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I'm a Brit and America, your health care system is torturing me

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Re: I'm a Brit and America, your health care system is torturing me

#31

Post by tptacek »

deogeo wrote: post #30
tptacek wrote: post #28

Earlier quoted context omitted.

How does this chart address the question of how we should fund our health care system? The problem is how much we're paying, not whether we pay for it in payroll taxes or out of pocket.

The chart shows a strong correlation between government funded healthcare, cost-efficiency, and effectiveness - that's how.

Correlation isn't causation. Switzerland's health spending is in line with that of Canada, France, and Germany, has roughly the same (better in some cases) life expectancy outcome, and is an entirely private system.

Life expectancy is also a poor way to compare health care systems, because major factors decreasing life expectancy have nothing to do with quality or access to care --- for instance, one of the most significant hits we take to life expectancy in the US is the prevalence of traffic fatalities.

Re: I'm a Brit and America, your health care system is torturing me

#32

Post by multjoy »

growlist wrote: post #8

Meanwhile, here in the UK the NHS - weaponised by the left and virtually above criticism/reform as a consequence - tortures people by making them wait months/years for treatment due to rationing of care, this rationing in no small part being due to the fact that care is free at the point of delivery, which leads some people to abuse the service. Even a token £10 charge for GP visits, for example (subsidised for the g…

>weaponised by the left

Flying your flag there, champ.

Re: I'm a Brit and America, your health care system is torturing me

#33

Post by multjoy »

Simulacra wrote: post #12

I think universal single payer healthcare would be wonderful, but the issue of healthcare is politicized enough as it is. With a private company I can fight. I might lose, I might have to go elsewhere, but I have a choice. With the government I have no choice, and I have no recourse. When has that ever led to better outcomes?

You can still pay for private healthcare if you want to skip waiting lists.

In terms of choice, the NHS allows you to shop around for your specialist, and they're also the same doctors you'll see privately.

Re: I'm a Brit and America, your health care system is torturing me

#34

Post by tptacek »

kasey_junk wrote: post #29
tptacek wrote: post #27

Earlier quoted context omitted.

No, I don't think that's even partially true. Medicare also overpays for care and responds to the same structural wackiness the rest of us deal with. Medicare has lower administration costs, but those costs are still higher than administration elsewhere in the world, and administration is not actually where most of our dollars go.

So maybe I don't know what you mean by structural problems. I assumed you meant agency problems, administrative costs, medical professional pay, liability costs, over care & end of life care. All of which are directly impacted by how we fund the system.

Two examples of structural problems with our health care systems:

1. We lead the world in transitioning from inpatient to outpatient care; for instance, I read a source last night that said the majority of hernia repairs in the NHS were inpatient, and the overwhelming majority of them in the US were outpatient. That's good, but an unintended consequence of it is that it's easier to route a patient to a surgical procedure if it's done outpatient, and as a consequence US patients get a lot more of these procedures, some of them (cardiac stents being a recent well-publicized example) of dubious utility. Our relative overconsumption of services doesn't lead to better outcomes, and thus represents misallocation.

2. Our health provider systems are more decentralized, delivered in smaller clinics and hospitals. Our hospitals generally, nationwide, have poor utilization. Not only do we therefore overspend on plant and salary costs (which we do, relative to Europe) but coupled with our price transparency problems we end up with the situation Atul Gawande described a year or two back, when he noted the insane difference in prices for an MRI at different imaging centers in a small region of (iirc) Texas.

Our system right now isn't good and some of it (but by no means all of it) is related to how we regulate the way it's funded. But Medicare overspends on many of the same things. The structural problems will need to be corrected no matter how we design the rest of the system.

Ultimately I think the problem in the US is a sort of perfect storm of badnesses.

(Good sources: Kauffman's health cost explorer, the McKinsey report, the Health Care Cost Institute annual breakdowns).

Re: I'm a Brit and America, your health care system is torturing me

#35

Post by kasey_junk »

tptacek wrote: post #34
kasey_junk wrote: post #29

Earlier quoted context omitted.

So maybe I don't know what you mean by structural problems. I assumed you meant agency problems, administrative costs, medical professional pay, liability costs, over care & end of life care. All of which are directly impacted by how we fund the system.

Two examples of structural problems with our health care systems: 1. We lead the world in transitioning from inpatient to outpatient care; for instance, I read a source last night that said the majority of hernia repairs in the NHS were inpatient, and the overwhelming majority of them in the US were outpatient. That's good, but an unintended consequence of it is that it's easier to route a patient to a surgical proce…

Both of those are classic examples of the outcomes being directly related to how we fund our medical care.

In the first instance it's a tension between the providers trying to maximize service, insurers trying to minimize risk and the user having little agency in the outcome.

The second example is a straight up agency problem.

None of that changes the argument, it is a perfect storm of badness and even if nationalized healthcare was politically feasible it wouldn't fix all of these issues.

I just want to get to the point where my insurance doesn't come from my employer...

Re: I'm a Brit and America, your health care system is torturing me

#36

Post by bb88 »

tptacek wrote: post #23
rayiner wrote: post #10

I favor nationalized health insurance, but I worry American idealism would screw up implementation. The British are aggressive about rationing care. They aim to pay around 20-30,000 pounds per quality adjusted life year: https://www.bbc.com/news/health-28983924 There was an article on HN the other day that talked about how much debt a woman had incurred for her husband’s cancer treatment after she hit her insurer’s l…

Another problem is that for a variety of reasons, some of them structural, Americans consume significantly more medical services (diagnostics, procedures, visits) than Europeans do, without improved outcomes. There are fundamental inefficiencies in our system --- for instance, incentives have led to the creation of lots of small hospitals that see poor utilization --- that lead to this, and will be baked into any sin…

> (high on my list would be price transparency regulations)

Why didn't the republicans do that over the past two years in the US? It seems like it would be great for the free market, and also encourage competition. Or do they believe in large company profit "protectionism"?

Re: I'm a Brit and America, your health care system is torturing me

#37

Post by tptacek »

kasey_junk wrote: post #35
tptacek wrote: post #34

Earlier quoted context omitted.

Two examples of structural problems with our health care systems: 1. We lead the world in transitioning from inpatient to outpatient care; for instance, I read a source last night that said the majority of hernia repairs in the NHS were inpatient, and the overwhelming majority of them in the US were outpatient. That's good, but an unintended consequence of it is that it's easier to route a patient to a surgical proce…

Both of those are classic examples of the outcomes being directly related to how we fund our medical care. In the first instance it's a tension between the providers trying to maximize service, insurers trying to minimize risk and the user having little agency in the outcome. The second example is a straight up agency problem. None of that changes the argument, it is a perfect storm of badness and even if nationalize…

There are a bunch of ways to rebut that argument. First, you can look at private systems that don't have these problems (ie: all the rest of the private systems). Second, you can note that Medicare, our single-payer system, interacts with the same structurally inefficient provider system. And, of course, if we switch to single-payer tomorrow, we're still going to be doing most care on an outpatient basis (because we should), and are still as a result going to be overprescribing procedures to patients.

Re: I'm a Brit and America, your health care system is torturing me

#38

Post by [deleted] »

bb88 wrote: post #36
tptacek wrote: post #23

Earlier quoted context omitted.

Another problem is that for a variety of reasons, some of them structural, Americans consume significantly more medical services (diagnostics, procedures, visits) than Europeans do, without improved outcomes. There are fundamental inefficiencies in our system --- for instance, incentives have led to the creation of lots of small hospitals that see poor utilization --- that lead to this, and will be baked into any sin…

> (high on my list would be price transparency regulations) Why didn't the republicans do that over the past two years in the US? It seems like it would be great for the free market, and also encourage competition. Or do they believe in large company profit "protectionism"?

[deleted]

Re: I'm a Brit and America, your health care system is torturing me

#39

Post by tptacek »

bb88 wrote: post #36
tptacek wrote: post #23

Earlier quoted context omitted.

Another problem is that for a variety of reasons, some of them structural, Americans consume significantly more medical services (diagnostics, procedures, visits) than Europeans do, without improved outcomes. There are fundamental inefficiencies in our system --- for instance, incentives have led to the creation of lots of small hospitals that see poor utilization --- that lead to this, and will be baked into any sin…

> (high on my list would be price transparency regulations) Why didn't the republicans do that over the past two years in the US? It seems like it would be great for the free market, and also encourage competition. Or do they believe in large company profit "protectionism"?

I don't know, except to say that national health policy has become a political football. I don't think there's an ideological reason for the decisions Congress has made; the system we have now was the Republican's proposed system in the 1990s (and was even a policy plank the the 1996 Republican Platform).

Re: I'm a Brit and America, your health care system is torturing me

#40

Post by DanBC »

rayiner wrote: post #10

I favor nationalized health insurance, but I worry American idealism would screw up implementation. The British are aggressive about rationing care. They aim to pay around 20-30,000 pounds per quality adjusted life year: https://www.bbc.com/news/health-28983924 There was an article on HN the other day that talked about how much debt a woman had incurred for her husband’s cancer treatment after she hit her insurer’s l…

This is absolutely not true, as you've been told before. The fact you keep repeating this is fucking annoying.

You're making some assumptions: i) that expensive treatment is good treatment, ii) that expensive treatment is not available and that iii) it is available for people with insurance.

Not one of those is correct.

Also, the cancer drugs fund (mentioned in your link) provided access to drugs that were very expensive and which did not work. https://www.bmj.com/content/357/bmj.j2097

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