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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#151

Post by glenstein »

pixl97 wrote: post #77
glenstein wrote: post #52

Earlier quoted context omitted.

I will piggy back off of your comment because I was going to say a very similar thing. In my state, electric utilities are guaranteed a rate of return on investment of approximately 12%, if I remember correctly. And so there's a lot of incentive for build out and maintenance that's high in total dollar amount and high in volume of work done. In some ways it's the system working as designed but the "cap" can incentivi…

So you have an excessively built out electrical system... sounds like a win to me.

Except for the cost to the ratepayers.

Re: The American Healthcare Conundrum

#152

Post by raw_anon_1111 »

twoodfin wrote: post #137
ipsento606 wrote: post #85

Earlier quoted context omitted.

> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be

Why is that inherently bad? Should I be able to buy fire insurance on pre-existing embers?

If you live long enough, you will have a pre existing condition.

The way it was suppose to work with the original mandate is that everyone had to be insured either through their employee or the exchange. So you couldn’t just buy insurance when you were sick. The Supreme Court struck that down.

If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insurance at any cost.

But you do realize that the entire idea of not being able to get insurance because of pre-existing conditions is completely unique to the US?

Costa Rica for instance (where I am right now for a month and half) allows anyone to become a resident as long as you have guaranteed income of around $2000 a month or you deposit $60K into a local bank account and they arrange monthly disbursements and you pay 15% of your stated income to CAJA. Healthcare is both better and more affordable here.

The same is true for Panama. Why can’t the US figure this out?

Re: The American Healthcare Conundrum

#153

Post by ChadNauseam »

JKCalhoun wrote: post #144
legitster wrote: post #91

Earlier quoted context omitted.

The US also has GDP per capita of $90k and Japan has a GDP per capita of ~ $35k. Put another way, in both countries a hip replacement surgery is almost exactly 1/8 of someone's per capita GDP.

Too bad Walmart greeter isn't making "per capita GDP".

They make more than they would in Japan. But people can make $0 in any country. Regardless, part-time Walmart greeters are fortunately not paying full price for health insurance in the US.

Re: The American Healthcare Conundrum

#154

Post by bandofthehawk »

0xbadcafebee wrote: post #135
timtim51251 wrote: post #7

Lots of people are saying nonsense here. The actual reason commercial insurers pay more is that's the only way to can make more profits. Because of Obamacare requiring 80% of the money they collect to be spent, the insurance companies just get to keep 20%. So insurance companies spend more so they can collect higher premiums. That's how they make more money. Several doctor friends have told me this as well.

That's not why prices continue to increase. They can't just let prices skyrocket to pad their pockets. If they try, government regulators will block premium hikes, regular people will ditch them for cheaper competitors, and big businesses that pay premiums from cash will fire them for not keeping medical bills lower.

But prices already have skyrocketed, and insurance execs have already become significantly richer. Why didn't the feedback loops work?

Re: The American Healthcare Conundrum

#155

Post by nomilk »

nradov wrote: post #122
nomilk wrote: post #99

I recently travelled to Vietnam for dental work, it's really shocking how easy to it to shop around when dentists actually publish their price lists online for easy comparison/perusal. In my native country, dentists rarely if ever publish prices online, and it's hard to get prices over the phone. If hospitals could be forced to publish price lists, it would be game changing, allowing patients to shop and compare qual…

Hospitals are forced to publish price lists (charge master). https://www.cms.gov/priorities/key-initiatives/hospital-pric... But at a consumer level it's still quite difficult to predict what your total out-of-pocket expense will be for the same course of treatment at two different facilities.

Oh wow. Appreciate the correction. I wonder what improvements in price transparency Trump has in mind. Perhaps it's that website in the parent comment.

Re: The American Healthcare Conundrum

#156

Post by glenstein »

toomuchtodo wrote: post #104
pixl97 wrote: post #77

Earlier quoted context omitted.

So you have an excessively built out electrical system... sounds like a win to me.

They said excessively expensive, not excessively robust. There is a difference.

There's not necessarily a difference because they overlap on the venn diagram. The returns to the shareholders go up the more you build out, the benefits and performance face diminishing returns. Different utilities around the country get different scores for reliability and infrastructure integrity, because a dollar spent by one utility on one grid doesn't necessarily have the same impact as a dollar spent by another.

Re: The American Healthcare Conundrum

#157

Post by lupire »

bsjshshsb wrote: post #143
CGMthrowaway wrote: post #92

Earlier quoted context omitted.

Digi is correct here. >For example Cigna requires all maintenance medication be purchased through express scripts Important note: Cigna owns Express Scripts. Today the biggest "insurance" companies are actually massive conglomerates that own the clinics, the doctors and the pharmacies. United = Optum. Aetna = CVS + Caremark. Humana = CenterWell. Elevance/Blue Cross/Anthem/Carelon. Centene = Envolve Once a giant like…

Why wasn't it set up so the government is the insurer. Rather than 3rd partying it. It is akin to federal reserve using wells fargo to store their money.

Because of regulatory capture and lobbying and campaigning to get people to vote against their self interest.

Re: The American Healthcare Conundrum

#158

Post by actionfromafar »

bsjshshsb wrote: post #143
CGMthrowaway wrote: post #92

Earlier quoted context omitted.

Digi is correct here. >For example Cigna requires all maintenance medication be purchased through express scripts Important note: Cigna owns Express Scripts. Today the biggest "insurance" companies are actually massive conglomerates that own the clinics, the doctors and the pharmacies. United = Optum. Aetna = CVS + Caremark. Humana = CenterWell. Elevance/Blue Cross/Anthem/Carelon. Centene = Envolve Once a giant like…

Why wasn't it set up so the government is the insurer. Rather than 3rd partying it. It is akin to federal reserve using wells fargo to store their money.

That's communist talk I'm told. We must have lobbyists (remember, money is people, too) instead.

Re: The American Healthcare Conundrum

#159

Post by bandofthehawk »

cj wrote: post #149
JKCalhoun wrote: post #144

Earlier quoted context omitted.

Too bad Walmart greeter isn't making "per capita GDP".

Some quick googling suggested cashiers at Seiyu in Japan earn $7-9/hour USD while Walmart is about double that.

If the Japanese cashier makes half the amount, but spends only 1/3 on healthcare that still seems to favor Japan

Re: The American Healthcare Conundrum

#160

Post by lotsofpulp »

nradov wrote: post #117
lotsofpulp wrote: post #47

Earlier quoted context omitted.

>So insurance companies spend more so they can collect higher premiums. That's how they make more money. > If this is correct, then how come there are so many complaints about insurance denying payment for healthcare or the hoops they make patients and doctors jump through for pre authorizations? If the path to more profit was spend more money, then there would be no reason to question a doctors’ orders? Nor threaten…

Complaints about denied claims or prior authorization requirements should generally be directed at employer HR departments. Most HN users in the USA probably have employer-sponsored group health plans, and often those are self-funded where the insurance company doesn't actually bear any risk but just administers the plan. Commercial insurers would be happy to sell plans that pay every claim that comes in at 100% with…

> Commercial insurers would be happy to sell plans that pay every claim that comes in at 100% with zero denials. It would be less work for them. But naturally employers don't want to pay for that, so the HR departments have the insurance carriers impose more restrictive coverage rules to hold down medical expenses.

This is not my experience as a buyer of health plans on healthcare.gov, or as a buyer of health plans as an employer (where the employer is not self insuring). The prior authorizations and denials happen all the same.

Additionally, the premiums are the same between employers’ self insured plans and healthcare.gov plans, so the coverage must be similar.

https://www.kff.org/health-costs/how-aca-marketplace-costs-c...

>In 2024, individual market insurance premiums averaged $540 per member per month, slightly below the average $587 per member per month premium for fully-insured employer coverage.

The idea that health insurers can simply spend more to earn more is not passing the smell test.

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