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Every other nation on earth somehow finds a way to deal with that. Given the US is 48th in life expectancy[0] behind all these other nations that spend much les

Every other nation on earth somehow finds a way to deal with that. Given the US is 48th in life expectancy[0] behind all these other nations that spend much less, that explanation doesn't seem to hold much water. [0]https://www.worldometers.info/demographics/life-expectancy/ https://www.worldometers.info/demographics/life-expectancy/

whimsicalism 2y ago
> Every other nation on earth somehow finds a way to deal with that. well not every other nation, but i know what you mean. other nations are much better at managing overutilization by denying care where it is not needed. the US insurance system shields people from cost and encourages overutilization due to a number of stupid policy choices (aka refusal to have 'death panels' like in Canada/UK but also refusal to do away with massive publicly subsidy for health expenditure). for a personal story, my parents basically get free MRIs from the state for little reason whereas people I know have to pay an arm and a leg for MRIs because their insurance is worse. at minimum, we could at least also make my parents have to pay an arm and leg for useless MRIs and doctors would stop encouraging them or lose patients.
- willcipriano 2y ago
  MRIs only cost that much in the US[0](2015 prices: $1,145 in America and $138 in Switzerland), everything is inexplicably ten fold more expensive here. That more expensive care doesn't result in ten fold better outcomes as all the health measures you can find indicate. That's the root of the problem and the thing is no politician[1] is really willing to address it and they don't really cover it clearly on the news[2], I wonder why? [0]https://www.vox.com/2014/9/4/6104533/the-125-percent-solution-for-american-health-care https://www.vox.com/2014/9/4/6104533/the-125-percent-solutio... [1]https://www.opensecrets.org/federal-lobbying/industries/summary?cycle=2024&id=H04 https://www.opensecrets.org/federal-lobbying/industries/summ... [2]https://www.fiercepharma.com/marketing/hey-big-spenders-pharma-ranks-top-five-industries-for-tv-media-spending-says-report https://www.fiercepharma.com/marketing/hey-big-spenders-phar...
  - s1artibartfast 2y ago
    Correct, you have identified the problem. Prices are high because there is no agent in the US system looking to allocate spending on the basis of cost and health returns. The closest we come is the much hated insurance denials.
    - whimsicalism 2y ago
      yes, precisely my point
    - willcipriano 2y ago
      Its likely true that more procedures are performed and more prescriptions written, but why are those procedures and prescriptions many times more expensive? Economies of scale should make them cheaper. An MRI machine and technician that sits there unused half the day has to charge more per visit than one used all day long. Have too many customers? Get more machines and techs, now the MRI manufacturer is making more units, offering volume discounts... Rationing of care doesn't explain why the individual units of care are themselves much more expensive. Compare inhaler prices in Canada vs the US, $10 in Canada $100 here[0], that isn't because too many of them are given out. It's theft. Addendum: Further, the young and healthy ration their care quite a bit under the current system, they are taxed too heavily (to pay for the care of the elderly) to afford it for themselves so they go without. [0]https://www.usnews.com/news/healthiest-communities/articles/2024-03-10/why-asthma-medication-is-so-expensive-in-the-u-s https://www.usnews.com/news/healthiest-communities/articles/...
      - s1artibartfast 2y ago
        Why charge $138 when your customers will pay $1,145 and keep coming back? you need someone willing shop and pick the cheaper options for competition to bring down prices. You also need someone willing to say "that's too expensive, I wont buy it" and walk away. Same is true for the inhalers. If someone will pay $100 before switching to the generic, that is what they get charged. In Canada, the state is only willing to pay $10, so that is the price. This is the demand side of the problem. There is also a supply problem, where the state provides medical company monopolies through "certification of need". It is basically illegal to open an MRI clinic that would compete with an existing one in many jurisdictions. https://radiologybusiness.com/topics/medical-imaging/magnetic-resonance-imaging-mri/court-battle-over-certificate-need-mri https://radiologybusiness.com/topics/medical-imaging/magneti...

whimsicalism 2y ago

> Every other nation on earth somehow finds a way to deal with that. well not every other nation, but i know what you mean. other nations are much better at managing overutilization by denying care where it is not needed. the US insurance system shields people from cost and encourages overutilization due to a number of stupid policy choices (aka refusal to have 'death panels' like in Canada/UK but also refusal to do away with massive publicly subsidy for health expenditure). for a personal story, my parents basically get free MRIs from the state for little reason whereas people I know have to pay an arm and a leg for MRIs because their insurance is worse. at minimum, we could at least also make my parents have to pay an arm and leg for useless MRIs and doctors would stop encouraging them or lose patients.

willcipriano 2y ago
MRIs only cost that much in the US[0](2015 prices: $1,145 in America and $138 in Switzerland), everything is inexplicably ten fold more expensive here. That more expensive care doesn't result in ten fold better outcomes as all the health measures you can find indicate. That's the root of the problem and the thing is no politician[1] is really willing to address it and they don't really cover it clearly on the news[2], I wonder why? [0]https://www.vox.com/2014/9/4/6104533/the-125-percent-solution-for-american-health-care https://www.vox.com/2014/9/4/6104533/the-125-percent-solutio... [1]https://www.opensecrets.org/federal-lobbying/industries/summary?cycle=2024&id=H04 https://www.opensecrets.org/federal-lobbying/industries/summ... [2]https://www.fiercepharma.com/marketing/hey-big-spenders-pharma-ranks-top-five-industries-for-tv-media-spending-says-report https://www.fiercepharma.com/marketing/hey-big-spenders-phar...
- s1artibartfast 2y ago
  Correct, you have identified the problem. Prices are high because there is no agent in the US system looking to allocate spending on the basis of cost and health returns. The closest we come is the much hated insurance denials.
  - whimsicalism 2y ago
    yes, precisely my point
  - willcipriano 2y ago
    Its likely true that more procedures are performed and more prescriptions written, but why are those procedures and prescriptions many times more expensive? Economies of scale should make them cheaper. An MRI machine and technician that sits there unused half the day has to charge more per visit than one used all day long. Have too many customers? Get more machines and techs, now the MRI manufacturer is making more units, offering volume discounts... Rationing of care doesn't explain why the individual units of care are themselves much more expensive. Compare inhaler prices in Canada vs the US, $10 in Canada $100 here[0], that isn't because too many of them are given out. It's theft. Addendum: Further, the young and healthy ration their care quite a bit under the current system, they are taxed too heavily (to pay for the care of the elderly) to afford it for themselves so they go without. [0]https://www.usnews.com/news/healthiest-communities/articles/2024-03-10/why-asthma-medication-is-so-expensive-in-the-u-s https://www.usnews.com/news/healthiest-communities/articles/...
    - s1artibartfast 2y ago
      Why charge $138 when your customers will pay $1,145 and keep coming back? you need someone willing shop and pick the cheaper options for competition to bring down prices. You also need someone willing to say "that's too expensive, I wont buy it" and walk away. Same is true for the inhalers. If someone will pay $100 before switching to the generic, that is what they get charged. In Canada, the state is only willing to pay $10, so that is the price. This is the demand side of the problem. There is also a supply problem, where the state provides medical company monopolies through "certification of need". It is basically illegal to open an MRI clinic that would compete with an existing one in many jurisdictions. https://radiologybusiness.com/topics/medical-imaging/magnetic-resonance-imaging-mri/court-battle-over-certificate-need-mri https://radiologybusiness.com/topics/medical-imaging/magneti...