Obamacare is the law of the land


I believe one reason Obamacare was so disliked is that people didn’t have any idea how much their employer based insurance cost, and when employers finally started asking them to pay something (or a larger something) they believed it was because of ACA. They had no idea employers for years have had to eat health care cost increases of 5-15% a year.


A lot of the issues in the US also have to do with the insane costs of insurance priced healthcare. Healthcare organizations charge insurances inflated rates over the non-insured rates, because they can. Because insurance can eat the cost and increase the premiums year over year.

The money is being gobbled up in the middle. We could do a lot to slow down the rapid price increases of healthcare with some regulations

In 2009, a lumbar spine MRI costed 160$ in Japan, and over 1700$ in the U.S.

Because the Japanese government fixes prices that can be charged for many healthcare services.

The current system in the U.S. is unsustainable, costs will continue to increase, premiums will continue to rise, if we don’t do anything. Pharmaceutical companies, medical equipment companies, and everyone else can charge us more for the same medicine and equipment than other countries, because they just can.


I think everyone agrees with this.


Here is another article explaining the massive amount of waste in costs that the US Healthcare system is dealing with.

Administrative costs, meanwhile, accounted for 8 percent of the GDP in the U.S. For the other countries, they ranged from 1 percent to 3 percent. Health care professionals in America also reported a higher level of “administrative burden.” A survey showed that a significant portion of doctors call the time they lose to issues surrounding insurance claims and reporting clinical data a major problem.

Dealing with insurance companies is costing us at least 5% more of our total GDP in spending than other countries. I have friends that are doctors and pharmacists, and they complain about this the most. They don’t have degrees in hospital billing, or insurance coverages or claims, but they often have to deal with issues on a daily basis. That is time lost that could be used on care.

A good thing? With all of that money, at least we are getting some of the best care in the world, but due to the issues with costs and insurance, there are many people missing out on that excellent care, which makes it pointless.


My wife went into insurance coding several years ago, it was supposed to be the next big thing, with experienced coders making $40+ per hour and working from home. Well, some do that, but the last company she worked for was subbing the work out to companies overseas. Locally inexperienced coders might make $16 an hour.


Oh, I know all about dealing with mis-coded claims. Having to deal with that issue recently.


Family favorite: A procedure for my mother-in-law was coded as a prostate exam.


My last doctor used to code his own stuff in the examining room after giving you a physical. That was pretty weird.

Coding is a strange and specialized thing. People who are good at it, and do the “hard” stuff are paid pretty well. Some hospitals hire off the street for coding the “easy” stuff. I recently heard of an ex co-worker who was doing that. I can only imagine the quality of her work.


My current doctor now does this. I need to get procedure codes for him and the diagnosis code, and go on to my insurer’s website to ensure it is listed as a covered service.



The coders in the physician offices and the inpatient codes in a hospital setting are entirely different beats. One has a shortage, the other is heavily pushed to go offshore, and some of the ones overseas cannot gets their certification due to limits on giving those to oversea entities.

The mess we’re in now is largely self-inflicted. Abuses were done, fraud committed and now we have all these weirdo requirements originally designed to catch that but is largely done to help insurance companies get out of paying.


I like that article because goes over many of the cost drivers that explain why US health care is so expensive. Administrative cost add an extra 5%, I believe I’ve used that same figure. But in the context of $10K per person health care cost that is only $500. Not nothing but not a silver bullet. Prescription drugs $1400 vs $700-$900 for the rest of the developed world definitely a factor but not THE factor. Higher salaries for Doctor and nurses another contributing factor. More expensive equipment, catscans , MRI, more individual monitoring stations. Then we get into patient amenities, we have a lot more private and semi-private rooms which also means more equipment. The sad truth is we can’t wave a magic wand e.g. “medicare for all” and drive health cost down to anything approaching the rest of the world any time soon.

It is going to be a hard process, and while even those in the medical field agree something needs to be done. There is no way it is not going to similar to taxes. “do not tax you, don’t tax me, tax the fellow behind the tree.”


I think you might be reading that wrong. It’s costing 8% of our GDP and they spend 1-3% of theirs. 8% of the USA GDP in administrative costs for healthcare is absurd. That’s 8% of 18 trillion dollars, or 1.4 trillion in administrative costs. That’s about 5k per person in the USA per year. That’s 20k for my family of 4. There’s a big part of the runaway healthcare costs - for profit insurance working hard to not pay your claims for healthcare.


I’m pretty sure that figure it is BS. Although, one of the biggest issue with health care in the US is the complete lack of transparency so who really knows. But when I sanity check it doesn’t make sense.

The best estimate I found is that insurance company collect about $1 trillion in premiums. (Approximately 1/3 of 3.4 trillion we spend is from Uncle Sam and many large companies self insure). If we look at the largest insurance company United Health Care it had 201 billion in revenue in 2017 and it paid out it $154B in payments to providers. (That number under estimates the pay outs because United Health has a HMO which is more than 1/3 of the revenue). So the administrative cost is the difference between 201-154 or $47 billion. United Health Cares pay ration actually corresponds quite well to the ACA rules which requires that 80% of all premium collected be paid out as benefits. Of the $47 billion in gross profit, United Healthcare made a $15 billion in profits and the rest is admin cost. (Total insurance company profits are about $250-300/person even if we cap all salaries at $1 million/year) Now there is certainly admin cost on the part of doctors but I don’t think it is anywhere near the cost that would get to $1.5 trillion. Unless, you include a far broad definition of admin cost, janitors, receptions, cafeteria workers etc. In a link free article is pretty much impossible to know

Most estimates I’ve seen of Social Security put the admin cost at 3-4% and health insurance companies at 7-9% of the total health care cost, not GDP. Hence my comments.


There is a theory that giving the government power to negotiate things would drop costs significantly. Which is basically what other countries do and why a drug costs like 50 times as much in America as it does in say Denmark.

Now I’m sure that wouldn’t be enough, but I think most people would be willing to see a tax increase if it meant not paying for health insurance, which for a lot of people is getting to be more expensive than their mortgage if they want to actually ever use it.

I mean I’ve talked to Aussies who are insanely conservative. They have hidden guns on their property and aren’t fans of the “Abos”. They’re not big on homosexuals. They’re not big on government regulation for the most part. They fucking love their nationalized healthcare.
“It’s not free we fucking paid into it our whole lives. Why can’t you Americans sort it out? Are you fucking stupid?”


One thing to think about on the issue of health care reform reducing prices: no other county has actually reduced prices; the best they have done is hold the rate of health care increase to the rate of inflation. You can roughly track the percentage of GDP a developed country spends on health care with the era when they adopted government price reform in health care. If they adopted early, they end up with health care at a low percentage of GDP, 5% or 6% (like Great Britain, although I believe part of that low cost is that the British NHS is on the penurious side). If they adopted somewhat later, they end with costs somewhere in the 8% to 12% of GDP range (Canada, France, Germany). If they just kept slamming their head against he wall of inelastic demand til now, they are paying almost 18% of GDP (yeah, guess who.)

Basically, there are a lot of sunk costs, issues of path dependency and the fact that humans are “sticky” about their incomes all of which make it very hard to actively reduce the revenue of an industry like health care. However, government price reform has successfully held the rate of health care price increase to the general rate of inflation (rather than 2X or 3X inflation like we chumps have) in many countries.

So, yeah, in theory, government price reform (which I strongly support) could lower prices, but in the big picture I think that’s a big ask. I would settle for reigning in the unsustainable and crushing growth, and not look for any magic ponies of cost saving falling from the sky. As Strollen said, health care reform is hard. Despite that, it’s still worth doing. Actually, it’s not just “worth” doing; we must reform health care further in this country or the temporary reprieve provided by the ACA is going to get overwhelmed by the continued insanity of double or treble inflation price hikes, increasing costs to employers and individuals, and general health care suckitude.

My current favorite proposal remains some form of “Medicare Buy In” (which is not exactly the same as “Medicare for All” as generally conceived.)

Must sleep now. I drove 900 work related miles today, appeared in court, and took a doctor deposition, and now my brain is like slow cooked oatmeal.


There is also a theory that the USA subsidizes these drugs which means if the USA stopped doing that, the cost to other countries should go up. Again, that’s a theory, not proven.


I don’t even know if it’s a theory or more just an excuse. The pharmaceuticals distribute into other markets because they make money at the negotiated price.

While I’m sure their bottom line would be hit hard by sane pricing in the US, that’s a feature and not a bug for me. Cost savings need to come from somewhere and that’s a good place to start, as long as they’re still profitable.

EDIT: This wasn’t posted in disagreement or anything with you, Nesrie. I was just continuing off of your statement about the subsidization theory.


It would kill their US marketing teams. Do you hate jobs Kevin? Think of all those poor marketing people who no longer can make a living trying to convince people that their ennui can be solved with some Zoloft.

Liberals always trying to kill jobs through regulation, it’s frankly Un-American


(Some of these companies don’t really exist anymore, due to buyouts and mergers.)


I hate jobs and… checks notes… the little people. And I’m talking about all you insignificant cogs, not people too short to ride the halberd.

(wow, that sounded a lot more dirty out loud than it did in my head)