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The True Cost of Healthcare in the US

truecostofhealthcare.org

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Re: The True Cost of Healthcare in the US

#71

Post by cpleppert »

nirvana wrote: post #21

Back when he was alive, Milton Friedman did a study of the costs of health care in the US from 1900 to the 1970s. (I think the first study was in the 1970s, and it was updated in the 1990s) What he found was that the funding mechanism of health care over that time had shifted from patients paying out of pocket to government paying hospitals and government incentivized (by making it a tax write off for employers) and…

>>I with Obamacare this has dramatically ramped up and now there are boards to decide who gets what care based on cost measures, rather than medical need.

It would help if actually knew what you were talking about. There are no "boards." There is the IPAB which makes cuts to medicare if congress can't. I'm sure you are in favor of reducing this "socialized medicine" so your stated basis of opposition is nonsensical. Maybe you would prefer instead a "board" made up of people elected across the US that will make cuts to medicare instead. It's called Congress and maybe you should learn about it as I hear it has existed for a long time.

>>Command economies don't work, and the change in health care over the last century has been a centralization in control. >>Whenever someone talks about the need for socialized medicine because "otherwise people would go bankrupt", remember it is the socialization of medicine that caused costs to rise to the point where people would go bankrupt.

Milton Friedman also said that single payer system have many advantages over the system we have right now.[1] It isn't centralization of control its a broken system that has never had any reform whatsoever.

[1] http://www.hoover.org/publications/hoover-digest/article/729...

Re: The True Cost of Healthcare in the US

#72

Post by Spooky23 »

pulledpork wrote: post #63
specialp wrote: post #60

Earlier quoted context omitted.

For example 1: The reason why the hospital charges so much is the fact that it gets stiffed for a lot of emergecy patients without insurance. Many hospitals are on the brink of bankruptcy especially in poorer areas. This does not always reflect in the huge disparity in prices people pay, but is a big factor. Hospitals try to offset their losses by charging paying customers more. The real problems here especially with…

Do you have any links backing that statement up? It sounds plausible but I'd love to verify it. I have no idea what % of people in the emergency room are uninsured and what % are not in an emergency setting.

It varies by region. Your state health department probably publishes the data.

Remember that emergency rooms cannot turn people away, doctors can.

Poor people in general often don't have primary care providers -- even with Medicaid or private insurance. Reasons are varied and complex. Access is a big issue... for example, if you don't have a car, how do you get to the only doctor who is accepting new medicaid patients across town?

Re: The True Cost of Healthcare in the US

#73

Post by wutbrodo »

Alex3917 wrote: post #58
adjwilli wrote: post #38

Earlier quoted context omitted.

Isn't 17% roughly 20%? Or rather, isn't 17% roughly a fifth?

Only if you consider ~450 billion dollars to be a rounding error.

Compared to ~15 trillion (15,000 billion)? That seems fairly reasonable.

Re: The True Cost of Healthcare in the US

#74

Post by rubyrescue »

danielweber wrote: post #61
rubyrescue wrote: post #56

Earlier quoted context omitted.

It's just not true that large numbers of Canadians go to the US for healthcare. You need to supply evidence of this. The numbers are vanishingly small.

The numbers are vanishingly small Well, compared to what? The odds of having your private health insurance rescinded in the US is also very small -- but it's quite likely among people who suddenly rack up big health care costs. Similarly, if you compare Canada-to-US medical tourists to the Canadian population, I'm sure it's amazingly tiny. But how does it compare to the people of means who have a medical procedure de…

Well, I can't find any canadians who don't want their system. I can't find any (non-partisan) news sources complaining of a even a small number of people who would opt out of the Canadian system. Tommy Douglas, the founder of the system, is repeatedly voted the most popular Canadian in history... And...anecdotally every Canadian friend of mine loves to likes the system. I'd love to see some, any, hard evidence that the Canadian system is such a disaster that they're fleeing to the US to escape its tyranny.

Re: The True Cost of Healthcare in the US

#75

Post by dave48 »

Hi, My name is David Belk and I wrote the website. I noticed a lot of traffic from here this Morning. I'd just like to say thank you and, are there any questions I can answer? I'm having a busy Morning but I'll be free in about an hour.

Re: The True Cost of Healthcare in the US

#76

Post by gbhn »

danielweber wrote: post #18
bdesimone wrote: post #13

I haven't read the whole site yet but I jumped to the topic I know fairly well, medical malpractice. Just some additional notes to consider: * 9 out of 10 physicians would discourage their children from becoming doctors.[3] There are many reasons for this. Malpractice insurance premiums are a factor. Not the only factor. * California physicians have the lowest insurance premiums in the country. This is directly the r…

Richard Thaler just had this op-ed in the NYT on ways to reduce costs, talking some about tort reform: http://www.nytimes.com/2013/02/24/business/overcoming-obstac... ; I'm skeptical about tort reform as a panacea. However, lawsuits are incredibly expensive, and so doctors take steps that we would otherwise call economically unreasonable to avoid them. The amount of tort reform I think is really necessary is whatever…

Yes. Malpractice insurance isn't super costly, but knowing many doctors (my father was a doctor as well), the adversarial relationship that malpractice suits sets up is a heavy burden. We know that overtreatment is a huge source of the cost overages we have in the US relative to other countries with the same health outcomes, and malpractice threats are a significant contributor to that, although it is obviously very hard to measure.

Personally, I think there could be some advantages in making a more patient-responsible system. The most expensive healthcare we have is ongoing (chronic) stuff, and most people with issues like that end up being experts on their own conditions. Why not allow them to get their own medicine and equipment directly rather than be forced to visit the doctor every N weeks to refill a prescription? Or be severely inconvenienced by being somewhere where it is difficult to obtain the right prescription for the medication they know, any sensible person knows, they need? That's silly and inefficient.

Re: The True Cost of Healthcare in the US

#77

Post by noarchy »

rubyrescue wrote: post #74
danielweber wrote: post #61

Earlier quoted context omitted.

The numbers are vanishingly small Well, compared to what? The odds of having your private health insurance rescinded in the US is also very small -- but it's quite likely among people who suddenly rack up big health care costs. Similarly, if you compare Canada-to-US medical tourists to the Canadian population, I'm sure it's amazingly tiny. But how does it compare to the people of means who have a medical procedure de…

Well, I can't find any canadians who don't want their system. I can't find any (non-partisan) news sources complaining of a even a small number of people who would opt out of the Canadian system. Tommy Douglas, the founder of the system, is repeatedly voted the most popular Canadian in history... And...anecdotally every Canadian friend of mine loves to likes the system. I'd love to see some, any, hard evidence that t…

I live in western Quebec, home to two of the worst hospitals in the country (those in Hull and Gatineau). Getting a family doctor here requires years of waiting, and many will go across the river and pay out of pocket to see a doctor in Ottawa. You'll no doubt find some Canadians who live in areas where things are working out pretty well. People in the US don't often realize that the Canadian system is not monolithic, and is based more on your province, and sometimes where you are within a given province.

Re: The True Cost of Healthcare in the US

#78

Post by guylhem »

dave48 wrote: post #75

Hi, My name is David Belk and I wrote the website. I noticed a lot of traffic from here this Morning. I'd just like to say thank you and, are there any questions I can answer? I'm having a busy Morning but I'll be free in about an hour.

One question : just how would you prioritize actions to turn heathcare into a real market, or as close to it as possible ?

I would go for:

1) full price transparency

2) making price discrimination illegal

3) attacking the information asymmetry by providing a free, subsidized first line triage

Whether treatment is taken or the patient decides to do without it, making sure tests and diagnosis are performed could help proper self regulation of consumption

It could also be made as a public service since it seems very close to a natural monopoly (due to the subadditivity of the cost function - see for ex http://www.clt.astate.edu/crbrown/eleven1.htm - having big labs to process blood test gives economy of scales but require high fixed costs)

It could therefore be politically defensible on grounds of efficient pricing (ie pricing at the marginal cost, which requires subsidizing for natural monopolies since average cost are above marginal costs), to avoid deadweight loss.

The first line triage could then provide full price transparency (diagnosis -> probabilistic DRG), from which the patient could either decide to "wait and see", or to browse a catalog of hospital offering services (DRG -> prices) knowing the price paid would be no different with or without insurance.

At that point, it might be possible to remove all price caps and floors, and let the market work.

So basically, we could get a working market on the treatment side.

Traditional monopoly and oligopoly management (watching the HHI before allowing fusions) could then keep it that way.

I'm a bit out of idea however to have integral pure and perfect competition, at least until we get user-operable "all-in-one diagnosis devices" (like Star Trek tricoders) to remove the information asymmetry.

My last rants on this topic were posted on http://news.ycombinator.com/item?id=5261137

Re: The True Cost of Healthcare in the US

#80

Post by rowanseymour »

skylan_q wrote: post #50
smutticus wrote: post #44

Earlier quoted context omitted.

>Whenever someone talks about the need for socialized medicine because "otherwise people would go bankrupt", remember it is the socialization of medicine that caused costs to rise to the point where people would go bankrupt. Because there are thousands of Canadians every year that go bankrupt because of health care costs. Your argument doesn't even begin to make sense.

Because there are thousands of Canadians every year that go bankrupt because of health care costs. Actually, there are. They go the US to get care that's not offered in Canada. The care here is about as good as former soviet bloc countries. If there was a chance that an illness such as cancer could kill me, I'd get out of Canada in a heartbeat and embrace poverty if it meant keeping my life.

"as good as former soviet bloc countries"... really.. ?

How many Americans (like Sarah Palin) are going the other way across the border?

According to one study [1], only 0.61% of Canadians are going to the US for healthcare. And you have to consider that that the Canadian government pays for much of that care in the US. I'd imagine that if things were as bad as you claim, that number would be a bit higher

[1] http://www.aarp.org/politics-society/government-elections/in...

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