Same cancer, worse results and twice the cost in the US

[EMNofSeattle]

Sounds like another industry I know, education.

Yep.

There are many things governments do that increase the price of hospitals, there's CON (certificate of need) laws that limit new hospitals and thus competition and increase price, there's Medicaid and Medicare compliance that add large amounts of administrative overhead, there's the non-profit model which disallows retaining earnings directly and thus incentivizes unnecessary spending and inflated billing so that on paper hospitals don't make a "profit". There's laws making it difficult for physicians to own hospitals directly. It's often difficult for skilled foreign doctors to immigrate here and keep their level of medical licensing which excacerbates doctor shortages. There is reams of government involvement in the healthcare market. I think opposition to free market medicine often stems from a false impression what we have NOW is free market medicine, it is not.

 

[PeteEU]

The reality is that the return on R&D has been dropping (perhaps in part because the world is not very interested in paying for new things and the U.S. is losing its taste for picking up the slack).

LOL of course the return is falling, as R&D is falling. The US is not picking up the slack.. it is exploiting the sick for higher profits.

One doesn't have to like pharma's practices to at least acknowledge they do produce things of tremendous value. And it's in everyone's interests to keep that going.

Yes they do, however they are also hypocrites. They claim poverty, and yet have massive profits. They claim that they spend tons on R&D and they dont. They push bull**** theories that the US consumer is subsidising the rest of the world....

 

[MAGAnificent]

I'll be interested to hear your take on it once you're enrolled.

As I am already getting the literature, I can already give you my take. I have paid into the Medicare system since i was 16 through payroll deductions and what am I going to get out of it? The only part that comes without premiums comes with an $1,850.00 annual deductible(Part A) the other parts come with premiums deductibles and copays. One of the parts is "medicare advantage" The only reason any recipient needs that is that Parts A and B are not worth a **** and you need to supplement them with a private plan to make it work like real insurance. What's the use? I am considering just taking Part A for back up hospital insurance and continuing to use VA healthcare as my primary coverage.

 

[Helix]

As I am already getting the literature, I can already give you my take. I have paid into the Medicare system since i was 16 through payroll deductions and what am I going to get out of it? The only part that comes without premiums comes with an $1,850.00 annual deductible(Part A) the other parts come with premiums deductibles and copays. One of the parts is "medicare advantage" The only reason any recipient needs that is that Parts A and B are not worth a **** and you need to supplement them with a private plan to make it work like real insurance. What's the use? I am considering just taking Part A for back up hospital insurance and continuing to use VA healthcare as my primary coverage.

That's interesting. I don't know if my parents have a two grand deductible. I'll have to ask them. If that's the case, then it's something that needs fixing. How much are the premiums?

 

[MAGAnificent]

uh, rationed? I'm American, my wife is Canadian. She goes to the doctor for a cold. She takes the kid to the ER when she has a toothache. My 7 year old has been to the doctor at least three times as much as I have in my whole life, and she has no medical issues. She is completely healthy. And she didn't get sick for a whole year one time, and the doctor reprimanded us for not bringing her in more at her yearly checkup.

Healthcare isn't rationed in Canada. You can literally go anytime you want, for any reason you want. There are three walk in clinics you don't even need an appointment for, here in town.

And the wait times are just as short as they were in the States. By the way, I live in a remote Northern Area with a population density of 3 people per square mile.

And I didn't even bother getting a private health plan during my immigration, because I went to the er and the bill was 200 bucks. Without Insurance. For the same thing that cost me 3 grand in the States.

I beg to differ. Going to the doctor for routine illnesses in Canad may not be an issue, however if you need a specialist, waiting times are the norm. That is rationing. Meanwhile, if I were to go to the doctor in the US tomorrow and was told I needed an MRI, I could get one in the same day or the next day.

https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2017

 

[MAGAnificent]

That's interesting. I don't know if my parents have a two grand deductible. I'll have to ask them. If that's the case, then it's something that needs fixing. How much are the premiums?

The premiums depend on your annual income and which private carrier you choose for supplements. I am sure it's better then Obamacare, however for something you have paid into for your entire life, it's a load of crap.

 

[Greenbeard]

LOL of course the return is falling, as R&D is falling. The US is not picking up the slack.. it is exploiting the sick for higher profits.

One could just as easily argue the rest of the world is exploiting America's sick. The majority of the burden of financing medical innovation falls to this market. One doesn't need to think the biomedical companies of the world are model corporate citizens to at least acknowledge that.

That's interesting. I don't know if my parents have a two grand deductible. I'll have to ask them. If that's the case, then it's something that needs fixing. How much are the premiums?

Medicare 2018 costs at a glance

 

[Helix]

The premiums depend on your annual income and which private carrier you choose for supplements. I am sure it's better then Obamacare, however for something you have paid into for your entire life, it's a load of crap.

Yep. Should be all expenses paid at that point, IMO. hopefully, we'll get there eventually.

 

[ludin]

We are managing to afford it. But it takes a huge chunk out of our retirement budget and for what we get for the money is pretty frustrating.

Yea he had a couple of pensions coming in as well as some of his investments.
he deferred some of his retirement off so his wife could continue to get his full SS benefits.

He passed recently and she has cut back some of the things but their house was paid for along with a lot of other items.
they had virtually no debt.

 

[MAGAnificent]

Yep. Should be all expenses paid at that point, IMO. hopefully, we'll get there eventually.

For seniors yes. For everybody...no.

Sent from my SM-G900V using Tapatalk

 

[bluesmoke]

Medicare still pays well above what OECD countries do for care--and that's because costs here are higher.

I agree. Still, Medicare managed healthcare is much less expensive than privately managed healthcare. I would go for it any day rather than hold out for "OECD style universal healthcare or nothing." That's what got us screwed when Ted Kennedy refused to compromise on his healthcare plan. Hillary, too.

 

[Greenbeard]

I agree. Still, Medicare managed healthcare is much less expensive than privately managed healthcare. I would go for it any day rather than hold out for "OECD style universal healthcare or nothing." That's what got us screwed when Ted Kennedy refused to compromise on his healthcare plan. Hillary, too.

Fair enough, but it's worth noting that Medicare alone won't support our current level of provider capacity.

 

[Napoleon]

I agree. Still, Medicare managed healthcare is much less expensive than privately managed healthcare. I would go for it any day rather than hold out for "OECD style universal healthcare or nothing." That's what got us screwed when Ted Kennedy refused to compromise on his healthcare plan. Hillary, too.

But less expensive for whom exactly? Medicare spent $588 billion in 2016 to cover 15% of the population. We would be talking massive tax increases - probably in the form of payroll taxes - to cover 100%. There need to be strict price controls and punishments to match in place before even contemplating universal healthcare.

 

[bluesmoke]

Fair enough, but it's worth noting that Medicare alone won't support our current level of provider capacity.

Yup. However, the negative margins are mostly due to commercial payment rate growth where they have the high admin costs I spoke of the Medicare does not. Switching to an entirely Medicare system would eliminate most, if not all, of the negative margin. Efficient hospitals (hospitals that keep cost low and quality high) are just starting to experience negative Medicare margins for the first time. So, there would still have to be slight increases in Medicare rates.

MedPAC: Hospitals' Medicare margins continue to drop - Modern Healthcare

 

[bluesmoke]

But less expensive for whom exactly? Medicare spent $588 billion in 2016 to cover 15% of the population. We would be talking massive tax increases - probably in the form of payroll taxes - to cover 100%. There need to be strict price controls and punishments to match in place before even contemplating universal healthcare.

The total cost would still be much less. The difference is cost would be more evenly shared by everyone, meaning some people would be paying that didn't pay at all before. Just like with SS and WC, employers would have to share some of the cost also.

 

[TU Curmudgeon]

Yep.

There are many things governments do that increase the price of hospitals, there's CON (certificate of need) laws that limit new hospitals and thus competition and increase price, there's Medicaid and Medicare compliance that add large amounts of administrative overhead, there's the non-profit model which disallows retaining earnings directly and thus incentivizes unnecessary spending and inflated billing so that on paper hospitals don't make a "profit". There's laws making it difficult for physicians to own hospitals directly. It's often difficult for skilled foreign doctors to immigrate here and keep their level of medical licensing which excacerbates doctor shortages. There is reams of government involvement in the healthcare market. I think opposition to free market medicine often stems from a false impression what we have NOW is free market medicine, it is not.

When Canada introduced its own universal medical insurance program the Canadian doctors lobbied vigorously against it because they would only be reimbursed at 80% of the negotiated fee schedules. What the Canadian doctors overlooked is that they were (on average) only being paid half the amount that they were billing.

Once the Canadian doctors realized that 80% of 100 is more than 100% of 50, they shut up.

I favour the European "mixed model" where there is a government run universal medical insurance program but there is a mixture of private and government health care providers. The private health care providers have an incentive to be economical and that tends to restrain the government health care providers.

One way of doing the actual PROVISION of health care would be for the government to determine what health care facilities are needed in a defined geographic zone and provide the physical plant while private corporations bid for the right to operate those facilities. Structured properly, the facilities in a given "contract group" would be a mixture of "high positive margin", "low positive margin", and "negative margin" facilities so that the private corporation's profit on the "positive margin" facilities would exceed their losses on the "negative margin" facilities. The contract would, of course, set out standards of care which would be applicable REGARDLESS of margin.

 

[TU Curmudgeon]

LOL of course the return is falling, as R&D is falling. The US is not picking up the slack.. it is exploiting the sick for higher profits.

Another reason why the ROI for R&D is falling is that the rate that anything that is actually new is being discovered is falling. This has been going on in all sectors of the US economy since the 1970s.

Yes they do, however they are also hypocrites. They claim poverty, and yet have massive profits. They claim that they spend tons on R&D and they dont.

Yes they do. Most of that expense is going to finding ways around the patents of other drug companies.

They push bull**** theories that the US consumer is subsidising the rest of the world....

Well, the US consumer is certainly subsidizing the American pharmaceutical companies.