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)

#131

Post by DonaldFisk » Sat, Jul 04, 2020, 6:40 PM UTC

mardifoufs wrote: post #124

NicoJuicy wrote: post #76

Earlier quoted context omitted.

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 :)

Different countries have different methods of counting. In Belgium, suspected cases in care homes are included in the figures, without any testing being done (https://www.euronews.com/2020/04/22/analysis-can-we-trust-be...), so the official figures are an overestimate. In the UK, there are two different figures published. The headline figure is for confirmed deaths (i.e. with COVID-19 being listed as the cause of death on death certificates), but the Office of National Statistics less frequently publishes excess deaths (i.e. compared to previous years). The Belgian per capita suspected death count, which is probably similar to its excess death count, does exceed the UK confirmed death count but is well below the UK excess death count.

The per capita figure in https://multimedia.tijd.be/oversterfte/ for VK (United Kingdom) is for confirmed deaths (62.2 per 100,000). In mid June, the total figure was at 42,000, while excess deaths totalled 65,000, so that would make UK excess deaths 96.3 per 100,000, significantly higher than the Belgian suspected figure of 84.4 per 100,000.

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

#132

Post by dan-robertson » Sat, Jul 04, 2020, 6:45 PM UTC

FpUser wrote: post #71

quadrifoliate wrote: post #35

Earlier quoted context omitted.

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…

* Bigger homes means you feel more comfortable being lazy and spending all your time indoors I call BS on that. Accordingly to this logic homeless must be the healthiest people. That aside, rich people (who also happen to have bigger houses) actually exercise more than the poor. * Bigger cars means you are incentivized to drive 20 miles to a restaurant in comfort instead of walking over to a closer one You telling th…

I think this is a reasonable criticism. The post you’re replying to appeals to common sense but I don’t see much reason to believe it would be borne out by facts

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

#133

Post by lotsofpulp » Sat, Jul 04, 2020, 6:49 PM UTC

jmeister wrote: post #127

lotsofpulp wrote: post #111

Earlier quoted context omitted.

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.

The idea that the US could simply threaten the world’s factory with 4x the population of the US is ludicrous to me. They are top down, focused, and the only problem they had was lack of education, which is solved by time.

The only way for the US to have been able to threaten China without using force would have been to sow political discord and break it up into smaller countries. The US has 330M people, mostly getting older. China has 1.4B. Both have nukes so it’s not in anyone’s interest to engage militarily, and both have sufficient resources to not have to depend on someone else. And both need each other economically.

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

#134

Post by JamesBarney » Sat, Jul 04, 2020, 6:57 PM UTC

lnsru wrote: post #129

JamesBarney wrote: post #113

Earlier quoted context omitted.

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.

Oh sorry I'm not arguing that it never happens, just that in every clinical trial I've seen that followed participants for 5 years it was so rare to keep the weight off that the average weight loss for the group was insignificant(clinically not statistically).

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

#135

Post by lotsofpulp » Sat, Jul 04, 2020, 6:57 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…

> So now I wonder, what factors lead to that kind of city planning in US.

A car requirement (and hence minimum fuel purchasing requirement) helps keep lower socioeconomic classes out of higher socioeconomic classes’ neighborhoods. This results in marked improvements in economic performance of children in school, as the public school students are determined by the area they are in, and spacing things out results in a populace with a minimum level of financial security who can afford to travel further.

The original impetus may not have been exactly that, as people generally like their space anyway, but it’s affects are well known. Historically, I’m sure there was also a racial component to it, with white people moving to more expensive areas that non white people couldn’t afford.

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

#136

Post by readthenotes » Sat, Jul 04, 2020, 6:58 PM UTC

evanpw wrote: post #23

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.

Here's a long data analysis making that argument: https://randomcriticalanalysis.com/why-conventional-wisdom-o... .

What I got from that is that Americans are price-gouged more.

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

#137

Post by lotsofpulp » Sat, Jul 04, 2020, 7:02 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…

> pretty much none have more of a free market in health than the US,

US healthcare doesn’t have a free market by any definition. You would need a buyer and seller agreeing on a price, and without price information, there is no market.

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

#138

Post by lotsofpulp » Sat, Jul 04, 2020, 7:04 PM UTC

Retric wrote: post #85

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 huge factor is multiple insurance companies add a lot of overhead to the system as they all try to negotiate lower prices. It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead.

> It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead.

How do you know the doctor wouldn’t be billing erroneously anyway? People have no idea what doctors do or what is appropriate. The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacists) to reduce over billing.

Yes, the people working at insurance companies could be over zealous, but the same applies to healthcare providers.

If doctors didn’t want to deal with insurance, they are free to hang a sign that says $50 per 15 min consultation.

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

#139

Post by dragonwriter » Sat, Jul 04, 2020, 7:12 PM UTC

lotsofpulp wrote: post #138

Retric wrote: post #85

Earlier quoted context omitted.

A huge factor is multiple insurance companies add a lot of overhead to the system as they all try to negotiate lower prices. It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead.

> It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead. How do you know the doctor wouldn’t be billing erroneously anyway? People have no idea what doctors do or what is appropriate. The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacist…

> The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacists) to reduce over billing.

Insurance company profits are capped at a percentage of payout, and they are part of oligopolies protected by high barriers to entry, why would they reduce overbilling or advocate for patients?

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

#140

Post by lnsru » Sat, Jul 04, 2020, 7:19 PM UTC

JamesBarney wrote: post #134

lnsru wrote: post #129

Earlier quoted context omitted.

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.

Oh sorry I'm not arguing that it never happens, just that in every clinical trial I've seen that followed participants for 5 years it was so rare to keep the weight off that the average weight loss for the group was insignificant(clinically not statistically).

That’s probably the same effect as with Weight Watchers where long time success is rather limited. I have been there too. After couple years old habits return, one starts eating bad things, something happens (let’s take some illness) and exercising ends. Pounds are coming back and cycle starts again.