28 ms·

The Astonishingly High Administrative Costs of U.S. Health Care

232 points by digital55 8y ago

cozzyd 8y ago
"Your desire to live is my opportunity" - some health care administrator.
- ethbro 8y ago
  Never ascribe to malice, what can be explained by apathy.
  - deleted 8y ago
    [deleted]
  - tedajax 8y ago
    If you're so apathetic as to be actively harmful that's still malicious. Also, as they are actively looking to increase profits, I can't possibly see how this is "apathetic". Quit making excuses for garbage people.
    - ethbro 8y ago
      You know what's easy? Blaming people. "How could they be so evil / greedy / stupid / mean / etc? Don't worry. We'll fire them and bring in new people. Everything fixed." You know what's harder but more productive? Admitting there are systemic, structural issues. And having enough compassion for people trying to do their jobs. Because suddenly there's no easy scapegoat. And the only response is to actually change the system. -- The issue with the US health system isn't some malevolent Oz pulling strings behind the scenes, but that none of the legally defined and empowered players have their interests fully aligned with the patient.
      - AnimalMuppet 8y ago
        Worse: Some of the players have their interests exactly the opposite of other players. In particular, the doctors want to get paid, and the insurance company makes money partly by finding ways to not pay doctors. So the insurance companies pay people to find ways to not pay doctors, and the doctors pay people to find ways to get the insurance companies to pay. (Almost?) all of those people, on both sides, are a net lost to society as a whole.
        ethbro 8y ago
        And that's partly my point. Does the doctor want to kill you? No, he or she wants to heal you and be paid well. Does the claims analyst at the insurance company want customers to die? No, he or she wants to pay as little as possible while keeping you healthy. And yet when both of these players are placed in the system we've constructed, the strictly dominating, logical strategies for both are sociopathic. And so they adjust their behavior in that direction. I'm hopeful that pushing outcome-driven analytics onto the medical field will drive a lot of productive change. The whole reason we abstracted care choices from payment is that we couldn't answer the question, "How much is this procedure / test / consult worth to you?" And without that, we're waving our hands in the air as to whether or not it makes sense to skip an MRI scan.
        dredmorbius 8y ago
        Bad assumption: "Indiana cardiologists sued for alleged unnecessary surgeries" (October 28, 2014) MUNSTER, Ind. (WLS) -- Dozens of people are joining a lawsuit filed against three Northwest Indiana cardiologists as well as Munster Community Hospital for allegedly performing unnecessary procedures. After two patients announced legal action six months ago, dozens more have come forward accusing three Indiana doctors of medical malpractice and, in some cases, wrongful death. Lawyers say their investigation has revealed that 75 percent of heart procedures were performed unnecessarily.... http://abc7chicago.com/health/indiana-cardiologists-sued-for-alleged-unnecessary-surgeries/370155/ http://abc7chicago.com/health/indiana-cardiologists-sued-for... More: https://scholar.google.com/scholar?q=unnecessary%20surgery&btnG=Search&as_sdt=800000000001&as_sdtp=on https://scholar.google.com/scholar?q=unnecessary%20surgery&b... (550,000 results) https://duckduckgo.com/?q="unnecessary+surgery"+fraud https://duckduckgo.com/?q="unnecessary+surgery"+fraud
      - tedajax 8y ago
        Suggesting there aren't malicious forces actively pushing for their bottom line over say, structural changes that would improve healthcare for everyone is really really dumb. Sometimes there really are just evil greedy people being bad.
        ethbro 8y ago
        Are there greedy people out there? Of course. Do I spend time focusing on them? Not a minute. That's what the justice system is for, and it's not terrible at punishing people who break the law. Th difference is in outcome. If you focus on people, you get to feel righteous, targeted anger, and nothing ever changes. If you focus on the system, you're left viscerally unsatisfied ("The US healthcare system is dysfunctional? I can't yell at that..."), but might effect real change.
        beaconstudios 8y ago
        often, the malicious force actively pushing for increasing profits is systemic itself - the responsibility of public company executives to maximise shareholder value. also, most of the time I think "evil greedy people" is just people who are far enough abstracted away from the impact of their deeds that they have no connection to the impact. If you're looking at departmental budgets all day, you probably don't see the patient who gets refused treatment.
  - dredmorbius 8y ago
    Arendt's book introduced the expression and concept "the banality of evil".[6] Her thesis is that Eichmann was not a fanatic or sociopath, but an extremely average person who relied on cliché defenses rather than thinking for himself and was motivated by professional promotion rather than ideology. Banality, in this sense, is not that Eichmann's actions were ordinary, or that there is a potential Eichmann in all of us, but that his actions were motivated by a sort of stupidity which was wholly unexceptional. https://en.wikipedia.org/wiki/Eichmann_in_Jerusalem#The_banality_of_evil https://en.wikipedia.org/wiki/Eichmann_in_Jerusalem#The_bana...
- sp332 8y ago
  http://i.imgur.com/ddU50.jpg http://i.imgur.com/ddU50.jpg "We prefer your extinction to the loss of our job!" "Too far-fetched?" "Not enough, really."
  - LyndsySimon 8y ago
    That is an awesome comic.
Bucephalus355 8y ago
I wish I had a link for this, but I believe as Obamacare was being drafted / the economy was in dire straits in 2009, the Obama administration had to make a choice about whether to radically streamline health care, but at the cost of killing employment in (at the time) the only growing sector of the United States. They chose to not streamline it, which is understandable, but obviously a price had to be paid at some point. Related story, went with my wife into a small but advanced local hospital where she has a surgical consult about her sinuses. This hospital was beautiful and fully loaded with all the latest technology, big screen TVs, tablets, etc. Nonetheless, in the waiting room there were 5 office admins each with dual monitors checking people in. It’s like they didn’t get any benefit at all from the technology......
- ebikelaw 8y ago
  This is the problem with common economic measures. We spend 18% of GDP on health care, but that's just overhead and we should be trying to drive it to zero.
  - toomuchtodo 8y ago
    The people who are that overhead do not want it to be driven to zero.
    - bunderbunder 8y ago
      Not per se, but they do wish their own health care weren't so @#$#@% expensive, which amounts to roughly the same thing.
      - kgwgk 8y ago
        Not if the “waste” represents maybe 5% of their spending but accounts for 100% of their income.
    - LarryDarrell 8y ago
      When blue collar jobs get destroyed, all I hear about is the benefits of creative destruction and the people will benefit through lower prices. When white collar jobs are threatened, everyone loses their shit.
conorh 8y ago
At my wife's practice they employ two people full time just to do insurance authorizations. edit: actually one of those people does verification (checking to see what insurance patients have, what is covered, and estimate what they will owe) and the other person just does authorization (getting the insurance company to approve the procedure)
- Spooky23 8y ago
  I use my GP as the example. It's a fun tale. When he was in a partnership with 4 other doctors, he started with a paper system. They had two receptionists, and three clerk/billers. I used to help him out with some tech stuff. They implemented an EMR prior to the Medicare mandate, with an ROI driven by dropping 2.5 FTE. They ended up dropping the clerks and hiring IT expertise at a cost 50% higher than the clerks. Medicare mandate came, and the EMR didn't meet requirements and had to be replaced. They joined a larger physician group, and paid for 0.2 IT FTE. But they had to hire two PAs and a NP to drive revenue and now have 6 clerical people. (+1 from paper) Now they were acqui-hired by a sprawling medical network. Their cost center became a dumping ground for redundant hospital staff and they have 10 non-medical people (+5 from paper-based, independent practice). Now they run two EMRs and are transitioning to a third. They lost the ability to collect money at the counter, and now bill for every co-pay and lab. (My wife received a paper bill for $0.78 for a pregnancy test via postal mail) In short, between bad policy, government encouragement of cartel behavior, and general stupid big company bullshit my doctor went from a progressive medical practice with talented doctors and medical staff to a bloated sales funnel for unnecessary specialist care over the course of about 15 years.
  - nojvek 8y ago
    Granted America’s love for ACA is sound. Poor people shouldn’t have to forgo medical procedures because they are poor and die. But the execution is a giant shit show. Trump abandoned it but I highly doubt anything will replace it. If Trump doesn’t cause another financial disaster, there are chances the next President can make some headway to get US a sane healthcare system. It’s so ripe for disruption. Amazon’s insane valuation I bet is also based on the fact that they are going after Healthcare. If they can bring Amazon level service and convinience we may turn the tables. Personal preference but even though I don’t support making Bezos accumulate so much wealth, Amazon prime service is unbeatable. It’s just so darn convenient. I don’t see any close alternative.
tabtab 8y ago
As worded, it sounds like emulating the Switzerland or Germany model is the best solution. They offer decent patient choice but don't pay significantly higher for that choice than single-system countries. USA citizens on average prefer choice, and would probably agree to pay a little more to get choice.
mkirklions 8y ago
If you ever want to know why something sucks, just look at who is bribing politicians: https://www.opensecrets.org/lobby/top.php?indexType=s https://www.opensecrets.org/lobby/top.php?indexType=s So here is the process it takes to get medicine that is legal in china. >Schedule appointment, talk to 1 person >Wait in the lobby, talk to 1 person and fill out government HIPPA + clinic paperwork >Go to back room, talk to nurse. Fill out paperwork >Wait >Talk to Physicians Assistant or Physician, get perscription >Pay office 120 dollars >forward perscription to pharmacy 1-2 people involved >Go to pharmacy >Talk to person at register >Pay Remember that in China, you just go to the store to buy 4$ amoxicillin. And despite the Physicians in the United States screaming about superbugs, China and Mexico both havent made superbugs despite not having massive regulations. This is a self made problem from corruption. The Medical profession milks the consumer because the consumer has no other option.
- felix_nagaand 8y ago
  Antibiotic resistant e.coli with mcr1 found in China. https://www.scientificamerican.com/article/superbug-resistant-to-last-resort-antibiotic-arises-in-china/ https://www.scientificamerican.com/article/superbug-resistan...
- fma 8y ago
  You're being downvoted probably because of the superbug statement...but my wife had surgery to remove a breast lump. It cost $3k and with all these appointments it happened over the course of 2 months. The cost does not include all these other scans and crap before. My cousin went to China (family visit). Lump was discovered here...surgery in China. Got seen in one day, surgery the next. $800. When my wife discovered a new lump...just doing follow up scans was $900. $500 for imaging center, $200 for the doctor at the imaging center...and $200 for her annual physical (they billed it as a problem visit and not an annual because she brought up the fact she has a lump, rather than the doctor finding it, even though breast cancer detection is part of annual!...still fighting, but I'll probably drop it because it's so stressful and time consuming)
  - madengr 8y ago
assblaster 8y ago
Administrative = bureaucratic. Government-run healthcare has the same problems associated with heavily regulated sectors like our current healthcare system, but to a much larger degree because of lack of incentives to improve performance. The way to decrease cost is decrease regulation and get rid of all the unnecessary paper pushers we have right now.
- jjoonathan 8y ago
  Back in Health Care Policy class I dug through these numbers and the opposite was true: bureaucratic overhead was much larger in the US system. The US system also wound up being twice as expensive overall. Has that changed or are you just repeating a talking point you heard somewhere? Markets serve the person with bargaining power. If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do -- why do you think a free-er market will give you a better deal?
  - assblaster 8y ago
    The US system is a combination of heavily regulated private industry and government-run healthcare. The US is ridiculously more expensive than other countries precisely because of regulations and government-run bureaucracy (and defensive medicine, and poorly run bidding for drugs and equipment, and fraud). Government-run healthcare actually puts all the bargaining power in themselves, but they don't try to cut costs because that's not an incentive in government. Actually with government, the more you spend in one year, the more you get budgeted the next year. The worst way to run a government agency, in the eyes of bureaucrats is to run leaner than budget because your budget will be cut the next year. Doctors have very close to no bargaining power.
    - ionised 8y ago
      The US healthcare industry is more expensive simply because it is run for profit. There are plenty of other developed nations with regulation that manage to grant healthcare to all their citizens without the cluster-fuck the US makes out of the situation.
mhkool 8y ago
The reason that health care costs rise in almost all countries is that we are doing something wrong. The question is what? Can it be that doctors who do not try to find the root causes of diseases have no solutions ? Can it be that doctors who prescribe drugs to suppress symtoms cause problems in the long run ? Cancer is a disease with high costs where a lot can be gained. Watch a documentary about Dr Burzynski who has a cure for various types of cancer: https://www.youtube.com/watch?v=rBUGVkmmwbk https://www.youtube.com/watch?v=rBUGVkmmwbk The documentary shows how officials and the National Cancer Institute work against him and hence continue the high cost. On websites like https://drhyman.com https://drhyman.com and https://www.chriskresser.com https://www.chriskresser.com you can find doctors who explain a lot about root causes of diseases and how to cure oneself. If all would read these sites the costs for health would drop more than 50%.
- tathougies 8y ago
  Chris Kresser -- despite his many virtues -- is not a doctor. Moreover, he has never published any research indicating his findings or results are statistically significant. While his advice is often good, there is no reason to believe that it offers 'cures' to diseases hitherto considered uncurable. If anything, the fact that you think he's a doctor with magic cures suggests the need for ever more regulation, and thus bureaucracy.
  - LyndsySimon 8y ago
    > If anything, the fact that you think he's a doctor with magic cures suggests the need for ever more regulation, and thus bureaucracy. Why? Why should the state assume the burden of protecting someone from themselves? I might see it differently if knowledgeable, well-researched care were difficult to find... but it's not. If someone decides they want to go to a homeopath to treat their terminal illness, why should we stop them?
    - tathougies 8y ago
      The government shouldn't protect people from themselves. It should however prevent people who are not doctors from falsely advertising they are.
Simulacra 8y ago
I think the biggest driver of healthcare costs is the middle-men. All of the people who pad the bill, add fees, etc. The doctors who step into the O.R. for a minute and charge a fee[0]. They all add to feeding at the trough, so to speak.. [0]. https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur...
chadmeister 8y ago
Healthcare tends towards natural monopolies. Without competitive pressures, what incentives are there for them to slim?
richpimp 8y ago
I wonder with more frequency every day if there will ever truly be a solution to the problem of rising health care costs in the US. I see a lot of posts here suggesting that privatization should be removed, and any jobs lost that are related to the current industry will be unfortunate byproducts of getting rid of a broken system; a necessary evil that will ultimately make way for a health care system that is both cheaper and available to all. It's tempting and easy to adopt that line of thinking given where, I would suspect most of us here, are at in our lives from a career and financial perspective. As a software developer, it's easy for me to switch jobs and make a good wage. I can weather most unforeseen costs. In the decade plus that I spent working blue collar jobs for a very low wage, I would've been screwed if I'd lost my job. This speaks to a much larger problem that is consuming the US every day. I don't have any answers, but I can empathize with those who fear their livelihoods being taken away, even if saving those jobs has a net negative effect on the economy and job market. There isn't a day that goes by, especially in today's political climate, where I'm not thankful for having the opportunity to put myself in a better position. I'm the outlier, though. Most people can never bring themselves up out of poverty.
- analog31 8y ago
  ...any jobs lost that are related to the current industry will be unfortunate byproducts of getting rid of a broken system I'm tempted to argue that an equal number of jobs are lost every day to the opportunity cost of people not taking business risks due to the added risk of losing their healthcare, myself included. My optimistic vision is that the economic growth resulting from removing this burden will absorb the displaced workers, plus create even more jobs on top of that.
  - nojvek 8y ago
    We forget. This isn’t going to happen overnight. Sure people will lose jobs, but not millions overnight. Imagine how many humans are spending their lives doing busy work. We can free them up to do better things. Imagine how many good doctors have to join a medical factory where they churn out patients and slap big bills. Going solo doesn’t make sense. Just the way cloud made it so Indie hackers can build great products with a small team, Healthcare needs this “cloud” like system which takes care of all the unnecessary bullshit related to insurance and payments so they can focus on the core of providing great service and making people healthier.
f4rker 8y ago
i took a 3mile ambulance ride and was given no drugs. the fee was about $700. dafuck?
snarfybarfy 8y ago
The health care and pharma industry is in serious need of some whistle-blowers.

232 points by digital55 8y ago

cozzyd 8y ago

"Your desire to live is my opportunity" - some health care administrator.

ethbro 8y ago
Never ascribe to malice, what can be explained by apathy.
- deleted 8y ago
  [deleted]
- tedajax 8y ago
  If you're so apathetic as to be actively harmful that's still malicious. Also, as they are actively looking to increase profits, I can't possibly see how this is "apathetic". Quit making excuses for garbage people.
  - ethbro 8y ago
    You know what's easy? Blaming people. "How could they be so evil / greedy / stupid / mean / etc? Don't worry. We'll fire them and bring in new people. Everything fixed." You know what's harder but more productive? Admitting there are systemic, structural issues. And having enough compassion for people trying to do their jobs. Because suddenly there's no easy scapegoat. And the only response is to actually change the system. -- The issue with the US health system isn't some malevolent Oz pulling strings behind the scenes, but that none of the legally defined and empowered players have their interests fully aligned with the patient.
    - AnimalMuppet 8y ago
      Worse: Some of the players have their interests exactly the opposite of other players. In particular, the doctors want to get paid, and the insurance company makes money partly by finding ways to not pay doctors. So the insurance companies pay people to find ways to not pay doctors, and the doctors pay people to find ways to get the insurance companies to pay. (Almost?) all of those people, on both sides, are a net lost to society as a whole.
      - ethbro 8y ago
        And that's partly my point. Does the doctor want to kill you? No, he or she wants to heal you and be paid well. Does the claims analyst at the insurance company want customers to die? No, he or she wants to pay as little as possible while keeping you healthy. And yet when both of these players are placed in the system we've constructed, the strictly dominating, logical strategies for both are sociopathic. And so they adjust their behavior in that direction. I'm hopeful that pushing outcome-driven analytics onto the medical field will drive a lot of productive change. The whole reason we abstracted care choices from payment is that we couldn't answer the question, "How much is this procedure / test / consult worth to you?" And without that, we're waving our hands in the air as to whether or not it makes sense to skip an MRI scan.
        dredmorbius 8y ago
        Bad assumption: "Indiana cardiologists sued for alleged unnecessary surgeries" (October 28, 2014) MUNSTER, Ind. (WLS) -- Dozens of people are joining a lawsuit filed against three Northwest Indiana cardiologists as well as Munster Community Hospital for allegedly performing unnecessary procedures. After two patients announced legal action six months ago, dozens more have come forward accusing three Indiana doctors of medical malpractice and, in some cases, wrongful death. Lawyers say their investigation has revealed that 75 percent of heart procedures were performed unnecessarily.... http://abc7chicago.com/health/indiana-cardiologists-sued-for-alleged-unnecessary-surgeries/370155/ http://abc7chicago.com/health/indiana-cardiologists-sued-for... More: https://scholar.google.com/scholar?q=unnecessary%20surgery&btnG=Search&as_sdt=800000000001&as_sdtp=on https://scholar.google.com/scholar?q=unnecessary%20surgery&b... (550,000 results) https://duckduckgo.com/?q="unnecessary+surgery"+fraud https://duckduckgo.com/?q="unnecessary+surgery"+fraud
    - tedajax 8y ago
      Suggesting there aren't malicious forces actively pushing for their bottom line over say, structural changes that would improve healthcare for everyone is really really dumb. Sometimes there really are just evil greedy people being bad.
      - ethbro 8y ago
        Are there greedy people out there? Of course. Do I spend time focusing on them? Not a minute. That's what the justice system is for, and it's not terrible at punishing people who break the law. Th difference is in outcome. If you focus on people, you get to feel righteous, targeted anger, and nothing ever changes. If you focus on the system, you're left viscerally unsatisfied ("The US healthcare system is dysfunctional? I can't yell at that..."), but might effect real change.
      - beaconstudios 8y ago
        often, the malicious force actively pushing for increasing profits is systemic itself - the responsibility of public company executives to maximise shareholder value. also, most of the time I think "evil greedy people" is just people who are far enough abstracted away from the impact of their deeds that they have no connection to the impact. If you're looking at departmental budgets all day, you probably don't see the patient who gets refused treatment.
- dredmorbius 8y ago
  Arendt's book introduced the expression and concept "the banality of evil".[6] Her thesis is that Eichmann was not a fanatic or sociopath, but an extremely average person who relied on cliché defenses rather than thinking for himself and was motivated by professional promotion rather than ideology. Banality, in this sense, is not that Eichmann's actions were ordinary, or that there is a potential Eichmann in all of us, but that his actions were motivated by a sort of stupidity which was wholly unexceptional. https://en.wikipedia.org/wiki/Eichmann_in_Jerusalem#The_banality_of_evil https://en.wikipedia.org/wiki/Eichmann_in_Jerusalem#The_bana...
sp332 8y ago
http://i.imgur.com/ddU50.jpg http://i.imgur.com/ddU50.jpg "We prefer your extinction to the loss of our job!" "Too far-fetched?" "Not enough, really."
- LyndsySimon 8y ago
  That is an awesome comic.

Bucephalus355 8y ago

I wish I had a link for this, but I believe as Obamacare was being drafted / the economy was in dire straits in 2009, the Obama administration had to make a choice about whether to radically streamline health care, but at the cost of killing employment in (at the time) the only growing sector of the United States. They chose to not streamline it, which is understandable, but obviously a price had to be paid at some point. Related story, went with my wife into a small but advanced local hospital where she has a surgical consult about her sinuses. This hospital was beautiful and fully loaded with all the latest technology, big screen TVs, tablets, etc. Nonetheless, in the waiting room there were 5 office admins each with dual monitors checking people in. It’s like they didn’t get any benefit at all from the technology......

ebikelaw 8y ago
This is the problem with common economic measures. We spend 18% of GDP on health care, but that's just overhead and we should be trying to drive it to zero.
- toomuchtodo 8y ago
  The people who are that overhead do not want it to be driven to zero.
  - bunderbunder 8y ago
    Not per se, but they do wish their own health care weren't so @#$#@% expensive, which amounts to roughly the same thing.
    - kgwgk 8y ago
      Not if the “waste” represents maybe 5% of their spending but accounts for 100% of their income.
  - LarryDarrell 8y ago
    When blue collar jobs get destroyed, all I hear about is the benefits of creative destruction and the people will benefit through lower prices. When white collar jobs are threatened, everyone loses their shit.

conorh 8y ago

At my wife's practice they employ two people full time just to do insurance authorizations. edit: actually one of those people does verification (checking to see what insurance patients have, what is covered, and estimate what they will owe) and the other person just does authorization (getting the insurance company to approve the procedure)

Spooky23 8y ago
I use my GP as the example. It's a fun tale. When he was in a partnership with 4 other doctors, he started with a paper system. They had two receptionists, and three clerk/billers. I used to help him out with some tech stuff. They implemented an EMR prior to the Medicare mandate, with an ROI driven by dropping 2.5 FTE. They ended up dropping the clerks and hiring IT expertise at a cost 50% higher than the clerks. Medicare mandate came, and the EMR didn't meet requirements and had to be replaced. They joined a larger physician group, and paid for 0.2 IT FTE. But they had to hire two PAs and a NP to drive revenue and now have 6 clerical people. (+1 from paper) Now they were acqui-hired by a sprawling medical network. Their cost center became a dumping ground for redundant hospital staff and they have 10 non-medical people (+5 from paper-based, independent practice). Now they run two EMRs and are transitioning to a third. They lost the ability to collect money at the counter, and now bill for every co-pay and lab. (My wife received a paper bill for $0.78 for a pregnancy test via postal mail) In short, between bad policy, government encouragement of cartel behavior, and general stupid big company bullshit my doctor went from a progressive medical practice with talented doctors and medical staff to a bloated sales funnel for unnecessary specialist care over the course of about 15 years.
- nojvek 8y ago
  Granted America’s love for ACA is sound. Poor people shouldn’t have to forgo medical procedures because they are poor and die. But the execution is a giant shit show. Trump abandoned it but I highly doubt anything will replace it. If Trump doesn’t cause another financial disaster, there are chances the next President can make some headway to get US a sane healthcare system. It’s so ripe for disruption. Amazon’s insane valuation I bet is also based on the fact that they are going after Healthcare. If they can bring Amazon level service and convinience we may turn the tables. Personal preference but even though I don’t support making Bezos accumulate so much wealth, Amazon prime service is unbeatable. It’s just so darn convenient. I don’t see any close alternative.

tabtab 8y ago

As worded, it sounds like emulating the Switzerland or Germany model is the best solution. They offer decent patient choice but don't pay significantly higher for that choice than single-system countries. USA citizens on average prefer choice, and would probably agree to pay a little more to get choice.

mkirklions 8y ago

If you ever want to know why something sucks, just look at who is bribing politicians: https://www.opensecrets.org/lobby/top.php?indexType=s https://www.opensecrets.org/lobby/top.php?indexType=s So here is the process it takes to get medicine that is legal in china. >Schedule appointment, talk to 1 person >Wait in the lobby, talk to 1 person and fill out government HIPPA + clinic paperwork >Go to back room, talk to nurse. Fill out paperwork >Wait >Talk to Physicians Assistant or Physician, get perscription >Pay office 120 dollars >forward perscription to pharmacy 1-2 people involved >Go to pharmacy >Talk to person at register >Pay Remember that in China, you just go to the store to buy 4$ amoxicillin. And despite the Physicians in the United States screaming about superbugs, China and Mexico both havent made superbugs despite not having massive regulations. This is a self made problem from corruption. The Medical profession milks the consumer because the consumer has no other option.

felix_nagaand 8y ago
Antibiotic resistant e.coli with mcr1 found in China. https://www.scientificamerican.com/article/superbug-resistant-to-last-resort-antibiotic-arises-in-china/ https://www.scientificamerican.com/article/superbug-resistan...
fma 8y ago
You're being downvoted probably because of the superbug statement...but my wife had surgery to remove a breast lump. It cost $3k and with all these appointments it happened over the course of 2 months. The cost does not include all these other scans and crap before. My cousin went to China (family visit). Lump was discovered here...surgery in China. Got seen in one day, surgery the next. $800. When my wife discovered a new lump...just doing follow up scans was $900. $500 for imaging center, $200 for the doctor at the imaging center...and $200 for her annual physical (they billed it as a problem visit and not an annual because she brought up the fact she has a lump, rather than the doctor finding it, even though breast cancer detection is part of annual!...still fighting, but I'll probably drop it because it's so stressful and time consuming)
- madengr 8y ago

assblaster 8y ago

Administrative = bureaucratic. Government-run healthcare has the same problems associated with heavily regulated sectors like our current healthcare system, but to a much larger degree because of lack of incentives to improve performance. The way to decrease cost is decrease regulation and get rid of all the unnecessary paper pushers we have right now.

jjoonathan 8y ago
Back in Health Care Policy class I dug through these numbers and the opposite was true: bureaucratic overhead was much larger in the US system. The US system also wound up being twice as expensive overall. Has that changed or are you just repeating a talking point you heard somewhere? Markets serve the person with bargaining power. If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do -- why do you think a free-er market will give you a better deal?
- assblaster 8y ago
  The US system is a combination of heavily regulated private industry and government-run healthcare. The US is ridiculously more expensive than other countries precisely because of regulations and government-run bureaucracy (and defensive medicine, and poorly run bidding for drugs and equipment, and fraud). Government-run healthcare actually puts all the bargaining power in themselves, but they don't try to cut costs because that's not an incentive in government. Actually with government, the more you spend in one year, the more you get budgeted the next year. The worst way to run a government agency, in the eyes of bureaucrats is to run leaner than budget because your budget will be cut the next year. Doctors have very close to no bargaining power.
  - ionised 8y ago
    The US healthcare industry is more expensive simply because it is run for profit. There are plenty of other developed nations with regulation that manage to grant healthcare to all their citizens without the cluster-fuck the US makes out of the situation.

mhkool 8y ago

The reason that health care costs rise in almost all countries is that we are doing something wrong. The question is what? Can it be that doctors who do not try to find the root causes of diseases have no solutions ? Can it be that doctors who prescribe drugs to suppress symtoms cause problems in the long run ? Cancer is a disease with high costs where a lot can be gained. Watch a documentary about Dr Burzynski who has a cure for various types of cancer: https://www.youtube.com/watch?v=rBUGVkmmwbk https://www.youtube.com/watch?v=rBUGVkmmwbk The documentary shows how officials and the National Cancer Institute work against him and hence continue the high cost. On websites like https://drhyman.com https://drhyman.com and https://www.chriskresser.com https://www.chriskresser.com you can find doctors who explain a lot about root causes of diseases and how to cure oneself. If all would read these sites the costs for health would drop more than 50%.

tathougies 8y ago
Chris Kresser -- despite his many virtues -- is not a doctor. Moreover, he has never published any research indicating his findings or results are statistically significant. While his advice is often good, there is no reason to believe that it offers 'cures' to diseases hitherto considered uncurable. If anything, the fact that you think he's a doctor with magic cures suggests the need for ever more regulation, and thus bureaucracy.
- LyndsySimon 8y ago
  > If anything, the fact that you think he's a doctor with magic cures suggests the need for ever more regulation, and thus bureaucracy. Why? Why should the state assume the burden of protecting someone from themselves? I might see it differently if knowledgeable, well-researched care were difficult to find... but it's not. If someone decides they want to go to a homeopath to treat their terminal illness, why should we stop them?
  - tathougies 8y ago
    The government shouldn't protect people from themselves. It should however prevent people who are not doctors from falsely advertising they are.

Simulacra 8y ago

I think the biggest driver of healthcare costs is the middle-men. All of the people who pad the bill, add fees, etc. The doctors who step into the O.R. for a minute and charge a fee[0]. They all add to feeding at the trough, so to speak.. [0]. https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur...

chadmeister 8y ago

Healthcare tends towards natural monopolies. Without competitive pressures, what incentives are there for them to slim?

richpimp 8y ago

I wonder with more frequency every day if there will ever truly be a solution to the problem of rising health care costs in the US. I see a lot of posts here suggesting that privatization should be removed, and any jobs lost that are related to the current industry will be unfortunate byproducts of getting rid of a broken system; a necessary evil that will ultimately make way for a health care system that is both cheaper and available to all. It's tempting and easy to adopt that line of thinking given where, I would suspect most of us here, are at in our lives from a career and financial perspective. As a software developer, it's easy for me to switch jobs and make a good wage. I can weather most unforeseen costs. In the decade plus that I spent working blue collar jobs for a very low wage, I would've been screwed if I'd lost my job. This speaks to a much larger problem that is consuming the US every day. I don't have any answers, but I can empathize with those who fear their livelihoods being taken away, even if saving those jobs has a net negative effect on the economy and job market. There isn't a day that goes by, especially in today's political climate, where I'm not thankful for having the opportunity to put myself in a better position. I'm the outlier, though. Most people can never bring themselves up out of poverty.

analog31 8y ago
...any jobs lost that are related to the current industry will be unfortunate byproducts of getting rid of a broken system I'm tempted to argue that an equal number of jobs are lost every day to the opportunity cost of people not taking business risks due to the added risk of losing their healthcare, myself included. My optimistic vision is that the economic growth resulting from removing this burden will absorb the displaced workers, plus create even more jobs on top of that.
- nojvek 8y ago
  We forget. This isn’t going to happen overnight. Sure people will lose jobs, but not millions overnight. Imagine how many humans are spending their lives doing busy work. We can free them up to do better things. Imagine how many good doctors have to join a medical factory where they churn out patients and slap big bills. Going solo doesn’t make sense. Just the way cloud made it so Indie hackers can build great products with a small team, Healthcare needs this “cloud” like system which takes care of all the unnecessary bullshit related to insurance and payments so they can focus on the core of providing great service and making people healthier.

f4rker 8y ago

i took a 3mile ambulance ride and was given no drugs. the fee was about $700. dafuck?

snarfybarfy 8y ago

The health care and pharma industry is in serious need of some whistle-blowers.