Why Americans Spend So Much on Health Care–In 12 Charts • Hacker News Board

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#71

Post by RightMillennial » Tue, Jul 31, 2018, 3:43 PM UTC

sv123 wrote: post #61

malvosenior wrote: post #31

Earlier quoted context omitted.

So the democrats are not to blame for implementing it? I don't see how you can single out any particular party for this situation and if I had to, I'd go with the people that actually jacked up my premiums (democrats).

The democrats big mistake was trying to compromise with the republicans, who still refused to work on it. it's clear the whole system is borked, and I only see one party at least trying to do something about it.

What compromise? The ACA passed the House [1] and Senate [2] without a single Republican vote.

[1]: http://www.washingtonpost.com/wp-dyn/content/article/2010/03...

> The House voted 219 to 212 to approve the measure, with every Republican voting no.

[2]: http://www.washingtonpost.com/wp-dyn/content/article/2009/12...

> Vice President Biden presided over the 60 to 39 party-line vote, ...

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#72

Post by richmarr » Tue, Jul 31, 2018, 3:43 PM UTC

intended wrote: post #18

rayiner wrote: post #15

Earlier quoted context omitted.

Do democratic politicians have some sort of training in maintaining the farce that more things should be handled by government, when governments in Illinois, California, New York, etc.--democratic strongholds where Republicans cannot be pointed to as the scapegoats--are on the verge of bankruptcy? I don't think, deep down, republicans think the current system is better. They just don't trust whatever replaces it won'…

It doesnt matter. These are just the general American talking points. Fortunately since this is a global forum, people can point out that the situation in AMerica is farce. The basic stats are just solid - every first world country does better. You guys have the worst of all worlds, and because of America's prediliction for everything market oriented, and the absurd partisanship - you have no solutions, and are ok wi…

Not to mention the fact that companies can write off insurance contributions against tax, and individuals can recieve that benefit without paying income or payroll tax on it. In effect that's a subsidy in favour of the middle classes and 1% to the tune of "between $174 billion and $429 billion over a six-year period".

https://www.nytimes.com/2017/07/07/health/health-insurance-t...

(Edited to include the missing point about income/payroll)

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#73

Post by howard941 » Tue, Jul 31, 2018, 3:44 PM UTC

whatok wrote: post #41

howard941 wrote: post #12

> Consumers, meanwhile, buoyed by insurance and tax breaks, have little idea how much they are really spending and little incentive to know underlying costs. Almost weekly there's another post showing that consumers literally cannot find out costs usually because the provider cannot supply it. It's time to put a stake in the heart of the recurring blame-the-consumer trope.

Even if you got complete disclosure of costs, there is no incentive for consumers to negotiate costs because of insurance coverage. Sure, rates go up but that's a detached and opaque process.

A piece of anecdata on what happens when it's not as opaque: I took the script for a lumbar MRI to a standalone imaging chain advertising low costs. The phone quote was 1/10th the price quoted by the hospital. What puzzled me was that although the imaging place accepts my insurance it asked for $395 if I wanted payment to apply against my insurance deductible but only $275 if I paid without going through the insurer. Was the delta reflecting the imager's cost to file a claim? They couldn't tell me. I wish there were ombudsmen to turn to.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#74

Post by ElmntOfSurprise » Tue, Jul 31, 2018, 3:44 PM UTC

The charts are not really "Why Americans Spend Much on Health Care", just "Americans Spend Much on Health Care (or More than Others and More than They Used To, Anyway)". Believable causes that I have read being suggested are "demographics", "lack of single payer health care", "unhealthy lifestyle", "inefficient allocation of resources towards terminally ill patients", "Americans pay for drug research that inhabitants of other countries get for free", "expensive safeguards against malpractice lawsuits". Lobbying, taxation and opacity to consumers seems like a poor explanation of why healthcare in the US is so much more expensive than in other countries, and more expensive than in the past.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#75

Post by malvosenior » Tue, Jul 31, 2018, 3:46 PM UTC

chrisbennet wrote: post #70

malvosenior wrote: post #13

Earlier quoted context omitted.

You do realize that it was under democratic leadership that healthcare costs shot up so much. Obamacare increased my monthly payment almost 2X.

Health care costs were (and are) increasing. The rate of increase slowed under the last administration. [1] Your costs may have gone up if you were part of a low risk group because under Obamacare, low risk individuals were made to share the cost of other insureds who were stupid enough to get old, be poor or have existing health issues that made them unprofitable for insurance companies to insure. Obamacare also rem…

> low risk individuals were made to share the cost of other insureds

Yes, that's a huge part of the problem right there. If I'm healthy and work hard to be healthy, I have zero interest in paying for someone else's health problems. I have my own family to feed and we're talking about massive amounts of money that I get no direct benefit from.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#76

Post by ta1234567890 » Tue, Jul 31, 2018, 3:48 PM UTC

y-c-o-m-b wrote: post #43

Healthcare costs are by far the #1 reason why I want to move out of the U.S. as soon as possible. I am well off, but due to recent experience I have a major anxiety about going bankrupt from another unexpected health issue. I had emergency spine surgery last year and despite coordinating everything I could to stay in network prior to entering the hospital - surgeon was in network, hospital in network, etc... - the mo…

So sorry for what happened to you. Can relate a bit. A few months ago, when we learned that my wife would have to get a C-section, we tried getting an estimate for how much it would cost - asked doctors, nurses, hospital staff, insurance company, etc. No one could or would tell us, not even give us a range. Our best guess was to read online articles, which don't really help very much (unless you are into stressing yourself out). It's been 5 months after the C-section now and we still haven't gotten the bill. Our insurance agent told us it looks like it's going to be $85k total before coverage, and we have no idea how much we'll have to pay out of that. Btw, this was in SF which apparently is the most expensive city in the US where to give birth :(

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#77

Post by harryh » Tue, Jul 31, 2018, 3:48 PM UTC

andybak wrote: post #20

rayiner wrote: post #15

Earlier quoted context omitted.

Do democratic politicians have some sort of training in maintaining the farce that more things should be handled by government, when governments in Illinois, California, New York, etc.--democratic strongholds where Republicans cannot be pointed to as the scapegoats--are on the verge of bankruptcy? I don't think, deep down, republicans think the current system is better. They just don't trust whatever replaces it won'…

Is it possible both accusations are valid? i.e. "A plague on both your houses"... Maybe it's your political class that's broken.

I think that is part of it. I also think a lot of it has to do with size & diversity.

- The US is ~4x more populous than Germany (most populous in Western Europe)

- The US is ~15x larger than France (largest in Western Europe)

- The US is significantly more racially diverse than any country in Europe which is a huge advantage in many ways but also comes with more challenging governance particularly when you factor in the US's legacy of slavery & racism towards blacks (~12% of the population).

- The US also has greater financial inequality (much, but not all of which is due to government policy of course)

I could list a few more bullet points, but you get the gist. The US is just bigger and more complicated that other places. It makes us harder to govern efficiently.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#78

Post by mfringel » Tue, Jul 31, 2018, 3:48 PM UTC

JimboOmega wrote: post #22

howard941 wrote: post #12

> Consumers, meanwhile, buoyed by insurance and tax breaks, have little idea how much they are really spending and little incentive to know underlying costs. Almost weekly there's another post showing that consumers literally cannot find out costs usually because the provider cannot supply it. It's time to put a stake in the heart of the recurring blame-the-consumer trope.

I don't read it as "blame the consumer" but "the system is opaque". The consumer doesn't know and can't find out. Articles have been written for, I don't know, a decade or more decrying the opacity of the "Chargemaster", etc, and how if you call a hospital to ask the charge for a procedure, they probably can't give you a quote. If you have certain kinds of insurance, you're not even incentivized to care - you tolerat…

The problem I have with the "blame the consumer" trope is that there's the implicit "and if consumers had full pricing knowledge, The Market(tm) would correct all of the other issues, and healthcare in the US would be fixed." I assert this mostly through anecdotal evidence based on where these conversations tend to go.

I also find it to be some of the most disingenuous handwaving I've seen in recent memory. No one is going to comparison-shop when they have a ruptured appendix. Worse, if they think they can just "tough out" the abdominal pain because they can't afford the doctor visit _or the treatment that might result from it_, they'll just die.

Just to head something off... if your answer to "What if people still can't afford healthcare?" is "If you can't afford healthcare, then you're not contributing enough to society to receive healthcare.", then I thank you for your candor and your ideological consistency, and have you considered that you might be a sociopath?

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#79

Post by harryh » Tue, Jul 31, 2018, 3:49 PM UTC

richmarr wrote: post #72

intended wrote: post #18

Earlier quoted context omitted.

It doesnt matter. These are just the general American talking points. Fortunately since this is a global forum, people can point out that the situation in AMerica is farce. The basic stats are just solid - every first world country does better. You guys have the worst of all worlds, and because of America's prediliction for everything market oriented, and the absurd partisanship - you have no solutions, and are ok wi…

Not to mention the fact that companies can write off insurance contributions against tax, and individuals can recieve that benefit without paying income or payroll tax on it. In effect that's a subsidy in favour of the middle classes and 1% to the tune of "between $174 billion and $429 billion over a six-year period". https://www.nytimes.com/2017/07/07/health/health-insurance-t... (Edited to include the missing point…

You say this like it's some special provision in the tax code, but it's not. Companies pay taxes on profits, not revenue. And insurance contributions (like many many other things) are an expense that reduces profits.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#80

Post by richmarr » Tue, Jul 31, 2018, 3:49 PM UTC

chimeracoder wrote: post #45

knuththetruth wrote: post #23

Earlier quoted context omitted.

...implementing a healthcare policy cooked up by conservative think tanks in the 1990s. The rest of the developed world shows that anything short of national healthcare system is an expensive mistake.

> The rest of the developed world shows that anything short of national healthcare system is an expensive mistake. Of "the rest of the developed world", only one country (the UK) has a "national healthcare system", and even that's a bit of a stretch, because England, Scotland, Wales, and Northern Ireland all have different systems. Canada runs healthcare at the provincial level. France, Germany, Spain, the Netherland…

> Of "the rest of the developed world", only one country (the UK) has a "national healthcare system", and even that's a bit of a stretch, because England, Scotland, Wales, and Northern Ireland all have different systems.

England, Wales, Scotland and Northern Ireland makes 4 countries, just FYI.

This handy graphic explains in case of confusion: https://upload.wikimedia.org/wikipedia/commons/thumb/2/28/Br...