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[alway]

I never quite understood America's healthcare price problem. On one side, of  course most peocedures would be a bit more expensive purely due to the higher price of labor, but then again it doesn't matter what angle I look; total cost; cost to production; cost to household income...

I now get that insurance gets a sweet cut on that, but it is still far too much over the common cost in developed and undeveloped nations.

From what I've heard a massive chunk of it is the added administrative duties. In the US, most doctor appointments consist largely of the doctor sitting in front of a computer, asking questions from the insurance forms and entering the answers. Eventually they'll get around to asking you about why you came in. Behind the scenes is more of the same: form after form filed to ensure payment from the insurance companies. These are then submitted to insurance companies, who consist primarily of staff working to check over and deny payment based on said forms. Wages for actual healthcare providers like doctors are actually lower as a percentage than pretty much anywhere else because of this overhead. Every time you go for a routine doctor appointment, behind the scenes you're paying for 10 consecutive games of Papers Please to be played by invisible beancounters, as well as the managers and CEOs above them.
On top of that, private hospitals also have management and CEOs to pay; usually significantly higher than the doctors.

[redwallzyl]

I never quite understood America's healthcare price problem. On one side, of  course most peocedures would be a bit more expensive purely due to the higher price of labor, but then again it doesn't matter what angle I look; total cost; cost to production; cost to household income...

I now get that insurance gets a sweet cut on that, but it is still far too much over the common cost in developed and undeveloped nations.

From what I've heard a massive chunk of it is the added administrative duties. In the US, most doctor appointments consist largely of the doctor sitting in front of a computer, asking questions from the insurance forms and entering the answers. Eventually they'll get around to asking you about why you came in. Behind the scenes is more of the same: form after form filed to ensure payment from the insurance companies. These are then submitted to insurance companies, who consist primarily of staff working to check over and deny payment based on said forms. Wages for actual healthcare providers like doctors are actually lower as a percentage than pretty much anywhere else because of this overhead. Every time you go for a routine doctor appointment, behind the scenes you're paying for 10 consecutive games of Papers Please to be played by invisible beancounters, as well as the managers and CEOs above them.
On top of that, private hospitals also have management and CEOs to pay; usually significantly higher than the doctors.

Capitalist efficiency™

[Frumple]

Eeehhhh... technically it's market inefficiency causing the resource inefficiency, not capitalist efficiency. Decent capitalist efficiency wonders why the hell you're trying to push an industry that necessarily distorts capitalist economic mechanisms towards a market-style management that's going to going to give you increasingly poor results... *grumbles vaguely*

... though I guess in this case one of the idiots involved in that trademarked the term, and no one's gotten around to beating them with a lawyer until that's fixed. So Capitalist efficiency™, indeed. Now someone go shank sue whoever did that and get the term back into unfettered public domain.

[smjjames]

I remember this year some door-to-door guy druming up support for one of the governors that was running this year.  His plan was to pay for healthcare by cutting mental health.  It honestly seemed backward and genuinely insulted me somehow.

Let me guess, a Republican governor?

[EnigmaticHat]

Mental health /= healthcare... that's new.  They both even have the same word right there in the name.

[McTraveller]

Regarding healthcare inefficiency... that's kind of what I was hinting at by the "we don't have enough health care providers" comment.  Since prices are so high in the US, you'd think that more people would try to become providers and with more efficiency to reap more of that massive revenue stream.

A combination of many factors, however, means this isn't possible. The mandatory and de-facto paperwork requirements and the excessive education / certification requirements alone contribute to a massive barrier to entry that reduces the overall count of new providers and limits the productivity improvements available to all providers (new or old).

Note that isn't limited to direct care providers either - it also covers pharma and medical device manufacturers as well.  Pharma companies, for instance, couldn't increase prices on existing products tens-fold if there was a market with low entry barriers.

[wierd]

(Psst.. the AMA actively resists allowing there to be more doctors, specifically to keep doctor wages high.)

http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high/

Many people try every year to become doctors. More than half are prevented from even attending school for it, despite applying. Similar story for Nurse Practitioners.

It is as if at some point, it stopped being about caring for people, and became all about the money. (rolls eyes)  Naturally, there will be wails about how this exclusivity is GREAT for medicine, because it allows only the most gifted, and the most tenacious to become physicians, but let's not kid ourselves. The major reason why the number of doctors is kept artificially low is to increase medical costs, including doctor salaries, even though this causes a much greater burden on the physicians that do make it and practice, causing burnout and fatigue, and with those, increases in medical accidents (which drive up healthcare costs through other avenues.) Nevermind that in other industrialized nations that dont play this bullshit cartel game, the healthcare is overall much cheaper, and much better.

[smjjames]

(Psst.. the AMA actively resists allowing there to be more doctors, specifically to keep doctor wages high.)

http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high/

Seriously? Pfft....

Sometimes it feels like we need a foriegner to teach us how to do healthcare properly.

[wierd]

You might wonder then, since the road to becoming a doctor in the US is artificially controlled, why there is not a glut of doctors from other industrial nations seeking to practice in the US...

well... Again, artificial controls.  Specifically, they still have to do a residency in the US to get their own practice, and guess what--- the same people are in charge of residency placement!

http://www.wbur.org/commonhealth/2016/09/30/foreign-trained-doctors-challenges

At some point, you have to acknowledge that conspiracy is going on.  Yet, our government seems awfully tight lipped about this situation. Most people dont even know it is a thing at all!!

[Magistrum]

Wow, and I thought Brazil's medic distribution was a problem. At least we got something going for us.

[Frumple]

Mental health /= healthcare... that's new.  They both even have the same word right there in the name.

Eh... nooooot really new. At all. Lots of people for quite a long time have been uncomfortable with addressing mental health issues, even if they're otherwise on board with better healthcare. We're only barely getting to the point of starting to treat such concerns as something other than a taboo to never be spoken of and buried as far under the table as possible.

[wierd]

Sadly true.  The US's culture is pretty victorian-esque in that respect.

I cannot prove it, but I strongly suspect it is due to strong corporate forces at work, not wanting to acknowledge that stress promotes depression, and that depression is a mental illness that needs treatment. (because then they would have to address work related stress in real ways, and not try to get 120hr workweeks out of everyone.)

[Frumple]

Work related stuff pretty certainly is involved, sure. There's a mess of stuff beyond it, though. Not really any singular cause, just some larger ones (work ethic, religion related stuff, behavioral norms not strongly related to work, to name some) and who knows how many smaller ones.

The sentiment's definitely eroding and pretty quickly, at least. Fortunately.

[SalmonGod]

Naturally, there will be wails about how this exclusivity is GREAT for medicine, because it allows only the most gifted, and the most tenacious to become physicians, but let's not kid ourselves.

Nah... the wails will come from people calling for you to reinforce your tinfoil hat.  "Big Pharma" conspiracy is maybe only slightly more accepted than most other types of conspiracy theory.  Which means that it doesn't matter how much evidence is out there.  People will shrug it off until there's some massive Snowden-style leak that brings it into focus.  Then they'll act like that was the first time anyone had any knowledge of it.

[redwallzyl]

Eeehhhh... technically it's market inefficiency causing the resource inefficiency, not capitalist efficiency. Decent capitalist efficiency wonders why the hell you're trying to push an industry that necessarily distorts capitalist economic mechanisms towards a market-style management that's going to going to give you increasingly poor results... *grumbles vaguely*

... though I guess in this case one of the idiots involved in that trademarked the term, and no one's gotten around to beating them with a lawyer until that's fixed. So Capitalist efficiency™, indeed. Now someone go shank sue whoever did that and get the term back into unfettered public domain.

I"m poking fun at the tendency for people to use the vague magic of capatlism to excuse being a corporate sellout. The irony of the praported champions of capatlism underming it by turning it into  essentially a trademark to sell their policies.