The US spends more on healthcare for no gain says new report from Johns Hopkins • Hacker News Board

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

#501

Post by lostlogin » Tue, Jan 08, 2019, 5:27 PM UTC

Fiahil wrote: post #420

patient_zero wrote: post #389

Earlier quoted context omitted.

For a second I read your comment as liberal tears, and had to do a double-take. :) Speaking to the 500$ charge, are you saying that is a typical cost around the world for a MRI? Is there something about the machine's cost that justifies this or are you just saying that a 500$ charge is typical in the american system?

And here I thought my last 120 EUR MRI was very expensive... (in France, of course)

That’s impressive. The purchase price and running cost are high. Then there are expensive labour costs (doctor, probably 2x techs and admin/reception staff. Often a nurse is around for more complex procedure too). Peripheral equipment isn’t cheap, with defib, contract injectors, RIS/PACS, reporting stations etc. Scans are slow relative to CT and x-ray so I have no idea how they make that work. Did you pay the whole bill? I am an MR tech.

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

#502

Post by monocasa » Tue, Jan 08, 2019, 5:28 PM UTC

tptacek wrote: post #466

dmitriy_ko wrote: post #332

Earlier quoted context omitted.

This issue existed before Obamacare 80/20 rule. In a free market the way for a profitable insurer to grow is by growing marketshare -- whether 80/20 rule exists or not. And the way to grow marketshare is to offer cheaper insurance. To offer cheaper insurance insurers have to push service prices down. Somehow this is not happening.

Hey, wait a minute, that's true. The McKinsey study predates the ACA and establishes the overconsumption narrative. The 80/20 ACA thing can't be the problem.

I'm not staying it's the problem; for something as systemically wrong as the US healthcare system there isn't just one thing wrong.

I'm merely debunking your assertion that insurance companies don't have a financial incentive to keep costs high.

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

#503

Post by lostlogin » Tue, Jan 08, 2019, 5:35 PM UTC

yholio wrote: post #441

JAlexoid wrote: post #295

Earlier quoted context omitted.

No it's not an unreasonable charge. The amount I had to go through and the necessity of it was the question. I got charged with two things - XRay and MRI. One was enough, apparently... And I wasn't in any critical condition to an XRay immediately.

It's 2-3x more than you would pay in a regular civilized country... it speaks volumes about the US system that you think it's not an unreasonable fee.

I’m not sure you are correct in that - MRI scanners are expensive to run as they are rarely as low priced as you are suggesting. See link below which is a little old but gives a spread of prices. Note that the prices cited i this thread is less than half the US average.

Another factor that is relatively rarely discussed is the quality. You can do a fast scan or a good scan. That’s inherent in how MRI works. A good gynaecological, cardiac or liver scan takes about 45mins, and there isn’t much you can do to improve on that as you are limited by metabolic activity (eg liver or heart contast wash-in and wash-out). If corners are cut here diagnosic quality will be reduced.

I regularly see scans that are of such poor quality that they are initially mistaken for the survey scans/scouts that we use to localise the patient in the bore. They are generally from places that you would intuitively avoid for healthcare, but not always.

https://www.statista.com/statistics/312020/price-of-mri-diag...

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

#504

Post by entity345 » Tue, Jan 08, 2019, 5:37 PM UTC

dragonwriter wrote: post #499

entity345 wrote: post #458

Earlier quoted context omitted.

> while healthcare delivery systems that broadly and effectively serve the whole population are in the third. That's your interpretation but that's really a political view, and indeed the definition of that third duty is highly subjective. As I wrote in another comment, the line must be drawn somewhere. Note that my point wasn't to discuss regalian functions in general but to counter the argument that calling the Bri…

> That's your interpretation but that's really a political view Smith's concept of regalian functions is just as much a “political view”. > and indeed the definition of that third duty is highly subjective. So are the definition of what particular actions of sovereign are within the boundary of the what is essential within the other two (and all three expressly vary by context, including available physical and social…

It is very relevant otherwise one might indeed draw a parallel with the police and the military, as already said.

As also said, health are is a productive service that has the potential of being 'socialist'.

I'm not here to argue for the sake of it and I don't see any actual argument on the original points in your replies...

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

#505

Post by tptacek » Tue, Jan 08, 2019, 5:46 PM UTC

monocasa wrote: post #502

tptacek wrote: post #466

Earlier quoted context omitted.

Hey, wait a minute, that's true. The McKinsey study predates the ACA and establishes the overconsumption narrative. The 80/20 ACA thing can't be the problem.

I'm not staying it's the problem; for something as systemically wrong as the US healthcare system there isn't just one thing wrong. I'm merely debunking your assertion that insurance companies don't have a financial incentive to keep costs high.

What's the financial incentive they had to keep costs high in 2010? You're making an extraordinary claim: health insurance companies are deliberately making themselves liable for provider costs in order to somehow benefit on the backend. You should have some kind of evidence?

What's the trend line since 2010? Since the 80/20 rule went into effect, has the rate of provider costs increased or decreased or stayed the same? If it hasn't increased, does your hypothesis actually explain any empirical observations?

If not, are you concerned this might be a just-so story?

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

#506

Post by will_brown » Tue, Jan 08, 2019, 5:46 PM UTC

refurb wrote: post #489

will_brown wrote: post #411

Earlier quoted context omitted.

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.

Yes but the Medicare plans are private insurance, the same insurers for the “commercial market” as you call it. You can’t separate the insurers dropping providers from networks and buying practices/hospitals from Medicare plans to non Medicare plans.

In other words if you aren’t a Medicare patient and are insured by UnitedHealth for example, you will be subject to the same networks of doctors/hospitals as their Medicare plans, so private is driven my the Medicare plans, because Medicare rules are driving the consolidation of the market.

And yes everyone will tell you star ratings are about “outcomes” not price, but if you knew/know anything about the star rating metrics it’s obvious “outcomes” is marketing/PR for cost cutting. Otherwise I’d ask to point out any metrics that increase star ratings that don’t lower costs, whereas it’s easy to point out the metrics that result in better “patient outcomes”/higher star ratings but lower quality of care.

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

#507

Post by vasilipupkin » Tue, Jan 08, 2019, 6:09 PM UTC

nerdponx wrote: post #495

vasilipupkin wrote: post #407

Earlier quoted context omitted.

Being able to see my doctor for a health problem on short notice improves my quality of life but it probably doesn’t change outcomes as there is a very low likelihood that my problem is both life threatening and urgent. But choosing to pay doctors more to reduce wait times is not right or wrong - it’s just a different preference.

My point is that you don't see people spending extra to see private doctors in Canada despite it being a generally wealthy nation. There is more at play than the original suggestion that high spending is simply a function of being a richer nation with more money to spend on "extras" like short waiting times.

You do actually - Canadians sometimes go across the border to US for surgeries, etc.

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

#508

Post by tialaramex » Tue, Jan 08, 2019, 6:16 PM UTC

kodablah wrote: post #106

grecy wrote: post #71

Earlier quoted context omitted.

> Are there any measures of how America does compared to Europe if you only count Americans that have good health insurance? Anecdotally, I'd say they do crap. Friends outside LA are upper-middle class. Extremely good health insurance for the last 20+ years. Had a baby, emergency C-section. Less than 12 hours later they were told they must move hospital or else pay the $60,000 per day out of pocket because their insu…

I think the commenter was asking about quality regardless of cost, especially for the upper tier.

It's going to be very hard to usefully measure, because it'll vary hugely by personal experience, where you are, what services you needed, etcetera.

I can't imagine how any experiences I have with the NHS could be better privately, I have enough money that I could afford a private system if I had any idea why or how that could be better, so I'd be genuinely torn (I support the existence of the NHS and one way to kill something like the NHS is to encourage everybody who can afford to go privately to leave the system) but it never comes up at all.

Not everything is perfect, but the less-than-perfect things don't feel like private healthcare could fix them e.g.

At home I live near a hospital, because I live in a city, but where I grew up there isn't a nearby hospital. Private doesn't fix that, under the US system I might be even further from an "in network" option, and even in a sane system the private hospitals would be in similar places to those for a universal system, it doesn't help.

I had cancer years back. Nothing about this seemed awful except the "having cancer" part which I'm sure private healthcare doesn't get rid of. Curing cancer is urgent so there was no waiting for treatment, the staff were competent, my oncology consultants were the exact sort of "no nonsense" people I'd have picked if I had a free choice. The hospital was nice. A+++ would recommend (except cancer, don't get cancer)

Once upon a time I moved to a new city and friends were all like "Oh my god, get a private dentist, ugh, it's just impossible to get an NHS dentist". And being contrary I was like "Huh, I wonder how impossible it is?" and the answer was "You phone this number and they assign you one" and I'm still with the same dental practice twenty years later. In fact my specific dentist left last year and I was like "Oh, maybe he went private and I could follow?" but nope, he retired, I feel old. His replacement is young enough to be my daughter. But she's already nagging me about stuff just like he did, so that's fine.

I had a scary moment in a distant city last year, I had found a lump and was experiencing peripheral neuropathy. I went to an Urgent Care clinic and rather than examine me they booked me into my own GP for the next day and I went home early. In hindsight they should have examined me, because my GP was like "The clinic nurse could have told you this is not what you were worried it might be". But, would private healthcare have done the examination? That comes down to personal judgement by a clinic nurse, and money wouldn't change that.

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

#509

Post by pjmorris » Tue, Jan 08, 2019, 6:18 PM UTC

vonmoltke wrote: post #450

pjmorris wrote: post #101

Earlier quoted context omitted.

US GDP is ~19 Trillion. If US Health care spending is 18% of GDP, that's about 3.5 Trillion annually. Pfizer's (largest drug co) net income in 2017 was ~21 Billion [0], less than one percent of health care spending. I didn't tally the rest of the industry up, but I'd be surprised if it hit 10% of total costs. [0] https://en.wikipedia.org/wiki/Pfizer

Why are you looking at net income? Revenue is the relevant number, which was $52.55B in 2017.

Actually, both revenue and income are proxies for the relevant number, given that I had in mind to address the GP's point of 'effectively funding a significant portion of R&D.' If the article [0] is to be believed, that's about 8-9 Billion for Pfizer, and about 70 Billion for the top 15 pharma companies, about 2% of US health care spending. Even if we cut US health care spending in half (to, say, the UK's level), funding pharma research at current levels would be a fraction of total costs.

[0] https://endpts.com/top-pharma-biotech-research-development-b...

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

#510

Post by cteague » Tue, Jan 08, 2019, 6:55 PM UTC

hannasanarion wrote: post #398

cteague wrote: post #355

Earlier quoted context omitted.

Every market has information asymmetry. Software is probably the biggest one today. Yet software keeps getting better and better... I agree there are needs for regulations--more like proper norms though and a good tort system.

No it doesn't. You can negotiate the price of software before you buy it, and you can shop around and choose between alternatives, or choose not to buy at all. If you need a piece of rebar removed from your chest, then you need a piece of rebar removed from your chest. The price doesn't matter, the choice of provider doesn't matter. The "consumer" is completely at the whim of whatever provider happens to be closest.…

You're engaging in 'all-or-nothing' thinking. The vast majority of medical expenses are not like that. And that's the whole point of insurance--to be covered in case something happens so you don't have to negotiate on the spot.

That's like saying we should socialize food distribution because people can't negotiate when they're starving.