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The American Healthcare Conundrum

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331–340 of 690 posts

Re: The American Healthcare Conundrum

#331

Healthcare administrative overhead in the US is pretty huge and has been for a long time. Back in the early 90s I worked on claim processing software and I recall it being discussed as being around a third of healthcare costs. Last year this podcast said that nobody wants to solve this because solving it is going to eliminate (IIRC) hundreds of thousands of jobs. Which is a point to consider. In 2021, the U.S. spent…

Isn't this true across other sectors as well? NYC DOE spends $42,000 per child on education ~half of that is administration costs.

https://apps.schools.nyc/dsbpo/sbag/default.aspx?DDBSSS_INPU...

Re: The American Healthcare Conundrum

#332

Healthcare administrative overhead in the US is pretty huge and has been for a long time. Back in the early 90s I worked on claim processing software and I recall it being discussed as being around a third of healthcare costs. Last year this podcast said that nobody wants to solve this because solving it is going to eliminate (IIRC) hundreds of thousands of jobs. Which is a point to consider. In 2021, the U.S. spent…

>Last year this podcast said that nobody wants to solve this because solving it is going to eliminate (IIRC) hundreds of thousands of jobs. That's the reason why a lot of inefficiencies are kept in countries around the world: it keeps people employed and moves money through the economy. If broken things were suddenly to be made efficient overnight, the government wouldn't be able deal with masses of angry people/vote…

This reminds of a debate in the German parliament 30 years back or so, about the cost for the Eurofighter project (IIRC). Essentially one speaker had argued against the staggering cost, and a second speaker from the government defended the project by saying how many jobs it created. Someone shouted that building a pyramid in honor of Helmut Kohl and it would create a lot of jobs as well, that didn't mean it's a good idea.

Re: The American Healthcare Conundrum

#333

The problem with healthcare is that it can have infinite cost. The question that each society tries to answer is how much are they willing to pay to prolong the life of each individual. There are no right answers unfortunately, as all of them lead to preventable deaths. But some of them at least promote the concept of a caring society.

One example of this calculation is QALYs (Quality Adjusted Life Years) which is used in the UK to determine what drugs are worthwhile: https://www.nice.org.uk/news/articles/changes-to-nice-s-cost...

Re: The American Healthcare Conundrum

#334
post #172

Earlier quoted context omitted.

If the Japanese cashier makes half the amount, but spends only 1/3 on healthcare that still seems to favor Japan

Well sure, then you're kinda cherry picking data that could easily be considered within a margin of error to make a rather unconvincing point

It is not cherry picking to respond to presented data

Re: The American Healthcare Conundrum

#335

Healthcare administrative overhead in the US is pretty huge and has been for a long time. Back in the early 90s I worked on claim processing software and I recall it being discussed as being around a third of healthcare costs. Last year this podcast said that nobody wants to solve this because solving it is going to eliminate (IIRC) hundreds of thousands of jobs. Which is a point to consider. In 2021, the U.S. spent…

>Last year this podcast said that nobody wants to solve this because solving it is going to eliminate (IIRC) hundreds of thousands of jobs. That's the reason why a lot of inefficiencies are kept in countries around the world: it keeps people employed and moves money through the economy. If broken things were suddenly to be made efficient overnight, the government wouldn't be able deal with masses of angry people/vote…

This is a sign of a broken system. It's the old joke about paying someone to smash windows and someone to repair them, how that's great for The GDP.

Re: The American Healthcare Conundrum

#336

Earlier quoted context omitted.

Social reasons it would never work. I hate to mention anything race related online but simple truth is America has complicated history and African Americans are 30% more likely to be obese than White Americans and also earn approximately 60% of income that whites earn. A fat tax, especially one that properly allocated the cost burden to the individual, would erode race relations.

Is that controlled for income / poverty levels?

It doesn't matter as the cited numbers will be cherry picked.

Re: The American Healthcare Conundrum

#337

The problems are so vast it is difficult to even describe to outsiders. For example, if I purchase a particular medication at a local pharmacy, it costs $25. However, my insurer mandates that I purchase it via their Pharmacy Benefit Managers (PBM) Optum, which charges $125. Easy enough right, you price shop? Well then it doesnt count towards your deductible. The whole thing is an elaborate trap to not pay. Sometimes…

Prescriptions are a total racket. A good portion of actual medication literally costs a few dollars at most. Then there’s layer upon layer of bloat and bureaucracy that add no value but drive the cost up 10x or more. It’s totally bonkers.

When these Rx cards and Marc Cuban CostPlus drugs came out where you just pay cash and a fraction of the price I thought there must be some catch or scam here. But turns out no, they’re just cutting out all the middleware bloat and selling you the meds at a defensible markup plus their logistics costs. Love what these guys are doing.

The fact that something like that even exists highlights how corrupt and broken the health insurance companies have become. It’s their job to get better prices at scale and yet somehow they manage to sell at prices far worse that Joe Blogs off the street can get with cash.

In many ways the quality of care in the US is far better than what folks get elsewhere, which in part is probably why there isn’t a total patient rebellion, but the US’s challenges are all rooted in massive administrative overhead. If we got rid of that and had a lean system where healthcare providers can do their job without interference there would be plenty of money to go around for amazing care at lower cost.

Re: The American Healthcare Conundrum

#338

Lots of people are saying nonsense here. The actual reason commercial insurers pay more is that's the only way to can make more profits. Because of Obamacare requiring 80% of the money they collect to be spent, the insurance companies just get to keep 20%. So insurance companies spend more so they can collect higher premiums. That's how they make more money. Several doctor friends have told me this as well.

> Obamacare requiring 80% of the money they collect to be spent,

did they not write unit tests for this when it was proposed to catch obvious subversions like you mentioned.

Re: The American Healthcare Conundrum

#339
post #172

Earlier quoted context omitted.

Well sure, then you're kinda cherry picking data that could easily be considered within a margin of error to make a rather unconvincing point

Whats your point, US healthcare is ridiculously expensive to detriment of all US citizens sans those working for health insurance conglomerates. Any objective data you pick will show this, no need for strawmen.

It’s really good for clinicians and their paychecks, too.

Re: The American Healthcare Conundrum

#340

I see a lot of the comments operating from an empirical framing. This is valid analysis and is good; we should want to understand the waste in the system as it stands. However, that isn't enough. US healthcare is wildly inefficient because the paying customer is different than the serves customer. This has been known for sixty years, since Arrow published his paper (he identified four reasons, three of which are not…

The reason you tell several different people why you are there is because that is important. if a system doesn't they need to start!

people often remember things when asked latter. this gives more opportunity to ask about everything you care about even if you forget the first time.

people sonetimes grab the wrong chart. This helps ensure that they check for things that matter to you and not someone else - your history is on the chart if they are watching you for something weird in you history this is important.

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