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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#261

Post by Panzer04 »

nradov wrote: post #126
programmertote wrote: post #121

Earlier quoted context omitted.

Agreed. As a spouse of a specialist doctor in the US, average folks don't include doctors when they blame the exorbitant prices of the US healthcare. Sure, big pharma, insurance companies, hospital admins and everyone in between play a part in this big profit-making machine. But doctors (a lot of them, not all) are complicit in this healthcare complex. American Medical Association is one of the top lobbying groups in…

The AMA may cause some problems but you can't reasonably blame them for this one. They are not a regulatory or accreditation body. State medical boards control provider certification. Some universities have combined BS / MD programs that cut education time down to 6 years.

Doctors are motivated, intelligent and sometimes self-interested. By no means are all of them against it but like any party there are plenty who unabashedly oppose increased accessibility to their profession in favor of increasing their own value/pay.

Re: The American Healthcare Conundrum

#262

Post by dzink »

Huge chunk of the costs come from the fact that Doctors pay astronomical malpractice insurance rates in some states with no tort reform. Some have to spend more than 100k on insurance - 1/3 of their total pay. Since some states allows multi-million dollar judgments from juries that raises insurance everywhere, which raises not only prices for everyone but also dramatically contributes to more procedures and tests being done at even higher costs to avoid liability. The risks of having your entire livelihood wiped out chases out doctors from those states and reduces availability of care for patients as well. If you want objective cost comparison, compare Veterinary care which has similar consumables and training, but no insurance and liability impact on prices.

Re: The American Healthcare Conundrum

#263

Post by jimt1234 »

Dylan16807 wrote: post #166
nradov wrote: post #120

Earlier quoted context omitted.

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.

Fat shaming! ... It makes me sad whenever I hear that response to any mention of the health problems associated to obesity.

Re: The American Healthcare Conundrum

#264

Post by jeffreyrogers »

> The US spends ~$14,570 per person on healthcare. Japan spends ~$5,790 and has the highest life expectancy in the OECD.

Ethnic Japanese in the US live have about the same life expectancy as Japanese living in Japan do (within 1 year). US GDP per capita is about 2.4x Japan's. So the numbers don't look nearly as bad when you adjust for that. The higher drug prices in the US are definitely part of it, part of it is our population is less healthy in general (fatter, worse diet, more drug and alcohol abuse), but part of it is Baumol's cost disease[0]. Biggest barrier to lowering healthcare costs in the US is it probably requires paying doctors, nurses, etc. significantly less and most of them work hard and feel like they deserve to be paid as well as they do.

[0]: https://en.wikipedia.org/wiki/Baumol_effect

Edit: to some extent high US drug prices are a public good that subsidizes healthcare for the rest of the world. I don't know the data but I would guess the US is responsible for a disproportionate share of new drugs.

Re: The American Healthcare Conundrum

#265

Post by danny_codes »

turlockmike wrote: post #239

Unregulate the insurance industries problem solved. Let people actually buy insurance for it's intended purpose. No insurance company would pay these rates willingly, they do it because of all the regulations. They aren't allowed to profit normally, so they find ways around it. Just let them operate normally, like all sorts of other insurance programs.

Back to pre-existing conditions eh?

Yeah no thanks, let’s do the tried and true universal healthcare that literally every else does. They get better results AND it’s cheaper. We’re literally paying more for something worse.

Re: The American Healthcare Conundrum

#266

Post by hax0ron3 »

paulmist wrote: post #254
novok wrote: post #247

When you really dig into the difference it's metabolic health that is driving most of it, and that will be fixed by agricultural and food regulation for the most of it, starting with going with the whitelist system that japan and the EU have for food additives & manufacturing processes vs. the wild west that is GRAS in the USA, and way more strict food quality / inspection standards than you would think.

This! I flew from Madrid to SF last year and I can't begin to describe the difference in the quality of food. The scale of agricultural industrialization is terrifying - I wish you luck but I don't think anything short of this becoming a major campaign issue will help you.

I think it is possible that the majority of Americans do not know what they are missing. It is difficult to really understand how much better simple things like fruits, vegetables, and bread can taste without experiencing it. It's like The Matrix, you just have to see it for yourself. Well, taste it for yourself. I find that in America even local farm produce at the "farmer's market" often tastes flat and uninspiring. For whatever reason, heirloom tomatoes tend to be good though - they constitute an exception.

To be fair, I was not born in America. So it is possible that it's not that American food is actually subpar, it's just that I became used to particular nuances of how certain foods taste back when I was a child and I do not get that from most American food, and to Americans their produce tastes extremely delicious. I'm pretty skeptical of this idea though. My hunch is that I'm not experiencing some sort of chemical nostalgia, and that American produce actually isn't very good.

RFK Jr. successfully made some of this kind of stuff a minor campaign issue in the most recent US presidential election, so whatever one thinks about RFK Jr., at least it seems that there is some demand for food production reforms in the US electorate.

Re: The American Healthcare Conundrum

#267

Post by jimt1234 »

linsomniac wrote: post #244

Healthcare administrative overhead in the US is pretty huge and has been for a long time. Back in the early 90s I worked on claim processing software and I recall it being discussed as being around a third of healthcare costs. Last year this podcast said that nobody wants to solve this because solving it is going to eliminate (IIRC) hundreds of thousands of jobs. Which is a point to consider. In 2021, the U.S. spent…

I witnessed this devolution with my GF. She's a medical provider in CA that, since the mid-90's, got her funding from a state agency. She met with the agency once per quarter, reviewed her funding claims, worked out any discrepancies one-on-one, in-person with her representative. Worked great. Then private insurance muscled their way in. It's been a bureaucratic nightmare ever since. She had to hire a full-time staffer just to handle all the insurance BS. She never needed that before private insurance.

The nightmare isn't just for her; it's also for her patients. She now spends almost as much time walking her patients through the insurance bureaucracy than she spends on actual treatment. And it's so sad because her patients are so desperate (parents of extremely sick children), but often get nothing but bureaucratic run-around from their private insurers.

So yeah, it's been a lose-lose situation since private insurance took over.

Re: The American Healthcare Conundrum

#268

Post by danny_codes »

rybosworld wrote: post #72

For a country that prides itself on CapItAlIsM, U.S. healthcare is the farthest thing from it. - Doctors and hospitals don't compete on price - Prices aren't just opaque, they are unknowable - Shopping around is not possible - Insurer incentive is to maximize billing (cost). They pass along cost as increased premiums to an employer. Employer passes along increased costs to employee as below-inflation wage increases

Capitalism doesn’t work well for goods with inelastic demand. Every other developed country understands this and has a nationalized system. The only reason we don’t have universal healthcare is basically unlucky flukes.

Re: The American Healthcare Conundrum

#269

Post by duped »

tptacek wrote: post #195

I buy that the locus of American overspending is in fees charged by providers (my understanding is that a further principle component of that spending is in end-of-life care). The problem, though, with going after pharma costs, and pharma benefit managers is that pharma is a relatively small component of overall spending; it's less than 10%. That is to say, you could make all pharmaceuticals entirely free, and we'd g…

Even if it's 10% in aggregate it could be much higher for individuals and families that are screwed over by drug pricing.

But anyway we really do need to go after providers and end the racket that is employer provided health insurance.

Re: The American Healthcare Conundrum

#270

Post by hattmall »

bcooke wrote: post #220

This project reminds me of a book I highly recommend called An American Sickness. It sheds a lot of light on the same sorts of issues. One underlying, perverse incentive behind many of the problems is that insurers are regulated based on percentages of spending rather than total costs. The US passed laws meant to limit marketing and overhead that tied insurers economics to the size of the overall medical bill... whic…

It's almost as if the insurance companies wrote those regulations. The same ones that required everyone to purchase their product and implemented government subsidies to pay them. Legitimately no way anything other than price increases and insurance profits could happen.
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