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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#551

Post by adventured »

bhelkey wrote: post #545

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/medic…

Incomes are dramatically higher in the US than in Japan. Their economy has imploded so badly due to debt + currency destruction that they're now just barely above Lithuania (which has come a long ways of course) on economic output per capita.

Japan is no longer a primary economic power and their (perpetually falling) purchasing power + incomes represent that.

US GDP per capita is estimated at $92,000 for 2026. Norway is $96,000 for comparison. 340 million people vs one of the world's richest nations at 5 million people. The UK is $60k, and Japan is a mere $36k.

Read that again. US GDP per capita will soon be 3x that of Japan.

Doing a direct comparison of healthcare costs is silly accordingly. At a minimum you need to 2x to account for the drastically higher US incomes vs Japan, and at least 50% higher vs the UK.

Re: The American Healthcare Conundrum

#552

Post by stronglikedan »

simojo wrote: post #533
thegrim33 wrote: post #491

Am I completely tripping out or does rexroad's profile use a template where they were supposed to fill in a blank but forgot? "Former [your background if relevant]". Really opens my eyes to all the other politics posting accounts that have a similarly constructed profile description .. But of course, they'll never be banned and instead they get front page of HN and hundreds of upvotes.

What do you see as the bad part of this? That the user is trying to farm points by copying patterns of upvote-winning users, or that there's a flood of inauthentic new users? Genuinely asking.

every forum has busybodies who try to make something out of nothing

Re: The American Healthcare Conundrum

#553

Post by mekdoonggi »

SoftTalker wrote: post #529
mekdoonggi wrote: post #430

Earlier quoted context omitted.

By "the insurance" I was referring to Medicare. I'm a working, healthy person and rarely use healthcare outside of preventative care. You could raise my Medicare taxes by hundreds monthly and still be less than what I pay for private insurance. In a Medicare-for-all scenario, the individual price of a given procedure doesn't need to be so high, because the reimbursement is guaranteed. Right now, the "list" price of t…

Your private insurance isn't there (ideally) to pay for your preventative care, which you can easily pay for out of pocket. It's there to pay for the low-probability but very expensive scenarios, such as cancer, major accident/injury, etc. that would otherwise bankrupt you.

I understand how insurance is supposed to work. The problem is that private insurance captures all of the value I pay in during my working life, and doesn't have to pick up the tab when I inevitably get old and sick.

To use car insurance as an example, it would be like if we had a government program for cars over 150k miles. You have to pay for both private and government insurance. The private company collects more money than the government, but the government pays for all the expensive stuff because that's when cars break down. It's completely pointless.

If you want a medicare-for-all scheme where working people have a higher cost-share than children/retirees, fine, that's reasonable. Having private companies rake in profits from a system that has no business being a profit enterprise is insane.

Re: The American Healthcare Conundrum

#554

Post by shaftoe »

rectang wrote: post #544
nsvd2 wrote: post #509

Earlier quoted context omitted.

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.

In this market, neither the producer nor the consumer are responding to price signals and often neither knows what anything costs. The Payer (literal healthcare industry terminology) does but isn't producing nor consuming the service.

This is why this isn't a free market. It's not about regulation, it's about the system being divorced from responding to market dynamics.

Re: The American Healthcare Conundrum

#555

Post by CGMthrowaway »

raw_anon_1111 wrote: post #410
CGMthrowaway wrote: post #396

Earlier quoted context omitted.

Before ACA, insurance had a more traditional "insurancey" role by excluding pre-existing conditions (aka managing moral hazard) in order to make money via premiums. In the "guaranteed issue" world post-ACA, insurance companies have pivoted instead to extracting as much money as they can from an increasingly vertically integrated ecosystem (PBMs etc)

You have the two mixed up. Insurance companies - even for group insurance like through your company where they always had to accept everyone - required you to have “continuing coverage” and not have gaps or you had waiting periods. The ACA also was written to enforce that through mandates and subsidies - a carrot and stick approach. The moral hazard was caused once there weren’t any mandates because of lawsuits by Re…

We are talking past each other. When I said moral hazard I'm talking about adverse selection(1), my bad if that was unclear. And I was responding to some comments about denial for pre-existing conditions, which as you point out is irrelevant for continuous coverage group policies. Removing the mandate penalty without also adjusting the pre-existing condition protections did introduce adverse selection in the current regime. None of that disqualifies my argument about the current state of affairs though re the business model of modern insurance companies

If you were just looking to shout "dems good GOP bad" and find others who agree with you, that's cool too.

(1)https://en.wikipedia.org/wiki/Adverse_selection

Re: The American Healthcare Conundrum

#556

Post by shimman »

steveBK123 wrote: post #369
linsomniac wrote: post #244

Healthcare administrative overhead in the US is pretty huge and has been for a long time. Back in the early 90s I worked on claim processing software and I recall it being discussed as being around a third of healthcare costs. 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. In 2021, the U.S. spent…

Middle men in processes add overhead, but on various analyses I've seen.. zeroing all middleman (insurance, PBM, etc) out still leaves us as far more expensive than the rest of the rich world. One thing which is not terribly popular to point out is that at least on procedure pricing - wages are way way higher here. Some of that is that education is far more expensive so then we need to pay very well to pay that down.…

Why are we attacking literal healers that want to be compensated fairly and have better standards for their patients?

The US is being pilfered by like less than 10,000 people so the federal government can give them corporate welfare worth $50 trillion over the decades [1] at the expense of workers.

But yeah... it's those damned nurses wanting to have fair wages and working hours that are the true enemy not the ghouls in SV that profit off of human misery... it's the nurses...

The idea that healthcare needs to be profit driven should be an idea excised from our collective intelligence.

[1] https://time.com/5888024/50-trillion-income-inequality-ameri...

Re: The American Healthcare Conundrum

#557

Post by cherryteastain »

youknownothing wrote: post #368
Turskarama wrote: post #353

Earlier quoted context omitted.

> In many ways the quality of care in the US is far better than what folks get elsewhere, which in part is probably why there isn’t a total patient rebellion How sure of this are we really? Other countries mostly have problems with emergency departments being full, but that's less because those emergency departments are worse and more because in the US people aren't going, they just stay home and hope they don't die.

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…

You can also get private medical insurance in the UK. The cost is usually much lower than the US and quality is decent. NHS acts as an anchor keeping down premiums.

Re: The American Healthcare Conundrum

#558

Post by shimman »

bloppe wrote: post #172
bandofthehawk wrote: post #159

Earlier quoted context omitted.

If the Japanese cashier makes half the amount, but spends only 1/3 on healthcare that still seems to favor Japan

Well sure, then you're kinda cherry picking data that could easily be considered within a margin of error to make a rather unconvincing point

It's cherry picking to describe the typical worker experience? You do realize that vast majority of Americans don't make more than $100k right?

Re: The American Healthcare Conundrum

#559

Post by titzer »

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?

Pittsburgh / UPMC.

Now try to schedule a colonoscopy. It'll probably take two or three months.

Re: The American Healthcare Conundrum

#560

Post by shimman »

rexroad wrote: post #461
Aurornis wrote: post #125

Earlier quoted context omitted.

The US is a wealthier country and wages are higher here than Japan. The median equivalised household disposable income of a US household is over twice that of a household in Japan. This is one of many reasons why it’s so misleading to compare prices across countries in a vacuum. All of the people doing the work for those education, transportation, and other services and all of their inputs aren’t going to work for Ja…

The wage adjustment is worth testing with data. Japan's GDP per capita on a PPP basis is roughly $47,000 versus the US at $80,000, a 1.7x income gap. The per-capita healthcare spending gap is $14,570 vs $5,790, a 2.5x ratio. Healthcare costs outpace the income gap by a meaningful margin even on PPP terms. The outcome data is what makes the adjustment argument hard to sustain. Japan has the highest life expectancy in…

Median salary in the US is barely $45k a year:

https://www.ssa.gov/oact/cola/central.html

So what you're describing is even worse.

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