5 ms·

Number 3 can’t be overstated. Healthcare costs for the exact same care are 2x-3x what they are in Europe. Global health insurance plans usually come in two fla

by qgin 2y ago

Number 3 can’t be overstated. Healthcare costs for the exact same care are 2x-3x what they are in Europe. Global health insurance plans usually come in two flavors: 1. Global coverage 2. Global coverage excluding United States (for half the monthly premium of the first plan) The United States in an extreme outlier in terms of cost. This is separate from rationing care. This is separate from even population health (ex. higher obesity rates)

firejake308 2y ago
I know of at least one source arguing that in fact, population health (mainly obesity and gun violence) explain upwards of 70% of the difference in healthcare spending between the US and other developed nations.[1] To me, this seems like the most likely explanation because I believe we have pretty similar diagnostics and treatments to other developed countries, and I don't feel like a British doctor would give me any treatment that an American doctor wouldn't, and vice versa. As for the other 30%, I think it's probably due to inefficiencies in the insurance-based payment system and our patents lasting too long making drugs more expensive. [1] https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/#rcatoc-diminishing-returns-to-spending-and-worse-lifestyle-factors-explain-americas-mediocre-health-outcomes https://randomcriticalanalysis.com/why-conventional-wisdom-o...
- silvestrov 2y ago
  It is very expensive to run the insurance companies, plus all the time the hospitals need to spend to talk/plead with the insurance companies. When you have the state as a single payer then all those expenses just vanishes.
  - yadaeno 2y ago
    Even the various single payer models in Europe and asia still have insurance companies. The difference is that in these systems the government has some stake — whether it’s providing the public insurance fund, or owning the company itself — so that the government is financially incentivized to reduce costs. In the US case everything is private so all parties are incentivized to increase costs as much as possible. We really should to copy the Bismarck model. Public owned “public fund”, heavily regulated private insurance and care.
    - llamaimperative 2y ago
      Competition among insurance companies in most other systems (like the Bismarckian system) is far more constrained and so consumes far less capital. A huuuuge portion of health insurance premiums just go toward spending on ads to pull members from other insurers and otherwise retain your own (especially while they are paying into the plan rather than pulling from the plan, at which point you’re happy to lose them).
      - JumpCrisscross 2y ago
        > A huuuuge portion of health insurance premiums just go toward spending on ads Wrong. "I̶n̶ 2̶0̶2̶3̶ a̶l̶o̶n̶e̶, t̶h̶e̶ f̶o̶u̶r̶ b̶i̶g̶g̶e̶s̶t̶ i̶n̶s̶u̶r̶a̶n̶c̶e̶ c̶o̶m̶p̶a̶n̶i̶e̶s̶ i̶n̶ t̶h̶e̶ U̶.S̶. p̶a̶i̶d̶ a̶ t̶o̶t̶a̶l̶ o̶f̶ $̶3̶.7̶ b̶i̶l̶l̶i̶o̶n̶ t̶o̶ g̶e̶t̶ t̶h̶e̶i̶r̶ n̶a̶m̶e̶s̶ o̶n̶ y̶o̶u̶r̶ s̶c̶r̶e̶e̶n̶s̶" [1] (EDIT: It's less than $30bn [3].) out of $1.5 trillion of premiums collected [2]. [1] https://www.bankrate.com/insurance/car/insurance-advertising/ https://www.bankrate.com/insurance/car/insurance-advertising... [2] https://www.cms.gov/files/document/highlights.pdf https://www.cms.gov/files/document/highlights.pdf [3] https://www.emarketer.com/content/us-healthcare-pharma-ad-spending-2024 https://www.emarketer.com/content/us-healthcare-pharma-ad-sp...
        llamaimperative 2y ago
        1. Your $3.7 billion figure is about auto insurers 2. I misspoke and meant "marketing" broadly, not ads in particular. This all fits under administrative overhead which is one of the major sources of inefficiency between private health plans in the US compared to Medicare/Medicaid.
        JumpCrisscross 2y ago
        > misspoke and meant "marketing" broadly Do you have a figure for this?
        llamaimperative 2y ago
  - gramie 2y ago
    A doctor I know worked in the US and then returned to Canada. In his US clinic, each doctor had 2-3 employees devoted to billing (patient-paid and insurance). In his Canadian clinic, they had 1 employee doing the billing for 4 doctors.
- buckle8017 2y ago
  The us healthcare statistics include people paying out of pocket for care that is extremely expensive and literally not available anywhere else. A number of gene therapies are to expensive for any public health system, so are only available in the us. Needles to say they're experimental and carry lots of weight in a effectiveness vs cost analysis.
  - sudosysgen 2y ago
    Experimental therapies do exist in public healthcare systems, the costs are generally borne by the universities with special financing for experimental treatments. Many universities in public systems are run directly by universities which simplifies the process.
- apercu 2y ago
  The U.S. has orders of magnitude of admin costs due to middlemen at every stage in health care. This should be obvious to HN types.
  - llamaimperative 2y ago
    Also should be noted that health insurers’ marketing costs are part of “administrative overhead.”
- tzs 2y ago
  > I know of at least one source arguing that in fact, population health (mainly obesity and gun violence) explain upwards of 70% of the difference in healthcare spending between the US and other developed nations I have my doubts. Over the last 50 years the ratio of US per capita health care costs and European per capita health care costs (or per capita health care costs for most of the rest of first world countries) has stayed about the same. In other words, health care costs have risen at about the same rate throughout the first world over the last 50 years. So if in 1970 the US was paying say 3x per capita what some other country paid the US would still now be paying about 3x what they are now paying. Both would be paying maybe 35x now than they were in 1970. Over that same time both US and European obesity rates went up, but they went up way more in the US. If obesity was a major factor driving health care costs then I'd expect US health care costs to be rising significantly faster than European health care costs.
  - firejake308 2y ago
    This implies that healthcare costs in the US were already higher than those in Europe in 1970. Is that a correct conclusion to draw?
- skissane 2y ago
  > I believe we have pretty similar diagnostics and treatments to other developed countries I don't know. I remember reading an MIT PhD thesis describing how Kaiser Permanente does autism diagnosis [0] – and comparing it to my personal experience of the same topic in Australia, it seemed significantly more rigorous – e.g. specialist centres that only do autism diagnosis, using the multidisciplinary team diagnosis model instead of the single clinician diagnosis model, use of research reliable examiners for ADOS (the training and validation process required to use ADOS in research settings is much more intensive than that required to use it clinically), etc. Now, the thesis does acknowledge that Kaiser is somewhat of an outlier in this regard compared to the US average (plus it is 10 years old so now so I don't know how things have evolved since), but I still get the impression that this highly rigorous approach to autism diagnosis is much more of a thing in the US than in Australia – and if that's true of autism, maybe it is true of other conditions as well. [0] https://dspace.mit.edu/handle/1721.1/90070 https://dspace.mit.edu/handle/1721.1/90070 – the first half of the thesis uses the pseudonym "Allied Health", but I know from other sources that "Allied"=Kaiser; the second half discusses Kaiser without any pseudonym
  - pclmulqdq 2y ago
    Kaiser is above average in the US, but in the major cities on the East coast you can actually find care that is much more sophisticated than you will get at Kaiser. If I were dying of a rare and aggressive form of cancer right now, I would rather be in Florida (Mayo), New York (Mount Sinai and Sloan Kettering), Boston (Dana-Farber), or DC (Johns Hopkins) than California. Kaiser's big advantage is the whole-life aspect of care, which is pretty appealing as a healthy person, but the medicine available in the US gets much more complicated.
    - jquery 2y ago
      A recent study showed Kaiser had the lowest denial rate of any major insurer, at 7%, versus the industry average of 16%. https://axenehp.com/wp-content/uploads/2024/12/20241218_chart_01.png https://axenehp.com/wp-content/uploads/2024/12/20241218_char... If you live in an area served by Kaiser and don’t have a very specific health reason to choose a different provider, I highly recommend them. They might not be able to treat that rare and aggressive cancer as well as the Mayo Clinic, but because it’s whole-life care, you’re more likely to find the cancer early. Edit: Question. Can Mayo expand to cover everyone in Florida? Or is their advantage in hiring the best of the best? What makes their model better than Kaiser?
- ted_dunning 2y ago
  I have an apples to apples comparison here. I had almost identical cases of cellulitis, one in the US and one in the UK. In the UK, I opted for private hospitalization in one of the fancier hospitals in London. The care was noticeably superior in the UK hospital. The attending doctor was available for a case summary on a few minutes notice, the sterilization and cleaning of the room was vastly better and the nursing staff could recite my case notes and recent test results and vitals at any time. None of these applied for the US hospital. The bill in the UK was about half what it was in the US and the walk-in price in the US if I hadn't had local insurance would have been nearly double the price I did pay. The kicker was that the UK hospital was run by HCA, an American corporation.
harry8 2y ago
20 years ago I read a story about an obstetrician in the USA. His premiums at that time for professional negligence were $1m per year. He would have to keep paying those premiums for 18 years after his retirement. Same for every obstetrician. Professional fees then must be set to cover those insurance premiums. Has that changed for the better in the USA? Seems very unlikely to be the same in Europe. Obstetrics is obviously a illustrative case. How are the professional negligence premiums across the other specialties? Why does the effect of the US legal system never seem to come up much in the “US healthcare is insanely expensive” discussion? Is the effect of it really not significant?
- deleted 2y ago
  [deleted]
  - OneDeuxTriSeiGo 2y ago
    [dead]
- etchalon 2y ago
  This was an argument in the 90s/early 20s. TX, where I live, implemented tort reform in 2003 to limit doctor's exposure, and decrease insurance costs. It hasn't had much impact on costs: https://healtheconomicsreview.biomedcentral.com/articles/10.1186/s13561-017-0174-2 https://healtheconomicsreview.biomedcentral.com/articles/10....
  - deleted 2y ago
    [deleted]
  - sarchertech 2y ago
    It’s because physician compensation is only around 8% of medical costs and physician services billed are only 14%. So that’s your limit to how much reducing malpractice insurance premiums can reduce healthcare costs. Also over the last 20 years physicians groups have mostly been bought up by private equity, so any actual savings just gets vacuumed up as their profit.
- 2y ago
michpoch 2y ago
> Healthcare costs for the exact same care are 2x-3x what they are in Europe. And so are the salaries.
- ThePowerOfFuet 2y ago
  >> Healthcare costs for the exact same care are 2x-3x what they are in Europe. >And so are the salaries. The original estimate was off by at least a factor of ten, so alas your comeback falls apart.
MisterBastahrd 2y ago
I went into the hospital for shortness of breath but my main issue was fluid accumulation. I had 3 paracenthesis procedures and was hooked up to a drip of Lasic and a catheter bag for 20 days. I didn't even recognize that I was in the ICU until I got the bill. They charged $194,000. Insurance claims they paid $193,781. Of that, it was $7300 a day for staying in the ICU. My ambulance ride was $2500 for an 11 minute trip where one guy listened to my lungs and took my blood pressure. I had a palliative care doctor who met with me for 1.5 hours during my entire stay. She charged me $1K per hour.
- isoprophlex 2y ago
  With rates like that, you could at least argue that everyone is HIGHLY incentivized to keep you alive
- sarchertech 2y ago
  >palliative care When you consider that the PE firm that owns her group skimmed half of that off the top, if she met with you for 1.5 hours, she spent at least twice that time thinking about you, ordering meds, completing notes, and answering questions from the rest of the team caring for you, she probably made about $250 an hour or less. Then consider that she accepted liability for you. Which includes the possibility that if you had a bad outcome your family could sue her for more than the total payout of her malpractice insurance, so she could literally lose her house. And palliative care requires a fellowship so she has 12 years of total training with probably $200k-$400 in student loans. And she didn’t start making any serious money until her 30s. Then factor in that she’s on call constantly and frequently works terrible hours and she pays thousands a year in certification fees, and continuous education (plus in most cases hundreds of unpaid hours a year training residents and med student, sitting on advisory boards, or other unpaid expected service work). I think $250 an hour is pretty fair.
  - MisterBastahrd 2y ago
    The entirety of what she did was record keeping. Palliative care is a broad term, but she did not (a) do any diagnosis, (b) prescribe or change any meds, or (c) treat me in any way. She was basically an extension of the case manager. Our most impactful meeting was when she recorded the names, phone numbers, and associations of my emergency contacts, which had already been done a few days prior. Had she never shown up at all, nothing about my stay or outcome would have changed. I didn't pay $250 an hour. I paid a thousand an hour. You don't get to arbitrarily eliminate money because it didn't go directly to her. It still got paid.
pclmulqdq 2y ago
> The United States in an extreme outlier in terms of cost. This is separate from rationing care. This is separate from even population health (ex. higher obesity rates) Are you sure? People comparing US healthcare costs to European costs don't realize that these are two very different products. The US population is much more unhealthy, yet it has about the same life expectancy as an average European country. This would suggest that Americans actually have access to significantly more healthcare services than Europeans do. I think a lot of people assume that some of this stuff is linear when it actually seems to be exponential (or super-exponential) in cost. The median American spends half of their lifetime medical bills in their last year of life. That's a lot of money for not a lot of time. Incidentally, American doctors also tend to spend a lot less in this period, indicating that they have a much more healthy relationship with at least one of health or death. I haven't been particularly convinced, looking at the healthcare systems across the pond, that they are providing anywhere near the same level of service that you get from the ultra-expensive US healthcare system. They are somewhat more optimized for efficiency and the US healthcare system is much more optimized for outcomes - partly because Americans are so litigious and IMO partly because the patient is the customer. That doesn't lead to low costs.
- sudosysgen 2y ago
  That's the point of looking at global healthcare plans, which are giving two prices for the same person depending on whether they will or won't be in the US. And while they aren't giving the same service, there isn't much evidence the service is necessarily worse. More healthcare doesn't necessarily lead to better outcomes, it's not uncommon for more liberal treatment guidelines to only improve through statistical errors or to lead to compensatory idiopathic illness. This is systematically incentivized in the US, where both the doctors (obviously) will be paid more for more/worse care, but also the insurers which have to follow the 80/20 or 85/15 rules and are therefore incentivized to increase costs to increase total profits, especially in places where they have little competition, or agreements with hospital systems to pay a similar amount to other insurers. Additionally, the spurious nature of claims in the US system wastes massive amounts of resources where insurers (with their 15-20% of premiums) but also practitioners (sometimes even over 20%) spend their time just haggling over approvals instead of using a clear and deterministic system, which also causes knock-on consequences later.
brightball 2y ago
The way to attack the problem economically would have involved giving everyone in the USA an HSA that was funded to allow them to directly consume healthcare services with price exposure. It would naturally force competition on price. The ACA that we got instead cemented the separation of people from the price of their service and costs have ballooned even more than that were previously. The economic approach is the only real way to fix things long term.
- otterley 2y ago
  I think you’d be surprised how little price competition there would be if everyone paid out of pocket. It won’t change insurance premiums; it won’t change the amount of investment (training and certification) needed to become a health care provider; it won’t change the price of advanced medical equipment; and it won’t change the price of patented drugs. Before you conclude that the free market can solve everything, consider too that health care isn’t a typical service that follows ia supply/demand curve. The demand curve is practically vertical, especially when your life is on the line. You’re not going to shop around when your appendix is about to burst. Plus there are still high base costs, and scarcity (artificial or otherwise) of healthcare resources. And the monopolies granted to medical device and drug makers through the patent system keep prices high so the patentees can recoup their investments. There is no easy way to solve this problem, despite breathless claims to the contrary that have been plaguing our airwaves since the 1980s.
  - cfraenkel 2y ago
    Sure there is. It's called single payer. There's no way to fix this with the current layers of middlemen milking profits from what should be a public utility.
    - otterley 2y ago
      I meant to say there’s no market-based solution to the problem. That said, single payer has problems, too, which is why few countries use it in its purest form. Everyone gets a “floor” of coverage, which is a good thing, but people also hate waiting long periods for treatments and the inability to choose a specific care provider. Britons love NHS, but they hate it, too.

by qgin 2y ago

firejake308 2y ago

I know of at least one source arguing that in fact, population health (mainly obesity and gun violence) explain upwards of 70% of the difference in healthcare spending between the US and other developed nations.[1] To me, this seems like the most likely explanation because I believe we have pretty similar diagnostics and treatments to other developed countries, and I don't feel like a British doctor would give me any treatment that an American doctor wouldn't, and vice versa. As for the other 30%, I think it's probably due to inefficiencies in the insurance-based payment system and our patents lasting too long making drugs more expensive. [1] https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/#rcatoc-diminishing-returns-to-spending-and-worse-lifestyle-factors-explain-americas-mediocre-health-outcomes https://randomcriticalanalysis.com/why-conventional-wisdom-o...

silvestrov 2y ago
It is very expensive to run the insurance companies, plus all the time the hospitals need to spend to talk/plead with the insurance companies. When you have the state as a single payer then all those expenses just vanishes.
- yadaeno 2y ago
  Even the various single payer models in Europe and asia still have insurance companies. The difference is that in these systems the government has some stake — whether it’s providing the public insurance fund, or owning the company itself — so that the government is financially incentivized to reduce costs. In the US case everything is private so all parties are incentivized to increase costs as much as possible. We really should to copy the Bismarck model. Public owned “public fund”, heavily regulated private insurance and care.
  - llamaimperative 2y ago
    Competition among insurance companies in most other systems (like the Bismarckian system) is far more constrained and so consumes far less capital. A huuuuge portion of health insurance premiums just go toward spending on ads to pull members from other insurers and otherwise retain your own (especially while they are paying into the plan rather than pulling from the plan, at which point you’re happy to lose them).
    - JumpCrisscross 2y ago
      > A huuuuge portion of health insurance premiums just go toward spending on ads Wrong. "I̶n̶ 2̶0̶2̶3̶ a̶l̶o̶n̶e̶, t̶h̶e̶ f̶o̶u̶r̶ b̶i̶g̶g̶e̶s̶t̶ i̶n̶s̶u̶r̶a̶n̶c̶e̶ c̶o̶m̶p̶a̶n̶i̶e̶s̶ i̶n̶ t̶h̶e̶ U̶.S̶. p̶a̶i̶d̶ a̶ t̶o̶t̶a̶l̶ o̶f̶ $̶3̶.7̶ b̶i̶l̶l̶i̶o̶n̶ t̶o̶ g̶e̶t̶ t̶h̶e̶i̶r̶ n̶a̶m̶e̶s̶ o̶n̶ y̶o̶u̶r̶ s̶c̶r̶e̶e̶n̶s̶" [1] (EDIT: It's less than $30bn [3].) out of $1.5 trillion of premiums collected [2]. [1] https://www.bankrate.com/insurance/car/insurance-advertising/ https://www.bankrate.com/insurance/car/insurance-advertising... [2] https://www.cms.gov/files/document/highlights.pdf https://www.cms.gov/files/document/highlights.pdf [3] https://www.emarketer.com/content/us-healthcare-pharma-ad-spending-2024 https://www.emarketer.com/content/us-healthcare-pharma-ad-sp...
      - llamaimperative 2y ago
        1. Your $3.7 billion figure is about auto insurers 2. I misspoke and meant "marketing" broadly, not ads in particular. This all fits under administrative overhead which is one of the major sources of inefficiency between private health plans in the US compared to Medicare/Medicaid.
        JumpCrisscross 2y ago
        > misspoke and meant "marketing" broadly Do you have a figure for this?
        llamaimperative 2y ago
- gramie 2y ago
  A doctor I know worked in the US and then returned to Canada. In his US clinic, each doctor had 2-3 employees devoted to billing (patient-paid and insurance). In his Canadian clinic, they had 1 employee doing the billing for 4 doctors.
buckle8017 2y ago
The us healthcare statistics include people paying out of pocket for care that is extremely expensive and literally not available anywhere else. A number of gene therapies are to expensive for any public health system, so are only available in the us. Needles to say they're experimental and carry lots of weight in a effectiveness vs cost analysis.
- sudosysgen 2y ago
  Experimental therapies do exist in public healthcare systems, the costs are generally borne by the universities with special financing for experimental treatments. Many universities in public systems are run directly by universities which simplifies the process.
apercu 2y ago
The U.S. has orders of magnitude of admin costs due to middlemen at every stage in health care. This should be obvious to HN types.
- llamaimperative 2y ago
  Also should be noted that health insurers’ marketing costs are part of “administrative overhead.”
tzs 2y ago
> I know of at least one source arguing that in fact, population health (mainly obesity and gun violence) explain upwards of 70% of the difference in healthcare spending between the US and other developed nations I have my doubts. Over the last 50 years the ratio of US per capita health care costs and European per capita health care costs (or per capita health care costs for most of the rest of first world countries) has stayed about the same. In other words, health care costs have risen at about the same rate throughout the first world over the last 50 years. So if in 1970 the US was paying say 3x per capita what some other country paid the US would still now be paying about 3x what they are now paying. Both would be paying maybe 35x now than they were in 1970. Over that same time both US and European obesity rates went up, but they went up way more in the US. If obesity was a major factor driving health care costs then I'd expect US health care costs to be rising significantly faster than European health care costs.
- firejake308 2y ago
  This implies that healthcare costs in the US were already higher than those in Europe in 1970. Is that a correct conclusion to draw?
skissane 2y ago
> I believe we have pretty similar diagnostics and treatments to other developed countries I don't know. I remember reading an MIT PhD thesis describing how Kaiser Permanente does autism diagnosis [0] – and comparing it to my personal experience of the same topic in Australia, it seemed significantly more rigorous – e.g. specialist centres that only do autism diagnosis, using the multidisciplinary team diagnosis model instead of the single clinician diagnosis model, use of research reliable examiners for ADOS (the training and validation process required to use ADOS in research settings is much more intensive than that required to use it clinically), etc. Now, the thesis does acknowledge that Kaiser is somewhat of an outlier in this regard compared to the US average (plus it is 10 years old so now so I don't know how things have evolved since), but I still get the impression that this highly rigorous approach to autism diagnosis is much more of a thing in the US than in Australia – and if that's true of autism, maybe it is true of other conditions as well. [0] https://dspace.mit.edu/handle/1721.1/90070 https://dspace.mit.edu/handle/1721.1/90070 – the first half of the thesis uses the pseudonym "Allied Health", but I know from other sources that "Allied"=Kaiser; the second half discusses Kaiser without any pseudonym
- pclmulqdq 2y ago
  Kaiser is above average in the US, but in the major cities on the East coast you can actually find care that is much more sophisticated than you will get at Kaiser. If I were dying of a rare and aggressive form of cancer right now, I would rather be in Florida (Mayo), New York (Mount Sinai and Sloan Kettering), Boston (Dana-Farber), or DC (Johns Hopkins) than California. Kaiser's big advantage is the whole-life aspect of care, which is pretty appealing as a healthy person, but the medicine available in the US gets much more complicated.
  - jquery 2y ago
    A recent study showed Kaiser had the lowest denial rate of any major insurer, at 7%, versus the industry average of 16%. https://axenehp.com/wp-content/uploads/2024/12/20241218_chart_01.png https://axenehp.com/wp-content/uploads/2024/12/20241218_char... If you live in an area served by Kaiser and don’t have a very specific health reason to choose a different provider, I highly recommend them. They might not be able to treat that rare and aggressive cancer as well as the Mayo Clinic, but because it’s whole-life care, you’re more likely to find the cancer early. Edit: Question. Can Mayo expand to cover everyone in Florida? Or is their advantage in hiring the best of the best? What makes their model better than Kaiser?
ted_dunning 2y ago
I have an apples to apples comparison here. I had almost identical cases of cellulitis, one in the US and one in the UK. In the UK, I opted for private hospitalization in one of the fancier hospitals in London. The care was noticeably superior in the UK hospital. The attending doctor was available for a case summary on a few minutes notice, the sterilization and cleaning of the room was vastly better and the nursing staff could recite my case notes and recent test results and vitals at any time. None of these applied for the US hospital. The bill in the UK was about half what it was in the US and the walk-in price in the US if I hadn't had local insurance would have been nearly double the price I did pay. The kicker was that the UK hospital was run by HCA, an American corporation.

harry8 2y ago

20 years ago I read a story about an obstetrician in the USA. His premiums at that time for professional negligence were $1m per year. He would have to keep paying those premiums for 18 years after his retirement. Same for every obstetrician. Professional fees then must be set to cover those insurance premiums. Has that changed for the better in the USA? Seems very unlikely to be the same in Europe. Obstetrics is obviously a illustrative case. How are the professional negligence premiums across the other specialties? Why does the effect of the US legal system never seem to come up much in the “US healthcare is insanely expensive” discussion? Is the effect of it really not significant?

deleted 2y ago
[deleted]
- OneDeuxTriSeiGo 2y ago
  [dead]
etchalon 2y ago
This was an argument in the 90s/early 20s. TX, where I live, implemented tort reform in 2003 to limit doctor's exposure, and decrease insurance costs. It hasn't had much impact on costs: https://healtheconomicsreview.biomedcentral.com/articles/10.1186/s13561-017-0174-2 https://healtheconomicsreview.biomedcentral.com/articles/10....
- deleted 2y ago
  [deleted]
- sarchertech 2y ago
  It’s because physician compensation is only around 8% of medical costs and physician services billed are only 14%. So that’s your limit to how much reducing malpractice insurance premiums can reduce healthcare costs. Also over the last 20 years physicians groups have mostly been bought up by private equity, so any actual savings just gets vacuumed up as their profit.
2y ago

michpoch 2y ago

> Healthcare costs for the exact same care are 2x-3x what they are in Europe. And so are the salaries.

ThePowerOfFuet 2y ago
>> Healthcare costs for the exact same care are 2x-3x what they are in Europe. >And so are the salaries. The original estimate was off by at least a factor of ten, so alas your comeback falls apart.

MisterBastahrd 2y ago

I went into the hospital for shortness of breath but my main issue was fluid accumulation. I had 3 paracenthesis procedures and was hooked up to a drip of Lasic and a catheter bag for 20 days. I didn't even recognize that I was in the ICU until I got the bill. They charged $194,000. Insurance claims they paid $193,781. Of that, it was $7300 a day for staying in the ICU. My ambulance ride was $2500 for an 11 minute trip where one guy listened to my lungs and took my blood pressure. I had a palliative care doctor who met with me for 1.5 hours during my entire stay. She charged me $1K per hour.

isoprophlex 2y ago
With rates like that, you could at least argue that everyone is HIGHLY incentivized to keep you alive
sarchertech 2y ago
>palliative care When you consider that the PE firm that owns her group skimmed half of that off the top, if she met with you for 1.5 hours, she spent at least twice that time thinking about you, ordering meds, completing notes, and answering questions from the rest of the team caring for you, she probably made about $250 an hour or less. Then consider that she accepted liability for you. Which includes the possibility that if you had a bad outcome your family could sue her for more than the total payout of her malpractice insurance, so she could literally lose her house. And palliative care requires a fellowship so she has 12 years of total training with probably $200k-$400 in student loans. And she didn’t start making any serious money until her 30s. Then factor in that she’s on call constantly and frequently works terrible hours and she pays thousands a year in certification fees, and continuous education (plus in most cases hundreds of unpaid hours a year training residents and med student, sitting on advisory boards, or other unpaid expected service work). I think $250 an hour is pretty fair.
- MisterBastahrd 2y ago
  The entirety of what she did was record keeping. Palliative care is a broad term, but she did not (a) do any diagnosis, (b) prescribe or change any meds, or (c) treat me in any way. She was basically an extension of the case manager. Our most impactful meeting was when she recorded the names, phone numbers, and associations of my emergency contacts, which had already been done a few days prior. Had she never shown up at all, nothing about my stay or outcome would have changed. I didn't pay $250 an hour. I paid a thousand an hour. You don't get to arbitrarily eliminate money because it didn't go directly to her. It still got paid.

pclmulqdq 2y ago

> The United States in an extreme outlier in terms of cost. This is separate from rationing care. This is separate from even population health (ex. higher obesity rates) Are you sure? People comparing US healthcare costs to European costs don't realize that these are two very different products. The US population is much more unhealthy, yet it has about the same life expectancy as an average European country. This would suggest that Americans actually have access to significantly more healthcare services than Europeans do. I think a lot of people assume that some of this stuff is linear when it actually seems to be exponential (or super-exponential) in cost. The median American spends half of their lifetime medical bills in their last year of life. That's a lot of money for not a lot of time. Incidentally, American doctors also tend to spend a lot less in this period, indicating that they have a much more healthy relationship with at least one of health or death. I haven't been particularly convinced, looking at the healthcare systems across the pond, that they are providing anywhere near the same level of service that you get from the ultra-expensive US healthcare system. They are somewhat more optimized for efficiency and the US healthcare system is much more optimized for outcomes - partly because Americans are so litigious and IMO partly because the patient is the customer. That doesn't lead to low costs.

sudosysgen 2y ago
That's the point of looking at global healthcare plans, which are giving two prices for the same person depending on whether they will or won't be in the US. And while they aren't giving the same service, there isn't much evidence the service is necessarily worse. More healthcare doesn't necessarily lead to better outcomes, it's not uncommon for more liberal treatment guidelines to only improve through statistical errors or to lead to compensatory idiopathic illness. This is systematically incentivized in the US, where both the doctors (obviously) will be paid more for more/worse care, but also the insurers which have to follow the 80/20 or 85/15 rules and are therefore incentivized to increase costs to increase total profits, especially in places where they have little competition, or agreements with hospital systems to pay a similar amount to other insurers. Additionally, the spurious nature of claims in the US system wastes massive amounts of resources where insurers (with their 15-20% of premiums) but also practitioners (sometimes even over 20%) spend their time just haggling over approvals instead of using a clear and deterministic system, which also causes knock-on consequences later.

brightball 2y ago

The way to attack the problem economically would have involved giving everyone in the USA an HSA that was funded to allow them to directly consume healthcare services with price exposure. It would naturally force competition on price. The ACA that we got instead cemented the separation of people from the price of their service and costs have ballooned even more than that were previously. The economic approach is the only real way to fix things long term.

otterley 2y ago
I think you’d be surprised how little price competition there would be if everyone paid out of pocket. It won’t change insurance premiums; it won’t change the amount of investment (training and certification) needed to become a health care provider; it won’t change the price of advanced medical equipment; and it won’t change the price of patented drugs. Before you conclude that the free market can solve everything, consider too that health care isn’t a typical service that follows ia supply/demand curve. The demand curve is practically vertical, especially when your life is on the line. You’re not going to shop around when your appendix is about to burst. Plus there are still high base costs, and scarcity (artificial or otherwise) of healthcare resources. And the monopolies granted to medical device and drug makers through the patent system keep prices high so the patentees can recoup their investments. There is no easy way to solve this problem, despite breathless claims to the contrary that have been plaguing our airwaves since the 1980s.
- cfraenkel 2y ago
  Sure there is. It's called single payer. There's no way to fix this with the current layers of middlemen milking profits from what should be a public utility.
  - otterley 2y ago
    I meant to say there’s no market-based solution to the problem. That said, single payer has problems, too, which is why few countries use it in its purest form. Everyone gets a “floor” of coverage, which is a good thing, but people also hate waiting long periods for treatments and the inability to choose a specific care provider. Britons love NHS, but they hate it, too.