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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#391

Post by onlyrealcuzzo »

mekdoonggi wrote: post #374
onlyrealcuzzo wrote: post #366

Earlier 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…

> 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.

I strongly think that covering everyone in the existing system is not the best way to go.

The existing system is designed to cost as much as possible, and we have way too much demand for treatment (as is) and not enough supply. ER wait-times aren't 2-4 hours just because.

First, that needs to break.

Then, you can cover everyone.

We simply do not have enough doctors for how many old and unhealthy people we have. We should be thinking about how to keep people from going to the hospital that don't really need to be there. Do you really need to go to the ER because you stubbed your toe? If you didn't have insurance, you'd go to a low-cost clinic and get the same treatment for 1/10th the price.

We are slowly getting there already. Low cost clinics weren't widely available, but they are becoming more and more available as the cost of health care even WITH insurance is too high for most people.

The infrastructure for the bottom ~50% of people needs to exist to break free from a system that is not designed for them BEFORE they can move off it.

It's almost there.

Since One Medical became widely available, I basically have not gone to the hospital in 5+ years. Before, you kind of needed to go even for routine things (or at least I didn't know of a viable alternative). More and more places like this are springing up all over the US.

Re: The American Healthcare Conundrum

#392

Post by gnz11 »

youknownothing wrote: post #368
Turskarama wrote: post #353

Earlier 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'm sure there is a lot of nuance but long term healthcare outcomes are generally lower in the US compared to other countries. https://www.healthsystemtracker.org/chart-collection/quality...

Re: The American Healthcare Conundrum

#393

Post by 46493168 »

some_random wrote: post #387
46493168 wrote: post #380

Earlier quoted context omitted.

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

[flagged]

What does this comment mean?

Re: The American Healthcare Conundrum

#394

Post by rayiner »

autoexec wrote: post #176
rayiner wrote: post #41

Earlier quoted context omitted.

Trying to understand why healthcare in the U.S. is so expensive is like trying to understand why building subway in New York is so expensive: https://www.nytimes.com/2017/12/28/nyregion/new-york-subway-... . The issues lend themselves to facile explanations ("insurance companies are greedy," "NYC's government is wasteful") but those are driven by ideology not analysis.

What we can say for certain is that heath insurance companies in the US stuff their pockets with tens of billions in profits each year and that Americans are paying far more while getting less for their money than other developed nations. I don't think those two things are unrelated.

U.S. healthcare spending is over $5 trillion a year. That’s $5,000 billion. So the “tens of billions in profits” you’re pointing to accounts for very little of what people spend on healthcare.

That’s what I mean when I refer to facile ideological reactions. For many people, “profits” are the problem, and they don’t care that health insurers on average are less profitable than Subway franchises. It’s just the mirror image of people who say the New York MTA is a disaster because the government is running it, and don’t care that governments in other countries manage to run cost-efficient train systems.

Re: The American Healthcare Conundrum

#395

Post by projektfu »

mlrtime wrote: post #331
linsomniac wrote: post #244

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...

I didn't see those figures in your link. It looks like $34,000 is the per capita funding of that school, and it wasn't really broken down into administrative or not.

Re: The American Healthcare Conundrum

#396

Post by CGMthrowaway »

tptacek wrote: post #188
CGMthrowaway wrote: post #106

Earlier quoted context omitted.

We traded the cruelty of Exclusion for the cruelty of Extraction.

What does that mean?

Before ACA, insurance had a more traditional "insurancey" role by excluding pre-existing conditions (aka managing moral hazard) in order to make money via premiums. In the "guaranteed issue" world post-ACA, insurance companies have pivoted instead to extracting as much money as they can from an increasingly vertically integrated ecosystem (PBMs etc)

Re: The American Healthcare Conundrum

#397

Post by mekdoonggi »

46493168 wrote: post #393
some_random wrote: post #387

Earlier quoted context omitted.

[flagged]

What does this comment mean?

I think that some_random is saying sarcastically, "46493168, keep doing libel on people of white blood by stating that they vote against health insurance reform because they are racist, and maybe it will solve the problem."

Re: The American Healthcare Conundrum

#398

Post by onlyrealcuzzo »

Projectiboga wrote: post #378
mekdoonggi wrote: post #374

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…

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.

> private insurance is around 33% of claim dollars.

The Medical Loss Ratio (MLR) requirement established by the Affordable Care Act (ACA) is 20%.

Typically it's closer to 15%.

As these are private companies, some percentage of that is obviously profit.

It doesn't cost that much more to run private insurance than Medicare.

The problem is the incentive of insurance to drive up cost to get a larger fixed cut, and the lack of a public option (which would require private insurance to actually be worth it).

Re: The American Healthcare Conundrum

#399

Post by WarmWash »

hermanzegerman wrote: post #277
WarmWash wrote: post #147

Earlier quoted context omitted.

Exactly, ask anyone in a job for the money how their week was. Not saying nursing is stress free, or every nurse is bad, but like tech companies in 2021, it's full of directionless people who pushed through the cert program to get paid $50/hr with $100/hr weekend shifts and be disgruntled with you that you are making them do work.

What an arrogant comment. Nursing is one of the most physically and mentally demanding jobs I know of, at least in Germany. And I bet 80% of the Techbros here wouldn't last a month in it, given how many lost their minds over a simple RTO-Mandate. Maybe watch the movie "Late Shift" to get an idea of how a Workday is https://m.youtube.com/watch?v=C7o-omvW_DI I doubt that "directionless" people would put up with those w…

Perhaps unlike Germany, in the US, people in those positions will not be able to come close to earning what they earn if they leave. Probably only half at best. A medical cert doesn't translate to much else besides the cert.

So like you mentioned, it's very difficult and grueling work, and people (in the US at least) get trapped because of the money. Passionless souls doing something they hate because they'll lose their upscale home and Mercedes if they quit.

Re: The American Healthcare Conundrum

#400

Post by throwaway173738 »

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…

Oh you must have United Healthcare. Yeah they do this with IVF drugs too, and I’m sure with chemotherapy drugs. Plus it all has to be shipped so if you’re mid-cycle and the doctor orders a different medication you either waste the benefits or pay out of pocket. And they structure all their pricing so the fertility benefit covers a cycle but the medications aren’t fully covered so you pay out of pocket in medication that’s 3-4x as expensive as the cash price would be at a pharmacy like Alto.
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