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)

#111

Post by lotsofpulp » Sat, Jul 04, 2020, 4:49 PM UTC

enaaem wrote: post #106

lotsofpulp wrote: post #69

Earlier quoted context omitted.

> 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 natur…

Maintaining that superiority does not require trillion dollar useless fighter jet boondoggles, or invading a country for no country wide gain, or being stuck occupying said country for decades due to a fabricated problem, or the use of mercenaries (private military contractors) who have connections to politicians.

There is zero valid reason the world’s mightiest military should need mercenaries.

A far better plan to remain as the world leader would be to court the world’s top minds and lure them into living in the US permanently. And all it would have required is handing out green cards at graduation. But that is another topic.

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

#112

Post by durnygbur » Sat, Jul 04, 2020, 4:49 PM UTC

vgchh wrote: post #89

I recently got a shock when I went for a tooth extraction. A nurse and a surgeon spent an hour to complete the procedure. It came out to ~$6000. I had to pay for $700 for calcium grafting right then and there and they were going to get back to me for the remaining after consulting with insurance plan. I am still waiting for the call, albeit terrified of the possibilities. I understand there are many parties in the fo…

At which point one draws the line and says "wait... they're not doctors or dentists - they're scammers"?

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

#113

Post by JamesBarney » Sat, Jul 04, 2020, 4:51 PM UTC

lnsru wrote: post #59

dominotw wrote: post #39

Earlier quoted context omitted.

> Obesity is treatable. How?

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

This is repeated a lot but if you actually look at the research you find that physical exercise has very little effect(except maybe as a preventative). That nutrition in general has a small effect. And dieting has a larger effect but is only temporary, and no dietary interventions have shown any real success over the long term.

Bariatric surgery is currently the only real effective treatment. With GLP agonists like semaglutide having similar effects at least in the near term.

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

#114

Post by ezconnect » Sat, Jul 04, 2020, 4:51 PM UTC

quadrifoliate wrote: post #35

standardUser wrote: post #13

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…

The way the country is designed you really need to drive to buy a simple thing.

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

#115

Post by chiefalchemist » Sat, Jul 04, 2020, 4:52 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…

Agreed. Look at the CDC's leading causes of premature death. A significant number are preventable (i.e., diet and lifestyle). Interesting enough, many of these are diseases that Covid 19 does well to exploit. If you are in good health, the chances of being taken to the grave by Covid 19 are rare.

What's odd is that the concept of comorbidies has been abandoned in the C19 era. There is little transparency when it comes to C19's co-conspirators.

Editorial: It troubles me when article after article about the high price is insulin fails to mention demand; and that close to all the demand created by Type 2 is avoidable.

Might there be manufacturer price gouging? Perhaps. But it's universally agreed that demand will increase price.

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

#116

Post by mschuster91 » Sat, Jul 04, 2020, 4:55 PM UTC

vgchh wrote: post #89

I recently got a shock when I went for a tooth extraction. A nurse and a surgeon spent an hour to complete the procedure. It came out to ~$6000. I had to pay for $700 for calcium grafting right then and there and they were going to get back to me for the remaining after consulting with insurance plan. I am still waiting for the call, albeit terrified of the possibilities. I understand there are many parties in the fo…

reminds me of an old joke: 15$ for positioning a screw, 10.000$ to know where to put that screw.

If the US wants to tackle its healthcare costs, it not only has to get rid of the pointless middlemen everywhere and the notion of uninsured people whose bills have to be picked up by the rest, but also enlarge its supply of new doctors, and reduce the student debt they have to pay off.

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

#117

Post by mschuster91 » Sat, Jul 04, 2020, 5:02 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.

They are cheap if bought in bulk (which many poor people can't do because of upfront cost or lack of freezer space) and if there actually is a place to buy at least decent-quality vegs.

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

#118

Post by SkyPuncher » Sat, Jul 04, 2020, 5:15 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.

My wife is a resident physician. I'm a software engineer. I will out earn my wife for most of our careers - even with her at a $250k salary. My wife will eventually out earn me, but I doubt her career wages ($/hour) will ever come above mine. It's really easy to rip on doctors when you only look at a single data point without understanding the larger picture.

That $250k salary looks outrageous because you're ignoring all of the opportunity cost that went to get there.

* 4 years of med school. $40k tuition/year. $160k in principal total.

* 4 years of med school. No salary. $100k/year opportunity cost. $400k total.

* 4 years of residency. $60k salary. Yay, she's making an income. Boo, it's literally all going towards student loans. $80k/year opportunity cost. $320k total.

* Congrats, you're now an attending. You're living the "good life". Oh, don't forget that $160k of tuition, it's full cost is roughly $300k.

* $400k + $320k + $300k = ~$1M in the hole. That doesn't include a bunch of misc. expenses - exams, re-locations, interviews (residency programs don't pay for your travel).

During that entire time, my wife is consistently outworking me by 50% to 100%. Step exams, board exams, residency interview season (holy shit that's a stressful time), volunteering, research, etc, etc, etc. Even when she's an attending, she still has a bunch of things she needs to do to maintain her licensing.

This is also $1M in the hole in a critical part of building a life/savings. A good portion/all of that $1M could be going towards long term investments like retirement, college funds, etc. We're basically 10 years behind on retirement. That's easily $500k of interest lost.

----

Physician pay is only 8.6% of health care costs [0]. You could cut physician salaries in half and the effects on your health care would be trivial.

[0] https://www.beckershospitalreview.com/compensation-issues/ph...

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

#119

Post by refurb » Sat, Jul 04, 2020, 5:16 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:…

Russ isn’t 100% unbiased (is anyone), but what I like about his podcast (been a while since I last listened) is he is willing to bring people on with very different views and let’s them have the floor for a bit.

He also does a nice job of “O.K., this is where we have differing opinions”. Unlike a lot of media that covers politics issues, it’s much more civilized to me.

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

#120

Post by SkyPuncher » Sat, Jul 04, 2020, 5:19 PM UTC

bawana wrote: post #81

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.

Actually, you are wrong. PCPs start at 90-100k salary. If you are quoting gross income before expenses then its about 200k. The overhead of running a physicians office is high. In terms of specialists, it's come down quite a bit. Just check the ads in the back of professional journals. 400k is more like the 70s. Also you can look at the training of all the recent physicians, - many are from abroad. Same thing that th…

FYI, all of the numbers you listed are close, but not totally accurate. See my other comment: https://news.ycombinator.com/item?id=23733575

That being said, the overall point is correct. There is a HUGE opportunity cost to becoming a physician. People would rather ignore that because it doesn't support their argument. It's much easier to cherry pick point-in-time data without looking at the larger picture.