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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#631

Post by adrianN »

anon7000 wrote: post #373
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…

> 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…

Human well-being should reduce medical expenses, so at least in theory it should be a goal of insurance companies.

Re: The American Healthcare Conundrum

#632

Post by adrianN »

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.

Patient outcomes should provide reasonably hard data for comparisons. Life expectancy at least is not vastly better in the US, how about other metrics?

Re: The American Healthcare Conundrum

#633

Post by adrianN »

dinkumthinkum wrote: post #627
bandofthehawk wrote: post #450

Earlier quoted context omitted.

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?

Obesity is a problem in lots of countries.

Re: The American Healthcare Conundrum

#634

Post by evandijk70 »

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?

It doesn't.

The Netherlands has a system with both not-for-profit and for-profit insurers, that works reasonably well.

- Transparent, identical rules for minimum coverage and strict rules on minimum and maximum deductible for all insurers and insurees. - Mandatory coverage for everyone (just like liability insurance is mandatory for cars in the US) - Insurers do not have the right to refuse any applicants based on pre-existing conditions - Insurers directly negotiate with hospitals on rates. Emergency care has to be covered regardless of whether hospitals are in network or not.

Re: The American Healthcare Conundrum

#635

Post by boppo1 »

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…

This kind of bureaucracy sounds like the stuff my teachers criticised communism and socialism for in school. Isn't our 'capitalist' system supposed to thwart this?

Re: The American Healthcare Conundrum

#636

Post by kdheiwns »

glitchc wrote: post #424
kdheiwns wrote: post #294

Earlier quoted context omitted.

This is absolutely not true. I pay the equivalent of about $40 for X-rays and blood tests. A simple consultation is about $15, if that. I recently got diagnosed with asthma, and the whole set of tests plus a month of medicine came out to about 6000 yen, which I suppose is $40. The only reason you would pay that much is if you're visiting a private no-insurance clinic and not using insurance. And private clinics prett…

The whole debate is about what insurance companies are paying for those services, right? It's when one walks in without insurance that you see the true cost of the service. > The only reason you would pay that much is if you're visiting a private no-insurance clinic and not using insurance What alternatives does a tourist have? If Japan truly had cheaper procedures, it would see a huge uptick in medical tourism. Ther…

A country has no obligation to make its medical system cheap and affordable for tourists. Your mention of "foreigner" was wrong because foreigners have access to all the same health care as a local.

No matter what country on earth you go to, a tourist will pay more than a resident for doctor's visit. That's why travel insurance exists. And health tourism is a disaster for any country since it results in high paying foreigners lining up for treatment and locals being neglected. There's a reason primarily poor and corrupt countries offer it for regular treatments, putting aside vanity treatments (balding, rhinoplasty, etc)

Re: The American Healthcare Conundrum

#639

Post by mekdoonggi »

b_t_s wrote: post #493
onlyrealcuzzo wrote: post #391

Earlier quoted context omitted.

> You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it, which is when they get old. I strongly think that covering everyone in the existing system is not the best way to go. The existing system is designed to cost as much as possible, and we have way too much demand for treatment (as is) and not enough supply. ER…

>ER wait-times aren't 2-4 hours just because . ER wait times are long because ERs are the only place in the country where we effectively have medicare for all, albeit in a particularly perverse and dysfunctional form. Everyone gets treated at the ER even if they're broke & uninsured as long as they're willing to wait long enough. Now imagine if those folks could go to any primary care doc or even use One Medical, CVS…

Agreed. We all collectively understand that we can't allow people to die in the streets because of their lack of health insurance. We already have universal healthcare, we just have the worlds dumbest way to pay for it.

Re: The American Healthcare Conundrum

#640

Post by Retric »

lotsofpulp wrote: post #323
rexroad wrote: post #71

Earlier quoted context omitted.

The MLR incentive question is one I'm digging into for a future issue. The short version: the ACA's 80/85% MLR floor was supposed to constrain overhead, but vertical integration changed the math. When UnitedHealth's Optum division provides services to UnitedHealthcare's members, those internal payments count as "medical expenses" for MLR purposes. The money stays in-house but reports as care delivery. On the denial r…

> That gap between the overturn rate and the appeal rate is where the profit lives. Or doesn’t live. https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g... All the other managed care organizations have similar 2% profit margins. It is funny seeing complaints of excess profit margins from businesses earning 2%, that compete against non profits, from people on a forum composed of employees of tech businesses e…

Profit margins are difficult to compare across industries, game developers on average have great profit margins in part because all the studios that fail quickly stop counting.

Grocery stores on the other hand are a known as a low margin business, but as people constantly need more food every month it can be really stable. Further as most stock turns over multiple times a month your return on capital can be extremely high. Even better during a downturn when people buy 20% less food you also need to buy 20% less stock and employ fewer people to stock shelves etc, which makes your profits far more resilient.

Suddenly grocery stores are looking like a much better investment than making games.

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