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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#591

Post by downrightmike »

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…

Japan's economy imploded because it was doing better than the US and Japanese were buying big American names like Rockefeller Center, so the US forced Japan to destroy their currency, which popped the Asian miracle.

Re: The American Healthcare Conundrum

#592

Post by sixo »

twoodfin wrote: post #137
ipsento606 wrote: post #85

Earlier quoted context omitted.

> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be

Why is that inherently bad? Should I be able to buy fire insurance on pre-existing embers?

We as a society accept the insurance system as an implementation of "funding healthcare" because market capitalism is supposed to lead to lower prices, fair allocation of scarce resources, and innovation, among other things. That is, the insurance industry is a market solution to a moral problem.

If insurance companies then can wiggle out of covering pre-existing conditions, they're no longer solving the moral problem they were brought into the world to solve, and now we need some other solution to solve the rest of it. Then, whatever that other solution is, it's solving the hard part, so why not extend it to solve the whole thing and cut the insurance middlemen out of the economy entirely? What are they even doing at that point besides extracting a rent?

(This is one answer among many good ones to what is really a bad-faith question—health-insurance is not a lot like fire-insurance at all)

Re: The American Healthcare Conundrum

#593

Post by red-iron-pine »

ChadNauseam wrote: post #153
JKCalhoun wrote: post #144

Earlier quoted context omitted.

Too bad Walmart greeter isn't making "per capita GDP".

They make more than they would in Japan. But people can make $0 in any country. Regardless, part-time Walmart greeters are fortunately not paying full price for health insurance in the US.

put another way, they're so poor that the US gov has to subsidize their healthcare since they couldn't get insurance or care otherwise.

Re: The American Healthcare Conundrum

#594

Post by ethbr1 »

alistairSH wrote: post #580
ethbr1 wrote: post #501

Earlier quoted context omitted.

> 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?

In my experience Kaiser / the Blues have their issues (mostly inefficiency), but not nearly as many directly anti-patient incentives as United Healthcare et al.

Generally speaking, you get decent outcomes with {not for profit} + {efficiency/outcome based KPI}, because the primary thing you're fighting is apathy (not for profit) instead of malicious profiteering (for profit).

And capitalism doesn't particular lend itself to running an insurance company. Fundamentally, there's not that much that should change year-to-year at insurers than {actuaries / pricing}.

Have pharmacy benefits or all the other kooky for-profit inventions really improved patient experience and outcomes?

Re: The American Healthcare Conundrum

#595

Post by eigencoder »

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…

But that's not rugged individualism. It's just letting the market actually do its job, and let consumers and producers actually communicate a price

Re: The American Healthcare Conundrum

#596

Post by ethbr1 »

LorenPechtel wrote: post #582
ethbr1 wrote: post #501

Earlier quoted context omitted.

> 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.

Medicare Advantage is a clusterfuck from start to finish (denying more claims than Medicare while also costing taxpayers more), precisely because it tries to micro-manage KPIs.

If you want to look at them done correctly, look at the FEP program. High-level KPIs that are difficult to game (without actually improving service & outcomes) tied to financial incentivizes.

Re: The American Healthcare Conundrum

#597

Post by dsr_ »

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.

There are certainly locations in the US where the standard of patient care -- ignoring cost -- is world-class.

And there are certainly locatioms in the US where the standard of patient care is nowhere close to that, and would be easily beaten at any major hospital in any other first-class economy.

Re: The American Healthcare Conundrum

#598

Post by dsr_ »

fragmede wrote: post #530
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…

The catch is that Mark Cuban is now the one capturing the rewards instead of the now-unknown-to-me-in-the-wake-of -Luigi-Mangione healthcare tech company CEO

https://en.wikipedia.org/wiki/Stephen_J._Hemsley

You're welcome.

Re: The American Healthcare Conundrum

#599

Post by LorenPechtel »

onlyrealcuzzo wrote: post #366
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…

Health care is so broken that I think it will unbreak itself. You can eliminate most of the problem by mandating true cost billing by hospitals (get rid of their insurance mandated 500%+ markups to make it look like your insurance does anything at all besides make your care as costly as possible). As you said, it's oftentimes cheaper to buy drugs without insurance. The average person would quickly find out that insur…

And this is supposed to be an answer?

1) In many cases you are paying that high "markup" for the handling rather than the product.

2) Hospitals are typically not making much money. Available 24/365 costs. Deadbeats cost.

3) Yes, most people don't pay much healthcare in any given year. But you don't know what year they are going to.

4) I like the idea of it as a tax--but in the real world this always ends up with the fox guarding the henhouse. Because most people don't need much care in a given year it's easy to satisfy the majority of the population with poor quality care. The ones that see the failure aren't enough to change the outcome of the ballot box.

Re: The American Healthcare Conundrum

#600

Post by [deleted] »

onlyrealcuzzo wrote: post #565
46493168 wrote: post #540

Earlier quoted context omitted.

>You FIRST have to fix the system before you open up the floodgates. I don't see any reason to fix the system on a nationwide level. Let the individual states figure it out. There's things that the top 5 US states for healthcare have in common, and there's things that the bottom 5 US states have in common [0]. They know how to talk to each other if they want to know more. [0] https://www.commonwealthfund.org/publicat…

> I don't see any reason to fix the system on a nationwide level. Let the individual states figure it out. It's a problem because the nation already ineffectively covers the tail. The state shall not fix what is not a problem for the state.

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