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The US spends more on healthcare for no gain says new report from Johns Hopkins

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Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#481

Post by jasonlotito »

These studies never seem to differentiate between different types of care. We left Canada for the US because of the healthcare. Autism care and support is far better in the US then Canada. Even if this is costing us more as a whole (it's far cheaper in my out of pocket costs), there are gains. So in general, we might be doing worse in general, but that doesn't mean we aren't doing amazingly betting in certain areas. I realize I'm talking about one specific area, but knowing how much was spent in the US vs Canada in terms of care, yes, more was spent on my child in the US instead of Canada, but the results were so much better.

Basically, it's easier to spend less when you just don't do certain things that are much more expensive.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#482

Post by kingaillas »

tobylane wrote: post #445
refurb wrote: post #240

Earlier quoted context omitted.

As someone who works in the industry, you are somewhat correct. Once a drug is approved, it is priced independently of the R&D cost. However, the decision to bring a drug through clinical trials (the "D" in "R&D") is gated. The potential price of the drug is estimated and the financial costs and potential return are calculated. If the return isn't that great because you can't get the volume or price, the R&D investme…

There's sticker price and there's what buyers with the ability to negotiate pays. I hear the government healthcare suppliers (Medicare, Medicaid and VA) aren't allowed to ask for lower prices for bulk despite being some of the world's largest customers, each.

>I hear the government healthcare suppliers (Medicare, Medicaid and VA) aren't allowed to ask for lower prices for bulk despite being some of the world's largest customers, each.

Yep, that's part of Medicare Part D, in turn part of the "Medicare Prescription Drug, Improvement, and Modernization Act", and went into effect in 2003 under Bush 43.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#483

Post by VBprogrammer »

dogma1138 wrote: post #440
VBprogrammer wrote: post #404

Earlier quoted context omitted.

In the UK which hospital you would go to is nearly 100% based on ease of getting there and the facilities they have on hand. The idea of driving past a hospital to get to another which is more friendly to my insurance plan completely blows my mind.

Only if you use the NHS, private insurance would require you to pay extra if you don’t live there especially for inner London Hospitals.

Have you lived in the UK? I personally haven't encountered anyone who has had that issue. Most people primarily use the NHS and private health insurance is provided only occasionally as an employee benefit (often by American companies). That's nice for perhaps getting faster treatment for minor issues and maybe getting a nicer room but generally not required.

I'm sure that the 1% have other arrangements but that's another thing altogether.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#484

Post by mac01021 »

mrep wrote: post #170
jdhn wrote: post #157

Earlier quoted context omitted.

>If you don't pay your premiums, nothing happens, but if you need healthcare you're not covered until you pay your back premiums. So what happens if you don’t pay your premium but then have to use the ER? Do they refuse to take you, or are you stuck with a bill? Does that bill go away if you pay your back premiums or not!

Don't quote me, but I've read many places in the US that ER's are required to take you if you are in a life threatening situation and if you cannot pay, the hospital just ends up owning the costs and then passes those costs to everyone else through insurance fees.

I've witnessed this first hand. For a nonemergency even. A friend with bad English went to the ER to have a rash looked at (not understanding what the more appropriate action would have been).

The ER don't doctor spent about 2 minutes with her and wrote a prescription for some topical thing.

Later the hospital sent her a bill for about $1500. I went with her to the hospital's billing Dept, helped her fill out a form that basically said "I have no insurance and no money".

The hospital ate the bill.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#485

Post by cm2187 »

isostatic wrote: post #405
marcus_holmes wrote: post #354

Earlier quoted context omitted.

yeah. Can you refuse treatment from an OON provider in a hospital? Because that would be my first question if approached by a doctor who could potentially bill me $100K

When I go to hospital, on the assumption I'm conscious, the last thing on my mind is deciding which doctor I want

For ER agreed. For anything else that is serious / non trivial, you also want to consider the repuation of the department. Some doctors are world specialist of something, or treat dozens of a particular condition every year. Others rarely do or are simply not good. I don't think there is any way for a layman to know. You kind of need to ask relatives in the profession, who can themselves ask around. I have a few doctors as relatives and they systematically check the reputation.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#486

Post by telchar »

cm2187 wrote: post #471
arethuza wrote: post #369

Earlier quoted context omitted.

"there is no reason my money should pay for the care of others" Isn't the cultural issue largely a idealogical issue - things like the UK NHS are avowedly socialist? In the words of Aneurin Bevan, founder of the NHS: " A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society." https://en.wikipedia.org/wiki/Aneurin_Bevan Personally, at least when it comes to healthcare, I…

Paying for the care of others is also the insurance model, which is not socialism. I think where you lose support from part of the population is when the system is being abused. I understand France for instance has an abnormally high number of depressions, as it is a common way for a lazy employee to take some time off at the expense of the system. In the US I understand there is an abnormally high number of people o…

Fact, you say? I think you're right about the psychology here but if you're going to assert that state management is factually bad please provide some support to that.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#487

Post by refurb »

tobylane wrote: post #445
refurb wrote: post #240

Earlier quoted context omitted.

As someone who works in the industry, you are somewhat correct. Once a drug is approved, it is priced independently of the R&D cost. However, the decision to bring a drug through clinical trials (the "D" in "R&D") is gated. The potential price of the drug is estimated and the financial costs and potential return are calculated. If the return isn't that great because you can't get the volume or price, the R&D investme…

There's sticker price and there's what buyers with the ability to negotiate pays. I hear the government healthcare suppliers (Medicare, Medicaid and VA) aren't allowed to ask for lower prices for bulk despite being some of the world's largest customers, each.

That's not true in the slightest.

Medicare - gets an automatic discount equal to the average discount that commercial customers pay

Medicaid - gets another 23.1% discount on top of what Medicare gets

VA - lowest price of all customers, get at least a 24% discounts on top of what Medicare gets

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#488

Post by notabee »

JAlexoid wrote: post #297
vasili111 wrote: post #228

Earlier quoted context omitted.

>I had this in US. Shoulder pain, that was diagnosed via an XRay... But the doctor decided he wanted an MRI. Xray is mainly for bone problems. MRI shows well soft tissue. In medicine, if something you suspect even it has a low probability and the diagnostics are not invasive, it is better to check than to miss and regret later. Why are you so sure that MRI was not necessary in your case?

I saw my other doctor, slightly more decorated orthopaedic surgeon, that literally told me that I was blasted with XRay for no reason or my MRI wasn't necessary. I have an irritating bone spur in the shoulder, that's the only problem. The doctor ordered both Xray and MRI at the same time, while there was literally no need for one of them.

You are reasoning backwards. Had the cause been something besides a bone spur, such as a tumor or vascular problem, the X-ray might have missed it. Some things like soft tissue calcification don't show up as well on MRI as on a plain X-ray film which is a really low radiation dose these days anyways. Go read up on the terms sensitivity and specificity.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#489

Post by refurb »

will_brown wrote: post #411
refurb wrote: post #150

Earlier quoted context omitted.

Insurers control care to reduce costs. The upward pressure on prices is from providers. In terms of these insurers who control providers, can you give an example?

Insurers are really controlling care to improve their “star rating”. Insurers are given a star rating by many things outside their control and in the domain of providers and pharmacists. That’s why they are dropping docs and pharmacies from their networks and otherwise buying them to consolidate the market and their control. Next time you go to your primary doctor ask them how many faxes they get from the pharmacist…

Star ratings are for Medicare plans only, not commercial. They are related to the quality of the insurers for the customers, not prices.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#490

Post by DennisP »

rscho wrote: post #425
DennisP wrote: post #410

Earlier quoted context omitted.

People want complete price information because we don't have price controls, like they have in Germany, France, and Japan. Having a "free market" in healthcare without showing prices in advance of providing services is sort of obviously the worst way to get a reasonably priced healthcare system. That's somewhat mitigated by negotiations between insurers and providers, but not entirely given out-of-network charges.

Agreed, however there is a solid base of evidence (as solid as medical evidence can be, which is not saying much) that health can't humanely be handled as a commodity. Plus, providing complete price info itself is not free. Talk about administrative inflation!

So then, go with price controls. We have multiple examples of that working just fine. The answer cannot be that we make people responsible for payment before telling them what the price will be, and it's unsurprising that by doing that, we have the most expensive healthcare system in the world.
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