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This is nonsense. Health care costs about twice as much in US as everywhere else and only the rich can afford it. Health insurance companies fight against docto

This is nonsense. Health care costs about twice as much in US as everywhere else and only the rich can afford it. Health insurance companies fight against doctors and patients to subvert health and profit as much as possible.

nradov 2y ago
92% of Americans have health plan coverage, so we're not talking only about the rich here. There are certainly problems that we should fix but spreading misinformation about basic facts doesn't help anything. https://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_Estimates_2024_Q11.pdf https://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_Es... It's easy for populists to demonize health insurance companies. But even if we somehow magically cut all payer profits to zero that would only marginally reduce total system costs. Much of what they do in fighting against doctors by negotiating lower reimbursement rates and denying claims that don't meet coverage rules actually helps to control costs for their main customers, the large self-insured employers that purchase health plans for their employees. At the national policy level, one change that would probably help would be breaking the linkage between employment and health plan coverage in order to better align incentives. Other countries that spend less on healthcare also have lower provider wages, longer queues for advanced treatments, rationed care based on QALYs (or similar metrics), and less innovation in drugs and medical devices. Maybe that would be better overall but let's not pretend that there aren't severe trade-offs. You can't have your cake and eat it too.
- whoitwas 2y ago
  So what if they have health plan coverage if they can't afford to use it? Insurance is wildly out of control and needs to be reformed out of it's current form of existence. Health insurance companies act in bad faith against patients and doctors and many people with insurance go bankrupt anyway. What percentage of bankruptcies are from medical bills? It's impossible to objectively defend unless the goal is to make money at the cost of human health.
  - nradov 2y ago
    The vast majority of consumers with health plan coverage do use it. At a minimum they can access preventive care benefits at zero out-of-pocket cost. https://www.healthcare.gov/coverage/preventive-care-benefits/ https://www.healthcare.gov/coverage/preventive-care-benefits... About 4% of bankruptcies are from medical bills. https://doi.org/10.1056/NEJMp1716604 https://doi.org/10.1056/NEJMp1716604
    - XorNot 2y ago
      That study (full text[1]) is extremely selective: namely, the only factor they looked at was hospitalizations causing bankruptcies, and ignored emergency care expenses, chronic conditions and other long term treatment. In fact from their introduction you can very much see the problem: the fraction of people filing for bankruptcy who happen to have substantial medical expenses. Like...that is a weird factor to just try and wash away with sample selection. The only factor they considered was the proportion of people who filed for bankruptcy by years before/after hospitalization, which they found was about 4% of total bankruptcies - for non-elderly adults. we estimate that hospitalizations cause only 4% of personal bankruptcies among nonelderly U.S. adults, which is an order of magnitude smaller than the previous estimates described above. Now let's put that in perspective: one of the most common routine surgeries for a healthy person would be having your appendix out. That's a hospitalization, you stay overnight. It's also fairly cheap and immensely routine. It is also notable that the study was focused on patients at a single Californian hospital - we therefore selected a sample of people who were admitted to the hospital in California Our study was based on a random stratified sample of adults 25 to 64 years of age who, between 2003 and 2007, were admitted to the hospital (for a non–pregnancy-related stay) for the first time in at least 3 years In short, the way this study is being thrown around to assert how medical bankruptcy works is invalid. And I'm calling completely bullshit on this methodology. Even their conclusions more or less paint the picture: We have found that hospitalizations cause: *increased out-of-pocket spending on medical care*, *increased medical debt*, and decreased employment and income * asterisk emphasis mine. [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC5865642/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5865642/
    - whoitwas 2y ago
- XorNot 2y ago
  > longer queues for advanced treatments Americans always toss this out like it means something. If you're not in queue because you can't afford it, then you are in the queue it's just infinitely long but you're not counted. Your entire culture here is so broken you are fundamentally incapable of even beginning to understand how other countries discuss these metrics: when they discuss wait times it's for everyone who needs it - no one is unable to afford it or being denied it by their health insurance. "The queue" is triaged against available resources - i.e. patients needing urgent care will get it earlier then those who are stable. Could it be shorter? Of course it could, but it also includes everyone who needs it. And if you don't like the queue the gasp you can still pay to be treated privately and receive prompter service under most systems. Your system is so broken you literally can't comprehend the wording of complaints about other systems because you contextualize it through your own. Built into the entire model is that "the queue is long and also we already kicked a bunch of people out of it, which is not what anyone is talking about in regards to the NHS, or Australian Medicare or any other system.
  - nradov 2y ago
    I am quite familiar with the systems in other countries. Every country rations care. Some do it by condition severity, others by ability to pay. The vast majority of US consumers have health plan coverage and the co-insurance or co-payment amounts are fairly low. I won't attempt to defend the vagaries of the US healthcare system but let's not pretend that everyone who needs treatment in other developed countries actually gets it in a timely matter. Why are 5-year cancer survival rates higher in the USA than the UK? It's pretty common to see affluent Canadians come to the US as medical tourists and pay out of pocket for procedures like MRI scans or joint replacement surgery. This is a real thing that happens all the time. Depending on your perspective that might be acceptable in the name of fairness and cost control but there are always trade-offs.
- Yeul 2y ago
  Ah yes the kind of health plan coverage that still requires you to pay thousands of dollars out of pocket...

nradov 2y ago

92% of Americans have health plan coverage, so we're not talking only about the rich here. There are certainly problems that we should fix but spreading misinformation about basic facts doesn't help anything. https://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_Estimates_2024_Q11.pdf https://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_Es... It's easy for populists to demonize health insurance companies. But even if we somehow magically cut all payer profits to zero that would only marginally reduce total system costs. Much of what they do in fighting against doctors by negotiating lower reimbursement rates and denying claims that don't meet coverage rules actually helps to control costs for their main customers, the large self-insured employers that purchase health plans for their employees. At the national policy level, one change that would probably help would be breaking the linkage between employment and health plan coverage in order to better align incentives. Other countries that spend less on healthcare also have lower provider wages, longer queues for advanced treatments, rationed care based on QALYs (or similar metrics), and less innovation in drugs and medical devices. Maybe that would be better overall but let's not pretend that there aren't severe trade-offs. You can't have your cake and eat it too.

whoitwas 2y ago
So what if they have health plan coverage if they can't afford to use it? Insurance is wildly out of control and needs to be reformed out of it's current form of existence. Health insurance companies act in bad faith against patients and doctors and many people with insurance go bankrupt anyway. What percentage of bankruptcies are from medical bills? It's impossible to objectively defend unless the goal is to make money at the cost of human health.
- nradov 2y ago
  The vast majority of consumers with health plan coverage do use it. At a minimum they can access preventive care benefits at zero out-of-pocket cost. https://www.healthcare.gov/coverage/preventive-care-benefits/ https://www.healthcare.gov/coverage/preventive-care-benefits... About 4% of bankruptcies are from medical bills. https://doi.org/10.1056/NEJMp1716604 https://doi.org/10.1056/NEJMp1716604
  - XorNot 2y ago
    That study (full text[1]) is extremely selective: namely, the only factor they looked at was hospitalizations causing bankruptcies, and ignored emergency care expenses, chronic conditions and other long term treatment. In fact from their introduction you can very much see the problem: the fraction of people filing for bankruptcy who happen to have substantial medical expenses. Like...that is a weird factor to just try and wash away with sample selection. The only factor they considered was the proportion of people who filed for bankruptcy by years before/after hospitalization, which they found was about 4% of total bankruptcies - for non-elderly adults. we estimate that hospitalizations cause only 4% of personal bankruptcies among nonelderly U.S. adults, which is an order of magnitude smaller than the previous estimates described above. Now let's put that in perspective: one of the most common routine surgeries for a healthy person would be having your appendix out. That's a hospitalization, you stay overnight. It's also fairly cheap and immensely routine. It is also notable that the study was focused on patients at a single Californian hospital - we therefore selected a sample of people who were admitted to the hospital in California Our study was based on a random stratified sample of adults 25 to 64 years of age who, between 2003 and 2007, were admitted to the hospital (for a non–pregnancy-related stay) for the first time in at least 3 years In short, the way this study is being thrown around to assert how medical bankruptcy works is invalid. And I'm calling completely bullshit on this methodology. Even their conclusions more or less paint the picture: We have found that hospitalizations cause: *increased out-of-pocket spending on medical care*, *increased medical debt*, and decreased employment and income * asterisk emphasis mine. [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC5865642/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5865642/
  - whoitwas 2y ago
XorNot 2y ago
> longer queues for advanced treatments Americans always toss this out like it means something. If you're not in queue because you can't afford it, then you are in the queue it's just infinitely long but you're not counted. Your entire culture here is so broken you are fundamentally incapable of even beginning to understand how other countries discuss these metrics: when they discuss wait times it's for everyone who needs it - no one is unable to afford it or being denied it by their health insurance. "The queue" is triaged against available resources - i.e. patients needing urgent care will get it earlier then those who are stable. Could it be shorter? Of course it could, but it also includes everyone who needs it. And if you don't like the queue the gasp you can still pay to be treated privately and receive prompter service under most systems. Your system is so broken you literally can't comprehend the wording of complaints about other systems because you contextualize it through your own. Built into the entire model is that "the queue is long and also we already kicked a bunch of people out of it, which is not what anyone is talking about in regards to the NHS, or Australian Medicare or any other system.
- nradov 2y ago
  I am quite familiar with the systems in other countries. Every country rations care. Some do it by condition severity, others by ability to pay. The vast majority of US consumers have health plan coverage and the co-insurance or co-payment amounts are fairly low. I won't attempt to defend the vagaries of the US healthcare system but let's not pretend that everyone who needs treatment in other developed countries actually gets it in a timely matter. Why are 5-year cancer survival rates higher in the USA than the UK? It's pretty common to see affluent Canadians come to the US as medical tourists and pay out of pocket for procedures like MRI scans or joint replacement surgery. This is a real thing that happens all the time. Depending on your perspective that might be acceptable in the name of fairness and cost control but there are always trade-offs.
Yeul 2y ago
Ah yes the kind of health plan coverage that still requires you to pay thousands of dollars out of pocket...