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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#471

Post by 1234letshaveatw »

alexfoo wrote: post #347
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…

This always baffles me. There’s so much rampant profiteering in the US healthcare system it’s unbelievable. Other countries look at it from afar in utter disbelief. I’m glad I had no serious health problems when I lived there 25 years ago (and I had health insurance via my employer). In the UK prescriptions are effectively capped at about USD125 per year: https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-pr..…

What an amazing system! Poof! just like magic you can pretend that sophisticated medicines, that are years in development, should cost nothing just because! And then you can act all smug about it!

Re: The American Healthcare Conundrum

#472

Post by estearum »

triceratops wrote: post #463
estearum wrote: post #448

Earlier quoted context omitted.

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.

Why does the government need to spend money on slots at all? Do other countries do it like that?

Because it makes pretty much no economic sense for anyone else to do it

One of many failure modes of the glorious and totally perfect Free Market

Yes most other countries use public money to educate their doctors

Re: The American Healthcare Conundrum

#473

Post by estimator7292 »

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…

My new job has some kind of insurance add-on which is an entire company of people with the express purpose of negotiating with your primary insurance to get specialty medication paid for.

Sticker price on my partner's medication is $10k/mo. Insurance alone refused to pay anything. This third party negotiator managed to get insurance to pay some, the manufacturer to discount it, and a "copay card" with several thousand dollars preloaded appeared to pay the rest.

We ended up paying zero out of pocket for the medication but it took two weeks of thrice-daily phone calls with various entities.

The very notion that an entire company can exist and sustain itself solely on negotiating with your insurance provider on your behalf is utter insanity. I've heard horror stories about communist bureaucracy from Soviet-occupied European countries, but I don't think even the USSR can compete with the modern American healthcare bureaucracy. It's outrageous and unconscionable.

Re: The American Healthcare Conundrum

#474

Post by pessimizer »

nullpoint420 wrote: post #439
heyitsmedotjayb wrote: post #436

Earlier quoted context omitted.

> 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.

So what?

Are you arguing that since we think we're all special that we should be accepting that other people think they're special?

Meanwhile, people getting laid off (just so the jobs could be exported to countries with more poverty and lower pollution, worker's rights, and standards for working conditions) were getting berated that they should "learn to code" for decades, while we laughed and discussed our stock options.

Re: The American Healthcare Conundrum

#475

Post by randusername »

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 am less interested in the quantitative analysis, but the qualitative analysis. Why, culturally, has the US shot itself in the foot in this way?

> And I think part of the answer is that in most cases, individuals and families themselves must allocate resources they control to make this happen.

Assuming uniquely American selfishness got us in this mess, I don't buy that rugged individualism is the route out. You'll just get that classic pattern of those with enough resources to manage criticizing the resource management of those with too few resources to learn to manage. That just further corrodes solidarity.

Re: The American Healthcare Conundrum

#476

Post by a123b456c »

tartuffe78 wrote: post #444
gorbachev wrote: post #364

Earlier quoted context omitted.

> 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.

If Intuit and other tax preparers can protect their tax preparation rents at the expense of all income earners, then it is not difficult to believe that the medical industry is also able to protect its own rents.

Re: The American Healthcare Conundrum

#477

Post by soupfordummies »

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…

Free idea: AI-powered "agent" that fights health insurance and medical bills for you.

Re: The American Healthcare Conundrum

#478

Post by orangecat »

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…

The #1 thing we need to do is make it illegal for your healthcare to be tied to your employment

Yes. Or at the very least, stop making it mandatory. Health insurance should work like literally everything else: your employer pays you money, and you use that money to buy it.

Re: The American Healthcare Conundrum

#480

Post by rexroad »

Correction on ownership breakdown: A CMS cost report expert flagged that my CTRL_TYPE mapping in the HCRIS processing script was wrong — I had for-profit and nonprofit hospital categories swapped. The corrected figures: for-profit hospitals have a 4.11x median markup (highest), nonprofits 2.46x, government 2.22x. The 254% commercial-to-Medicare finding ($73B savings estimate) is unaffected — that's from RAND, not my HCRIS analysis. Corrected code and a full audit report are on GitHub. This is exactly why the code is open-source.
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