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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#601

Post by Vrondi »

soupfordummies wrote: post #477
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…

Free idea: AI-powered "agent" that fights health insurance and medical bills for you.

The people writing the AI agents are being paid by the insurance companies.

Re: The American Healthcare Conundrum

#602

Post by LorenPechtel »

onlyrealcuzzo wrote: post #496
throwaway173738 wrote: post #405

Earlier quoted context omitted.

Who would you choose not to cover? The sick? I hate to break it to you but insurance is meant to be a tax on the entire risk pool. What changed after the ACA is we couldn’t kick anyone out of the risk pool for getting sick.

> Who would you choose not to cover? The sick? You didn't read the post. The sick are mostly the old (if you're looking at total spending), and they are already covered by Medicare. The sick young are a minority, and are often times covered by Medicaid. If the state covers the tail end and assuming they aren't covered already by Medicaid, there just isn't that much spending remaining. They can get private insurance t…

The premium charged for the sick, young is high enough that your math doesn't make sense. ACA plans have to pay out 80%. Since I'm paying $11k/yr for my ACA plan they are clearly paying out at least an average of $9k in claims for the average member of my cohort. (And the reality is worse as they are limited in the ratio between young and not so young, this effectively makes the young subsidize us not so young.)

Re: The American Healthcare Conundrum

#603

Post by LorenPechtel »

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.

Paying for the preventative is because it's been demonstrated that doing so reduces costs overall. The amount involved isn't all that much, it's not the driver of the costs.

Re: The American Healthcare Conundrum

#604

Post by ChadNauseam »

red-iron-pine wrote: post #593
ChadNauseam wrote: post #153

Earlier quoted context omitted.

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.

I'm curious what you're implying. Is there a country where the poorest person is so rich they can get all the insurance and care they require without government subsidy?

Re: The American Healthcare Conundrum

#605

Post by LorenPechtel »

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…

Why do you think we can??

We already have mandated covering the things where spending now saves more down the road. And the medical community has standards of proper care. If there was a way to reduce costs by improving patient health it would already have been done!

Think we haven't learned a fair bit about our own health issues? If there was some magic answer a lot of people would have found it.

Re: The American Healthcare Conundrum

#606

Post by LorenPechtel »

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.

Lots of people without a lot of assets would gamble.

The current system exists because yours is even worse.

Re: The American Healthcare Conundrum

#607

Post by paulddraper »

rexroad wrote: post #69
levocardia wrote: post #18

Earlier quoted context omitted.

Also, commercial insurers are essentially cross-subsidizing Medicare: the higher revenue from commercial insurers is partly why Medicare can be paid less. Similar dynamics exist with drug prices: the high US cost is a cross-subsidy to other countries. Maybe this is good (someone's got to fund R&D), maybe this is bad (it's a net wealth transfer to the elderly), but it's an important part of the dynamic either way.

The cross-subsidy argument is one hospitals use to justify high commercial rates: "Medicare underpays, so we have to make it up on commercial." The HCRIS data lets you test this. If cross-subsidization were the full story, you'd expect cost-to-charge ratios to be tight — hospitals would charge commercial just enough to cover the Medicare shortfall. Instead, the median markup is 2.6x across all hospitals, and 3.96x fo…

Of course it's not just to cover costs...

Who says to being paid more?

Re: The American Healthcare Conundrum

#608

Post by paulddraper »

piva00 wrote: post #298
nradov wrote: post #44

Earlier quoted context omitted.

If you want to understand the hidden cross-subsidies in the US healthcare financing system then a good place to start is the book "The Price We Pay: What Broke American Health Care--and How to Fix It" by Dr. Marty Makary. https://www.bloomsbury.com/us/price-we-pay-9781635574128/

Looked into a summary of the book, with notes by chapter and haven't found any mention of the American system subsidising pharma prices for other countries. It mentions a lot PBMs (like CVS, Cigna, etc.) as the culprit for high prices in the USA and talks about how when pharmacies are allowed to compete the prices do go down. From the book it seems much more like the American public is being taken advantage of by the…

That book is very good, but yes it is US-only.

If you want the international perspective, see "The Price of Global Health" (Schoonveld) or "The Right Price: A Value-Based Prescription for Drug Costs" (Neumann, et al).

The short version is that the high price of drugs in the U.S. is the driving force in drug research.

Re: The American Healthcare Conundrum

#609

Post by LorenPechtel »

bluGill wrote: post #340
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…

The reason you tell several different people why you are there is because that is important. if a system doesn't they need to start! people often remember things when asked latter. this gives more opportunity to ask about everything you care about even if you forget the first time. people sonetimes grab the wrong chart. This helps ensure that they check for things that matter to you and not someone else - your histor…

Or the patient makes the mistake. I've seen it happen:

My wife has a foreign name--an English speaker coming at it cold is going to butcher it. Someone gets it right--either they've been told or they speak some Chinese. (It's not hard to say, but you have to know the Chinese Pinyin rules to get it right.) Over the decades we have grown used to responding to anything in the ballpark and then sitting back down if someone else responds. Oops--L shaped waiting room, we didn't see the somebody else. She ended up in back, the check caught it there.

Or look at my own name. That's the male spelling--but most people don't realize there is a male spelling. It's caused confusion over the years.

Re: The American Healthcare Conundrum

#610

Post by LorenPechtel »

mlrtime wrote: post #331
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…

Isn't this true across other sectors as well? NYC DOE spends $42,000 per child on education ~half of that is administration costs. https://apps.schools.nyc/dsbpo/sbag/default.aspx?DDBSSS_INPU...

Huge data problem here. How much of it is special education? There's a huge division here, the per-capita spending is not remotely what is spent on the average student in the classroom.
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