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> to the overhead of health insurance Not really. The ACA (Obamacare) caps overhead and profits at either 15% or 20% depending on market (google "medical loss

> to the overhead of health insurance Not really. The ACA (Obamacare) caps overhead and profits at either 15% or 20% depending on market (google "medical loss ratio"). The dirty secret is that too many doctors go into medicine for the wrong reasons (making money, instead of helping people), and collude to limit the number of new doctors created each year. The AMA is by far the most effective union in the US.

munk-a 5y ago
The profits may be capped but US healthcare is still insanely expensive compared to other first world nations. Articles on the internet seem to say that the US was 4-5 times as expensive in 2019 - but more reliable research from 2010[1] puts that number closer to 2 times as expensive. The issue is that the US's broken healthcare system just costs a lot more per patient than anything else - and a lot of companies take cuts of every dollar that goes into that cost while, in Canada, a lot of types of organizations: PBMs, Payers, Reimbursers - are all just the government, and it doesn't do that work for free, but it's a lot more efficient. 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024588/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024588/
- labcomputer 5y ago
  > The profits may be capped but US healthcare is still insanely expensive compared to other first world nations. Number 1: It's not the profits that are capped. Profits plus operating expenses are capped. Operating expenses (like paying folks in the call center to answer questions about coverage, adjudicating claims, etc.) come out of the insurance company's 15/20% (national/regional). If medical claims are less than 75/80% of premiums, the insurer is legally obligated to issue rebates. If the cost of administering the plan is more than 15/20%... too bad, so sad: the insurance company is legally obligated to loose money and (eventually, if they don't fix it) go bankrupt. Number 2: I never said that it wasn't more expensive in the US. Just that health insurance companies are not the reason it is so (which was the reason you cited for the US's high healthcare costs). Mathematically, even if you assume it's entirely graft and profit (and it's not--processing claims is not free), the very best you can do is a 20% reduction in costs. What accounts for the rest? Bear in mind that medical doctors in the USA earn as much as FAANG engineers. The average doctor salary across all specialties in the USA is $300k. Many earn 2x that. By way of comparison, it is unusual for a doctor in the UK to earn even as much as $200k, and the average is around $100k. Unless the UK is somehow finding people who will pay money to the NHS in exchange for the honor of answering phones and administering claims, I find it difficult to believe that health insurers are anywhere close to the biggest driver of healthcare costs in the US.
  - DanBC 5y ago
    > By way of comparison, it is unusual for a doctor in the UK to earn even as much as $200k, and the average is around $100k. $100k is about £71k. Starting salary for consultants in England is £82096.
    - labcomputer 5y ago
      Sure, but: 1. Not every doctor is a consultant. Specialists range £41k to £76k. GPs range £61k to £91k. 2. The salary bands are fairly narrow. Consultants may start at £82k, but they only go up to £111k. Here you can have it from the horse's mouth: https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-doctors https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-d...
      - DanBC 5y ago
        When you include residents in the US pay the "average across all specialities" is way less than $300k. > Specialists range £41k to £76k. You've misunderstood what they said. They said "speciality doctors", not "specialist doctors". In England the trainee ranking is Foundation Years, Core Trainee, Speciality Trainee.

munk-a 5y ago

The profits may be capped but US healthcare is still insanely expensive compared to other first world nations. Articles on the internet seem to say that the US was 4-5 times as expensive in 2019 - but more reliable research from 2010[1] puts that number closer to 2 times as expensive. The issue is that the US's broken healthcare system just costs a lot more per patient than anything else - and a lot of companies take cuts of every dollar that goes into that cost while, in Canada, a lot of types of organizations: PBMs, Payers, Reimbursers - are all just the government, and it doesn't do that work for free, but it's a lot more efficient. 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024588/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024588/

labcomputer 5y ago
> The profits may be capped but US healthcare is still insanely expensive compared to other first world nations. Number 1: It's not the profits that are capped. Profits plus operating expenses are capped. Operating expenses (like paying folks in the call center to answer questions about coverage, adjudicating claims, etc.) come out of the insurance company's 15/20% (national/regional). If medical claims are less than 75/80% of premiums, the insurer is legally obligated to issue rebates. If the cost of administering the plan is more than 15/20%... too bad, so sad: the insurance company is legally obligated to loose money and (eventually, if they don't fix it) go bankrupt. Number 2: I never said that it wasn't more expensive in the US. Just that health insurance companies are not the reason it is so (which was the reason you cited for the US's high healthcare costs). Mathematically, even if you assume it's entirely graft and profit (and it's not--processing claims is not free), the very best you can do is a 20% reduction in costs. What accounts for the rest? Bear in mind that medical doctors in the USA earn as much as FAANG engineers. The average doctor salary across all specialties in the USA is $300k. Many earn 2x that. By way of comparison, it is unusual for a doctor in the UK to earn even as much as $200k, and the average is around $100k. Unless the UK is somehow finding people who will pay money to the NHS in exchange for the honor of answering phones and administering claims, I find it difficult to believe that health insurers are anywhere close to the biggest driver of healthcare costs in the US.
- DanBC 5y ago
  > By way of comparison, it is unusual for a doctor in the UK to earn even as much as $200k, and the average is around $100k. $100k is about £71k. Starting salary for consultants in England is £82096.
  - labcomputer 5y ago
    Sure, but: 1. Not every doctor is a consultant. Specialists range £41k to £76k. GPs range £61k to £91k. 2. The salary bands are fairly narrow. Consultants may start at £82k, but they only go up to £111k. Here you can have it from the horse's mouth: https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-doctors https://www.healthcareers.nhs.uk/explore-roles/doctors/pay-d...
    - DanBC 5y ago
      When you include residents in the US pay the "average across all specialities" is way less than $300k. > Specialists range £41k to £76k. You've misunderstood what they said. They said "speciality doctors", not "specialist doctors". In England the trainee ranking is Foundation Years, Core Trainee, Speciality Trainee.