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What makes the US healthcare system so expensive? Why is the US so expensive compared to Canada?
There are a long list of reasons but here's a start.1. Americans won't permit or accept healthcare rationing. America spends much more for care in the last 6 months of life than any other country. By a lot.Walk through any ICU and you'll routinely see some people in vegetative conditions with virtually no chance of getting better. Yet they are receiving a full court press with anything and everything that can be done from the standpoint of medical technology.Some of the push for this care comes from families who are adamant against witholding or withdrawing care. But doctors are also guilty of over treatment. We all know some crazy doctors who believe that miracles can happen daily in the ICU regardless of how hopeless the situation may be.The expense is enormous and American families are divorced from it. If the patient is uninsured, the costs are absorbed by the treating hospital and the doctors. If the patient is insured, the deductible has been met and the rest is paid for by insurance or via the taxpayers (Medicaid/Medicare). 28% of Medicare costs involve the last 6 months of life. That is a ton of money.You won't see this in any other country with a national health service. Elderly patients don't get started on dialysis in the NHS in England. They die of kidney failure. You won't see 75 or 80 year olds getting quadruple bypass surgery either. Cancer patients in Canada and England routinely don't get $10,000 a month drugs for cancer treatment that prolongs life by several months (on average). The drugs either aren't available at all like in Canada where some cancer drugs never get approved, or they are made virtually unavailable through a lottery in England.Americans are often overtreated. NHS patients are often under-treated.End-Of-Life Care: A Challenge In Terms Of Costs And QualityCancer drug lottery still rife I'm proof that a new wonder drug beats skin cancer. So how can the NHS let thousands like me die?Wait Time For Cancer Drugs In Canada Exceeds U.S., Europe2. Americans pay much more for pharmaceuticals than anyone else in the world. The American government under pressure from the Big Pharma lobby refuses to negotiate discount rates for Medicare. So Americans pay 30% to 300% more than Canadians for the identical drug made in New Jersey or California.U.S. Consumers Foot the Bill for Cheap Drugs in Europe and Canada3. There is gigantic waste and fraud in Medicaid and Medicare programs. Billing is electronic and payment is automatic. Auditing is very expensive and apparently very rarely occurs. It's so lucrative and easy to skim hundreds of millions of dollars per scheme that organized crime is now involved.  There are reasonable estimates that the fraud is $120-180 billion a year. This are astronomic numbers.Comments are frequently made about how efficient Medicare/Medicaid are because they have such low administrative costs compared to insurance companies. (It's pretty difficult to scam insurance companies for large amounts of money.) But the administration of Medicare/Medicaid includes the Department of HHS and also various law enforcement arms of the federal government. That's not cheap. And it's apparently not very effective either.And while every state struggles with Medicaid fraud, the Office of the Inspector General says the five topping the list are California, Texas, New York, Ohio and Kentucky. The good news is that states recovered $1.7 billion in fraudulent payments in 2022. The bad news is the government had to spend $208 million to do it.Medicare And Medicaid Fraud Is Costing Taxpayers Billions4. Americans demand immediate access to technology. We want the ability to get an MRI or PET scan tomorrow or that latest diagnostic test and treatment reported on CNN. That kind of access is incredibly expensive both in overhead to build the facilities and purchase the machines let alone the costs of the procedures.  In no other country does this happen. Many small American cities have more MRI scans and PET scans than exist in entire provinces of Canada. In Canada and England there is a waiting list for these kinds of tests and they are often not approved because the yearly budget runs out of funds.We Americans want these tests sometimes even when they are considered not necessary for good health. We ask our doctors to rule out the 1 in 10,000 event. It's human nature to want the latest and greatest of everything. But its never free and this kind of medical care costs a tremendous amount of money.More than half of lower-back MRIs ordered at two Canadian hospitals were inappropriate or of questionable value for patients—and family doctors were more apt than other specialists to order these unnecessary tests, according to newly published medical research from Alberta and Ontario teams.The findings are important because in some parts of the country, MRI tests for the lower back account for about one-third of all MRI requests. Across the country, wait times for MRIs are long and patient access is limited.Requests for lower-back MRIs often unnecessary: studyOur friends in Canada and England accept rationing of healthcare sevices. Americans give no indication that they are willing to. Look at the uproar over the IPAB (called by some death panels) in the ACA law.5. The wasteful practice of defensive medicine. In American there are enormous numbers of unnecessary tests and scans that are performed by a doctor to cover his/her ass just in case of a lawsuit. It's impossible to practice in America without facing the threat of litigation. I and every doctor answering honestly will admit to ordering defensive tests.I've seen estimates of $600+ billion a year in unneeded tests and procedures done primarily to avoid litigation. That's a lot of money that could otherwise go to insuring the uninsured. Opponents to tort reform quote very small numbers because they only use the cost of defending lawsuits in their equation. But that's a drop in the bucket compared to what doctors in America waste so that no one will accuse them of "missing something".Defensive Medicine: A Cure Worse Than The Disease
How do I compare the benefits of Long Term Care Insuarance to other investment options?
I would not place long-term care insurance in the same basket of investments, keep in mind INVESTMENT is action or process you take of investing money for profit. when you invest you expend your money with the expectation or the hope of achieving a profit.A long-term care insurance plan is a protection, a smart move on your part by preparing your self in case you need long-term care.That's another word to keep in mind LONG TERM CARE meaning those who suffer from chronic illnesses, disabilities or serious conditions need on a minute, hourly or daily basis over an extended period of time.There is no profit here to be made, the benefit would amount to which coverage options you choose and that in itself come with requirements such asageincomesavingstaxes...When you looking at a long-term care insurance you not looking to make any profit whatsoever. The most important factor to you should be asking yourself if in the future I suffer from chronic diseases and need of long-term care, will I be ok! will I be able to sustain my needs.
How do Kejriwal fanatics explain the fact that he simply increased the subsidy to reduce the power bills and increase the water allocation conditionally on a short term basis with no major long term benefit?
Right not much long term benefit but relief to alot of poor people..A public representative felt that one category of people were suffering, so he gave subsidy for them.. On a long term, he wanted to give relief without by reducing cost and no subsidy..
What are some basic financial advice that can benefit you now?
[Indian context]Maintaining minimum balance in your savings accounts: If your bank rquires you to maintain, say 10000 rupees, as minimum balance, don't worry it does NOT mean you'll have to keep Rs. 10k at all times in your. RBI guidelines require banks to calculate minimum balance on Monthly Average basis (MAB) or Quarterly Average basis (QAB). If it is MAB, it means your minimum balance will be calculated as sum of balances at the end of each day of the month divided by 30. So 30k kept for 10 days is equal to 10k kept for 30days or 20k kept for 15days. For QAB the average is calculated for 90 days. You can meet the min balance requirements accordingly.For Public Provident Fund (PPF) accounts, the interest for each month is calculated on the minimum balance between the 5th and the end of the month. So make sure you deposit into your PF account before 5th of a month to maximize your interest income.You may have come across articles and write ups telling you how investing in shares of Eicher Motors or Wipro 10 or 20 years ago would have given you X times returns (where X is any large number). However, these write ups don't tell you that there are double the number of stocks that went from triple digit values to becoming penny stocks during the same period. So a "very long term" strategy is no guarantee of huge returns in the stock market.Continuing with stock markets, do not go for intra-day trading if you are a novice, no matter how tempting it seems. The big players out there have good deal of insider info and manipulative capacity. They are the ones who make money.Pay your credit card bills in full and on time.If you are still holding cryptocurrencies, sell them off NOW.Do not share your OTP for any reason whatsoever. Also, do not believe in "you've won X million dollars" mails/SMS. This advice might sound too obvious, but believe me, an alarmingly huge number of educated people fall prey to such scams. This includes banks professionals!Update: Seems like advice #6 is not readily acceptable to the crypto-enthusiasts. If you are one of them, you should read this - Alqama Pervez's answer to Does the Reserve Bank of India recognize Bitcoin as currency? Should an Indian buy it?
What is the best way to make a million dollars?
There is no one best way to do anything, but there IS a shortcut to making a million dollars.First of all, a million dollars is not a lot of money in relative terms. You drive by millions of dollars every day and you don’t blink.Case in point, have you ever driven by McDonalds?The average McDonalds restaurant makes $2.6 million a year in revenue at a $500,000 - $1 million profit.So, if you could open up a McDonalds, that might get you there.However, here is another way to look at it…It is easier to make a million dollars if you have a starving crowd.Specifically, if you can find a group of people who is starving for something and is willing to spend money to get what they want, it is easy to make money. Go to a college/professional football game and watch what what happens at halftime.Thousands of people get up, go to the bathroom, and buy food. The concession stands aren’t full of great salespeople. They have minimum training order takers and they rake money in hand over fist.Why? The people are literally starving for food!So, to make a million dollars, find areas where people are starving for something and feed them. That can be knowledge, a product, a service, anything.When you break an arm and go to the hospital, you don’t shop around for the best price. You just want your arm fixed.When the new iPhone comes out, there is a mad rush to get the latest model. They’ll be backordered for months potentially. Anybody selling the new iPhone has no trouble making sales.When the Tesla Model 3 was announced, thousands of people signed up to pre-order.When a catastrophe happens like a hurricane, the government spends millions on food, water, and shelter for people.When people have to file their taxes every year, accountants are swamped with customers.And so on and so forth…You don’t have to be particularly brilliant or good if you are in the right market. You can make a lot more money being average in a market that is starving than being an exceptional in a market that isn’t.Anyone can sell water to thirsty travelers in the desert. It’s harder to sell a snow cone at the north pole.So to me, the best way is to find hungry people and feed them. And if you pay attention, you’ll see them all around you.Now, if you want to get started on getting to making a million dollars I’ll give you a trick to use and then I’ll explain why it’s so important that you do this.Go to your house, apartment, or wherever you live and find something you want to get rid of. Like an old video game, a copy of Harry Potter, or a set if tire rims sitting in your garage.It can be just about anything.What you need to do is take that item and post it to Craigslist for sale at a price you believe someone would be willing to buy it (that’s not the same as how much you want to sell it for or you think it should be worth).Take good pictures. Write a thorough description. Leave good contact information.And when you are done ask yourself, “if I saw this on CraigsList, would I call/text/email to see the item in person?” If yes, you’re good to go, if no, go back and fix the ad.Depending on where you live, you might get phone calls on it the same day. Great.It might take longer and that’s fine too.Take the money you get from selling this and get more stuff to sell profitably. After a while, you’ll get an idea of what people buy and why they buy it.This works as well for used audio equipment as it does used cars. I know of men who have made good side incomes selling both on CraigsList.Once you get good at turning money over, you’ll start looking for more ways to turn money over and more places where there are starving crowds.Eventually, you’ll find yourself making a lot of money. Could be thousands, could be millions. The dollar amount is not important.The important skill is finding starving crowds and• SELLING TO THEM!You only make money when you sell something. The real key to making a million dollars is to sell millions of dollars worth of stuff, and to do that you need to get good at selling.Go get good at selling.-BrianP.S. I unpack more ideas in Creative Genius
What would an ideal drug discovery/drug development process look like?
Some great answers covering a number of key ideas. I have a slightly different (slightly off topic) thought. I hope it can be considered relevant.An ideal drug discovery / development process would be one that is completely decoupled from the whims of investors and banks. Whilst there are many, many inefficiencies and pitfalls available for the drug discovery process to fall prey to (I speak from experience here!), the biggest step we could take to make the process ideal would be to remove all concept of return-on-investment / profit making from the process. This can be illustrated pretty simply:Average desired time-frame for an investor or VC to achieve  5-10 fold return on investment : 3-5 yearsAverage "acceptable" tenure for a CEO within the sector : 3-5 years (?) Time to design and develop a successful drug, from concept through to market: 15-20 yearsIt doesn't take a genius to see there is a clear disconnect here.Until the money required to perform the science is linked to a realistic time-frame and expectation, the drug discovery process will continue to falter: Scientific research is not a true process in the classical business sense and it's practitioners require time to actually, well, search. Bringing unrealistic (i.e. fixed!) time frames into the process is only going to result in low quality products designed to appease the money masters and ultimately result in a failure.Once we've solved that little conundrum (!), and to truly answer your question, I would say the ideal drug discovery process would look like this:1) Smart academic group make significant, robust discovery concerning the involvement of a particular protein in a particular disease (Year 0)2) Drug discovery groups (i.e. biotech / pharma / research institutes) discover a relevant means of interfering with this protein (biologic or small molecule starting point) (Year 1)3) Medicinal chemists and / or molecular biologists turn the starting point into a product capable of being a drug (i.e. improving the potency, thus lowering the dose, modifying and stabilizing the product such that it can be administered in the desired manner with the desired dosing regimen) (Years 2-5)4) Prepare the product for phase I clinical trials, including preliminary toxicology and establishing a means for manufacturing on the required scale (Years 6-8)5) Phase I trials (Year 9)6) Prepare for Phase II trials (Years 10-11)7) Phase II trials (Year 12)8) Analysis of Phase II data (Year 13)9) Prepare Phase III (Year 14)10) Phase III trials (Years 15-16)11) Analysis of Phase III data (Year 17)12) Regulatory filing and regulatory body decisions (Years 18-19)13) To Market! (Year 20)
How effective is the healthcare system in Israel?
For all tl,dr's out there I shall just state that it's a semi-public, mostly subsidized system, which IMHO is a very efficient, modern healthcare system, and most importantly - affordable for all, without compromise on quality of care. Below is a more tedius account of how exactly the Israeli healthcare system is build and works.The Israeli heathcare system is a simple, efficient system (4th in the world[1]) mostly subsidized by the government. Unlike other countrie's subsidized systems where the goverment is also the sole services provider, here there are 4 competing healthcare "providers", they have a regulated competition for the consumer's pockets. These are called "Kupot Holim" (קופות חולים, literally ״sick peoples funds", miserable choice of words..) Each provider gets high subsidies from the government, but may request each registered member a (regulated) monthley or quarterly fee - These fees should not be likened to insurance, but more to a co-op membership fee. Discrimination by these funds on the grounds of pre-existing conditions is illigal. Mobility between providers is possible. Monthly fees are same to all members (nowdays they do have "gold packs" which are a bit more expensive) If I'm not mistaken, it's around 20$ For 3 months for the regular pack. People under the poverty line get government help (social insurance etc) so being a member in such a fund is really accessible even for the poorest. According to a 2022 survey [2], 2m out of the 7.7m insured members had their fees reduced or payed in full by the government since they are unemployed, senior citizens, disabled etc. To my knowledge, no one has ever been arrested for "not becoming a member" of such a fund. Inability to pay will usually be sorted by government assistance of some sort. I don't think they take the periodic fee things to court. So it's mandatory, but not heavily enforeced. Anyway, since it's so cheap, the vast majority of the people have no issue with it being compulsory.As Ido Sarig mentions, one should note that the biggest expense in addition to the above mentioned copayments / monthly membership fees is a mandatory, socialist-in-character, must-pay progressive health tax of 3.1%-5.1% of one's income (capped). This been said, about 30% of israeli's don't pay any of this tax, and many more pay a minimum of 30$ (103NIS) a month. Minor children are exempt. (That is, parents are exempt from paying their children's health insurance tax..) The tax is deducted from one's paycheck, and Employers are not involved in this (no employer contribution). Unemployed, self employed, and others are taxed in other ways. (When not exempt) Soldiers are exempt. Basically from the age of 0 to 21 your parents barely pay anything to pryou with healthcare. (At least not in direct taxation)In addition to periodic fees, the providers collect fees for services on a per-use per-item basis. These fees are very low. A meeting with a gp can cost around 5$ (usd) where in the consecutive three months one is alloted (about) three or four additional meetings for free. Same goes for specialists - a single 5$ fee typically buys you a few meetings. Ultrasound, lab tests etc. are also very cheap, some are free of charge. All providers have web sites and mobile apps where one can see lab results, find a doctor by location, availabilty, gender, spoken languages, specialty, and set an appointment. All medical files are digital. Scribbled doctor handwrting is a rare sight. The providers operate "big" clinics - smaller than a hospital, bigger than a private western world clinic. Usually a 10-30 room building, with reception and other amenities. Feels like a public building, usually clean, sometimes the decor is outdated and worn out, but the clinics are always clean and tidy. Some are general medicine clinics, some are specialists' clinics. The big ones also have labs, x-ray, ultrasound and more services. Waiting times for simple services are really ok - I usually get to see a gp the same day I want to, within the hour is not rare. (Even for influenza etc.) Doctors do have their scheduled timing pushed, and usually one may wait 15 minutes after the appointed time to get in. Waiting times for services such as blood lab, x-ray are worse, and can be half an hour to an hour.. Availability gor a specialist is usually in the range of few daus to a two week wait, depending on the specialty and urgencgy of the matter.Pharmacy drugs are subsidized as well. Most pharmacies respect most healthcare providers, passing the provider's magnetic card at the cash register will slash the bill by 50%-70%. Over the counter drugs are not subsidized, perscription drugs are, and the majority of these are really cheap. Unless you have a really rare or expensive drug that you need, you won't go broke from drug costs, even in chronic, long term consumption.Hospitals are run by a mixture of the healthcare providers, government, and private operators, where ER admittance and real care there is free for all. I have never had to feel I may not be helped because of my coverage, and the bulk of the paperwork is left for after the patient was taken care of and treated completely. I was once hospitalized for two days and later realized I was never required to fill any form or get any paperwork while I was there except for passing my provider's magnetic card and giving my details in the ER admittance/triage.The bad things in the system are surgeries and long term hospitalization or complex, rare diseases. Long waiting times for surgeries, costly transplants, and surgeons who practice under the provider's umbrella AND private hospitals concurrently, surgeons who make it a practice to pitch private services to their patients and more rarely but not that rarely, take bribes for faster/better services, or transfer of a public time-slot they comitted to for the benefit of a privatly paying patient, thus "robbing" already scheduled surgeries from public (provider) patients, casing those to be pushed later. With all this said, still, one can be hospitalized for a few days in a nice room with a 1-4 other patients for a price that would be liveable - no one here considers leaving hospitalization earlier because it will be too expensive for them. One can feel confident enough thst unless one has a rare condition or a need for a hugh surgical expert transplant, the cost will be possible to withstand with an everage salery, without going bankrupt or breaking your saving funds / pension plans. In the past few years the healthcare system has been inching towards more privatization and insurance company intervention - it seems like prices rise as greedy unregulated parties get bigger and bigger pieces of the pie. In israel, it is a common conception thet a totally free, capitalist health market wil be bad for most citizens, and will assentisly be a provider cartel or health business complex price-fixing greedy scam on a national level. Many Israelis are aware of how the US health market/circus looks like.Children and fertility is a fanatically subsidized area. Infant/child development clinics ("Tipat Halav" טיפת חלב - literally "a drop of milk") are free, vaccinations, consult, child development follow up and checkups are slmost all free, meeting are scheduled FOR parents and sent to their homes at regular intervals, even thiugh attendance us not mandatory by any law or regulation. Most parents arrive, though feel a bit pushed to do so by the "establishment". Fertility treatments and IVF thingies are heavily subsidized as well.Old peoples homes are not subsidized (at leat not by the healthcare system), but old people do have reduced fees for many services in Israel, and under a certain income/pension threashold get government help for a nursing/old peoples home. If one takes a (degrading) assesmet by a national insurance official, the government progressively helps pay for a private nurse for that elder, according to severity, usually for a few days per week. The elder (or elder's family) may hire whoever they wish to hire (licenced nurses) and may compliment with their own funds for a full 7 days or 24/7 nursing coverage.An anacdote of this elder nursing thing is that so many elders can afford some kind of hired caregiver, that a real wave of Philippines, Srilankan and other Asian foreign workers have influx on work visas Into Israel. So much that the sunny steets around school hours typically host a hefty amount of elders strolling along with walkers or wheelchairs accompanied by young Asian caregivers, usually with some kind of mobile device to pass their time.[1]http://www.bloomberg.com/visual-...[2] http://www.btl.gov.il/Publicatio...[2]  http://en.m.wikipedia.org/wiki/H...
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