What makes the US health care system so expensive – Inpatient Care | Hacker News Reader

What makes the US health care system so expensive – Inpatient Care

theincidentaleconomist.com

27 pointsAnon848 comments

Its the bureaucracy that amazes me (as a European quack).

When I was in LA, I was amazed that small hospitals have teams of individuals dealing with insurance forms with many specialising in just one company.

I hope that America can lead the way in reforming healthcare and I think that an entrepreneurial group will shake things up. It will work out better for patients in the long run.

The entrepreneurial spirit isn't very welcome in health care. In fact, in some areas of the country you cannot open a new hospital with the permission of the existing hospitals. Expect medical devices to get more expensive with some of the provisions of the new health care bill.

I still think the US missed the boat by not properly looking at input costs and risks in the health care system.

  It is far too expensive to certify a drug or device.  Even with all the testing, the company is going to get sued.
  Medical training costs a lot of money - spend some of the Government money on scholarships for high GPA students
  Do a flood style insurance by the government for cases of over $100K
  Allow real medical saving accounts that can be inherited

An interesting read, in which I learned that Americans spend far fewer days in the hospital than others, but our costs per day are ~2x average, and we receive 25% more procedures than others. I wonder how much of this is waste due to either profit motives or fear, versus how much is due pioneering new procedures that will gain widespread usage a few years down the road elsewhere. (That's intended to be a sincere question.)

One sentence struck me as odd, confusing me as to what the author was trying to demonstrate:

> "In fact, the increased numbers of percutaneous coronary interventions, knee replacements, coronary bypasses, and cardiac catheterizations alone accounts for an extra $21 billion in additional inpatient costs."

Percutaneous coronary interventions are life-saving procedures. It's a bit odd to see them lumped in with diagnostic caths and knee replacements. I would like to see at least X PCIs, where X is the number of myocardial infarctions that occur each year.

It's quite complex to compare countries. Especially when other social programs can reduce hospital visits dramatically. For example: reducing alcohol related violence, lower gun shot /knife wounds, housing people reducing homeless hospital visits, lower obesity reducing many problems, sexual disease education reducing STI/STD, easy contraception availability, better sexual education, free medical care meaning people go earlier to get help reducing the cost down the line... the list just goes on and on.

Countries with better social services can often save money on medical care down the line.

So just comparing medical costs is silly. You need to take into account other social, and education programs too.

perhaps he's trying to lump it into some sort of category that is accounted for by the 'american way of life'. coronary disease is at least somewhat affected by living a healthier lifestyle.

After years of covering the healthcare industry I would argue it is actually an easy answer: people have been too far removed from the actual cost of healthcare. Nobody knows who and how their healthcare is paid for which is why one night in an emergency room can cost $15,000, completely defying all the laws of supply and demand. Without getting into pricing theory, a general rule of thumb is that if you provide a service that is unaffordable even to the rich (so 99.9% of society), market forces will put downward pressure on your pricing. This doesnt happen in healthcare because everyone but the individual pays for it (it either comes from your work, your insurance company, subsidized by someone else or the government).

Intuitively that seems to make sense, but how does that account for almost every first world country except the US? In countries like Canada, the UK, etc. healthcare costs don't seem to be nearly as out of control as they are in the US, yet I would expect that patients in countries with socialized health insurance (like Canada), or socialized health care (like the UK) would be even farther removed from the actual cost of healthcare than their US counterparts. Why are their healthcare costs not dramatically more out of control than costs in the US?

Is it a good idea for Gov to provide free diagnosis? And patients will pay hospitals for treatment.

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