Diabetic groom dies from taking cheaper insulin to fund wedding - "Known as “human insulin,” ReliOn requires more time to become effective than the “analogue” insulin that Wilkerson had previously been taking — but, at one-tenth of the price, it was more affordable for the northern Virginia dog kennel supervisor, who was earning $16.50 an hour."
People are using this to bash US healthcare, but this is misleading. Switching to a different medication without taking into account the difference in its properties isn't dangerous only in the US
Healthcare price transparency can address inflation’s largest and longest-running source - "core inflation rose by 6.6 percent over the past year, the fastest rate in 40 years. Health insurance costs rose by 28.2 percent over the same period — more than four times this record rate. Economists predict healthcare prices will increase even more in the coming months. For instance, the Federal Reserve Bank of Dallas estimates the healthcare inflation rate will double between mid-2022 and mid-2023... HHS can achieve the president’s goal and substantially lower broader care and coverage costs by committing to robust enforcement of its federal hospital price transparency rule that took effect on Jan. 1, 2021... Hospitals are driving much of these high costs. Johns Hopkins University research found that hospitals charge an average of seven times their cost of care. Leaked hospital pricing practices published in the LA Times reveal some hospitals automatically add markups as much as 675 percent. Employers need not passively accept such escalating prices by passing them on to their employees. In fact, they can reject the opaque and inflationary status quo and enjoy substantial savings by elevating health plan decisions from HR departments to C-suites and proactively treating healthcare prices like any other aspect of their supply chain, with a keen eye toward price and quality. Innovative employers nationwide, such as Rosen Hotels and the Osceola School District in Florida, have saved 30 percent to 50 percent on their healthcare costs by analyzing their health claims data, rejecting price-gouging hospitals, and pursuing direct contracts with providers that offer the best care at the best prices. They are sharing these savings with their employees in the form of lower premiums and higher pay. Hospital price transparency will allow more employers to follow their lead by making it easier to compare and save. The federal hospital price transparency rule requires hospitals to post their discounted cash and all negotiated health insurance rates online, allowing consumers to spot widespread price differentials for the same care, even at the same hospital. The rule empowers employers to engage in meaningful healthcare and coverage procurement through financial review and analysis of actual prices. When prices are known, no employer will tolerate paying 10 times more than their competitors for the same treatment. Price transparency can hold hospitals accountable for overcharging, upcoding, and fraudulent billing. Unfortunately, this rule has been marred by widespread hospital non-compliance. A recent study by PatientRightsAdvocate.org concludes that only 16 percent of hospitals nationwide fully comply with it"
What does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics - "Measuring consumer responsiveness to medical care prices is a central issue in health economics and a key ingredient in the optimal design and regulation of health insurance markets. We leverage a natural experiment at a large self-insured firm that required all of its employees to switch from an insurance plan that provided free health care to a nonlinear, high-deductible plan. The switch caused a spending reduction between 11.8% and 13.8% of total firm-wide health spending. We decompose this spending reduction into the components of (i) consumer price shopping, (ii) quantity reductions, and (iii) quantity substitutions and find that spending reductions are entirely due to outright reductions in quantity. We find no evidence of consumers learning to price shop after two years in high-deductible coverage. Consumers reduce quantities across the spectrum of health care services, including potentially valuable care (e.g., preventive services) and potentially wasteful care (e.g., imaging services). To better understand these changes, we study how consumers respond to the complex structure of the high-deductible contract. Consumers respond heavily to spot prices at the time of care, reducing their spending by 42% when under the deductible, conditional on their true expected end-of-year price and their prior year end-of-year marginal price. There is no evidence of learning to respond to the true shadow price in the second year post-switch."
Are Health Care Services Shoppable? Evidence from the Consumption of Lower-Limb MRI Scans - "We study how privately insured individuals choose lower-limb MRI scan providers. Despite significant out-of-pocket costs and little variation in quality, patients often received care in high-priced locations when lower priced options were available. The choice of provider is such that, on average, patients bypassed 6 lower-priced providers between their homes and treatment locations. We show that referring physicians heavily influence where patients receive care. The influence of referring physicians is dramatically greater than the influence of patient cost-sharing or patients’ home zip code fixed effects. Patients with vertically integrated referring physicians are also more likely to receive costlier hospital-based scans."
Jonathan Clavell MD, FACS on Twitter - "Surgeon: I need X Medication for the patient.
Hospital: patient needs to pay for it upfront
S: patient is under gen anesthesia, send bill after case
H: it has to be paid upfront
S: …
H: You can provide your credit card and we can charge you.
Yes, this happened!"
Health Disadvantage in US Adults Aged 50 to 74 Years: A Comparison of the Health of Rich and Poor Americans With That of Europeans - "At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England...
Several factors may explain why Americans have worse health than Europeans. Although major risk factors such as smoking are similarly prevalent, the obesity epidemic is more advanced in the United States than in Europe. In addition, Europe's social and healthcare policies are more comprehensive and contrast with less accessible US programs. Most notably, whereas healthcare access is universal in Europe, about 41 million Americans remain uninsured. Furthermore, most European health care systems have a strong focus on primary care, which contrasts with a marked focus on specialist care in the United States."
The superior US healthcare system strikes again
VA Sees Improvements in Patient Satisfaction, Care Access - "82 percent of veterans report being at least somewhat satisfied with the healthcare they have received through the agency... Ninety-one percent of veterans said they would recommend receiving healthcare through the VA, save for one outlier state. In Alabama, only 74 percent of veterans recommended VA healthcare. Nationally, however, the number of veterans expressing dissatisfaction with their healthcare is relatively low. Only 7 percent of veterans said they were not satisfied with their VA healthcare and only 11 percent said they were neither satisfied nor dissatisfied. Fewer than one in ten veterans would not recommend VA healthcare... 84 percent of veteran respondents report that they have received their care in a timely manner. Fifty-four percent of respondents said they received an appointment within 14 days for most of their healthcare needs and 80 percent said they obtained an appointment within the 30-day timeframe outlined by the VA."
All the Americans who proclaim universal healthcare will never work and hate on the VA get very upset whenever I provide data on Veterans Affairs satisfaction
Patient satisfaction in VA medical centers and private sector hospitals: a comparison - "For the first time, we have data that can validly compare the satisfaction level of inpatients in Department of Veterans Affairs (VA) medical centers and private sector hospitals. It shows the satisfaction levels to be very similar. Since the VA will soon be changing its survey, this has been a very short time window. It may never recur. In addition to the general finding, there are some interesting comparisons regarding specific questions. For example, satisfaction with VA physicians, who are salaried and assigned to patients, is just as high as satisfaction with private physicians who are paid by fee and selected by the patient. This would seem to be critical information in the debate over U.S. health care reform."
New evidence that access to health care reduces crime - "[They] studied what happened to crime when local substance abuse treatment facilities opened or closed. Because facilities are likely to be located in communities where the need is greatest, a simple cross-sectional analysis might show that the presence of a treatment facility is correlated with higher crime rates. Instead, the authors looked at within-county changes over time in the number of facilities and crime rates. This allowed them to see whether a change in access to treatment led to a change in crime, after controlling for a variety of other factors that might independently affect crime (like unemployment rates and the size of the police force). The authors found that an increase in the number of treatment facilities causes a reduction in both violent and financially-motivated crime. This is likely due to a combination of forces: reducing drug abuse can reduce violent behavior that is caused by particular drugs, as well as property crimes like theft committed to fund an addiction. Reducing demand for illegal drugs might also reduce violence associated with the illegal drug trade. The authors estimate that each additional treatment facility in a county reduces the social costs of crime in that county by $4.2 million per year. Annual costs of treatment in a facility are approximately $1.1 million, so the benefits far exceed the costs. A primary obstacle to increasing the number of substance abuse treatment facilities is NIMBYism: residents worry that if such a facility moves into their neighborhood, it will attract drug users and criminals and local crime will go up. While this study can’t look at the precise locations of crime within a county (a topic for future research), it strongly suggests that such fears are unfounded. The net benefit at the county level implies that there are ways to make everyone better off. If treatment facilities draw drug users and criminals away from neighboring areas, then the areas that are now safer should be happy to subsidize both the cost of the facility and an increased police presence nearby. Another barrier to treatment access is cost: many people who need treatment don’t have health insurance, and so the care they need — even when available nearby — is unaffordable... He finds that Medicaid expansions have reduced violent crime by 5.8 percent and property crime by 3 percent. As one might expect, effects were larger in places that had higher pre-expansion uninsured rates among individuals subsequently eligible for Medicaid (that is, where more people were affected by the policy change). Vogler estimates that the ACA’s Medicaid expansions resulted in cost savings of $13.6 billion due to the reduction in crime."
This won't stop many Americans mocking universal healthcare
A Toronto hospital was just ranked 4th best in the entire world - "A prominent Toronto teaching and research hospital is making headlines once again this week for being named by Newsweek as one of the best hospitals in the world — for the third straight year in a row. Toronto General Hospital (TGH), located at University and Elizabeth right along the acclaimed "hospital row," took the fourth-highest spot on Newsweek's annual ranking for 2022, besting all but the famous Mayo Clinic, the world-renowned Cleveland Clinic, and Harvard's own Massachusetts General Hospital... Part of University Health Network (UHN), TGH is a global pioneer in the fields of transplantation, cardiac medicine, thoracic surgery and — NDB — it also introduced the clinical use of insulin to the world. Doctors at TGH performed the world's first successful lung transplant in 1983 and, countless breakthroughs later, made history again in 2021 by performing the world's first drone-assisted double lung transplant. Home to the world-leading Sprott Department of Surgery, Peter Munk Cardiac Centre and Ajmera Transplant Centre, TGH is the largest organ transplant centre in North America and has the largest lung transplant program on Earth."
Weird. According to champions of the US healthcare system, socialist healthcare is always shit and cannot innovate
How to Fix the Hot Mess of U.S. Healthcare - Freakonomics - "Marty MAKARY: If there are two fundamental drivers of our broken, costly healthcare system, I would say it’s pricing failures and inappropriate care... We did a national survey asking physicians across the country, what percent of medical care, in your opinion, is unnecessary? The average answer was 21 percent. If one in five services delivered in any industry is entirely unnecessary, you’d say that’s where the waste is and that’s where we need to focus...
The U.S. does not spend much money on prevention. The Centers for Disease Control and Prevention — it’s right there in the name — the C.D.C. spends just $1.2 billion a year for “all chronic disease prevention activities.” That is less than $4 per person...
MAKARY: When American hospitals were built, they were built with a charter dedicating them to take care of the sick and injured, “regardless of one’s race or creed or ability to pay” in some instances. Many hospitals were built by churches. They operated in the red for decades, supported by philanthropy. Where is that today? Today, you see some of the most aggressive predatory billing practices in the United States. We’ve created a term called financial toxicity, which is essentially a complication of care.
“Financial toxicity” meaning that a patient’s out-of-pocket medical costs create a significant financial burden. How common is this? An estimated 20 percent of Americans are currently being pursued by a collection agency for medical debt. In a study of Virginia hospitals, Marty Makary found that in one year, those hospitals filed 20,000 lawsuits against patients for unpaid bills; the majority of the hospitals that sued were non-profits. Now, just to be clear: about 60 percent of community hospitals in the U.S. qualify as “non-profit,” but that word probably does not mean what you think it means. Until 1969, a non-profit hospital was required to provide care even to patients who couldn’t afford it. That so-called “charitable care standard” was replaced with what’s called a “community benefit standard” — which is, shall we say, a bit looser. And which allows non-profit hospitals to operate pretty much like a for-profit business while enjoying tax-exempt status. In fact, non-profit hospitals often make more money than for-profits. Where does that money go? Executive salaries, for one. A Forbes analysis of the 82 largest non-profit hospitals in the U.S. found that the vast majority of them paid their top-earning executive between $1 and $5 million a year, with 13 of the 82 non-profit hospitals paying their top executive between $5 million and $21.6 million a year. And where does all that money come from? There’s one key fact to appreciate that distinguishes hospitals from other businesses. Most businesses tell you right up front what you’ll pay for a given service. As we’ll hear later, that rarely happens in hospitals. Which can leave their patients — or customers, really — on the hook for bills way beyond their means...
Okay, let’s go back to those wage controls after the War.
VAN HORN: In a tight labor market, to attract labor, employers started adding fringe benefits to their compensation package. Health benefits became one of those fringe benefits.
By the way, this is not how most countries set up their health coverage during the 20th century. In Canada, for instance, employers do offer some healthcare coverage, but it’s supplemental to what the government is already providing. The U.S. became an outlier by tying healthcare coverage to employment. At first, companies extended these benefits only to the top-tier workers who had their wages capped; but it wasn’t long before unions demanded insurance for all employees. Before World War II, only 10 percent of U.S. employees had health benefits; by 1955, that number was nearly 70 percent. What made this palatable for employers was a revision of the federal tax code.
VAN HORN: If your employer pays you in the form of health benefits, it’s tax-exempt. They pay you in cash, you had to pay tax. So that tax-exempt treatment of employer-sponsored health benefits really perverts the definition of insurance, the marginal incentive of how to compensate, and the aggregate level of insurance that everybody has. And so it’s more than just the employer being the vehicle by which we pool risk and purchase insurance. It is this government subsidy in the form of tax-exempt treatment that is really pernicious...
In June 2019, President Trump issued an executive order on price transparency in healthcare...
PHILIPSON: Clearly, this will increase the price sensitivity of the customers, if patients have better price information. And that’s probably why both hospitals and insurers are against it. The paper I know that started this literature is my predecessor, Austan Goolsbee, who in the early 2000’s showed that life insurance prices went way down once there was posting on the Internet of their prices. And in healthcare, price transparency has led to about 27 percent reduction in lab-test spending and 13 percent reduction in imaging...
Rather than continue to focus on paying for procedures:
AZAR: We started paying for outcomes. So this is what we call the total cost of care initiative, where we will pay providers a total amount of money for a year and they can work with you to improve your health, to keep you out of the hospital, keep you out of a nursing home. And that could mean they might buy you air conditioning at home or send in meals at home or do home visits — the social determinants of health we talk about, to keep you healthy and out of those institutions. And if they reduce cost, they’ll get 100 percent of that savings and if you cost them more money, then they’ll eat 100 percent of that cost. And so these kinds of initiatives are, I think, going to be viewed a decade from now as having fundamentally changed how healthcare is delivered in the United States in a way that puts the patient at the center, not our institutions, and not our insurance companies.
MAKARY: We’re now realizing that we have been doing too much as physicians... “Hey, can we treat gut problems with healthy foods? Can we start treating joint problems with yoga or treat diabetes with cooking classes? Maybe the first-line treatment for hypertension should be meditation or changing your social environment. And maybe loneliness is one of the greatest public health epidemics that stresses the body’s physiology.”
32% of American workers have medical debt and over half have defaulted - "Almost a third of working Americans currently have some kind of medical debt and about 28% of those who have an outstanding balance owe $10,000 or more on their bills. When asked if they’ve ever defaulted on those bills, about 54% of people with medical debt said they had... And that’s among people who are employed and typically have health insurance... “Even if people have insurance, their deductibles are going up and people are spending more on health care,” he says. “Across the country, across different income levels, we see the reason people are short on money and often need to borrow money is often related to medical debt.”... Americans spend an average of about $5,000 a year on out-of-pocket health care costs, including insurance, prescriptions and medical supplies... 45% of survey respondents say they feel worried or stressed when thinking about health care costs. A third report they have avoided going to the doctor and getting medical care due to the cost... Keep in mind this is occurring at a time when the U.S. workforce is solid and the economy has been on an upward trajectory"
NSW court: Disabled teen to be forced into chemo - "A severely disabled teenager who has up to six seizures a day will be forced to undergo “invasive” cancer treatment despite her family’s desire for her to “die peacefully” at home following a landmark court ruling. The 14-year-old girl, who has drug resistant epilepsy and severe developmental delays, was diagnosed with acute lymphoblastic leukaemia on March 5 at a base hospital in rural New South Wales. The hospital, which has not been identified for privacy reasons, has since sought orders from the NSW Supreme Court to authorise treatment after the mother expressed a desire for her daughter to instead receive palliative care to avoid the “pain and suffering” of the treatment... The mother’s wishes were backed by the girl’s pediatrician, who told the court he first treated the patient at 18 weeks of age following her first seizure. The pediatrician said the girl would likely need to be “shackled down” in order to receive the treatment with the court noting the girl had already pulled out two cannulas from her arm and removed a nasal gastro tube. The day before the girl was diagnosed, she had to be “forcefully held in place for two hours” in order to receive a blood transfusion... “I agree with the mother’s opinion that [the patient] would not manage the painful procedures associated with chemotherapy.” The pediatrician also noted the girl may require “extremely intensive” procedures such as bone marrow transplantation."
I can't wait for Americans to claim that this is the fault of socialised healthcare and death panels, because they don't understand that "protecting the best interests of the patient" is different from "saving money"
So much for leaving medical decisions to the patients' doctors
the Rich on X - "10% of food stamp money goes to sugary beverages That’s $12B/yr more than the entire budget of the NSF or 50% of NASA’s budget"
Jim O’Neill on X - "Many Americans think we have free markets in health care. We don't. Hundreds of bureaucratic rules, perverse incentives, and opaque pricing make health care more expensive and less efficient than it should be. Providers of care are usually paid by volume, not outcomes. And government makes chronic disease worse by subsidizing unhealthy food and offering poor nutritional advice to families who are trying their best to stay healthy."
Meme - Alec Stapp @AlecStapp: "The doctor shortage was intentional."
"Figure 4: In 1980, medical schools implemented a freeze on new MD slots."
Talia Lavin @mobydickenergy: "there should be an enormous increase in the number of medical resident positions in america thus clearing the bottleneck for med school admissions"
Thread by @anup_malani on Thread Reader App – Thread Reader App - "Single most under-appreciated chart for understanding health insurance policy in the US. Uninsured typically pay less than $5k out of pocket for care, regardless of their bill. So, even without formal health insurance, ppl effectively have a $5000 deductible insurance policy.
The reason is
1/ the govt requires hospitals treat people before billing them (EMTALA)
2/ the threat of bankruptcy (incl exemptions) gives people bargaining power to negotiate down these bills (debts)
You don’t have to go into bankruptcy to do this. Most debts are marked down without bankruptcy. Fair debt collection laws help reduce the burden of this process. All this means EMTALA + bankruptcy is a substitute for insurance. So demand for & enrollment in insurance is low. Don’t feel to sorry for the hospitals. Hospitals exaggerate debt by inflating list prices. Plus the govt subsidizes hospitals likely to have a lot of bad debt via DSH payments. Unsurprisingly, when the govt reduced uncompensated care by hospitals by expanding Medicaid in the ACA, they also cut back DSH payments. They weren’t necessary. Once you understand this chart and its causes, you can see why the 2 largest health insurance experiments in the US found minimal health benefits from insurance. (RAND found only the very poor benefit, Oregon found only peace of mind effects.) The chart also helps explain why the ACA had insurance mandates. It wasn’t adverse selection causing people to go without care. It was about financing. The govt wanted low risk (young people) to pay more, rather than existing (high income) tax payers to fund high risk patients."
Bankruptcy as Implicit Health Insurance
Meme - Jim O’Neill @regardthefrost: "One reason health care is too expensive is an artificial cap on the number of doctors. We have fewer general practitioners than many other countries, which drives costs up. A bipartisan reform to remove bottlenecks and correct incentives would make health care more affordable."
Canada actually has about 4x the number of generalists per capita as the US
Wall Street Apes on X - "American ER Doctor is explaining how in the ER they have “regulars” “Regulars” are people who come in multiple times, up to 4x a day to get emitted into the ER to get turkey sandwiches. Just imagine how much this is costing taxpayers"
Of course, the "solution" is not just free healthcare but free food
