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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#351

Post by pif »

legitster wrote: post #91
graemep wrote: post #60

> The US spends ~$14,570 per person on healthcare. Japan spends ~$5,790 and has the highest life expectancy in the OECD. That gap is roughly $3 trillion per year. The difference in life expectancy will be influenced by multiple factors and may have more to do with diet and lifestyle than with healthcare. Japan also spends less per capita than the UK, France or Germany. The US spends a lot more than any of those so th…

The US also has GDP per capita of $90k and Japan has a GDP per capita of ~ $35k. Put another way, in both countries a hip replacement surgery is almost exactly 1/8 of someone's per capita GDP.

The important question is: which fraction of people can afford it in either country?

Re: The American Healthcare Conundrum

#353

Post by Turskarama »

cmiles8 wrote: post #337
TuringNYC wrote: post #327

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, the…

> 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

How sure of this are we really? Other countries mostly have problems with emergency departments being full, but that's less because those emergency departments are worse and more because in the US people aren't going, they just stay home and hope they don't die.

Re: The American Healthcare Conundrum

#354

Post by speefers »

elgertam wrote: post #329

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 question we ought to ask is how we can buy better health outcomes for people

spend more money. you DO live in the greatest country on the planet, surely if an american citizen cannot raise the funds for healthcare, in what country can you expect to?

Re: The American Healthcare Conundrum

#355

Post by pif »

joe_mamba wrote: post #325
roenxi wrote: post #310

Earlier quoted context omitted.

The sentiment reminds me of the people who believe that having so much prosperity that people feel comfortable not working all year around... represents some terrible threat that must be vigorously resisted for the greater good! Think of what it would do to the poor metrics. Literal overnight change might be too radical (although, frankly, I'd want to see some academic work on the matter because it sounds like it mig…

>not working all year around Keeping people employed through inefficient bullshit jobs is better for the government than paying them to sit at home, since this way you have control over their livelihoods and their votes.

In civilised places, the government is the people. And civilised people know they are the government.

Re: The American Healthcare Conundrum

#356

Post by joe_mamba »

pif wrote: post #355
joe_mamba wrote: post #325

Earlier quoted context omitted.

>not working all year around Keeping people employed through inefficient bullshit jobs is better for the government than paying them to sit at home, since this way you have control over their livelihoods and their votes.

In civilised places, the government is the people. And civilised people know they are the government.

Like which places are those?

This is some idealist fairytale view that people like to believe in but doesn't actually exist.

Re: The American Healthcare Conundrum

#357

Post by arethuza »

alexfoo wrote: post #347
TuringNYC wrote: post #327

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…

This always baffles me. There’s so much rampant profiteering in the US healthcare system it’s unbelievable. Other countries look at it from afar in utter disbelief. I’m glad I had no serious health problems when I lived there 25 years ago (and I had health insurance via my employer). In the UK prescriptions are effectively capped at about USD125 per year: https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-pr..…

In Scotland and, I think, Wales there are no subscription charges at all.

Re: The American Healthcare Conundrum

#358

Post by PaulHoule »

cmiles8 wrote: post #337
TuringNYC wrote: post #327

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, the…

See https://pharmacy.osu.edu/news/prescription-discount-cards-wh...

Re: The American Healthcare Conundrum

#359

Post by alexfoo »

Turskarama wrote: post #353
cmiles8 wrote: post #337

Earlier quoted context omitted.

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, the…

> 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 How sure of this are we really? Other countries mostly have problems with emergency departments being full, but that's less because those emergency departments are worse and more because in the US people aren't going, they just stay home and hope they don't die.

I guess that's because many/most countries don't have the concept of a private emergency department.

It doesn't really matter how much money you have if you have a broken leg as you'll be queuing up with everyone else for the triage and initial treatment.

I have amazing private healthcare coverage in the UK through my employer. I've had certain treatments done in under a week where the NHS waiting lists for the same procedure are measured in years.

But if I have a serious acute illness, or break a bone, my private healthcare can't help other than give me a telephone appointment with a doctor within 10 minutes at which point they'll say "What are you doing calling us? Go to the emergency department now!"

After the initial triage/treatment/stabilisation there may be a different pathway for people with private healthcare, but the doors of the emergency department are the first port of call for pretty much everyone who is in dire need.

(I'm sure for people who are seriously rich there are private arrangements, most people with serious money have doctors/dentists/etc on retainer, but these are the 0.001%)

Re: The American Healthcare Conundrum

#360

Post by mexicocitinluez »

cmiles8 wrote: post #3

Challenge is the whole system is just a mess. Medicare probably lays too little. Commercial insurers have formed a mountain of red tape and bureaucracy and arguably pay too much, although individual bills (EOBs) are rarely logically defensible against any scrutiny. Healthcare providers try and combat all this by literally just making up pricing and trying to negotiate something while also having bloated administrativ…

> Medicare probably lays too little.

What's wild, is that at least in the slice of healthcare I'm in, Medicare is one of our best most reliable payors. In fact, in some cases, our contracts with private insurers have them promise to pay at least 80-85% of what Medicare would reimburse us.

The other benefit with Medicare is that they just give us a lump sum of money and let us do what we want with it as long as we get good outcomes. Which means we don't have to fight for every visit we make to the patient. And they base it off of a public formula that we have access to (unlike with the private insurers).

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