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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#381
post #342
post #330

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And yet it is still vastly more inaccessible and inefficient than other countries where the same holds. There is a lot that could be learned from other countries. So it's good to see that this repo does so.

I notice the repo has no data on supply of doctors per person in different countries. It's well known that the US residency system with its limited slots constrains the supply of doctors who can practice in the US.

There exist similar systems in pretty much any other western nation. The problem is that teaching doctors is expensive and isn't something you can ramp up quickly because you need other doctors to teach the new doctors. The supply of doctors is a problem that is universal to essentially all western nations especially if you move away from metropolitan areas. It's largely due to aging populations and failure to increase spending on medical education over decades. I think the US is actually better off than many other countries, because they pay disproportionately high salaries so get more immigrants.

That said I don't think there's evidence that lack of doctors is what is driving up cost in the US. Just an example, growth in hospital administrators has significantly outpaced medical staff over the last decades, which will directly increase cost.

Re: The American Healthcare Conundrum

#382
post #219
post #190

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What is the profit margin of a health insurance company? Google suggests 2-4%, with United at about 6%. This does not seem that extravagant.

Something around half of UnitedHealth Group (UHN) profits come from other business units that aren't directly related to UnitedHealthcare insurance plans. They have a huge software business under the Optum brand that would be one of the top 20 largest US tech companies if it was broken out separately.

That means the insurer part makes even less profit.

Re: The American Healthcare Conundrum

#383

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...

Where are you getting that from the link that you shared (which is one specific school)? The link you shared shows a figure of $34k and doesn't show a clear breakdown of administrative vs non-administrative costs. The closest I can see in that link is that $13k/$34k is allocated to central services, but most of that cost goes to things like the school buses and the cafeteria and the security guards, which are direct services to students, not administrative overhead. They just are run at the system level, not the individual school level.

Re: The American Healthcare Conundrum

#385

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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.

There are people who have lived in multiple countries, and speaking with them the only place that seems to be comparable (until you factor in private healthcare of course) is Switzerland.

Re: The American Healthcare Conundrum

#386

Earlier quoted context omitted.

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

Ah yes, forgot about that. The regional differences are quite odd. I got my ADHD diagnosis via Right-To-Choose, so it is considered an NHS diagnosis and I get my medication via the NHS (and therefore cheap). But the RTC pathway isn't available in Wales/Scotland/NI. I'd either have to wait years for an NHS diagnosis or go private and then have to pay £££ for my prescriptions privately. The UK system has many problems…

I got my ADHD diagnosis privately (mostly because of the length of the NHS waiting lists, and I'm currently waiting on a NHS RTC provider to transfer my care there) and I pay the trade price plus pharmacy markup (so ~£40/mo) for my medication, for whatever it's worth as comparison.

Definitely not cheap (I would prefer the £9.90 NHS prescription fee) but I get the feeling that it's cheaper than I would pay elsewhere in the world anyway.

Re: The American Healthcare Conundrum

#387

Earlier quoted context omitted.

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

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Re: The American Healthcare Conundrum

#388
post #276

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I really don’t think doctor salaries are the primary difference when they make up less than 10 % of health care costs: > However, new research by Stanford health economist Maria Polyakova and colleagues — using unique data on physician income — shows that physicians’ personal earnings account for only 8.6 percent of national health-care spending https://siepr.stanford.edu/news/just-how-much-do-physicians-...

Doctors are only part of the problem. Nurses and all of the other skilled positions also all suck up huge amounts of money because there are shortages of all of them. It was bad even before COVID, it’s even worse now. There are tons of regulations prohibiting the significant increase in creating new doctors and nurses (and air traffic controllers, but that’s a different but remarkably similar story). Limits on new pr…

Again like doctors, nurse wages aren’t a major factor in the discrepancy between US healthcare costs and elsewhere. They are a factor, in a death by a thousand cuts situation.

In a source posted by another commenter, their wages are accountable for 5% of the difference.

I also don’t think it’s accurate to say regulations are what’s prohibiting an increase in nurses. They don’t have a government imposed mechanism like residency funding that creates a bottleneck like the one in medical training.

We have a nurse shortage because we have an aging population increasing demand, it’s a tough job, and people are leaving the profession.

Re: The American Healthcare Conundrum

#389
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 difference in life expectancy will be influenced by multiple factors and may have more to do with diet and lifestyle than with healthcare

Less than 5% of Japanese are obese (BMI >30) compared with 36% of Americans, additionally 1 in 10 Americans are severely obese (BMI>35) whereas the number in Japan is negligible.

https://theworlddata.com/us-obesity-rate-compared-to-other-c...

Re: The American Healthcare Conundrum

#390
post #224

Earlier quoted context omitted.

Please stop spreading lies and propaganda. China does not have "universal healthcare" in any meaningful sense. They may claim to have it, but it's not something that poor people can actually access for expensive treatments. Patients have to pay out of pocket for most services.

So let’s talk about Canada, Great Britain, every country in the EU…

Is that Canada and Britain that the have an ever persisting complaint that the delays are absurd? Among the specific points that…

With Canada now ending the life of 100k citizens a year making their MAID program now the leading cause of death in the country out ranking cancer and heart disease? How strange that in Canada you can deduct health expenses on your taxes… what a strange thing for a place with free healthcare?

And in Britain you mean the scandal-free and extremely popular NHS? I guess you have a great point there because it’s not their elite would immediately come to the US for care.

The grass is not greener. This is a bad system made worse and worse by heavy handed government “helping”. Healthcare in the US only got worse after ACA.

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