Employer health plans are getting pricier and skimpier • Hacker News Board

Re: Employer health plans are getting pricier and skimpier

#331

Post by d1zzy » Wed, Sep 25, 2019, 10:31 PM UTC

adamredwoods wrote: post #307

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

There is a WHY (or at least a general why): Obfuscation. - lack of clarity on competitive pricing - obfuscation by adding multiple layers in buying process (broker - insurance - claims adjuster - hospital) - obfuscation through too-many-options syndrome (Obamacare versus Medicare versus state-driven healthcare versus emergency-only healthcare) - lack of clarity when being billed (getting several bills from several di…

The typical insurance company returns are pretty small (~5%) so that alone doesn't seem to explain why prices are so high.

Re: Employer health plans are getting pricier and skimpier

#332

Post by zanny » Wed, Sep 25, 2019, 10:34 PM UTC

geggam wrote: post #195

weeksie wrote: post #165

Earlier quoted context omitted.

Free markets don't work with the information asymmetries involved in healthcare.

Odd how it worked before insurance took over the healthcare system. Care to share what you see would be different ?

50 years of medical innovation leading to the propagation of procedures, medicines, and equipment costing upwards of tens of millions of dollars to procure and maintain.

Nobody is equipped to try to make an informed purchasing decision on if they want the $50k or $100k option to try to save their life while bleeding out of a gurney after getting hit by a car.

Re: Employer health plans are getting pricier and skimpier

#333

Post by ch4s3 » Wed, Sep 25, 2019, 10:34 PM UTC

romwell wrote: post #279

eric_b wrote: post #204

Earlier quoted context omitted.

It amuses me when people think that letting the government run something will make it more efficient. I do not disagree there is tremendous waste in the current system. I strongly believe that expanding the government's role will only make it worse.

If only we had examples where the government running something like healthcare resulted in a better outcome for citizens. Perhaps a country in Europe, as developed as the US is. I mean, a country that we literally border with would be too much to ask for. Perhaps some of us would be less amused by the concept of government-run healthcare. Too bad we don't have the example of literally all of Europe, Australia, and Ca…

To play devil’s advocate, those nations are also good at providing other services that the US provides poorly.

Re: Employer health plans are getting pricier and skimpier

#334

Post by rayiner » Wed, Sep 25, 2019, 10:34 PM UTC

philjohn wrote: post #309

simonsarris wrote: post #295

Earlier quoted context omitted.

But why those nations have lower costs isn't so simple. If you remove all profit and admin overhead from the US system, its still something like $5000/person more expensive than other countries (I think that that was vs Canada). A large component of healthcare cost in the US is simply healthcare use. We are deeply, deeply unhealthy with 75% overweight rates and absurd levels of pre/diabetes, which are the largest com…

In the UK the NHS negotiates prices for drugs. NICE have to approve all drugs and if a drug is too expensive, the manufacturer either has to lower the price so that the benefit outweighs the cost, or they lose a large market. This is why hand waving away "bargaining power" ignores one of the sources of high costs. The other is that our doctors are mostly either employed by the NHS, or employed by a private provider w…

The difference in drug spending between countries amounts to a small fraction of overall healthcare spending. $1200 a year in the US versus $900 in Switzerland or $800 in Germany, Canada, and Japan.

Re: Employer health plans are getting pricier and skimpier

#335

Post by fzeroracer » Wed, Sep 25, 2019, 10:36 PM UTC

eric_b wrote: post #248

mullen wrote: post #218

Earlier quoted context omitted.

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will oc…

Sure, the government can say they'll only pay half as much as they do now, so providers will only provide half the care. Have you ever actually done any government procurement? Saying the government can just wave a magic wand and lower prices because "they said so" will only hurt the quality of care patients receive in the US.

The 'quality of care' you receive in the US is entirely dependent on your wealth and it's only the upper class that actually benefit from it.

You know what quality care I got as a poor person? Nothing, because my family couldn't afford it. I was given the privilege of going through highschool and college with teeth quite literally broken down to the gumlines and abscessed because it was either that or not being able to have a future.

I'm tired of hearing nonsense about quality of care because for a lot of people the quality is set to null.

Re: Employer health plans are getting pricier and skimpier

#336

Post by zanny » Wed, Sep 25, 2019, 10:38 PM UTC

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

> One thing that will not make healthcare less expensive is "Medicare For All".

A large part of what makes American per-capita healthcare costs so outrageous is how much is treatment rather than prevention. Because going to a doctor is so expensive people just don't go, and then mundane problems that could have been fixed with at worst a routine surgery end up in an emergency room on life support expending a hundred thousand dollars of resources a day to correct.

Thats in addition to substantive productivity losses incurred by people being sick all the time without the financial resources to actually fix their ailments.

Even when you have health insurance the absurd deductibles mean you can't see a doctor anyway without being out the equivalent of half the months food or your entire utility bill.

It is absolutely imperative that any nations people have affordable access to medical professionals before they are suffering ill from all the things they noticed were off but didn't want to become indebted over.

Re: Employer health plans are getting pricier and skimpier

#337

Post by dmitrygr » Wed, Sep 25, 2019, 10:39 PM UTC

jandrese wrote: post #294

GreenJelloShot wrote: post #286

Earlier quoted context omitted.

Really? So there are zero people from other industrial nations that come into the US for health care?

Zero people from other nations come to the US to save money on health care. The ones that do come are looking for specialists for some exotic condition, not because they love the level of care or the price tags.

And do you think those specialists would exist here if we had medicare for all? no, evidence: all those other countries that have that and no such specialists.

Re: Employer health plans are getting pricier and skimpier

#338

Post by ytNumbers » Wed, Sep 25, 2019, 10:41 PM UTC

romwell wrote: post #279

eric_b wrote: post #204

Earlier quoted context omitted.

It amuses me when people think that letting the government run something will make it more efficient. I do not disagree there is tremendous waste in the current system. I strongly believe that expanding the government's role will only make it worse.

If only we had examples where the government running something like healthcare resulted in a better outcome for citizens. Perhaps a country in Europe, as developed as the US is. I mean, a country that we literally border with would be too much to ask for. Perhaps some of us would be less amused by the concept of government-run healthcare. Too bad we don't have the example of literally all of Europe, Australia, and Ca…

In my opinion, the best yardstick for a health care system is how long you have to wait to be treated for cancer. By that yardstick, countries like Canada and England stack up quite poorly when compared to the USA. Canadians don't come to the US to save money on health care. They come to the US because they have an expensive potentially fatal medical condition, and they might not survive a six month waiting period for treatment.

Re: Employer health plans are getting pricier and skimpier

#339

Post by forrestthewoods » Wed, Sep 25, 2019, 10:47 PM UTC

mullen wrote: post #218

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will oc…

There are 60 million people on Medicare. If you can’t negotiate with twice the population of Canada I don’t think the problem is not enough beneficiaries.

Re: Employer health plans are getting pricier and skimpier

#340

Post by d1zzy » Wed, Sep 25, 2019, 10:49 PM UTC

I would love if everyone that seems to be in support of a single player system would make a mental note right now that they were in support of it, and then years later after the US moves to such a system (seems pretty likely?) they review how much it helped.

I grew up in a single payer system and I'm theoretically in support of it for the many reasons people already listed in the comments (larger negotiation position, spreading the risk to more people, because it's humane, because it removes an incentive to stay in the wrong job, etc). But while I agree with those arguments I also have a strong conviction that if such a system were to be adopted in the US, it will NOT result in better care and more efficient and overall reduce the costs in the system. Not without many other changes in other laws and even cultural changes. Just because something works in Germany for example it doesn't mean it will work in the US, there are different demographics, different mentality, different service expectations, different tax system and a largely different legal and law system. Not to mention we were just discussing a few days back about the increasing national debt and this needs to be done without increasing the deficit.