Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The American Healthcare Conundrum

github.com

Post reply on HN
Print view View original

511–520 of 690 posts

Re: The American Healthcare Conundrum

#511

Post by ninalanyon »

biophysboy wrote: post #426
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…

There are other public healthcare models besides Beveridge though. Some countries do the payment & financing via gov, but the actual service is a mix of public/private. Not a perfect solution, but in my opinion better than what we have now. Maybe more achievable than Beveridge too.

Norway funds health care through taxation, seems to work pretty well here. But we don't have PFI, instead there are fully private healthcare companies that act as suppliers of services such as MRI, CAT scans, etc. So if your GP orders an X-ray or MRI you will most likely get it done by a private company rather than the local hospital. The patient doesn't really see any difference most of the cost is borne by the state, the patient pays a small egenandel (like copay in the US, excess in UK insurance terms) wherever it is done.

I'm not sure how the other Nordic countries do it but I think it's probably similar.

Re: The American Healthcare Conundrum

#513

Post by matwood »

titzer wrote: post #446
avhception wrote: post #419

Earlier quoted context omitted.

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 p…

> I didn't have to wait long for an MRI (two weeks) versus months in the US.

Where in the US did you have to wait months? There seems to be an MRI/imaging location in every other shopping center in the US right now. I've never had a problem getting a same day MRI when needed. Perhaps you were waiting for the 'free' one your insurance would accept?

Re: The American Healthcare Conundrum

#514

Post by Aeolun »

cmiles8 wrote: post #337
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…

Prescriptions are a total racket. A good portion of actual medication literally costs a few dollars at most. Then there’s layer upon layer of bloat and bureaucracy that add no value but drive the cost up 10x or more. It’s totally bonkers. When these Rx cards and Marc Cuban CostPlus drugs came out where you just pay cash and a fraction of the price I thought there must be some catch or scam here. But turns out no, the…

> In many ways the quality of care in the US is far better than what folks get elsewhere

Or so people keep telling themselves to not feel completely fucked?

Re: The American Healthcare Conundrum

#515

Post by nsvd2 »

randusername wrote: post #475
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 j…

The unfortunate answer is that the US seems to be very bad at fighting regulatory corruption which allows small parts of the market to buy laws which give them a moat. Rinse and repeat over the last half century and you get to the situation we're in.

Re: The American Healthcare Conundrum

#516

Post by Aeolun »

dabiged wrote: post #367
alexfoo wrote: post #359

Earlier quoted context omitted.

I guess that's because many/most countries don't have the concept of a private emergency department. It doesn't really matter how much money you have if you have a broken leg as you'll be queuing up with everyone else for the triage and initial treatment. I have amazing private healthcare coverage in the UK through my employer. I've had certain treatments done in under a week where the NHS waiting lists for the same…

Australia reporting in. We have private emergency rooms. We call them urgent care and you can go and see a qualified physician with allied health services (radiology, pathology). If they can fix you up they will. If not you get transferred via ambulance to the nearest public hospital and triaged as required. I took my kid to one last weekend as they had been diagnosed by our family Dr as having pneumonia. The emergen…

Does it make sense to get an x-ray for that? I’m sympathetic to the desire, but isn’t the end result for pneumonia always antibiotics anyway?

Re: The American Healthcare Conundrum

#517

Post by onlyrealcuzzo »

rickydroll wrote: post #505
onlyrealcuzzo wrote: post #437

Earlier quoted context omitted.

> 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…

That's a mighty big assumption you're making. I've had private insurance for years, and I've always been unhappy with it because of treatment delays, Treatment denials, pre-approvals, and unrealistic copay limitations. Many of my health needs are not expensive, but my body's reaction to treatments is. Frequently, cheap drugs are all side effects and no benefit. Also, private insurance has bizarre coverage gaps. For e…

Okay - so you could keep your private insurance and not be happy, or move to Medicare and also not be happy.

I think you want a third solution - but that seems highly unlikely to be available in the mid term - and it doesn't look like anything is changing in the short term.

Who knows, my crystal ball doesn't work any better than anyone else's.

Re: The American Healthcare Conundrum

#518

Post by alexfoo »

akpa1 wrote: post #386
alexfoo wrote: post #363

Earlier quoted context omitted.

Ah yes, forgot about that. The regional differences are quite odd. I got my ADHD diagnosis via Right-To-Choose, so it is considered an NHS diagnosis and I get my medication via the NHS (and therefore cheap). But the RTC pathway isn't available in Wales/Scotland/NI. I'd either have to wait years for an NHS diagnosis or go private and then have to pay £££ for my prescriptions privately. The UK system has many problems…

I got my ADHD diagnosis privately (mostly because of the length of the NHS waiting lists, and I'm currently waiting on a NHS RTC provider to transfer my care there) and I pay the trade price plus pharmacy markup (so ~£40/mo) for my medication, for whatever it's worth as comparison. Definitely not cheap (I would prefer the £9.90 NHS prescription fee) but I get the feeling that it's cheaper than I would pay elsewhere i…

Yeah, mine would have been £50/mo if I’d been private according to the receipts I never had to pay on RTC. Luckily I only had to wait about 9 months from referral to RTC to diagnosis and starting titration. I know some people who have only had to wait a couple of weeks, it’s another lottery based on the individual providers and the phase of the moon.

Meanwhile we’ve spent close to £7k on my kids ADHD/ASD diagnoses privately as it was a 4 year waiting list for a NHS CAHMS referral. Luckily the GP has agreed to take on the private diagnosis and prescribe the meds under a shared care agreement.

I’ve no idea what happens in a few years when my kid hits 18. I’m hoping they don’t have to back out of the SCA leaving them without access to meds. It’s something I need to research although the fallback is paying privately I guess.

Re: The American Healthcare Conundrum

#519

Post by onlyrealcuzzo »

46493168 wrote: post #380
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…

The United States will never have universal healthcare because a subset of the population would rather pay more for worse health outcomes than participate in a system the provides abortions, HRT, or PreP, or any healthcare at all to Black people. See, for example, “Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland” by Jonathan Metzl

> The United States will never have universal healthcare because a subset of the population would rather pay more for worse health outcomes than participate in a system the provides abortions, HRT, or PreP, or any healthcare at all to Black people.

This subset does exist, but is smaller than the percentage of people who think the system is broken - and the solution is not to just open up the floodgates and make it even more broken and even more expensive.

You FIRST have to fix the system before you open up the floodgates.

I am on your side that I think it would actually cost LESS to move all high-cost patients off of the ER and onto Medicaid.

But that's not a big enough problem to actually move the needle. In the rosiest scenario, you might save 2% per year. That's still like $20-40B, so nothing to scoff at - but in realistic scenarios, I'm doubtful it would save >$10B.

Even if they had Medicaid, they're so conditioned on going to the ER for everything, a lot of them might still go there instead of somewhere cheaper. For one, they might be convinced they get better care there (and maybe they would).

There's way bigger fish to fry.

Re: The American Healthcare Conundrum

#520

Post by kstrauser »

conductr wrote: post #179
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…

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…

Those are fair points. From our specialty clinic's POV, Medicare has been great as far insurers go[0]. I've not had to deal with them at a hospital's scale.

[0]File under "damning with faint praise".

Post reply on HN