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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#181

Lots of people are saying nonsense here. The actual reason commercial insurers pay more is that's the only way to can make more profits. Because of Obamacare requiring 80% of the money they collect to be spent, the insurance companies just get to keep 20%. So insurance companies spend more so they can collect higher premiums. That's how they make more money. Several doctor friends have told me this as well.

You can really just say anything and get upvoted on this website.

If this were true then private insurers would have paid comparable rates to Medicare prior to the ACA passing, and that's just not the case. This fact has been a fixture of the US healthcare system since the creation of Medicare.

Re: The American Healthcare Conundrum

#182

Lots of people are saying nonsense here. The actual reason commercial insurers pay more is that's the only way to can make more profits. Because of Obamacare requiring 80% of the money they collect to be spent, the insurance companies just get to keep 20%. So insurance companies spend more so they can collect higher premiums. That's how they make more money. Several doctor friends have told me this as well.

So I happen to be in Costa Rica for the month. Just like every other 1st world country, it has managed to have universal health care that is better and cheaper without private insurance. Even if you do get private insurance for quicker access, it’s still much cheaper than the US. I just spoke to someone who flew down here to save $30K on dental work. The problem isn’t the ACA, it’s the ass backwards American health c…

It's a difficult fix, because the real issue here isn't who pays, but how much it's paid, total. If the cost of care in the US was the same as the cost in, say, Spain, the vast majority of people would have little problem paying out of pocket, and having just high deductible insurance for really big ticket items. At the same time, it'd be easy to have the government pay for it all. The US system is just very expensive in general, so it's a problem regardless of who pays for it.

Most of the costs are ultimately salaries to Americans, and money handed to American companies, so most savings would come from someone's livelihood. That's why we cannot reform: The party that actually cuts costs will build resentment for decades, and create a blip of unemployment. Nobody wants to do that, and therefore you aren't going to be a serious, relentless attempt at cutting costs. We've seen how the attempts that the ACA made were counteracted by consolidation at all levels.

Serious cuts have to have no mother. Say, if we ever did have an AI that worked well enough at this, and outcompeted primary care physicians. Foreign pharmacies bypassing all controls and being able to hand you much discounted drugs the day after. Telemedicine and cheap travel put together to make surgery that didn't involve an ER visit just as easy and much cheaper than using the US system. Straight out disruption, because the incentives are such we sure aren't getting improvements in regulation.

Re: The American Healthcare Conundrum

#183

Earlier quoted context omitted.

If you live long enough, you will have a pre existing condition. The way it was suppose to work with the original mandate is that everyone had to be insured either through their employee or the exchange. So you couldn’t just buy insurance when you were sick. The Supreme Court struck that down. If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insu…

>If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insurance at any cost. This is a flat out lie. You absolutely could buy health insurance without being at a company.

Not if you had a pre-existing condition - the entire point of this thread.

Re: The American Healthcare Conundrum

#184
post #60

> The US spends ~$14,570 per person on healthcare. Japan spends ~$5,790 and has the highest life expectancy in the OECD. That gap is roughly $3 trillion per year. The difference in life expectancy will be influenced by multiple factors and may have more to do with diet and lifestyle than with healthcare. Japan also spends less per capita than the UK, France or Germany. The US spends a lot more than any of those so th…

The US also has GDP per capita of $90k and Japan has a GDP per capita of ~ $35k. Put another way, in both countries a hip replacement surgery is almost exactly 1/8 of someone's per capita GDP.

This feels like a misleading ratio, it's just saying the cost is the same in per capita terms but says nothing about the absolute cost or more importantly cost as a percentage of income, which matters for the majority of people in the denominator of the GDP per capita calculation.

Re: The American Healthcare Conundrum

#185

Earlier quoted context omitted.

What OP said is true. You’re forgetting that health insurers are just one organization in the corporate chart. They often work to own the providers as well to funnel money to parent corporations. So if United is the insurer they’re owned by an umbrella, that umbrella takes 20% or less. However United makes special deals and steers people to providers owned by the Umbrella. So that the Umbrella makes more money as wel…

Digi is correct here. >For example Cigna requires all maintenance medication be purchased through express scripts Important note: Cigna owns Express Scripts. Today the biggest "insurance" companies are actually massive conglomerates that own the clinics, the doctors and the pharmacies. United = Optum. Aetna = CVS + Caremark. Humana = CenterWell. Elevance/Blue Cross/Anthem/Carelon. Centene = Envolve Once a giant like…

Pharmaceuticals are a small component of overall US health spending. Upcoding is endemic across the entire system; it's endemic across the whole system. Ironically, the complaint you'd be making with upcoding under Advantage is that Medicare should be denying coverage to people; Advantage upcoding involves altering risk scores to authorize more care.

Re: The American Healthcare Conundrum

#186
post #37
post #20

Earlier quoted context omitted.

In a vacuum sure. But insurance companies operate the only part of the healthcare system that is moderately competitive. In the end employers are the ones largely paying and they are professional negotiators enough to put price pressure on insurance plans. 20% of $0 is $0. As such, as light of an incentive it is - it’s the only party in the entire system that is incentivized in any way whatsoever to keep costs down.…

> part of the healthcare system that is moderately competitive. That’s only half the story though insurance companies also try and reject way more claims, cover fewer people, and are just harder to get money from than Medicare. This means hospitals can’t afford to give them cheaper rates as they just require vastly more work from staff for the same procedure. The industry isn’t blind to this effect, but has little re…

It can't be both: either insurers are incentivized to authorize as much care as possible so as to fit more money through the 20% opening, or they're incentivized to deny care to minimize their expenses. Which is it?

Re: The American Healthcare Conundrum

#187
post #37

Earlier quoted context omitted.

> part of the healthcare system that is moderately competitive. That’s only half the story though insurance companies also try and reject way more claims, cover fewer people, and are just harder to get money from than Medicare. This means hospitals can’t afford to give them cheaper rates as they just require vastly more work from staff for the same procedure. The industry isn’t blind to this effect, but has little re…

This isn't even close to true. Keep in mind that Medicare, together with Medicaid (which operates under much of the same administrative rules), account for nearly half of medical spending. So basically, if a provider doesn't want to play by their rules, they MUST deal with Medicare. That is, the government is nearly a monopsony in this industry. There's a common, misleading, claim that Medicare is more efficient beca…

It's further the case, regarding Medicare expense ratios, that their admin costs are low relative to private insurance because the median private insurance customer incurs far lower medical costs, leaving admin as a higher fraction.

Re: The American Healthcare Conundrum

#188

Earlier quoted context omitted.

> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be

We traded the cruelty of Exclusion for the cruelty of Extraction.

What does that mean?

Re: The American Healthcare Conundrum

#189
There's so much culturally different here that blaming just the differences in the system of health care is effectively meaningless.

Yearly physical exams are much more thorough in Japan. Unless you are optimally fit, you will be prescribed lifestyle changes to make and there is a strong expectation that you will work hard on these. Your employer will be involved. There is _tremendous_ social pressure if you are overweight.

Healthy food options are ubiquitous there with healthy and cheap meals available 24/7. Combini food certainly has bad options but nothing compared to American fast food or the American diet generally.

There are other health problems that are significantly overrepresented in Japan compared to the western world. Alcohol, smoking and stress-related illnesses. Liver & Kidney diseases. Peptic ulcers, GI problems in general.

Re: The American Healthcare Conundrum

#190
post #41

Earlier quoted context omitted.

Trying to understand why healthcare in the U.S. is so expensive is like trying to understand why building subway in New York is so expensive: https://www.nytimes.com/2017/12/28/nyregion/new-york-subway-... . The issues lend themselves to facile explanations ("insurance companies are greedy," "NYC's government is wasteful") but those are driven by ideology not analysis.

What we can say for certain is that heath insurance companies in the US stuff their pockets with tens of billions in profits each year and that Americans are paying far more while getting less for their money than other developed nations. I don't think those two things are unrelated.

What is the profit margin of a health insurance company? Google suggests 2-4%, with United at about 6%. This does not seem that extravagant.
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