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The American Healthcare Conundrum

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571–580 of 690 posts

Re: The American Healthcare Conundrum

#571

Post by georgeburdell »

jimt1234 wrote: post #546
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…

I have never heard of shingles as a chronic condition. Will the vaccine not work?

Re: The American Healthcare Conundrum

#572

Post by nradov »

crazygringo wrote: post #414
nradov wrote: post #216

Earlier quoted context omitted.

No, that's not how it works. Due to the ACA minimum medical loss ratio, most health plans have no direct financial incentive to deny treatment.

They still do, because that's a minimum . If they have to spend 80% of premiums on medical care, then they make a lot more profit by spending just that mandated 80%, as opposed to 85% or 90%. Which they can achieve by denying claims. That's the direct financial incentive.

You seem to be confused about basic arithmetic. First of all, the minimum MLR for most health plans is actually 85% (and most come in significantly above that for competitive reasons). And due to the MLR, health plans actually have a perverse incentive to approve more claims because 15% of a large number is more than 15% of a small number. This is one of the many reasons why total healthcare costs have continued to grow faster than inflation.

Re: The American Healthcare Conundrum

#573

Post by lesuorac »

orangecat wrote: post #478
snarf21 wrote: post #404

Earlier quoted context omitted.

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…

The #1 thing we need to do is make it illegal for your healthcare to be tied to your employment Yes. Or at the very least, stop making it mandatory. Health insurance should work like literally everything else: your employer pays you money, and you use that money to buy it.

> Health insurance should work like literally everything else

Eh, everything else varies significantly by company. Tradesmen have to buy their own tools. FANG provides free lunches.

I've yet to see an argument for why a singular person is going to be able to do a better job making healthcare more efficient than a company that shells out millions of dollars for that line item. Like why doesn't HR drop the health insurer that just keeps lock-step increasing prices? And why doesn't that reason apply to an individual?

Re: The American Healthcare Conundrum

#574

Post by bhelkey »

adventured wrote: post #551
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…

I don't agree with your framing but let's accept it for the sake of this conversation.

The UK and Japan are not the only countries with more efficient healthcare systems than the US. We can look at a variety of countries, some of which have a higher GDP per capita than the US.

If we look at a graph of 'healthcare spending per capita' by 'GDP per capita' [1], we can see that the US is a massive outlier spending ~2x countries with comparable GDP per capita.

In fact, the US has a higher healthcare spending per capita than every other OECD country. By a large margin.

[1] https://www.healthsystemtracker.org/chart-collection/health-...

Re: The American Healthcare Conundrum

#575

Post by snarf21 »

shimman wrote: post #549
snarf21 wrote: post #404

Earlier quoted context omitted.

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.

I think politically it is an easier sell than medicare for all or government only healthcare.

Re: The American Healthcare Conundrum

#576

Post by mekdoonggi »

SoftTalker wrote: post #564
mekdoonggi wrote: post #553

Earlier quoted context omitted.

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…

The value is that it is there. Most insurance isn't used, or ever pays back what you paid into it. That's the point; that's how it's a viable product. There's no way to insure old, sick people, that's why the government does it. It would be like selling automobile insurance only to drunk drivers, or selling homeowners insurance to people whose houses are already on fire.

There's a way to insure old, sick people (who were once young and healthy) and it's how every other developed nation does so at lower cost. How is it lower cost? the profits from the young and sick don't get shoveled to private corporations for performing the exact same function at higher cost.

Re: The American Healthcare Conundrum

#577

Post by [deleted] »

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…

[deleted]

Re: The American Healthcare Conundrum

#578

Post by yeahwhatever10 »

bcooke wrote: post #220

This project reminds me of a book I highly recommend called An American Sickness. It sheds a lot of light on the same sorts of issues. One underlying, perverse incentive behind many of the problems is that insurers are regulated based on percentages of spending rather than total costs. The US passed laws meant to limit marketing and overhead that tied insurers economics to the size of the overall medical bill... whic…

So same as realtors and most other brokers.

Re: The American Healthcare Conundrum

#579

Post by alistairSH »

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.

There are degrees of freedom, but within the American framework, medical care is on the less-free end of the spectrum.

Aside all the insurance stuff, you cannot open an MRI imaging lab or similar without a letter of need from the local government. The supply side is quite literally gated by existing players in the market (via campaign bribes and similar).

Re: The American Healthcare Conundrum

#580

Post by alistairSH »

ethbr1 wrote: post #501
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…

> The entire point of the insurance business model is to avoid paying for [human well-being] as much as possible For-profit health insurance. Which imho should be illegal. A lot of the US' quasi free-market, in-name-only health insurance problems would be solved by: 1. Requiring all insurers to be not-for-profit (critically: also including all corporate owners of insurers too) 2. Tying financial incentives and disinc…

Does "not for profit" actually solve anything? Aren't most private universities also not-for-profit, while also being major real estate owners, developers, managing massive investment portfolios, etc?
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