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Health insurers just published close to a trillion hospital prices

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Re: Health insurers just published close to a trillion hospital prices

#211

Post by dominotw »

groby_b wrote: post #188
dominotw wrote: post #166

Earlier quoted context omitted.

> countries without that or with less generally have better outcomes at less cost. > Looking for evidence to the contrary There was no evidence behind your claim either. 90% of US healthcare costs go to managing ( not treating ) obesity/metabolic disease . Yes 90% [1]. Which country with similar metabolic disease rate has better outcomes with less costs? 1. https://www.cdc.gov/chronicdisease/about/costs/index.htm

That is not at all what your link says. "90% of the nation's $4.1 trillion in annual health care expenditures go to people with chronic and mental health conditions" Obesity is $173 billion, diabetes $327 billion. We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous. Diabetes cost is roughly the same percentage of total expenditure as it is in other industrialized nati…

see: page 20 https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221...

> We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous.

How so? Only recommendation for all these chronic conditions is 'diet and exercise' is it not ?

Obesity isn't the only one. I am not obese , not even close, but I have hyperlipidemia. I am managing it with 'diet and exercise' after initially being put on statins. Same with hypertension, heart disease ect. All of these are metabolic diseases. Sure, I'll give you 'mental health conditions' may not be a lifestyle disease ( Even those are being now linked to diet ) .

Re: Health insurers just published close to a trillion hospital prices

#212

Post by pessimizer »

TedDoesntTalk wrote: post #200
Barrin92 wrote: post #129

Earlier quoted context omitted.

beyond Europe as well. Singapore which has exceptionally low healthcare spending (5.9% of GDP) heavily controls prices and purchases down to individual equipment in hospitals.

Singapore has a population of 5.6 million. USA has a population of 330 million. How would you control prices and purchases at that level?

What difference does the population make other than that at 330 million economies of scale might appear that aren't significant at 5.6 million?

Re: Health insurers just published close to a trillion hospital prices

#213

Post by dominotw »

groby_b wrote: post #194
dominotw wrote: post #171

Earlier quoted context omitted.

> Singapore which has exceptionally low healthcare spending yea because they have healthy population, its not because of some smart govt policy( if only it was that easy). singapore obesity rate = 10% usa obesity rate = 42 % usa obesity healthcare spend = 90%

That 90% number is plain not true. Please cite any source for that. The costs for obese folk are on average 90%-100% higher than for non-obese folk, but that's not 90% of total spending. (See e.g. https://pubmed.ncbi.nlm.nih.gov/33470881/ ) Total cost approaches 20% of spending: https://www.hsph.harvard.edu/obesity-prevention-source/obesi...

I was using obesity as a standin for metabolic syndrome to compare populations. Not sure if measure how many ppl have 'metabolic syndrome.

https://www.nhlbi.nih.gov/health/metabolic-syndrome

metabolic disease = all things that can be fixed by lifestyle modifications ( unless you are too far gone, ie).

see my reply here: https://news.ycombinator.com/item?id=32744868

Re: Health insurers just published close to a trillion hospital prices

#214

Post by pessimizer »

imapeopleperson wrote: post #210
groby_b wrote: post #194

Earlier quoted context omitted.

That 90% number is plain not true. Please cite any source for that. The costs for obese folk are on average 90%-100% higher than for non-obese folk, but that's not 90% of total spending. (See e.g. https://pubmed.ncbi.nlm.nih.gov/33470881/ ) Total cost approaches 20% of spending: https://www.hsph.harvard.edu/obesity-prevention-source/obesi...

Don’t get so hung up on precise numbers. We all know Americans are obese and that greatly adds to healthcare costs. I can’t imagine any downside of trying to prioritize lowering obesity.

Thank god we aren't discussing your imagination, then.

Re: Health insurers just published close to a trillion hospital prices

#215

Post by planetsprite »

ChrisLomont wrote: post #39
planetsprite wrote: post #9

I wonder what percentage of work in the US healthcare system is completely unnecessary from a general perspective but made necessary deliberately to justify the unethical system that allows millions to die unnecessarily.

> to justify the unethical system that allows millions to die unnecessarily Which people are those millions? The system saves millions of lives that would have died in generations past. How do you factor that into your claim?

I'm comparing the number of preventable deaths in the US vs countries with similar GDP/capita

https://www.oecd-ilibrary.org/sites/3b4fdbf2-en/index.html?i...

The US has a mortality rate due to preventable causes comparable to Poland/Slovakia despite having nearly a 4x higher GDP per capita. Even poorer countries with better systems do far better w.r.t preventable mortality. This amounts to an extra 100,000 deaths per year approx vs countries like Italy, Germany, Switzerland, Sweden, etc.

Re: Health insurers just published close to a trillion hospital prices

#216

Post by pessimizer »

notch656a wrote: post #206
nradov wrote: post #204

Earlier quoted context omitted.

Should we apply the same sort of "stupid X law" to people who drink alcohol or drive motorcycles or play rugby? This is one of the moral hazards of a socialized medical system. When the rest of society is paying for your medical care it becomes tempting to save money be dictating exactly how you're allowed to live your life. Obesity is a serious public health problem but we won't fix it by calling people stupid or ch…

>Should we apply the same sort of "stupid X law" to people who drink alcohol or drive motorcycles or play rugby? Yes, precisely. Keep chopping down at these factors until all that's practically left is private healthcare -- that's a feature not a bug. It's enough that I have to pay the bill to scrape the blood off the street when a motorcycle is crashed, not interested in paying someone elses motorcycle related healt…

Yes, I'm getting sick of paying for people who drive cars, go to restaurants and concerts, and have children.

> socialize your health related losses while privatizing the gains you reap.

Those famous health care gains.

Re: Health insurers just published close to a trillion hospital prices

#217

Post by galangalalgol »

jahewson wrote: post #97
paulmd wrote: post #76

Earlier quoted context omitted.

> The US pays about twice per nurse or doctor in the system, and part of that is because the US pays nearly twice for most skilled work. which is in turn because in the US an average GP comes out of medical school with $200k-300k of student debt that has to have interest serviced and paid off within some 10-20 year timespan. That cost ultimately ends up being borne by the patient and their insurance. unfortunately th…

A debt of 1 to 1.5 years salary does not go very far to explain why US doctors are paid double what they would be in other countries. The US brought this problem upon itself by cutting medical school funding in the 1980s to reduce the number of doctors and keep salaries high. That situation remained until 2005. Now we have too few doctors, too few schools, and a generation that grabbed all the money for themselves an…

My understanding is that the largest portion of the discrepancy with other nations is the price of facilities. And that those facilities cost much more at non-profit hospitals (which is most of them). The hypothesis is that administration compensation is proportional to procedures performed, but money taken in can't be kept, so it is pumped back into facilities perpetuating the cycle.

Re: Health insurers just published close to a trillion hospital prices

#218

Post by tzs »

e_i_pi_2 wrote: post #71
duffpkg wrote: post #70

I'm author of Hacking Healthcare for O'Reilly, 20 year health system executive, blah, blah. It's very easy for people to forget the scale of the US "health system", we are talking 1/5, maybe more, of the entire US economy. If US healthcare spending were a country, it would have the third largest GDP in the world. Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes that…

Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? Or is there some other reason healthcare "just costs more" here? Also wondering what you think a solution is - single-payer for better and simpler price negotiations, or some other approach? My main concern is if we're spending 20% of GDP on something…

> Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry?

That we spend more per capita for approximately the same level of care as most other first world countries is certainly annoying. But sometimes I think we are too focused on that and not putting enough effort into trying to stop the cost from increasing.

I think increasing costs are a more serious problem because the problem of spending so much more than the others is a US problem. That suggests it is just something we are doing wrong, and by making our system more like some of those others we can fix it.

The problem of rising costs also plagues those other countries, and to about the same extent as it does the US. That suggests it is a much harder problem to solve.

Here are some examples of rising costs per capita.

How much costs per capita went up from 2000 to 2018: US 2.3x, Germany 2.1x, France 1.8x, Canada 2.0x, Italy 1.7x, Japan 2.6x, and UK 2.6x.

Costs per capita in 1980, 1990, 2000, 2010, and 2020 divided by 1970 costs:

     1980 1990 2000 2010 2020
  US  3.2  8.2 13.9 24.1 36.3
  UK  3.1  6.3 15.3 27.8 40.5
  FR  3.4  7.6 14.9 21.1 28.5
Here's the ratio of each given year to the cost 10 years earlier:

     1980 1990 2000 2010 2020
  US  3.2  2.6  1.7  1.7  1.5
  UK  3.1  2.0  2.4  1.8  1.5
  FR  3.4  2.2  2.0  1.4  1.4
Data source: https://data.oecd.org/healthres/health-spending.htm

If "latest data available" is checked, uncheck it to unlock the slider that lets you look at historical data back to 1970.

Re: Health insurers just published close to a trillion hospital prices

#219

Post by AndrewKemendo »

duffpkg wrote: post #70

I'm author of Hacking Healthcare for O'Reilly, 20 year health system executive, blah, blah. It's very easy for people to forget the scale of the US "health system", we are talking 1/5, maybe more, of the entire US economy. If US healthcare spending were a country, it would have the third largest GDP in the world. Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes that…

I might be joining a large EHR company in the near future as a VP and am wondering if I can send you a question from time to time as they come up via email? Would love to connect but don't see anything on your profile here.

I'm akemendo at the google mail service

Re: Health insurers just published close to a trillion hospital prices

#220

Post by pc86 »

kev33 wrote: post #197
profile53 wrote: post #191

Earlier quoted context omitted.

This reads as very hostile. Someone is taking time out of their day, for free, to answer questions and provide context.

Quoted post unavailable.

There's no reason to come on here and be nasty to someone you've never met because you or some relative of yours had a bad experience.

If it's that big of a deal for you, work to fix it and you can come on here with your credentials and blah blah instead of whining about people who have experience in what they're talking about :)

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