Talk for Article "Why American healthcare is so expensive"

Talk about this Article

  1. [ This comment is from a user you have muted ] (show)

    Hi, I just stumbled upon this article through the WT email newsletter.

    I noticed that a link cited in the article does not specifically address the state of junk food among poor people in the U.S., although it is cited as such. As a matter of fact, the findings cited in the Guardian article are from the NHS in the UK.

    I propose that this be corrected if not removed.

    “People from a lower socioeconomic background are more likely to smoke (Washington Post), more likely to live in areas with polluted air (Scientific American) and consume junk food (Guardian). So while the U.S. healthcare system struggles to contain costs, public health professionals must also grapple with how to address unhealthy factors that occur outside of hospital grounds.”

    https://www.theguardian.com/commentisfree/2015/nov/29/kis-junk-food-dont-blame-parents

    1. [ This comment is from a user you have muted ] (show)

      I used a better link. thank you!

  2. [ This comment is from a user you have muted ] (show)

    Io sono un cittadino italiano. Il nostro Sistema Sanitario garantisce l’assistenza ospedaliera (pubblica) a tutti i richiedenti, anche non italiani. La qualità dei servizi è buona con punte di eccellenze.
    Oggi il costo di gestione ospedaliera è coperta dallo Stato italiano tramite tassazione. Però è costoso.
    Questo problema è assimilabile al problema della esosità delle tasse! Però ciò si può risolvere facilmente applicando la mia soluzione aulica partendo dall’abbattimento del debito pubblico che affligge – chi più e chi meno – quasi tutti gli Stati democratici dell’Occidente come ho riportato sul mio sito Internet ovvero http://www.econ-agan.blogspot.com .
    Si tratta di un metodo che non richiede alcuna risorsa economica (ma di una forma di cooperazione delle parti sociali) ed è di breve applicazione e con risultati immediati ed efficaci mai smentito da alcun economista da me interpellato. Sembra incredibile ma è vero!
    Grazie per la cortese attenzione.
    agan

  3. [ This comment is from a user you have muted ] (show)

    I don’t have any good sources for this, but I was pretty sure the threat of lawsuits played a part in costs being higher as well. I believe hospitals have more pressure to sometimes be overly cautious out of fear of being sued. I’m guessing this can be a good thing, but I would guess this typically increases the costs to some degree. The doctors probably also need more insurance to protect against lawyers. Not sure how any of this compares to other countries or what the magnitude is.

    1. [ This comment is from a user you have muted ] (show)

      You’re completely right, Gareth. Others have also recommended a section on “defensive medicine.”

      Please feel free to include something, I will try to include this as soon as possible.

  4. [ This comment is from a user you have muted ] (show)

    Very interesting article. I didn’t even realise that doctors where not usually paid a flat wage but on a service basis. No wonder the system is broken. My sister lives in Mexico which has a similar system to the USA. She was told she needed urgent cervical spine surgery and it would cost US$60,000. When I heard this I told her to get on a plane to London and go see my neurologist. Cut a long story short she was told it was not an urgent matter and anyway they could offer her less intrusive surgery for £9,000 ($12,600). That’s at a well know private hospital in London and includes hospital stay, medication, everything.

    1. [ This comment is from a user you have muted ] (show)

      Doctors are not only paid a fixed price, but when it comes to contracts with any of the corporate insurance providers doctors will often be paid less than the medicare approved rate and they will have to suffer much more office paper work with what those plans will require to have claims paid properly. The insurance companies very often own hospitals and doctors so they are able to keep all of the prices for those without insurance very high – then people purchase insurance out of fear.

      1. [ This comment is from a user you have muted ] (show)

        The insurance/hospital relationship is underreported. Do you know any good resources to inform a report?

        1. [ This comment is from a user you have muted ] (show)

          insurance companies own hospitals! they own the doctors. the lab. the blood bank. the pharmacy. the formulary (tells patients what meds they are allowed to take). media is owned by the insurance industry so not sure where u will find it openly reported. but in the same way you will never read about the CIA kicking in the wrong door – you will also never read about a patient who was harmed because of the insurance company wanting to maximize its profit at the cost of patient health

  5. [ This comment is from a user you have muted ] (show)

    If the expensive shambles of the American health “care” system is the best the much-vaunted capitalist system can offer to address the unfair and unpredictable occurrence of ill health then capitalism itself should be committed to intensive care or a mental health facility.

  6. [ This comment is from a user you have muted ] (show)

    Great foray into the murky world of healthcare funding. Thanks for writing it!

    There are a few interesting points, especially about the Silver plan available via the ACA.

    Are there any estimates about the rate of a hypothetical sales tax would have to be to provide a Silver level plan to every citizen? I’m sure there must be a good reason why a healthcare system can’t be funded through general taxation or is it as simple as the political environment in the US is opposed to what some would see as a over reach of federal government.

    In the UK, General Practices are given a flat fee for everyone on their books, so the healthier folk effectively subsidise the cost of the care of more frequent users of the service. Are there any NHS Trust type organisations in the USA? Where a hospital, GP and other specialist services band together under a board of trustees who get their funding indirectly (government funding through taxes) or directly from people in that jurisdiction, perhaps made mandatory through city legislators?

    1. [ This comment is from a user you have muted ] (show)

      “Are there any estimates about the rate of a hypothetical sales tax would have to be to provide a Silver level plan to every citizen?”

      There was a federal subsidy that kept deductibles lower for Silver plans, known as Cost Sharing Reduction. But President Trump repealed it last year via Executive Order. So any increase of subsidies in the individual market is unlikely under this administration. Read our coverage on that: https://www.wikitribune.com/story/2017/10/21/united_states/developing-trump-sours-on-bipartisan-solution-to-obamacare-debate/9442/

      “In the UK, General Practices are given a flat fee for everyone on their books, so the healthier folk effectively subsidize the cost of the care of more frequent users of the service”

      This is sort of how Obamacare works: if everyone buys health plan, insurance companies will be able to cover those with chronic conditions. It’s also how Medicaid works (especially the flat fee part), but this is only available for the poor.

      The “direct primary care” model is also somewhat you’re referring to. Patients pay a monthly subscription to a GP and receive unlimited visits. The cost for DPC is far lower than what private insurance and Medicare pay.

      “Are there any NHS Trust type organisations in the USA? Where a hospital, GP and other specialist services band together under a board of trustees who get their funding indirectly (government funding through taxes) or directly from people in that jurisdiction, perhaps made mandatory through city legislators?”

      What you’re describing is essentially an insurance company. Can local government replicate this? Probably not. It would take a lot of taxpayer money, a lot of people to make the risk pool manageable, and enough doctors who’d be willing to participate. If doctors or young and healthy people leave the city, the system wouldn’t survive.

      But there are some states, and even some cities, with more generous health benefits. The New York State, for example, offered coverage to people with pre-existing conditions before ACA was passed.

  7. [ This comment is from a user you have muted ] (show)

    Why is the United States federal government barred from negotiating prescription drug prices related to Medicare coverage?

    1. [ This comment is from a user you have muted ] (show)

      It was part of the Medicare Part D legislation passed under President George W. Bush.

      https://www.ssa.gov/OP_Home/ssact/title18/1860D-11.htm

      (i) Noninterference.—In order to promote competition under this part and in carrying out this part, the Secretary—

      (1) may not interfere with the negotiations between drug manufacturers and pharmacies and PDP sponsors; and

      (2) may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.

    2. [ This comment is from a user you have muted ] (show)

      This is also to the benefit of the pharmacy benefit managers – (PBM) who can then charge the customer a higher price at the pharmacy and also capture a rebate from the production company. (example, the PBM pays $50 for an antibiotic by discount from the drug company – but is able to charge the patient/customer $80 ($70 cash price if you have no insurance) at the counter because gag orders are in place preventing the pharmacy from telling the patient the cash price is lower).

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