301–310 of 389 posts
It's always fascinating to see that even compared to prices you pay as a self-paying patient in Germany (which are already 1.5x - 2x higher than what the "public" insurances, ie. 85% of the population, pay for the same procedures), the prices in the US are about 5x to 10x higher. The standard of care seems to be quite comparable if you look at outcomes, so there must be huge inefficiences in the American system (doct…
Earlier quoted context omitted.
My understanding is the insurance companies are incented for C to increase as well - under the ACA insurance companies can only have a certain profit margin, so the only way to increase profit is to increase revenue and payouts.
From a personal conversation with an insurance company board member, I’ve been told this isn’t a factor as most aren’t running anywhere close to that line. The bigger factor in his eyes is healthcare providers building local monopolies. I don’t know how true that is, but I wanted to share.
In fairness, he's not wrong, and neither is parent. Hospitals companies have local monopolies, which they can use to charge ridiculously high prices. On the other hand, insurance companies do get a kickback of sorts when the hospitals bump prices - the negotiators get compensation based on the dollar amount of savings they can bring from negotiation, so effectively, even if the hospital bumps prices high enough and renegotiates the chargemaster rates to a lower one, while still ensuring a profit for the negotiators, they'll go for it. Bloomberg did a nice write up of it a few years back, but it's now behind pay wall.
Earlier quoted context omitted.
My experience as a child was great. As a working adult I spend hours fighting with insurance, hospitals, and doctors to get my bills properly covered. It feels like a bunch of wolves arguing over whose gonna eat the sheep (me). For this privilege I get to pay insurance a minor fee of 3k/month for my family of 5.
There definitely had been a few snags with insurance that we had to work through - not claiming it's perfect. However I recall the night my son was born - the facilities, staff and resources of the hospital were unmatched - the mother and baby would not have the same experience anywhere else in the world. My wife works in the ER - they constantly use procedures and deploy resources in ways that would be considered im…
We had a wonderful experience with the birth of our daughter, but I have no idea how I could claim it was better than anywhere in the world. I'm asking because you seem to be making a low-hyperbole claim here: what is your basis for saying that? Particularly, when the US has some of the worst metrics for infant mortality, birth weights, and mother mortality rates in the developed world.
> My wife works in the ER - they constantly use procedures and deploy resources in ways that would be considered impractical elsewhere in the world.
Does this actually lead to better health outcomes? The US ranks low in the developed world in many health-related areas. Some of them are at least in part due to cultural issues and it is completely fair to attribute to our healthcare system. But some of them like our rates of medical and lab errors clearly are. I'm genuinely looking for data to support the idea that the tradeoff you mentioned actually exists.
Earlier quoted context omitted.
Out of curiosity, how much will this reduce the cost of health care? The idea, as it's been explained to me, is that visibility into the cost of medical care will result in downward price pressure. How much?
For example, an appendectomy (MSDRG 343) in my area will cost $56,000. With my insurance plan, that will max out my $8,000 deductible, + another $8,000 co-insurance to hit my out of pocket maximum of $16,000. That's what I'd pay, $16,000. Or, I can go to Tennessee and get the appendectomy (MSDRG 343) for $4,700 and pay that directly. Many people will make that choice Kaiser gets less business putting downward pressur…
I just read an article about quiet / dream jobs (park ranger etc.) In it, every single person has a side gig(s) or is otherwise making decisions on their careers based on medical coverage. Every one of them! One of the people says most people leave when they turn 26 because they can't stay on their parents' health insurance. What?! > And like other dream jobs I learned about, it’s not enough to survive on: During > o…
// Having the freedom from health care costs is more freedom for more people than the "freedom" to not pay health insurance or taxes to cover it. This is not how freedom works. Your argument is akin to saying "freedom from hearing uncomfortable opinions" benefits more people than "freedom of expression" does. On the broader level, I got to experience healthcare in the US both as a broke-ass immigrant child and as a w…
I just read an article about quiet / dream jobs (park ranger etc.) In it, every single person has a side gig(s) or is otherwise making decisions on their careers based on medical coverage. Every one of them! One of the people says most people leave when they turn 26 because they can't stay on their parents' health insurance. What?! > And like other dream jobs I learned about, it’s not enough to survive on: During > o…
// Having the freedom from health care costs is more freedom for more people than the "freedom" to not pay health insurance or taxes to cover it. This is not how freedom works. Your argument is akin to saying "freedom from hearing uncomfortable opinions" benefits more people than "freedom of expression" does. On the broader level, I got to experience healthcare in the US both as a broke-ass immigrant child and as a w…
According to this the US is mostly in the high top 10 for outcomes in cancer and cardiovascular disease treatment outcomes:
https://en.wikipedia.org/wiki/List_of_countries_by_quality_o...
But the US spends more than double the OECD average per capita to achieve those marginal gains:
https://upload.wikimedia.org/wikipedia/commons/thumb/0/0b/OE...
There's an argument to be made that the cost overruns are paying for better outcomes, or maybe the outcomes have some sample bias due to Americans being less healthy, or sicker people are seeking treatment in the US.
But on the other hand, the gains are so marginal that those costs might also be due to significant corruption and regulatory capture.
Earlier quoted context omitted.
From a personal conversation with an insurance company board member, I’ve been told this isn’t a factor as most aren’t running anywhere close to that line. The bigger factor in his eyes is healthcare providers building local monopolies. I don’t know how true that is, but I wanted to share.
Well he was just shoving the issues under the rug. In fairness, he's not wrong, and neither is parent. Hospitals companies have local monopolies, which they can use to charge ridiculously high prices. On the other hand, insurance companies do get a kickback of sorts when the hospitals bump prices - the negotiators get compensation based on the dollar amount of savings they can bring from negotiation, so effectively,…
I think my takeaway from the whole conversation is that the insurance business can be counterintuitive to outsiders. Salvation may not be as simple as getting rid of them.
Another tidbit is that insurance companies don’t mind being the bad guys. I’m not sure if our focus on that industry blinds us to effective solutions for controlling costs.
Earlier quoted context omitted.
There definitely had been a few snags with insurance that we had to work through - not claiming it's perfect. However I recall the night my son was born - the facilities, staff and resources of the hospital were unmatched - the mother and baby would not have the same experience anywhere else in the world. My wife works in the ER - they constantly use procedures and deploy resources in ways that would be considered im…
> However I recall the night my son was born - the facilities, staff and resources of the hospital were unmatched - the mother and baby would not have the same experience anywhere else in the world. We had a wonderful experience with the birth of our daughter, but I have no idea how I could claim it was better than anywhere in the world. I'm asking because you seem to be making a low-hyperbole claim here: what is you…
Conversations with friends and family abroad.
// Particularly, when the US has some of the worst metrics for infant mortality, birth weights, and mother mortality rates in the developed world.
Not an expert but I understand there's a ton of measurement variability. Something like:
Baby born 3 months premature and dies shortly after. Many countries just consider that still birth and it doesn't count towards infant mortality. In the US we actually fight to save these kids so if they die, they count towards infant mortality. Perhaps weight at birth works the same way?
I just read an article about quiet / dream jobs (park ranger etc.) In it, every single person has a side gig(s) or is otherwise making decisions on their careers based on medical coverage. Every one of them! One of the people says most people leave when they turn 26 because they can't stay on their parents' health insurance. What?! > And like other dream jobs I learned about, it’s not enough to survive on: During > o…
Earlier quoted context omitted.
// Having the freedom from health care costs is more freedom for more people than the "freedom" to not pay health insurance or taxes to cover it. This is not how freedom works. Your argument is akin to saying "freedom from hearing uncomfortable opinions" benefits more people than "freedom of expression" does. On the broader level, I got to experience healthcare in the US both as a broke-ass immigrant child and as a w…
That may be true but the USSR is a collapsed state, we should be comparing wealthy countries. According to this the US is mostly in the high top 10 for outcomes in cancer and cardiovascular disease treatment outcomes: https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... But the US spends more than double the OECD average per capita to achieve those marginal gains: https://upload.wikimedia.org/wikipedia/com…
