Where is the Waste in Health Spending?

Up to 25% of health spending in the US is wasteful. Where is that money being lost? What can we do about it?
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[@lewtenant_k]

Is there a reason transparency of hospital prices isn't listed as an intervention to reduce price inefficiencies? The whole "free market" idea kind of hinges on knowing the prices *before* you spend the money.

[@GreenBeetle]

Kurt Kreuger no free market for insurance means the consumer is stuck with the prices they’re charged unless they want to change jobs to get a different policy that allows them to enter a different network or go to a different hospital.

[@lewtenant_k]

@@GreenBeetle That's exactly my point. Price inefficiencies could be improved if hospitals were required to make all their prices available to the public. They could then shop around, at least for some things. (This isn't the total solution, though, since the listed price isn't the price insurance companies pay, or even the price someone who pays all in cash pays.)

[@whychoooseausername4763]

@@lewtenant_k From what I've understood, Americans have a limited number of practitioners included in their insurance. Also, while I'm sure in liberal medicine the idea of a free market with certain limits can apply (you don't want doctors sending everyone with a cold home with antibiotics because it's more time-efficient and increases patient satisfaction), I don't see how it can in a hospital environment. If I think you need 1 1L IV bag a day after surgery, it isn't realistic to expect to be able to skip a day and save up for when you can afford it. And IV bags are a good example of a relatively cheap product that's overcharged, but extended ICU stays (worst case scenario but possible after any type of surgery) will always cost more than what an average person could ever plan for.

[@Loathomar]

I assume that this is because this place focuses on peer reviewed work that would show results and looking for things, most peer reviewed work on transparency of hospital prices have shown little to no effect on over all pricing. We can see some changes in very limited areas, like outpatient imaging or lab testing, but they make up such a tiny part of the overall cost to be rather pointless. Outpatient MRI costs drop by 13% in one study, which seems like a lot. At almost $650 per, that is $85 per scan and there could be 20 million scans, a savings of $1.7B, which seems great, but we are looking at a $4T medical cost, so that is 0.04% change in cost and it is one of the best results from transparency. Over all, the study found a 2.1% reduction over all in prices paid for shoppable services, and if all series where shoppable, this would be some serous savings, but only about 7% of all medical costs are consider highly shoppable and upto 43% has some shoppablity to it. At most, a 1% cost reduction, so it is much like the fraud or misuse, an easy target and something worth looking at, but it is not solve the issue when peer reviewed work looks at it.

[@lewtenant_k]

@@Loathomar Thanks for that breakdown. Do you happen to know a review paper that covers this?

[@lohphat]

CEOs, ad budgets, admin overhead paper-pushing, and "shareholder value".

[@DDCrp]

Sandwiching CEOs and shareholders in there doesnt make it true

[@XxThunderflamexX]

@@DDCrp Yeah. It being true makes it true. Worker coops work better than private enterprise, that is a fact.

[@forgotn42]

Pretty sure insurance companies are one of the biggest wastes of money in the system.

[@lewtenant_k]

That probably fits into the lack of a single payer system, at least partly. Because there are so many insurances, health professionals need to know the billing practices, the drugs covered, and other details for each. Super inefficient.

[@bkbland1626]

Insurance gangsters are most of the problem. Greedy assholes, all.

[@odizzido]

The CEOs of insurance companies effectively find excuses to kill people so they can profit off their deaths. It's great.

[@EmpressMermaid]

Very true. Doctors and hospitals have almost as big an army of paper pushers to deal with insurance as they have workers that actually care for you.

[@NewMateo]

God I love Canada. I broke my hand and within 1 day I was in a cast and in a week I was under the knife. Went to physio for a while and got my functioning back. The whole ordeal cost me whatever I ate for lunch each day while in the hospital. Apparently it would have cost me thousands in America.

[@TheLionPear]

New Mateo surgery? Try tens of thousands. Possibly more.

[@vengefulavenger1510]

In the UK even the hospital food is free

[@phantomkate6]

I'm so glad things worked out for you. I, on the other hand, have been waiting for 11 months for treatment for a different problem (6+ months further waiting estimate). Am having to go to US to pay for private care, which makes economic sense as I want to get back to work. It's only health *care* if you're able to access the treatment you need.

[@odizzido]

@@phantomkate6 Yeah unfortunately not all provinces are equal and honestly our health care system could be a lot better. I've heard in my province they're looking to cut health spending even more which is unfortunate, but that's what people voted for. I wish we looked to countries like france for our medical system.

[@phantomkate6]

@@odizzido If only they would cut from the bloated bureaucracy that sucks up all of the cash and slows the whole system down...but we all know they'll cut frontline staff and place more limits on the services that doctors can bill the province for. I just wish there was a private option. I'd happily pay for actual care.

[@chessplayer0106]

SINGLE PAYER WILL SAVE US 200 BILLION PER YEAR IN WASTEFUL ADMINISTRATIVE COSTS??? DID I HEAR THAT RIGHT??

[@brevinainslie6357]

So...everything?

[@harshbarj]

Want to greatly eliminate waste, eliminate insurance companies. Each company has redundant positions that would be unnecessary with government run healthcare.Another step could be elimination of hospital networks (companies). Have a single healthcare system that all hospitals are owned by and operated under, again eliminating redundant and wasteful positions.

[@TheWolphren]

When my spouse was giving birth, the hospital blood typed her even though her OB had her typed and the labs sent to the hospital with us. When I pointed this out, I was told it was hospital policy to test everyone giving birth regardless of whether they have been typed before....And my insurance paid for it! That is definitely waste we can fix!

[@whychoooseausername4763]

It's actually standard practise to have a test that's less than a week old if you're planning to do a blood transfusion and it also detects hemolytic disease of the newborn (a feto-maternal blood incompatibility that can appear before or around childbirth).

[@TheWolphren]

@@whychoooseausername4763 If that's the case, why was it ordered by the OB during the pregnancy and why did the insurance company pay for it then? It is still a waste of medical resources and money.

[@victorco.6308]

We need single payer system for working people. People still don't understand, health care cannot be a free market. Free markets require, among other things, price transparency (hospitals do not disclose costs), competition (in many places there is only one hospital available), etc. Only single insurance company has the power to negotiate a fair contract and fair prices for consumers.

[@victorco.6308]

"Free medical market system" with many small insurance companies is the disaster for working people, the system failed to provide basic consumer protection and must be transformed into single insurance company with private medical providers. Common problem in many medical plans: pre-existing conditions denial, don't cover basic/essential health problems, bankruptcy of people/families who even had medical insurance, problems with payment for out of network providers in emergencies, huge/unreasonable deductibles, very low annual limit, very little providers in network of your insurer, etc. Add to above the highest prices in the world we are paying for services and medications.

[@whychoooseausername4763]

One example of waste I encountered today : GPs putting older patients with CV risk factors on preventative doses of aspirin when there is no formal indication, out of habit or excess of "precaution" (and this is the best researched area of medicine, so there really is no excuse to fiddle with modern guidelines for the overwhelming majority of patients). While the cost of that medication is 2,05 euros a month, there's a significant increase in the risk of hemorrhagic complications, which can cost in the hundreds and thousands to treat, and result in significant and long lasting impairments or death.

[@jankelsey9738]

Nothing discussed in this video sounds complicated. Administrative costs and excessive service costs estimated at 500 billion annually is simply unacceptable. That's 5 trillion over ten years! Either stringent price controls or negotiations via a single payer system is simply a matter of political will for this moral necessity for the entire psychological, health and financial well being of this nation.

[@matthew6466]

Inefficiencies include paying me to call BCBS to sit on the line with a robot that can't hear or understand me that will read what I already read when I logged into their web portal that then finally let's me talk to a human that answers my question in 5 minutes, hopefully correctly. Please. Single payer so I don't have to spend hours finding what client's coverage actually is, communicating it to the client and practitioner, and then entering it into our system and hoping I'm correct the first time. Fun fact, when you verify coverage, insurance stipulates what they tell you is not a guarantee of coverage and that determination is made at the time of the claim (after the service is rendered).

[@dvklaveren]

Imagine if the US government declared a national emergency over it's healthcare system. Because it is. Imagine that for 6 months or a year, the military set up military-grade administration and logistics networks. I'm not saying this is a good idea, but I'm just thinking about what a security risk the healthcare system of the US really is.

[@TheBetterGame]

2:34 We need that to be a new meme!

[@phantomkate6]

I'm really curious to learn about where the waste is in Canada's systems. Would have to focus on one or more provinces separately, as there are differences.

[@gx9254]

Spending on drugs in Canada is much more than other countries (except the US and Switzerland) because we don't have universal pharmacare. This is especially true when considering quality - we pay much more for drugs but millions of Canadians are uninsured or underinsured when it comes to medications. In other respects we're pretty similar to other single-payer countries.

[@tabaks]

Waste in health spending is paying 10-100 fold higher prices for equal level care as elsewhere!

[@bluejedi723]

What are your thoughts on the woman who got billed $20 grand only to find out her sore throat was just a cold?

[@evilsharkey8954]

Blue Jedi, my thoughts are it was a mistake; someone accidentally selected all the possible tests, and nobody bothered to ask if that was correct. I wonder if they even did them all, since you’re need a lot of vials to run that many tests, and that would seem weird. If it’s happened more than once, however, this place needs to be investigated.

[@NotShowingOff]

He Should just say that in regulated profits drive the costs up. Ppl need healthcare. That’s not really a market.

[@Kaliraptor]

it would be helpful if you preface 'JAMA' with it's full name "The Journal of the American Medical Association". Not everyone will recognize it or its authority.

[@lobaxx]

Pretty telling that the big way to reduce waste is Single Payer, but no one wants to that because that waste is a giant insurance corps source of profit

[@terryharnden5510]

Root cause analysis to analyze and minimize toxins (prevention) would eliminate 90% of chronic sickness and resultant productivity losses. It would also speed up healing from injury.

[@ZakiAoi]

Glad to see you feel better this week. You sound really sick last week

[@kathyfausett9301]

In case you haven't been paying attention (and you haven't), the insurance industry is THE cause of out of control healthcare spending. Prior to their involvement in healthcare, costs were extremely affordable. When the government and insurance companies highjacked healthcare, costs spiraled completely out of control, yet your fix for all of this is different kinds of insurance? Please!

[@SandfordSmythe]

It is easy to leave everything to the market, if you cut out the poor and not so poor.

[@johnfausett3335]

@@SandfordSmythe What does that mean?

[@SandfordSmythe]

@@johnfausett3335 What do you do if you don't have enough cash on hand to pay for treatment. Insurance and government can supply that. Maybe I missed something here.And don't tell me that competition would lower prices to that level for this population. You are thinking of your world of financial comfort.

[@johnfausett3335]

@@SandfordSmythe Yes, you're certainly missing something, and when did I expose any sign of financial comfort? You don't have to be a financial guru to understand that when a third party is added to the equation, someone besides your doctor will require payment. If you don't have any money, you aren't likely to have insurance, so they're not going to take care of you. Medicaid is a government insurance for poor people but the lion's share of money devoted to that program is swallowed by administrative costs. If people decide to support universal healthcare, they can expect inferior services at a higher cost.

[@SandfordSmythe]

@@johnfausett3335 As usual, you folks don't want to deal with my main concern.

[@frankm.973]

The guy said if payments to hospitals are lowered quality may degrade..

[@MyNameIsntRyan]

Hey Triage, would you consider looking over the healthcare plan Andrew Yang has proposed? He has proposed a healthcare plan that looks very different to what other Democrats are putting forward. And while he does want to expand Medicare, he thinks we need to prioritize tackling individual issues in the industry. I'd love to hear someone's opinion on the matter who is very educated as he's faced some criticism for taking the stance he has. Thanks!

[@scotthendricks5665]

Hmmm. Sounds like you need to get universal healthcare.

[@evilsharkey8954]

Scott Hendricks, we do, badly, but it’s met with fierce resistance because there’s so much money to be made.

[@Praisethesunson]

Administrators are a waste. Get rid of them.

[@peanut12345]

It's all the way around, Insurance,Pharma,Hospital,Doctor,Rates,TV Ads, everybody but the sucker/patient.

[@Unsensitive]

The biggest waste is poor nutrition and health advice, and the processed food market promoting crap. Fix nutrition, fix much of the health issues and cost, which are related to metabolic syndrome.

[@masterkey6596]

And it's cheap to do prevention.

[@TheLionPear]

I feel like everyone knows how to eat right and just chooses not to do so (myself included). Short of force-feeding people, how would you propose making people healthier?

[@evilsharkey8954]

Other countries with higher obesity rates than us still have better healthcare costs and outcomes. The problem is more systemic than just having more sick people.

[@TunaBagels]

End the entire private healthcare insurance industry. Nobody involved deserves their job. Well regulated, single payer systems are effective across the globe, in every developed nation. Furthermore, we need to pressure the government to crack down on price gouging in patented or niche healthcare products, like the EpiPen or the infamous Daraprim.

[@BTheBlindRef]

Who would ever invest in the development of a niche treatment if they couldn't be sure of earning a return on their investment? How do you define price gouging here? I'm not saying it doesn't happen, but it certainly isn't as simple as you make it sound.

[@elliottmiller3282]

How do you have a more competitive health market is what I want to know. lets solve this issue with the free market. But note something. 20- 25% reduction is not free healthcare. Healthcare will never be free.

[@gx9254]

It seems slightly dishonest to suggest that there's no good evidence of "what works" to address these issues when every single country with a single payer system doesn't have anything close to the same amount of waste. The evidence that a single payer system would reduce health spending, including waste, is overwhelming. I'd also be curious to compare how much is lost to "waste" to how much is lost to profits made by pharmaceutical companies, insurance providers, for profit hospital systems, etc.

[@NOATSFilms]

Sooooooooooooooooo... #FeelTheBern?

[@poky888nuju]

Reduction in waste could lead to a reduction in jobs. The current job market encourages looking busy. Wisecrack KZbin channel did a bit on this problem in their analysis of “The Office.”

[@contentwatcher1629]

Medicare for all!

[@NeedForMadnessSVK]

Easy. Not being universal healthcare system.

[@miaa7097]

You guys need public system We Canadians spend half of the amount of money yet everyone is covered !! Edited: we have better health outcomes too for half price

[@ratdude747]

And yet everybody in the US opposed to such seems to know a Canadian who was killed by the system (or thinks it's the worst things since Hitler). I do know Canadians who think so (used to go to London, ON for work a lot), but they seem to be a vocal minority?

[@forgotn42]

@@ratdude747 Nah. The people opposed rarely actually know someone killed by the system. That was a Fox News talking point that was repeated ad infinitum in order to get their constituents to believe it. So when people say that, they're often just repeating what they heard rather than giving actual anecdotal evidence.

[@tylerwyat9592]

You don't have better outcomes. You'll find one or two, but the big killers you fall short. Oh, and you use our drugs and medical advancements. You're welcome.

[@lewtenant_k]

@@tylerwyat9592 But a single payer system (which, according to the video, doesn't impact prices) would reduce the biggest part mentioned here. So no, the drug and medical advancements (perhaps partly why prices are higher) don't make up the whole difference. And if the US really is founded on the free market idea, let Canadians and others increase their prices to pay for the system. This argument seems like just dodging the question to me.

[@Loathomar]

@@lewtenant_k A single payer system, according to the video, would at least remove the admin cost waste, 5-10% of total US healthcare cost, but just medicare for all would not address much of the US healthcare waste. It would be better to fight for group pricing like every other country in the world does so that the US can stop paying 2-3 times as much as every other country in the world for drugs that where developed and made in the US. We would be best to have a healthcare for all that also focused on lowering costs while not effect outcomes. Peer reviewed work shows that the overall outcome of Canada's healthcare system regularly out preforms the US, though this is not across the board, some areas the US does better, but most areas and total overall outcomes are better in Canada's system. This would be reasonable if Canada was paying more then the US for it's healthcare system, but they are paying WAY less. Canada spends 10.4% of it's GDP on healthcare and the US spends 17.8% of it's GDP. So, when you say "let Canadians and others increase their prices to pay for the system", what do you mean? The US is spending 70% more then Canada to get worse results! Also, the US government spends more per person then the Canadian government on healthcare.

[@overseachininadoll]

high cost is because the price tag is high and expensive. when cut the price to half the percentage GDP will go down to 9%

[@Bmanritchie]

#m4a

[@stevep.2449]

Aaron - clearly you are a fan of M4A - got it!! But you fail to have a plan, that I have seen, on how you overcome the provider shortage that already exists in this country. So unless you have some miraculous plan to solve that - all ERs will be even more overrun than they are now. ERs in most countries with a state-run insurance company has the right to refuse patients who do not need to be there. Are you a fan of having Triage Nurses/Paramedics in ERs here in the US having the ability to refuse service for nonurgent patients? Otherwise, there goes your saving on waste.

[@BandBHawks]

A single payer healthcare system will produce fewer catastrophic health emergencies because people will be able to afford to go to the doctor earlier on, when the problem is not as severe or can be prevented entirely. That's actually a huge cost savings aspect of M4A.

[@SandfordSmythe]

Urgent Care facilities covered by insurance.

[@djp1234]

Bernie 2020

[@wormsblink2887]

Why not just copy another country’s healthcare system wholesale?

[@evilsharkey8954]

Worms Blink, fitting another country’s system with our laws, Constitution, culture, and existing infrastructure wouldn’t work. We should look at countries with the best healthcare systems in terms of cost/benefit, patient satisfaction, effectiveness, wait times, etc. and try to find ways to fold the principles and execution of their systems into ours.

[@mahirrahman7]

In the bureaucracy of paperwork of the many health insurance companies. #MedicareForAll #Bernie2020

[@BigPappy1231]

Cut the admins. Voila

[@ChristianMCI]

Vote for Bernie then help him pass Medicare for All. Nobody else wants to improve the healthcare system, because insurance companies have insane profits and current legislators get "donations" from them to not change anything.

[@engdallal]

We need to increase supply of medical services by reducing the barriers to entry to the medical profession and to reduce the monopoly control of pharmaceutical companies on drugs they own the patents to. Like everything else in this universe, we have to accept the tradeoffs with lower quality and less innovation in making new drugs. It’s funny that the article doesn’t address that the restrictions to entry to the medical profession which make doctors on high demand and able to make 6 or 7 figure per year. Maybe, those doctor researchers like it as is.

[@greymind9815]

Capitalism is Corporatism. Monopoly will always form and the class of capitalist will always consolidate wealth. And monopoly isn't inherently wrong economy's of scale and what not, the problem is the class who raises the price. Workers should own the business and elect the managers instead.

[@km1dash6]

We all say we want to reduce waste until we actually try cutting it. It's because our economy incentivizes waste. Waste = GDP growth. Waste means money going to people. If we had an efficient healthcare system, the economy would contract and we'd be plunged into a recession.

[@DamnKids10]

Funny, you mention fraud and abuse as small but then not so small when referring to an earlier 5% savings from admin costs. Bit biased from a physician. How about the savings from price transparency which is no where to be found on your channel yet is one of the largest changes in US healthcare? Or sit neutral payments? Also not on your channel. I gave up watching your channel when it comes to policy approaches because clearly the only policy approach that can fix anything for you is single payer, which may save money but is an unrealistic expectation. Why not get back to reality and look at things working? Things that are market based? Btw, look at the recent health affairs articles that came out this month on bundled payments, they only really work with orthopedic conditions and not so much with highly complex conditions. Moreover, look into the antitrust exemptions relating to ACOs and tell me how that does not contribute to increased consolidation in healthcare thus higher prices. You know what, just try doing research that doesn't confirm your bias for once or get researchers that are knowledgeable in valuation, law, and economics. To start take a read at the Stark law proposed rule change before you get all huffy over fraud and abuse. Not meaning to be dissmisive but your channel should probably steer clear of policy when your researchers have at best a superficial knowledge or clear bias, which is obvious when you cite one article as the basis of your video and provide no citations in your description to provide help to people watching. But also, the article isn't recent. It's from October, and the results were already covered by almost everyone else, even mainstream places like Bloomberg. Running out of ideas over there? Best, -a

[@Loathomar]

First, he gave the numbers for both fraud and abuse and admin costs. Admin costs was $266B vs fraud and abuse costs of $59B to $86B, so Admin cost waste is objectively 3-4 times that of fraud and abuse. The US is also already spending money on stopping fraud and abuse where as we are spending and doing nothing for to lower wasted admin costs. Because this page focus on peer reviewed work for it answered, there aren't a lot of very positive works for price transparency in peer reviewed work. From what I can find, some of the best results from price transparency is a 1% net savings to overall healthcare costs. Not nothing, but even smaller then fraud and abuse costs. But, if you have peer reviewed work on healthcare savings that has been shown to work, please link it. Or else really you are giving up on a page because the peer reviewed work is not what you want to hear and you would rather believe your own political views then what good studies show.

[@DamnKids10]

@@Loathomar Fraud and abuse would be larger without the deterrent from CMS and HHS-OIG. I am not being political, I do not care about parties, I care about policies. He brings up one study, peer-reviewed or not, that is not new. He is not well-versed in policy. Doesn't bring up APMs really at all, what about a discussion from Health Affairs on bundled payments? Came out this month. Why doesn't he bring up any of the final or proposed rule changes from CMS? Why does he mention nothing from the administration that has been done recently to change how healthcare is operated?You asked for studies so here you go do some reading and come to your own conclusion: Price transparency: “21st century political science: A reference handbook” By John T. Ishiyama & Marijke Breuning, Thousand Oaks, CA: SAGE Publications, Inc., 2011, p. 7. Finding that when patients are provided the right comparison tools and information on how to use them to offset mistakes they will make superior healthcare spending choices. “Price Transparency: Not a Panacea for High Health Care Costs” By Kevin G. Volpp, Journal of the American Medical Association, Vol. 315, Issue 17 (May 2016), p. 1842-1847. “The Market for “Lemons”: Quality Uncertainty and the Market Mechanism” By George Akerlof, The Quarterly Journal of Economics, Vol. 84, No. 3 (August 1970), available at: www2.bc.edu/thomas-chemmanur/phdfincorp/MF891%20papers/Ackerlof%201970.pdf “Economic Report of the President: Together with the Annual Report of the Council of Economic Advisers” The White House, March 2019, www.whitehouse.gov/wp-content/uploads/2019/03/ERP-2019.pdf , p. 205. “An Empirical Model of Price Transparency and Markups in Health Care” Zach Y. Brown, August 2019, www-personal.umich.edu/~zachb/zbrown_empirical_model_price_transparency.pdf , p. 2-4. “Shopping For Price in Healthcare” By Paul B. Ginsburg, Health Affairs, Vol. 26, No. 2 (February 6, 2007), www.healthaffairs.org/doi/full/10.1377/hlthaff.26.2.w208 “Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates; Price Transparency Requirements for Hospitals to Make Standard Charges Public” Health and Human Services Department, unpublished rule filed on 11/15/19, available at: www.federalregister.gov/documents/2019/11/27/2019-24931/medicare-and-medicaid-programs-cy-2020-hospital-outpatient-pps-policy-changes-and-payment-rates-and , p. 73, 109, 118, 124. “HHS Finalizes Rule Requiring Manufacturers Disclose Drug Prices in TV Ads to Increase Drug Pricing Transparency” U.S. Department of Health & Human Services, May 8, 2019, www.hhs.gov/about/news/2019/05/08/hhs-finalizes-rule-requiring-manufacturers-disclose-drug-prices-in-tv-ads.html Site-neutrality research I can get you too, I also have a drop box I can send you with more research if you require it. Love, -a

[@DamnKids10]

@@Loathomar Also, not to self-promote but I can send over my articles if you're ever curious ;)

[@Loathomar]

@@DamnKids10 Thank you for that. Though many are not peer reviewed studies on the subject, there is some good information in here. And the only one where I can find clear hard data is "Price Transparency Not a Panacea for High Health Care Costs" where it seems to back up my idea that while there is some saving to be had in Price Transparency , it is highly limited. The best areas for Price Transparency will also a 13-14% savings, while other areas will only see a 1% savings and 65-70% of healthcare cost will have no effect from Price Transparency because people don't have a real choice. And yes, if there where no laws protecting us from Fraud and abuse, then Fraud and abuse would be larger. But where we are now, Fraud and abuse isn't a huge problem and we are currently spending 25% of the savings from Fraud and abuse on trying to stop Fraud and abuse. But we always go from the low hanging fruit first, so if we double spending on stopping fraud and abuse, we would likely get only 50% more cases or less, which might still be reasonable, as would are saving more then is spending. But now we have gone from stop ~10% of fraud to 15%, and by the time we get to 20 or 25%, we will likely be spending as much or enforcement as we are saving, which would be a net loss on cost because we are currently getting a net gain. Over investigation can also has negative effects on the healthcare system. Now, we might be under investing on Fraud and abuse, but to have a real impact on the total Fraud and abuse means a lot of innocent MD would need to be investigated. Ei, when we are only going after what looks like clear cases of fraud, we get a trail 90+% of the time and MD are rarely get falsely accused, but we only get 10% of the abuse. To double this, we will likely need to increase investigations by 4x, so we go from 9 of 10 cases being good to 18 of 40. People don't like being falsely accused, and MD have choices, they are all smart people who could choose to do other things, so we end up with less or worse MD. Or else MD start working "defensive medicine" but to defend against being accused of fraud, which means people get sub-optical care. Fraud and abuse is one of the few areas where we are doing something and it is not that large, doing more with not likely have a big impact and the impact will likely be complex.

[@DamnKids10]

@@Loathomar Research more on price transparency in NH. As far as fraud and abuse it has $4 return for every dollar expended. There is prevalent fraud and abuse and enforcement should be stepped up because so many medical professionals commit fraud. I am not on my work laptop so I do not have the references but off the top of my head here is this: oig.hhs.gov/publications/docs/hcfac/FY2018-hcfac.pdf , pg. 10 And there has been a reform of Stark and AKS, please see: Stark: www.federalregister.gov/documents/2019/10/17/2019-22028/medicare-program-modernizing-and-clarifying-the-physician-self-referral-regulations AKS: www.federalregister.gov/documents/2019/10/17/2019-22027/medicare-and-state-healthcare-programs-fraud-and-abuse-revisions-to-safe-harbors-under-the I can give you reference to a good issue brief on both documents so you don't have to read the whole thing when I am back on my work laptop. However, I think you may be misled or misinformed. Also, no comment on site-neutrality? Bundled payments? ACOs? HMOs? Market consolidation? Insurance tax? Here's some more on transparency: “Self-Insured Employers Are Using Price Transparency To Improve Contracting With Health Care Providers: The Indiana Experience” By Gloria Sachdev, Chapin White, Ge Bai, Health Affairs, October 7, 2019, www.healthaffairs.org/do/10.1377/hblog20191003.778513/full/ “Leadership Commitments to Improve Value in Healthcare: Finding Common Ground: Workshop Summary” By John W. Rowe, LeighAnne Olsen, W. Alexander Goolsby, and J. Michael McGinnis, The Institute of Medicine of the National Academies, 2009, p. 273-274. “Does Price Transparency Improve Market Efficiency? Implications of Empirical Evidence in Other Markets for the Health Sector (CRS Report for Congress)” By D. Andrew Austin and Jane G. Gravelle, Congressional Research Service, July 24, 2007, fas.org/sgp/crs/secrecy/RL34101.pdf , p. 1. Veerma has a pretty strong rationale behind transparency, read here: “Commentary: You wouldn’t buy a car without knowing the price. So why are health care prices hidden?” By Seema Verma, The Chicago Tribune, December 3, 2019, www.chicagotribune.com/opinion/commentary/ct-opinion-health-care-prices-20191203-mpphzha4ofhwhftwid3od4mxoi-story.html Prices rising faster due to higher prices charged by healthcare organizations: “Hospital Prices Grew Substantially Faster Than Physician Prices For Hospital-Based Care In 2007-14” By Zack Cooper, Stuart Craig, Martin Gaynor, Nir J. Harish, Harlan M. Krumholz, and John Van Reenen, Health Affairs, Vol. 38, No. 2 (February 2019), p. 184. “National Health Care Spending In 2018: Growth Driven By Accelerations In Medicare And Private Insurance Spending” By Micah Hartman, Anne B. Martin, Joseph Benson, Aaron Catlin, and The National Health Expenditure Accounts Team, Health Affairs, Vol. 39, No. 1 (January 2020), p. 8. “Drivers of 2018 Health Insurance Premium Changes” The American Academy of Actuaries, July 2017, www.actuary.org/content/drivers-2018-health-insurance-premium-changes ; Hartman, Martin, Benson, Catlin, and The National Health Expenditure Accounts Team, p. 8. Health insurance tax: “IRS says reinstating ACA insurance tax would cost insurers $15.5B in 2020” By Michael Brady, Modern Healthcare, September 4, 2019, www.modernhealthcare.com/insurance/irs-says-reinstating-aca-insurance-tax-would-cost-insurers-155b-2020 “Analysis of the Impacts of the ACA’s Tax on Health Insurance in Year 2020 and Later” By Chris Carlson, Glenn Giese, and Thomas Sauder, Oliver Wyman a Marsh & McLennan Company, August 28, 2018, health.oliverwyman.com/content/dam/oliver-wyman/blog/hls/featured-images/August18/Insurer-Fees-Report-2018.pdf , p. 3-4. what about advantage plans? “Medicare Advantage 2019 Spotlight: First Look” By Gretchen Jacobson, Anthony Damico, and Tricia Neuman, Kaiser Family Foundation, available at: files.kff.org/attachment/Data-Note-Medicare-Advantage-2019-Spotlight-First-Look , p. 1-4. Really admin costs? But what about when insurers leave a market? “The Marketplace Premiums Increase: Underwriting Cycle Or Death Spiral?” By Jon Gabel and Heidi Whitmore, Health Affairs, February 8, 2017, www.healthaffairs.org/do/10.1377/hblog20170208.058341/full/ “Market Concentration and Potential Competition in Medicare Advantage” By Richard G. Frank and Thomas G. McGuire, The Commonwealth Fund, February 2019, available at: www.commonwealthfund.org/sites/default/files/2019-02/Frank_market_concentration_medicare_advantage_ib_0.pdf “Competition Among Medicare’s Private Health Plans: Does It Really Exist?” By Brian Biles, Giselle Casillas, and Stuart Guterman, The Commonwealth Fund, August 2015, available at: www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2015_aug_1832_biles_competition_medicare_private_plans_ib_v2.pdf But having health insurance makes people use it more, increasing spending: “Insurance and utilization of medical services” By Jonathan Meer and Harvey S. Rosen, Social Science & Medicine, Vol. 58, Issue 9, May 2004, p. 1623-1624. Why not just automate most of what physicians do and eliminate error and reduce a major portion of healthcare costs? To see the research and articles on this please wait until I get to my work laptop. You may find this interesting. Best, -a

[@WarrenQueeney]

The first point in this video is wishful thinking at best: "Even a 'divided' America can agree on this goal: a health system that's cheaper but doesn't sacrifice quality." That doesn't seem to be true given the broader discourse amongst our politicians and the media at large. This channel has a fundamentally "ivory tower" perspective that pre-assumes a certain level of education and critical thinking that most of our electorate and representatives simply don't have. In the end, the content of these videos, coupled with Aaron's loud and aggressive delivery, serves only to stress out people like me who fundamentally agree with these evidence-based arguments, and I'm doubtful that any viewer's opinion has actually been changed as a result. I started watching these videos in order to have a more informed opinion about health care in general, but the value I get from these videos has been decreasing for quite some time. I've decided I'm going to unsubscribe, but I wanted to give this feedback; in my opinion the format of these videos needs some rethinking. What is the message? Who are the audience? Is the content being delivered in an excessively condensed way? I have never doubted Aaron's competence, and he is very efficient in sharing information and making his point. But I have only gotten more disparaged by these videos over time, and I'm simply fed up.

[@DustinMaxim1015]

@Healthcare Triage , I do love this channel and Aaron, but I have three points of critique I'd like to address. 1) I too think you should consider the rhetorical purpose of each video. Perhaps make your thesis more clear. 2) As I assume the team is aware, many of your videos have been preaching similar ideas. I think we're all sick of hearing about bad research, even if it garners views through people sharing your videos with their misled friends and relatives. 3) As important as the research is in each episode, it can be very hard for the viewer to hold on to the central thesis when several minutes of the video are spent going over details of research. You may need to slow down and hand-hold the viewer into understanding WHY research is relevant.

[@Hyperian]

Just vote for Yang!

[@anttikokko7209]

Dumbass

[@UnbreakableRukawa]

Only dumbasses are the ones not voting for yang if they actually need the extra 1k income.

[@greymind9815]

@@UnbreakableRukawa lmao imagine thinking you can use those thousand to pay healthcare bills. Yangs healthcare plan is WORSE than joe bidens!

[@emceeunderdogrising]

So President's write health care legislation now? I always thought Congress did that part? Can you look at me with a straight face and say Yang wouldn't sign a M4A bill?

[@jimmytyson6726]

@@emceeunderdogrising He wouldn't he does nothing to address the private insurance companies that have leeched off the American people and their government for 100 years.