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Across the board price controls seem to be a common to the various European health care systems. It is my understanding that upper limits are set for the cost o

Across the board price controls seem to be a common to the various European health care systems. It is my understanding that upper limits are set for the cost of medicine. There is quite a bit of variety across Europe - U.K. is 100% government run, France is a public/private mix, Germany is similar to Obamacare in some ways, others are single payer, apparently some are private, also. But I've read that they all have cost controls.

Barrin92 4y ago
beyond Europe as well. Singapore which has exceptionally low healthcare spending (5.9% of GDP) heavily controls prices and purchases down to individual equipment in hospitals.
- dominotw 4y ago
  > Singapore which has exceptionally low healthcare spending yea because they have healthy population, its not because of some smart govt policy( if only it was that easy). singapore obesity rate = 10% usa obesity rate = 42 % usa obesity healthcare spend = 90%
  - groby_b 4y ago
    That 90% number is plain not true. Please cite any source for that. The costs for obese folk are on average 90%-100% higher than for non-obese folk, but that's not 90% of total spending. (See e.g. https://pubmed.ncbi.nlm.nih.gov/33470881/ https://pubmed.ncbi.nlm.nih.gov/33470881/) Total cost approaches 20% of spending: https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/economic/ https://www.hsph.harvard.edu/obesity-prevention-source/obesi...
    - imapeopleperson 4y ago
      Don’t get so hung up on precise numbers. We all know Americans are obese and that greatly adds to healthcare costs. I can’t imagine any downside of trying to prioritize lowering obesity.
      - pessimizer 4y ago
        Thank god we aren't discussing your imagination, then.
      - GendingMachine 4y ago
        "Don't get so hung up on precise numbers", uh, 90% isn't just imprecise, it's so catastrophically wrong that it undermines your entire argument
        imapeopleperson 4y ago
        This is a topic that’s always going to have wildly different numbers. Who cares? It doesn’t change what we all know to be true. Nothing has been undermined whatsoever
        groby_b 4y ago
        What we all know to be true is your troll status.
        dominotw 4y ago
        Do you know the right number by any chance?
    - dominotw 4y ago
      I was using obesity as a standin for metabolic syndrome to compare populations. Not sure if measure how many ppl have 'metabolic syndrome. https://www.nhlbi.nih.gov/health/metabolic-syndrome https://www.nhlbi.nih.gov/health/metabolic-syndrome metabolic disease = all things that can be fixed by lifestyle modifications ( unless you are too far gone, ie). see my reply here: https://news.ycombinator.com/item?id=32744868 https://news.ycombinator.com/item?id=32744868
      - heavyset_go 4y ago
        Metabolic syndrome is often a side effect of medication or symptom of other diseases that can't be fixed with lifestyle modifications alone. For example, there are a lot of people on psychiatric medications that can cause metabolic syndrome as a primary side effect.
        dominotw 4y ago
        > is often Would be interesting to know how often.
        heavyset_go 4y ago
        Tens of millions of people in the US take atypical antipsychotics and antidepressants that cause metabolic syndrome as a very common side effect.
    - JamesBarney 4y ago
      I wonder though how much this drives up the cost. Because obesity also drives down lifespan, and age has a huge impact on healthcare expenditures.
      - heavyset_go 4y ago
        Obesity, like smoking, is one of those morbidities that lower lifetime healthcare costs significantly, as most costs are incurred in old age, as you saisd. Obesity, smoking, etc can kill before reaching an age where people start incurring high costs.
        consumer451 4y ago
        There is a lovely tale from Czech Republic in 2001 where Philip Morris was distributing analysis showing the economic benefits of smoking to their shared healthcare pool. https://www.wsj.com/articles/SB995230746855683470 https://www.wsj.com/articles/SB995230746855683470
  - notch656a 4y ago
    My state has a "stupid motorist" law that requires people who negligently put their vehicles in danger and then use state resources to get bailed out, to pay for the rescue themselves. Perhaps we could create a "stupid eater law" for medicare/medicaid, forcing obese people etc to pay for their own private health insurance or healthcare which would free up money for others to buy more healthcare privately (via lower tax burden). My families healthcare would definitely be more affordable if I weren't burdened paying for the negligent actions of others.
    - nradov 4y ago
      Should we apply the same sort of "stupid X law" to people who drink alcohol or drive motorcycles or play rugby? This is one of the moral hazards of a socialized medical system. When the rest of society is paying for your medical care it becomes tempting to save money be dictating exactly how you're allowed to live your life. Obesity is a serious public health problem but we won't fix it by calling people stupid or charging them extra.
      - notch656a 4y ago
        >Should we apply the same sort of "stupid X law" to people who drink alcohol or drive motorcycles or play rugby? Yes, precisely. Keep chopping down at these factors until all that's practically left is private healthcare -- that's a feature not a bug. It's enough that I have to pay the bill to scrape the blood off the street when a motorcycle is crashed, not interested in paying someone elses motorcycle related health premiums on top of that (I've gotten enough motorcycle injuries while carrying my own private healthcare :) ) >This is one of the moral hazards of a socialized medical system. As you say with public healthcare the effect (you say temptation) is to socialize your health related losses while privatizing the gains you reap.
        pessimizer 4y ago
        Yes, I'm getting sick of paying for people who drive cars, go to restaurants and concerts, and have children. > socialize your health related losses while privatizing the gains you reap. Those famous health care gains.
  - Barrin92 4y ago
    >yea because they have healthy population, its not because of some smart govt policy yes it is, because the health population itself is supported by strong intervention. Singapore banned the advertisements of sugary drinks years ago, Singapore strictly regulates the number of vehicle licenses in the country encouraging public transport and walking, it forces citizens to allocate money for healthcare to private savings funds which incentives reducing your own healthcare costs, and so on. The reason American's are obese isn't a miracle or because Americans are stupider, it's because Americans refuse to take collective action when it comes to the health of the nation.
- TedDoesntTalk 4y ago
  Singapore has a population of 5.6 million. USA has a population of 330 million. How would you control prices and purchases at that level?
  - cammikebrown 4y ago
    Perhaps on a state level?
  - pessimizer 4y ago
    What difference does the population make other than that at 330 million economies of scale might appear that aren't significant at 5.6 million?
  - stackbutterflow 4y ago
    According to this website [0] there are 30 states with a population of less than 6 millions. Why can't they each operate like Singapore? [0] https://worldpopulationreview.com/states https://worldpopulationreview.com/states
    - Spooky23 4y ago
      The problem is that states are like accidents of history and are fairly arbitrary. You need this with lots of stuff. “Vice” states are adjacent to more prudish states. Think New Hampshire, Delaware, Pennsylvania, South Carolina. In the case of healthcare, states tend to push costs to somewhere else. As in send the sick person to NYC.
    - boomboomsubban 4y ago
      Singapore's area is 283 square miles. Rhode Island is the smallest state, and it has an area of 1214 square miles. Four times larger, with people throughout needing care. That alone will add a fair amount of cost. Granted, not the total amount spent, but city states do have some advantages on things like this.
- refurb 4y ago
  Singapore does not control prices (though it’s moving in that direction), it’s public hospitals are privately run, and it has a system of “forced savings” to make sure patients have enough money to cover out of pocket costs and buy health insurance. It’s ethos is “the patient has to pay something out of pocket, even if it’s just $2”. It’s also more than happy to tell poor patients “if you don’t have enough money, there is nothing we can do”. It is more similar to the US system than a system like the UK or Canada.
  - Barrin92 4y ago
    >Singapore does not control prices (though it’s moving in that direction), it’s public hospitals are privately run, Singapore controls prices through collective bargaining at the national level and unlike the US practically every purchase in its hospitals has to go through registration with the HSA (the country's relevant regulatory agency). You essentially cannot purchase any major equipment without running it by the national government. That's one of the reasons why the country has a very transparent pricing system. It's not only savings accounts but also a very tight control over costs and acquisitions that keeps the price low, that's completely missing in the American system which just keeps growing.
    - refurb 4y ago
      Singapore doesn’t control all prices - drugs can be freely priced, but as I stated it’s changing right now. And getting HSA approval doesn’t have anything to do with price - that regulatory. Even the FDA has to approve anything used in the US. It is true you can’t purchase at the hospital level without some agreement on price, but the hospitals often do their own tenders, which are confidential prices. It’s not done at the national level for everything. And yes, prices are tightening but companies are already deciding to just not market in Singapore if prices get too low. Check out Germany, I think it was AZ that decided to just not launch a drug there at all because the price was too low.
  - AlphaSite 4y ago
    Aren’t all 3 major hospital groups government owned? These are not private hospitals, they may charge you fees, but ultimately they’re government owned.
jen20 4y ago
> U.K. is 100% government run This is not true. Private healthcare is alive and well in the UK in the supply of both privately and publicly-commissioned healthcare.
- mikem170 4y ago
  You're right, thanks for the correction on that. Wikipedia said 8% of health care in England is private, mostly specialist, often through employer provided plans meant to augment NHS. The other 92% of health care is directly supplied by NHS [0]. So they appear to be a mix of public and private, like many other systems. [0] https://en.wikipedia.org/wiki/Healthcare_in_England https://en.wikipedia.org/wiki/Healthcare_in_England
DanBC 4y ago
> U.K. is 100% government run I know I'm a broken record on this but people who say this are simply wrong. 1) There is not one NHS for the UK. Health is devolved and there are totally separate systems for NI, Scotland, Wales, and England. 2) Speaking only for England, it's not "run by the government". The NHS in England is run by NHS England and Improvement. The people who work for NHSE/I are not civil servants, they do not work for the government.

Barrin92 4y ago

beyond Europe as well. Singapore which has exceptionally low healthcare spending (5.9% of GDP) heavily controls prices and purchases down to individual equipment in hospitals.

dominotw 4y ago
> Singapore which has exceptionally low healthcare spending yea because they have healthy population, its not because of some smart govt policy( if only it was that easy). singapore obesity rate = 10% usa obesity rate = 42 % usa obesity healthcare spend = 90%
- groby_b 4y ago
  That 90% number is plain not true. Please cite any source for that. The costs for obese folk are on average 90%-100% higher than for non-obese folk, but that's not 90% of total spending. (See e.g. https://pubmed.ncbi.nlm.nih.gov/33470881/ https://pubmed.ncbi.nlm.nih.gov/33470881/) Total cost approaches 20% of spending: https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/economic/ https://www.hsph.harvard.edu/obesity-prevention-source/obesi...
  - imapeopleperson 4y ago
    Don’t get so hung up on precise numbers. We all know Americans are obese and that greatly adds to healthcare costs. I can’t imagine any downside of trying to prioritize lowering obesity.
    - pessimizer 4y ago
      Thank god we aren't discussing your imagination, then.
    - GendingMachine 4y ago
      "Don't get so hung up on precise numbers", uh, 90% isn't just imprecise, it's so catastrophically wrong that it undermines your entire argument
      - imapeopleperson 4y ago
        This is a topic that’s always going to have wildly different numbers. Who cares? It doesn’t change what we all know to be true. Nothing has been undermined whatsoever
        groby_b 4y ago
        What we all know to be true is your troll status.
      - dominotw 4y ago
        Do you know the right number by any chance?
  - dominotw 4y ago
    I was using obesity as a standin for metabolic syndrome to compare populations. Not sure if measure how many ppl have 'metabolic syndrome. https://www.nhlbi.nih.gov/health/metabolic-syndrome https://www.nhlbi.nih.gov/health/metabolic-syndrome metabolic disease = all things that can be fixed by lifestyle modifications ( unless you are too far gone, ie). see my reply here: https://news.ycombinator.com/item?id=32744868 https://news.ycombinator.com/item?id=32744868
    - heavyset_go 4y ago
      Metabolic syndrome is often a side effect of medication or symptom of other diseases that can't be fixed with lifestyle modifications alone. For example, there are a lot of people on psychiatric medications that can cause metabolic syndrome as a primary side effect.
      - dominotw 4y ago
        > is often Would be interesting to know how often.
        heavyset_go 4y ago
        Tens of millions of people in the US take atypical antipsychotics and antidepressants that cause metabolic syndrome as a very common side effect.
  - JamesBarney 4y ago
    I wonder though how much this drives up the cost. Because obesity also drives down lifespan, and age has a huge impact on healthcare expenditures.
    - heavyset_go 4y ago
      Obesity, like smoking, is one of those morbidities that lower lifetime healthcare costs significantly, as most costs are incurred in old age, as you saisd. Obesity, smoking, etc can kill before reaching an age where people start incurring high costs.
      - consumer451 4y ago
        There is a lovely tale from Czech Republic in 2001 where Philip Morris was distributing analysis showing the economic benefits of smoking to their shared healthcare pool. https://www.wsj.com/articles/SB995230746855683470 https://www.wsj.com/articles/SB995230746855683470
- notch656a 4y ago
  My state has a "stupid motorist" law that requires people who negligently put their vehicles in danger and then use state resources to get bailed out, to pay for the rescue themselves. Perhaps we could create a "stupid eater law" for medicare/medicaid, forcing obese people etc to pay for their own private health insurance or healthcare which would free up money for others to buy more healthcare privately (via lower tax burden). My families healthcare would definitely be more affordable if I weren't burdened paying for the negligent actions of others.
  - nradov 4y ago
    Should we apply the same sort of "stupid X law" to people who drink alcohol or drive motorcycles or play rugby? This is one of the moral hazards of a socialized medical system. When the rest of society is paying for your medical care it becomes tempting to save money be dictating exactly how you're allowed to live your life. Obesity is a serious public health problem but we won't fix it by calling people stupid or charging them extra.
    - notch656a 4y ago
      >Should we apply the same sort of "stupid X law" to people who drink alcohol or drive motorcycles or play rugby? Yes, precisely. Keep chopping down at these factors until all that's practically left is private healthcare -- that's a feature not a bug. It's enough that I have to pay the bill to scrape the blood off the street when a motorcycle is crashed, not interested in paying someone elses motorcycle related health premiums on top of that (I've gotten enough motorcycle injuries while carrying my own private healthcare :) ) >This is one of the moral hazards of a socialized medical system. As you say with public healthcare the effect (you say temptation) is to socialize your health related losses while privatizing the gains you reap.
      - pessimizer 4y ago
        Yes, I'm getting sick of paying for people who drive cars, go to restaurants and concerts, and have children. > socialize your health related losses while privatizing the gains you reap. Those famous health care gains.
- Barrin92 4y ago
  >yea because they have healthy population, its not because of some smart govt policy yes it is, because the health population itself is supported by strong intervention. Singapore banned the advertisements of sugary drinks years ago, Singapore strictly regulates the number of vehicle licenses in the country encouraging public transport and walking, it forces citizens to allocate money for healthcare to private savings funds which incentives reducing your own healthcare costs, and so on. The reason American's are obese isn't a miracle or because Americans are stupider, it's because Americans refuse to take collective action when it comes to the health of the nation.
TedDoesntTalk 4y ago
Singapore has a population of 5.6 million. USA has a population of 330 million. How would you control prices and purchases at that level?
- cammikebrown 4y ago
  Perhaps on a state level?
- pessimizer 4y ago
  What difference does the population make other than that at 330 million economies of scale might appear that aren't significant at 5.6 million?
- stackbutterflow 4y ago
  According to this website [0] there are 30 states with a population of less than 6 millions. Why can't they each operate like Singapore? [0] https://worldpopulationreview.com/states https://worldpopulationreview.com/states
  - Spooky23 4y ago
    The problem is that states are like accidents of history and are fairly arbitrary. You need this with lots of stuff. “Vice” states are adjacent to more prudish states. Think New Hampshire, Delaware, Pennsylvania, South Carolina. In the case of healthcare, states tend to push costs to somewhere else. As in send the sick person to NYC.
  - boomboomsubban 4y ago
    Singapore's area is 283 square miles. Rhode Island is the smallest state, and it has an area of 1214 square miles. Four times larger, with people throughout needing care. That alone will add a fair amount of cost. Granted, not the total amount spent, but city states do have some advantages on things like this.
refurb 4y ago
Singapore does not control prices (though it’s moving in that direction), it’s public hospitals are privately run, and it has a system of “forced savings” to make sure patients have enough money to cover out of pocket costs and buy health insurance. It’s ethos is “the patient has to pay something out of pocket, even if it’s just $2”. It’s also more than happy to tell poor patients “if you don’t have enough money, there is nothing we can do”. It is more similar to the US system than a system like the UK or Canada.
- Barrin92 4y ago
  >Singapore does not control prices (though it’s moving in that direction), it’s public hospitals are privately run, Singapore controls prices through collective bargaining at the national level and unlike the US practically every purchase in its hospitals has to go through registration with the HSA (the country's relevant regulatory agency). You essentially cannot purchase any major equipment without running it by the national government. That's one of the reasons why the country has a very transparent pricing system. It's not only savings accounts but also a very tight control over costs and acquisitions that keeps the price low, that's completely missing in the American system which just keeps growing.
  - refurb 4y ago
    Singapore doesn’t control all prices - drugs can be freely priced, but as I stated it’s changing right now. And getting HSA approval doesn’t have anything to do with price - that regulatory. Even the FDA has to approve anything used in the US. It is true you can’t purchase at the hospital level without some agreement on price, but the hospitals often do their own tenders, which are confidential prices. It’s not done at the national level for everything. And yes, prices are tightening but companies are already deciding to just not market in Singapore if prices get too low. Check out Germany, I think it was AZ that decided to just not launch a drug there at all because the price was too low.
- AlphaSite 4y ago
  Aren’t all 3 major hospital groups government owned? These are not private hospitals, they may charge you fees, but ultimately they’re government owned.

jen20 4y ago

> U.K. is 100% government run This is not true. Private healthcare is alive and well in the UK in the supply of both privately and publicly-commissioned healthcare.

mikem170 4y ago
You're right, thanks for the correction on that. Wikipedia said 8% of health care in England is private, mostly specialist, often through employer provided plans meant to augment NHS. The other 92% of health care is directly supplied by NHS [0]. So they appear to be a mix of public and private, like many other systems. [0] https://en.wikipedia.org/wiki/Healthcare_in_England https://en.wikipedia.org/wiki/Healthcare_in_England

DanBC 4y ago

> U.K. is 100% government run I know I'm a broken record on this but people who say this are simply wrong. 1) There is not one NHS for the UK. Health is devolved and there are totally separate systems for NI, Scotland, Wales, and England. 2) Speaking only for England, it's not "run by the government". The NHS in England is run by NHS England and Improvement. The people who work for NHSE/I are not civil servants, they do not work for the government.