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Americans Are Delaying Health Care Until Tax Refunds Arrive

bloomberg.com

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Re: Americans Are Delaying Health Care Until Tax Refunds Arrive

#241

Post by heisenbit »

brudgers wrote: post #135
peteradio wrote: post #109

Earlier quoted context omitted.

I paid 400 dollars to have a doctor tell me to neti pot my nose after having sinus infection for 3 months. Might not be rational but fuck everything about this system. Who is pocketing all this goddamn money?

Through no fault of the author, this comment thread explains the trick. The article talks about US health care access but the discussion quickly goes off into the weeds of the US health insurance market. As soon as we start talking about premiums we adopt business language and metrics and abandon medical language and metrics. All that money is pocketed by businesses run for profit. It's pocketed because it can be. It…

Exactly. German perspective here: I pay for my public health care quite a lot. Probably around $10.000 a year pre-tax which is half coming from my employer and half out of my pocket. My wife is having a private insurance and is paying a little less. That is ok, even if I don't think her option should exist and the overall system is only working due to the gating for the private option. I'm earning above average and am paying for some who earn less. Any public option that covers a large population section needs to include some redistribution aspects. Because health care is too expensive for people on lower incomes.

But it does not need to be as expensive as in the US i.e. twice as expensive as anywhere else and no better outcomes. Insurance companies are not the party that is benefiting the most. They make money and probably more than they should but this does not explain the difference. Most doctors are also not swimming in money. So where does it go?

One is Pharma companies who are then using that money to do marketing. So Pharma Marketing gets a share including doctors taking money from that source (another whole can of worms).

Larger hospital organizations and their management as one of the stronger buyers of services being able to push for high rates and low salaries.

Bill adjusters, debt collectors, partly working in insurance companies (where they contribute to insurance cost) to deal with the chaotic billing, payments and non-payments.

There are many, many who earn a good living who would not be able to get similar jobs in other advanced countries as these jobs simply do not exist. The US system is inefficient but there are powerful incentives for many to keep it going.

It is really important to separate access from payment. Otherwise small wounds will fester until it is too late or really expensive. A good compromise imho. is having some small access fee (in Germany we had a once per quarter 10 Euro fee on top of a 5€ per prescription fee. That was too much for low income and too much paperwork and the former was scrapped) as we know there is a huge difference between demand for free services and services that cost $0.01.

Re: Americans Are Delaying Health Care Until Tax Refunds Arrive

#242

Post by heisenbit »

Blackstone4 wrote: post #231
AnthonyMouse wrote: post #205

Earlier quoted context omitted.

> As soon as we start talking about premiums we adopt business language and metrics and abandon medical language and metrics. To provide healthcare you need doctors, who need money to pay rent and student loans. You need an office to put the doctors in. You need drugs and medical devices, and researchers to come up with them. You need lawyers to keep the doctors from conducting the Tuskegee Experiment. And nurses and…

The US has by far the highest pharma/biotech drug prices in the world. They are effectively paying for global R&D. Other countries use collective bargaining and government regulation to negotiate price. If I'm correct this is illegal in the US. In the UK for instance, we do not have access to the best drugs because they are too expensive. A large part of US insurance expenditure goes to pharma...

They are not paying for R&D but they are paying for drug pushers and doctors bribes. Seriously, the marketing budget exceeds the R&D budget.

Re: Americans Are Delaying Health Care Until Tax Refunds Arrive

#243

Post by [deleted] »

EliRivers wrote: post #106
anbop wrote: post #85

Earlier quoted context omitted.

Why would you expect that a bank teller has their own apartment? Your own apartment isn’t some kind of birthright. I had roommates until I was 27.

We don't expect it. We expect all but the rich to be continually milked and bled more and more, their productivity harvested and their income withered, and with it their lives - healthcare, living quarters, food, family, leisure, whatever can be given up to give the rich more - until it can be reduced no more. That's what we expect; we only aspire to better things.

[deleted]

Re: Americans Are Delaying Health Care Until Tax Refunds Arrive

#244

Post by state_less »

EliRivers wrote: post #106
anbop wrote: post #85

Earlier quoted context omitted.

Why would you expect that a bank teller has their own apartment? Your own apartment isn’t some kind of birthright. I had roommates until I was 27.

We don't expect it. We expect all but the rich to be continually milked and bled more and more, their productivity harvested and their income withered, and with it their lives - healthcare, living quarters, food, family, leisure, whatever can be given up to give the rich more - until it can be reduced no more. That's what we expect; we only aspire to better things.

You’re being downvoted, but you raise an important dynamic. When we bargain down and lower our expectations, who benefits? If we pack ourselves into tighter living quarters and don’t pocket the savings, or pay higher insurance premiums for no more or better care, where do you suppose the benefit goes?

The disadvantaged need to step up their bargaining game. When have you ever heard of a businessperson say, “I can’t ask for this benefit, I haven’t done anything to deserve it?” Their whole ethos is to always ask for more to maximize profits and they’ve been quite successful over the years, clearly.

Imagine if the lower income earners rose up to meet the challenge posed by the profiteers.

Re: Americans Are Delaying Health Care Until Tax Refunds Arrive

#245

Post by AnthonyMouse »

heisenbit wrote: post #242
Blackstone4 wrote: post #231

Earlier quoted context omitted.

The US has by far the highest pharma/biotech drug prices in the world. They are effectively paying for global R&D. Other countries use collective bargaining and government regulation to negotiate price. If I'm correct this is illegal in the US. In the UK for instance, we do not have access to the best drugs because they are too expensive. A large part of US insurance expenditure goes to pharma...

They are not paying for R&D but they are paying for drug pushers and doctors bribes. Seriously, the marketing budget exceeds the R&D budget.

They are paying for R&D and marketing. Even if you subtract out the difference in marketing budgets, the US is still paying for a disproportionate share of the R&D.

Moreover, ban drug marketing if you like, but keep in mind two things. One, the marketing is primarily so "worthwhile" because of the price insensitivity. Patient requests equivalent but better-advertised drug even if it costs $75,000 more dollars, when they're not the one paying. So fix that and the marketing budgets drop along with drug prices. Two, marketing increases the number of "customers" by more than the cost of the marketing (or why do it?), and the extra money is what both encourages and pays for more R&D.

Re: Americans Are Delaying Health Care Until Tax Refunds Arrive

#246

Post by usaar333 »

exabrial wrote: post #187
bryan11 wrote: post #102

As employers switch to High Deductible Health Plans where insurance doesn't kick in until one has spent a deductible of several thousand dollars, many people are delaying health care in general. A doctor's visit that once cost a co-pay of $30 is now frequently a cash price from $130 to $400, plus more for lab work. With higher costs and much of them unknown in advance, many skip getting things checked until it seems…

Actually I find that with my high ductable Health Plan, my visits did not change price. And you failed to mention how you get to save/grow/spend your money tax free. I made 12% on my HSA last great and didn't pay a dime of tax.

A lot of folks are in California on this board which hurts the investment case for HSAs (state taxes investment and contributions). New Jersey similarly doesn't recognize HSAs.

Re: Americans Are Delaying Health Care Until Tax Refunds Arrive

#247

Post by AnthonyMouse »

LifeLiverTransp wrote: post #232
brudgers wrote: post #209

Earlier quoted context omitted.

And yet, here we are talking about business instead of health.

Because its a scam to extract the maximum amount of wealth from people with no real choice options out. And the ilusion, that in this stick-up of scenarios, the individual is to be able to engage in a free-market decision.

If you have some cold symptoms, you can't call around to find a doctor who will diagnose it for a reasonable price, because they won't give you one.

But that's not a stick up, it's a lack of price transparency. So how about we get a price transparency law?

The "stick up" scenario is limited to emergency care, and there is an argument that emergency services should be provided by the city for that reason. But most healthcare is not emergency services, nor would having your city do that require any kind of national policy -- you can go implement that right now.

It's the exact thing that works perfectly at the local level, because the stick up scenario itself is what prevents arbitrage. People in Houston can't vote to cut local emergency services and then go to the emergency room in Boston when they have a heart attack, because it's too far away.

Re: Americans Are Delaying Health Care Until Tax Refunds Arrive

#248

Post by apta »

romski wrote: post #124
apta wrote: post #110

Earlier quoted context omitted.

Practically all owns today are usurious, since interest is involved. If you look at the old testament and the Quran, this was prohibited for a reason, and we see the effects today very clearly.

Why would anyone lend money without interest?

One reason is purely out of goodwill, to help someone out. Another way is to invest your money (which is basically what a lot of people end up doing today), this can be viewed as a form of lending, but with the possibility of making profit. So if someone wants to take a loan to start a business for example, you lend them money to own a portion of it, and hopefully get something in return. Basically what VCs do nowadays.

Re: Americans Are Delaying Health Care Until Tax Refunds Arrive

#249

Post by apta »

Spooky23 wrote: post #155
apta wrote: post #110

Earlier quoted context omitted.

Practically all owns today are usurious, since interest is involved. If you look at the old testament and the Quran, this was prohibited for a reason, and we see the effects today very clearly.

Living in 2019, I’m not referring to the medieval context of the word.

This is a dismissive non-argument. Interest (usury) is a disastrous and parasitic practice that inherently feeds off of the needy. We already see the effects of that today.

Re: Americans Are Delaying Health Care Until Tax Refunds Arrive

#250

Post by colejohnson66 »

ianai wrote: post #194
colejohnson66 wrote: post #127

Earlier quoted context omitted.

Should probably add: why would anyone lend money without interest to someone they don’t know ?

Because there’s a very substantial system of laws and governance enforcing the terms of the loan.

But if there’s no money to be made, why would a business bother?
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