America’s Health-Care Crisis Is a Gold Mine for Crowdfunding

One source: https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_s...

This is a shockingly ignorant statement, the kind of cheap criticism that comes from someone very far away.

Did you know that CMS (Centers for Medicare and Medicaid Services) is the largest American healthcare payer?

In 2015, private insurance total healthcare expenditure was $1,072.1 billion ($1.072T).

But Medicare and Medicaid spent $1,191.3 billion ($1.191T).

The federal government's ability to act a single healthcare purchaser larger than the entire private market has a dramatically large effect on the cost of medical care -- it suppresses as the rock-bottom CMS rates are significantly below private reimbursement.

Of course, this only examines the impact of the federal government directly on the market as its largest participant -- it does not BEGIN to examine the massive statutory/regulatory influence the government has on the price of health care.

>If anything, they suppress flow of cheap money to medical providers which only inflates its costs even more.

It's the exact opposite.

CMS/federal healthcare spending is the ultra-low cost one, flowing an enormous sum of cheap-per-person money to any service provider that will take them.

It's the massively-inflated private reimbursements which service providers love.

>The largest shares of total health spending were sponsored by the federal government (28.7 percent) and the households (27.7 percent). The private business share of health spending accounted for 19.9 percent of total health care spending, state and local governments accounted for 17.1 percent, and other private revenues accounted for 6.7 percent.

https://www.cms.gov/research-statistics-data-and-systems/sta...

The more you know.

Off the top of my head:

* 68% of all medical costs in the US are borne by governments (MediCare, Medicaid, VA, public-sector employee programs). They aren't allowed to negotiate drug prices in effective ways, driving up their costs

* Most health insurance in the US is employer-sponsored specifically because of Congress-created tax law. Without it, the individual market would probably be much healthier and more competitive.

* Congress is responsible for legislation that forces all emergency rooms in the US to provide life-saving care to any person, regardless of their ability to pay. @see EMTALA [1]

* "COBRA" [2] (pricy emergency health insurance coverage option after you leave an employer) was created by Congress.

* Governments set laws which define how and when litigation can be applied to medical workers + hospitals. Legislators could decide to enact tort reform, should they choose to.

* Governments control the medical licensing requirements and how graduates of medical institutions from other countries can work in US health care (they currently can't, for the most part).

* FDA and other government regulators control how fast new drugs come to market (and can effectively price some potential drug makers out of the market).

* Congress controls patent regulation

[1] https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...

[2] https://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Re...

Working as intended.

* Based on a little research I did; I'll find out for sure next April :P

P.S. Another nice thing about going solo is your 401k. You can set up a Solo 401k, which has a MUCH higher contribution limit. 401k through employer is limited to ~14k, while a solo 401k is up to something like 50k. Plus, you get to pick your 401k provider, and as far as I could tell Solo 401k through Vanguard was _significantly_ better than the criminal fees I was subjected to under my previous company's 401k.

This is all assuming your side business is successful enough to fill that extra 50k bucket :P

The free market rules that work for consumer goods start to really break down for inelastic goods.

You're also paying for dramatically increased litigation risk faced by care providers, which is being passed onto you.

You're also paying for intermediaries at each step in the care chain who believe they are entitled to healthy margins.

If we want to make healthcare cheaper, we need to start by deciding who we want to take away from, whether it be EOL life extension (which tends to be way overdone), pharma profits, or taxpayer funds from whatever bracket you feel is right to take from.

Interestingly, people complain when CDC tries to implement public health programs that help to reduce unhealthy lifestyle choices (some call it nanny-state). But you can't complain about high healthcare costs and then not support the public health efforts meant to prevent it.

Specifically, to lower health care costs from tobacco use, tax tobacco (which has over half the effect to get people to quit), ban smoking in public places, spend $1 or $2 per capita for hard-hitting, scary anti-smoking ads. Yet, the Federal Govt. has a roughly $1 tobacco tax. Many states have very low tobacco taxes.

> Why is medicine so expensive?

Medicine for most people with chronic hypertension and most people with high cholesterol is generic in the $100 per year cost range.

  - There is an artificial limit on the number of medical student openings at US accredited medical schools ("rent-seeking")
  - US medical licensing organizations don't recognize almost any overseas schools
  - The cost of US education has skyrocketed in the past few decades, along with health care costs (probably somewhat correlated due to the university degree needed to practice medicine)
  - The Constitution gives Congress the authority to create Intellectual Property laws and regulate patents, which then become the focus of lobbying (@see Disney lobbying to extend copyright TTLs)
  - The US is wealthy and US consumers end up subsidizing medical R&D costs because most other wealthy countries have centralized pharma purchasing contracts
  - 68% of all health care spending in the US is done by governments (think MediCare, MedicAid, VA, government employee contracts), but those governments are largely prevented from using their size to negotiate better drug prices
  - Something like 50% of medical costs are currently spent in the last year of life. @see "How Doctors Die", a famous article where a Doctor describes how doctors and civilians handle their wishes / medical proxy decisions very differently
  - We, as a society, don't want to to die. We have unrealistic expectations of what doctors can do and our quality of life.
  - Medical consumers (err, humans) very much undervalue preventative care investing in {healthy food, exercise, mental stimulation, mental health}. We Americans are generally too arrogant when it comes to our bodies and stigmatize people with physical/mental abnormalities, thus we reject reality when we are confronted with the possibility of becoming "abnormal".
  - We very much overvalue doctors, hospital rooms, and drugs / pills that do the equivalent of "magic"
  - There is no shortage of medical need. Medicare only pays ~60% of the market price for many procedures, so many doctors simply won't see MediCare patients as they can make more by charging the wealthy
  - Recent consolidation in hospitals and health insurance leads to even less competition
  - Hospital pricing is opaque. The cost to get most procedures can't be compared apples-to-apples with other hospitals.
  - Health care in the US is charged by the cost to attempt a procedure, not to fix an ailment
  - The principal–agent problem occurs when {health insurers, hospital admins, doctors, and patients} are at odds when it comes to unnecessary procedures. I just heard a podcast where a man tried to interview doctors to see if he wanted to change and a doctor tried to give him a CAT scan to be able to charge for his interview time
  - Employer-sponsored health insurance is tax-deductable for the company in the US, so there is a huge bias away from individual plans which reduce wasteful premium spending
  - FDA doesn't rubberstamp approvals and actually requires new drugs to perform better than the placebo effect
  - The public stock market is currently biased towards short-term profits
  - The cost of sterilized equipment made to exacting standards is far higher than in countries where exacting standards aren't required
  - Entrenched interests always throw a wrench in any proposed legislation that might aim to change the status quo
  - Opportunity costs: many entrepreneurs are turned off by the heavily-regulated nature of health systems (EHR, apps, software updates, etc) and many other industries (apps, games, social media, finance) can be much more profitable
  - Regulation drives up price and it tends to "mission-creep" over time in the US.
  - Lots of people complain that medical litigation is out of hand and tort-reform could lower costs, but the impact of tort reform varied by whom you talk to

But routine visits often severely reduce the rate of catastrophic events. Catching cancers early, assessing risk factors, etc.

But I'm confused why you think gratefulness and knowing how "gave them life" is key. If my work-provided insurance plan pays for medicine I need to survive, who should I be supplicating myself to to satisfy your moral demands for appropriate gratefulness? Do I have less value as a human being in your eyes because I accepted payment from a faceless remote corporation instead of by begging my social network to give me the money?

You would be a statistical outlier. People don't go to the hospital for fun.

The only exceptions have been dentists and dermatologists - where I'm largely paying out of pocket anyway.

Pretty versus ugly, young versus old, white versus black, man versus woman, overweight vs average weight, high school dropout versus university graduate, religious versus non-believer, etc., etc., the ability to look past all of these things and donate purely based on need is not something crowds have ever been good at doing.