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I'm author of Hacking Healthcare for O'Reilly, 20 year health system executive, blah, blah. It's very easy for people to forget the scale of the US "health sys

I'm author of Hacking Healthcare for O'Reilly, 20 year health system executive, blah, blah. It's very easy for people to forget the scale of the US "health system", we are talking 1/5, maybe more, of the entire US economy. If US healthcare spending were a country, it would have the third largest GDP in the world. Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes that results in the very clumsy way of pricing healthcare services that results in this massive matrix of data. As pointed out elsewhere there is a tremendous amount of cost distribution that goes into the code matrix and this plays a large role in negotiations with health insurers as well. Ground is given in one set of procedures and lost in others. This is a big step in shining light into areas that need it to improve the system overall.

e_i_pi_2 4y ago
Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? Or is there some other reason healthcare "just costs more" here? Also wondering what you think a solution is - single-payer for better and simpler price negotiations, or some other approach? My main concern is if we're spending 20% of GDP on something other countries accomplish with 10%, then that's a huge waste, especially in a country with a larger total GDP pool.
- duffpkg 4y ago
  Healthcare is such a base layer of the economy, I find comparisons to be extraordinaly difficult between countries. On the most basic level our pathway to becoming a healthcare provider of all sorts is dramatically more expensive and limited than other countries, what healthcare providers are paid is dramatically more than other countries, we invest many times per capita what other countries put into basic medical research, the way are population is taxed is very different than other countries, our patient population is very different from other countries, our expectations are very different from other countries, our scale is dramatically different than other countries, and so on. The US is a singular animal politically in that it is a compact of individual states that especially in regards to healthcare, the federal goverments powers (though it may not seem so at times) are actually quite limited. It's all but impossible to come up with reasonable numerators and denominators for comparison.
  - anonymouse008 4y ago
    > Healthcare is such a base layer of the economy Academically this sounds enlightening, but it only takes one cursory walk around a supermarket in the US to see this is unequivocally false. Healthcare is an externality, not a base of anything. From the average customer to the product in the aisle to the marketing - everything is 100% not a direct cost benefit function in terms of healthcare.
    - rgrieselhuber 4y ago
      And add on top the oft-repeated that “health insurance is healthcare.” That’s how you obfuscate a whole of things.
    - skybrian 4y ago
      I'm not sure what that proves, given that you went to a grocery store instead of a pharmacy.
      - QuarterReptile 4y ago
        I'm guessing parent was saying that most medical spending is payback for terrible US American eating habits?
        Forgeties79 4y ago
        I hope his view isn’t so myopic/“boot straps” but I guess it’s possible.
        anonymouse008 4y ago
        Thanks for the benefit of doubt, 'hoo!
    - refurb 4y ago
      After you criticized the comment as only “sounding enlightening” I was eager to hear your thoughts. Unfortunately I think your comment is even less enlightening. I mean, not all healthcare problems are caused by lifestyle. So clearly healthcare is a base layer - there is no situation where it wouldn’t exist.
- medlazik 4y ago
  As with everything it touches, it's the intrinsic failure of capitalism (ofc success for the capitalists / bourgeoisie). It's the amount of capitalism that defines prices. In every other country the more healthcare is a public matter, the cheaper it is for the people.
  - gwright 4y ago
    Healthcare in the US is definitely not driven by the free market. It is probably one of the most regulated industries. Whatever disfunction you want to call out in US healthcare it is going to be difficult to pin that on the free market.
    - medlazik 4y ago
      Free market? Capitalism. I know we're on HN but, say the word? Capitalists take a cut. Shareholders of big pharma, insurance companies and hospitals are why healthcare in the US is expensive. Public sector not being monopolistic is why healthcare in the US is expensive. In France, social security reimburses about 70% of most costs. Cheap private insurance reimburses the rest. About 75% of public hospitals and not for profit. Generic medicine being prescribed is the norm. The state naturally fixes healthcare prices because it's monopolistic on healthcare. Same as all public services.
      - a-user-you-like 4y ago
        Non free market? Communism. I know we’re on HN but, say the word? Of course the US market is highly regulated and so the market is not free to lower prices. Of course the AMA is a racket. Of course needs of certificate are abhorrent. Given the customer non—coerced access to his preferred provider, and not taking his money and slapping a bunch of regulations on him will of course lower prices and give him better care. I don’t see why the other side can’t see it.
        medlazik 4y ago
        That's right, communism. Social security in France is literally a communist system, founded by a communist minister. Hence why neoliberals want to destroy it.
- spaetzleesser 4y ago
  Number one is full price transparency of the whole chain. I work for a medical device company and even the marketing people can't really tell what our stuff costs. There are a ton of middlemen with obscure contracts and very high markups. My ex got one of our devices and I was told by our people that the hospital should have received the device for between 20k-30k (nobody seems to really know) and the hospital charged 80k for the device alone. They also charged another 200k for a one hour surgery with a total hospital stay of six hours. It's also hard to explain that US patients pay a multiple of the drug price people in other parts of the world pay for the something. The problem is that if the US wastes 10% of GDP on health care inefficiencies this creates a huge lobby that will fight tooth and mail to keep that money.
  - t0mas88 4y ago
    The prices as charged in the US regularly make it onto Twitter and Reddit etc where us Europeans wonder how on earth it's possible that something in the US costs $ 800 which is charged at less than $ 100 over here (and then paid by insurance). Same for that $ 30k device being sold for $ 80k. What we all forget is that nobody is actually paying the US healthcare invoices. Roughly two options... 1. You have insurance and they negotiated a different (much lower) rate or 2. you don't have insurance and can't pay the amount on the invoice. In option 2 you either declare bankruptcy and they get nothing or they sell the claim for something like 20% of the invoice to a collections agency.
    - spaetzleesser 4y ago
      Not correct. The insurance paid 80k for the device and 300k total for the surgery after one year of fighting almost daily. Also: if you make a certain amount of money and they hit you with a 100k bill you can't just declare bankruptcy. The court won't allow you to do it because you make too much money.
      - e_i_pi_2 4y ago
        > you can't just declare bankruptcy. The court won't allow you to do it because you make too much money Isn't this always the case? My understanding was that bankruptcy is for when you don't have enough income to pay bills, so if you have a bill for any amount but are able to pay it then you wouldn't be allowed to declare bankruptcy
- brightball 4y ago
  I’ve heard a lot of complaints about Medicare/Medicaid. It does not inspire confidence in single payer.
  - e_i_pi_2 4y ago
    There's always complaints about healthcare and probably no perfect system, but a bad one where everyone has coverage seems a lot better than a bad one where everyone doesn't
- dnissley 4y ago
  Is it really the same standard of care? I would speculate that the standard of care in the US is at least marginally higher than many other developed countries based on my admittedly anecdotal experience, especially if you plug wait times for providers into the calculation (this seems to be the number one complaint that comes from people I've met that have immigrated to the US).
  - simsla 4y ago
    If your outside experience was in the UK, I would tend to agree. Their healthcare is drastically underfunded. In comparison to France, Germany, Belgium, the Netherlands, etc I would disagree.
- refurb 4y ago
  Google search for the McKinsey report on US healthcare spending - I think it was around 2009. I work in the industry as well and it’s one of the few reports that actually breaks down the spending in a logical way. They basically adjust US spending by GDP (high GDP countries spend more generally) then compare each category to the OECD average (also adjust by GDP), on a price and volume measure. The answer is - yes, higher price are a factor, but volume is also a major factor. In hospital spending is actually in line with other countries. Drugs costs more but it doesn’t contribute that much to total spending. In terms of durables (equipment) the US spends less. The biggest driver? Out patient procedures. Not just price, but Americans get way more out patient procedures done compared to other countries and it accounts for like half of the “excess spend” of the US compared to other countries.
- soheil 4y ago
  > if we're spending 20% of GDP on something other countries accomplish with 10%, then that's a huge waste I don't think that money is necessarily a waste if it goes back into the economy one way or another. There are very few things that are actually a waste, one example is probably flying first class or private jet. If you literally burn money then it's clearly a waste. A part of me thinks the huge cost of healthcare is contributing to more R&D by the big pharma and possibly the reason we're seeing RDNA breakthroughs. Yes a lot of that money also ends up in the pocket of people running the show, but they most likely then invest it with a Blackrock which in turn pushes the money back into the economy in form of private equity, VC funds, etc. For the record I don't like the high healthcare prices and wish US was more similar to other countries in this regard.
- tzs 4y ago
  > Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? That we spend more per capita for approximately the same level of care as most other first world countries is certainly annoying. But sometimes I think we are too focused on that and not putting enough effort into trying to stop the cost from increasing. I think increasing costs are a more serious problem because the problem of spending so much more than the others is a US problem. That suggests it is just something we are doing wrong, and by making our system more like some of those others we can fix it. The problem of rising costs also plagues those other countries, and to about the same extent as it does the US. That suggests it is a much harder problem to solve. Here are some examples of rising costs per capita. How much costs per capita went up from 2000 to 2018: US 2.3x, Germany 2.1x, France 1.8x, Canada 2.0x, Italy 1.7x, Japan 2.6x, and UK 2.6x. Costs per capita in 1980, 1990, 2000, 2010, and 2020 divided by 1970 costs: 1980 1990 2000 2010 2020 US 3.2 8.2 13.9 24.1 36.3 UK 3.1 6.3 15.3 27.8 40.5 FR 3.4 7.6 14.9 21.1 28.5 Here's the ratio of each given year to the cost 10 years earlier: 1980 1990 2000 2010 2020 US 3.2 2.6 1.7 1.7 1.5 UK 3.1 2.0 2.4 1.8 1.5 FR 3.4 2.2 2.0 1.4 1.4 Data source: https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm If "latest data available" is checked, uncheck it to unlock the slider that lets you look at historical data back to 1970.
  - ramraj07 4y ago
    Data doesn’t make sense. If US costs went up similar to other countries but US is significantly more expensive than other countries today, does it mean costs in US have always been much higher?
    - tzs 4y ago
      Yes (at least as far back as the data at oecd.org goes, which is 1970). In 1970 US health care spending was $327.0/per capita. France was $192.1, and UK was $124.0. That's 1.7x France and 2.6x UK for the US. In 2020 it was $11859 for the US, $5468 for France, and $5019 for the UK. That puts 2020 US spending at 2.2x France and 2.4x UK. From 1970 to 2020 US went up 36x, France 28x, and UK 40x. It looks like much of the first world has a serious rising health spending problem, with costs rising roughly the same over time everywhere. The US was more expensive long ago, and since the rising costs have been roughly the same the US has stayed more expensive by about the same ratio. If we could get our spending down to match the rest of the first world, without reducing the level of care, that would be great. BTW, it is similar if we go by percent of GDP instead of per capita. US was spending 6.2% of GDP on health in 1970, France 5.2%, and UK 4.0%. In 2020 that was 18.8% of GDP for the US, 12.2% France, and 12.0% UK.
- anonu 4y ago
  There's many things wrong with US healthcare. But somehow the USA comes up with the the first vaccines for the coronavirus and if you want any sort of complex procedure you travel to the US to get it. So maybe thats where the extra cost goes? To drive research, and support the infrastructure that creates good to better health outcomes on average vs the rest of the world. Saying something is a failure just because it costs so much is only looking at one side of the coin.
  - jeeeb 4y ago
    On average healthcare outcomes in the US aren’t particularly great compared to other developed countries though (https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019 https://www.commonwealthfund.org/publications/issue-briefs/2...). In particular life expectancy is very low by developed world standards and deaths from preventable causes are very high. I don’t doubt that the US has world leading hospitals but the population level outcomes delivered are poor by developed world standards. The US is a net exporter of healthcare services but mostly to developing countries and the numbers involved are tiny (https://www.usitc.gov/publications/332/executive_briefings/chambers_health-related_travel_final.pdf https://www.usitc.gov/publications/332/executive_briefings/c...) The idea that people who want any sort of complex procedure travel to the US is pure fantasy. As for the COVID-19 vaccines. The first approved vaccine was the “Pfizer” vaccine developed by BioNTech in Germany (https://en.m.wikipedia.org/wiki/Pfizer–BioNTech_COVID-19_vaccine https://en.m.wikipedia.org/wiki/Pfizer–BioNTech_COVID-19_vac...).
  - amanaplanacanal 4y ago
    Vaccines for the COVID were developed simultaneously in multiple countries.
  - e_i_pi_2 4y ago
    > But somehow the USA comes up with the the first vaccines for the coronavirus and if you want any sort of complex procedure you travel to the US to get it This isn't true, the US didn't make the first vaccines, it was created by a German company that partnered with Pfizer for trials/production/distribution[0]. People more often travel outside the US for care, we actually have the second highest amount of people leaving their home country for medical care[1], with the top destinations being in South America [1a]. > creates good to better health outcomes on average vs the rest of the world This would be nice if true, but we spend more and still have worse outcomes in almost every area[2]. The only things I could actually find that are better here is post-op sepsis and 30-day heart attack survival, but in just about every other area it's more dangerous to get care in the US. [0]: https://en.wikipedia.org/wiki/History_of_COVID-19_vaccine_development https://en.wikipedia.org/wiki/History_of_COVID-19_vaccine_de... [1]: https://www.health-tourism.com/medical-tourism/statistics/ https://www.health-tourism.com/medical-tourism/statistics/ [1a]: https://amjmed.org/medical-tourists-incoming-and-outgoing/ https://amjmed.org/medical-tourists-incoming-and-outgoing/ [2]: https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/ https://www.healthsystemtracker.org/chart-collection/quality...
- nradov 4y ago
  The US is (exaggerating a bit) a nation of obese, sedentary substance abusers. We are sicker on average than other developed countries and thus have a higher demand for healthcare. We might be able to eke out some minor improvements by tweaking the payment model and eliminating some waste. Those things are worth doing, but they won't fix the fundamental problem. The US won't get healthcare spending down to Japan's levels until Americans start acting like Japanese. There are some other key factors as well. A large fraction of healthcare spending goes toward treating elderly patients with serious chronic conditions in their last few years of life. Some countries explicitly deny care to such patients because they don't think it's justified on a QALY basis, but Americans seem uncomfortable with rationing on that basis. And some aspects of the US healthcare system are top notch. For many types of cancers we have the world's best 5-year survival rates. There is a thriving medical tourism business where patients from countries with socialized medicine such as Canada come here to receive rapid treatment instead of waiting for years for something like a hip replacement.
- vineyardmike 4y ago
  I’m not the OP and have no deep knowledge, but I’ve often heard cited that the US out-researches other nations, so we incur “R&D” costs for healthcare that other nations use. Eg pharmaceuticals are researched in the US while the patents are used in other nations through a cost structure that doesn’t allow the original researching party to recoup costs. On-shoring that research also seems to be an advantage -Looking at the astounding amount of research that poured into covid post 2020 would show that we have a huge dormant muscle that can be flexed in unison during an emergency.
  - Sakos 4y ago
    I've never seen any convincing evidence for this theory.
    - deleted 4y ago
      [deleted]
  - briffle 4y ago
    Then why do they spend so much more on marketing than R&D? https://www.ahip.org/news/articles/new-study-in-the-midst-of-covid-19-crisis-7-out-of-10-big-pharma-companies-spent-more-on-sales-and-marketing-than-r-d https://www.ahip.org/news/articles/new-study-in-the-midst-of...
    - vineyardmike 4y ago
      I’m not trying to defend pharma companies… they’re generally pretty scummy. But I’m guessing most companies spend more on marketing than R&D. Beyond that, the theory that they need to recoup costs still holds true with this. In fact, a big marketing budget indicates that they’re aggressively trying to sell the drug (maybe to recoup costs?). Generally in business marketing budgets should generate more sales than they cost (in ideal case), so big budgets doesn’t mean that they’re “wasting” that money that could go elsewhere. If the sale wouldn’t happen without an ad, then that’s a necessary ad.
      - 4y ago
linkdink 4y ago
In your opinion, what would be the lowest hanging fruit that could be changed to have the largest positive impact?
- duffpkg 4y ago
  People are rarely satisfied with this answer but its demonstrably true and was proven time and time again at the facilities ClearHealth managed. 1) Feverent, almost religious, adherence to hand washing. 2) No neck ties or dangly sleves whatsoever in buildings that house patients. 3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". Those are simple, virtually free, things that have a very meaningful impact on outcomes. Some of the most viscous fights I've had with hospital boards were over what amounted to the "uglier look" of copper/brass. It is an extremely unpopular topic in healthcare but the area that takes a lot of effort to solve but also has a tremendously out-weighted benefit is reducing preventable medical errors. My opinion after being in healthcare ~20 years is that preventable medical error is absolutely in the top 3 causes of death in the US. The easiest subset of it to resolve is prescription related errors, we have all the tools to resolve those but not the will.
  - linkdink 4y ago
    Well, I'm satisfied with that answer. But maybe that's because I think brass and copper look better than stainless steel.
  - BitwiseFool 4y ago
    >"3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". Because of the pandemic I started encountering doors that have a shoe pull, where you can use your foot to open the door instead of having to touch the handle. I really hope these catch on, but they are still quite rare.
    - snuxoll 4y ago
      Also stop getting rid of paper towels if you still have manual faucets. Nothing grosses me out more than going to a public restroom with only air dryers, but manually operated faucets that now require you use clean hands to turn off after you turned them on with presumably dirty hands.
iancmceachern 4y ago
I've worked in the medical device industry for 20 years and have a similar takeaway. I often describe it as the "hospital insurance company industrial complex".
AndrewKemendo 4y ago
I might be joining a large EHR company in the near future as a VP and am wondering if I can send you a question from time to time as they come up via email? Would love to connect but don't see anything on your profile here. I'm akemendo at the google mail service
Dave3of5 4y ago
> Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes Erm this is incorrect given that ICD are international it's actually the WHO that creates them source: https://en.wikipedia.org/wiki/International_Classification_of_Diseases https://en.wikipedia.org/wiki/International_Classification_o...
daniel-cussen 4y ago
It's more it's like 38%. Hollywood accounting all the way. In particular the deadweight cost of the the AMA monopoly on licensing is like 50% of GDP, which doesn't sound possible but if you know what a deadweight cost is it's a part of the nation's income that can't exist because it isn't there. It's how much better life would be if a doctor were as cheap as an uber driver, or if people healing others didn't get medium security prison as a result. It's the greatest threat to National Security, more than Russia China and the Middle East combined. And it's a military problem, wounded soldiers yeah get help from the Veteran's Association but they have to compete for those doctors and it ends up...out of pocket if they really want good care. Military gets fucked paying for doctors. America spends more money on obesity, than it does on defense. AMA is treason. Standard Oil had a lot of different shareholders, John D. Rockefeller was never majority owner, that was an organization AMA is an organization there's now medical families. Common heirs. Medical students from a medical family get little hazing compared to the rest. All the maneuvers they make to avoid the words "monopoly" and "cornered market" are of no help and mitigate nothing. So they know people get fucked off with those words, like bad, they're afraid of those words.
JAA1337 4y ago
In a vacuum ... It does not seem reasonable that 20% of a countries economy is spent on health care. Just as it doesn't seem reasonable for the cost of healthcare to be ~12% of the household income for a family (third highest living expense).

e_i_pi_2 4y ago

Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? Or is there some other reason healthcare "just costs more" here? Also wondering what you think a solution is - single-payer for better and simpler price negotiations, or some other approach? My main concern is if we're spending 20% of GDP on something other countries accomplish with 10%, then that's a huge waste, especially in a country with a larger total GDP pool.

duffpkg 4y ago
Healthcare is such a base layer of the economy, I find comparisons to be extraordinaly difficult between countries. On the most basic level our pathway to becoming a healthcare provider of all sorts is dramatically more expensive and limited than other countries, what healthcare providers are paid is dramatically more than other countries, we invest many times per capita what other countries put into basic medical research, the way are population is taxed is very different than other countries, our patient population is very different from other countries, our expectations are very different from other countries, our scale is dramatically different than other countries, and so on. The US is a singular animal politically in that it is a compact of individual states that especially in regards to healthcare, the federal goverments powers (though it may not seem so at times) are actually quite limited. It's all but impossible to come up with reasonable numerators and denominators for comparison.
- anonymouse008 4y ago
  > Healthcare is such a base layer of the economy Academically this sounds enlightening, but it only takes one cursory walk around a supermarket in the US to see this is unequivocally false. Healthcare is an externality, not a base of anything. From the average customer to the product in the aisle to the marketing - everything is 100% not a direct cost benefit function in terms of healthcare.
  - rgrieselhuber 4y ago
    And add on top the oft-repeated that “health insurance is healthcare.” That’s how you obfuscate a whole of things.
  - skybrian 4y ago
    I'm not sure what that proves, given that you went to a grocery store instead of a pharmacy.
    - QuarterReptile 4y ago
      I'm guessing parent was saying that most medical spending is payback for terrible US American eating habits?
      - Forgeties79 4y ago
        I hope his view isn’t so myopic/“boot straps” but I guess it’s possible.
        anonymouse008 4y ago
        Thanks for the benefit of doubt, 'hoo!
  - refurb 4y ago
    After you criticized the comment as only “sounding enlightening” I was eager to hear your thoughts. Unfortunately I think your comment is even less enlightening. I mean, not all healthcare problems are caused by lifestyle. So clearly healthcare is a base layer - there is no situation where it wouldn’t exist.
medlazik 4y ago
As with everything it touches, it's the intrinsic failure of capitalism (ofc success for the capitalists / bourgeoisie). It's the amount of capitalism that defines prices. In every other country the more healthcare is a public matter, the cheaper it is for the people.
- gwright 4y ago
  Healthcare in the US is definitely not driven by the free market. It is probably one of the most regulated industries. Whatever disfunction you want to call out in US healthcare it is going to be difficult to pin that on the free market.
  - medlazik 4y ago
    Free market? Capitalism. I know we're on HN but, say the word? Capitalists take a cut. Shareholders of big pharma, insurance companies and hospitals are why healthcare in the US is expensive. Public sector not being monopolistic is why healthcare in the US is expensive. In France, social security reimburses about 70% of most costs. Cheap private insurance reimburses the rest. About 75% of public hospitals and not for profit. Generic medicine being prescribed is the norm. The state naturally fixes healthcare prices because it's monopolistic on healthcare. Same as all public services.
    - a-user-you-like 4y ago
      Non free market? Communism. I know we’re on HN but, say the word? Of course the US market is highly regulated and so the market is not free to lower prices. Of course the AMA is a racket. Of course needs of certificate are abhorrent. Given the customer non—coerced access to his preferred provider, and not taking his money and slapping a bunch of regulations on him will of course lower prices and give him better care. I don’t see why the other side can’t see it.
      - medlazik 4y ago
        That's right, communism. Social security in France is literally a communist system, founded by a communist minister. Hence why neoliberals want to destroy it.
spaetzleesser 4y ago
Number one is full price transparency of the whole chain. I work for a medical device company and even the marketing people can't really tell what our stuff costs. There are a ton of middlemen with obscure contracts and very high markups. My ex got one of our devices and I was told by our people that the hospital should have received the device for between 20k-30k (nobody seems to really know) and the hospital charged 80k for the device alone. They also charged another 200k for a one hour surgery with a total hospital stay of six hours. It's also hard to explain that US patients pay a multiple of the drug price people in other parts of the world pay for the something. The problem is that if the US wastes 10% of GDP on health care inefficiencies this creates a huge lobby that will fight tooth and mail to keep that money.
- t0mas88 4y ago
  The prices as charged in the US regularly make it onto Twitter and Reddit etc where us Europeans wonder how on earth it's possible that something in the US costs $ 800 which is charged at less than $ 100 over here (and then paid by insurance). Same for that $ 30k device being sold for $ 80k. What we all forget is that nobody is actually paying the US healthcare invoices. Roughly two options... 1. You have insurance and they negotiated a different (much lower) rate or 2. you don't have insurance and can't pay the amount on the invoice. In option 2 you either declare bankruptcy and they get nothing or they sell the claim for something like 20% of the invoice to a collections agency.
  - spaetzleesser 4y ago
    Not correct. The insurance paid 80k for the device and 300k total for the surgery after one year of fighting almost daily. Also: if you make a certain amount of money and they hit you with a 100k bill you can't just declare bankruptcy. The court won't allow you to do it because you make too much money.
    - e_i_pi_2 4y ago
      > you can't just declare bankruptcy. The court won't allow you to do it because you make too much money Isn't this always the case? My understanding was that bankruptcy is for when you don't have enough income to pay bills, so if you have a bill for any amount but are able to pay it then you wouldn't be allowed to declare bankruptcy
brightball 4y ago
I’ve heard a lot of complaints about Medicare/Medicaid. It does not inspire confidence in single payer.
- e_i_pi_2 4y ago
  There's always complaints about healthcare and probably no perfect system, but a bad one where everyone has coverage seems a lot better than a bad one where everyone doesn't
dnissley 4y ago
Is it really the same standard of care? I would speculate that the standard of care in the US is at least marginally higher than many other developed countries based on my admittedly anecdotal experience, especially if you plug wait times for providers into the calculation (this seems to be the number one complaint that comes from people I've met that have immigrated to the US).
- simsla 4y ago
  If your outside experience was in the UK, I would tend to agree. Their healthcare is drastically underfunded. In comparison to France, Germany, Belgium, the Netherlands, etc I would disagree.
refurb 4y ago
Google search for the McKinsey report on US healthcare spending - I think it was around 2009. I work in the industry as well and it’s one of the few reports that actually breaks down the spending in a logical way. They basically adjust US spending by GDP (high GDP countries spend more generally) then compare each category to the OECD average (also adjust by GDP), on a price and volume measure. The answer is - yes, higher price are a factor, but volume is also a major factor. In hospital spending is actually in line with other countries. Drugs costs more but it doesn’t contribute that much to total spending. In terms of durables (equipment) the US spends less. The biggest driver? Out patient procedures. Not just price, but Americans get way more out patient procedures done compared to other countries and it accounts for like half of the “excess spend” of the US compared to other countries.
soheil 4y ago
> if we're spending 20% of GDP on something other countries accomplish with 10%, then that's a huge waste I don't think that money is necessarily a waste if it goes back into the economy one way or another. There are very few things that are actually a waste, one example is probably flying first class or private jet. If you literally burn money then it's clearly a waste. A part of me thinks the huge cost of healthcare is contributing to more R&D by the big pharma and possibly the reason we're seeing RDNA breakthroughs. Yes a lot of that money also ends up in the pocket of people running the show, but they most likely then invest it with a Blackrock which in turn pushes the money back into the economy in form of private equity, VC funds, etc. For the record I don't like the high healthcare prices and wish US was more similar to other countries in this regard.
tzs 4y ago
> Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? That we spend more per capita for approximately the same level of care as most other first world countries is certainly annoying. But sometimes I think we are too focused on that and not putting enough effort into trying to stop the cost from increasing. I think increasing costs are a more serious problem because the problem of spending so much more than the others is a US problem. That suggests it is just something we are doing wrong, and by making our system more like some of those others we can fix it. The problem of rising costs also plagues those other countries, and to about the same extent as it does the US. That suggests it is a much harder problem to solve. Here are some examples of rising costs per capita. How much costs per capita went up from 2000 to 2018: US 2.3x, Germany 2.1x, France 1.8x, Canada 2.0x, Italy 1.7x, Japan 2.6x, and UK 2.6x. Costs per capita in 1980, 1990, 2000, 2010, and 2020 divided by 1970 costs: 1980 1990 2000 2010 2020 US 3.2 8.2 13.9 24.1 36.3 UK 3.1 6.3 15.3 27.8 40.5 FR 3.4 7.6 14.9 21.1 28.5 Here's the ratio of each given year to the cost 10 years earlier: 1980 1990 2000 2010 2020 US 3.2 2.6 1.7 1.7 1.5 UK 3.1 2.0 2.4 1.8 1.5 FR 3.4 2.2 2.0 1.4 1.4 Data source: https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm If "latest data available" is checked, uncheck it to unlock the slider that lets you look at historical data back to 1970.
- ramraj07 4y ago
  Data doesn’t make sense. If US costs went up similar to other countries but US is significantly more expensive than other countries today, does it mean costs in US have always been much higher?
  - tzs 4y ago
    Yes (at least as far back as the data at oecd.org goes, which is 1970). In 1970 US health care spending was $327.0/per capita. France was $192.1, and UK was $124.0. That's 1.7x France and 2.6x UK for the US. In 2020 it was $11859 for the US, $5468 for France, and $5019 for the UK. That puts 2020 US spending at 2.2x France and 2.4x UK. From 1970 to 2020 US went up 36x, France 28x, and UK 40x. It looks like much of the first world has a serious rising health spending problem, with costs rising roughly the same over time everywhere. The US was more expensive long ago, and since the rising costs have been roughly the same the US has stayed more expensive by about the same ratio. If we could get our spending down to match the rest of the first world, without reducing the level of care, that would be great. BTW, it is similar if we go by percent of GDP instead of per capita. US was spending 6.2% of GDP on health in 1970, France 5.2%, and UK 4.0%. In 2020 that was 18.8% of GDP for the US, 12.2% France, and 12.0% UK.
anonu 4y ago
There's many things wrong with US healthcare. But somehow the USA comes up with the the first vaccines for the coronavirus and if you want any sort of complex procedure you travel to the US to get it. So maybe thats where the extra cost goes? To drive research, and support the infrastructure that creates good to better health outcomes on average vs the rest of the world. Saying something is a failure just because it costs so much is only looking at one side of the coin.
- jeeeb 4y ago
  On average healthcare outcomes in the US aren’t particularly great compared to other developed countries though (https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019 https://www.commonwealthfund.org/publications/issue-briefs/2...). In particular life expectancy is very low by developed world standards and deaths from preventable causes are very high. I don’t doubt that the US has world leading hospitals but the population level outcomes delivered are poor by developed world standards. The US is a net exporter of healthcare services but mostly to developing countries and the numbers involved are tiny (https://www.usitc.gov/publications/332/executive_briefings/chambers_health-related_travel_final.pdf https://www.usitc.gov/publications/332/executive_briefings/c...) The idea that people who want any sort of complex procedure travel to the US is pure fantasy. As for the COVID-19 vaccines. The first approved vaccine was the “Pfizer” vaccine developed by BioNTech in Germany (https://en.m.wikipedia.org/wiki/Pfizer–BioNTech_COVID-19_vaccine https://en.m.wikipedia.org/wiki/Pfizer–BioNTech_COVID-19_vac...).
- amanaplanacanal 4y ago
  Vaccines for the COVID were developed simultaneously in multiple countries.
- e_i_pi_2 4y ago
  > But somehow the USA comes up with the the first vaccines for the coronavirus and if you want any sort of complex procedure you travel to the US to get it This isn't true, the US didn't make the first vaccines, it was created by a German company that partnered with Pfizer for trials/production/distribution[0]. People more often travel outside the US for care, we actually have the second highest amount of people leaving their home country for medical care[1], with the top destinations being in South America [1a]. > creates good to better health outcomes on average vs the rest of the world This would be nice if true, but we spend more and still have worse outcomes in almost every area[2]. The only things I could actually find that are better here is post-op sepsis and 30-day heart attack survival, but in just about every other area it's more dangerous to get care in the US. [0]: https://en.wikipedia.org/wiki/History_of_COVID-19_vaccine_development https://en.wikipedia.org/wiki/History_of_COVID-19_vaccine_de... [1]: https://www.health-tourism.com/medical-tourism/statistics/ https://www.health-tourism.com/medical-tourism/statistics/ [1a]: https://amjmed.org/medical-tourists-incoming-and-outgoing/ https://amjmed.org/medical-tourists-incoming-and-outgoing/ [2]: https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/ https://www.healthsystemtracker.org/chart-collection/quality...
nradov 4y ago
The US is (exaggerating a bit) a nation of obese, sedentary substance abusers. We are sicker on average than other developed countries and thus have a higher demand for healthcare. We might be able to eke out some minor improvements by tweaking the payment model and eliminating some waste. Those things are worth doing, but they won't fix the fundamental problem. The US won't get healthcare spending down to Japan's levels until Americans start acting like Japanese. There are some other key factors as well. A large fraction of healthcare spending goes toward treating elderly patients with serious chronic conditions in their last few years of life. Some countries explicitly deny care to such patients because they don't think it's justified on a QALY basis, but Americans seem uncomfortable with rationing on that basis. And some aspects of the US healthcare system are top notch. For many types of cancers we have the world's best 5-year survival rates. There is a thriving medical tourism business where patients from countries with socialized medicine such as Canada come here to receive rapid treatment instead of waiting for years for something like a hip replacement.
vineyardmike 4y ago
I’m not the OP and have no deep knowledge, but I’ve often heard cited that the US out-researches other nations, so we incur “R&D” costs for healthcare that other nations use. Eg pharmaceuticals are researched in the US while the patents are used in other nations through a cost structure that doesn’t allow the original researching party to recoup costs. On-shoring that research also seems to be an advantage -Looking at the astounding amount of research that poured into covid post 2020 would show that we have a huge dormant muscle that can be flexed in unison during an emergency.
- Sakos 4y ago
  I've never seen any convincing evidence for this theory.
  - deleted 4y ago
    [deleted]
- briffle 4y ago
  Then why do they spend so much more on marketing than R&D? https://www.ahip.org/news/articles/new-study-in-the-midst-of-covid-19-crisis-7-out-of-10-big-pharma-companies-spent-more-on-sales-and-marketing-than-r-d https://www.ahip.org/news/articles/new-study-in-the-midst-of...
  - vineyardmike 4y ago
    I’m not trying to defend pharma companies… they’re generally pretty scummy. But I’m guessing most companies spend more on marketing than R&D. Beyond that, the theory that they need to recoup costs still holds true with this. In fact, a big marketing budget indicates that they’re aggressively trying to sell the drug (maybe to recoup costs?). Generally in business marketing budgets should generate more sales than they cost (in ideal case), so big budgets doesn’t mean that they’re “wasting” that money that could go elsewhere. If the sale wouldn’t happen without an ad, then that’s a necessary ad.
    - 4y ago

linkdink 4y ago

In your opinion, what would be the lowest hanging fruit that could be changed to have the largest positive impact?

duffpkg 4y ago
People are rarely satisfied with this answer but its demonstrably true and was proven time and time again at the facilities ClearHealth managed. 1) Feverent, almost religious, adherence to hand washing. 2) No neck ties or dangly sleves whatsoever in buildings that house patients. 3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". Those are simple, virtually free, things that have a very meaningful impact on outcomes. Some of the most viscous fights I've had with hospital boards were over what amounted to the "uglier look" of copper/brass. It is an extremely unpopular topic in healthcare but the area that takes a lot of effort to solve but also has a tremendously out-weighted benefit is reducing preventable medical errors. My opinion after being in healthcare ~20 years is that preventable medical error is absolutely in the top 3 causes of death in the US. The easiest subset of it to resolve is prescription related errors, we have all the tools to resolve those but not the will.
- linkdink 4y ago
  Well, I'm satisfied with that answer. But maybe that's because I think brass and copper look better than stainless steel.
- BitwiseFool 4y ago
  >"3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". Because of the pandemic I started encountering doors that have a shoe pull, where you can use your foot to open the door instead of having to touch the handle. I really hope these catch on, but they are still quite rare.
  - snuxoll 4y ago
    Also stop getting rid of paper towels if you still have manual faucets. Nothing grosses me out more than going to a public restroom with only air dryers, but manually operated faucets that now require you use clean hands to turn off after you turned them on with presumably dirty hands.

iancmceachern 4y ago

I've worked in the medical device industry for 20 years and have a similar takeaway. I often describe it as the "hospital insurance company industrial complex".

AndrewKemendo 4y ago

I might be joining a large EHR company in the near future as a VP and am wondering if I can send you a question from time to time as they come up via email? Would love to connect but don't see anything on your profile here. I'm akemendo at the google mail service

Dave3of5 4y ago

> Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes Erm this is incorrect given that ICD are international it's actually the WHO that creates them source: https://en.wikipedia.org/wiki/International_Classification_of_Diseases https://en.wikipedia.org/wiki/International_Classification_o...

daniel-cussen 4y ago

It's more it's like 38%. Hollywood accounting all the way. In particular the deadweight cost of the the AMA monopoly on licensing is like 50% of GDP, which doesn't sound possible but if you know what a deadweight cost is it's a part of the nation's income that can't exist because it isn't there. It's how much better life would be if a doctor were as cheap as an uber driver, or if people healing others didn't get medium security prison as a result. It's the greatest threat to National Security, more than Russia China and the Middle East combined. And it's a military problem, wounded soldiers yeah get help from the Veteran's Association but they have to compete for those doctors and it ends up...out of pocket if they really want good care. Military gets fucked paying for doctors. America spends more money on obesity, than it does on defense. AMA is treason. Standard Oil had a lot of different shareholders, John D. Rockefeller was never majority owner, that was an organization AMA is an organization there's now medical families. Common heirs. Medical students from a medical family get little hazing compared to the rest. All the maneuvers they make to avoid the words "monopoly" and "cornered market" are of no help and mitigate nothing. So they know people get fucked off with those words, like bad, they're afraid of those words.

JAA1337 4y ago

In a vacuum ... It does not seem reasonable that 20% of a countries economy is spent on health care. Just as it doesn't seem reasonable for the cost of healthcare to be ~12% of the household income for a family (third highest living expense).