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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#541

Post by pnutjam »

matwood wrote: post #513
titzer wrote: post #446

Earlier quoted context omitted.

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?

Why wouldn't you wait for one your insurance would approve? You're probably paying them thousands every month.

Re: The American Healthcare Conundrum

#542

Post by pnutjam »

hammock wrote: post #413
cmiles8 wrote: post #337

Earlier quoted context omitted.

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…

People are waking up and a lot is happening to counteract some of this. In the FY26 omnibus bill passed by Congress and signed last month by Trump is the most aggressive federal crackdown on PBMs in history. Starting in 2028 it bans PBMs from taking a percentage cut, which is exactly what incentivized them to drive up the sticker price of your meds. It forces PBMs to pass 100% of the rebates and discounts they negoti…

TrumpRx is mostly hot air. https://democrats-energycommerce.house.gov/sites/evo-subsite...

Re: The American Healthcare Conundrum

#543

Post by ciupicri »

nsvd2 wrote: post #509
anon7000 wrote: post #373

Earlier quoted context omitted.

> It’s their job to get better prices at scale and yet somehow they manage to sell at prices far worse Maybe on paper, in reality their job is to return as much profit as possible to shareholders. Convoluted bureaucracy, complicated regulations, layers of useless middlemen… they all help to reduce competition and increase profits. There are industries where the “free” market doesn’t work, partly because “human well-b…

In no way shape or form is the medical industry in the US a free market, it's one of the most heavily regulated sectors in the economy. Remember when the government wanted to make purchasing health insurance mandatory? Forcing employers to pay for their employees health insurance greatly distorts the market. And many other things... By the way, as much as people complain about the profit seeking motives of insurers,…

In Romania the employer takes a cut from the employee's salary and gives it to a government agency for the health insurance (some thing with income tax, social security (pension), etc). I think this is happening in other European countries as well.

Some employers also offer as a bonus a sort of subscription at a private clinic, so you can see a private doctor or have an operation for a lower price or even for free.

Re: The American Healthcare Conundrum

#544

Post by rectang »

nsvd2 wrote: post #509
anon7000 wrote: post #373

Earlier quoted context omitted.

> It’s their job to get better prices at scale and yet somehow they manage to sell at prices far worse Maybe on paper, in reality their job is to return as much profit as possible to shareholders. Convoluted bureaucracy, complicated regulations, layers of useless middlemen… they all help to reduce competition and increase profits. There are industries where the “free” market doesn’t work, partly because “human well-b…

In no way shape or form is the medical industry in the US a free market, it's one of the most heavily regulated sectors in the economy. Remember when the government wanted to make purchasing health insurance mandatory? Forcing employers to pay for their employees health insurance greatly distorts the market. And many other things... By the way, as much as people complain about the profit seeking motives of insurers,…

> In no way shape or form is the medical industry in the US a free market, it's one of the most heavily regulated sectors in the economy.

If any regulation at all makes a market not "free", then there are no free markets as soon as we have any laws.

Like all free markets, this one is regulated. There are degrees of freedom.

Re: The American Healthcare Conundrum

#545

Post by bhelkey »

Public perception is that the US is not willing to pay for universal healthcare. However, the US spends enough money, it just spends it inefficiently.

The US spends ~$900 Billion a year on Medicaid [1] and ~$1.1 Trillion a year on Medicare [2]. If the US spent this money as efficiently as Japan (or UK [3], ...) it could pay for Universal Healthcare without increasing its budget.

[1] https://www.kff.org/medicaid/medicaid-financing-the-basics/#...

[2] https://usafacts.org/answers/how-much-does-medicare-cost-the...

[3] https://www.bbc.com/news/articles/cwy7zvp5xrqo

Re: The American Healthcare Conundrum

#546

Post by jimt1234 »

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 Boomer mother has a mild case of shingles. Her health insurance will only pay for an expensive monthly injection. She tried it, but doesn't want it, as she says the side-effects are worse than the shingles. She prefers to apply a cream when she experiences a flare up - maybe, twice per year. Well, her insurance won't pay for the prescription cream; they keep insisting on the monthly injection. She was told if she insists on the cream, she needs to buy it on her own - cost, around $150. Thankfully, we live not far from Mexico, where I can purchase the exact same cream for around $7.

So, it seems the solution to the high cost of prescription drugs in the US is to live near a border. LOL

Re: The American Healthcare Conundrum

#547

Post by teeray »

onlyrealcuzzo wrote: post #391
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…

> 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. I strongly think that covering everyone in the existing system is not the best way to go. The existing system is designed to cost as much as possible, and we have way too much demand for treatment (as is) and not enough supply. ER…

> Do you really need to go to the ER because you stubbed your toe?

Where else are some people supposed to go? Maybe that toe is starting to change colors… is it broken? Do I need to have it set? Is that possible for toes?

People have valid medical questions and don’t want to wait weeks to see their primary care. They might not live near an urgent care. The urgent care may have terrible hours, or they made the mistake of mentioning chest pain for their heartburn incident and now they are forced to the ER.

It’s a chicken and egg problem. Faster medical answers will lead to reduced ER wait times. Reducing ER wait times lead to faster medical answers.

Re: The American Healthcare Conundrum

#548

Post by jasonhong »

I saw Jim Clark (founder of SGI, Netscape, Healtheon) talk one time about entrepreneurship. He said something that compactly explains a lot of issues humanity faces in general: "One person's inefficiency is someone else's bottom line."

A lot of the things that the original post shares has this characteristic. Sure, things in US healthcare are wildly inefficient, but that's how a lot of these companies make a lot of money. And they will lobby and fight to the death that cash flow.

Re: The American Healthcare Conundrum

#549

Post by shimman »

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…

Why make this so complicated when we can just have medicare for all? You're right that healthcare shouldn't be tied to your employment, but what you're proposing is something that only the rich + affluent can achieve independently.

All you're doing is playing musical chairs with different capitalists, just stop playing the game. A large part of the electorate wants to stop playing the game.

Re: The American Healthcare Conundrum

#550

Post by ThrowawayTestr »

Taikonerd wrote: post #423

I think the root problem is fee-for-service. Doctors and other providers bill for each individual thing they do. But that means that their incentive is to do as much as possible , so they can quickly rack up billable codes. It's like if developers billed their employer per line of code they wrote: the incentive is for churn, when it should be for slowing down and thinking about quality.

Doctors in Canada also bill the government for everything they do but I've never felt pressured for procedures by my doctor. Don't kid yourself, it's the insurance companies.
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