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279 points bookofjoe | 18 comments | | HN request time: 1.506s | source | bottom
1. siliconc0w ◴[] No.44609926[source]
Sadly health insurance in the US is unlikely to pay for most preventative care because the followup costs of false-positives and that they are betting that down the line someone else will pick up the tab when you get sick decades later (like the government).

It's kind of why I'm favor of universal option to align financial incentives. Like given how sick the US population is, it probably makes sense to put a lot more people of GPL-1s and invest in improving their efficacy and permanence. Like nationalize-the-patent COVID-operational-warp-speed level urgency. There are over 100M Americans that are pre-diabetic, the cost of treating a diabetic is about 20k/yr. So $4 trillion in new costs, on top of the misery and human suffering.

replies(6): >>44610089 #>>44610202 #>>44610203 #>>44610287 #>>44612299 #>>44613546 #
2. johnisgood ◴[] No.44610089[source]
It is sad that prevention is not something the US considers very important.
replies(1): >>44610217 #
3. riscy ◴[] No.44610202[source]
How do you convince those pre-diabetic people to use a GLP-1? There was quite a bit of backlash about the one-time injection COVID vaccine when it was mandated.
replies(2): >>44610473 #>>44611129 #
4. ada1981 ◴[] No.44610203[source]
I wonder how much of that is directly tied to corn subsidies.
5. ziml77 ◴[] No.44610217[source]
They care about prevention but only if it's very cheap. I get emails all the time from my insurance company about joining their program that is supposed to help you live a healthier lifestyle.
replies(1): >>44610431 #
6. ruralfam ◴[] No.44610287[source]
I have a friend nearing mid-60s. Retired military so now covered by Medicare, then Tri-Care. Having prostate issues. PSA went from 12 to 19. Desperate to get a PET scan to determine his is benign BPH, or cancer. Cannot get his scan approved since both insurances will not approve a PET as an early diagnostic tool (scan is about $7500). Cannot imagine what will happen if everyone getting a cancer DNA signal of this type tries to get clarification via additional tests. USA health care really does not work that way. HTH, RF
replies(1): >>44610737 #
7. johnisgood ◴[] No.44610431{3}[source]
Any details on this program?
replies(1): >>44610957 #
8. lispisok ◴[] No.44610473[source]
Are you expecting the government to mandate GLP-1 agonists the same way they tried to mandate the covid shot?
9. brudgers ◴[] No.44610737[source]
A PSA of 12 is pretty far past the threshold for an MRI (don’t know about a PET scan) and an MRI would be pretty determinative about whether or not a biopsy is warranted. A biopsy would be pretty good at identifying cancer.

Sounds like either there are complicating factors or an absence of standard protocol adherence.

US health insurance is a mess, but that doesn’t sound like the entire story. I suspect urologists see a fair amount of friction for routine procedures related to prostrate health.

replies(1): >>44611139 #
10. jacobgkau ◴[] No.44610957{4}[source]
I started getting emails from Cigna about Omada after switching over to them last year. They pitch it as something you can sign up for to get health coaching. They (or their AI, soon if not already) provide that by sending you some "free" sensors (scale, pedometer, etc) and collecting lots of health information.

Searching the web shows that Cigna forces some patients to use this program in order to receive coverage for certain conditions. They're likely saving all the info collected through it in order to use it to deny you coverage if they can at all make an argument that something was caused by your lifestyle, was pre-existing for a certain amount of time, etc-- at least, that's the vibe I got from researching it.

replies(1): >>44611295 #
11. skissane ◴[] No.44611129[source]
You don’t need to mandate it, heaps of people who are obese or overweight are eager to take it, because they are sick of being this way, worried about the long-term health risks, feel the societal sigma, etc. For many such people who currently don’t, the big reason is not that they don’t want to, it is that their insurance doesn’t cover it and they can’t afford the $$$ of paying for it uninsured-but as patents expire the price is going to come down. Other people don’t like injecting themselves, but oral formulations are becoming available

COVID was different because being a transmissible disease, there was a strong motivation to try to maximise the percent of the population immunised. With GLP-1 agonists, if you made them freely available, likely over >50% of eligible patients would take them voluntarily, which would result in massive long-term cost savings from lifestyle diseases, even considering the continued costs from the other 50% who will refuse. And insurers may even give discounts to those who take GLP-1s (if permitted by regulators)

GLP-1s are probably going to have the unintended side effect of increasing weight stigma - already obesity skews poor, once most of the well-off obese people cure their obesity with GLP-1s it is going to skew even more poor. I can foresee a cycle in which GLP-1s increase weight stigma which pushes more people into taking them which then increases weight stigma even more, which could drive up their adoption even further

12. ruralfam ◴[] No.44611139{3}[source]
He had the MRI. Not conclusive. The PSA jump (alredy very high) is biggest concern. PET would -- according to him -- be most conclusive. Yet he cannot get it approved, so lives in a cruel medical purgatory.
replies(1): >>44611269 #
13. brudgers ◴[] No.44611269{4}[source]
Prostate biopsy is an out-patient procedure and is a standard protocol for determining the presence of cancer.

Like I said, there is more to this story.

replies(1): >>44611663 #
14. johnisgood ◴[] No.44611295{5}[source]
> They're likely saving all the info collected through it in order to use it to deny you coverage

Oh God, that is so sad and infuriating. :(

15. ruralfam ◴[] No.44611663{5}[source]
He had a biopsy a while ago. It was negative (and very painful he said). He has been working closely with his urologist who has recommended the PET. Given the PSA jump he is really worried, and cannot get what I presume is his urologist's next recommendation. He has taken all the right steps, just to be denied re: PET. (To be honest I do not know if PET is that effective, but he says it would be definitive.) He was told, though, that should he get cancer the PET would be approved to enhance the diagnosis. My heart goes out to him. RF.
16. refurb ◴[] No.44612299[source]
US private healthcare insurance is required to pay for “medically necessary” treatments and generally does pay for medicine where they are unlikely to see the benefits (see statins).
17. ETH_start ◴[] No.44613546[source]
Any bureaucratic system is going to be inefficient. You see it in countries with universal healthcare. In Canada, some provinces now have wait times of over a year from referral to treatment. Many European countries face similar access issues, though France and the Netherlands perform somewhat better.

The U.S. is a different kind of mess. It’s a patchwork of heavy government restrictions, large public programs like Medicare, and for-profit corporations, all thrown together without a coherent design. It’s no surprise it’s expensive. In 2023, healthcare spending was nearly 18% of GDP. Another factor could simply be wealth: higher per capita GDP tends to correlate with higher healthcare spending. To be fair to the U.S. healthcare system, it is highly capitalized, with much higher concentrations of diagnostic equipment like MRI machines than other OECD countries, and it does have some of the highest five-year survival rates for cancer and heart disease.

Even so, all of these healthcare systems are heavily dysfunctional in many ways.

In contrast to all of this, cosmetic surgery and laser eye surgery are the only fields of medicine where prices have actually fallen in inflation-adjusted terms, which is extraordinary, as prices in healthcare in general have increased much faster than inflation. The superior performance of these fields is because of basic market dynamics. People pay out of pocket, so they’re price conscious, and providers compete. There are also fewer regulatory restrictions since these fields aren’t tied up in government programs like Medicare.

Innovation is the only thing that reliably drives prices down. But in most of healthcare, it moves slowly. Devices often take 10-30 years to cycle out. Compare that to consumer electronics, where turnover happens every 1-2 years.

If it were up to me, I’d make restrictions on medical providers much lighter. Anyone could offer medical procedures as long as they disclose they’re uncertified and include a government-mandated warning. That kind of freedom is necessary to solve hard problems. You can’t regiment innovation and industry development. Gatekeeping in the name of consumer safety is the worst thing that can be done to any industry, and unfortunately, there is heavy gatekeeping in healthcare.

That is not to say that I am opposed to government intervention in general. I think it can play a critical role in advancing healthcare. Where government intervention creates the most value is in funding research for the public domain: drug designs, medical procedures, and open datasets. These investments have enormous returns and are best handled by governments. If the private sector focused on delivery and innovation, with governments making strategic contributions in foundational research, healthcare would see revolutionary improvements generation after generation.

replies(1): >>44614317 #
18. chronogram ◴[] No.44614317[source]
> though France and the Netherlands perform somewhat better.

It's all private in the Netherlands, just with non-discriminatory mandatory private insurance, so that makes sense.