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Comment by willcipriano | Hacker News Reader

The US government spends more on healthcare per capita than any other OECD nation. We are just being robbed.

Americans also consume a lot more healthcare. And doctors and nurses earn 2x more than in other countries. An NHS nurse makes something like $33k a year. In the US it's going to be $60-70k before overtime.

I'd be curious to see what portion of US health care goes to salaries of licensed health care workers, and how the relates to labor costs of various middle men and administrators, as well as regulatory compliance people.

Administration costs have gone something like 4x since 1980. The specific share they take is probably dependent on the niche, but like universities, a huge portion of cost is siphoned away to paper pushing.

When you go to the doctor ask them if they think they are making more or less than your deductible for the visit.

The only time I've seen a doctor since I've been responsible for health insurance was when the police took me there in handcuffs against my will and without a court order or any legal basis. Obviously on that occasion I refused to provide insurance. I've never been to the doctor voluntarily as an independent adult or paid a deductible for my healthcare. Can you explain how the deductible relates and is useful for figuring doctor's pay?

When you see a doctor when you have insurance you have to pay an out of pocket fee. Because economics teaches us that patients needs skin in the game otherwise people will abuse 'free healthcare'. This makes total sense if you're an economist. Because well if you are an economist you are an extremely stupid person.

Now if you're an accountant you'd take 20 patients a day X 250 working days a year X $50 and get $250,000. Which is close or more than a doctors take home.

That still mixes a lot of factors in, including how often people need care and what kind of care is provided. Better to compare the same procedure/drug/etc in the US vs elsewhere. I think in the US it's usually more costly that way, especially when it comes to drugs.

> healthcare per capita than any other OECD nation.

You also need to mention that the US is not like any other OECD nation. It also happens to he the nation with the largest innovation in Healthcare, and not just by a little. By Far.

Yep! Innovative billing practices, and innovative marketing!

Actual R&D is a distant second. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...

there's no discernible innovation in healthcare, at least if you go by any actual metric that would indicate that. Life expectancy in Cuba is higher than in the US, infant mortality in the US is higher than in any peer country, drug death rates are higher than in most if not all comparable nations, and so on.

The pharmaceutical industry might produce innovations concerning some rare diseases or whatever, but there's no discernible reason why that is, or should be paid for by the public healthcare sector.

> infant mortality

You have to be careful with statistics like that. I did some research on that a few years ago. Different countries define infant mortality differently. Other countries would classify many failed pregnancies as a miscarriage that the US classifies as infant mortality, for example. This is because the US is very aggressive at trying to save premature babies.

Is your theory that medical research and innovation is why it's so outrageously expensive to get stitches to close a wound?

The expense comes from the cost of poor people getting free emergency room treatment getting passed on to the paying customers.

No, it doesn't.

https://link.springer.com/article/10.1007/s11606-020-06147-9

> The overall mean for charity care as percent of total expenses was 2.62% for for-profit hospitals compared with 2.95% for nonprofit hospitals...

That's total expenses, not emergency room expenses.

Yes, and much of that small, single-digit percentage of charity hospital expenses will be that sort of care. It's a rounding error on their books. Stitches are costly whether you're in the ER or in the ICU after surgery. Forcing poor folks to rely on the ER for treatment is silly, and needlessly expensive, but it's hardly the primary driver of healthcare cost rises.

Which is heavily paid for by taxpayer-funded research, so Americans are paying for it on both sides.

Heavily is something of a stretch: the NIH is a fairly small part ($40B) of the federal budget ($1,600B discretionary + another $4,000 mandatory spending).

It's about 0.5% of the total budget, which works out to about a dollar a week for the average taxpayer. On top of that R&D spending has a huge multiplier: a lot of that money supports small, high-tech businesses, which in turn hire people...etc

I never claimed it was a huge part of the federal budget, only that NIH and NSF provide a large fraction of basic science research. It’s always tricky tracing that to actual treatments but the drug companies tend to fund development of promising candidates from taxpayer-funded basic research more than doing that basic science themselves, and a lot of their R&D goes to tweaking existing drugs which might make them more effective/convenient but definitely protects the company’s margin against generics.

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