Friday, August 17, 2018

Explaining the High Cost of US Health Care: No Skin in the Game





  • I completely disagree with the idea that universal medicare cannot work.  It has actually worked well enough everywhere else.  The insurance companies are not involved at all. as it should be for a universal need.  Do you pay an insurance company to provide your food?
     
    My key point though is 'well enough'  That amazingly in Canada provides a plane trip for a rare brain operation handled in one key place.  You simply do not need two places and you have only a handful.
     
    What is not provided is best service for discretionary aspects, but so what. The easy fix to all that is allowing queue jumping for cash because there is actually slack enough.  Waiting a year for a knee operation is no fun but most are already retired.  Paying to have it now is an option.

    We are now trending toward a massive improvement in human health and in outcomes as well.  This will actually drop the general cost profile.
     
    A free market is only possible in the USA if the insurance gaming is excluded.  Fifteen percent of that twenty percent is drained by unnecessary admin and insurance profiteering with markups stacked on markups.

    Explaining the High Cost of US Health Care: No Skin in the Game

     https://moneymaven.io/mishtalk/economics/explaining-the-high-cost-of-us-health-care-no-skin-in-the-game-hDmB3UoWIkOK-J_D5BKQHA/
    Costs are expensive because there is almost no skin in the game. Graft has taken over.

    The Wall Street Journal has an interesting article on healthcare: Why Americans Spend So Much on Health Care—In 12 Charts.
    The U.S. spends more per capita on health care than any other developed nation. It will soon spend close to 20% of its GDP on health—significantly more than the percentage spent by major Organization for Economic Cooperation and Development nations.

    What is driving costs so high? As this series of charts shows, Americans aren’t buying more health care overall than other countries. But what they are buying is increasingly expensive. Among the reasons is the troubling fact that few people in health care, from consumers to doctors to hospitals to insurers, know the true cost of what they are buying and selling.

    Contributions to employer-sponsored health coverage aren’t taxed, which makes it less expensive for companies to pay workers with health benefits than wages.

    Generous benefits lead to higher spending, according to many economists, because employees can consume as much health care as they want without having to pay significantly more out of their own pockets.

    The prices of many medicines are hidden because pharmacy-benefit managers—the companies that administer drug benefits for employers and health insurers—negotiate confidential discounts and rebates with drugmakers.
    Price Growth Since 2000


     Hospitals are becoming more consolidated and are using their market clout to negotiate higher prices from insurers.
    Tax Benefits



    Contributions to employer-sponsored health coverage aren’t taxed, which makes it less expensive for companies to pay workers with health benefits than wages.

    Generous benefits lead to higher spending, according to many economists, because employees can consume as much health care as they want without having to pay significantly more out of their own pockets.

    The tax benefit is the country’s biggest single income-tax break, costing billions to government revenue.

    WSJ Misses the Big Picture
    The charts are interesting but the WSJ misses the big picture: There is no incentive anywhere to reduce costs.
    No Skin in the Game
    Where the hell is "skin in the game"?
    • Those covered by Medicare have no skin in the game. And that is precisely why Medicare for All would be an abomination.
    • Those covered under company plans have little incentive to reduce costs. Once deductibles are met, there is "no skin in the game".
    • Lobbyists wrote Obamacare. The results speak for themselves.
    • Congress had a golden opportunity to allow drug imports but failed to act. Drug companies can charge what they want and insurers will pony up.
    • There is no right to refuse service. Hospitals take anyone and everyone whether or not they have insurance. As such, many don't have insurance. They have no skin in they game. Bankruptcy is a way out.
    • Massive amounts of money are wasted to keep terminal patients alive. Why? Because hospitals get paid by insurers. If hospitals didn't get paid, and had they had right of refusal, such nonsense would stop.
    • Obama himself: Obama dictated what had to be be in healthcare plans. They labeled them Gold, Silver, and Bronze. Lovely. Arguably they should have been called dumb, dumber, and dumbest. Why? Millennials and healthy people had to overpay to support everyone else. The millennials dropped out, just as free market principles would have dictated.
    Let the Free Market Work
    Please, let the free market work. Let insurers offer whatever plans they want. Let people buy whatever they want. And let those without insurance pay the price. I assure you, prices will plummet.
    If you need a liver transplant and your insurance doesn't cover it. Sorry, you lose.
    Costs for routine services will plunge because hospitals will not have to pay $200 for one aspirin to make up for the cost of an unpaid liver transplant.
    Insurance plans ought to be able to force treatment overseas if someone is healthy enough to travel. A heart bypass operation in India is 10% of the cost here.
    At a bare minimum, insurance companies ought to be able to offer such plans.
    Personal Experiences - Stop and Smell the Lilacs
    I seriously wonder if chemotherapy is more of a torture than a blessing. I watched my mom die in misery. The cost today is surely thousands of times higher. For what? To prolong someone's life for six months? At what cost? And who should pay?
    When my mom stopped breathing, they asked my dad if he wanted them to try and revive her. He said no. Had he not been there, what would they have done? Why?
    My wife, Joanne, died from ALS (Lou Gerhig's Disease). She was on extremely expensive drugs paid for under Medicare. Note that one does not have to be 65 to be under Medicare. Rather, Medicare picks up all costs on some terminal diseases.
    Did those drugs do her any good? I doubt it. We also need to define "good". If they kept her alive for another three months (which I highly doubt), it was another three months of pain and suffering.
    I sponsored a raffle for the benefit of the Les Turner ALS Foundation. And we put on a economic conference. John Hussman did a generous match of non-raffle proceeds. All told, we raised $500,000 for the Les Turner foundation.
    This was an early post promoting the fund raiser: My Wife Joanne Has Passed Away; Stop and Smell the Lilacs
    I am very proud of that, and also the amazing support from the Hussman Foundation.
    That's skin in the game. Thanks again John!
    Brass Tacks
    We really need to get down to brass tacks.
    Other countries seemingly have better healthcare because they control the cost of education, doctors fees, etc. They get cheaper drugs from the US than we have here.
    Unless the US wants to control the cost of education, the cost of drugs, the cost of hospital care, and literally the cost of everything related, the US will not compare favorably to other countries.
    Medicare for All cannot possibly work here, even if it "seems" to work elsewhere. I suggest we try the free market, not more Obamaism.


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