71–80 of 244 posts
When there's lack of competition, one needs to look for artificial barriers. Ah, found it: "Intermountain executives said that they would seek approval to manufacture the products from the Food and Drug Administration, which has vowed to give priority to companies that want to make generics in markets for which there is little competition."
I always assumed it would be CVS that got into the game. There are are probably a dozen or so drugs that account for the majority of consumption. Flu vaccines, blood pressure, cholesterol, thyroid, insulin, asthma, progesterone, beta-blockers, gerd, etc. Providing these at minimum cost, as well as community public health services. Could be enormously cost effective. And extend general wellness and productivity many t…
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The real root problems with the system are that a tiny minority of very sick patients account for an overwhelming majority of treatment costs; that it's difficult to prevent this from happening; and that the current care structures make it hard to take early action to incentivize these patients to improve. It also is almost impossible to have a real discussion about this fact because it makes people uncomfortable.
There's a lot of moralizing in this, without numbers justifying it. Show me the evidence that an overwhelming majority of costs come from few recalcitrant bad actors vs things like cancers, expensive surgical or drug remedies of rare diseases, or just plain expensive end-of-life care (a somewhat separate discussion from the others, but a conversation that'll have to be had sometime). Without that... the costs will al…
"The real root problems with the system are that a tiny minority of very sick patients account for an overwhelming majority of treatment costs"
It's impossible to tell exactly what the parent comment meant any more precisely without clarification, whether they were talking about unnecessary over-consumption of resources (Americans have been over-healthcare'd for decades), or that eg cancer patients or elderly consume vast resources (as one would expect). However, it is of course the case that a tiny percentage of the population produces a very large share of the cost. The bottom 50% of healthcare consumers, are a mere 3% of the cost in the system. I don't know what the point of any of that is however, there are only ultimately two choices: go back to the old system that was far less expensive for the majority, but didn't properly cover about 1/3 of the population; or continue to shift toward universal healthcare with a fully distributed cost (which means significantly raising taxes on the middle class, as in every universal healthcare system).
"When it comes to America's spiraling health care costs, the country's problems begin with the 5%. In 2008 and 2009, 5% of Americans were responsible for nearly half of the country's medical spending. ... In 2009, the top 1% of patients accounted for 21.8% of expenditures."
https://www.theatlantic.com/business/archive/2012/01/5-of-am...
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But is the high cost of those surgeries a product of the broken system? I say yes.
In Canada, developing an accidental MRSA infection after a routine surgery will trivially turn a $5000 procedure into a $25,000 package of life-saving treatment and associated hospital stay. When things go bad in medicine, your bill grows really, really, really fast. Also, unlike a mechanic with a car, your doctor can't stop working on you after they blow through their quoted budget and ask if you still want to pay f…
Even if nobody had insurance and shopped around, the US style of billing would lead to very little downward pressure on prices, as it's impossible to have a clue of what you are going to pay.
Many businesses, including freelance developers, will not charge per hour, but by job. You jack up the price to end up ahead in the case of typical complications, but there are cases where you lose money, and that's on you being bad at estimates and billing. Billing by procedure in the medical system is just setting the wrong incentives, and a recipe for maximum waste, if not downright fraud.
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Some, if not most, of this is a result of the insurance system. The insurance companies only pay x% of any given item, therefore the hospitals have to jack prices through the roof to collect enough to survive. The problem with our healthcare system is that too much money goes to drug companies, medical device makers, and insurance companies and not enough makes it to the people actually providing the care. Its a bit…
Oh please. Doctors in the US get huge amounts of money, to the point they're the actual 1%. You don't see anything like this in OCDE countries. Doctor associations all across the country create enormous barriers to the opening of new medical schools to avoid competition. Don't get me wrong, medical doctors are generally good hard working people. But we need to acknowledge they're part of the problem.
A surgeon in CA earns on average about $400k while its peer in UK makes $100.
4x the cost of labor should partially explain why a surgery can easily cost 6 figures.
Earlier quoted context omitted.
Some, if not most, of this is a result of the insurance system. The insurance companies only pay x% of any given item, therefore the hospitals have to jack prices through the roof to collect enough to survive. The problem with our healthcare system is that too much money goes to drug companies, medical device makers, and insurance companies and not enough makes it to the people actually providing the care. Its a bit…
"The problem with our healthcare system is that too much money goes to drug companies, medical device makers, and insurance companies and not enough makes it to the people actually providing the care. " The surgeons I see through work have very nice houses and 100k+ cars so they are part of this.
Median surgeon salary in CA is $400K. In UK, a surgeon gets about $100K.
Let's say they succeed in launching a new generics company. Ten years down the line they will divest in order to build each hospital a shiny new geriatrics wing. Within six months the spun-off drug company will jack up prices and the cycle will continue.
From that perspective, does any country have their own publicly owned pharmaceutical manufacturer? It's the kind of thing the NHS should do, since they control most other aspects of health care, but I don't think they do. There's so little benefit to competition with generics, you may as well have that vertical integration to at least provide what hospitals need.
It's not quite the same as manufacturing it themselves, but the bulk buying does bring the price down quite substantially.
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On the other hand, when I bring my car to an auto shop they give an estimate of cost before actually doing any work.
The people I've known who needed expensive care (high-5-figures or 6-figures) were made well aware of the costs in advance, because at that point the facility wants to make sure your insurance will cover it beforehand . But it doesn't do that much for the patients - comparison shopping doctors and facilities is extremely stressful stuff and a lot of people would rather not think about it, even when some outcome info…
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On the other hand, when I bring my car to an auto shop they give an estimate of cost before actually doing any work.
Your car is unlikely to experience life-threatening complications with a nearly unbounded upper cost while it's being fixed. Your body is. A routine surgery can absolutely turn into a hundred-thousand-dollar nightmare. Never mind that a mechanic has a much better understanding of a car, then a doctor does of a human body.
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There's a lot of moralizing in this, without numbers justifying it. Show me the evidence that an overwhelming majority of costs come from few recalcitrant bad actors vs things like cancers, expensive surgical or drug remedies of rare diseases, or just plain expensive end-of-life care (a somewhat separate discussion from the others, but a conversation that'll have to be had sometime). Without that... the costs will al…
The parent comment was correct when they said this: "The real root problems with the system are that a tiny minority of very sick patients account for an overwhelming majority of treatment costs" It's impossible to tell exactly what the parent comment meant any more precisely without clarification, whether they were talking about unnecessary over-consumption of resources (Americans have been over-healthcare'd for dec…
Can't find data right now, but a generally healthy person will spend most of it's lifetime healthcare expenses on its last 2 years.
NHS adopts this measures in the so called death panels. So it can have money to fund preventive care and promote healthy lifestyles.