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Comment by Buttons840 | Hacker News Reader

There's so much ancillary work around medical care. Like 20% of US workers are in some supporting industry. Insurance companies pay a bunch of people to find reasons to deny claims, hospitals pay a bunch of people to fight the insurance companies. They all ultimately get paid by my medical bills and premiums.

In my mind's eye is a political-style poster depicting the patriotic duty it is to pay your medical bill. Insurance company takes a cut, people who fight insurance companies take a cut, CEOs take a cut, everyone takes a cut, my medical bill is keeping half the nation afloat it seems, until at the end there's even a few dollars left over for the doctor. All because I spent 5 minutes talking to a doctor about an ear ache.

Fixing this will require eliminating a lot of these ancillary jobs and it won't be popular among those groups.

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This is one reason I hate it when productive jobs are destroyed. Economists say we'll find new things things for people to do, but those often seem extremely low value, like insurers/providers paying people to fight with each other over billing questions. And a lot of the time it seems like the replacement is either that sort of bullshit-esq job, or else some minimum-wage thing which is not acceptable to a lot of people - especially those carrying tens of thousands of debt in student loans from college.

A hair over 17% of the US GDP is spent on health care. That's the highest among peer nations.

Not just healthcare, the US outspends everyone at everything: infrastructure, education, defense, research, police, housing, prisons, etc. both in relative(by % GDP) and in absolute numbers.

It does so because it can. It's the wealthiest country on Earth so such high inefficiencies where a lot of the money is squandered to the benefit of few wealthy and unscrupulous parties, can be financially absorbed while still delivering a system that's functional enough for its citizens to not revolt over and want to hang someone. After all, it's still better than scary communism.

How can it outspend everyone in everything using relative numbers?

Everyone has the same 100%, just distributed differently.

Relative meaning as a percentage of each country's respective GDP. I edited now to make it more clear.

I don't see how this solves the problem?

If Country A is spending 10% of it's GDP on 10 things, Country B cannot possibly outspend it in every category as a percentage of their respective GDPs, because "percentage of GDP" is always a 100-point scale.

If you go up one percent in one category, you have to go down one percent somewhere in the other categories.

Don't forget that us Americans pay 120% of what we should be paying, so there are extra percent points to go around.

I think as the industry moves from a post-pay model, to a pre-pay/real-time model, this antagonistic relationship between providers and payers should slowly improve. Definately not a silver bullet though.

In terms of aligning incentives, there is a lot of potential in shifting from a fee-for-service model to a capitated value-based care model. But this will force further consolidation by provider organizations. Only the largest, most sophisticated multi-specialty health systems have the scale to take on and manage those risks. Small, independent practices will essentially be forced to either sell their businesses or switch to something like concierge medicine.

Nah prior auths (prepay) can get screwed up just as much as claims (postpay) for the same reason.

Sorry, i used some jargon most people don't know. Prepay the way I meant it is not referring to prior auths, but rather pre-adjudication. Not everything can go through a pre-pay process, but I believe most claims can.

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