221–230 of 359 posts
>Currently, up to 40% of all healthcare funding is wasted on operational inefficiencies Your inefficiencies are someone else's revenue. Or to say another way: Healthcare is ~20% of US GDP Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.
http://www.investopedia.com/ask/answers/08/broken-window-fal...
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Exactly! Hospitals don't care about inefficiencies because insurance pays for it. Patients don't care either again because insurance pays for it. Insurance can't negotiate with hospitals as patients don't ever want to lose their doctors and revolt if insurance even brings up dropping a hospital for charging exorbitant rates. Add to it an insane 4 years in college + 4 years med school curriculum that does not incentiv…
You forget one part: patients do not care what insurance costs because their employer chooses what they use and what price they pay. If I could buy health insurance separately from my company I'd look into it. I know my company pays at least as much as I do for my insurance, but if I go off the company plan I can't get that money to use for insurance I like. The result of this is I have incentive to not care what any…
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Corruption. However, the line is generally described as: If companies can't discount per country then all countries end up paying high prices without discounts. However, if they can discount prices in some countries then that maximizes profits which increasing the customer base.
It's much more complicated than that. Sales in the US where they can charge more are what actually offer pharma companies good ROI. Effectively the US is subsidizing R&D for the rest of the world.
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>Universal healthcare is already much more cost effective than fully or semi-privitised health care. That's not true. Most developed countries have some form of privatized system, falling into your 'semi-privatized' definition. It's more cost-effective.
In Australia we have a universal healthcare system for everybody and a private system that runs alongside that essentially gets you a more comfortable bed and the ability to jump the queue for non-critical surgery.
(Full-time co-founder of a healthcare startup here): W/r/t the US specifically: it seems there is no shortage of inefficiencies and obvious solutions to the inefficiencies in the US healthcare system. To me, the real problem seems to be a system that has almost diabolically evolved to create competing interests that deadlock all sides into a sub-optimal solution. Specifically-- patients, payers, physicians, pharma, f…
Whenever you have a $500 bottle of orange juice, I think it screams that you're not in a competitive market.
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It's much more complicated than that. Sales in the US where they can charge more are what actually offer pharma companies good ROI. Effectively the US is subsidizing R&D for the rest of the world.
Agreed. Pharma is managing their expenses and profitability based upon the ability to charge much higher prices in the US. Take that away and suddenly everyone outside the US will have to pay more -or- Pharma will have to rethink their business model. The more this connection is obfuscated the easier it is to confuse decision makers.
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I bet making structural changes so that cost of care is more visible to patients would help a lot in the US. Of course this means disincentivizing health care as a benefit rather than incentivizing it, so it will never happen. It is kind of happening with things like HSAs, but not really. We should also work on removing arbitrary barriers to entering the supply side of the market. Not just for individuals that want t…
> but certificates of need But they came about to protect the consumer from high prices. If I own a hospital and buy a $300,000 MRI machine I need to make that money back over the 10 year life of the machine. I charge one price if it's used by 10 people a day; I need to charge double if it's only used by 5 people a day. The extra supply reduces demand and thus increases prices to the customer. And it's unethical to j…
Please give me one other example in an unregulated market where your MRI machine example makes sense. It sounds good on paper, but that doesn't happen in any other market in the western world.
If there are two competing gas stations, prices get cheaper. Two competing airlines, prices get cheaper.
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>> Add to it an insane 4 years in college + 4 years med school curriculum that does not incentivize more people to even attempt getting into med school. While I agree with your points in general, this point is wrong. There are far more applicants for medical school (both MD and DO programs) than there are slots. I've been told this was done by the AMA to keep the supply of physicians in the US low to maintain high wa…
Residency slots are the limiting factor, not medical school slots. There's no point increasing medical school slots if you're going to create a bunch of people shut out on Match Day with $200K+ in debt. It should be noted that licensing requirements of doctors mean that medical school graduates are also competing against foreign Blaming the AMA is a dated view. I believe that used to be the case, but certainly isn't…
It's both dated and wrong. The AAMC, not the AMA, formerly capped the number of medical students in the country. But over ten years ago, they decided to lift the cap.
As you said, though, the residency slots are the bottleneck, so exactly what has happened is that we now have even more people graduating with debt from medical school who are unable to train in residency and eventually practice medicine.
Residency funding is subsidized by Medicare, so they're the ones who have the power to expand GME, if they want to.
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Exactly! Hospitals don't care about inefficiencies because insurance pays for it. Patients don't care either again because insurance pays for it. Insurance can't negotiate with hospitals as patients don't ever want to lose their doctors and revolt if insurance even brings up dropping a hospital for charging exorbitant rates. Add to it an insane 4 years in college + 4 years med school curriculum that does not incentiv…
You forget one part: patients do not care what insurance costs because their employer chooses what they use and what price they pay. If I could buy health insurance separately from my company I'd look into it. I know my company pays at least as much as I do for my insurance, but if I go off the company plan I can't get that money to use for insurance I like. The result of this is I have incentive to not care what any…
You can. It's probably not in your best interest, because the individual market plans are more expensive, but there's nothing stopping you.
> I know my company pays at least as much as I do for my insurance, but if I go off the company plan I can't get that money to use for insurance I like.
That's your employer's choice. They could provide a cafeteria plan, which would give you the choice (but again, since individual plans are always going to be more expensive for the same level of coverage[0], they'd have to pay more money overall to provide the same tier of benefits).
[0] simply due to basic actuarial math
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The number of positive results found by the RAND experiment is completely in line with what you'd expect from false positives from multiple comparisons, particularly given that these results were all found in non-preregistered segments. nor are competing therapies or competing providers of the same therapy offering a commodity product that can be freely selected between, just as if you suffer a catastrophic injury yo…
The vast majority of emergency medicine is not emergency medicine, but emergencies are among the most likely things to have a catastrophic impact at the individual level. I cannot possibly treat the entire complexity of healthcare in a single comment and neither can you. That's why I'm offering a limited specific counterexample to your general argument, to point out the existence of fundamental economic problems in h…
And this is handled by the high copay, high cap model proposed by RAND, Singapore and myself. You still have not identified any "fundamental economic problems" or misrepresentations of the behavior of the healthcare market.
Unless you're poor or chronically sick.
False - the group studied in the Oregon experiment was poor. Oregon explicitly studied a medicaid expansion. RAND included poor folks too - in fact, one conclusion you can data mine from RAND (if you are so inclined) is that low cost medical care increased certain health problems for poor folks.
(Of course, that result is just as shaky as all the other data mined results.)
You have made it abundantly clear time and again on HN that you do not believe in altruism...
When did I make this clear? Are you confusing my opposition to harmful or wasteful altruism as opposition to all altruism? You are confusing my criticism of bad implementations with opposition to solving the problem.
Concretely: I have no major objection to effective altruism - perhaps something like Singapore's model. I object to wasteful feel-good measures that don't have any measurable benefits, like Obamacare's medicaid expansion.
As for things like maintaining an excess supply of medical pros to handle crises, if that's necessary I don't think it should be provided via random inefficiency. It should be explicitly planned in.