Comment by abeppu | Hacker News Reader

Comment by abeppu | Hacker News Reader

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But you have to be really careful to not confuse the 'value' of healthcare with the cost of healthcare.

- If my health insurance lists a benefit value of $1500/mo for PrEP, and has a sticker price of $500/mo in other countries (and out-of-pocket might be $15-$60), is the "value" of the care I receive 3x greater than that received by a similar person in Belgium? Is it 25x the value of the same care received by someone in Ireland?

- If the healthcare I receive includes GP visits needed to get a referral to a specialist to satisfy my insurance co, or extra tests to convince them that a procedure is necessary, is that "value" that I received?

- If 20-30% of healthcare costs are billing and administration, is that "value"?

Our employers aren't just stealing this money from us, but for-profit healthcare providers and health insurance companies and pharmacy benefit manager companies creating inefficiency to their benefit and to the harm of patients.

https://www.thebody.com/article/what-does-prep-cost-outside-...

> But you have to be really careful to not confuse the 'value' of healthcare with the cost of healthcare.

Do you? Regardless of the price in other countries or what processes are currently “required”, there’s the price you have to pay. If you are going to buy a car, you either “value” it at or above the price you pay, or you don’t buy it. Why is healthcare different?

Because without a car you walk, take the bus, train, bicycle. Without healthcare you get sicker or die.

Yes, exactly my point. You compare alternatives and come up with value.

Do you compare alternatives based on value when making a health care choice? From what I can see you get the cost AFTER the issue has been resolved.

I'm really tired of people who think they can ignore all systemic economic problems by invoking value as this magical substance that can take any shape needed to conceal the fact that: A lot of people get paid a lot of money just to fill up society's `node_modules`, and this is not something for which the end users deserve blame or responsibility.

> I'm really tired of people who think they can ignore all systemic economic problems by invoking value as this magical substance

As someone part of a family that has recently consumed a lot of healthcare (myself included), I am not ignoring them at all, pretending they don’t exist, or arguing that we don’t need significant reform (I think we do). But they currently do exist and they currently are part of the cost and therefore currently dictate the value.

To put it plainly, in America, the value of Healthcare compared to the cost is shit.

Your beholden to your employment to keep it and if you work for a smaller company they usually have shittier plans leading to worse bargaining power. Also if that company is looking to cut costs they may choose even worse plans which you have ZERO control over.

Just because that's the way it is doesn't mean things couldn't improve.

Not sure how strong your metaphor is:

If you are going to buy drinkable water, you either "value" it at or above the price you pay, or you don't buy it. Why is healthcare different?

No, that’s exactly the same.

Healthcare isn't _intrinsically_ different, but it's a really distorted market.

Americans don't "value" their health 2x more than people in other developed countries. But Americans pay more for worse outcomes. It's silly to say that our worse-performing, often racist, hostile-to-the-poor healthcare system is providing "more value" just because corporate interests have aligned to price it higher.

If I live in a company town where my employer owns the water supply, and tells me that the 'cost' of that water has increased by some enormous multiple, and now they'll pay me a 'water benefit' in lieu of compensation increases, it would be absurd to say if I'm doing the same work, consuming the same amount of water, and getting the same pay, that my company is suddenly providing me "more value" just because it has declared that the cost of the same amount of water is higher.

I value the healthcare I’ve received recently more than the price I’ve paid for it.

That’s not to say I’m happy with it or would like to pay those inflated rates. Or that I don’t wish it were cheaper for me and for everyone else. But when it comes down to it, the value I have placed on it is higher.

If fact, other countries may value their health more than average Americans, given relative activity levels and rates of obesity and other diseases such as type 2 diabetes, despite their cost of healthcare services being cheaper.

I'm glad your healthcare was not so overpriced that it's not worth it. That's a bleak statement to have to make.

Suppose we built a Byzantine system around food like we do for prescription drugs. Food can be powerful medicine after all ... so imagine if you needed a nutritionist to prescribe specific foods in specific quantities. When you go to the grocery store, you're not allowed to just pick whatever, and you don't find out the cost of anything until weeks later. Grocery billing specialists send endless documents back and forth. Everyone in this society spends twice as large a portion of their income on food as their peers in other countries, but the food is worse. Food becomes so expensive and costs are so unpredictable that employers provide grocery insurance benefits that pull down the salaries they can pay. But when you're hungry, you need to eat so of course you "value the food you've received recently more than the price you paid for it". Does the fact that a hungry person with no options will pay a lot to not continue being hungry really imply that the high prices in this system match high value being delivered? Or can we perhaps recognize that the value being provided (food to be eaten) is similar to the food-value provided at much lower cost in other systems, and therefore the high prices in this system do not imply that its services are especially valuable?

"But I already have enough food so like this doesn't really apply to me "

I find it really hard to understand how people will continually go against their own self interests to align with their beliefs, without question.

Things can be different, things do change and we're not always right.

Data has shown we could all be spending considerably less on Healthcare with single player [1] and not be at the mercy of our employment for it... But it's still shunned because it's socialism or some other reason.

1. https://www.ucsf.edu/news/2020/01/416416/single-payer-system...

> If the healthcare I receive includes GP visits needed to get a referral to a specialist to satisfy my insurance co, or extra tests to convince them that a procedure is necessary, is that "value" that I received?

Do you think all of those tests are irrelevant? Who sent you to the specialist, if not your primary care provider?

What do you think health care value actually is? It appears you don’t think it includes actual care or diagnosis.

My primary care doctor has to consider what my insurance allows when providing me care, and that includes knowing what my insurance will allow for procedures that require a specialist. We talk about it all the time, and he hates it, because he knows I need to see the specialist for a specific procedure, but knows that without the test, I'll end up with the bill instead of the insurance company.

Who should I trust more with my health? My doctor, or my insurance?

In October of 2019 I needed a hip replacement. I had bone grinding into bone. You could literally hear it if you walked beside me. Imaging showed it clearly. My doctor, being a doctor, knew that the best course of treatment was to replace it with a prosthetic ball and socket, despite the risks (I will need two more in my life, if I live to average age).

My insurance refused to pay for it, saying my age alone disqualified me (too young).

It's 2024. I'm still fighting that insurance company. I'm totally healed, feel no pain, and can actually run as a hobby. My health as a result has drastically improved.

Do you believe that health insurance companies provide value?

Given your particular medical history, preexisting conditions, including past GPs and specialists which your current insurance company may know nothing about, you may already know who you need to see. Re-convincing an insurer can be a waste of everyone's time, and can in some cases create greater net expense and delayed care.

And GPs and other medical professionals have complained to me in the past that some test is not actually necessary, that they are confident in a diagnosis, but some additional test is necessary purely to convince the insurance company that they do in fact know what they know.

I value diagnosis by the appropriate trusted medical professional. I do not value the opinion of my insurance company.

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