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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#271

Post by tptacek »

duped wrote: post #269
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.

Wait, I hate employer-provided health insurance and think it's a terrible policy but what does that have to do with providers charging everyone --- including Medicare! --- way too much for services?

Re: The American Healthcare Conundrum

#272

Post by jimt1234 »

> Issue #4 examines pharmacy benefit managers ...

I'm curious to read that. I worked for a PBM back in the 90s/early-2000s. When I was hired, it was just a job; I had no idea what the business did to make money. After working there a few years and learning - well, I would've felt better about myself if I had become an actual drug dealer, selling cocaine and meth. That's not a huge exaggeration.

Re: The American Healthcare Conundrum

#273

Post by dyauspitr »

jimt1234 wrote: post #263
Dylan16807 wrote: post #166

Earlier quoted context omitted.

"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.

It’s what all of Asia does and it’s very effective. Make people’s weight their primary problem until they resolve it. It’s not like it is some unchangeable attribute that can’t be fixed through self control and discipline. The shaming is just unsolicited motivation that works. I feel sad if people are made fun of for attributes they can’t change.

Re: The American Healthcare Conundrum

#274

Post by standardUser »

nine_k wrote: post #238
onraglanroad wrote: post #228

Earlier quoted context omitted.

> the existence of America's prescription drug markets drives the new innovative drugs that the rest of the world picks up for cheap. That's the ludicrous propaganda that you've been fed but you really should be intelligent enough to dismiss it. The world would get along just fine without you overpaying for your drugs. You pay for marketing costs.

Mostly not marketing (still large), but the R&D costs and clinical trial costs. The latter are in hundreds of millions to billions range for the entire journey from a promising discovery to an FDA-approved medicine.

Right, but the idea that Americans specifically should pay higher prices is beyond propaganda. It's Stockholm Syndrome-level delusion. Big Pharm has thrived for generations on our research universities (for the time being anyway) and had a front row seat to expanding foreign markets under US-led globalization. In return, we get the world's most expensive healthcare system and the privilege of paying too much for meds because our leaders won't cut a deal. All they have to lose is the "hundreds of millions to billions range" in annual lobbying expenditures by Big Pharma.

In a sane world - or literally any other country - that $300-$500 million in annual lobbying would be the literal difference that makes medicine accessible for those who need it. Instead, it goes to expensive lunches.

Re: The American Healthcare Conundrum

#275

Post by sneak »

dyauspitr wrote: post #273
jimt1234 wrote: post #263

Earlier quoted context omitted.

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

It’s what all of Asia does and it’s very effective. Make people’s weight their primary problem until they resolve it. It’s not like it is some unchangeable attribute that can’t be fixed through self control and discipline. The shaming is just unsolicited motivation that works. I feel sad if people are made fun of for attributes they can’t change.

If everyone could control their weight via simply willing themselves to have more self-control, then nobody would be fat.

Self-control is, ironically, not usually within one’s self control.

Most people don’t contemplate very deeply about the gap between their will and their behavior. I’m extremely focused on self-determination and it’s absolutely astounding (and irritating) to me how little control I have over my actions relative to the control that circumstances have over me.

Your attitude about the matter is common, and seems like plain old common sense. It’s also dead wrong.

Re: The American Healthcare Conundrum

#276

Post by sneak »

tacticalturtle wrote: post #67
hardtke wrote: post #53

Earlier quoted context omitted.

We rarely discuss the primary source of health care cost differences in the United States -- US doctors get paid a lot more than elsewhere. I haven't seen a credible proposal to address that. Most of the salary difference can be blamed on deliberately created shortages of doctors in many specialities. Not enough medical school slots (horror stories among my kid's friends of not getting accepted) and then also shortag…

I really don’t think doctor salaries are the primary difference when they make up less than 10 % of health care costs: > However, new research by Stanford health economist Maria Polyakova and colleagues — using unique data on physician income — shows that physicians’ personal earnings account for only 8.6 percent of national health-care spending https://siepr.stanford.edu/news/just-how-much-do-physicians-...

Doctors are only part of the problem. Nurses and all of the other skilled positions also all suck up huge amounts of money because there are shortages of all of them.

It was bad even before COVID, it’s even worse now. There are tons of regulations prohibiting the significant increase in creating new doctors and nurses (and air traffic controllers, but that’s a different but remarkably similar story).

Limits on new providers, and tons of corrupt regulation keeping people from opening new medical schools, clinics, and hospitals.

A ton of it is simple supply and demand - and the supply side is capped. Go to a place with a functioning competitive market and the prices (and wages) are a fraction of what they are in the US.

Re: The American Healthcare Conundrum

#277

Post by hermanzegerman »

WarmWash wrote: post #147
soared wrote: post #141

Earlier quoted context omitted.

[flagged]

Exactly, ask anyone in a job for the money how their week was. Not saying nursing is stress free, or every nurse is bad, but like tech companies in 2021, it's full of directionless people who pushed through the cert program to get paid $50/hr with $100/hr weekend shifts and be disgruntled with you that you are making them do work.

What an arrogant comment.

Nursing is one of the most physically and mentally demanding jobs I know of, at least in Germany.

And I bet 80% of the Techbros here wouldn't last a month in it, given how many lost their minds over a simple RTO-Mandate.

Maybe watch the movie "Late Shift" to get an idea of how a Workday is https://m.youtube.com/watch?v=C7o-omvW_DI

I doubt that "directionless" people would put up with those working conditions, and many leave the sector after a few years, simply because they burn out. Nearly no one works 100% long-term, just because it's too much too.

Re: The American Healthcare Conundrum

#278

Post by hermanzegerman »

shigawire wrote: post #230
WarmWash wrote: post #147

Earlier quoted context omitted.

Exactly, ask anyone in a job for the money how their week was. Not saying nursing is stress free, or every nurse is bad, but like tech companies in 2021, it's full of directionless people who pushed through the cert program to get paid $50/hr with $100/hr weekend shifts and be disgruntled with you that you are making them do work.

The disillusionment comes from hospital admins constantly squeezing blood from a stone. Patient populations are up, nursing FTEs down. Support staff down.

And those Admin Idiots never cut staff in Admin, it's always the Nurses and Doctors who get the pressure

Re: The American Healthcare Conundrum

#279

Post by thrwaway55 »

nine_k wrote: post #238
onraglanroad wrote: post #228

Earlier quoted context omitted.

> the existence of America's prescription drug markets drives the new innovative drugs that the rest of the world picks up for cheap. That's the ludicrous propaganda that you've been fed but you really should be intelligent enough to dismiss it. The world would get along just fine without you overpaying for your drugs. You pay for marketing costs.

Mostly not marketing (still large), but the R&D costs and clinical trial costs. The latter are in hundreds of millions to billions range for the entire journey from a promising discovery to an FDA-approved medicine.

Why not just research it outside of the US if the problem is the FDA cost

Re: The American Healthcare Conundrum

#280

Post by slashtom »

It's great to see work being done to highlight an issue but I do wonder what background does the author have? Would recommend gestalt/cleveland as a good grounding, the visualizations is editorial rather than analytical.

Choosing US versus Japan, which Japan has the lowest cost and highest life expectancy in the OECD, it's cherry picking. I'd recommend showing the full distribution of OECD per-capita spending rather than just a single cherry picked comparison.

This also is troubled by McNamara Fallacy, we're looking at metrics that are qunatifiable but ignoring what can't be measured or overlooked, is speed of access being considered, how about innovation incentives, quality and outcomes variation across systems, patient choice and flexibility, in addition to workforce compensation (nurses and physicians in the US earn significantly more). Where are the trade-offs?

Summary Statistics can be dangerous. 254% of medicare is a single ratio summarizing enormous variation across thousands of hospitals and procedures. Median markup of 3.96x inherently hides the distribution, some hopsitals may be higher or lower, why is that?

I think the biggest one to me was the confirmation bias, the $3 trillion gap that represented 'fixable waste' was the conclusion. Every price difference is interpreted as waste rather than investigating the potential cost drivers, was there a null finding framework in place where US spending appears justified or is it all bad?

Overall, glad someone is looking into the data and pulling insights, please don't take this as discouragement just a comment from the peanut gallery.

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