Health insurers just published close to a trillion hospital prices • Hacker News Board

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

#521

Post by salawat » Thu, Sep 08, 2022, 1:35 PM UTC

bhupy wrote: post #465

nicoburns wrote: post #407

Earlier quoted context omitted.

> The NHS's difficulty lies in the simple fact that it is understaffed and underpaid — leading to unprecedented wait times. This is because the "list prices" that the NHS pays for GP, nurses, and services are not subject to market forces, they are set by the government. The government is currently failing to address the supply loss with little political will to increase list prices. And the US's problem is that the l…

> And the US's problem is that the list prices it pays for GPs, nurses, and services are subject to market forces and thus are too high. The government is currently failing to address the service provision loss with little political will to decrease list prices (even though they would propagate through to consumers as decreased costs). Yeah that's completely untrue; the list prices that insurers pay for GPs are heavi…

> big reason for this is that employers (especially medium-to-large businesses) have a much higher purchasing power (and hence, willingness to pay) than individuals.

I'm going to call you on this point, because what you're hinting at, whether you realize it or not, is that employers need to step up their medical care spend management game, which if implemented, looks damn near dystopian. As someone that works in insuretech, the number of times I've raised concerns about revealing too much about the shape of medical spend to employers is scary to quantify, because once you start going down that road, it isn't that far to "huh, 20% of our workforce is 80% of spend" hrrrm...

We do not want to be going down the road where employers are singled out as the appropriate optimizers there.

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

#522

Post by vitiral » Thu, Sep 08, 2022, 2:05 PM UTC

adgjlsfhk1 wrote: post #446

vitiral wrote: post #440

Earlier quoted context omitted.

I have really no opinion on any of this, but please realize there are more factors than health care on life expectancy.

What is a better metric and how does the US do on it?

I don't know, but almost everything is more complicated than people often make it out to be. Unless you'd like to spend 40+ hours/days/years researching it, you're probably better off trying to be more laid back.

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

#523

Post by e_i_pi_2 » Thu, Sep 08, 2022, 2:10 PM UTC

vineyardmike wrote: post #504

briffle wrote: post #475

Earlier quoted context omitted.

Then why do they spend so much more on marketing than R&D? https://www.ahip.org/news/articles/new-study-in-the-midst-of...

I’m not trying to defend pharma companies… they’re generally pretty scummy. But I’m guessing most companies spend more on marketing than R&D. Beyond that, the theory that they need to recoup costs still holds true with this. In fact, a big marketing budget indicates that they’re aggressively trying to sell the drug (maybe to recoup costs?). Generally in business marketing budgets should generate more sales than they…

> If the sale wouldn’t happen without an ad, then that’s a necessary ad

I think that's the core issue here, healthcare and pharmaceuticals have basically inelastic demand. The US is one of only two countries where it's even legal for pharma companies to advertise directly to consumers.

I know in practice they can create demand for products, but that doesn't necessarily seem like a good thing, so I think you could argue that it's still a waste of money even if it does create profit for the company.

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

#524

Post by e_i_pi_2 » Thu, Sep 08, 2022, 2:13 PM UTC

spaetzleesser wrote: post #459

t0mas88 wrote: post #457

Earlier quoted context omitted.

The prices as charged in the US regularly make it onto Twitter and Reddit etc where us Europeans wonder how on earth it's possible that something in the US costs $ 800 which is charged at less than $ 100 over here (and then paid by insurance). Same for that $ 30k device being sold for $ 80k. What we all forget is that nobody is actually paying the US healthcare invoices. Roughly two options... 1. You have insurance a…

Not correct. The insurance paid 80k for the device and 300k total for the surgery after one year of fighting almost daily. Also: if you make a certain amount of money and they hit you with a 100k bill you can't just declare bankruptcy. The court won't allow you to do it because you make too much money.

> you can't just declare bankruptcy. The court won't allow you to do it because you make too much money

Isn't this always the case? My understanding was that bankruptcy is for when you don't have enough income to pay bills, so if you have a bill for any amount but are able to pay it then you wouldn't be allowed to declare bankruptcy

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

#525

Post by e_i_pi_2 » Thu, Sep 08, 2022, 2:15 PM UTC

brightball wrote: post #152

e_i_pi_2 wrote: post #71

Earlier quoted context omitted.

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…

I’ve heard a lot of complaints about Medicare/Medicaid. It does not inspire confidence in single payer.

There's always complaints about healthcare and probably no perfect system, but a bad one where everyone has coverage seems a lot better than a bad one where everyone doesn't

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

#526

Post by e_i_pi_2 » Thu, Sep 08, 2022, 2:33 PM UTC

anonu wrote: post #233

e_i_pi_2 wrote: post #71

Earlier quoted context omitted.

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…

There's many things wrong with US healthcare. But somehow the USA comes up with the the first vaccines for the coronavirus and if you want any sort of complex procedure you travel to the US to get it. So maybe thats where the extra cost goes? To drive research, and support the infrastructure that creates good to better health outcomes on average vs the rest of the world. Saying something is a failure just because it…

> But somehow the USA comes up with the the first vaccines for the coronavirus and if you want any sort of complex procedure you travel to the US to get it

This isn't true, the US didn't make the first vaccines, it was created by a German company that partnered with Pfizer for trials/production/distribution[0]. People more often travel outside the US for care, we actually have the second highest amount of people leaving their home country for medical care[1], with the top destinations being in South America [1a].

> creates good to better health outcomes on average vs the rest of the world

This would be nice if true, but we spend more and still have worse outcomes in almost every area[2]. The only things I could actually find that are better here is post-op sepsis and 30-day heart attack survival, but in just about every other area it's more dangerous to get care in the US.

[0]: https://en.wikipedia.org/wiki/History_of_COVID-19_vaccine_de...

[1]: https://www.health-tourism.com/medical-tourism/statistics/

[1a]: https://amjmed.org/medical-tourists-incoming-and-outgoing/

[2]: https://www.healthsystemtracker.org/chart-collection/quality...

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

#527

Post by sassy_quat » Thu, Sep 08, 2022, 2:40 PM UTC

e_i_pi_2 wrote: post #526

anonu wrote: post #233

Earlier quoted context omitted.

There's many things wrong with US healthcare. But somehow the USA comes up with the the first vaccines for the coronavirus and if you want any sort of complex procedure you travel to the US to get it. So maybe thats where the extra cost goes? To drive research, and support the infrastructure that creates good to better health outcomes on average vs the rest of the world. Saying something is a failure just because it…

> But somehow the USA comes up with the the first vaccines for the coronavirus and if you want any sort of complex procedure you travel to the US to get it This isn't true, the US didn't make the first vaccines, it was created by a German company that partnered with Pfizer for trials/production/distribution[0]. People more often travel outside the US for care, we actually have the second highest amount of people leav…

I think the preceding comment was operating on the presumption of linear returns from medical research. Since higher medical costs in the US goes directly towards medical companies, and indirectly to medical research after taxes and dividends and stockbuybacks...

Of course the biggest issue of all time is that germs are evolving to survive our antibacterial soap, we may need to develop a large variety of antibiotics.

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

#528

Post by chefandy » Thu, Sep 08, 2022, 4:21 PM UTC

ahtihn wrote: post #368

echelon wrote: post #353

Earlier quoted context omitted.

There are people genetically predisposed to gain weight or have heart disease. Cancer can be Russian roulette, as is your immune system picking up random autoimmune disorders. Accidents happen. There are too many stakeholders with too many backgrounds and conditions for anything like your proposed system to work. Everyone would be angry.

> There are people genetically predisposed to gain weight And this genetic mutation somehow happened in the last 50-100 years or so? Obese people have always existed. Obese poor people are fairly new. The root cause is diet, not genetics.

It's "common knowledge!"

Read "a contamination theory of the obesity epidemic" to see how incorrect your assumptions are.

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

#529

Post by chefandy » Thu, Sep 08, 2022, 4:26 PM UTC

Dylan16807 wrote: post #305

pessimizer wrote: post #216

Earlier quoted context omitted.

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.

I'm not sure how the heck you jumped from "drive motorcycles" to "drive cars". Driving cars would be minor and apply to almost everyone, so it would mostly cancel out and be negligible. Really it would be a slight discount for taking transit, and that seems... fine to me. And those other ones aren't even notable risk factors.

Not people who live in dense cities with good subway systems and a walkable infrastructure. Driving is one of the most dangerous things humans do. The argument that all health care should be private– the perspective this comment addressed– would not make such a consolation simply because it's common.

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

#530

Post by deburo » Thu, Sep 08, 2022, 4:29 PM UTC

californical wrote: post #349

pessimizer wrote: post #125

Earlier quoted context omitted.

> countries without that or with less generally have better outcomes at less cost. This isn't necessarily a great metric, because almost all countries have better outcomes and all countries have lower per capita cost, whether their systems are public, private, or mixed. The US spends more public funds on healthcare than countries with universal socialized health care systems. The fact that we're also personally bankr…

Wow, I had to check your facts here, and I can’t believe it. The US federal healthcare spending is very close to the UK healthcare spending, but we cover WAY less for individuals. The US federal govt spends >8% of GDP on healthcare, with the current system of all of our insurance and payments and everything that we have to pay in addition, totaling nearly 20% of GDP: https://www.crfb.org/papers/american-health-care-h…

>but we cover WAY less for individuals.

That has to be related to the fact that American drugs are sold to a lesser price abroad than at home, right?

In Quebec, cancer treatment is free. Given that even late-stage cancer patients live much longer nowadays, and those treatments are probably expensive as heck, I wonder how we can afford it.