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)

#121

Post by refurb » Sat, Jul 04, 2020, 5:20 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.

Why would a nationalized R&D program not need marketing? I can assure you that the doctors who are aware of new drugs in development is a very thin slice of all doctors.

Even if run by the government, you’d still need to market (educate) about new drugs.

And R&D in the big pharma firms is spread out across the entire population. That diabetes drug that sold $1B last year is paying for the cancer R&D this year.

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

#122

Post by refurb » Sat, Jul 04, 2020, 5:21 PM UTC

DougWebb wrote: post #82

satyrnein wrote: post #68

Earlier quoted context omitted.

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…

Patients do not need to be informed of new drugs, and never were until pharmaceutical companies lobbied Congress to remove the ban on direct advertising, which had been put in place as a consumer protection law due to 19th century "snake oil" salesmen/con-men. For doctors, a monthly publication of drugs currently in development, their status, and their uses would be adequate. It'd be much better for doctors to get th…

If you want to know why DTC is allowed in the US, you should read the FDA studies on it.

https://www.fda.gov/drugs/drug-information-consumers/impact-...

The FDA identified several benefits of DTC ads.

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

#123

Post by jackcosgrove » Sat, Jul 04, 2020, 5:28 PM UTC

dragonwriter wrote: post #92

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…

> 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 tr…

Other developed countries' public health facilities ration care based on medical need rather than ability to pay. There is always concierge medicine but it's not nearly to the extent in the US. Rationing of care this way means fewer medical procedures on the whole.

I've seen numbers to the effect that health outcomes are 30% genetic, 30% diet, 30% lifestyle, and 10% medical intervention. Frankly Americans don't need as many procedures done as they have done. Medical care is rationed everywhere and there is no way for supply to meet demand. The only question is how do you ration it. Turns out rationing by ability to pay leads to unnecessary procedures with no boost in outcomes.

The hard part to accept is that the system that imposes a 3-6 month wait for non-life threatening treatments is better because some number of cases resolve themselves during that time period and reduce total demand.

Overall medicine has limited tools to improve health compared to diet and exercise. We like to believe an intervention by someone else - surgical, pharmaceutical, etc. - can fix our problems, but that's not the case for many people. Medicine can really help with things such as pain management and trauma, but to an unsettling degree we rely on the body to heal itself.

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

#124

Post by mardifoufs » Sat, Jul 04, 2020, 5:29 PM UTC

NicoJuicy wrote: post #76

francisofascii wrote: post #8

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.)

Belgium On your own initiative ( partially paid back): - 9.6€ for the Covid test - 17 € for the doctor visit By Government: - fully paid back by our health care, including doctor visit I love transparent pricing :)

But the highest COVID death rate in the western world! You gain some, you lose some I guess :)

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

#125

Post by adjkant » Sat, Jul 04, 2020, 5:30 PM UTC

rgblambda wrote: post #94

vishnugupta wrote: post #72

Earlier quoted context omitted.

> 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.

What other countries? The US is very much an outlier. The only one I can think of is maybe Australia?

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

#126

Post by mrfredward » Sat, Jul 04, 2020, 5:41 PM UTC

dragonwriter wrote: post #92

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…

> 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 tr…

Most developed nations have highly regulated healthcare systems, and part of the government involvement is in setting prices.

The U.S., through everything from safety regulations to IP laws to insurance regulation has destroyed competition, but outside of medicare isn't involved in determining prices. The result is predictable.

Markets work great when the incentives are right. It's hard to get incentives right in healthcare and most nations want medicine to be part of a government safety net, so they go the direction of socializing healthcare. Almost anything would be better than the system the U.S. has now.

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

#127

Post by jmeister » Sat, Jul 04, 2020, 5:48 PM UTC

lotsofpulp wrote: post #111

enaaem wrote: post #106

Earlier quoted context omitted.

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…

“You can’t handle the truth!” - Col. Jessup.

Look at China’s aggression in the past couple of months, especially with India. It would never have happened 10 or 20 years back with a strong America. Yes, the US does serve as the world’s policeman.

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

#128

Post by satyrnein » Sat, Jul 04, 2020, 6:02 PM UTC

DougWebb wrote: post #82

satyrnein wrote: post #68

Earlier quoted context omitted.

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…

Patients do not need to be informed of new drugs, and never were until pharmaceutical companies lobbied Congress to remove the ban on direct advertising, which had been put in place as a consumer protection law due to 19th century "snake oil" salesmen/con-men. For doctors, a monthly publication of drugs currently in development, their status, and their uses would be adequate. It'd be much better for doctors to get th…

I'm not sure a monthly roundup is a drop-in replacement. Presumably that could exist now, but isn't as effective for whatever reason.

On the other point, subsidizing drugs for those who need them is a perfectly reasonable goal. It just seemed to me (incorrectly, it appears) like you were suggesting this cost shifting lowers the total cost.

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

#129

Post by lnsru » Sat, Jul 04, 2020, 6:11 PM UTC

JamesBarney wrote: post #113

lnsru wrote: post #59

Earlier quoted context omitted.

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 s…

I lost recently 70 lbs without any surgery. Talking about extreme cases I have no idea, never met any people above 300 lbs. I can only guess, that start is always the same. Personally I am not a friend of surgical interventions.

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

#130

Post by tonyedgecombe » Sat, Jul 04, 2020, 6:14 PM UTC

dan-robertson wrote: post #9

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…

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.

America spends 18% of GDP on healthcare, in the UK its about 9%. Arguably the UK could do with spending more but right now we get broadly similar outcomes for half the spending.