Which firms profit most from America’s health-care system (2018) • Hacker News Board

Re: Which firms profit most from America’s health-care system (2018)

#141

Post by ashayh » Sat, Jul 04, 2020, 7:19 PM UTC

mardifoufs wrote: post #124

NicoJuicy wrote: post #76

Earlier quoted context omitted.

Belgium On your own initiative ( partially paid back): - 9.6€ for the Covid test - 17 € for the doctor visit By Government: - fully paid back by our health care, including doctor visit I love transparent pricing :)

But the highest COVID death rate in the western world! You gain some, you lose some I guess :)

Can't really compare all of US to a single EU country and maybe vice versa.

NY has ~19M people, death per 1M ~1700 Belgium has ~11M people, death per 1M ~840

The US has 5 states with a far higher death rate than Belgium: https://www.worldometers.info/coronavirus/country/us/ So far.

Re: Which firms profit most from America’s health-care system (2018)

#142

Post by lotsofpulp » Sat, Jul 04, 2020, 7:22 PM UTC

dragonwriter wrote: post #139

lotsofpulp wrote: post #138

Earlier quoted context omitted.

> It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead. How do you know the doctor wouldn’t be billing erroneously anyway? People have no idea what doctors do or what is appropriate. The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacist…

> The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacists) to reduce over billing. Insurance company profits are capped at a percentage of payout, and they are part of oligopolies protected by high barriers to entry, why would they reduce overbilling or advocate for patients?

Because if they payout too much then they have higher premiums compared to their competitors, which means customers would opt for a different insurer?

Obviously not forcing everyone to go through healthcare.gov crippled the ability for numerous health insurance to exist and compete, but that is a political problem.

Re: Which firms profit most from America’s health-care system (2018)

#143

Post by boublepop » Sat, Jul 04, 2020, 7:31 PM UTC

nazgulsenpai wrote: post #93

boublepop wrote: post #64

Earlier quoted context omitted.

As I see it consolidation isn’t the root cause. The central problem is that pharmacy benefits manager have been allowed to invert the normal market. Normally for someone arranging the “resale” of a product from a producer to costumers would make more money if the price got negotiated down. But since PBMs have forced rebates of 70%+ that means that they are making most of the money on a drug sale. So even thought they…

Pharmacies, PBMs and insurance companies being owned by the same group is all an effect of consolidation. Source: worked for an independent specialty pharmacy that was purchased by a PBM that in turn merged with a major national insurer

I mean sure it’s an effect in the sense that when it happens we call it consolidation. My point is that none of the groups owning the insurance companies are buying up the pharmaceutical companies. And why should they? They are pulling home 2/3 of the profits of the price hiking campaigns they are driving and go about blaming it all on the companies who’s day-to-day is focused all about how we can make these drug cheaper, yet that never reaches the consumer.

Re: Which firms profit most from America’s health-care system (2018)

#144

Post by Retric » Sat, Jul 04, 2020, 7:46 PM UTC

lotsofpulp wrote: post #138

Retric wrote: post #85

Earlier quoted context omitted.

A huge factor is multiple insurance companies add a lot of overhead to the system as they all try to negotiate lower prices. It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead.

> It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead. How do you know the doctor wouldn’t be billing erroneously anyway? People have no idea what doctors do or what is appropriate. The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacist…

With single payer systems it’s much easier to sanity check what’s going on. For example billion one organization for 20 hours of work per day is laughable, but spread that across 10 companies and they can’t tell. Similarly, having more data allows for better statistical analysis when combined with random sampling.

Re: Which firms profit most from America’s health-care system (2018)

#145

Post by dominotw » Sat, Jul 04, 2020, 7:50 PM UTC

lnsru wrote: post #59

dominotw wrote: post #39

Earlier quoted context omitted.

> Obesity is treatable. How?

By fixing nutrition and adding some physical exercises. Though it’s slow, count 1 kg weight loss/week in average.

I assumed that was in reference to solving obesity at society level not individual level.

Re: Which firms profit most from America’s health-care system (2018)

#146

Post by ebg13 » Sat, Jul 04, 2020, 8:05 PM UTC

dominotw wrote: post #101

ebg13 wrote: post #79

Earlier quoted context omitted.

> It was tried and rolled back in chicago because it was deemed as unfairly targeting the poor. There's no reason why you couldn't pair taxing sugar with price-subsidies on non-sugary foods. The US already knows how to subsidize food production. Just stop subsidizing corn syrup and shift the subsidies to something less clearly destructive.

> price-subsidies on non-sugary foods. That makes a big assumption that people aren't buying more spinach because of price of spinach. beans and rice are already super cheap. Much healthier and cheaper option than mcdonalds.

> beans and rice are already super cheap. Much healthier and cheaper option than mcdonalds.

Why are you slyly shifting from "sugar" to "mcdonalds"? Minus drinks and desserts, McDonalds' offerings are not high in sugar.

> That makes a big assumption that people aren't buying more spinach because of price of spinach.

The price per calorie of spinach is extremely high. Micronutrients are great and all, but you can't live off micronutrients alone.

Re: Which firms profit most from America’s health-care system (2018)

#147

Post by lotsofpulp » Sat, Jul 04, 2020, 8:22 PM UTC

Retric wrote: post #144

lotsofpulp wrote: post #138

Earlier quoted context omitted.

> It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead. How do you know the doctor wouldn’t be billing erroneously anyway? People have no idea what doctors do or what is appropriate. The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacist…

With single payer systems it’s much easier to sanity check what’s going on. For example billion one organization for 20 hours of work per day is laughable, but spread that across 10 companies and they can’t tell. Similarly, having more data allows for better statistical analysis when combined with random sampling.

Yes, but without single payer, I don’t see a viable alternative to insurance companies or a similar organization double checking a doctor’s billing.

Re: Which firms profit most from America’s health-care system (2018)

#148

Post by lnsru » Sat, Jul 04, 2020, 8:47 PM UTC

dominotw wrote: post #145

lnsru wrote: post #59

Earlier quoted context omitted.

By fixing nutrition and adding some physical exercises. Though it’s slow, count 1 kg weight loss/week in average.

I assumed that was in reference to solving obesity at society level not individual level.

I would say, unhealthy food must be taxed, so that healthy stuff is the cheaper choice too.

Re: Which firms profit most from America’s health-care system (2018)

#149

Post by motohagiography » Sat, Jul 04, 2020, 9:39 PM UTC

yesenadam wrote: post #34

motohagiography wrote: post #10

The U.S. health system is what happens when corruption goes on so long you just call it the culture. "All professions are a conspiracy against the layman." was said by either G.B. Shaw or Ambrose Bierce, depending on your reference point. It's a form of business that is orthogonal to producing things people want, where instead it's mainly in the business of depriving people of what they need. Rent seeking is what pro…

> either G.B. Shaw or Ambrose Bierce, depending on your reference point. I googled it, it's from Shaw's Doctor's Dilemma . (I'm a big fan of both those guys.) Only 3 hits on the internet saying it was Bierce - all 3 are your comments on HN! hehe.

That's hilarious. I'd swear I read it in the Devil's Dictionary it in a fortune file somewhere.

Re: Which firms profit most from America’s health-care system (2018)

#150

Post by Retric » Sat, Jul 04, 2020, 10:24 PM UTC

lotsofpulp wrote: post #147

Retric wrote: post #144

Earlier quoted context omitted.

With single payer systems it’s much easier to sanity check what’s going on. For example billion one organization for 20 hours of work per day is laughable, but spread that across 10 companies and they can’t tell. Similarly, having more data allows for better statistical analysis when combined with random sampling.

Yes, but without single payer, I don’t see a viable alternative to insurance companies or a similar organization double checking a doctor’s billing.

One option is to separate the verification process from the insurance companies. In other words you have some list of pre defined standards that are covered at some rate and then an independent agency applies those standards and looks for fraud.

Aka a hospital might negotiate a separate rate for stitches with each company, but they don’t get to decide if it was needed on a case by case basis. Alternatively, apply the Japanese system where all procedures have a single agreed upon rate negotiated regularly.