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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#431

Post by 9x39 »

avhception wrote: post #419
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…

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.

What's usually missing from anecdotes is class cohorts - so, US working class with Medicaid or a crappy marketplace plan vs working professional with an amazing plan vs retiree with Medicare vs...

Nothing's perfect, but the plan differences seem stark. For example, my wife had a crappy marketplace plan and I had a plan through my employer. For her, an MRI was denied, denied, then finally approved with many calls. For me, it was approved immediately. For her, pre-auth to a specialist was denied until her doctor went and tried a different referral strategy. For me...well, I haven't been denied yet. It goes on - same city, same hospital, some of the same referrals, etc.

I've come to think the price discrimination really does mean we have class-based care which seems to allow for the sensationalism. Combine a dire scenario with a working or indigent class American, and they don't have to exaggerate much at all.

Re: The American Healthcare Conundrum

#432

Post by conductr »

mexicocitinluez wrote: post #362
conductr wrote: post #179

Earlier quoted context omitted.

Medicaid is usually a big loss for hospitals. It’s just a cost of doing business and another reason why someone else has to pay more. It’s completely a subsidy essentially. This is why certain areas only have a county hospital, it’s likely the same area that is a food desert and has no retail banks, the simple truth is too high of a Medicaid mix will quickly sink a for profit hospital. Medicare is as I described. Eve…

> Executives like to lament the lose money on Medicare but I never really saw it that way. We're in the totally opposite boat. We actually prefer Medicare patients vs private insurance not only because of the reimbursement, but the way in which they reimburse us (one lump sum vs visit-by-visit auth that requires manpower to manage). Some of the requirements can be onerous, but on the whole, they're easier to plan for…

You’re not a hospital then. I see this with some specialties or types of providers. I’ve also seen it do complete 180. As in, Medicare is high reimbursement for a decade or two allowing a specialty to proliferate, then one day they rug pull the rates and the specialty is scrambling because they’ve not been running managed care part of their practice (the part that negotiates with commercial plans). It’s a huge headache all around and I do agree Medicare is easy once established.

Re: The American Healthcare Conundrum

#433

Post by conductr »

mexicocitinluez wrote: post #361
kstrauser wrote: post #167

Earlier quoted context omitted.

Sure you’re not thinking of Medicaid? Medicare was generally pretty good for reimbursement. When my wife treated Medicaid patients, she often lost money on the cost of the supplies used to treat them, let alone rent and paying the staff etc etc. Most doctors who see Medicaid patients do it as basically pro bono. Some figured out how to game the system with economies of scale but it’s nearly impossible do do and maint…

> But Medi care was right with the commercial insurers on reimbursement. As I said in another comment, I'm with a provider and Medicare is easily one of our best payors. We actually have contracts with private insurers that say they have to reimburse us at least 80-85% of what Medicare would. They also give us the money up front, with a public formula that we can count on vs. a hidden formula that requires us to go b…

Contracts are negotiations

Re: The American Healthcare Conundrum

#434

Post by rickydroll »

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…

Breaking the existing system will be extremely difficult. I have decade-long relationships with all of my doctors. The thought of a health plan that forces me to change all my doctor relationships is anger-provoking and exhausting. New doctors don't know me, they don't know my history, and haven't seen the medical shit show you've been through and why your treatment is the way it is. Then they think they can change your treatment to something that has already failed because "I didn't give it a long enough trial" or "That's a rare side effect," it won't happen to you.

I highly recommend you read the book "We've Got You Covered." It's an economist's view of health systems and how we can rearrange government spending to provide coverage for everybody and prevent medical bankruptcies.

One Medical looks interesting, but I wonder how they keep the price that low. Is it subsidized? Are they putting constraints on physicians and what they can do in the same way BetterHelp messes with the therapists? Are they servicing only the young and healthy?

Their senior care plans tell an interesting story. They only work with Medicare Advantage plans, specifically those known for up-coding, excessive pre-authorization requirements, and high rates of care denials. Medicare Advantage is an interesting failure in the marketplace in that it costs the government significantly more than classic Medicare and provides worse-quality care.

For the rest of us, we can skip the ER by going to an urgent care. But around here, urgent care offices are owned by private equity, have deceptive billing and are part of the reason why medical care costs so much.

Re: The American Healthcare Conundrum

#435

Post by WarmWash »

hermanzegerman wrote: post #425
WarmWash wrote: post #399

Earlier quoted context omitted.

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 th…

I doubt that they hate what they do, it's just the shitty working conditions that render you unempathic and cynical. Most of them care very much about what they do, and give everything they can for the patients. Otherwise they would have quit a long time ago. (I've had to do a 3-month nursing internship as part of my medical studies, it's mandatory in Germany) Better staffing makes a day and night difference. I've ex…

Well then, I am glad Germany figured out better pricing for healthcare. If the pay is middling and the work hard, you end up with mostly committed workers, because others don't enter the field with dollar signs in their eyes.

I hope you see that my point isn't that nursing is easy, my point is that (in the US) the pay is very high and the barrier to entry is moderate. So it becomes a magnet for people who just want to make money. This becomes even more true for med tech jobs, where you can blast through a cert in a year, and land a $30/hr job pretty quickly. That's about 50% more money than people typically in that education class earn.

Re: The American Healthcare Conundrum

#436

Post by heyitsmedotjayb »

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…

> 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.

Why not simply hire them to do something that isn't pointless - like dig ditches or clean garbage

Re: The American Healthcare Conundrum

#437

Post by onlyrealcuzzo »

rickydroll wrote: post #434
onlyrealcuzzo wrote: post #391

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. 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…

Breaking the existing system will be extremely difficult. I have decade-long relationships with all of my doctors. The thought of a health plan that forces me to change all my doctor relationships is anger-provoking and exhausting. New doctors don't know me, they don't know my history, and haven't seen the medical shit show you've been through and why your treatment is the way it is. Then they think they can change y…

> I have decade-long relationships with all of my doctors. The thought of a health plan that forces me to change all my doctor relationships is anger-provoking and exhausting.

You are clearly not in the bottom 50% of health care spenders. You would be in the group that would keep private insurance and be happy.

> One Medical looks interesting, but I wonder how they keep the price that low. Is it subsidized?

No.

> Are they putting constraints on physicians and what they can do in the same way BetterHelp messes with the therapists?

The vast majority of their "doctors" are Physician's Assistants. You can see whoever you want for whatever you want (that they provide).

> Are they servicing only the young and healthy?

Mainly. It's a clinic. You can't go there for Open Heart Surgery and cancer treatments. They'll just (cheaply) refer you to a specialist (who will be expensive and require insurance).

What you can do is avoid huge wait times and get good enough treatment for ~90% of what the mostly healthy group of ~50% of the population needs for fair up-front prices - which previously did not exist.

Re: The American Healthcare Conundrum

#438

Post by heyitsmedotjayb »

jimt1234 wrote: post #267
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…

I witnessed this devolution with my GF. She's a medical provider in CA that, since the mid-90's, got her funding from a state agency. She met with the agency once per quarter, reviewed her funding claims, worked out any discrepancies one-on-one, in-person with her representative. Worked great. Then private insurance muscled their way in. It's been a bureaucratic nightmare ever since. She had to hire a full-time staff…

At least those parents have the freedom to choose which animated 3d mascot is on their insurance paperwork.

Re: The American Healthcare Conundrum

#439

Post by nullpoint420 »

heyitsmedotjayb wrote: post #436
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…

> 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. Why not simply hire them to do something that isn't pointless - like dig ditches or clean garbage

You could say the same to tech workers after AI.

Re: The American Healthcare Conundrum

#440

Post by mexicocitinluez »

conductr wrote: post #433
mexicocitinluez wrote: post #361

Earlier quoted context omitted.

> But Medi care was right with the commercial insurers on reimbursement. As I said in another comment, I'm with a provider and Medicare is easily one of our best payors. We actually have contracts with private insurers that say they have to reimburse us at least 80-85% of what Medicare would. They also give us the money up front, with a public formula that we can count on vs. a hidden formula that requires us to go b…

Contracts are negotiations

Yes, that's what a contract is. I don't remember asking for a definition.
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