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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

#191

Post by runako »

johnnienaked wrote: post #117
runako wrote: post #42

Earlier quoted context omitted.

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

> Health care is fine here if you have a decent job

This statement is at odds with itself.

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

#192

Post by antisthenes »

pxmpxm wrote: post #17
fzeroracer wrote: post #12

Earlier quoted context omitted.

No, it definitely did not always cost $2k a month.

Bronze plans with $5-6k deductibles have always ran more than what people paid for rent. Healthcare is the one thing that's outpaced inflation in higher education.

> Bronze plans with $5-6k deductibles have always ran more than what people paid for rent.

Unsubsidized bronze plans were in the $250-350 range in 2016/2017. That's nowhere near rent.

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

#193

Post by Tadpole9181 »

ArtemZ wrote: post #148
nradov wrote: post #111

Earlier quoted context omitted.

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.

But isn't it insurers actually set how much a service is going to cost you and then make "a discount" on that figure?

Yes and no.

What happens in practice is that a provider charges $200 for "distributing Advil" and $50 for two pills. Then the insurance company, whose legally allowed profit is proportional to payouts, "negotiates" the price down to $150 total and claims to the person "we saved you $100". Then their accountant says "we paid out $150, so we get a profit margin of $40" (instead of the $0.50 they would get with a real at-cost charge).

But the price is made up nonsense and 100x actual cost for 15 seconds handing a 1¢ pill over. Which is why asking for an itemized receipt and saying you can't afford that suddenly drops the bill to $1.50.

When providers don't "play ball" with the price fixing the way insurance company wants, they go off network.

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

#194

Post by gilbetron »

nradov wrote: post #190
gilbetron wrote: post #182

Earlier quoted context omitted.

You assume that there is any meaningful competition. What we are seeing, across industries including education, is a type of indirect collusion that is keeping prices crazy, not competition. Over regulation is a big piece of what enables all this.

Some states require a "Certificate of Need" to open a new hospital so we ought to do away with those to promote competition. But beyond that, which specific regulations are harming competition?

https://www.ftc.gov/news-events/features/certificates-public...

Lack of health care records interoperability (locks patients into a system).

Much of the well-intended regulation around healthcare ends up getting perverted to prevent competition.

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

#195

Post by jdlshore »

runako wrote: post #185
jdlshore wrote: post #99

Earlier quoted context omitted.

That’s grossly exaggerated. Individual deductibles are limited by law to ~$6500 even on the worst plans. And no one is paying $3500 per month for individual coverage on one of those plans. The actual rates depend on age and zip code, but I’d be very surprised if they’re that high anywhere. To see the actual costs for yourself, go to healthcare.gov. The “bronze” plans are the ones with high deductibles. If you’re youn…

> Individual deductibles are limited by law to ~$6500 even on the worst plans This was not the case for 2025, so I just did a search to determine whether you are referencing a new law. No, you are just flat wrong on this claim. In Georgia (georgiaaccess.gov), the first bronze plan I looked at has an individual deductible of $10,600 (family deductible is $21,200). The plan's SBC is available to the public[1]. > no one…

I stand corrected.

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

#196

Post by jjav »

choeger wrote: post #47

Where does all that money go to, though? Is there a rich caste of doctors or pharmaceutical shareholders that don't need to work and live off these dividends? Or is the system so inefficient that most people in it aren't contributing to actual health care?

> Where does all that money go to, though?

Nearly all of it goes to grifters who hang on to the system but don't contribute anything. The obvious ones are all the insurance company employees who don't provide any healthcare, just push paperwork to try to find ways to deny coverage. And all the oberpaid administrators, and of course those multi-million bonuses to all executives involved need to be paid somehow.

If that sounds overly cynical, consider a primary care doctor visit. I get about 15 minutes of the time of a nurse assistant (some searching suggests average wage 50K) and 12 minutes with the doctor (searching suggests average wage of 250K).

So the cost of salaries to the people that actually provided me healthcare that day, is $6 + $24 = $30. Even if we double the salaries of both nurse and doctor, it'd be a $60 visit.

Of course, there's office overhead like rent, utilities, etc.

But I get billed $500 for that visit. SO where is all that money going? Obviously not to the health care professionals.

If we simply removed all the grifters from the system, health care would be quite affordable.

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

#197

Post by nradov »

gilbetron wrote: post #194
nradov wrote: post #190

Earlier quoted context omitted.

Some states require a "Certificate of Need" to open a new hospital so we ought to do away with those to promote competition. But beyond that, which specific regulations are harming competition?

https://www.ftc.gov/news-events/features/certificates-public... Lack of health care records interoperability (locks patients into a system). Much of the well-intended regulation around healthcare ends up getting perverted to prevent competition.

You misunderstand. We only have a degree of interoperability for patient records due to federal regulation. Regulation in that area actually helps competition.

https://www.cms.gov/priorities/burden-reduction/overview/int...

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

#198

Post by jjav »

jdlshore wrote: post #99
frogperson wrote: post #68

Earlier quoted context omitted.

Yep, you and your employer pay $3500/month for the premium. Then you as an individual have a $12k to $15k per year deductible before the insurance even kicks in.

That’s grossly exaggerated. Individual deductibles are limited by law to ~$6500 even on the worst plans. And no one is paying $3500 per month for individual coverage on one of those plans. The actual rates depend on age and zip code, but I’d be very surprised if they’re that high anywhere. To see the actual costs for yourself, go to healthcare.gov. The “bronze” plans are the ones with high deductibles. If you’re youn…

> Individual deductibles are limited by law to ~$6500 even on the worst plans.

Deductibles can be higher, but more importantly it's very important to undertand that "out of pocket maximum" does not mean the same thing to normal people vs the insurance companies.

One would think that a 10K/yr "out of pocket maximum" means in the worst case scenario you may have to pay 10K/yr and then insurance covers the rest. Which wouldn't be that bad.

If that were true the US wouldn't have the epidemic of people going bankrupt over medical costs.

What really happens is you get hit with a 200K bill from a hospital visit and the insurance company decides unilaterally they don't really feel like paying based on some obscure technicality, so then that amount does not count towards your "out of pocket maximum". So now you're on the hook for the 200K, good luck.

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

#199

Post by ckemere »

tirant wrote: post #184
docdeek wrote: post #179

Earlier quoted context omitted.

>> In your case you believe your cost is only 1200€ a year, because your government has not made at all clear to you how much you’re paying from your other taxes into the healthcare system. I absolutely do not believe my healthcare costs only €1200 a year. As I wrote, my top-up insurance costs about €1200 a year, and the healthcare costs more and that is why my taxes are so high.

Ok, then I misinterpreted you. However it’s still unclear how much you’re paying, as the problem with socialized services like healthcare is that you never know exactly how much you’re paying and if you’re overpaying or underpaying as there’s no free competition whatsoever. There are of course also negative second order consequences. In socialized health care systems, where doctors and hospitals are payed the same no…

Hot take - the private doctors tell you they are great but the public doctors can often be spectacular because their motives are not primarily economic.

For example, the absolute best diagnosticians in Houston are at the public hospital primarily serving Medicaid and Harris Health patients. Super evidence based, order tests for differential diagnosis not to make $$. Passionate about what they do. In a unexplained emergency my doctor friends would go there to be diagnosed and then the fancy privates to be treated.

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

#200

Post by beej71 »

ArtemZ wrote: post #147
beej71 wrote: post #137

Earlier quoted context omitted.

We pay more tax for healthcare in the US than virtually anyone else. Last I looked, only Norway had us beat in terms of taxes for healthcare.

Then how our taxes are lower on average than most other developed countries?

Because we pay less tax for other things; for example, making post-secondary education affordable. Our taxpayer-funded system for healthcare-over-65 costs us more than Germany's taxpayer-funded system for healthcare-over-0.
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