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'A full-blown crisis': Americans brace for a surge in healthcare costs

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Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#111

Post by nradov »

runako wrote: post #92
czhu12 wrote: post #49

One thing that I’ve been trying to understand about this discourse: Is the sum of the increase in costs some people are now paying greater than the subsidies that previously existed? In other words: was there always a massive bill to be paid here, but it was just previously socialized and hidden in the form of taxes/ public debt? Or does the act of subsidizing it actually decrease the total?

There's a third piece too, which is that insurers are ramping price much faster than inflation. Our (unsubsidized) premiums increased 20% year-over-year, after also increasing faster than the rate of inflation the last few years. Since premiums never decrease, one can pretty easily plot out that in the next ~decade we will see family premiums larger than the median salary. The economics of all this are going to get v…

That's all true, but insurers are ramping up premiums faster than inflation largely because providers have raised their prices, and utilization has greatly increased due to an aging sicker population. The ACA minimum medical loss ratio means that health plans profits aren't increasing much.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#113

Post by nradov »

runako wrote: post #95
dboreham wrote: post #79

Earlier quoted context omitted.

Quick note that for people aged 65 and over the US does have a healthcare system somewhat like other developed nations.

Given that older people tend to be some of the main cost drivers in healthcare, it's sort of silly that we cover them and then refuse to allow younger (cheaper) people to opt in to the same system & perhaps defray costs that way.

You're missing a key piece. Medicare only sort of works because the larger healthcare system has a hidden cross subsidy where commercial health plans reimburse providers at much higher rates. In some cases providers are actually losing money caring for Medicare beneficiaries. We already have a problem with doctors refusing to accept new Medicare patients, and if we moved more patients from commercial insurance to Medicare then that provider shortage would only get worse.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#114

Post by azal »

geerlingguy wrote: post #5

I was paying around $1200/month last year (a little under that with subsidy). This year I'm paying $2100/month for a family of five, on a roughly equivalent plan. Except, none of the options in my state allow me to visit the PCP I switched to this year (since none of the plans last year covered my PCP from the year before). So I guess I'm on a primary care physician merry go round :D I am at least able to have my mai…

I take Remicade for UC on a monthly cadence. From $500 to now $1300/m for 2 in TX, and an added bonus of a 10% lab coPay + All kinds of fees.

I am Blessed running a good startup but I've always felt this deeply.... "But I can't imagine what people have to sacrifice to keep any kind of coverage (with high deductible and horrible coinsurance and prescription drug coverage) for their families if they don't have a decent income :("

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#115

Post by venturecruelty »

protocolture wrote: post #108

I find the US healthcare "system" to be an interesting topic. More nuanced than people think. It honestly seems like the worst way to run anything. Like I honestly cant see who its for, other than maybe US Corporations on the list of approved medical vendors. Like, putting on my "Lives in a free(ish) healthcare country" hat, it looks bonkers from that angle. But even from a more libertarian mode, the whole thing look…

If you want to know whom US healthcare is for, look at who makes the most money from it. There's your answer.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#116

Post by venturecruelty »

jameslk wrote: post #53

At what point does it become a better financial decision to do telehealth and medical procedures completely in a different country? Can you be health insured outside of the country you live?

Never, because the person who cleans your toilet cannot simply hop on a flight to Mexico every time she needs surgery. But that's also not a great solution for society, to have the software developer caste be the only ones who can afford medicine by taking an expensive vacation.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#117

Post by johnnienaked »

runako wrote: post #42
p0w3n3d wrote: post #37

Earlier quoted context omitted.

Guy from Poland here. What happened to ObamaCare? I thought you got finally a primary healthcare for all?

Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.) Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter. One other thing the ACA did is stop the scourge of scam insurers. This is a thing where peo…

Health care is fine here if you have a decent job. Health care is not that great in public systems and you still pay for it with higher taxes

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#118

Post by nradov »

protocolture wrote: post #108

I find the US healthcare "system" to be an interesting topic. More nuanced than people think. It honestly seems like the worst way to run anything. Like I honestly cant see who its for, other than maybe US Corporations on the list of approved medical vendors. Like, putting on my "Lives in a free(ish) healthcare country" hat, it looks bonkers from that angle. But even from a more libertarian mode, the whole thing look…

There is no US healthcare "system" in the sense of having a cohesive entity pursuing a unified goal. It's a bunch of separate entities each pursuing their own goals, often in conflict with each other. If we were designing a healthcare system from scratch it obviously wouldn't look anything like what we have today. But we arrived here through a process that economists call "path dependence", and this makes it stubbornly resistant to systemic improvements.

https://en.wikipedia.org/wiki/Path_dependence

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#119

Post by venturecruelty »

nradov wrote: post #83
Workaccount2 wrote: post #52

Private equity should be banned from healthcare. What could go wrong putting a bunch of finance bros at the wheel of a "Pay this amount or suffer/die" industry?

PE is a convenient whipping boy but it's not the main problem. There has been so much consolidation of health systems and other provider organizations in some regions that they now effectively have monopolies, allowing them to jack up prices. The effect is largely the same whether the owner is a PE firm or a non-profit foundation. In order to counteract that we would need much more vigorous antitrust enforcement, whi…

I'm so sick of this trope. "It's the insurance companies!" "No, it's private equity!" "No, it's the PBMs!" I don't care. Jesus Christ, going to the doctor is rapidly becoming unattainable for more and more people, including the PMC now, and all of the rich people are simply pointing at each other saying "it's the other guy!".

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#120

Post by johnnienaked »

rimbo789 wrote: post #67

Nationalize health care. Doctors should work for the government, hospitals should be owned by the government; for profit health care is a scam.

Your taxes would double, and don't even bother trying to say they wouldn't literally every country with public health care pays twice as much as we do in tax
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