> US pays 7–581x more than peer nations for the same drugs This is what pays for future drug research for the world.
No, it pays for ticket-clipping middle-men and political corruption.
It also does that.
The American Healthcare Conundrum
371–380 of 690 posts
Re: The American Healthcare Conundrum
#372Earlier quoted context omitted.
> 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.
As a person who has lived in Spain, UK, and now California, I can attest to one thing: the quality of care in California (I can't speak for the whole country) is vastly superior to what I received in both Spain and UK. Sate-sponsored universal healthcare is amazing, I love the concept, but it also means that they have to run it like a very stingy HMO. They have a rulebook and they go by it, if your case is even the s…
I think this is mostly a problem with state funded healthcare budgets being cut (relative to population demographics) in these countries. If the UK or Spain spent anywhere even close to what the US spends on healthcare (per capita), I have no doubt that it's healthcare provision would be just as good. In the UK, healthcare provision was notably dramatically better 20-30 years ago under the same system (except for less private finance).
Re: The American Healthcare Conundrum
#373The 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…
> It’s their job to get better prices at scale and yet somehow they manage to sell at prices far worse
Maybe on paper, in reality their job is to return as much profit as possible to shareholders. Convoluted bureaucracy, complicated regulations, layers of useless middlemen… they all help to reduce competition and increase profits. There are industries where the “free” market doesn’t work, partly because “human well-being” is a non-goal for any health insurance company. The entire point of the insurance business model is to avoid paying for it as much as possible
Re: The American Healthcare Conundrum
#374The 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…
Health care is so broken that I think it will unbreak itself. You can eliminate most of the problem by mandating true cost billing by hospitals (get rid of their insurance mandated 500%+ markups to make it look like your insurance does anything at all besides make your care as costly as possible). As you said, it's oftentimes cheaper to buy drugs without insurance. The average person would quickly find out that insur…
You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it, which is when they get old.
If the US had the equivalence of Canadian health insurance, the spending reduction would be so big, that as a working person, your health insurance bill would go to zero, out of pocket costs to zero, and everyone would have health insurance.
Re: The American Healthcare Conundrum
#375"Our high spending is overwhelmingly a product of our high incomes and if other OECD countries had our exceptionally high material standard of living most of them would be spending very similarly, with similar utilization, similar intensity, similar prices, and otherwise not obviously better overall outcomes."
https://randomcriticalanalysis.com/2018/11/19/why-everything...
Re: The American Healthcare Conundrum
#376Is the author GPT-5?
Kinda insane no one else is talking about this.
The entire repo reeks of a "Write an extensive analysis comparing the american and japanese medical care systems" prompt.
Not saying all the findings are invalid, but most of them are just the LLM trying to justify it, like the life expectancy one.
Re: The American Healthcare Conundrum
#377You and I look with dismay at the high prices, but remember that a million hospital administrators are high-fiving themselves. So ideas like "just cut waste" are opposed by a large group with a lot more skin in the game.
Re: The American Healthcare Conundrum
#378Earlier quoted context omitted.
Health care is so broken that I think it will unbreak itself. You can eliminate most of the problem by mandating true cost billing by hospitals (get rid of their insurance mandated 500%+ markups to make it look like your insurance does anything at all besides make your care as costly as possible). As you said, it's oftentimes cheaper to buy drugs without insurance. The average person would quickly find out that insur…
You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it, which is when they get old. If the US had the equivalence of Canadian health insurance, the spending reduction would be so big, that as a working person, your health insurance bill would go to zero, out of pocket costs to zero, and everyone would have health in…
Medicare's admin cost is around 5%, private insurance is around 33% of claim dollars. There are around 27-28% uninsured. The money is already there who pays needs to be moved to the Billionaire and Multimillionaire class to reduce the annual costs for those who work for a living.
Re: The American Healthcare Conundrum
#379Healthcare 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…
> Administrative spending accounts for between 15% and 30% of total medical spending
Healthcare is nearly 20% of GDP (and growing), so administration is 3%-6% of the US economy!
Re: The American Healthcare Conundrum
#380Earlier quoted context omitted.
Health care is so broken that I think it will unbreak itself. You can eliminate most of the problem by mandating true cost billing by hospitals (get rid of their insurance mandated 500%+ markups to make it look like your insurance does anything at all besides make your care as costly as possible). As you said, it's oftentimes cheaper to buy drugs without insurance. The average person would quickly find out that insur…
You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it, which is when they get old. If the US had the equivalence of Canadian health insurance, the spending reduction would be so big, that as a working person, your health insurance bill would go to zero, out of pocket costs to zero, and everyone would have health in…
The United States will never have universal healthcare because a subset of the population would rather pay more for worse health outcomes than participate in a system the provides abortions, HRT, or PreP, or any healthcare at all to Black people.
See, for example, “Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland” by Jonathan Metzl