5 ms·

Where does the money go? Aside from the waste and fraud, two places. First, we pay for convenience. We want to see a doctor now. We want immediate access to all

Where does the money go? Aside from the waste and fraud, two places. First, we pay for convenience. We want to see a doctor now. We want immediate access to all the best equipment, and specialists, and drugs, and we don't want to wait around or travel far. And we increasingly want it for every citizen. Second, over treatment of the dying - no subject is more uncomfortable. When asked what the biggest problem Kaiser Permanente faced, Charlie Munger, board member, responded over treatment of the dying. Various estimates are half of all healthcare spending takes place in the final two years of peoples' lives. In both cases, we've essentially deemed care as "cost no object", and when that happens, things get sideways fast. I'm not saying what is right or wrong, just what the problem is. Fast, cheap, good - you can always only pick two.

beatgammit 8y ago
Do you have links to those estimates or a book recommendation? I wonder if legalizing euthanasia would help significantly. Also, perhaps more awareness for geriatric strategies that promote comfort over cures. Many elderly people spend a ton trying to fix problems that can't really be fixed and should probably just have the discomfort treated. Also, I wonder how we stack up against the rest of the world if we ignore expenses for people over the age of 70 or so.
jorblumesea 8y ago
Not really, most of the costs go straight to shareholders. 25% of our spending is "Administrative costs" aka profits for investors. The issues of American healthcare are well documented and not a mystery. It boils down to two clear facts: 1) The US has no price controls whatsoever 2) The US has a for-profit system where your health is a business. It's not that complicated. The rest of the world has it figured out for the most part. https://www.commonwealthfund.org/publications/journal-article/2014/sep/comparison-hospital-administrative-costs-eight-nations-us https://www.commonwealthfund.org/publications/journal-articl...
skwb 8y ago
A good summary of the political economy that surrounds the US healthcare system is that people want healthcare that's: - fast - efficient - no restrictions on hospitals, doctors, or treatment - financed by taxes on the rich (defined in whoever is in a tax bracket higher than themselves) Now this is obviously untenable. In my professional estimation (ex-health policy analyst) I think you CAN have a public option be viable. But financing it will likely have to be done by expanding revenue through middle class tax hikes (not just millionaires), which never fend very well in our current political climate.
- ThrowMeDown01 8y ago
  Somehow you missed that the main point of the article being discussed here is - again! - that the US already pays more than the other top countries and receives less. Somehow that doesn't fit what you wrote at all, it's the exact opposite, to get better care you could do with less money. So where do you get that "we would have to raise taxes" from?
6nf 8y ago
> We want to see a doctor now. We want immediate access to all the best equipment, and specialists, and drugs, and we don't want to wait around or travel far. And we increasingly want it for every citizen. Australians can get these at a fraction of US prices though
- refurb 8y ago
  Can they? Mr Meschemberg’s cancer is HER 2-positive (HER 2 is a protein found on the surface of some cancer cells). HER 2-positive cancer cells tend to be far more aggressive, as they divide and grow faster than normal. “That makes [my cancer] a bit different,” he said. “There are drugs that are available to help but they’re not on the PBS.” https://www.news.com.au/lifestyle/health/health-problems/meet-the-aussies-whose-cancer-treatment-isnt-covered-by-the-pharmaceutical-benefits-scheme/news-story/d264fe3c6510bbed33d3e84bc8f351e2 https://www.news.com.au/lifestyle/health/health-problems/mee...
  - JAlexoid 8y ago
    I believe cancer is the only segment where US actually can boast great results. But thing is - not all medications are covered at the same level under American private insurances as well.
  - 6nf 8y ago
    It takes a few extra years for new drugs to get added to the PBS, but even if they are not, there's a cap on how much 'out of pocket' you'll pay for treating serious medical conditions. It's maybe $3000 per year depending on your situation. Medicare will cover the bulk of it even if it's not on the PBS.
JAlexoid 8y ago
I moved from London to NYC. I don't get fast - seeing a doctor immediately isn't easy, and I still have to wait in the reception. If I need immediate care, it's either $900 for ER, or a few hours wait... basically the same as UK NHS expectation. I don't get cheap - the premiums aren't cheap, and it's company sponsored. I can't say that it's much better care - they're only there for the damn ZocDoc review of a bedside manner. I mean... I had a tapeworm scare and my doctor was literally reading medical encyclopedia in front of me.

beatgammit 8y ago

Do you have links to those estimates or a book recommendation? I wonder if legalizing euthanasia would help significantly. Also, perhaps more awareness for geriatric strategies that promote comfort over cures. Many elderly people spend a ton trying to fix problems that can't really be fixed and should probably just have the discomfort treated. Also, I wonder how we stack up against the rest of the world if we ignore expenses for people over the age of 70 or so.

jorblumesea 8y ago

Not really, most of the costs go straight to shareholders. 25% of our spending is "Administrative costs" aka profits for investors. The issues of American healthcare are well documented and not a mystery. It boils down to two clear facts: 1) The US has no price controls whatsoever 2) The US has a for-profit system where your health is a business. It's not that complicated. The rest of the world has it figured out for the most part. https://www.commonwealthfund.org/publications/journal-article/2014/sep/comparison-hospital-administrative-costs-eight-nations-us https://www.commonwealthfund.org/publications/journal-articl...

skwb 8y ago

A good summary of the political economy that surrounds the US healthcare system is that people want healthcare that's: - fast - efficient - no restrictions on hospitals, doctors, or treatment - financed by taxes on the rich (defined in whoever is in a tax bracket higher than themselves) Now this is obviously untenable. In my professional estimation (ex-health policy analyst) I think you CAN have a public option be viable. But financing it will likely have to be done by expanding revenue through middle class tax hikes (not just millionaires), which never fend very well in our current political climate.

ThrowMeDown01 8y ago
Somehow you missed that the main point of the article being discussed here is - again! - that the US already pays more than the other top countries and receives less. Somehow that doesn't fit what you wrote at all, it's the exact opposite, to get better care you could do with less money. So where do you get that "we would have to raise taxes" from?

6nf 8y ago

> We want to see a doctor now. We want immediate access to all the best equipment, and specialists, and drugs, and we don't want to wait around or travel far. And we increasingly want it for every citizen. Australians can get these at a fraction of US prices though

refurb 8y ago
Can they? Mr Meschemberg’s cancer is HER 2-positive (HER 2 is a protein found on the surface of some cancer cells). HER 2-positive cancer cells tend to be far more aggressive, as they divide and grow faster than normal. “That makes [my cancer] a bit different,” he said. “There are drugs that are available to help but they’re not on the PBS.” https://www.news.com.au/lifestyle/health/health-problems/meet-the-aussies-whose-cancer-treatment-isnt-covered-by-the-pharmaceutical-benefits-scheme/news-story/d264fe3c6510bbed33d3e84bc8f351e2 https://www.news.com.au/lifestyle/health/health-problems/mee...
- JAlexoid 8y ago
  I believe cancer is the only segment where US actually can boast great results. But thing is - not all medications are covered at the same level under American private insurances as well.
- 6nf 8y ago
  It takes a few extra years for new drugs to get added to the PBS, but even if they are not, there's a cap on how much 'out of pocket' you'll pay for treating serious medical conditions. It's maybe $3000 per year depending on your situation. Medicare will cover the bulk of it even if it's not on the PBS.

JAlexoid 8y ago

I moved from London to NYC. I don't get fast - seeing a doctor immediately isn't easy, and I still have to wait in the reception. If I need immediate care, it's either $900 for ER, or a few hours wait... basically the same as UK NHS expectation. I don't get cheap - the premiums aren't cheap, and it's company sponsored. I can't say that it's much better care - they're only there for the damn ZocDoc review of a bedside manner. I mean... I had a tapeworm scare and my doctor was literally reading medical encyclopedia in front of me.