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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#411

Post by baggachipz »

snarf21 wrote: post #404
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…

> I worked in healthcare start-ups for many years

I learned a while back that there are two industries you should never ever touch as a startup:

- Healthcare

- Education

Both systems are so broken (for different reasons) that it's a fool's errand.

Re: The American Healthcare Conundrum

#412

Post by superxpro12 »

Until we eliminate for-profit health insurance companies, i will never be convinced this isn't anything other than a massive scam to over-inflate costs, and inflate insurance margins as much as the people can tolerate.

Im sure big-pharma has an interest in over-medicating too, but that should be solved by transparent pricing.

It still blows my mind i cant window shop hospital procedures.

The opaque-ness of medical billing in the US only further favors the for-profit insurance company margins.

Burn it all down. Single-payer for all. I really have zero sympathy for insurance companies who pride themselves on denying their paying clients life-saving care in favor of shareholder returns. It's such a crazy moral hazard that really highlights a sickness in America.

Re: The American Healthcare Conundrum

#413

Post by hammock »

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…

People are waking up and a lot is happening to counteract some of this.

In the FY26 omnibus bill passed by Congress and signed last month by Trump is the most aggressive federal crackdown on PBMs in history. Starting in 2028 it bans PBMs from taking a percentage cut, which is exactly what incentivized them to drive up the sticker price of your meds. It forces PBMs to pass 100% of the rebates and discounts they negotiate directly to employer health plans, stopping them from pocketing the savings. And PBMs are now mandated to provide detailed semiannual reports exposing their "spread pricing" (charging the plan more than they pay the pharmacy) and their shady practices of steering patients only to pharmacies they own

Also to do what Mark Cuban did but on a national scale, the federal govt launched TrumpRx.gov, a direct-to-consumer federal platform that completely cuts out the PBMs and insurance deductibles you're talking about , allowing people to buy dozens of the most popular meds for an average of 50% off.

Finally one benefit from the threats of tariffs has been that companies like Pfizer caved and signed landmark deals with the US to offer their drugs at “most favored nation” prices to Medicaid and directly to consumers

Re: The American Healthcare Conundrum

#414

Post by crazygringo »

nradov wrote: post #216
crazygringo wrote: post #203

Earlier quoted context omitted.

> health insurers...'re on your team and benefit from lower prices just as much as you do You're missing a very, very, very important piece here. Which is that the lowest price of all is to deny treatment entirely . They are not on your team, they are the opposite team. Their revenue is basically fixed, at the level of your premiums. But the more health care they pay for you to receive, the less profit they make . Th…

No, that's not how it works. Due to the ACA minimum medical loss ratio, most health plans have no direct financial incentive to deny treatment.

They still do, because that's a minimum. If they have to spend 80% of premiums on medical care, then they make a lot more profit by spending just that mandated 80%, as opposed to 85% or 90%. Which they can achieve by denying claims. That's the direct financial incentive.

Re: The American Healthcare Conundrum

#415

Post by ferguess_k »

I don't really think it (late Capitalism) is reversible in anyway. It is better to just let it completes its path, turn a new page and maybe we can start from scratch. A lot of people (you and me) are going to suffer and die. But human nature says that real changes only happen when the old bastion is dead.

Ancient Chinese wisdom: "People praise doctors who delay the progression of incurable diseases but not those who prevent them".

Re: The American Healthcare Conundrum

#416

Post by raw_anon_1111 »

antisthenes wrote: post #204
ipsento606 wrote: post #85

Earlier quoted context omitted.

> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be

> people have forgotten how bad things used to be Not really, because whereas before things were bad for people with pre-existing conditions, now they are really bad for everyone. People are paying exorbitant prices either for insurance, for routine health care stuff, or for both. There was no free lunch, so we traded some health care for the chronically ill, for slightly less healthcare for everyone else. The insura…

When I was looking for healthcare after my employer went tits up right before the ACA went into affect, I couldn’t buy insurance at any price because of a pre-existing condition. Mine you that I have had my ore-existing condition since birth in 1974, had one surgery my entire life - foot surgery in 1996 - and this was 2011 and now I’m 52 and still haven’t had any complications from it and don’t expect to.

I was also a part time fitness instructor, runner and could past any of the standardized fitness assessment standards for someone who was 5 years younger as far as push ups, sit ups, running etc.

I had a contract so I could have easily paid more based on risk.

Before anyone mentions COBRA, that’s only an option if your former group plan still exists and it didn’t when the company went out of business.

Just looking, even now the ACA Silver for my wife and I would be around $800 a month in my state. Even ignoring medical costs have gone up more than inflation, that would have been $550 a month in 2011 if the ACA had been available.

Re: The American Healthcare Conundrum

#417

Post by virgil_disgr4ce »

ferguess_k wrote: post #415

I don't really think it (late Capitalism) is reversible in anyway. It is better to just let it completes its path, turn a new page and maybe we can start from scratch. A lot of people (you and me) are going to suffer and die. But human nature says that real changes only happen when the old bastion is dead. Ancient Chinese wisdom: "People praise doctors who delay the progression of incurable diseases but not those who…

Although I'd be happy to see this insanity die, I don't understand how anyone thinks this is going to "complete its path." Honest question. Can someone describe what that end consists of?

Re: The American Healthcare Conundrum

#418

Post by Taikonerd »

snarf21 wrote: post #404
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…

> 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)

Doesn't this already partly exist? My (US) employer offers an HDHP (high-deductible health plan) that comes with an HSA.

(It's not quite what you described, because you have to use the insurer that the company picked. I think you're describing something more like the Singaporean system with Medisave.)

Re: The American Healthcare Conundrum

#419

Post by avhception »

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…

Yet, living in Germany, the problems I hear about our healthcare system from friends or in the media are an absolute far cry from the insanity that I hear about the US system. Maybe some of it is sensationalism, but I very much doubt that would account for the whole story.

Re: The American Healthcare Conundrum

#420

Post by glitchc »

AngryData wrote: post #290
glitchc wrote: post #259

Earlier quoted context omitted.

Try seeing a doctor in Japan as a foreigner. Just a simple consult costs $300 USD or so, and it goes up from there. It's actually a rather expensive system.

That doesn't seem more expensive to what I generally pay in the US.

Exactly, it's roughly on par. The OP was claiming it was significantly cheaper.
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