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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#441

Post by fearmerchant »

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…

I pay cash for a medication because the insurance won't pay for the 90 day supply and it's a hassle to deal with it every month. It's $70 for me to pay for 90 days out of pocket versus paying a $20 deductible each month. I'm only paying $10 extra to avoid the hassle. Worth it.

Re: The American Healthcare Conundrum

#442

Post by ferguess_k »

virgil_disgr4ce wrote: post #417
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?

It is just like anything in the world, that has a path to complete. I'm just saying that no one can stop it from completing its path. I don't know what the end consists of, or what exactly the path consists of, but nothing too good for ordinary people, I guess, as an armchair historian observing current affairs.

Re: The American Healthcare Conundrum

#443

Post by mchusma »

It’s disturbing to see multiple comments that “capitalism” is to blame for the costs in healthcare. The US healthcare market is the least free market in the US. Capitalism (when there is true competition) brings down costs pretty universally. Those parts of the market that are market oriented tend to get better and cheaper over time (for example, generic over the counter meds, needles, and even health care panels, AI health advice) all getting better and cheaper. You can get pretty cheap panels of blood drawn, for $200 or less with tons of data. It’s only when you hit the regulatory wall and you exit the market do you see costs explode.

Our imperfect system pays for the worlds medical R&D, so I would actually love to see per capita spending remain similar BUT have the market opened up, with a nice safety net at reasonable cost, and money pouring into curing aging and all disease.

Re: The American Healthcare Conundrum

#444

Post by tartuffe78 »

gorbachev wrote: post #364
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. Yet we're ok with spending trillions on AI to eliminate jobs everywhere, including healthcare. I don't think that's the reason. Personally I'm of the opinion the reason it isn't being solved, is because the people whose job it would be to solve it g…

Well right, people lobby not to change anything because they have giant companies that make them money. They need all those people in jobs to help them deny claims, identify fraud, waste, etc.

Re: The American Healthcare Conundrum

#445

Post by estearum »

mchusma wrote: post #443

It’s disturbing to see multiple comments that “capitalism” is to blame for the costs in healthcare. The US healthcare market is the least free market in the US. Capitalism (when there is true competition) brings down costs pretty universally. Those parts of the market that are market oriented tend to get better and cheaper over time (for example, generic over the counter meds, needles, and even health care panels, AI…

> Capitalism (when there is true competition) brings down costs pretty universally.

"True competition" is doing a lot of heavy lifting here. There are many conditions that must be true for prices to go down.

Re: The American Healthcare Conundrum

#446

Post by titzer »

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.

Having lived in both Germany and the US, my experience with the German system is that there are a lot more, smaller hospitals and private practices, the care is good, and all I ever paid for out of pocket was prescription medications. I didn't have to wait long for an MRI (two weeks) versus months in the US. I had a number of things that would have been hundreds or thousands of dollars in the US that I never paid a penny for in Germany. I'll also say that hospitals are absolutely crazy about sending bill collectors after you. I had a handful of small charges--like $10 or $20 things--that I hadn't realized were even there and two months later they freaking inundated me with bill collector notices.

It does make a big difference exactly where you are in the US, however. Some places have a glut of healthcare providers and other places don't.

Re: The American Healthcare Conundrum

#447

Post by estearum »

Taikonerd wrote: post #418
snarf21 wrote: post #404

Earlier quoted context omitted.

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 y…

I think the mechanic they're trying to speak to is that due to insurance being tied to employer, no insurance plan (besides Medicare/Medicaid) is truly motivated to ensure good health outcomes beyond a ~4 year horizon. You'll switch jobs and get a different plan.

Re: The American Healthcare Conundrum

#448

Post by estearum »

klipt wrote: post #342
Vinnl wrote: post #330

Earlier quoted context omitted.

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.

Clarification because people get this wrong a lot:

There is no imposed limit on the number of residency slots.

There is a limit to the amount of money the US government is willing to spend on slots.

Re: The American Healthcare Conundrum

#449

Post by Dumblydorr »

mchusma wrote: post #443

It’s disturbing to see multiple comments that “capitalism” is to blame for the costs in healthcare. The US healthcare market is the least free market in the US. Capitalism (when there is true competition) brings down costs pretty universally. Those parts of the market that are market oriented tend to get better and cheaper over time (for example, generic over the counter meds, needles, and even health care panels, AI…

Capitalism =\= free-market

We have crony capitalism in the US, healthcare is one of the easiest areas to see it.

Free-market is the illusive perfect sphere. Most markets are oval or amoeba shaped. Rarely can the US achieve a true free market in any industry, since money pours into politics and corrupts the laws and regulations.

Re: The American Healthcare Conundrum

#450

Post by bandofthehawk »

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...

I think this difference mostly disappears if you group Americans by wealth. So wealthy Americans have similar life expectancies to those in other countries. It's really the poor that are most affected by our dystopian healthcare system, which is probably a big part of why it never gets fixed.
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