7 ms·

How?

toomuchtodo 7y ago
Private healthcare optimizes for profits and value extraction. Public healthcare optimizes (one would assume with the proper governance, oversight, and controls) for quality of life, but also for reducing costs (it's cheaper to treat your type 2 diabetes with diet and exercise before we have to start amputating appendages and you have chronic issues, for example). Disclaimer: Medicare For All (single payer) supporter
- cabaalis 7y ago
  I'm in the healthcare analytics industry. I see the private payers optimizing for the things you say they don't. It's simply more profitable to have a healthier patient.
  - toomuchtodo 7y ago
    https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html https://www.axios.com/health-care-industry-on-track-massive-... (Health care industry on track for massive profits) https://www.forbes.com/sites/brucejapsen/2019/08/04/as-sanders-and-warren-attack-private-health-insurer-profits-soar/#478a4c08532b https://www.forbes.com/sites/brucejapsen/2019/08/04/as-sande... (As Sanders And Warren Attack, Health Insurer Profits Soar; "Take Humana, which last week said it made more than $1 billion in profits in the second quarter and raised its earnings and revenue forecast for the rest of the year thanks to growth of seniors signing up to Medicare Advantage plans. Cigna, too, which said it made more than $1 billion in the second-quarter, also increased its earnings forecast last week for the rest of the year. And the week before, Anthem, which operates Blue Cross and Blue Shield plans in 14 states, also reported more than $1 billion in profits in its second quarter and said its profits are ahead of expectations for the year due in part to the money its making off of government contracts with Medicare and Medicaid programs. Meanwhile, UnitedHealth Group's UnitedHealthcare health insurance unit reported last month $2.6 billion in earnings from operations in the second quarter and the parent company boosted its earnings forecast for 2019.") https://www.cnbc.com/2017/08/05/top-health-insurers-profit-surge-29-percent-to-6-billion-dollars.html https://www.cnbc.com/2017/08/05/top-health-insurers-profit-s... (As Obamacare twists in political winds, top insurers made $6 billion) https://www.gq.com/story/eat-the-health-care-ceos https://www.gq.com/story/eat-the-health-care-ceos (Last year, 62 CEOs of health-care companies made a combined total of $1.1 billion in compensation. That's according to a new report out from Axios, which coincidentally notes that CEO compensation eclipses what the Centers for Disease Control spent on chronic disease prevention by $157 million; The average CEO makes $18 million annually while one out of every five Americans is struggling with medical debt.) Those profits (which you mention they're optimizing for) are dollars that could be used to improve healthcare delivery. That's actual care someone could receive, instead of going to unnecessary middlemen and shareholders.
  - matt4077 7y ago
    How long do US citizen stay with a single healthcare provider (/insurance)? If, say, only 50% are still with the same provider at age 50 as they were at age 30, there is a discount on the benefits of preventative measures compared to single-payer systems.
    - thedaemon 7y ago
      As a US citizen I can say that we change Healthcare providers whenever our current employer changes our Healthcare provider option. This can be every single year.
  - mikelockz 7y ago
    I would posit it's more profitable to have customers that pay for insurance monthly but don't actually utilize any resources or services. Not using health care seems to be what is encouraged with high deductibles and copays for visits.
  - x86_64Ubuntu 7y ago
    Huh? So it's healthier to have patients that never see the doctor? I'm not sure there are many fields in which prevention per unit provides higher margin and revenues than repair and recovery.
    - deleted 7y ago
      [deleted]
Angostura 7y ago
In practical terms, the NHS for example sinks a lot of money into anti-smoking campaigns and into advertising campaigns about weight reduction .On the government side this tends to translate into things like taxation on sugar in drinks. I've just been called in for a check up on my blood pressure and if it had worstened, I would on the end of quite a lot of dietary and excerise advice in an attemp to avoid additional medication. Many GPs in the UK has teamed up with Parkrun and now prescribe park run participation for certain patients and conditions.
- thedaemon 7y ago
  This sounds like a nightmare on privacy. Government collaborating and sharing your data with outside Companies. Am I getting this right, or wrong?
  - alexgmcm 7y ago
    They don't share your data, they just encourage you to go for a run.
  - SolaceQuantum 7y ago
    "This sounds like a nightmare on privacy. Government collaborating and sharing your data with outside Companies" Unlike Private companies sharing our data with other private companies?
  - ben_w 7y ago
    Occasionally public-private data sharing gets in the news. Where I see it reported, it’s treated as a scandal even when the company in question is Alphabet and they got the data for AI research: https://www.theguardian.com/society/2019/jun/10/nhs-data-google-alphabet-tech-drug-firms https://www.theguardian.com/society/2019/jun/10/nhs-data-goo... Medical privacy is one of those places where I wonder if a personal desire for privacy might hurt society as a whole — Almost, but not quite, like the tragedy of the commons. Still, it’s easy for me to say that, none of my embarrassing aspects have medical consequences.
  - Angostura 7y ago
radicalbyte 7y ago
They earn money for treating the symptoms. The same thing goes for quality of medical care - when they mess up they get to fix their own mess and charge for it. For example when our first kid was born, the gynecologist had her trainee pull our son out with their rope thing. She was supposed to apply pressure during the contractions, only she panicked and pulled my son out in one go (she was using her legs to push for force, you can't make this up). The result is that the baby was born quickly and my wife was ripped open. She required urgent surgery to put herself back together, then a month stuck laying in bed and about three months before she was mobile. She still have problems because of it. The hospital were happy because they could charge three times as much for the corrective surgery than they charged for delivery. My example was in The Netherlands, where the healthcare costs are well under control and the culture isn't quite so brutally selfish ("free market") as other countries. I can't imagine what it's like living in the US.
- kube-system 7y ago
  In the US, we have medical malpractice lawyers on every street corner. Hospitals absolutely aren't profiting from malpractice. >A report issued by the US Department of Health and Human Services estimated the cost of malpractice insurance to doctors alone at $6.3 billion in 2002; with an additional cost of $60–108 billion related to the practice of defensive medicine, i.e., costs related to physician behavior in response to the threat of a lawsuit alleging medical negligence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628513/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628513/
  - davinic 7y ago
    US healthcare spending represents $3.4 trillion[0]. $6.3 billion is only 0.18% of the total costs. Not to mention that malpractice claims paid has decreased substantially (55.7%) in the last 2 decades [1]. [0]: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470361/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470361/
neffy 7y ago
Whilst in the US I snapped the tendon on my little finger. When you do this the little finger just hangs there and you can´t do anything with it. US hospital did a terrible job of splinting it, told me to come back following day to see a surgeon. (Cost $1000+, high copay since I didn´t yet have my work insurance which didn´t kick in for another month etc.) Went back home and googled it. NHS treatment, splint for 6 weeks do not disturb splint under any circumstances, followed by simple physiotherapy. I re-splinted using a plastic spoon handle (which is perfect for this btw.) and today the finger is completely recovered. A year after all this, I ran into a guy at a rental place in the US who had a little finger sticking out at right angles, and which was functionally immobile. He´d had the operation - several years previously, you could see the stiches. Finger had never recovered properly. But you can see where the profit incentive would lie for the American hospital.
- ronnier 7y ago
  How is that related to what I was asking about by the OP comment? Which was: > Without tackling the obesity/sedentary/nutrition problems the healthcare issue will persist. > Similarly the opioid/meth epidemics of the last 2 decades are not (just) healthcare problems

How?

Private healthcare optimizes for profits and value extraction. Public healthcare optimizes (one would assume with the proper governance, oversight, and controls) for quality of life, but also for reducing costs (it's cheaper to treat your type 2 diabetes with diet and exercise before we have to start amputating appendages and you have chronic issues, for example). Disclaimer: Medicare For All (single payer) supporter

cabaalis 7y ago
I'm in the healthcare analytics industry. I see the private payers optimizing for the things you say they don't. It's simply more profitable to have a healthier patient.
- toomuchtodo 7y ago
  https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html https://www.axios.com/health-care-industry-on-track-massive-... (Health care industry on track for massive profits) https://www.forbes.com/sites/brucejapsen/2019/08/04/as-sanders-and-warren-attack-private-health-insurer-profits-soar/#478a4c08532b https://www.forbes.com/sites/brucejapsen/2019/08/04/as-sande... (As Sanders And Warren Attack, Health Insurer Profits Soar; "Take Humana, which last week said it made more than $1 billion in profits in the second quarter and raised its earnings and revenue forecast for the rest of the year thanks to growth of seniors signing up to Medicare Advantage plans. Cigna, too, which said it made more than $1 billion in the second-quarter, also increased its earnings forecast last week for the rest of the year. And the week before, Anthem, which operates Blue Cross and Blue Shield plans in 14 states, also reported more than $1 billion in profits in its second quarter and said its profits are ahead of expectations for the year due in part to the money its making off of government contracts with Medicare and Medicaid programs. Meanwhile, UnitedHealth Group's UnitedHealthcare health insurance unit reported last month $2.6 billion in earnings from operations in the second quarter and the parent company boosted its earnings forecast for 2019.") https://www.cnbc.com/2017/08/05/top-health-insurers-profit-surge-29-percent-to-6-billion-dollars.html https://www.cnbc.com/2017/08/05/top-health-insurers-profit-s... (As Obamacare twists in political winds, top insurers made $6 billion) https://www.gq.com/story/eat-the-health-care-ceos https://www.gq.com/story/eat-the-health-care-ceos (Last year, 62 CEOs of health-care companies made a combined total of $1.1 billion in compensation. That's according to a new report out from Axios, which coincidentally notes that CEO compensation eclipses what the Centers for Disease Control spent on chronic disease prevention by $157 million; The average CEO makes $18 million annually while one out of every five Americans is struggling with medical debt.) Those profits (which you mention they're optimizing for) are dollars that could be used to improve healthcare delivery. That's actual care someone could receive, instead of going to unnecessary middlemen and shareholders.
- matt4077 7y ago
  How long do US citizen stay with a single healthcare provider (/insurance)? If, say, only 50% are still with the same provider at age 50 as they were at age 30, there is a discount on the benefits of preventative measures compared to single-payer systems.
  - thedaemon 7y ago
    As a US citizen I can say that we change Healthcare providers whenever our current employer changes our Healthcare provider option. This can be every single year.
- mikelockz 7y ago
  I would posit it's more profitable to have customers that pay for insurance monthly but don't actually utilize any resources or services. Not using health care seems to be what is encouraged with high deductibles and copays for visits.
- x86_64Ubuntu 7y ago
  Huh? So it's healthier to have patients that never see the doctor? I'm not sure there are many fields in which prevention per unit provides higher margin and revenues than repair and recovery.
  - deleted 7y ago
    [deleted]

Angostura 7y ago

In practical terms, the NHS for example sinks a lot of money into anti-smoking campaigns and into advertising campaigns about weight reduction .On the government side this tends to translate into things like taxation on sugar in drinks. I've just been called in for a check up on my blood pressure and if it had worstened, I would on the end of quite a lot of dietary and excerise advice in an attemp to avoid additional medication. Many GPs in the UK has teamed up with Parkrun and now prescribe park run participation for certain patients and conditions.

thedaemon 7y ago
This sounds like a nightmare on privacy. Government collaborating and sharing your data with outside Companies. Am I getting this right, or wrong?
- alexgmcm 7y ago
  They don't share your data, they just encourage you to go for a run.
- SolaceQuantum 7y ago
  "This sounds like a nightmare on privacy. Government collaborating and sharing your data with outside Companies" Unlike Private companies sharing our data with other private companies?
- ben_w 7y ago
  Occasionally public-private data sharing gets in the news. Where I see it reported, it’s treated as a scandal even when the company in question is Alphabet and they got the data for AI research: https://www.theguardian.com/society/2019/jun/10/nhs-data-google-alphabet-tech-drug-firms https://www.theguardian.com/society/2019/jun/10/nhs-data-goo... Medical privacy is one of those places where I wonder if a personal desire for privacy might hurt society as a whole — Almost, but not quite, like the tragedy of the commons. Still, it’s easy for me to say that, none of my embarrassing aspects have medical consequences.
- Angostura 7y ago

radicalbyte 7y ago

They earn money for treating the symptoms. The same thing goes for quality of medical care - when they mess up they get to fix their own mess and charge for it. For example when our first kid was born, the gynecologist had her trainee pull our son out with their rope thing. She was supposed to apply pressure during the contractions, only she panicked and pulled my son out in one go (she was using her legs to push for force, you can't make this up). The result is that the baby was born quickly and my wife was ripped open. She required urgent surgery to put herself back together, then a month stuck laying in bed and about three months before she was mobile. She still have problems because of it. The hospital were happy because they could charge three times as much for the corrective surgery than they charged for delivery. My example was in The Netherlands, where the healthcare costs are well under control and the culture isn't quite so brutally selfish ("free market") as other countries. I can't imagine what it's like living in the US.

kube-system 7y ago
In the US, we have medical malpractice lawyers on every street corner. Hospitals absolutely aren't profiting from malpractice. >A report issued by the US Department of Health and Human Services estimated the cost of malpractice insurance to doctors alone at $6.3 billion in 2002; with an additional cost of $60–108 billion related to the practice of defensive medicine, i.e., costs related to physician behavior in response to the threat of a lawsuit alleging medical negligence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628513/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628513/
- davinic 7y ago
  US healthcare spending represents $3.4 trillion[0]. $6.3 billion is only 0.18% of the total costs. Not to mention that malpractice claims paid has decreased substantially (55.7%) in the last 2 decades [1]. [0]: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470361/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470361/

neffy 7y ago

Whilst in the US I snapped the tendon on my little finger. When you do this the little finger just hangs there and you can´t do anything with it. US hospital did a terrible job of splinting it, told me to come back following day to see a surgeon. (Cost $1000+, high copay since I didn´t yet have my work insurance which didn´t kick in for another month etc.) Went back home and googled it. NHS treatment, splint for 6 weeks do not disturb splint under any circumstances, followed by simple physiotherapy. I re-splinted using a plastic spoon handle (which is perfect for this btw.) and today the finger is completely recovered. A year after all this, I ran into a guy at a rental place in the US who had a little finger sticking out at right angles, and which was functionally immobile. He´d had the operation - several years previously, you could see the stiches. Finger had never recovered properly. But you can see where the profit incentive would lie for the American hospital.

ronnier 7y ago
How is that related to what I was asking about by the OP comment? Which was: > Without tackling the obesity/sedentary/nutrition problems the healthcare issue will persist. > Similarly the opioid/meth epidemics of the last 2 decades are not (just) healthcare problems