9 ms·

Why Is U.S. Health Care So Expensive? Some of the Reasons Turn Out to Be Myths

dtech 9y ago
A lot of padding before the core: > There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. > And our complex payment system causes us to spend far more on administrative costs. > The United States also has a higher rate of poverty and more obesity than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems. So the explanation for "why is this so expensive" is "we pay more"...
harshreality 9y ago
The meat of the article: > There were two areas where the United States really was quite different: > We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. > And our complex payment system causes us to spend far more on administrative costs. > The United States also has a higher rate of poverty and more obesity than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems. Which is amusing, because people who argue against single-payer tend to argue that a) single-payer would lead to an inefficient government bureaucracy handling billing and administration, rather than the status quo of "efficient" hospitals and insurance companies; and b) private health insurance that requires everyone (or their employers) to pay for their own healthcare encourages more healthy living and more efficient pricing due to a more direct awareness of the costs.
- Moru 9y ago
  Most people realise that the cost of not living healthy is a reduction of quality of life and lifespan. I doubt many people are encouraged to get less sick from a lower bill...
  - kazen44 9y ago
    what might also add to the difference is the focus on a healthy lifestyle and assistance on maintaining it for the less fortunate in society. For instance, giving someone who is poor benefits so they can afford healthy food (or even better, taxing unhealthy foods and using that money to subsidize healthy food) will actually reduce healthcare costs down the line. A healthy lifestyle goes a long way in regards to sick preventions. I wonder if physical activity also has to do with this? the U.S is a very car oriented nations, which means people walk less?
    - RobertRoberts 9y ago
      >I wonder if physical activity also has to do with this? the U.S is a very car oriented nations, which means people walk less? I visited Japan, and I saw 1 single fat guy. He also was the only homeless man I saw in Tokyo... (it's illegal to pan-handle in Japan, so he did the universal thumb/fist-to-the-mouth-head-back motion to ask for a drink.) And yes, everyone walks a ton there. There's no reason people can't walk here, they just don't. To quote the movie L.A. Story "Go for a walk? In L.A.? Hahahahah."
      - phil21 9y ago
        > There's no reason people can't walk here, they just don't. You really think there is no reason? I mean you chose Japan as your example - I walked everywhere every single day I spent in Japan as well. Because the cities (heck, entire country) are set up with human pedestrians in mind as first class citizens, and are laid out in a manner which makes everywhere from small villages to Tokyo very walkable. For any trip under a mile or two, walking was always clearly the best option. The US? It's effectively a giant suburb except for an exceedingly tiny number of dense urban cores built prior to to the invention of the automobile. Walking in those areas is dangerous (many times done on purpose by city planners to discourage pedestrian "riff raffs"), typically pointless (e.g. you have to walk to walk as it's square miles of nothing but single family homes), and honestly utterly boring and socially disconnecting. Walking 4 blocks in my suburban neighborhood in Minneapolis is a soul crushing tour of how disconnected the community is (you likely won't even talk to a single person) - walking 4 blocks in my dense Chicago neighborhood is interesting and helps build community as the density and walking/transit focus forces the community to interact on a daily basis. I am quite convinced the suburbification of the US after WWII is the primary cause for the breakdown in social cohesion we're starting to see.
- pfisch 9y ago
  The 1st reason you listed here was basically corruption by drug makers and hospitals. Single payer would exacerbate this problem even more. Right now medicare can't lobby for drug prices. How that level of blatant corruption could be enshrined in law is hard to fathom. Honestly I'm not sure we need obamacare or any of it and I feel like it is all a circus. All we need is a law that no medical service or drug can cost more than the average price of a basket of oecd countries. The prices would hit the floor and all the other problems would mostly just disappear.
- chimeracoder 9y ago
  > Which is amusing, because people who argue against single-payer tend to argue that a) single-payer would lead to an inefficient government bureaucracy handling billing and administration, rather than the status quo of "efficient" hospitals and insurance companies; Medicare's billing is incredibly complicated and convoluted - and moreover, most of the complications in billing for private insurers ultimately stem from the rules that Medicare itself puts in place. Even under a single-payer system, you'd still have all the complexities of billing, and Medicare is quite possibly the single most complicated payer on the market, from a billing perspective.
  - deleted 9y ago
    [deleted]
- tytytytytytytyt 9y ago
  > and b) private health insurance that requires everyone (or their employers) to pay for their own healthcare encourages more healthy living and more efficient pricing due to a more direct awareness of the costs. How are these people saying that direct awareness leads to more efficient pricing? It's not like most people can shop around for reasonable alternatives.
- deleted 9y ago
  [deleted]
- SlowBro 9y ago
  It seems we in the United States have traded inefficiencies. Though our payments are higher, from the (little bit of) evidence I could gather from other single payer systems our wait times are far lower. This CNN opinion piece offers supporting evidence: https://www.cnn.com/2017/09/25/opinions/single-payer-failure-opinion-atlas/index.html https://www.cnn.com/2017/09/25/opinions/single-payer-failure... It's been my own experience as well. My dear friend in Australia who otherwise praises her system has had to wait over a year for some very important foot surgery. I was able to schedule a not-very-critical knee surgery in a matter of days, and I have the lowest-cost insurance plan my company offers. Even while unemployed and on government insurance, my daughter was able to have open heart surgery when she was six months old. She waited a few weeks for an opening. I shudder to think how long she might have had to wait in Canada. I can't see the article because my free views are up; Do they discuss what I view as the two most heavy flaws of United States healthcare? The increased regulations and the ability of doctors and hospitals to charge exorbitant prices due to insurance itself. Regulations (in my observation) consistently bring heavy cost burdens to every industry they are applied to. And insurance permits cost hiding: It doesn't trouble me terribly that a saline bag costs $70 if 3 million of those on my plan pay less than a penny each to pay for my saline. Doctors and hospitals have jacked prices sky high since insurance has become the norm. Whereas stories abound of cash payers getting their hospital bills slashed by significant margins. Only because they bypassed insurance.
  - frgtpsswrdlame 9y ago
    Couldn't it just be that most people aren't getting the treatments they need? When I forgo medical procedures because of cost, I'm technically increasing 'efficiency' for everyone else - that's not a positive of our healthcare system though.
  - clarkevans 9y ago
    It's easier to have lower aggregate wait times when a large chunk of your population knows they won't (e.g. can't afford to) get health care unless it's a life-threating emergency. Did the study cited normalize for "discouraged" patients from rural and inner-cities?
- pmorici 9y ago
  At least there is a choice in the current system. Just because it isn't great doesn't mean a one option government system would be better. If you look at the stats[0] about 50% of healthcare spending in the US is paid for by the government so in a sense we already have that single payer system. [0] https://www.statista.com/statistics/237043/us-health-care-spending-distribution/ https://www.statista.com/statistics/237043/us-health-care-sp...
  - RobertoG 9y ago
    A government system doesn't imply only one option, it implies that everybody is covered. Private health exist in countries with public health.
  - danieltillett 9y ago
    Most other countries have figured this out; you have a public and private system. Choice and universal coverage at way lower cost. Yes the USA is quite insane in that you already have mostly socialised medicine with Medicare and Medicaid. You even have a version of the British NHS system in the VA. The only people who don’t seem to have coverage are the people you actually want in any universal insurance scheme; the young and healthy.
- rayiner 9y ago
  I support single payer as a general principle. But after reading stories about how it costs us seven times as much to build a subway in New York than it costs London or Paris, I’m concerned that whatever implementation of single payer we came up with would be far worse and more expensive than what European countries have implemented, even if structured similarly.
  - danieltillett 9y ago
    Yes this is a major concern. The US healthcare system is a reflection of the underlying political and social structures. Once these are fixed then single payer will fall out as obvious.
    - deleted 9y ago
      [deleted]
  - chimeracoder 9y ago
    > I’m concerned that whatever implementation of single payer we came up with would be far worse and more expensive than what European countries have implemented, even if structured similarly. It's hard to compare the US to other developed countries, because the systems that exist in other developed countries could not exist as they do today without the US. While there are high barriers to trade (both artificial and natural - you can't fly across the Atlantic for emergency treatment, for example), you have to look at the global market to get a sense of how it works. For example: today, companies that engage in medical and pharmaceutical R&D receive most of their revenues from the US. This is true even of pharmaceutical companies based in Europe: the US is their primary source of funding for R&D. (Similarly, 50% of all R&D in the entire world takes place in the US). Any attempt to bring costs down in the US - whether single-payer or market-based - would result in higher costs for drugs and other supplies to the rest of the developed world[0]. Put another way, countries like Denmark and Canada and the UK have the appearance of negotiating leverage only because they're such a tiny market[1] compared to the US - and, crucially, a completely segregated market as well. So even if pharmaceutical companies end up selling drugs at very low rates there, they can easily make up the difference in revenue by increasing prices in the US[2]. The US doesn't even have to impose its own price controls to bring costs down - all they have to do is permit drug reimportation from other countries which honor US drug patents (like Canada). This would immediately cause drug prices in the US to drop (and, at equilibrium, drug prices in other countries to rise). There actually was a bill introduced in the Senate last year to do this, but it was voted down. [0] It wouldn't affect countries like India or China, because they already don't honor most relevant pharmaceutical patents. [1] Again, by revenue, not necessarily by population [2] This doesn't actually affect their sales much, because sales are relatively inelastic, thanks to insurance - the costs are borne collectively by the population.
- Asooka 9y ago
  You don't have a payment system problem in America. What you have is a cost problem. You need some form of government intervention to prevent healthcare providers and drug companies from charging the most optimal price (the one at which they make the biggest medium-term profit), because the most optimal price is the one at which a lot of poor people die and middle-class people go bankrupt. That is, you don't have to look for solutions for how to find enough money to pay for health care for those who can't afford it right now, you need solutions for how to bring the price down.
  - RobertRoberts 9y ago
    >You need some form of government intervention to prevent healthcare providers and drug companies from charging the most optimal price... Can't do it, to much focus of power in DC. The Democrats were supposed to achieve this and they couldn't. In fact even their attempt at it made things worse. The only decent solution is to be healthy yourself as much as possible and get catastrophic coverage. Or perhaps get state supported insurance? (state level politics is easier to deal with, but the fights with the feds backed by the multinational corps. often times doesn't go well.)
- adolph 9y ago
  The wonderful thing about market interventions is the way they justify the next intervention. It’s lawyers all the way down.
- mtgx 9y ago
  > The United States also has a higher rate of poverty and more obesity than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems. Yeah, but if the US had a single-payer healthcare system, the government would also have an incentive to ensure that doesn't happen as much - so it would take a much better and stricter look at what "food vendors" are allowed to sell in the US and what they can put in their foods or even how transparent they are about it. Right now it has very little incentive to do that because Americans being fat and sick is "not the government's problem". It's the people's and insurance companies' problem, which is why insurance companies fight to be responsible for treating as few conditions as possible. If the US had a single-payer healthcare system, it also wouldn't be the only country in the world that "doesn't believe" in climate change and "wants to save coal jobs" or even fracking jobs (in case you thought I was only referring to Trump's policies).
  - kazen44 9y ago
    > Right now it has very little incentive to do that because Americans being fat and sick is "not the government's problem". It's the people's and insurance companies' problem, which is why insurance companies fight to be responsible for treating as few conditions as possible. I wonder, does the US goverment (state, local or federal) insitute programs for physical excerise/sports? my goverment does this, especially with children and teenagers/young adults (the first two also have mandatory P.E Classes in school, and outside of school, sports is usually subsidized for the poor). Getting people to live healthy at a young age results in people living healthy when they are adults.
  - gravy 9y ago
    What incentive would the government have to ensure it?
- specialist 9y ago
  Administrative overhead accounts for most of our costs. Everything else is round off errors. https://drkevincampbellmd.wordpress.com/2015/04/16/the-rise-of-the-machine-how-hospitalpractice-administrators-have-assumed-control-over-healthcare/ https://drkevincampbellmd.wordpress.com/2015/04/16/the-rise-... https://drkevincampbellmd.files.wordpress.com/2015/04/growth-in-administrators.jpg https://drkevincampbellmd.files.wordpress.com/2015/04/growth... https://duckduckgo.com/?q=growth+of+physicians+and+administrators https://duckduckgo.com/?q=growth+of+physicians+and+administr... I believe, but cannot prove, runaway administrative costs are caused by insurance company driven blame shifting and profiteering. Though I am open to the notion that insurers may just be amoral bureaucratic beasts feeding on people. The Utopia of Rules: On Technology, Stupidity, and the Secret Joys of Bureaucracy by David Graeber http://a.co/6olvPDM http://a.co/6olvPDM Source: Healthcare IT. Everyone inside the beast knows single payer is the correct answer.
  - maxerickson 9y ago
    There's still twice as many doctors earning twice as much. 352,200 "Medical and Health Services Managers" at a median pay of $96,540 per year [0]. 713,800 "Physicians and Surgeons" at a median pay of $208,000 per year [1]. Now, I'm totally ready to concede that managers are adding less value to the healthcare system than doctors, but that chart is pretty much a textbook example of lying with statistics. Sure, growth has been huge. But it's also pretty obvious that the base number was small and that there's lots of compensation going elsewhere. [0] https://www.bls.gov/ooh/management/medical-and-health-services-managers.htm https://www.bls.gov/ooh/management/medical-and-health-servic... [1] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
    - specialist 9y ago
      Edit: Ask any of your doctors what portion of time they spend feeding the beast (paperwork) vs patient care. --- Expanding on my prior statement of the obvious... Value add vs overhead. I'm sure you've been in situations where some people are anti-productive. In this story, that's the private insurers. My go to example of frivolous make work is ICD-10 (and the transition from ICD-9). More data gathered, huge increase in cost, less value, no impact whatsoever on patient outcomes. Lately I've been wondering if there's a migration path between our current fee-for-service to the capitation model (aka The Correct Answer, a technology unlocked by the singer payer achievement). The defenders of our current system of private insurance focus on improving cost transparency (as a way to postpone the inevitable). Okay. Sure. Pretending for a moment that patients can go bargain hunting... Why are rates negotiated per procedure? As though healthcare is Taylorism reducible assembly line work. Even more absurdly, different patients are charged differently for supposedly the same work, totally invalidating the premise that the work is so easily quantifiable. (This unfair practice just hides the cost shifting.) Why aren't we billed for time and materials, plus overhead, plus profit? Why all the fuss with medical coding? I think this is called cost based accounting. https://en.wikipedia.org/wiki/Cost_accounting https://en.wikipedia.org/wiki/Cost_accounting I truly want to know.
- british_india 9y ago
  Medicare has the lower administrative costs than ALL private insurance.
asmth 9y ago
Sad to here that..
doktrin 9y ago
Maybe I just haven't had enough coffee, but this article felt really lacking. > There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. > “It’s not that we’re buying more pizzas, we’re just paying more for each pie,” We already know we pay more. That's literally stated in the title. Why are we paying more? Isn't that the central question being discussed? > It’s often argued that patients in the United States use too much medical care. But the country was below average on measures of how often patients went to the doctor or hospital. They don't specify, so I have to wonder if they made any effort to distinguish between hospital visitation rates for people with and without insurance (or with and without good insurance). Considering that visiting the hospital - or even worse, ending up the ER - can be financially crippling for those without adequate insurance, I have to think this is an important variable. Also, this article doesn't address what is probably one of the most oft-cited explanations for high healthcare costs in the US : prescription medicine. Specifically the idea that the US 'subsidizes' pharma R&D by virtue of not having any entity that is capable / willing to negotiate the prices that many other countries enjoy. You'd think that an article that purports to debunk 'common' explanations would at least mention the most common one of them all.
tyfon 9y ago
I don't live in the US, but I've always though it was because it is for profit. In most countries the hospitals don't have to return a profit to the owners and run at cost. In the US they have to pay the profit on top of the cost. In addition you have an insurance industry with high administrative cost and the need to turn a profit that makes it even more expensive. This in addition to very high medicine prices results in an overall expensive healthcare system. The article seems to support this notion although it doesn't spell it out directly. The punchline is “It’s not that we’re buying more pizzas, we’re just paying more for each pie,”
- randyrand 9y ago
  Does this imply every product sold online is a rip off? Even for-profit companies are often run at-cost when you subtract employee compensation (which is a necessary expense).
  - tyfon 9y ago
    If a company runs at cost it is not profitable though? In any case, if you are a merchant you usually buy lower than what a single individual could buy for and sell it for what the customer is willing to pay so in the end the customer will have the same or lower price than if they had to negotiate with the producer directly so I don't think that is a rip off.
    - randyrand 9y ago
      Many Ebay stores are operated this way. Many are sole proprietorships with themselves as the single employee. All profit goes to them but they still often barely have enough to scrape by in day to day life. Whether its called "profit" or "the cost of paying your sole employee a living wage" is mainly a semantic difference. Are these companies operating "at-cost", or earning a profit?
- clarkevans 9y ago
  A great many hospitals and care networks in the U.S. are non-profit. Many are attached to public or private but otherwise non-profit universities. Some are religious and/or regional non-profit organizations (e.g. Partners, Intermountain Healthcare) Some are operated though mutual insurance or local municipal governments. This doesn't mean that administration isn't paid exceptionally well. In particular, patients and even the physicians in the health care systems rarely have a say in how it is operated. In most university contexts, there is no real democracy other than through the board of trustees which is often appointed via an inner-circle. Although mutuals should permit insured patients a democratic vote, most are not setup to encourage participation in any sort of elections. That said, the drug industry is predominantly for-profit. Health care software vendors (Epic, Cerner) are for-profit. Some insurance systems are for-profit, such as Anthem. So are physicians who work independently or as part of a larger privately-held network. Even so, the vast majority of the U.S. healthcare system is a patchwork of "non-profits" (with lots of holes in it).
edmundhuber 9y ago
There's something horribly wrong with a system in which the doctor cannot readily tell you how much a procedure will cost. It's not like the doctor is building a new space rocket every time they do an appendectomy, or designing something completely new. It's a procedure that is done thousands of times per day. But still, no one can tell you how much it will cost. There's layers and layers of waste in American healthcare. No one seems to really want to take point in fixing it. Frankly, it seems like a hopeless situation that will only get worse.
- ZeroGravitas 9y ago
  Assigning a cost to something is actually fairly tricky in any business and there's often no single "correct" answer. And even if you had perfect pricing in medicine, deciding which procedure will be the best for you would involve a complex calculation of risk, balancing long term and short term health, impacts on quality of life and employment and so on. There are problems in any health system, but not all simple solutions are actually simple or solutions. The most obvious problems in the US system were attempted to be fixed by Obamacare according to the generally accepted wisdom of experts in the field. This was rejected by a large minority of voters just because it's easy for callous politicians to make any mildly complex thing into a conspiracy against their voters while pocketing cash from people who benefit from the policies they push. That to me seems the root of the issue, without fixing that then nothing else matters.
  - chimeracoder 9y ago
    > Assigning a cost to something is actually fairly tricky in any business and there's often no single "correct" answer. And even if you had perfect pricing in medicine, deciding which procedure will be the best for you would involve a complex calculation of risk, balancing long term and short term health, impacts on quality of life and employment and so on. On the other hand, India has a billion payer system, and it's quite trivial to find concrete price quotes for most common (and even uncommon) treatments. You'll even see providers advertising their prices and (surprise!) competing with each other on price. That's something that's all but unheard-of in the US, except for a couple of niche areas of treatment. Medicine isn't inherently special in this regard. It is unfeasible for doctors in the US today to provide price quotations (for reasons I explain below), but there's no reason it has to be this way.
nkkollaw 9y ago
Oh, no. Even the NYT uses click-bait titles, now. "journalism is dead, the reason will completely shock you!".
- aninhumer 9y ago
  It kinda sounds like that's an intentional reference to a common clickbait format. My guess would be the article is about how clickbait has affected journalism?
  - nkkollaw 9y ago
    I don't know because I don't click on those out of principle and didn't click on this one, either :-D
srge 9y ago
I’ve read the article but I am surprised by its lack of substance. The basic TL:DR is: health care is more expensive because we pay more for the same. That’s pretty obvious and also the reasons why it’s more expensive are not really detailed in the article (besides admin costs).
peg_leg 9y ago
1) Profit
coldcode 9y ago
One benefit for other countries is experience. Germany, where a national healthcare system started when the country did (originally Krupp offered it to their employees), when Germany became a country in the late 19th century, they adopted Krupp's ideas on a national scale. I have a relative that works in a Doctor's office in a small town in Germany, she sometimes drives them on house calls. People there don't worry about getting health care or paying for it, however on weekends and evenings you do have to drive to another town to get care. No system is perfect, but it generally involves little stress to the "customers" other than inconvenience. Also in Germany when you have surgery people are commonly sent to rest "resorts" to recover, so that when they return to work they are over the surgery. Her town is filled with these places because there are a lot of walking paths and nature for people to enjoy. All paid by the healthcare system. Of course they have challenges paying for this, yet it's still half of what the US pays per capita. No one gets rich working in healthcare in Germany, but no one goes bankrupt using it.
- kazen44 9y ago
  > No one gets rich working in healthcare in Germany, but no one goes bankrupt using it. the notion that one should get rich working in healthcare is a strange one to me? You work in healthcare because you want to help other people in getting a healthy (and hopefully happy) life? Money should not be the prime motivator for working in healthcare in my opinion. a good example of this is my S.O, which works in specialized care for the mentally ill. She makes around 30K euro's a year (which is slight below the global average in NL). Its a decent wage, it's not going to make you a millionare. It's a very demanding job in terms of working hours, stress and physical labour but the energy she get's from it makes it absolutely worth it for her. Money should not be your prime motivator in life.
  - Endy 9y ago
    If only you could convince most of America of that last point. I am reminded of the 'temporarily embarrassed millionaires' quote about Americans and socialism.
throwaway2016a 9y ago
Since this is Hacker News, I feel like asking... What startups working to fix these issues? Large companies? Is there a market opportunity here?
motiw 9y ago
I recently realized that maybe the biggest scam of the American health care is that we pay twice for healthcare. when young and healthy we sponser the profit of the health insurance industry and sponsor the older people higher expenses through taxes (Medicare)
c8d3f7b49897918 9y ago
A daily reminder that the US spends more per-capita on socialized medicine than any other country except Norway, and spends more on socialized medicine per capita than many first world countries (e.g. france, australia, japan) spend on medicine in total, both public and private. [1] Conservatives (I am a conservative) who say we have a free market system are wrong. Liberals who say we are too heartless to pay for a socialized medical system are wrong. Anyone who says our military spending is why we don't have public healthcare is wrong. Anyone who suggests the US is competent enough at public administration to implement a public health care system is also probably wrong. Collapse appears to be the only way out. [1] - https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

A lot of padding before the core: > There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. > And our complex payment system causes us to spend far more on administrative costs. > The United States also has a higher rate of poverty and more obesity than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems. So the explanation for "why is this so expensive" is "we pay more"...

harshreality 9y ago

The meat of the article: > There were two areas where the United States really was quite different: > We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. > And our complex payment system causes us to spend far more on administrative costs. > The United States also has a higher rate of poverty and more obesity than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems. Which is amusing, because people who argue against single-payer tend to argue that a) single-payer would lead to an inefficient government bureaucracy handling billing and administration, rather than the status quo of "efficient" hospitals and insurance companies; and b) private health insurance that requires everyone (or their employers) to pay for their own healthcare encourages more healthy living and more efficient pricing due to a more direct awareness of the costs.

Moru 9y ago
Most people realise that the cost of not living healthy is a reduction of quality of life and lifespan. I doubt many people are encouraged to get less sick from a lower bill...
- kazen44 9y ago
  what might also add to the difference is the focus on a healthy lifestyle and assistance on maintaining it for the less fortunate in society. For instance, giving someone who is poor benefits so they can afford healthy food (or even better, taxing unhealthy foods and using that money to subsidize healthy food) will actually reduce healthcare costs down the line. A healthy lifestyle goes a long way in regards to sick preventions. I wonder if physical activity also has to do with this? the U.S is a very car oriented nations, which means people walk less?
  - RobertRoberts 9y ago
    >I wonder if physical activity also has to do with this? the U.S is a very car oriented nations, which means people walk less? I visited Japan, and I saw 1 single fat guy. He also was the only homeless man I saw in Tokyo... (it's illegal to pan-handle in Japan, so he did the universal thumb/fist-to-the-mouth-head-back motion to ask for a drink.) And yes, everyone walks a ton there. There's no reason people can't walk here, they just don't. To quote the movie L.A. Story "Go for a walk? In L.A.? Hahahahah."
    - phil21 9y ago
      > There's no reason people can't walk here, they just don't. You really think there is no reason? I mean you chose Japan as your example - I walked everywhere every single day I spent in Japan as well. Because the cities (heck, entire country) are set up with human pedestrians in mind as first class citizens, and are laid out in a manner which makes everywhere from small villages to Tokyo very walkable. For any trip under a mile or two, walking was always clearly the best option. The US? It's effectively a giant suburb except for an exceedingly tiny number of dense urban cores built prior to to the invention of the automobile. Walking in those areas is dangerous (many times done on purpose by city planners to discourage pedestrian "riff raffs"), typically pointless (e.g. you have to walk to walk as it's square miles of nothing but single family homes), and honestly utterly boring and socially disconnecting. Walking 4 blocks in my suburban neighborhood in Minneapolis is a soul crushing tour of how disconnected the community is (you likely won't even talk to a single person) - walking 4 blocks in my dense Chicago neighborhood is interesting and helps build community as the density and walking/transit focus forces the community to interact on a daily basis. I am quite convinced the suburbification of the US after WWII is the primary cause for the breakdown in social cohesion we're starting to see.
pfisch 9y ago
The 1st reason you listed here was basically corruption by drug makers and hospitals. Single payer would exacerbate this problem even more. Right now medicare can't lobby for drug prices. How that level of blatant corruption could be enshrined in law is hard to fathom. Honestly I'm not sure we need obamacare or any of it and I feel like it is all a circus. All we need is a law that no medical service or drug can cost more than the average price of a basket of oecd countries. The prices would hit the floor and all the other problems would mostly just disappear.
chimeracoder 9y ago
> Which is amusing, because people who argue against single-payer tend to argue that a) single-payer would lead to an inefficient government bureaucracy handling billing and administration, rather than the status quo of "efficient" hospitals and insurance companies; Medicare's billing is incredibly complicated and convoluted - and moreover, most of the complications in billing for private insurers ultimately stem from the rules that Medicare itself puts in place. Even under a single-payer system, you'd still have all the complexities of billing, and Medicare is quite possibly the single most complicated payer on the market, from a billing perspective.
- deleted 9y ago
  [deleted]
tytytytytytytyt 9y ago
> and b) private health insurance that requires everyone (or their employers) to pay for their own healthcare encourages more healthy living and more efficient pricing due to a more direct awareness of the costs. How are these people saying that direct awareness leads to more efficient pricing? It's not like most people can shop around for reasonable alternatives.
deleted 9y ago
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SlowBro 9y ago
It seems we in the United States have traded inefficiencies. Though our payments are higher, from the (little bit of) evidence I could gather from other single payer systems our wait times are far lower. This CNN opinion piece offers supporting evidence: https://www.cnn.com/2017/09/25/opinions/single-payer-failure-opinion-atlas/index.html https://www.cnn.com/2017/09/25/opinions/single-payer-failure... It's been my own experience as well. My dear friend in Australia who otherwise praises her system has had to wait over a year for some very important foot surgery. I was able to schedule a not-very-critical knee surgery in a matter of days, and I have the lowest-cost insurance plan my company offers. Even while unemployed and on government insurance, my daughter was able to have open heart surgery when she was six months old. She waited a few weeks for an opening. I shudder to think how long she might have had to wait in Canada. I can't see the article because my free views are up; Do they discuss what I view as the two most heavy flaws of United States healthcare? The increased regulations and the ability of doctors and hospitals to charge exorbitant prices due to insurance itself. Regulations (in my observation) consistently bring heavy cost burdens to every industry they are applied to. And insurance permits cost hiding: It doesn't trouble me terribly that a saline bag costs $70 if 3 million of those on my plan pay less than a penny each to pay for my saline. Doctors and hospitals have jacked prices sky high since insurance has become the norm. Whereas stories abound of cash payers getting their hospital bills slashed by significant margins. Only because they bypassed insurance.
- frgtpsswrdlame 9y ago
  Couldn't it just be that most people aren't getting the treatments they need? When I forgo medical procedures because of cost, I'm technically increasing 'efficiency' for everyone else - that's not a positive of our healthcare system though.
- clarkevans 9y ago
  It's easier to have lower aggregate wait times when a large chunk of your population knows they won't (e.g. can't afford to) get health care unless it's a life-threating emergency. Did the study cited normalize for "discouraged" patients from rural and inner-cities?
pmorici 9y ago
At least there is a choice in the current system. Just because it isn't great doesn't mean a one option government system would be better. If you look at the stats[0] about 50% of healthcare spending in the US is paid for by the government so in a sense we already have that single payer system. [0] https://www.statista.com/statistics/237043/us-health-care-spending-distribution/ https://www.statista.com/statistics/237043/us-health-care-sp...
- RobertoG 9y ago
  A government system doesn't imply only one option, it implies that everybody is covered. Private health exist in countries with public health.
- danieltillett 9y ago
  Most other countries have figured this out; you have a public and private system. Choice and universal coverage at way lower cost. Yes the USA is quite insane in that you already have mostly socialised medicine with Medicare and Medicaid. You even have a version of the British NHS system in the VA. The only people who don’t seem to have coverage are the people you actually want in any universal insurance scheme; the young and healthy.
rayiner 9y ago
I support single payer as a general principle. But after reading stories about how it costs us seven times as much to build a subway in New York than it costs London or Paris, I’m concerned that whatever implementation of single payer we came up with would be far worse and more expensive than what European countries have implemented, even if structured similarly.
- danieltillett 9y ago
  Yes this is a major concern. The US healthcare system is a reflection of the underlying political and social structures. Once these are fixed then single payer will fall out as obvious.
  - deleted 9y ago
    [deleted]
- chimeracoder 9y ago
  > I’m concerned that whatever implementation of single payer we came up with would be far worse and more expensive than what European countries have implemented, even if structured similarly. It's hard to compare the US to other developed countries, because the systems that exist in other developed countries could not exist as they do today without the US. While there are high barriers to trade (both artificial and natural - you can't fly across the Atlantic for emergency treatment, for example), you have to look at the global market to get a sense of how it works. For example: today, companies that engage in medical and pharmaceutical R&D receive most of their revenues from the US. This is true even of pharmaceutical companies based in Europe: the US is their primary source of funding for R&D. (Similarly, 50% of all R&D in the entire world takes place in the US). Any attempt to bring costs down in the US - whether single-payer or market-based - would result in higher costs for drugs and other supplies to the rest of the developed world[0]. Put another way, countries like Denmark and Canada and the UK have the appearance of negotiating leverage only because they're such a tiny market[1] compared to the US - and, crucially, a completely segregated market as well. So even if pharmaceutical companies end up selling drugs at very low rates there, they can easily make up the difference in revenue by increasing prices in the US[2]. The US doesn't even have to impose its own price controls to bring costs down - all they have to do is permit drug reimportation from other countries which honor US drug patents (like Canada). This would immediately cause drug prices in the US to drop (and, at equilibrium, drug prices in other countries to rise). There actually was a bill introduced in the Senate last year to do this, but it was voted down. [0] It wouldn't affect countries like India or China, because they already don't honor most relevant pharmaceutical patents. [1] Again, by revenue, not necessarily by population [2] This doesn't actually affect their sales much, because sales are relatively inelastic, thanks to insurance - the costs are borne collectively by the population.
Asooka 9y ago
You don't have a payment system problem in America. What you have is a cost problem. You need some form of government intervention to prevent healthcare providers and drug companies from charging the most optimal price (the one at which they make the biggest medium-term profit), because the most optimal price is the one at which a lot of poor people die and middle-class people go bankrupt. That is, you don't have to look for solutions for how to find enough money to pay for health care for those who can't afford it right now, you need solutions for how to bring the price down.
- RobertRoberts 9y ago
  >You need some form of government intervention to prevent healthcare providers and drug companies from charging the most optimal price... Can't do it, to much focus of power in DC. The Democrats were supposed to achieve this and they couldn't. In fact even their attempt at it made things worse. The only decent solution is to be healthy yourself as much as possible and get catastrophic coverage. Or perhaps get state supported insurance? (state level politics is easier to deal with, but the fights with the feds backed by the multinational corps. often times doesn't go well.)
adolph 9y ago
The wonderful thing about market interventions is the way they justify the next intervention. It’s lawyers all the way down.
mtgx 9y ago
> The United States also has a higher rate of poverty and more obesity than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems. Yeah, but if the US had a single-payer healthcare system, the government would also have an incentive to ensure that doesn't happen as much - so it would take a much better and stricter look at what "food vendors" are allowed to sell in the US and what they can put in their foods or even how transparent they are about it. Right now it has very little incentive to do that because Americans being fat and sick is "not the government's problem". It's the people's and insurance companies' problem, which is why insurance companies fight to be responsible for treating as few conditions as possible. If the US had a single-payer healthcare system, it also wouldn't be the only country in the world that "doesn't believe" in climate change and "wants to save coal jobs" or even fracking jobs (in case you thought I was only referring to Trump's policies).
- kazen44 9y ago
  > Right now it has very little incentive to do that because Americans being fat and sick is "not the government's problem". It's the people's and insurance companies' problem, which is why insurance companies fight to be responsible for treating as few conditions as possible. I wonder, does the US goverment (state, local or federal) insitute programs for physical excerise/sports? my goverment does this, especially with children and teenagers/young adults (the first two also have mandatory P.E Classes in school, and outside of school, sports is usually subsidized for the poor). Getting people to live healthy at a young age results in people living healthy when they are adults.
- gravy 9y ago
  What incentive would the government have to ensure it?
specialist 9y ago
Administrative overhead accounts for most of our costs. Everything else is round off errors. https://drkevincampbellmd.wordpress.com/2015/04/16/the-rise-of-the-machine-how-hospitalpractice-administrators-have-assumed-control-over-healthcare/ https://drkevincampbellmd.wordpress.com/2015/04/16/the-rise-... https://drkevincampbellmd.files.wordpress.com/2015/04/growth-in-administrators.jpg https://drkevincampbellmd.files.wordpress.com/2015/04/growth... https://duckduckgo.com/?q=growth+of+physicians+and+administrators https://duckduckgo.com/?q=growth+of+physicians+and+administr... I believe, but cannot prove, runaway administrative costs are caused by insurance company driven blame shifting and profiteering. Though I am open to the notion that insurers may just be amoral bureaucratic beasts feeding on people. The Utopia of Rules: On Technology, Stupidity, and the Secret Joys of Bureaucracy by David Graeber http://a.co/6olvPDM http://a.co/6olvPDM Source: Healthcare IT. Everyone inside the beast knows single payer is the correct answer.
- maxerickson 9y ago
  There's still twice as many doctors earning twice as much. 352,200 "Medical and Health Services Managers" at a median pay of $96,540 per year [0]. 713,800 "Physicians and Surgeons" at a median pay of $208,000 per year [1]. Now, I'm totally ready to concede that managers are adding less value to the healthcare system than doctors, but that chart is pretty much a textbook example of lying with statistics. Sure, growth has been huge. But it's also pretty obvious that the base number was small and that there's lots of compensation going elsewhere. [0] https://www.bls.gov/ooh/management/medical-and-health-services-managers.htm https://www.bls.gov/ooh/management/medical-and-health-servic... [1] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
  - specialist 9y ago
    Edit: Ask any of your doctors what portion of time they spend feeding the beast (paperwork) vs patient care. --- Expanding on my prior statement of the obvious... Value add vs overhead. I'm sure you've been in situations where some people are anti-productive. In this story, that's the private insurers. My go to example of frivolous make work is ICD-10 (and the transition from ICD-9). More data gathered, huge increase in cost, less value, no impact whatsoever on patient outcomes. Lately I've been wondering if there's a migration path between our current fee-for-service to the capitation model (aka The Correct Answer, a technology unlocked by the singer payer achievement). The defenders of our current system of private insurance focus on improving cost transparency (as a way to postpone the inevitable). Okay. Sure. Pretending for a moment that patients can go bargain hunting... Why are rates negotiated per procedure? As though healthcare is Taylorism reducible assembly line work. Even more absurdly, different patients are charged differently for supposedly the same work, totally invalidating the premise that the work is so easily quantifiable. (This unfair practice just hides the cost shifting.) Why aren't we billed for time and materials, plus overhead, plus profit? Why all the fuss with medical coding? I think this is called cost based accounting. https://en.wikipedia.org/wiki/Cost_accounting https://en.wikipedia.org/wiki/Cost_accounting I truly want to know.
british_india 9y ago
Medicare has the lower administrative costs than ALL private insurance.

asmth 9y ago

Sad to here that..

doktrin 9y ago

Maybe I just haven't had enough coffee, but this article felt really lacking. > There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. > “It’s not that we’re buying more pizzas, we’re just paying more for each pie,” We already know we pay more. That's literally stated in the title. Why are we paying more? Isn't that the central question being discussed? > It’s often argued that patients in the United States use too much medical care. But the country was below average on measures of how often patients went to the doctor or hospital. They don't specify, so I have to wonder if they made any effort to distinguish between hospital visitation rates for people with and without insurance (or with and without good insurance). Considering that visiting the hospital - or even worse, ending up the ER - can be financially crippling for those without adequate insurance, I have to think this is an important variable. Also, this article doesn't address what is probably one of the most oft-cited explanations for high healthcare costs in the US : prescription medicine. Specifically the idea that the US 'subsidizes' pharma R&D by virtue of not having any entity that is capable / willing to negotiate the prices that many other countries enjoy. You'd think that an article that purports to debunk 'common' explanations would at least mention the most common one of them all.

tyfon 9y ago

I don't live in the US, but I've always though it was because it is for profit. In most countries the hospitals don't have to return a profit to the owners and run at cost. In the US they have to pay the profit on top of the cost. In addition you have an insurance industry with high administrative cost and the need to turn a profit that makes it even more expensive. This in addition to very high medicine prices results in an overall expensive healthcare system. The article seems to support this notion although it doesn't spell it out directly. The punchline is “It’s not that we’re buying more pizzas, we’re just paying more for each pie,”

randyrand 9y ago
Does this imply every product sold online is a rip off? Even for-profit companies are often run at-cost when you subtract employee compensation (which is a necessary expense).
- tyfon 9y ago
  If a company runs at cost it is not profitable though? In any case, if you are a merchant you usually buy lower than what a single individual could buy for and sell it for what the customer is willing to pay so in the end the customer will have the same or lower price than if they had to negotiate with the producer directly so I don't think that is a rip off.
  - randyrand 9y ago
    Many Ebay stores are operated this way. Many are sole proprietorships with themselves as the single employee. All profit goes to them but they still often barely have enough to scrape by in day to day life. Whether its called "profit" or "the cost of paying your sole employee a living wage" is mainly a semantic difference. Are these companies operating "at-cost", or earning a profit?
clarkevans 9y ago
A great many hospitals and care networks in the U.S. are non-profit. Many are attached to public or private but otherwise non-profit universities. Some are religious and/or regional non-profit organizations (e.g. Partners, Intermountain Healthcare) Some are operated though mutual insurance or local municipal governments. This doesn't mean that administration isn't paid exceptionally well. In particular, patients and even the physicians in the health care systems rarely have a say in how it is operated. In most university contexts, there is no real democracy other than through the board of trustees which is often appointed via an inner-circle. Although mutuals should permit insured patients a democratic vote, most are not setup to encourage participation in any sort of elections. That said, the drug industry is predominantly for-profit. Health care software vendors (Epic, Cerner) are for-profit. Some insurance systems are for-profit, such as Anthem. So are physicians who work independently or as part of a larger privately-held network. Even so, the vast majority of the U.S. healthcare system is a patchwork of "non-profits" (with lots of holes in it).

edmundhuber 9y ago

There's something horribly wrong with a system in which the doctor cannot readily tell you how much a procedure will cost. It's not like the doctor is building a new space rocket every time they do an appendectomy, or designing something completely new. It's a procedure that is done thousands of times per day. But still, no one can tell you how much it will cost. There's layers and layers of waste in American healthcare. No one seems to really want to take point in fixing it. Frankly, it seems like a hopeless situation that will only get worse.

ZeroGravitas 9y ago
Assigning a cost to something is actually fairly tricky in any business and there's often no single "correct" answer. And even if you had perfect pricing in medicine, deciding which procedure will be the best for you would involve a complex calculation of risk, balancing long term and short term health, impacts on quality of life and employment and so on. There are problems in any health system, but not all simple solutions are actually simple or solutions. The most obvious problems in the US system were attempted to be fixed by Obamacare according to the generally accepted wisdom of experts in the field. This was rejected by a large minority of voters just because it's easy for callous politicians to make any mildly complex thing into a conspiracy against their voters while pocketing cash from people who benefit from the policies they push. That to me seems the root of the issue, without fixing that then nothing else matters.
- chimeracoder 9y ago
  > Assigning a cost to something is actually fairly tricky in any business and there's often no single "correct" answer. And even if you had perfect pricing in medicine, deciding which procedure will be the best for you would involve a complex calculation of risk, balancing long term and short term health, impacts on quality of life and employment and so on. On the other hand, India has a billion payer system, and it's quite trivial to find concrete price quotes for most common (and even uncommon) treatments. You'll even see providers advertising their prices and (surprise!) competing with each other on price. That's something that's all but unheard-of in the US, except for a couple of niche areas of treatment. Medicine isn't inherently special in this regard. It is unfeasible for doctors in the US today to provide price quotations (for reasons I explain below), but there's no reason it has to be this way.

nkkollaw 9y ago

Oh, no. Even the NYT uses click-bait titles, now. "journalism is dead, the reason will completely shock you!".

aninhumer 9y ago
It kinda sounds like that's an intentional reference to a common clickbait format. My guess would be the article is about how clickbait has affected journalism?
- nkkollaw 9y ago
  I don't know because I don't click on those out of principle and didn't click on this one, either :-D

srge 9y ago

I’ve read the article but I am surprised by its lack of substance. The basic TL:DR is: health care is more expensive because we pay more for the same. That’s pretty obvious and also the reasons why it’s more expensive are not really detailed in the article (besides admin costs).

peg_leg 9y ago

1) Profit

coldcode 9y ago

One benefit for other countries is experience. Germany, where a national healthcare system started when the country did (originally Krupp offered it to their employees), when Germany became a country in the late 19th century, they adopted Krupp's ideas on a national scale. I have a relative that works in a Doctor's office in a small town in Germany, she sometimes drives them on house calls. People there don't worry about getting health care or paying for it, however on weekends and evenings you do have to drive to another town to get care. No system is perfect, but it generally involves little stress to the "customers" other than inconvenience. Also in Germany when you have surgery people are commonly sent to rest "resorts" to recover, so that when they return to work they are over the surgery. Her town is filled with these places because there are a lot of walking paths and nature for people to enjoy. All paid by the healthcare system. Of course they have challenges paying for this, yet it's still half of what the US pays per capita. No one gets rich working in healthcare in Germany, but no one goes bankrupt using it.

kazen44 9y ago
> No one gets rich working in healthcare in Germany, but no one goes bankrupt using it. the notion that one should get rich working in healthcare is a strange one to me? You work in healthcare because you want to help other people in getting a healthy (and hopefully happy) life? Money should not be the prime motivator for working in healthcare in my opinion. a good example of this is my S.O, which works in specialized care for the mentally ill. She makes around 30K euro's a year (which is slight below the global average in NL). Its a decent wage, it's not going to make you a millionare. It's a very demanding job in terms of working hours, stress and physical labour but the energy she get's from it makes it absolutely worth it for her. Money should not be your prime motivator in life.
- Endy 9y ago
  If only you could convince most of America of that last point. I am reminded of the 'temporarily embarrassed millionaires' quote about Americans and socialism.

throwaway2016a 9y ago

Since this is Hacker News, I feel like asking... What startups working to fix these issues? Large companies? Is there a market opportunity here?

motiw 9y ago

I recently realized that maybe the biggest scam of the American health care is that we pay twice for healthcare. when young and healthy we sponser the profit of the health insurance industry and sponsor the older people higher expenses through taxes (Medicare)

c8d3f7b49897918 9y ago

A daily reminder that the US spends more per-capita on socialized medicine than any other country except Norway, and spends more on socialized medicine per capita than many first world countries (e.g. france, australia, japan) spend on medicine in total, both public and private. [1] Conservatives (I am a conservative) who say we have a free market system are wrong. Liberals who say we are too heartless to pay for a socialized medical system are wrong. Anyone who says our military spending is why we don't have public healthcare is wrong. Anyone who suggests the US is competent enough at public administration to implement a public health care system is also probably wrong. Collapse appears to be the only way out. [1] - https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...