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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

#211

Post by djdjdjdjdj »

nradov wrote: post #107
chiefalchemist wrote: post #12

Earlier quoted context omitted.

Demand is also "artificially" driven up by the American diet and lifestyle. If the preventables (e.g., Type 2 Diabetes) were prevented, otherwise mitigated (less sugar!) then the resources / system could focus on real disease. The issue with the USA is it wants its cake, it wants to eat it, and expects to pay less for consistently making unhealthy choices.

Sure but most other countries are on track to have the same diet and lifestyle health problems as the USA. They're running a few years behind us but they'll catch up eventually.

Germany doesn't.

I can think of plenty other European countries.

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

#212

Post by ju-st »

ixacto wrote: post #179
ju-st wrote: post #154

Earlier quoted context omitted.

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 $30…

Half of it is paid by my employer. There are no deductibles (generally) and no surprise bills here but the health insurance is useless for e.g. the dentist, the insurance only pays for the minimum (the joke is they only pay for the removal of teeth and a blender).

But for the sake of comparison I don't have the impression that US health care costs are much worse than in Germany. Certainly not to the extent the internet wants to make one believe.

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

#213

Post by nradov »

djdjdjdjdj wrote: post #211
nradov wrote: post #107

Earlier quoted context omitted.

Sure but most other countries are on track to have the same diet and lifestyle health problems as the USA. They're running a few years behind us but they'll catch up eventually.

Germany doesn't. I can think of plenty other European countries.

Germany has a high rate of obesity just like most comparable countries.

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

#214

Post by andrewlgood »

noahtallen wrote: post #205
andrewlgood wrote: post #175

Earlier quoted context omitted.

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

That’s interesting, because your latter example is pretty excellent. USPS can deliver to anyone in the country (unlike the private companies) and I’d say it’s pretty streamlined. The IRS is definitely in a bad position, but there are two problems: firstly, they’re only enforcing the tax code written by Congress. They can’t just streamline the tax code. Secondly, there are private companies lobbying to prevent the IRS…

We clearly differ on the USPS. FedEx, UPS, DHL, etc clearly provide superior service for overnight and courier service. Rural service could be solved - it simply has a cost. To your point, "as a country we've decided that it's in everyone's best interest to be able to go get mail." We have also decided to subsidize the cost of the service with metropolitan customers subsidizing the rural (similar to phone service). If the US used taxes to pay a FedEx, there would be better quality service at a lower cost.

Having the government provide the service introduces politics to the operation of running a business. Where should post offices be located, how often should mail be delivered, what products should we offer, should prices vary according to cost to delivery, etc. These issues make the USPS what it is today - a bureaucratic behemoth that is still delivering Christmas cards from 2020.

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

#215

Post by andrewlgood »

DonnyV wrote: post #101
andrewlgood wrote: post #91

Earlier quoted context omitted.

Free goods have infinite demand. Medicare for All will simply degrade outcomes a lower common denominator. Interestingly, will the government allow private medical practices to exist in a Medicare for All regime? If so, it seems we would simply end up where we are now.

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

The introduction of high-deductible health care plans has accelerated consumerism (shopping for best deal) in health care delivery driving down costs.

Deloitte study: https://www2.deloitte.com/content/dam/Deloitte/tr/Documents/...

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

#216

Post by username90 »

throwawayboise wrote: post #111
DonnyV wrote: post #97

Earlier quoted context omitted.

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.

If they are the only payer, they control the prices. And when prices are controlled, shortages are the result.

Doesn't hold water, USA actually has less doctors per capita than most of the developed world.

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

#217

Post by 908B64B197 »

tryptophan wrote: post #112
heymijo wrote: post #69

Earlier quoted context omitted.

I just realized Physician Assistants (PAs) and Nurse Practitioners (NPs) have been forgotten in this equation. 126,000 practicing PAs [0] 325,000 licensed NPs [1] 985,000 practicing physicians (MDs and DOs) [2] I know that nurse practitioners are not under the same artificial residency constraints of MDs/DOs. I'm not sure about physician assistants. For someone not in the U.S., NPs and PAs often do the same role as g…

PA/NA education is a complete joke compared to what your average MD gets. They are not qualified to practice as general doctors at all. However, they are really cheap, which is why corporations are pushing them so hard. Substandard care in the name of profits.

> They are not qualified to practice as general doctors at all.

The way we train MDs is... highly counter-productive to say the least. First a completely unrelated undergrad, which really adds no value (hint: Foreign doctors can do a fellowship and get licensed to practice in the US without having an unrelated undergrad degree pre med-school). Then med school, which is completely detached from any clinical experience. Then residency, where practical knowledge is theoretically built but in practice is more of a legally sanctioned hazing (patient outcome doesn't really matter, what matters the most is impressing whoever is slightly higher on the pecking order in order to get the spot you want).

Multiple years of zero sum games and competition against your peers. Then, once you get your license, you are supposed to make a complete 180 and start becoming a team player.

To be completely honest, if you add up the useful time spent in school, an MD is just about on the same footing as a PA/NA.

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

#218

Post by smnrchrds »

ju-st wrote: post #212
ixacto wrote: post #179

Earlier quoted context omitted.

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 $30…

Half of it is paid by my employer. There are no deductibles (generally) and no surprise bills here but the health insurance is useless for e.g. the dentist, the insurance only pays for the minimum (the joke is they only pay for the removal of teeth and a blender). But for the sake of comparison I don't have the impression that US health care costs are much worse than in Germany. Certainly not to the extent the intern…

US spends twice as much as Germany per capita on health.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

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

#219

Post by trentnix »

noahtallen wrote: post #205
andrewlgood wrote: post #175

Earlier quoted context omitted.

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

That’s interesting, because your latter example is pretty excellent. USPS can deliver to anyone in the country (unlike the private companies) and I’d say it’s pretty streamlined. The IRS is definitely in a bad position, but there are two problems: firstly, they’re only enforcing the tax code written by Congress. They can’t just streamline the tax code. Secondly, there are private companies lobbying to prevent the IRS…

Of course the problems are solvable if you have desirable incentives. But as Pournelles Iron Law of Bureaucracy points out that the incentives to solve the problem are ALWAYS eventually replaced to preserve and grow the bureaucracy. And that’s why a universal, government solution is doomed to fail.

Funny you mention bad rural Internet considering that’s a problem technology and competition is about to solve.

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

#220

Post by biaachmonkie »

andrewlgood wrote: post #176
sebmellen wrote: post #174

Earlier quoted context omitted.

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.

This isn't a free sandwich promotion that ends with irrational people waiting hours in line! People are not going to go hangout in doctors offices, hospitals, clinics, etc... for fun. Most people that have good insurance, like myself, almost never go to the doctor because it's a pain, not because of a co-pay.

And if by some chance there is a big increase the use of medical care / services ... maybe that's a good thing, that people are going and finding issues before they become severe life threatening issues and everyone saves more overall in the long run. And they have better quality of life and less suffering from going untreated... Did you consider that?

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