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)

#101

Post by dominotw » Sat, Jul 04, 2020, 4:25 PM UTC

ebg13 wrote: post #79

dominotw wrote: post #38

Earlier quoted context omitted.

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

> It was tried and rolled back in chicago because it was deemed as unfairly targeting the poor. There's no reason why you couldn't pair taxing sugar with price-subsidies on non-sugary foods. The US already knows how to subsidize food production. Just stop subsidizing corn syrup and shift the subsidies to something less clearly destructive.

> price-subsidies on non-sugary foods.

That makes a big assumption that people aren't buying more spinach because of price of spinach.

beans and rice are already super cheap. Much healthier and cheaper option than mcdonalds.

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

#102

Post by lotsofpulp » Sat, Jul 04, 2020, 4:28 PM UTC

ianleeclark wrote: post #84

lotsofpulp wrote: post #67

Earlier quoted context omitted.

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.

> 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. Are you against a monopsony in healthcare? If you care about having a fair-shake for every consumer, then that's the most consistent way of wielding power against would-be price gougers.

There’s a balance to be had, a marketplace functions best when there are many buyers and many sellers. Obviously, health issues aren’t a perfect marketplace due to buyers not being able to shop around many times, and due to buyers not having sufficient knowledge about what they are buying due to the complexity inherent in medicine.

In all cases though, I think price transparency is always good as that is what helps to properly allocate resources in the long run. And I think that published healthcare prices coupled with high deductible health insurance is a good idea as it would allow proper information about pricing to be transmitted, at least for minor issues such as covid tests or broken bones or routine visits and procedures.

For more complex cases, I would have to defer to those with expertise on how to ration resources.

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

#103

Post by war1025 » Sat, Jul 04, 2020, 4:31 PM UTC

throwawayiionqz wrote: post #100

war1025 wrote: post #62

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. 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?

Iowa. I think the base rate here is about $1k / night. Could be wrong on that though. Our oldest is four and half now, so it's been a while. It's possible I just didn't read the bills correctly. Either way I'm sure it was less than what you describe.

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

#104

Post by lotsofpulp » Sat, Jul 04, 2020, 4:32 PM UTC

throwawayiionqz wrote: post #100

war1025 wrote: post #62

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. 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?

My experience in one of the most expensive suburbs of NYC, at the most highly rated hospital in the state, a baby with standard 2 night stay and delivery and no complications cost $20k or so all together with about $5k out of pocket on a gold HSA plan a couple years ago.

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

#105

Post by guerrilla » Sat, Jul 04, 2020, 4:36 PM UTC

nazgulsenpai wrote: post #95

guerrilla wrote: post #24

Earlier quoted context omitted.

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.)

The incentive is that they get to market first as well as the inherent value of the medicine. They could also be paid the cost of R&D or a market price for the initial release of the information rather than a royalty (ransom model).

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

#106

Post by enaaem » Sat, Jul 04, 2020, 4:40 PM UTC

lotsofpulp wrote: post #69

epistasis wrote: post #58

Earlier quoted context omitted.

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.

The military is used to protect "The American Order". There are some non-trivial benefits of the American Order:

1. Secure maritime trade for all. Protection against piracy and gone are the days when countries would just steal each other's cargo. 2. Global trading currency that is backed by the biggest economy in the world. 3. Establishment of a global trade network. Industrialised countries have access to more natural resources than ever without needing colonies.

Remember how the world was before the American Order. Colonies and hostility all over the world. Europe was in two world wars and would have probably been in another one with the Sovjets.

Generally speaking, people trust the American rule of law and trust that the US will help her allies. This only made relevant by having an ultra beefy military. It's hard to put a price on these things, and which portion the US tax payers have to pay.

Note that the current administration wants to cut back on these costs. European countries are benefitting a lot from the American Order, and should perhaps shoulder more of the costs.

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

#107

Post by amelius » Sat, Jul 04, 2020, 4:42 PM UTC

Auracle wrote: post #61

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.

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.

Quality vegetables aren't cheap. At least not for the consumer.

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

#108

Post by jogjayr » Sat, Jul 04, 2020, 4:46 PM UTC

Auracle wrote: post #61

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.

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.

Check out https://en.wikipedia.org/wiki/Food_desert

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

#109

Post by throwawayiionqz » Sat, Jul 04, 2020, 4:46 PM UTC

lotsofpulp wrote: post #104

throwawayiionqz wrote: post #100

Earlier quoted context omitted.

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?

My experience in one of the most expensive suburbs of NYC, at the most highly rated hospital in the state, a baby with standard 2 night stay and delivery and no complications cost $20k or so all together with about $5k out of pocket on a gold HSA plan a couple years ago.

We only paid $6k from HSA (maxing out the out-of-pocket) but that Mt Sinai hospital charges $80k (after adjustments) and the insurance pays the rest. I should add there was a C-secyion that barely added $10k to the bill.

I know, couldn't believe it either

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

#110

Post by JamesBarney » Sat, Jul 04, 2020, 4:48 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…

We pay way more per procedure than other countries, we get more procedures, and we get more expensive procedures.

I doubt obesity makes a very large difference because even though it increases morbidity I think it has a larger effect on mortality. If you're obese you might have to retire a few years early, but you'll also die even earlier missing out on years of being taken care of in a nursing home while you suffer from Alzheimer's.