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I write about America’s health care system, and I got caught up in it

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Re: I write about America’s health care system, and I got caught up in it

#101

Post by BobbyJo »

mnhn1 wrote: post #76
BobbyJo wrote: post #61

Earlier quoted context omitted.

> A system that rations care based on ability to pay... is immoral. You lost me there. What makes it immoral? Money is an asset allocation tool, so why is it morally wrong to use it for medicine the same way we do for food and housing? Genuine question. I have a hard time understanding what sets medicine apart from everything else when people think healthcare should be universally free, but not food, water, clothing,…

I don't think it's inconsistent. The people who advocate for free healthcare would probably also advocate for other parts of a social safety net, like food banks, food stamp programs, free access to water, temporary housing for the homeless and programs to get them to permanent homes, etc. And indeed the US has many such services, though they are often overwhelmed, or performed through a complex set of nonprofits com…

> don't think it's inconsistent. The people who advocate for free healthcare would probably also advocate for other parts of a social safety net, like food banks, food stamp programs, free access to water, temporary housing for the homeless and programs to get them to permanent homes, etc.

Isn't it though? "This thing should be free for everyone all the time" is a lot different than "we should help people out a little if they're down on their luck". Temporary housing, food banks, etc are the latter, and I'm all for the same with medicine. The fact that food and housing are subject to markets makes it easier for organizations to carry out such missions, which is one of the barriers you mention in your second paragraph when you talk about the complexities of dealing with insurance companies.

Re: I write about America’s health care system, and I got caught up in it

#102

Post by AuthorizedCust »

text70 wrote: post #52
AuthorizedCust wrote: post #41

Earlier quoted context omitted.

That’s exaggerated. Generics are well known to be effective, and exceptions are unusual. Here’s some commentary to that effect, talking about research to the contrary: https://www.health.harvard.edu/staying-healthy/do-generic-dr... It’s reasonable to expect people to exhaust lower cost alternatives, that are reasonably expected to work, before stepping up costs.

Speaking of genetics, screening for the genetic profile of variable liver enzymes for known mutations and their associated drug interactions could actually save on the shotgun approach to dispensing medicines. The problem is, you won't be able to hammer down the health of the patient to the lowest cost option, only the most effective.

Ha! My keyboard autocorrected generics to genetics! Fixed in the original comment.

Re: I write about America’s health care system, and I got caught up in it

#104

Post by jatone »

BobbyJo wrote: post #72
andi999 wrote: post #65

Earlier quoted context omitted.

The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand) If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give…

> The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand) Changing housing situations is exactly as easy as changing hospitals and emergency rooms no? Since the lat…

You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated. markets don't deal with this situation well. changing hospitals don't change the baseline costs for providing health care in a significant manner for there to be competition nor are many hospitals in a competitive market (often there is only one hospital for an entire rural region).

that's before even getting into pharma. which can charge millions of dollars for life saving/changing drugs for single course treatments. hell take a look at what happened with epipens. there is no protection against profiteering via nebulous 'markets' when your choices are 'purchase or die'.

Re: I write about America’s health care system, and I got caught up in it

#105

Post by rootusrootus »

AuthorizedCust wrote: post #41
kemiller2002 wrote: post #38

Earlier quoted context omitted.

It's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.

That’s exaggerated. Generics are well known to be effective, and exceptions are unusual. Here’s some commentary to that effect, talking about research to the contrary: https://www.health.harvard.edu/staying-healthy/do-generic-dr... It’s reasonable to expect people to exhaust lower cost alternatives, that are reasonably expected to work, before stepping up costs.

> Generics are well known to be effective, and exceptions are unusual.

A [relatively] well known exception is anticonvulsants. My younger brother paid for that with his life. I hope the FDA figures out how to properly evaluate generic equivalence.

Re: I write about America’s health care system, and I got caught up in it

#106

Post by ip26 »

pmyteh wrote: post #14
h2odragon wrote: post #10

> Some suggested I go to Walmart for $25 insulin, an older type I have no idea how to safely use. I'm sorry but this erodes my sympathy significantly. Learn about the options that exist if your first choice treatment isnt available. Learn about mitigation when no treatment is available. This is your life, act like its your responsibility already.

It takes weeks to get comfortable using a different insulin to manage your blood sugars, and the results on older NPH insulin are going to be much worse than a more modern one. Doing that, and damaging your body, just to avoid avoidable bureaucracy is not reasonable. In fact, it's mildly tragic.

These threads always talk out both sides of their mouths. First people say, insulin was invented 100 years ago and the patent was gifted away to help patients, so it should be free. Then people say, it is stupid to use anything but the most modern formulations, because they are way better than the old ones.

I have no love for pharma price gouging, but if insulin was free, everybody would be stuck on the 1921 formulation.

Re: I write about America’s health care system, and I got caught up in it

#107

Post by hallway_monitor »

mantas wrote: post #86
syki wrote: post #56

Earlier quoted context omitted.

In all healthcare systems some form of rationing occurs since there aren’t enough resources to provide the best care to everyone. A system that rations care based on ability to pay or on wether or not your employer is generous is immoral. It is also immoral to profit off of denying someone care. Tough decisions have to be made and financially rewarding a company by denying care is despicable.

In countries with public healthcare it’s still based on ability to pay. You pay out of pocket and cut the queue, have decent time allotment with the doctor, get best medication available without money-saving algorithms etc.

So the downsides don't affect the rich because they use a premium secondary market. That explains why so many US politicians support it.

Re: I write about America’s health care system, and I got caught up in it

#108

Post by Dma54rhs »

kemiller2002 wrote: post #38
refurb wrote: post #31

Earlier quoted context omitted.

Why is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

It's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.

Well at least in Europe pharmacists always tell you about generics, that they are cheaper and work the same. Not sure who is spreading misinformation here.

Maybe you're talking about different medicines that people are using (like different insulins), the generics use the same formula as the original.

Re: I write about America’s health care system, and I got caught up in it

#109

Post by hallway_monitor »

cascom wrote: post #87
lotsofpulp wrote: post #57

Earlier quoted context omitted.

Health insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families: https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family. The fact that most…

To your last point I wonder what the effect of not allowing a provider to charge a different price for the same service/product would be.

This is a really interesting idea. Seems like it would kind of level the playing field and might help guide us toward what I think is the ideal situation - no one needs health insurance other than for a catastrophic event because prices are known and reasonable and you just pay them, like literally every other service we need and consume.

Re: I write about America’s health care system, and I got caught up in it

#110

Post by mantas »

hallway_monitor wrote: post #107
mantas wrote: post #86

Earlier quoted context omitted.

In countries with public healthcare it’s still based on ability to pay. You pay out of pocket and cut the queue, have decent time allotment with the doctor, get best medication available without money-saving algorithms etc.

So the downsides don't affect the rich because they use a premium secondary market. That explains why so many US politicians support it.

Do they? I was under impression that all US politicians aside from Sanders support current system.

Anyway… I think both systems are very similar in the end. Rich (or even middle class) gets great service in premium facilities. Average folks get OK service with some downsides, likely paying out of pocket in various ways. The only difference may be poor people coverage which is subsidized by upper tier payers. Who themselves may never use public service and go to premium only.

Also, another major difference may be the big expensive procedures. Aside from the 1%, people would do the procedure in public hospital because it’s crazy expensive otherwise. But everything else leading up to it and recovery after it more likely to happen in premium market since it’s much more affordable.

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