Health care is turning into a consumer product • Hacker News Board

Re: Health care is turning into a consumer product

#121

Post by onlyrealcuzzo » Mon, Jan 10, 2022, 2:23 PM UTC

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

One point that gets skipped over a lot - the US is also one of the most unhealthy countries in the advanced world.

This is a big /part/ of the "worst outcomes" in the "highest cost, worst outcomes".

It is possible that you can spend a ton of money on healthcare - yet smoke and drink, drive everywhere and not exercise at all, and eat trash - that the healthcare spending is doomed to fail.

Europeans walk & bike more and don't eat as much garbage. Most Asians exercise much more, eat healthier, AND smoke and drink less.

Maybe the healthcare part is secondary to just generally taking care of your health?

It is well understood how terrible obesity is for you. Why should we expect the US to have better healthcare outcomes than Vietnam when Vietnam is 2.1% obese and the US is 42% obese. You can take all the heart medicine in the world. It would be better to simply not be obese in the first place!

This never seems to be a talking point. Have the statisticians controlled for all this when they come to these conclusions??

Re: Health care is turning into a consumer product

#122

Post by bluGill » Mon, Jan 10, 2022, 2:23 PM UTC

andrekandre wrote: post #85

bluGill wrote: post #61

Earlier quoted context omitted.

The US government is involved in ways that make it inefficient. For example, I don't get to choose my insurance, the government has ensured that instead my company does for me. While I can in theory get insurance elsewhere I lose a large subsidy in doing so, no insurance I can buy can possibly be a better deal for me, even the company insurance is bad. The incentives for insurance are to ensure that I don't quit, not…

> I don't get to choose my insurance, the government has ensured that instead my company does for me. how did that happen?

I don't know what my company pays for my insurance, but if I opt out of that insurance that money is lost. I know I pay $100/month (not the real number but close), and plans on the government health market start at $800/month (after the tax credit), plus by using the company plan they kick in another $100/month in a HSA match, and HSA money is a tax advantaged investment (AFAIK you can only get in an HSA from your employer). So by using my companies insurance it is like getting an additional $800/month in income (some of which is invested!).

I didn't look into details of the insurance market plans, but there were 40 different plans available there for me to choose from (as opposed to the 2 my companies gives me). I suspect that something similar to my work plan is more expensive than the one I listed above. I also suspect that if I was to look at all 40 plans I would choose something that wasn't not similar to the choices I have now. However with the amount of money I'd lose it isn't worth my time to examine my options.

Re: Health care is turning into a consumer product

#123

Post by cntainer » Mon, Jan 10, 2022, 2:23 PM UTC

toolz wrote: post #97

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

I'm curious how you can suggest the US government spends the most money in the world, by far, on healthcare and the simultaneously suggest there's less government involvement. The government is involved in every step of American healthcare. As you can imagine of a system that gets all of its funding thru companies completely overseen by regulatory bodies or thru social programs.

I didn't really suggest that the US Government spends money on healthcare, I was merely quoting the article: "Health care consumes 18% of GDP in America"

Please note that the wording implies that 18% of GDP is spent on health care overall not that the US Government is spending all that money out of its pocket directly on yearly budgets. The way I understand it is that it includes both money spent by public and private actors for all health related service.

I see this type of stat a warning that something might be dysfunctional within the system, and it's the government's job to get to the bottom of it.

Re: Health care is turning into a consumer product

#124

Post by syshum » Mon, Jan 10, 2022, 2:24 PM UTC

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

>>e most expensive and worst-performing in terms of outcomes compared to the other developed countries.

That is only true if you cherry pick statics that over sample for life style choices, and under sample of actual health care.

If you look at statics that are directly attributable to the care provided, not the life style choices of the patients then the US Healthcare system is far better than any other nation

Re: Health care is turning into a consumer product

#125

Post by dpierce9 » Mon, Jan 10, 2022, 2:27 PM UTC

pjc50 wrote: post #54

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

The problem is that "market" is a really bad fit for meeting healthcare needs, and doubly so when it's intermediated by insurers. People get the amount of healthcare they can afford from their discretionary budget and work their insurers for - not the amount they need. So they may get "more" (or at least more expensive) care than they need, or less. Note that many of the European systems are semi-private, so you reta…

US healthcare is a four-party arrangement since employers are also intermediaries. Employers select the plan (or plan options) and they pay the bulk of the premiums. Their check is always bigger than yours even if you pay more for your policy than they do. As such, most of the sales effort by health insurance companies is directed at the employer and they exercise a lot of judgment. In contrast, I have never once spoken to a representative of the health insurance company during open enrollment, it is always HR.

Re: Health care is turning into a consumer product

#126

Post by Bjartr » Mon, Jan 10, 2022, 2:28 PM UTC

onlyrealcuzzo wrote: post #121

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

One point that gets skipped over a lot - the US is also one of the most unhealthy countries in the advanced world. This is a big /part/ of the "worst outcomes" in the "highest cost, worst outcomes". It is possible that you can spend a ton of money on healthcare - yet smoke and drink, drive everywhere and not exercise at all, and eat trash - that the healthcare spending is doomed to fail. Europeans walk & bike more an…

This is a good point, and it's important to also remember that these ideas aren't independent. How people interact with the healthcare system over their lifetimes has an impact on how they think about their health, and the health impacting decisions in their lives.

Re: Health care is turning into a consumer product

#127

Post by DrBazza » Mon, Jan 10, 2022, 2:28 PM UTC

CraigJPerry wrote: post #56

ErikVandeWater wrote: post #51

Earlier quoted context omitted.

> So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. The US healthcare is an example of the government being massively over-involved and creating massive inefficiencies.

Counter point: the NHS in the UK has more government involvement than the US healthcare system. The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. “Better outcomes” needs more detail: Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an…

> The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US.

It really isn't underfunded. It's grossly inefficient, which is what happens to most if not all publicly funded bodies. It is actually ok to criticise the NHS organization.

They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. They (currently?) refused to recycle crutches, plastic casts and so on. They'll use their own (hospital pharmacy) drugs if you get admitted, and then discharge you with them, even if you have your own dosette box and refuse to take theirs back. My father was discharged with something in the region of £3-5000 pounds of drugs that we threw away on several occasions.

As a percentage of GDP, it's roughly the same as most other western countries.

Of most interest though is figure 3 in [2] - 80% of UK (NHS) funding came from public money, i.e. tax, and 20% from private money (e.g. insurance). For the US, it's 50% public money (tax), and 50% private money. I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. And compound interest (increase the NHS by 10% per annum!!) means we'd spend all our GDP on the NHS at some point rather quickly.

[1] https://www.statista.com/statistics/317708/healthcare-expend...

[2] https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

Re: Health care is turning into a consumer product

#128

Post by syshum » Mon, Jan 10, 2022, 2:30 PM UTC

CraigJPerry wrote: post #56

ErikVandeWater wrote: post #51

Earlier quoted context omitted.

> So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. The US healthcare is an example of the government being massively over-involved and creating massive inefficiencies.

Counter point: the NHS in the UK has more government involvement than the US healthcare system. The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. “Better outcomes” needs more detail: Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an…

"better outcomes" when talking about health should be things like 5 year cancer Survival rates, Wait time for Surgery, Wait time for Heart Stints, 5 year heart Attack Survival rates, Wait time for Specialist Care, etc

Not bankruptcy statics, or costs

Re: Health care is turning into a consumer product

#129

Post by michaelt » Mon, Jan 10, 2022, 2:31 PM UTC

roenxi wrote: post #27

qwerty456127 wrote: post #10

Earlier quoted context omitted.

This probably also is the hardest part. And the most alien to the whole American model of which lobbying is an integral part. IMHO you can only counter lobbying by allocating more to fact checking so it would be harder for them lobby things which are objectively wrong.

Why would fact checking have an influence on lobbying? Everyone knows what is going on. It isn't like the politicians, lobbyists, technical experts or public are in the dark about what is happening. If anything, a fact checking organisation has incentives to align with or even become a lobby group. We've seen what happens to "fact checking" in the political sphere.

> Why would fact checking have an influence on lobbying?

Some would say, if a senator doesn't believe in climate change that's a question of fact, and if they merely received better advice they'd change their opinion.

A cynical person, on the other hand, would say they know full well that climate change is real but they've accepted money to pretend they believe otherwise. In that case, no amount of independent advice will change their minds, as it is not a question of facts but of money.

Re: Health care is turning into a consumer product

#130

Post by pydry » Mon, Jan 10, 2022, 2:32 PM UTC

DrBazza wrote: post #127

CraigJPerry wrote: post #56

Earlier quoted context omitted.

Counter point: the NHS in the UK has more government involvement than the US healthcare system. The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. “Better outcomes” needs more detail: Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an…

> The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. It really isn't underfunded. It's grossly inefficient, which is what happens to most if not all publicly funded bodies. It is actually ok to criticise the NHS organization. They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. They (currently?) refused to recycle crutches, plastic…

>They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies.

You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power).

Pretty much any trade deal negotiations with the US involve the UK being asked to dial down NHS buying power on behalf of pharmas by making hospitals responsible for purchasing.

>As a percentage of GDP, it's roughly the same as most other western countries.

50% of the US - not because the UK is especially efficient but because the US healthcare is essentially legalized extortion.

>I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed.

The UK public adores the NHS and is one of the few things polls say that people would be happy to fund with tax raises. It's very very popular. In no small part because we can see how much of a racket the US is.

The ruling party does not like it, however, which is why it has been slowly degrading service over time as preparation for full privatization in 10-15 years. Part of this has been done by handing over chunks of the NHS to be run privately and incompetently by friends and donors of the party. The problems caused by this backdoor privatization will later be "fixed" with privatization. Whatever the problem, privatization will forever be the answer.

The tories argued for an American style healthcare system in 1948 and while they give tacit acknowledgement of the popularity of the NHS their views havent changed (Christopher Chope is a good bellwether of their more unsightly "hidden" views), they still want a US style system.