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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#161

Post by mjevans »

ChadNauseam wrote: post #150
twoodfin wrote: post #137

Earlier quoted context omitted.

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

It interacts badly with insurance being offered as workplace benefit. If you quit or lose your job, you'd lose your health insurance. And any plan you signed up for after that would then treat you as "pre-existing embers" and expect you to pay accordingly. The bundling of health insurance with workplace seems like the healthcare original sin to me. Obama couldn't change that, so the ACA redesigned the system to work…

The US is allergic to taxes. Maybe it's a marketing thing. Benefits paid for by society.

Maybe a department of Return on Investment. See what those taxes pay for. Contrast to buying private versions of the services at the same SLA or better.

Re: The American Healthcare Conundrum

#162

Post by lupire »

nradov wrote: post #138
Projectiboga wrote: post #55

Earlier quoted context omitted.

Yes but the Medicare and Medicaid reimbursement rates are below breakeven so cash and insurance rates have to be above provider breakeven. The main cost frictions are administrative costs for billing on both the insurance and provider sides.

That's true to an extent, but some provider organizations manage to survive with patient populations that are almost entirely Medicare / Medicaid. Many provider organizations are just badly managed and haven't taken steps to optimize their finances through automation or participation in value-based care programs.

See the above comment about fraudulent billing for non-existent illnesses that don't need treatment.

Re: The American Healthcare Conundrum

#163

Post by jmspring »

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.

Managed risk pools should not be for profit.

Re: The American Healthcare Conundrum

#164

Post by phil21 »

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.

Depends on if the investments were in the right stuff or not. Overbuilt sounds great, so long as it’s overbuilt in capacity and reliability.

If those were malinvestments instead it’s simply throwing money away for not even a theoretical “someday” return. Plenty of ways to look busy while spending massive amounts of capital.

Generally agreed in principle though. Investment in the grid is pathetic almost everywhere in the US and has been for generations.

Re: The American Healthcare Conundrum

#166

Post by Dylan16807 »

nradov wrote: post #120
graemep wrote: post #60

> The US spends ~$14,570 per person on healthcare. Japan spends ~$5,790 and has the highest life expectancy in the OECD. That gap is roughly $3 trillion per year. The difference in life expectancy will be influenced by multiple factors and may have more to do with diet and lifestyle than with healthcare. Japan also spends less per capita than the UK, France or Germany. The US spends a lot more than any of those so th…

Japan also has the "Metabo Law" (aka fat tax). Do you think Americans would go for that?

"Obesity costs the US healthcare system almost $173 billion a year."

So that's about 6% of the difference? I'm not immediately saying no, but it sounds like that's not the real problem.

Re: The American Healthcare Conundrum

#167

Post by kstrauser »

conductr wrote: post #51

Medicare prices are too low to operate on. They generally factor in the bare minimum or slightly less for the variable costs of a procedure but severely under value the fixed costs of providing the same procedure. So those costs largely get pushed to commercial payors as those are the only ones who can shoulder it. There’s plenty of arguements about waste and executive compensation but when I was a healthcare CFO we…

Sure you’re not thinking of Medicaid? Medicare was generally pretty good for reimbursement. When my wife treated Medicaid patients, she often lost money on the cost of the supplies used to treat them, let alone rent and paying the staff etc etc. Most doctors who see Medicaid patients do it as basically pro bono. Some figured out how to game the system with economies of scale but it’s nearly impossible do do and maintain a decent standard of care.

But Medi care was right with the commercial insurers on reimbursement.

Re: The American Healthcare Conundrum

#168

Post by SV_BubbleTime »

raw_anon_1111 wrote: post #19
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.

So I happen to be in Costa Rica for the month. Just like every other 1st world country, it has managed to have universal health care that is better and cheaper without private insurance. Even if you do get private insurance for quicker access, it’s still much cheaper than the US. I just spoke to someone who flew down here to save $30K on dental work. The problem isn’t the ACA, it’s the ass backwards American health c…

Costa Rica is a beautiful country. But it is in no way “first world”.

It has no military, and is effectively dependent of the US and in best cases neighboring countries. It has excellent weather and soil which account for its fruits exports… and outside of some niche industry, is mostly reliant on tourism which means importing money.

I love that country and have been many times. But if it were god forbid wiped off the face of the earth, it would be sad and annoying at best.

Costa Rica has “free healthcare” / healcare from taxes because it has 5 million people, about 1/2 of New Jersey.

This isn’t some mechanism that the US just refuses to use. It’s a matter of scale. You either don’t know and should remain silent on the topic, or do know it and lack the honor to not state it.

Re: The American Healthcare Conundrum

#169

Post by phil21 »

digi59404 wrote: post #70
phil21 wrote: post #20

Earlier quoted context omitted.

In a vacuum sure. But insurance companies operate the only part of the healthcare system that is moderately competitive. In the end employers are the ones largely paying and they are professional negotiators enough to put price pressure on insurance plans. 20% of $0 is $0. As such, as light of an incentive it is - it’s the only party in the entire system that is incentivized in any way whatsoever to keep costs down.…

What OP said is true. You’re forgetting that health insurers are just one organization in the corporate chart. They often work to own the providers as well to funnel money to parent corporations. So if United is the insurer they’re owned by an umbrella, that umbrella takes 20% or less. However United makes special deals and steers people to providers owned by the Umbrella. So that the Umbrella makes more money as wel…

I’m well aware of the vertically integrated systems. But that’s not the entire market - just getting to slowly be more and more common.

Insurance as standalone entities are not much better or worse for total cost than these giant vertical monopolies. At least yet, thy are only recently becoming large enough to truly put the screws to people. Because insurance was not all that profitable made it prime targets for these sorts of shell game shenanigans.

It’s basically the point I was making. Fixing “insurance” isn’t a fix at all because the problem is far greater than just that layer of the onion. Costs are hidden and embedded and cross-subsidied to the point no one can unwind it without burning the entire thing to the ground. It’s grift from bottom to top. Aside from a few poor souls actually at the ground level who are still true believers trying to provide service to patients. And a lot of those are burning out. I think out of the 5 or 6 medical doctors I met while they were in medical school, only one is still practicing. They would now be late 30s to early 40s and in theory at the prime of their careers. Instead they got out as soon as medical school debt was paid off and moved onto other less stressful things. Another hidden cost in the shit-tier system rarely talked about.

I’m simply pushing back on the idea that the 20% medical loss ratio is the source of all (or even most) issues for the cost of healthcare or why insurance sucks so much to deal with. It’s nearly irrelevant.

Re: The American Healthcare Conundrum

#170

Post by SV_BubbleTime »

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.

> regular people will ditch them for cheaper competitors

I love the particular irony of people who advocate for regulations then attempt refutation of free market theory for what is already unquestionably and objectively not a free market.

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