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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#401

Post by WarmWash »

unclad5968 wrote: post #249
WarmWash wrote: post #132

Firey take, but health insurers are not the problem they are made out to be. They're on your team and benefit from lower prices just as much as you do. They don't make any money either, don't argue with me, buy their stocks if you are so convinced and see how that goes over. Health care providers carry immense blame. It's full of passionless people in it for the outsized paychecks, who once inside will just seek what…

Having worked in medicine, I agree about providers. People who probably got in it to help people burn out immediately and become like the rest of us looking for the best paycheck with a tolerable workplace. Insurance companies make plenty of money though. Cigna makes $7-8B per year and pays a decent dividend.

They pay a 2% dividend and the stock is up 10% in 5 years.

That's a D tier stock.

Re: The American Healthcare Conundrum

#402

Post by [deleted] »

SV_BubbleTime wrote: post #390
raw_anon_1111 wrote: post #235

Earlier quoted context omitted.

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 healthca…

[deleted]

Re: The American Healthcare Conundrum

#403

Post by [deleted] »

gnz11 wrote: post #392
youknownothing wrote: post #368

Earlier quoted context omitted.

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...

[deleted]

Re: The American Healthcare Conundrum

#404

Post by snarf21 »

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…

I worked in healthcare start-ups for many years and the main problem is mis-aligned incentives.

The #1 thing we need to do is make it illegal for your healthcare to be tied to your employment. We can still have your employer provide a X% or $Y to an HSA account that the employee can buy health coverage wherever they like. (I'm not optimistic that this will ever happen politically)

The issue today is that NOT healing you makes everyone more money, like a LOT more. There is no incentive for anyone to help people get healthy just to have a different insurance company benefit from the decreased claims.

This is also the only way forward to value based care (for primary) where doctors (providers et al) can take on the risk/reward. They get some amount (say $1K ??) per year and they keep it and submit no claims. However, if there costs go above, they eat it loss. Now the doctor and the insurance company (payer) are all incentivized to get and keep people healthy.

Re: The American Healthcare Conundrum

#405

Post by throwaway173738 »

onlyrealcuzzo wrote: post #391
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…

> 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…

Who would you choose not to cover? The sick?

I hate to break it to you but insurance is meant to be a tax on the entire risk pool. What changed after the ACA is we couldn’t kick anyone out of the risk pool for getting sick.

Re: The American Healthcare Conundrum

#406

Post by raw_anon_1111 »

SV_BubbleTime wrote: post #390
raw_anon_1111 wrote: post #235

Earlier quoted context omitted.

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 healthca…

You know that before the ACA, there were lifetime maximums and if you couldn’t get treatment you would probably die?

And all of those people with pre existing conditions didn’t have just “delays” getting healthcare they didn’t get it all.

So sure insurance is great in America for you if as your handle suggests you work in tech in SV.

I don’t have a dog in this fight. I’ve got an exit plan if I have to get insurance before I’m 65 amd may just retire here even after 65

Re: The American Healthcare Conundrum

#407

Post by bigfudge »

steveBK123 wrote: post #369
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…

Middle men in processes add overhead, but on various analyses I've seen.. zeroing all middleman (insurance, PBM, etc) out still leaves us as far more expensive than the rest of the rich world. One thing which is not terribly popular to point out is that at least on procedure pricing - wages are way way higher here. Some of that is that education is far more expensive so then we need to pay very well to pay that down.…

Malpractice insurance is a big part of the higher salaries.

Re: The American Healthcare Conundrum

#408

Post by bigfudge »

joe_mamba wrote: post #356
pif wrote: post #355

Earlier quoted context omitted.

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.

This is unnecessarily confrontational. The real point here is that there better functioning democracies than the US. They have faults, but Scandinavia and much of northern Europe (partially excluding the UK) much better approximates what you call a fairytale than a US perspective might allow you to believe. Trust in and satisfaction with government institutions in Scandinavia and Finland are much, much higher than in the US, and it's largely justified by their competence and delivery of public goods.

Re: The American Healthcare Conundrum

#409

Post by sobjornstad »

hax0ron3 wrote: post #266
paulmist wrote: post #254

Earlier quoted context omitted.

This! I flew from Madrid to SF last year and I can't begin to describe the difference in the quality of food. The scale of agricultural industrialization is terrifying - I wish you luck but I don't think anything short of this becoming a major campaign issue will help you.

I think it is possible that the majority of Americans do not know what they are missing. It is difficult to really understand how much better simple things like fruits, vegetables, and bread can taste without experiencing it. It's like The Matrix, you just have to see it for yourself. Well, taste it for yourself. I find that in America even local farm produce at the "farmer's market" often tastes flat and uninspiring…

Lifelong American Midwesterner and I'm also convinced there's a big difference in the taste of some produce between what you get at a typical American grocery store and a farmer's market or my local natural foods store. I get all my produce there, and people who don't normally shop there often comment on how much better my raw vegetables are when they eat at my house.

Someday I should go buy some produce from each store at peak season and try them side by side.

Re: The American Healthcare Conundrum

#410

Post by raw_anon_1111 »

CGMthrowaway wrote: post #396
tptacek wrote: post #188

Earlier quoted context omitted.

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)

You have the two mixed up. Insurance companies - even for group insurance like through your company where they always had to accept everyone - required you to have “continuing coverage” and not have gaps or you had waiting periods.

The ACA also was written to enforce that through mandates and subsidies - a carrot and stick approach. The moral hazard was caused once there weren’t any mandates because of lawsuits by Republicans and the insurance companies still had to accept everyone.

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