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Health insurers just published close to a trillion hospital prices

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Re: Health insurers just published close to a trillion hospital prices

#231

Post by refurb »

anonymouse008 wrote: post #121
duffpkg wrote: post #89

Earlier quoted context omitted.

Healthcare is such a base layer of the economy, I find comparisons to be extraordinaly difficult between countries. On the most basic level our pathway to becoming a healthcare provider of all sorts is dramatically more expensive and limited than other countries, what healthcare providers are paid is dramatically more than other countries, we invest many times per capita what other countries put into basic medical re…

> Healthcare is such a base layer of the economy Academically this sounds enlightening, but it only takes one cursory walk around a supermarket in the US to see this is unequivocally false. Healthcare is an externality, not a base of anything. From the average customer to the product in the aisle to the marketing - everything is 100% not a direct cost benefit function in terms of healthcare.

After you criticized the comment as only “sounding enlightening” I was eager to hear your thoughts.

Unfortunately I think your comment is even less enlightening.

I mean, not all healthcare problems are caused by lifestyle. So clearly healthcare is a base layer - there is no situation where it wouldn’t exist.

Re: Health insurers just published close to a trillion hospital prices

#232

Post by pc86 »

kolbe wrote: post #205
linkdink wrote: post #77

Earlier quoted context omitted.

In your opinion, what would be the lowest hanging fruit that could be changed to have the largest positive impact?

I've been told credential easing is by far the easiest one to implement. Doctors often do 2-6 years of excess schooling residencies learning areas of medicine that will never be relevant to them. That's 10-20% more time working for existing doctors, and who knows how many more people would enter the profession. Nurses could be empowered to make doctor lite decisions very easily.

> Doctors often do 2-6 years of excess schooling residencies learning areas of medicine that will never be relevant to them.

Where in the world did you hear this? Don't trust anything else that person told you.

Aside from some low-income clinic hours for certain specialties (which is objectively a societal good, not to mention typically specific to a given specialty, e.g. OBs have an OB clinic not primary care) no doctor is spending 6 years of "excess schooling residencies" learning anything.

Med school is 2 years of classes then 2 years of rotations where the students - who aren't yet doctors - do 4-12 weeks of rotations through various core and elective specialties. After they graduate they're now doctors but have 3-6 years of specialty-based residency training where for 80-100 hours a week, 50+ weeks a year, they do nothing but their specialty. ACGME limits weekly hours to 80 (I think over a 2-3 week average), but 90% of the doctors I know said they regularly broke that and just didn't log the extra time.

Especially in surgical residencies, all you're doing is your specialty-specific stuff during that period of those.

Re: Health insurers just published close to a trillion hospital prices

#233

Post by anonu »

e_i_pi_2 wrote: post #71
duffpkg wrote: post #70

I'm author of Hacking Healthcare for O'Reilly, 20 year health system executive, blah, blah. It's very easy for people to forget the scale of the US "health system", we are talking 1/5, maybe more, of the entire US economy. If US healthcare spending were a country, it would have the third largest GDP in the world. Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes that…

Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? Or is there some other reason healthcare "just costs more" here? Also wondering what you think a solution is - single-payer for better and simpler price negotiations, or some other approach? My main concern is if we're spending 20% of GDP on something…

There's many things wrong with US healthcare. But somehow the USA comes up with the the first vaccines for the coronavirus and if you want any sort of complex procedure you travel to the US to get it.

So maybe thats where the extra cost goes? To drive research, and support the infrastructure that creates good to better health outcomes on average vs the rest of the world.

Saying something is a failure just because it costs so much is only looking at one side of the coin.

Re: Health insurers just published close to a trillion hospital prices

#234

Post by refurb »

nradov wrote: post #203
kev33 wrote: post #169

Earlier quoted context omitted.

Quoted post unavailable.

About 90% of Americans have medical insurance. Coverage caps were eliminated years ago, and the out-of-pocket maximum is low enough that the medical expenses from a single incident are unlikely to drive middle class people to bankruptcy. Where bankruptcy becomes an issue is when a medical condition leaves someone unable to work for months. With no income they can burn through savings and credit quickly. Then when the…

Interestingly this is a problem in Canada as well. Medical costs aren’t - there is no out of pocket at all.

But a medical condition that means you can’t work is the #1 cause of medical bankruptcy in Canada.

Re: Health insurers just published close to a trillion hospital prices

#235

Post by bottlepalm »

jcadam wrote: post #192
bottlepalm wrote: post #102

This is the real solution to healthcare costs and quality. Instead of the government handing hospitals a blank check for low quality services in a single payer scenario, we allow price transparency, competition and the free market to drive down costs and increase quality. Hate him if you want, but this was a huge accomplishment by Trump that has just started to take effect. If you think the government can bring down…

You had to know you'd be downvoted mercilessly for that, comrade.

I'm hovering at zero lol, a lot of my comments are a war between up and down voters. I wish I could see total votes.

Re: Health insurers just published close to a trillion hospital prices

#236

Post by groby_b »

dominotw wrote: post #211
groby_b wrote: post #188

Earlier quoted context omitted.

That is not at all what your link says. "90% of the nation's $4.1 trillion in annual health care expenditures go to people with chronic and mental health conditions" Obesity is $173 billion, diabetes $327 billion. We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous. Diabetes cost is roughly the same percentage of total expenditure as it is in other industrialized nati…

see: page 20 https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221... > We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous. How so? Only recommendation for all these chronic conditions is 'diet and exercise' is it not ? Obesity isn't the only one. I am not obese , not even close, but I have hyperlipidemia. I am managing it with 'diet and exercise' after initia…

No, "diet and exercise" is not the only recommendation. I don't even know what point you're trying to make there - if that were the only recommendation, health care costs would be fairly low.

And it's not just mental health issues (~25% of all chronic health issues), it's also respiratory issues (~10%).

Then add to that the fact that many metabolic diseases have long lists of causes that amount to "not really sure". Atherosclerosis? Can be caused by physical activity. Hypertension? Being older than 65 is a cause.

What the Rand paper does say is "90% of all health care cost is incurred by people with at least one chronic condition". Not metabolic diseases. What it also doesn't say is that the entire 90% are attributable to chronic diseases. (It's sort of akin to claiming that 10% of all healthcare costs are incurred by people named John, Robert, or James. True, but certainly not causal)

Again, I'm not saying that chronic diseases aren't contributing a huge cost burden. I am saying that they're far from the only cause of the cost burden, and that blaming it on metabolic diseases is highly misleading even if you just focus on chronic diseases.

Re: Health insurers just published close to a trillion hospital prices

#237

Post by refurb »

Barrin92 wrote: post #129
mikem170 wrote: post #90

Earlier quoted context omitted.

Across the board price controls seem to be a common to the various European health care systems. It is my understanding that upper limits are set for the cost of medicine. There is quite a bit of variety across Europe - U.K. is 100% government run, France is a public/private mix, Germany is similar to Obamacare in some ways, others are single payer, apparently some are private, also. But I've read that they all have…

beyond Europe as well. Singapore which has exceptionally low healthcare spending (5.9% of GDP) heavily controls prices and purchases down to individual equipment in hospitals.

Singapore does not control prices (though it’s moving in that direction), it’s public hospitals are privately run, and it has a system of “forced savings” to make sure patients have enough money to cover out of pocket costs and buy health insurance. It’s ethos is “the patient has to pay something out of pocket, even if it’s just $2”. It’s also more than happy to tell poor patients “if you don’t have enough money, there is nothing we can do”.

It is more similar to the US system than a system like the UK or Canada.

Re: Health insurers just published close to a trillion hospital prices

#238

Post by aquaticsunset »

dominotw wrote: post #211
groby_b wrote: post #188

Earlier quoted context omitted.

That is not at all what your link says. "90% of the nation's $4.1 trillion in annual health care expenditures go to people with chronic and mental health conditions" Obesity is $173 billion, diabetes $327 billion. We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous. Diabetes cost is roughly the same percentage of total expenditure as it is in other industrialized nati…

see: page 20 https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221... > We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous. How so? Only recommendation for all these chronic conditions is 'diet and exercise' is it not ? Obesity isn't the only one. I am not obese , not even close, but I have hyperlipidemia. I am managing it with 'diet and exercise' after initia…

Thank you for bringing this up. The medical community's intense obsession with people's size and shape over their health causes a lot of misleading conclusions and misguided efforts.

If you walk into the doctor's office underweight and concerned about an issue you're having, the doctor doesn't put you on a strict fettuccine Alfredo and hamburger diet before treating you.

If you're overweight and concerned about an issue, you're far more likely to be told to lose weight and ignored.

Re: Health insurers just published close to a trillion hospital prices

#239

Post by refurb »

dj_gitmo wrote: post #60
sl-dolt wrote: post #32

I'm the author. A question I have is: how did so many prices ever get negotiated in the first place? What kind of systems are in place to do this kind of micro-negotiation?

The US healthcare system is wildly complicated and inefficient because it is a double-bureaucracy; pubic and private. The government bureaucracy makes a bunch of rules and also provide healthcare through Medicare/Medicaid. The private bureaucracy compete with each other, and hospitals, and pharma companies, ect. Many of the private health providers are for-profit and lobby against rule changes that would reduce compl…

Canada is the only country I know of that has only one system - public.

So your claim of public + private being the issue makes no sense when almost every country has that.

Re: Health insurers just published close to a trillion hospital prices

#240

Post by dekhn »

drak0n1c wrote: post #78
mskar wrote: post #43

I work in data at https://www.carrumhealth.com/ , and I've been parsing this data for weeks. The transparency prices allow us to meaningfully negotiate with providers, and make tangible, incremental progress toward cheaper health care. Providers and existing insurance carriers leverage information asymmetry to control the market otherwise. For context, we bundle the 100's of itemized costs into a single, static bill…

Sounds like an application for ML, to determine which codes frequently coincide per-patient at each provider and then assign those groupings to cross-provider "Treatment XYZ" buckets to enable apples-to-apples comparisons.

Applying ML to health care is a guaranteed path to wealth, and later, insanity.
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