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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#581

Post by alistairSH »

gnz11 wrote: post #392
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…

I'm sure there is a lot of nuance but long term healthcare outcomes are generally lower in the US compared to other countries. https://www.healthsystemtracker.org/chart-collection/quality...

Personal anecdote... My uncle is an auto mechanic in Scotland (Scottish NHS) and my brother-in-law is an auto mechanic in WV, USA.

Both have similar health care outcomes - they have ready access to quality care, specialists, etc. ER/A&E is available. The biggest difference is the perceived cost and stress incurred by that cost. My uncle doesn't give much thought to health care - he can work, retire, whatever and be assured a reasonable level of care. My BIL will work to 65 or beyond, fighting red-tape the entire time, then retire and still have to deal with supplemental programs.

Looking at another uncle, who was a small business owner in Scotland vs my father (also small business owner), it's similar to above, just with more money at stake. Uncle also purchased additional insurance on top of NHS for faster access to selective care, still cost less than insurance in the US, even after accounting for tax differences.

American's kid themselves when they say the Western Europe has higher taxes. Once you account for medical care, college funding, and other similar things, it's pretty close.

Re: The American Healthcare Conundrum

#582

Post by LorenPechtel »

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…

Big problem here: You get more KPI, not better outcomes. Things like no doctor being willing to risk working a high risk patient.

We have already seen it with things like Medicare Advantage plans doing sign-up meetings on the second floor of buildings without elevators etc.

Re: The American Healthcare Conundrum

#583

Post by SoftTalker »

tmountain wrote: post #532
SoftTalker wrote: post #521

Earlier quoted context omitted.

If you can pay cash without insurance, then you don't need the insurance. Insurance is (should be) addressing the risk of unexpected expenses that you cannot afford. Not predictable, small expenses that everyone has.

This ignores catastrophic scenarios.

That is included in "unexpected expenses that you cannot afford"

Re: The American Healthcare Conundrum

#584

Post by LorenPechtel »

Turskarama wrote: post #353
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…

> 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.

Simple test: The reports saying the UHC systems are better always are using statistical games. If they were really better why would they put their thumb on the scale?

Things like making 20% of the score "fairness"--as in UHC. And hiding the fact that most of the life expectancy difference is infant mortality and most of the difference in infant mortality is a reporting issue: infant mortality + stillbirth produces a far flatter plot. Thus much of the difference is whether it's considered to have died before birth or after birth.

Re: The American Healthcare Conundrum

#585

Post by LorenPechtel »

nicoburns wrote: post #372
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…

I think this is mostly a problem with state funded healthcare budgets being cut (relative to population demographics) in these countries. If the UK or Spain spent anywhere even close to what the US spends on healthcare (per capita), I have no doubt that it's healthcare provision would be just as good. In the UK, healthcare provision was notably dramatically better 20-30 years ago under the same system (except for les…

The problem is that it always happens. There's no such thing as comparable funding.

Re: The American Healthcare Conundrum

#586

Post by rayiner »

shimman wrote: post #560
rexroad wrote: post #461

Earlier quoted context omitted.

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.

The above was comparing the average in Japan to the average in the US. If you want to compare medians, it’s about $43,000 in the U.S. (2023) versus 3.96 million Yen (2025). See: https://e-housing.jp/post/average-salary-in-japan-2024-insig.... At current exchange rates that’s about $25,000. So that’s the exact same 1.7x ratio as for the averages.

Re: The American Healthcare Conundrum

#587

Post by simonh »

ciupicri wrote: post #543
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 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.

Same in the UK.

In the USA the government health programs for people in low incomes, children and pensioners cost about as much as a typical European single payer health system. Then tax payers get to pay to be gouged by health insurance companies to get any cover for themselves.

Re: The American Healthcare Conundrum

#588

Post by LorenPechtel »

gnz11 wrote: post #392
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…

I'm sure there is a lot of nuance but long term healthcare outcomes are generally lower in the US compared to other countries. https://www.healthsystemtracker.org/chart-collection/quality...

So we do better at actually delivering care, they do better at getting it delivered to everyone.

Re: The American Healthcare Conundrum

#589

Post by unclad5968 »

WarmWash wrote: post #401
unclad5968 wrote: post #249

Earlier quoted context omitted.

Having worked in medicine, I agree about providers. People who probably got in it to help people burn out immediately and become like the rest of us looking for the best paycheck with a tolerable workplace. Insurance companies make plenty of money though. Cigna makes $7-8B per year and pays a decent dividend.

They pay a 2% dividend and the stock is up 10% in 5 years. That's a D tier stock.

I don't think how it relates to other stocks is meaningful to the question of whether or not insurance companies make money.

Re: The American Healthcare Conundrum

#590

Post by joe_mamba »

pif wrote: post #567
joe_mamba wrote: post #464

Earlier quoted context omitted.

>This is unnecessarily confrontational. Why? >but Scandinavia and much of northern Europe That's like 3-5 out of 195 countries and only 0,3%-0,5% of the world's population. Being born there is like winning the lottery so maybe take that into consideration when arguing with such examples since that's not the norm. Like what are the odds that people you talk to online are part of that 0,5%? So who's the one being needl…

> I'm talking from the perspective in Europe > > No law maker asked about the major decisions the EU made. Idiot brexiteer talk...

Did your mom teach you to talk like that?
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