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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#621

Post by LorenPechtel »

raw_anon_1111 wrote: post #152
twoodfin wrote: post #137

Earlier quoted context omitted.

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

If you live long enough, you will have a pre existing condition. The way it was suppose to work with the original mandate is that everyone had to be insured either through their employee or the exchange. So you couldn’t just buy insurance when you were sick. The Supreme Court struck that down. If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insu…

And if you had an expensive dependent better work for a big company. Saw it happen--wife lost her coverage through work because they had an employee with an expensive kid. Next year insurance wasn't offered.

Re: The American Healthcare Conundrum

#622

Post by phil21 »

estearum wrote: post #504
triceratops wrote: post #481

Earlier quoted context omitted.

> Because it makes pretty much no economic sense for anyone else to do it I think other funding models simply haven't been explored. I'll pull one out of my ass. The hospital does it themselves. In exchange the doctor works at the hospital for the next N years, or pays a contract break penalty. The hospital can pay the doctor somewhat less than market rate and doesn't have to deal with staff turnover. It should be ob…

Residency training costs like $750,000 to $1.5MM per physician Primary care doctors would have to work 12-15 years while giving up 25% of their gross salary just to pay for the residency program. They'd also have to pay x% of their salary to pay for their debt from med school training before the residency. People just wouldn't go into the field, which is already happening even in a world where the residency is funded…

I find it completely unbelievable that residencies are not a profit center for most teaching hospitals. The residents do almost all the day to day work with a half dozen of them reporting to a single attending physician.

It’s not like you get a discount if you’re seen by a resident vs attending either. Sure the first year or maybe two a resident needs a lot of close supervision, but not nearly as much as people think happens.

I would bet dollars to donuts that the vast majority of patients seen by a resident have no clue. They simply call them doctor.

My bet is it’s all accounting tricks. You’d be utterly incompetent not to somehow make a profit on 60-80hrs/week of basically free doctor labor even if those are junior doctors. They generate massive amounts of billable services. Plus they are basically guaranteed to work for you for 4+ years, aside from the few that wash out.

Re: The American Healthcare Conundrum

#623

Post by pif »

joe_mamba wrote: post #590
pif wrote: post #567

Earlier quoted context omitted.

> 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?

She taught me to only speak the truth.

Re: The American Healthcare Conundrum

#624

Post by phil21 »

mlmonkey wrote: post #566
onraglanroad wrote: post #228

Earlier quoted context omitted.

> the existence of America's prescription drug markets drives the new innovative drugs that the rest of the world picks up for cheap. That's the ludicrous propaganda that you've been fed but you really should be intelligent enough to dismiss it. The world would get along just fine without you overpaying for your drugs. You pay for marketing costs.

Agreed. I mean, where did the COVID mRNA vaccine come from? Which company makes the GLP-1 inhibitors like Ozempic and Mounjaro? Are these American companies?

Mounjaro and the next generation of soon-to-be best in class GLP-1 (Retatrutide) are Ely Lilly based out of the US.

Novo makes Ozempic, and is out of Denmark.

The mRNA stuff is a bit more murky, depends on how you squint. Best assignment there would be a split between the US and Germany I suppose?

Re: The American Healthcare Conundrum

#625

Post by throw0101c »

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?

> Does "not for profit" actually solve anything?

Ask the Swiss and/or Germans? AIUI there are (aspects of) their health insurance that are mandated to be non-profit.

Perhaps someone from one of those countries can give more details.

(IIRC, the Swiss only 'recently' moved to universal coverage: in the 1990s?)

Re: The American Healthcare Conundrum

#626

Post by openclaw01 »

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

[dead]

Re: The American Healthcare Conundrum

#627

Post by dinkumthinkum »

bandofthehawk wrote: post #450
gnz11 wrote: post #392

Earlier quoted context omitted.

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...

I think this difference mostly disappears if you group Americans by wealth. So wealthy Americans have similar life expectancies to those in other countries. It's really the poor that are most affected by our dystopian healthcare system, which is probably a big part of why it never gets fixed.

Hvae you considered that America is a much larger and much more diverse country that these other countries and and it is very different social norms? Obesity is a major problem in America and it is not the fault of the doctors. I wonder if this has anything to do with it?

Re: The American Healthcare Conundrum

#628

Post by throwaway173738 »

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…

I’m not understanding how this is better than just putting everyone in one risk pool and having the young and healthy subsidize the old and sick? You’re basically saying if you’re healthy don’t carry any insurance and just rely on the government and taxes for catastrophic coverage. And then as soon as you get sick you’re supposed to apply for this coverage that only applies when you’re sick? The biggest problem with Medicaid is that you have to prove you can’t get the means to pay for healthcare which is essentially impossible without paying for healthcare.

So now you have this huge apparatus for intake and for rejecting people who are not sick enough or old enough but who can’t conventionally afford care. And you have to pay for that apparatus. Why would that be any better for the young people, other than seemingly using their taxes to make cruel decisions about a portion of the old and sick instead of simply providing care?

And what’s worse is a lot of those sick people wouldn’t have gotten that sick if they could pay for preventative care. So now in your system you have this huge group of people who have through lack of means let their illnesses and maladies get so severe that they can’t afford to treat. The whole point of preventative care is to keep people healthy so they don’t become a cost burden to the insurer. That’s why we pay more relative to what it costs. And it’s a hedge for us. We might find ourselves among the desperate ill some day without the means to pay for treatment.

Re: The American Healthcare Conundrum

#629

Post by glenngillen »

dabiged wrote: post #367
alexfoo wrote: post #359

Earlier quoted context omitted.

I guess that's because many/most countries don't have the concept of a private emergency department. It doesn't really matter how much money you have if you have a broken leg as you'll be queuing up with everyone else for the triage and initial treatment. I have amazing private healthcare coverage in the UK through my employer. I've had certain treatments done in under a week where the NHS waiting lists for the same…

Australia reporting in. We have private emergency rooms. We call them urgent care and you can go and see a qualified physician with allied health services (radiology, pathology). If they can fix you up they will. If not you get transferred via ambulance to the nearest public hospital and triaged as required. I took my kid to one last weekend as they had been diagnosed by our family Dr as having pneumonia. The emergen…

Also Australia reporting in.

I've unfortunately had a number of emergency visits over the past few years. I'm a bit torn on the public vs private situation. For certain classes of issue (e.g., broken bones) my friends who work in hospitals have repeatedly said they'd go public purely because the volume of patients those surgeons have to treat daily means the teams in the public systems are typically incredibly experienced. And yet, I smashed my hand to pieces mountain biking on a holiday weekend and when I arrived at the ER the place was absolutely rammed and it was going to be a many hours wait to even get triaged. We got straight back in the car and drive to the private ER 5 minutes down the road and were seen immediately.

In the moment I was incredibly appreciative of that option. It does make me feel uncomfortable that it was only an option because I could afford to pay to jump the queue though.

Re: The American Healthcare Conundrum

#630

Post by gamblor956 »

CWuestefeld wrote: post #421
gamblor956 wrote: post #237

Earlier quoted context omitted.

2 FTEs vs a department. Most hospitals have entire departments to handle insurer coding and some even have departments just to handle insurer disputes.

to handle insurer coding Coding is a different layer. Everything needs coding, whether for gov't or commercial payers. So the folks doing this coding can't be separated out for commercial. In fact, it's kind of the opposite: CPT codes (for procedures) - these are defined by AMA, but mandated by CMS (i.e., Medicare/caid). Because the gov't mandated them, the commercial payers adopted them too. HCPCS codes (equipment a…

And yet my point still stands. Hospitals employ more people to handle private insurer coding than they do to handle Medicaid.
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