTC

claudeganon wrote: post #49

mchusma wrote: post #16

EconTalk has many great episodes digging into interesting aspects that are touched on here: why the US healthcare so expensive for so little extra value. This episode about the Oklahoma group that has had low cost & transparent prices for surgeries for many years. http://www.econtalk.org/keith-smith-on-free-market-health-ca... This one on why we get such expensive drugs with marginal benefit: http://www.econtalk.org/…

Roberts is well-read and diplomatic, but I wouldn’t exactly call what he does with his show thoughtful engagement. The very few instances he has guests that truly diverge from his ideological dispositions, he mostly dismisses their arguments without the same rigor that he defends those within his biases. His conversation with Elizabeth Anderson on workplaces as a form of private government is a good example of this:…

Ya. It'd be nice if the Freedom Markets™ advocates would remain mindful of the "freedom from coercion" parts of libertarianism. I remain mystified by the application of different standards for governments and corporations.

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

#99

Post by francisofascii » Sat, Jul 04, 2020, 4:12 PM UTC

amanaplanacanal wrote: post #83

sushshshsh wrote: post #25

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.

Part of the issue is that the supply of doctors is kept artificially low in the US. Another part is: why the heck do you need an office visit for this? Why can’t you go directly to the lab?

For the record, it was not a brick/mortar office, but a temporary tent set up specifically for Covid testing.

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

#100

Post by throwawayiionqz » Sat, Jul 04, 2020, 4:23 PM UTC

war1025 wrote: post #62

throwawayiionqz wrote: post #60

Earlier quoted context omitted.

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…

Private hospital in NYC: Just the hospital "room and board" line is north of $40k: $13k per night of "enhanced nursery" for the newborn and around $10k per night for Mom. That's before all the doctors add their services.

No idea how you can make it lower than $10k :) Where was that?