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Back when I took health care policy class in college, we did a cost breakdown / comparison tree between the US health care system and others. One striking resul

Back when I took health care policy class in college, we did a cost breakdown / comparison tree between the US health care system and others. One striking result was that each head of the hydra -- hospitals, insurance companies, drug companies -- did a remarkable job of evenly sharing the ~2x cost inflation factor vs other countries. Of course, each head of the hydra points at the other two and claims it isn't the problem.

karatestomp 7y ago
I’d replace “hospitals” with “care and testing providers generally” but yeah, I reached the same conclusion looking into this on my own. Each is screwing us a ton, which adds up to 3x a ton, but they can always say “don’t look at me, I’m not most of the problem!”
- jjoonathan 7y ago
  I'd accept that pull request.
digi59404 7y ago
This difference here is it’s not about the cost. Those are fake. Its about what is paid. The United States has non-discriminatory laws in place where healthcare providers can’t charge two groups different pricing. So what happens is hospitals and such charge insurance 100k for a service, and then discount it down to 20k. The cost of the service is reported as 100k, but the paid amount is 20k. Because of this individuals are forced to pay 100k if they don’t have insurance. Or if they don’t negotiate a rate on healthcare. This creates an environment where individuals feel they MUST have health insurance. Because of that health insurance companies are treated like they’re essential and can’t fail. It’s all a fake fucking sham. None of this is necessary.
- jjoonathan 7y ago
  No, those numbers were real, post-negotiation, money-changing-hands numbers. US hospitals are actually 2x more expensive. If you looked at hospital pre-negotiation asking prices, I'd expect them to be worse still. The insurance company side of this pissing contest is "nobody forces hospitals to list insane prices, certainly not us, but we can give you the leverage to make sure they don't stick -- good luck managing that on your own!"
api 7y ago
I blame the insurance companies based on the simple calculus that they are the ones in your list that add the least value. Drug companies and providers make things and do things. Insurance companies push paper. By your argument we could dispense with them, save 1/3, and lose nothing.
- kasey_junk 7y ago
  Insurance in the form of risk pooling is an extremely valuable service. The issue is that in the US the health insurers do way more than risk pooling. They also do gatekeeping, discounting, & provisioning. Plus there is an asinine indirection layer where their customers are employers instead of the covered. In a properly functioning health market there would be a very important role for insurance, our current market is just so insane it’s hard to see it.
  - jjoonathan 7y ago
    Insurance only risk-pools by accident. In a world where they had perfect information, they would risk-smooth over your life, but not risk-pool between people. Collective plans, like those provided by your employer, would risk-pool, but then should we really attribute the pooling to insurance companies?
    - kasey_junk 7y ago
      We don’t live in a world with perfect information which is what makes all insurance valuable. So yes? We should give credit to insurance for providing value in the real world.
      - jjoonathan 7y ago
        When I was asking "should we really give them credit," I was referring specifically to the imaginary world in which they had perfect information. I agree that we should give insurance companies credit for the value they accidentally create in the world that we live in -- so long as we keep in mind that the value creation was predicated on their inability to find & leverage information. However, going forward in a world of increasingly available information, do you think it is a good idea to rely on their inability to find & leverage information? I sure don't.

karatestomp 7y ago

I’d replace “hospitals” with “care and testing providers generally” but yeah, I reached the same conclusion looking into this on my own. Each is screwing us a ton, which adds up to 3x a ton, but they can always say “don’t look at me, I’m not most of the problem!”

jjoonathan 7y ago
I'd accept that pull request.

digi59404 7y ago

This difference here is it’s not about the cost. Those are fake. Its about what is paid. The United States has non-discriminatory laws in place where healthcare providers can’t charge two groups different pricing. So what happens is hospitals and such charge insurance 100k for a service, and then discount it down to 20k. The cost of the service is reported as 100k, but the paid amount is 20k. Because of this individuals are forced to pay 100k if they don’t have insurance. Or if they don’t negotiate a rate on healthcare. This creates an environment where individuals feel they MUST have health insurance. Because of that health insurance companies are treated like they’re essential and can’t fail. It’s all a fake fucking sham. None of this is necessary.

jjoonathan 7y ago
No, those numbers were real, post-negotiation, money-changing-hands numbers. US hospitals are actually 2x more expensive. If you looked at hospital pre-negotiation asking prices, I'd expect them to be worse still. The insurance company side of this pissing contest is "nobody forces hospitals to list insane prices, certainly not us, but we can give you the leverage to make sure they don't stick -- good luck managing that on your own!"

api 7y ago

I blame the insurance companies based on the simple calculus that they are the ones in your list that add the least value. Drug companies and providers make things and do things. Insurance companies push paper. By your argument we could dispense with them, save 1/3, and lose nothing.

kasey_junk 7y ago
Insurance in the form of risk pooling is an extremely valuable service. The issue is that in the US the health insurers do way more than risk pooling. They also do gatekeeping, discounting, & provisioning. Plus there is an asinine indirection layer where their customers are employers instead of the covered. In a properly functioning health market there would be a very important role for insurance, our current market is just so insane it’s hard to see it.
- jjoonathan 7y ago
  Insurance only risk-pools by accident. In a world where they had perfect information, they would risk-smooth over your life, but not risk-pool between people. Collective plans, like those provided by your employer, would risk-pool, but then should we really attribute the pooling to insurance companies?
  - kasey_junk 7y ago
    We don’t live in a world with perfect information which is what makes all insurance valuable. So yes? We should give credit to insurance for providing value in the real world.
    - jjoonathan 7y ago
      When I was asking "should we really give them credit," I was referring specifically to the imaginary world in which they had perfect information. I agree that we should give insurance companies credit for the value they accidentally create in the world that we live in -- so long as we keep in mind that the value creation was predicated on their inability to find & leverage information. However, going forward in a world of increasingly available information, do you think it is a good idea to rely on their inability to find & leverage information? I sure don't.