SoylentNews is people
SoylentNews
Study: More than a third of healthcare costs go to bureaucracy:
U.S. insurers and providers spent more than $800 billion in 2017 on administration, or nearly $2,500 per person – more than four times the per-capita administrative costs in Canada’s single-payer system, a new study finds.
Over one third of all healthcare costs in the U.S. were due to insurance company overhead and provider time spent on billing, versus about 17% spent on administration in Canada, researchers reported in Annals of Internal Medicine.
Cutting U.S. administrative costs to the $550 per capita (in 2017 U.S. dollars) level in Canada could save more than $600 billion, the researchers say.
“The average American is paying more than $2,000 a year for useless bureaucracy,” said lead author Dr. David Himmelstein, a distinguished professor of public health at the City University of New York at Hunter College in New York City and a lecturer at Harvard Medical School in Boston.
“That money could be spent for care if we had a ‘Medicare for all program’,” Himmelstein said.
To calculate the difference in administrative costs between the U.S. and Canadian systems, Himmelstein and colleagues examined Medicare filings made by hospitals and nursing homes. For physicians, the researchers used information from surveys and census data on employment and wages to estimate costs. The Canadian data came from the Canadian Institute for Health Information and an insurance trade association.
When the researchers broke down the 2017 per-capita health administration costs in both countries, they found that insurer overhead accounted for $844 in the U.S. versus $146 in Canada; hospital administration was $933 versus $196; nursing home, home care and hospice administration was $255 versus $123; and physicians’ insurance-related costs were $465 versus $87
They also found there had been a 3.2% increase in U.S. administrative costs since 1999, most of which was ascribed to the expansion of Medicare and Medicaid managed-care plans. Overhead of private Medicare Advantage plans, which now cover about a third of Medicare enrollees, is six-fold higher than traditional Medicare (12.3% versus 2%), they report. That 2% is comparable to the overhead in the Canadian system.
(Score: 1, Disagree) by The Mighty Buzzard on Thursday January 09 2020, @03:41PM (30 children)
Ahh, so you're looking to get rid of insurance and raise taxes on a truly massive scale then. I expect you'll still be excluding poor folks from paying income taxes at all (most of them don't right now) and effectively giving them free healthcare at the expense of everyone else? Good to know where you stand.
My rights don't end where your fear begins.
(Score: 4, Insightful) by JoeMerchant on Thursday January 09 2020, @04:07PM (22 children)
Define "poor folks" - you're all fuckin' peasants as far as I can see.
What you seem to be missing is: we're paying for healthcare today through insurance and taxes, if we provide the same healthcare tomorrow that we provide today, the cost for care will be the same. If we can drop the administrative costs and lose 33% of the total bill, that's "free money" to anyone who doesn't benefit from those costs right now. I don't really care if that money comes out of me in insurance payments, reduced salary because my company pays for insurance, or taxes - it comes out regardless.
If you're willing to pay an extra $6500 per year into "the system" just to keep the status quo of wealth distribution, you must be better off than 99% of the people I know.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Thursday January 16 2020, @04:31PM (21 children)
And I'm saying stop paying for healthcare through insurance or taxes. If medical providers and drug companies don't have someone with bottomless pockets to bill, I guarantee you prices will become far more sane.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Thursday January 16 2020, @06:44PM (20 children)
I do not believe in your KoolAid and I will not be drinking it.
However, private pay is an option already today in the U.S. - we did it with my wife for 2 years including one cancer treatment, and it was STILL cheaper than non-big-pool insurance (our only option at the time) would have been. Hell, on average no insurance is guaranteed to be cheaper than insurance simply because you don't have to pay for the insurance processing: people, people who have to have cars to drive to work, houses to live in, kids to put through college AND pay health insurance themselves - Ouroboros ain't cheap to feed.
If you want to paint a Yoko Ono fantasy landscape where everything instantly changes to match the picture in your mind, sure, you've got some valid points. Now: stop bitching about it on an obscure internet chat board that nobody reads and go try to do something about it. You've got time, look at Bernie: 70 what years old and about to make a difference, maybe.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Friday January 17 2020, @05:10PM (19 children)
You don't believe it because you don't want to. If you wanted the truth you have only to look back before everyone had insurance and government assistance.
You have your hobbies, I have mine.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Friday January 17 2020, @05:48PM (18 children)
My grandparents' generation. Both of my great grandfathers died around age 30, cardiac issues, although one managed to father 9 children before checking out. Of those 9 children, one was blind from birth - probably complications that a trip in from the farm to the hospital would have prevented (though, God only knows what other diseases you might catch while in town...) The woman who bore those 9 children chewed tobacco until she was 96, and lived to 98.
We can't all go back and live on the farm, with 9 kids, 30 grandkids, etc. those 400 acres just aren't enough to go around anyway.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Friday January 17 2020, @10:23PM (17 children)
We certainly can go back to not giving healthcare providers and drug companies a blank check to nearly bottomless pockets, which is precisely what insurance and government assistance do. Hell, even just removing all non-crucial, routine care and medication from medicare/insurance coverage would do an enormous amount to lower costs.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Friday January 17 2020, @11:19PM (15 children)
My work insurance policy (named BIND - sounds like handcuffs to me) is taking baby steps in that direction. They've pulled out some of the high ticket items like joint replacement, etc. and basically make you private-pay for those with a payment plan - but still with their negotiated prices which is extremely important in today's medical billing landscape (aka minefield).
I've been totally in favor of this kind of approach to national healthcare from the start. National healthcare shouldn't cover high dollar options. If your choice is between a $5K round of chemo, or a $50K round of LINAC radiotherapy, or a $250K round of proton therapy, even if proton therapy has a better outcome ratio, I'm fine with the national insurance paying you $5K that you can either use toward chemo for your 95% cure chance, or to help pay for whatever super-therapy you think you want to get that 97% cure chance. Is that cold, heartless? I don't think so when it means that millions of people who currently get NO care until they present at an ER literally on death's door would have affordable access to more cost-efficient preventative care.
To plug an old Michael Moore piece: what healthcare they have in Cuba for free, we should have in the U.S. for basically free. Not super state of the art everything, but M.D.s and HCPs with eyes on the patients making informed diagnoses, basic antibiotics and low cost preventative care - that's what's stupid about the U.S. system right now, locking people out of that.
You want to lock the doors on the "supercare" wing and require a gold card for access - I'm fine with that.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Monday January 20 2020, @01:47PM (14 children)
That's the exact opposite of what I suggested though. Insurance should be only for the costly, emergency care. Covering routine care and medication saves nobody anything but does add an extremely high bureaucracy tax on top of what you should be paying.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Monday January 20 2020, @02:28PM (13 children)
And, I guess what I am saying is: private insurance is for the costly stuff, single payer for the routine.
The AMA needs to be kicked to the curb and we need to start training M.D.s who are willing to work for something like 50% above the median household income - that would be ~$95K/yr today. That has to start back with med school, you can't saddle the M.D.s with $600K in debt if they're only going to make $95K/yr. There are plenty of highly competent people who would be willing to be an M.D. for lower pay, if they could get licensed.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Monday January 20 2020, @02:50PM (7 children)
Single-payer is deeper pockets even than the largest insurance company on the planet. It would do the exact opposite of its stated goal: saving the people money.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Monday January 20 2020, @04:22PM (6 children)
And it works for over 500M citizens in countries arguably more advanced than the U.S. without cost control problems, but, hey, think different - right? It worked for our great-great grandparents back before we had clean drinking water in the cities, why not try it again today?
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Monday January 20 2020, @04:31PM (5 children)
Without cost control problems because they have told US drug companies "sell it to us for $this or we will ignore your patents". So US drug companies are forced to sell to them for that or risk a competitor selling drugs they hold a patent on at a loss to the entire world. Fear not though, they pass the costs of those extortionate discounts on to the folks here in the US.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Monday January 20 2020, @04:48PM (4 children)
Listen to the sound of my tiny violin, not giving a single fuck.
I've given you the perspective in the past of what it costs to produce and sell a medical device (my personal career and experience), right? Drugs are much the same. You know how drug reps are recruited, right? Straight out of school based 100% on ability to influence, whether that influence is based on physical attractiveness, willingness to give lap dances, or literally whatever it takes to move the product. That's fine, but it's fucking expensive. Drug reps come into medical offices catering lunch on an unbelievable regular basis - some places literally get a really nice free lunch EVERY SINGLE DAY for every single employee in the building catered by the various drug reps. The M.D.s who have related these stories to me are generally of the position: I can buy my own lunch, but for the rest of the staff they really value it... that gets them access, expensive access, but access nonetheless to push their product.
The true astronomical costs of R&D aren't sunk into any particular drug or device, it's because of the 19 failures that make zero return for the one commercial success. Then the costs of selling those successful devices/drugs outstrip this cost of R&D by more than an order of magnitude. Then there are the smaller, but still significant, costly efforts put in for national legislation lobbying to support the whole fiasco. This is how you sell a pill that costs less than $0.40 each to make by hand for $20.00 each when it's sold through the pharma/sales rep/insurance channels. How you sell a device that costs less than $600 to make for over $30K per implantation.
The EU and ROW don't get that kind of bullshit extreme high cost hard sell treatment, even with their discounts and costs of entry to the countries, the profit margins are higher per unit overseas due to the lack of the hard-sell costs.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Monday January 20 2020, @05:02PM (3 children)
You should give a fuck. If they don't stand to make money by developing new drugs, they won't develop new drugs. And since the US develops the majority of the new drugs for the world...
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Tuesday January 21 2020, @01:49AM (2 children)
The system has developed itself into a shitty shitty way of making new drugs, and when you break down what's really spent on R&D vs what's spent on sales, you're going to find 20 sales twats out there, 9 of whom are pulling down $300K+ per year in commissions, mostly because they're breaking policies and laws and getting away with it - short term, while the other 11 are going to be cycled through the company in less than a year hoping to find fresh meat with new ideas about how to skirt or outright break the law - that's 20 sales schmucks for every actual R&D worker, in the successful drug companies. And, as a drug company, if you don't do the hard sell on all fronts, you are not competitive in the marketplace, your funding dries up, and you die - unless maybe you're lucky enough to sell out to a big marketing company that is willing to play the game.
As for innovation - what got innovated in the insulin field in the last 10 years, besides innovative new ways to jack up the price? And, it's not just insulin, not by a longshot.
The sad part of this equation is that most major drug and device development companies are giant multi-national operations, so there's not really an opportunity for big players in other countries to prove their ability to compete.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Tuesday January 21 2020, @05:30PM (1 child)
What's your point? Sales douches are apparently necessary to keep the money flowing in at a profit level high enough to warrant the R&D expenditures or even continued existence of the companies. What levels that requires of each is irrelevant. It wouldn't make a "should we do it" difference if it were a 99% to 1% split.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Tuesday January 21 2020, @06:54PM
Then I guess you really don't care about innovation. As a race, we've got limited resources on this planet, if we spend 99% of those resources in each others' faces trying to convince each other to buy our shit not theirs, that leaves precious little left over to actually improve the shit with.
First, we had to quit bashing each other over the head with rocks long enough to get a decent farm going. I think we're > 99% there, globally today.
Then, we had to quit burning each other's crops long enough to get some kind of civilization going. Probably closer to 95% achieved.
Then, we had to quit spending 50%+ of our GDP on weapons and troop deployments (and actual wars) to get some actual quality of life for the majority of people. This one I'm going to rate around 50% done today - depending on your thresholds and definitions I'd say it's clearly in the 20-80% range somewhere.
I'll agree that all of that is more important than worrying about whether we spin our wheels in inefficient lawsuits, god-awful sales practices, fradulent televangelist schemes, etc. but, what really concerns me is that the "good companies" like AT&T Bell Labs used to put 20-25% of their gross proceeds into R&D, but today you're lucky to get 10%, and the trends out of Wall Street continue to squeeze on the long term investments like R&D and encourage the short term gains like sales-push. At some point, the wheels are going to fall off the bus and we will have forgotten completely how to innovate.
When drug prices are inflated 50-100x over the cost of manufacture, and 90%+ of that margin is being plowed into S&M instead of R&D, I'd say we jumped the shark some time ago.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Monday January 20 2020, @02:58PM (4 children)
Man, I need more caffeine. Premature Submit due to lack of cognition.
There's a reason doctors command the wages they do. They spend unbelievable amounts of effort, hardships, and capital to attain their skills. They deserve to be compensated for the scarcity and difficulty of attainment of said skills. That and they're expected to pay insane malpractice insurance premiums so that people can sue them for gazillions of dollars when they're not absolutely perfect at all times.
Also, setting government wages for citizens ain't just socialism, it's flat out communism.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Monday January 20 2020, @04:29PM (3 children)
Supply and demand, like anything else. The AMA keeps a stranglehold on supply, putting M.D.s not only in high demand, but also with overinflated opinions of their own worth and importance leading to some seriously dysfunctional relationships in the medical profession.
Normal practicing M.D.s in the UK and EU, for example, do only make about €90K/yr, and they are providing a better overall quality of care to their populations as measured by health outcomes, life expectancy, infant mortality, etc.
Artificial scarcity created by the AMA's med school and residency requirements - requirements which are un-necessary to ensure quality care by the program graduates.
FTFY.
🌻🌻 [google.com]
(Score: 2) by JoeMerchant on Monday January 20 2020, @04:37PM
Creating artificial scarcity in markets is one of the worst aspects of monopolistic behavior - the evil head of capitalism that, like Hydra, needs constant vigilance because as soon as you cut one off two grow back in it's place.
How many competing AMAs do we have in our "free market"? Just the one, last I checked - absolute monopoly, worse than socialism or communism, both of which get a bad rap due to examples of them being implemented with corrupt central control.
And we're not talking about entertainment, or communication, or food, or transportation, or construction, or energy, we're talking about healthcare.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Monday January 20 2020, @04:43PM (1 child)
If that were true you wouldn't have every doctor who practices being sued every single year, likely multiple times. You can't have it both ways. Either doctors are competent and suing them for unrealistic expectations should be done away with or they aren't competent and the standards need to be raised even higher.
The scarcity and difficulty of attainment factor in to the value, so *shurg*.
As for doctors' wages? Those are trivial as a percentage of your healthcare costs. Removing their ability to work for whoever pays them the best like everyone else isn't just vile and contemptible, it's also unwarranted.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Monday January 20 2020, @04:55PM
Tort reform is a whole other area that's out of control, but maybe not quite as far out of control as healthcare costs.
You can't draw any rational conclusions based on frequency and payouts of lawsuits and settlements. The legal system is like a fucking casino, rigged, but with some big random payouts based on arbitrary lucky breaks.
Raising standards does not raise competence. Addressing how care is delivered improves outcomes. Giving M.D.s more time to spend on each individual case has direct measurable improvements in outcomes, flunking out prospective M.D.s in Chem 101 with arbitrarily hard exams does nothing - except to reduce the number of practicing M.D.s which does give them less time to spend on individual cases.
Specialist doctors' incomes ($1M+ per year) are, indeed trivial in the bigger picture of healthcare costs, but they are symptomatic of a shortage of M.D.s which is one of the root problems in the system.
🌻🌻 [google.com]
(Score: 2) by JoeMerchant on Friday January 17 2020, @11:44PM
Vaguely related insanity: https://gritpost.com/retiree-holiday-inn-senior-home/ [gritpost.com]
Over the course of a year, Robison would pay approximately $21,900 to stay at a Holiday Inn at the senior discount rate for 365 days. The retirement home he looked at would cost $68,620. And that’s typically the price for a senior home, according to Forbes.
“It takes months to get into decent nursing homes. Holiday Inn will take your reservation today,” he added. “And you’re not stuck in one place forever — you can move from Inn to Inn, or even from city to city.”
“The Inn has a night security person and daily room service. The maid checks to see if you are ok. If not, they’ll call an ambulance… or the undertaker,” Robison continued. “If you fall and break a hip, Medicare will pay for the hip, and Holiday Inn will upgrade you to a suite for the rest of your life.”
🌻🌻 [google.com]
(Score: 3, Insightful) by fustakrakich on Thursday January 09 2020, @07:37PM (6 children)
Yeah, yeah, we know, fuck the poor...
La politica e i criminali sono la stessa cosa..
(Score: 2) by The Mighty Buzzard on Thursday January 16 2020, @04:32PM (5 children)
Saying get your thieving hand out of my pocket is not the same as saying fuck the poor. I got nothing against charity but if you have pry the money from its rightful owner's wallet first under threat of imprisonment or death, it is not charity.
My rights don't end where your fear begins.
(Score: 1) by fustakrakich on Thursday January 16 2020, @04:59PM
Sorry, you want the bennies, you gotta pay the dues.
La politica e i criminali sono la stessa cosa..
(Score: 1) by fustakrakich on Thursday January 16 2020, @05:09PM (3 children)
:-) Such is life in the collective
La politica e i criminali sono la stessa cosa..
(Score: 2) by The Mighty Buzzard on Friday January 17 2020, @05:12PM (2 children)
"We are the Democrats. Existence as you know it is over. We will add your financial distinctiveness to our own. Resistance is futile."
My rights don't end where your fear begins.
(Score: 1) by fustakrakich on Friday January 17 2020, @07:18PM (1 child)
*sigh* So hopelessly biased
La politica e i criminali sono la stessa cosa..
(Score: 2) by The Mighty Buzzard on Friday January 17 2020, @10:27PM
That's not bias, that's their stated platform. Just paraphrased.
My rights don't end where your fear begins.