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Researchers chart path to drastically lower administrative costs of health care

med.stanford.edu

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Re: Researchers chart path to drastically lower administrative costs of health care

#171

Post by renewiltord »

benlivengood wrote: post #110

I worked in a hospital for 13 years. The economic incentives for the current system are quite perverse. The FDA has no cost constraints and so maximizes safety instead of QALYs. Medical equipment and drug manufacturers maximize profit and so fill the highest margin niches first instead of maximizing QALYs. Radiology and lab services are lucrative and separate themselves from clinical providers to maximize profits ins…

Well, that's because Americans have an aversion to QALYs. It might be related to the idea that the country is fundamentally Christian in a deep way.

A common accusation of anyone attempting to do a QALY based system would be that they are "sacrificing grandma for the dollar".

The recent COVID crisis is an example where QALY based evaluations (which may well have gone either way) were summarily considered "putting a number on the value of a life".

In that respect, it's not that the institutions are perverted but that the society they are in prefers them this way.

Re: Researchers chart path to drastically lower administrative costs of health care

#172

Post by UncleOxidant »

jostmey wrote: post #2

I agree with the three issues they identify driving up costs. But I fear “Medicare for All” won't fix all the issues, which go much deeper. For example, the US has extremely high standards restricting who can practice medicine compared to the rest of world, limiting the supply of doctors and artificially driving up their demand. There is a need for standards, but perhaps the AMA has too much political influence. Like…

If we do medicare for all or some other kind of universal healthcare in the US we're also going to need to train doctors way more cheaply than we do now. At the least we're going to need to offer free or heavily subsidized education to incentivize more people to go into medicine without graduating with debt higher than many mortgages.

Re: Researchers chart path to drastically lower administrative costs of health care

#173

Post by smooth_remmy »

mycologos wrote: post #17
throwaway13337 wrote: post #5

Earlier quoted context omitted.

Agreed. Entrenched institutions are the general problem with America. It's the police unions protecting bad policing, the restricting of doctor supply via the residency bottleneck, and local governments preventing new building for burgeoning populations. They're all the same problem really. Beneficial to the incumbent group at the expense of those they service. It's kind of amazing.

> the restricting of doctor supply via the residency bottleneck Assuming that you're referring to the AMA here, their role is pretty unclear to me. They appear to have played a lobbying role to get Congress to freeze residency funding in 1997 to avoid having lots of doctors [1], but for several years now, the AMA has at least publicly claimed that they've been lobbying congress to increase funding for residency slots…

AMA is a bad actor. They refuse to allow junior doctors (doctors who are MD school graduates but who have not completed residency) to practice medicine in ANY capacity.

Common sense says that junior doctors should have the same practice rights as physician assistants - but the AMA refuses to let that happen. They are a medical cartel.

A few states have allowed junior doctors to start practicing medicine in a limited capacity, because every other doctor so damn expensive. But the AMA does not support those states' decision.

Re: Researchers chart path to drastically lower administrative costs of health care

#174

Post by sebmellen »

andrewlgood wrote: post #113
DonnyV wrote: post #101

Earlier quoted context omitted.

With Medicare For All the government would act as an insurer, that is all. All hospital services stay private.

But it would be paid for by taxes spread across the tax-paying citizens. It would appear to all people in the US that their healthcare is free as they are not directly paying for it. Hence infinite demand.

That’s the worst argument I’ve ever heard against Medicare for All.

Rephrased in another way, you’re saying “the plebs are going to get medical treatment and overwhelm the system by doing so if we let them!”

I don’t think there is infinite demand for healthcare as people are not infinitely sick.

Re: Researchers chart path to drastically lower administrative costs of health care

#175

Post by andrewlgood »

DonnyV wrote: post #97
trentnix wrote: post #60

Earlier quoted context omitted.

> Worthless paper, administrative costs is only a piece of the many issues with US "Healthcare". Medicare For All is the better and cheaper way forward. As frustrating and arcane as the current system may be, the government fully in charge for the provisioning (rationing) and financing will only increase 'worthless paper, administrative costs'.

The government would act as an insurer, that is all. All hospital services stay private. And having all medical services have to go through one system to get paid would streamline it SIGNIFICATLY.

Like the IRS has streamlined taxes and the US postal service has streamlined mail delivery?

Re: Researchers chart path to drastically lower administrative costs of health care

#176

Post by andrewlgood »

sebmellen wrote: post #174
andrewlgood wrote: post #113

Earlier quoted context omitted.

But it would be paid for by taxes spread across the tax-paying citizens. It would appear to all people in the US that their healthcare is free as they are not directly paying for it. Hence infinite demand.

That’s the worst argument I’ve ever heard against Medicare for All. Rephrased in another way, you’re saying “the plebs are going to get medical treatment and overwhelm the system by doing so if we let them!” I don’t think there is infinite demand for healthcare as people are not infinitely sick.

But they may be excessively worried that they are sick and demand excess testing and excessive stays in hospitals.

Re: Researchers chart path to drastically lower administrative costs of health care

#177

Post by matheusmoreira »

google234123 wrote: post #144
lr1970 wrote: post #99

Earlier quoted context omitted.

> The US only accepts doctors who went to Canadian or American medical schools. This is factually incorrect. There are tons of doctors that graduated from European, Indian and Chinese medical schools. To practice medicine in the USA they need to pass the ECFMG tests (US graduates take similar USMLE tests) and then complete medical residency. The last part is the hardest, for the medical residency admission offices ar…

Why shouldn't domestic medical students have priority over foreign medical graduates?

Why should they? If I take the same tests as US medical students and pass, am I not at least as good as they are?

Re: Researchers chart path to drastically lower administrative costs of health care

#178

Post by benlivengood »

renewiltord wrote: post #171
benlivengood wrote: post #110

I worked in a hospital for 13 years. The economic incentives for the current system are quite perverse. The FDA has no cost constraints and so maximizes safety instead of QALYs. Medical equipment and drug manufacturers maximize profit and so fill the highest margin niches first instead of maximizing QALYs. Radiology and lab services are lucrative and separate themselves from clinical providers to maximize profits ins…

Well, that's because Americans have an aversion to QALYs. It might be related to the idea that the country is fundamentally Christian in a deep way. A common accusation of anyone attempting to do a QALY based system would be that they are "sacrificing grandma for the dollar". The recent COVID crisis is an example where QALY based evaluations (which may well have gone either way) were summarily considered "putting a n…

> The recent COVID crisis is an example where QALY based evaluations (which may well have gone either way) were summarily considered "putting a number on the value of a life".

I think a clarification is that a lot of U.S. citizens agree with putting a number on the value of a life but they value lives by the amount of wealth a particular life owns. What they actually don't like is the perception of having to pay their own money for other lives that they don't particularly value while simultaneously discounting their own risk of catastrophic medical costs. Irrational self-dis-interest, to coin a term.

Re: Researchers chart path to drastically lower administrative costs of health care

#179

Post by ixacto »

ju-st wrote: post #154
perlgeek wrote: post #79

Earlier quoted context omitted.

... and much cheaper than the US, currently.

I pay 759€/month for my German public health insurance while in the US according to Google the average cost of platinum insurance (the best?) is $750/month.

That is without employer subsidy or tax credits?

We can purchase insurance from state (ACA state) or federal exchange (non-Aca state), and also from the companies themselves. The cost will be either $0-1500+ Per month per person, yeah it varies a bit. Many employers will charge about $50-150 per month and subsidize the rest.

There are also high deductible plans that they are paying though, but they usually have a $3000-6000+ deductible per person, these are not good if you want to have kids or have a family history of chronic illness.

In my opinion the whole system is a huge inconsistent mess though. They will literally send you bills for hundreds of dollars (got a $350 therapist bill a few months ago) and I had to call them up an very politely tell them that yes I do have insurance with the credit card history to prove I’ve been paying the premiums, and to very politely fuck off.

The bill went away.

Re: Researchers chart path to drastically lower administrative costs of health care

#180

Post by opo »

rscho wrote: post #152
KptMarchewa wrote: post #134

Earlier quoted context omitted.

Isn't the problem that US requires having bachelor's degree before you even can start studying medicine, which effectively makes people start 4 years later?

The question is not "when do you leave school?" it's actually "when are you employable as an independent practitioner?". In my personal experience, it's _much_ easier to get an attending/private practice position in the US at a younger age. Just because the country is huge and lots of places lack docs, probably. Of course, that's my experience and I could be wrong.

Just because there is a Dr shortage in the US due to having a limited number of medical schools, there are still thousands of students who get their degree and can't find a residency:

>.... The matching challenge comes as the U.S. faces a physician shortage. The nation could be short as many as 139,000 physicians by 2033, according to the Times, which cites Association of American Medical Colleges data. Despite this shortage, thousands of medical school graduates are consistently rejected from residency experience, rendering their MD or DO "virtually useless," according to the report.

https://www.beckershospitalreview.com/hospital-physician-rel...

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