The US Healtcare system - AKA Hospitals are broke, no one does preventative care, and Insurance is asking for both kidneys and your firstborn

What do you think is the solution to the US' medical malady?

  • Stop eating avocado toast and get a job you lazy Milennial (Employer Mandate)

    Votes: 15 27.3%
  • I trust any government agency to be efficient and sensible when treating my ailments (Single Payer)

    Votes: 13 23.6%
  • 'Read my lips' (Income related tax credit)

    Votes: 4 7.3%
  • lol just don't get sick or hurt and you'll be fine (Status Quo)

    Votes: 11 20.0%
  • Spineless Centrist (Other)

    Votes: 12 21.8%

  • Total voters
    55

Fields Of Rye

Your friendly neighborhood schizo
kiwifarms.net
Federal student loan programs should be ended so medical schools implode and restructure their curriculum to not cost an arm and a leg and teach so much useless bullshit.
Can you be more specific? Medical schools teach all this shit because you don't really specialize until you get your residency. They might be expensive as fuck, but the actual money for the surgery is hardly going to the doctors.

There are fucking chairs in my hospital that cost more than what I make in a year. MDs are a small part of the standby crew.

Honestly, look, it's the fucking insurance companies and the middle men. I'm not going to go to far into it, but 30 years ago doctors ran their own practices. They purchased their equipment from a few general suppliers or got it custom made. They footed the bill on everything, and they made a total profit, and the sought to reduce costs whenever reasonable.

Now, a doctor doesn't buy the scalpel, needle, thread, disinfectant, drugs, and look to profit from the surgery.

Instead, the scalpel company profits from the scalpel. The needle company from the needle. The thread from the thread. Disinfectant from disinfectant. drugs from drugs, and in a $300,000 surgery the doctor pockets a few thousand. Every fucking step in the process has been bloated to high hell, as at every possible point some motherfucker shoves his tiny dick into the system and demands a prophet.

How do you think we get $700 advil? The chemical company produces it and sells it for like a cent per pill and they make a profit. 30 years ago the doc would buy it and give it to you for 10c. But now it goes to a supplier for 10c. Which goes to a distributor for $1. They give it to the hospital for $15, and then to you as a specialty drug for 700 because some bullshit decision marks it as a "specialty drug"

Then it goes to you insurance who says "lel no" and pays 10c. Or it goes to you, and you drop the 700 because you don't have a ton of fuckoff lawyers.
 

idosometimes

kiwifarms.net
Can you be more specific? Medical schools teach all this [poop] because you don't really specialize until you get your residency. They might be expensive as [weasels], but the actual money for the surgery is hardly going to the doctors.

There are fucking chairs in my hospital that cost more than what I make in a year. MDs are a small part of the standby crew.

Honestly, look, it's the [dunk]ing insurance companies and the middle men. I'm not going to go to far into it, but 30 years ago doctors ran their own practices. They purchased their equipment from a few general suppliers or got it custom made. They footed the bill on everything, and they made a total profit, and the sought to reduce costs whenever reasonable.

Now, a doctor doesn't buy the scalpel, needle, thread, disinfectant, drugs, and look to profit from the surgery.

Instead, the scalpel company profits from the scalpel. The needle company from the needle. The thread from the thread. Disinfectant from disinfectant. drugs from drugs, and in a $300,000 surgery the doctor pockets a few thousand. Every fucking step in the process has been bloated to high [heck], as at every possible point some mother[wash]er shoves his tiny [willy] into the system and demands a prophet.

How do you think we get $700 advil? The chemical company produces it and sells it for like a cent per pill and they make a profit. 30 years ago the doc would buy it and give it to you for 10c. But now it goes to a supplier for 10c. Which goes to a distributor for $1. They give it to the hospital for $15, and then to you as a specialty drug for 700 because some bull[fudge] decision marks it as a "specialty drug"

Then it goes to you insurance who says "lel no" and pays 10c. Or it goes to you, and you drop the 700 because you don't have a ton of [stink]off lawyers.
This is not true. Providers make much larger profits that insurance. Insurance is a minimal cost. Drugs, doctors, and medical supplies/appliances are where the money actually goes.

The doctors are also paid by fee for service model, which means that the patient gets a separate bill for the 3 minute visit from some specialist prior to surgery. Everyone gets a cut because doctors and medical providers do not are about prices. Doctors also fail at evidence based medicine. Doctors favor certain treatments because that is what their professors or hospital does, not because it is necessarily better than alternatives.

The real costs come from inefficiency, unnecessary care, and drugs/supplies being so expensive. People in US are also really afraid of death, so EOL care costs a bundle of a boatload.
 

eternal dog mongler

kiwifarms.net
This is not true. Providers make much larger profits that insurance. Insurance is a minimal cost. Drugs, doctors, and medical supplies/appliances are where the money actually goes.
You're half-right. Insurance has slim margins. But so do providers (unless you consolidate the fuck out of every hospital in a region and can dictate pricing to insurance companies).

The ones with the big margins are pharmaceutical and DME manufacturers. That's our biggest cost sink.

I support single payer but I'm not really going to lie that it will be expensive as fuck and CMS already can't deal with fraud or timely reimbursements as it is so it's going to be a bumpy fucking ride.
 
The biggest problem with the US healthcare system currently is the ACA.

However, as someone alluded to above, I have often wondered why, if drugs just are wildly overpriced in the US (You hear of shit that costs 30 a pill in the US costing .50 cents in canada, for example) couldn't someone with some venture capital just start a generic drug company and easily take over the entire market? Or is there some reason for those extreme high prices in the US that a new company would also be unable to avoid?

The free market is supposed to easily handle outrageous markups with the application of simple greed. Someone else sees the outrageous markups, says "Hey I'd like to make money hand over fist" and charges 2% less than the competition. I would love to know what is preventing the free market from handling this in the US.
 

mindlessobserver

kiwifarms.net
The problem is that a healthcare industry and a system that provides healthcare are mutually exclusive, which is something many free marketeers overlook. An industry needs to turn a profit, and a healthcare system needs to take care of people who can't (by definition) take care of themselves anymore due to illness or injury. Patients are economic net losses on the economy.

Also, in order for a market to be "Free", there needs to be certain factors involved.

  1. Both the seller and the buyer understand the good or service being made, sold, or exchanged.
  2. There is open competition between sellers for the attention of the buyer
  3. The buyer has free choice to obtain (or not obtain) the good or service
  4. All participants in the market function under the same set of rules, and all contracts between the participants are honored.
The Healthcare Industry is fucked because it doesn't follow any of those principles.

Point 1: The buyer often has no idea what they are buying. The doctor has market knowlege that would make a used care salesman blush. "I need to draw blood to do some tests". Test what? How? Do I need to? The buyer has no idea. Worse, the buyer often does not even know how much the test costs! And if they are insured, they may never know as healthcare providors deliberately hide the true cost of everything they do. Oftentimes even the doctor doesn't know either. If people don't even know the price of a service or good, how can they provide market pressure to get prices lowered by favoring more efficient doctors?

Point 2: This means that there is NO competition between providers, beyond outcomes. "The doc made me better, 5 star review on google!" All well and good, but if a doctors only market differentiation to his competitors is outcome, he's going to go the extra (unneccesary) mile to insure he gets those outcomes. He may even pander to an idiot patient who wants an expensive brand name drug rather then equally effective off brand generic. Anything to avoid a dreaded 1 star review. Reputation competition ONLY, which is far more ephemeral then pricing competition. Again to compare to a used care salesman, at the end of the day he has to offer better prices then the other used car salesman across the street if he is going to make the sale. Healthcare providers don't because they don't need too.

Point 3: They don't need to because the market is captive. Nobody goes to a doctor or hospital because they choose too. They go because something has gone terribly wrong or could go wrong, and the thing being sold is quite literally their own lives. People can choose to not buy the car from the used car salesman. There are alternatives. You can uber, take the bus, walk, bike, bum rides off friends, etc. But when it comes to your health there is not alternative. You have to pay. You have no choice, and this can lead to bad market distortions. When you want to buy a car, you want the best you can afford, which means the best car at your ideal lowest price point. Do you want to pay for the cheapest doctor or procedures if its your life on the line? Fuck no. You want the deluxe package. Nothing else will do when its quite literally your own neck at stake. And since it is a matter of life and death both the providors, and the politicians take advantage of it.

Point 4: Which means there are different rules for different people, and since we are a democracy the idea that the government won't be involved is just not going to fly. People always vote for the bread and butter, and nothing is more basic then their own health. This will inevitably lead to rules and regulations imposed by government in much the same way electric and water utilities are regulated. The biggest rule being a hospital cannot refuse to provide necessary life saving treatments to those who need it. Like the hobo on the street suffering an OD on Heroin. This is huge loss for the providers, and as such they need to make it up somewhere, so they build the cost of people who can't pay into the price for those who do pay.

tl;dr, healthcare is not a free market and it never will be.
 

eternal dog mongler

kiwifarms.net
However, as someone alluded to above, I have often wondered why, if drugs just are wildly overpriced in the US (You hear of shit that costs 30 a pill in the US costing .50 cents in canada, for example) couldn't someone with some venture capital just start a generic drug company and easily take over the entire market? Or is there some reason for those extreme high prices in the US that a new company would also be unable to avoid?
You need to get your generic approved by the FDA which requires an ANDA form and in vivo studies. You can't just start cranking them out.

Which is good because generics need to be bioequivalent based on plasma concentration curves. This is to avoid you taking generic hydrocodone XR and then it fucking all releases at once or something and then you stop breathing.

The in vivo studies are, however, quite expensive for generic manufacturers. It makes it difficult for a new company to enter the market. And also there's an issue of collusion between them right now that's spiking generic drug prices but that's a different matter.

e:

Point 3: They don't need to because the market is captive. Nobody goes to a doctor or hospital because they choose too. They go because something has gone terribly wrong or could go wrong, and the thing being sold is quite literally their own lives. People can choose to not buy the car from the used car salesman. There are alternatives. You can uber, take the bus, walk, bike, bum rides off friends, etc. But when it comes to your health there is not alternative. You have to pay. You have no choice, and this can lead to bad market distortions. When you want to buy a car, you want the best you can afford, which means the best car at your ideal lowest price point. Do you want to pay for the cheapest doctor or procedures if its your life on the line? Fuck no. You want the deluxe package. Nothing else will do when its quite literally your own neck at stake. And since it is a matter of life and death both the providors, and the politicians take advantage of it.
Yes, and the idea from some people that healthcare would be improved by free market solutions is bunk. No patient is looking up appendectomy costs at nearby hospitals while they're experiencing severe LLQ pain, nor should they be expected to. There's also no need for patients to question the training of their doctors or wonder if the medicine they're taking is actually what's listed on the label because of, wow, guess what, regulations.

The libertarian fantasy breaks down when you realize that patients are NOT rational consumers and there really does need to be regulation in this industry or else you get thalidomide babies.
 
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Chexxchunk

Take it off the rack, if it's wack put it back
kiwifarms.net
Americans are fat because of the corn and sugar they eat.
Yes, and designer foods that make you want to eat more food. The secret to losing weight is to not eat or drink things that stimulate appetite. Then it's pretty easy.

I think sweet beverages (artificial sweeteners and corn syrup) are the worst offenders. Coke will just turn you into a fat fuck outright, Diet Coke spikes your insulin and gives you the megamunchies because body is like "I taste sugar where is sugar??" and then there's a vicious feed cycle.

I switched from Diet Coke to Club Soda with Vinegar and Lemon Juice, and now I feel like I can comfortably fast all day because I just don't feel like eating. It's pretty miraculous feeling after all the other bullshit. Takes almost no discipline. I'm resigned to not getting away from caffeine, so I also take theanine with my coffee because it's a caffeine antidote and makes everything very smooth.

You need to get your generic approved by the FDA which requires an ANDA form and in vivo studies. You can't just start cranking them out.

Which is good because generics need to be bioequivalent based on plasma concentration curves. This is to avoid you taking generic hydrocodone XR and then it fucking all releases at once or something and then you stop breathing.

The in vivo studies are, however, quite expensive for generic manufacturers. It makes it difficult for a new company to enter the market. And also there's an issue of collusion between them right now that's spiking generic drug prices but that's a different matter.
How many drugs are actually really truly beneficial, though? And haven't we discovered most of them and made them generic by this point?
 

eternal dog mongler

kiwifarms.net
How many drugs are actually really truly beneficial, though? And haven't we discovered most of them and made them generic by this point?
There are a bunch of pointless, expensive drugs on the market right now (Linzess, for example. It makes you poop slightly more and it's like $400/mo, great) but no, there are still useful drugs being developed. MiRNA inhibitors and stuff like that.
 
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mindlessobserver

kiwifarms.net
You need to get your generic approved by the FDA which requires an ANDA form and in vivo studies. You can't just start cranking them out.

Which is good because generics need to be bioequivalent based on plasma concentration curves. This is to avoid you taking generic hydrocodone XR and then it fucking all releases at once or something and then you stop breathing.

The in vivo studies are, however, quite expensive for generic manufacturers. It makes it difficult for a new company to enter the market. And also there's an issue of collusion between them right now that's spiking generic drug prices but that's a different matter.

e:



Yes, and the idea from some people that healthcare would be improved by free market solutions is bunk. No patient is looking up appendectomy costs at nearby hospitals while they're experiencing severe LLQ pain, nor should they be expected to. There's also no need for patients to question the training of their doctors or wonder if the medicine they're taking is actually what's listed on the label because of, wow, guess what, regulations.

The libertarian fantasy breaks down when you realize that patients are NOT rational consumers and there really does need to be regulation in this industry or else you get thalidomide babies.
Actually the reason there are drug regulations is even more sad then the thalidomide babies. That example gets held up as regulations working because the FDA held up approval for better testing. But the reason there are drug regulations in the first place was because of the Elixir Sulfanimide incident.


The stuff used what was essentially anti freeze as the medications solvent. The pharmescists at the time were unaware it was poisonous and never did animal testing because the law did not require it. The stuff killed 100 people, including a 6 year old whose letter penned by her mother got national traction. It was not a pleasant death either. Cascading kidney failure. This is pre dialysis and pre painkillers. You died slow and you died painfully. Imagine that happening to a 6 year old girl. Was a huge scandal. One of the doctors suicided.
 
You need to get your generic approved by the FDA which requires an ANDA form and in vivo studies. You can't just start cranking them out.

Which is good because generics need to be bioequivalent based on plasma concentration curves. This is to avoid you taking generic hydrocodone XR and then it fucking all releases at once or something and then you stop breathing.

The in vivo studies are, however, quite expensive for generic manufacturers. It makes it difficult for a new company to enter the market. And also there's an issue of collusion between them right now that's spiking generic drug prices but that's a different matter.
Well sure, but other countries also have their own certification agencies, and somehow manage to offer medication at like 1% of the price it is in the US.

So I guess part of the issue is that each generic is it's own thing, separately patented, everyone doesn't just make the same generic following the same approved formula, so developing a generic version of a drug is almost as expensive as just inventing a new drug. Do I have that right?
 
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Mewtwo_Rain

Drown in the cesspool of darkness
kiwifarms.net
The biggest problem with the US healthcare system currently is the ACA.

However, as someone alluded to above, I have often wondered why, if drugs just are wildly overpriced in the US (You hear of shit that costs 30 a pill in the US costing .50 cents in canada, for example) couldn't someone with some venture capital just start a generic drug company and easily take over the entire market? Or is there some reason for those extreme high prices in the US that a new company would also be unable to avoid?

The free market is supposed to easily handle outrageous markups with the application of simple greed. Someone else sees the outrageous markups, says "Hey I'd like to make money hand over fist" and charges 2% less than the competition. I would love to know what is preventing the free market from handling this in the US.
Well the problem really is on the consumers. In capitalism (or "Free Markets") consumers are supposed to avoid making purchases if they are over priced or make smart decisions to avoid leading Capitalism into being corporatism (or just make smart decisions in general). The problem not only shows that consumers are not being intelligent about purchases (See every year where people buy new Apple phones for instance whether they actually need them or not) and an over regulated system, and we have developed that main specific issue.

Sure, it can be argued that other countries have dumb consumers as well, but those countries trade off the costs of medication for higher taxes, or higher priced goods which are offset when they import from other areas/countries.

The problem with medication costs is not everyone can just quit taking their medication especially if their life depends on it which has created a vicious cycle of the costs, and too many consumers won't stop taking their non-life threatening medication. If enough people did that would drive down profit and companies would be likely to drop costs on drugs/medication to get consumers back. Most people in America aren't taught this these days about responsibility on their part in free markets, thus we will to continue to suffer such dramatic costs in medications until either people learn this very concept or until (or if) people reject corporatism/over regulation. Both seem very unlikely to happen though.
 

mr.moon1488

kiwifarms.net
I wouldn't mind Japan's system, but it would never work the US. If I recall correctly it's actually a crime there to abuse medical services, regardless of your income, you have to pay at least SOMETHING into either a private, government, or employment service, and their medically related torte laws aren't as idiotic as ours. This would never work in the US because there's nothing Tyrone loves more than free shit, going to the emergency room for a hangnail, and then suing the doctor because he decided to sell his prescription meds rather than actually using them.
 
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