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GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

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Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#261

Post by arcticbull »

conanbatt wrote: post #255
arcticbull wrote: post #246

Earlier quoted context omitted.

Totally different things. It's like saying if I tweak this nob and it goes bad, well, why should I switch to a completely different system three counties down? Especially when that totally different system three counties down works for every other developed nation in the entire world. And also some of the developing ones. You should be defending why the American system is better than every other country in the world…

The american health system is worse than other countries for intense regulatory capture and regulation, thats my assessment and one shared by many economists in the healthcare space. Socialized programs dont resolve that. Having medicare for all does not abolish patent law, or creates doctors out of thin air, or reduces the cost of medical school, those are recognized problems. The socialized medicine plan is mostly…

>> The american health system is worse than other countries for intense regulatory capture and regulation, thats my assessment and one shared by many economists in the healthcare space.

I addressed where cost savings come from in another post you may have missed, another reply to your comment with specific examples, we can take that over there.

>> You will not get the canadian health insurance by signing a law that says you will.

Funny, that’s how we got ours in Canada in the 1970s, you should read up on it and on Tommy Douglas. No need to be defeatist.

We had a for profit system, and it was the worst, so we changed it. I’m not sure why America would be incapable of that when we weren’t. Further as in Canada, the system can be defined as the federal government requires minimum standards of care and the states execute in the way that makes sense for them.

Obviously Medicare is more expensive. America doesn’t have a free market for healthcare. The young, healthy and cheap to insure obtain cover in the private markets. All the worst customers (the sick, the old, the dying) are removed from the market and their care is already socialized. This is the definition of a manipulated market: privatized gains, socialized losses. The cost to cover for Medicare will drop substantially when the healthy pay for the sick directly the way it’s supposed to work.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#262

Post by yardie »

conanbatt wrote: post #258
yardie wrote: post #252

Earlier quoted context omitted.

Which country has a parallel public/private healthcare system? Most countries with public healthcare have a private supplement that build on top of what the national system already provides: in home care, private hospital rooms, dental and vision, and concierge service. I've yet to see a private system attempt to replace a functional public system.

> Which country has a parallel public/private healthcare system? Most that I know of. Unless the state has absolute monopoly on primary care providers/General practitioners, you will have both systems in place.

> Unless the state has absolute monopoly on primary care providers/General practitioners

Yes, that is what single-payer means. There is no parallel payment. You pay for basic service through taxes. You pay for better service through private. Private insurers like BUPA can only extend healthcare options. They don't replace it.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#263

Post by dragonwriter »

bostik wrote: post #182
dragonwriter wrote: post #68

Earlier quoted context omitted.

Oddly, the only hard to believe thing I see about that scenario as an actual, real thing in the US’s very near future is the use of bracket style voting rather than whole-field voting where some number are eliminated each episode. That would violate a strong trend in the reality competition genre.

Well, the entire genre is built around the concept of competitive elimination. Do it with access to healthcare and you sure turn the intensity up on elimination .

> Well, the entire genre is built around the concept of competitive elimination.

But bracket-style voting prevents the drama of upsets where a candidate most people think is good-but-not-best gets eliminated while a candidate widely seen as poor but with a dedicated fan base who would easily get clobbered in a bracket (or sensibly aggregated ranked preference) system gets spared by the perversity of an inverse first-past-the-post system.

Which drama is no doubt why inverse FPTP is so dominant in the genre, where audience voting is involved.

> Do it with access to healthcare and you sure turn the intensity up on elimination.

Oh, sure, I'm not arguing against that, just that brackets in particular would be a surprising choice.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#264

Post by conanbatt »

yardie wrote: post #262
conanbatt wrote: post #258

Earlier quoted context omitted.

> Which country has a parallel public/private healthcare system? Most that I know of. Unless the state has absolute monopoly on primary care providers/General practitioners, you will have both systems in place.

> Unless the state has absolute monopoly on primary care providers/General practitioners Yes, that is what single-payer means. There is no parallel payment. You pay for basic service through taxes. You pay for better service through private. Private insurers like BUPA can only extend healthcare options. They don't replace it.

That system is not inherently cheaper: people that go private pay twice (pay for public through taxes and then pay privately).

I dont think its palatable in the US to make policies that could increase national healthcare spending.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#265

Post by conanbatt »

arcticbull wrote: post #260
GabrielBen wrote: post #253

Earlier quoted context omitted.

The world of people advocating for ineffective cures is already here, you have homeopathy, and you also have plenty of actual pharma that have much bigger placebo effects than clinical effects, or the overstated claims about the latest diet, paleo, keto, pescatarian, vegan, vegetarian, gluten-free. Can you imagine having diets having to be clinically approved by the FDA? 10 years plus billions of dollars to say you s…

No, I get medication and you get unregulated death pills. Mine cost more under your model than they do now because lower volumes will drive up prices. The market further segments, only the wealthy can afford real medicines and the poor, barely able to afford medicine in the US as is are forced to risk their lives on unregulated garbage snake oil. This is just a way to kick the poor harder but with extra steps.

Funny that my unregulated deathpills have nothing to do with yours, but you want to ban them so your meds are cheaper!

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#266

Post by conanbatt »

maxxxxx wrote: post #195
conanbatt wrote: post #184

Earlier quoted context omitted.

How is universal care going to reduce the shortage of primary care doctors? How is universal care going to eliminate patents for pharma? How is universal care going to make non-profit hospitals cheaper? How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers? How is universal care going to reduce healthcare spending?

Countries with universal care also usually have tight regulations on what can be charged and how. A first step would be to make all prices transparent so people can actually compare. In my view the biggest problem in the US is that the billing aspect of health care is intentionally opaque.

Medicare is justs as opaque, and also distortive: Medicare costs 11k a year, but retirees pay less than half its cost as it is.

The main reason pricing is opaque is because patients dont have freedom to compare between insurance companies, and because insurance companies are not a good model for frequent care. If you had High-deductible plans, you would make a much better system but people hate those plans.

You need a big change in popular sentiment to make pricing work well. (i am all for HDPs)

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#267

Post by arcticbull »

GabrielBen wrote: post #253
arcticbull wrote: post #245

Earlier quoted context omitted.

Imagine if every late-night "male enhancement" pill was instead a cancer treatment. That's what the world of snake oil salesmen was like. That's the world you're advocating for. God help us all if you get your way. It's like how the rivers dont catch fire anymore so we don't need an EPA I bet you the costs of disposing of dangerous waste products went up exponentially after the EPA was established, and yet, nobody ca…

The world of people advocating for ineffective cures is already here, you have homeopathy, and you also have plenty of actual pharma that have much bigger placebo effects than clinical effects, or the overstated claims about the latest diet, paleo, keto, pescatarian, vegan, vegetarian, gluten-free. Can you imagine having diets having to be clinically approved by the FDA? 10 years plus billions of dollars to say you s…

You're not giving them insulin either, you're giving them who knows what. That's the problem. Regulations aren't there to hold the little guy down, they're there because life was the worst before, and little by little, we pushed back until it was pretty good.

It's a pointless argument. This is right up there with Antivaxx and crypto enthusiasm, and it's a libertarian pipe dream. You acknowledge the lack of regulation has led to a pile of worthless garbage and your argument is let's keep doing more of that, instead of lets regulate the homeopathic medicines and male enhancements, and yes, diets. If you want to claim your diet is effective, then we should have that statement approved. It'd kill the industry because they're largely all baloney. And I'd be totally ok with that.

We live in a society, believe it or not, and yes your unregulated garbage does interact with my regulated medicine via market economics. As I explained. You're basically just arguing we accelerate the path to Elysium. That's an argument you can make, though let's be honest about it.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#268

Post by hippich »

jmcqk6 wrote: post #259
hippich wrote: post #230

Earlier quoted context omitted.

I totally agree and trying to point it out all the time when I hear "they". But the reality is - when some person sits looooong away in Washington and makes some rules - they are hardly connected to the people they represent. Smaller and more compact governing bodies I think would resolve the problem, where we would still get a benefit of a dedicated person working on organizing life in the region, and yet not too di…

> But the reality is - when some person sits looooong away in Washington and makes some rules - they are hardly connected to the people they represent. I don't think that is the reality. I think that is the illusion that shelter in. It's easy to see them as completely disconnected, but they're not really. Many times, this is a result of having to deal with much greater complexity the larger the scale, and people not…

In tech people embrace micro-services despite complexity trying to arrange things to work. We do it because this way we are forced to deal with it, to negotiate between teams and services. We embrace that complexity and uncover it.

In governing we are trying to cover up this complexity with moving decision making into higher levels. Such covering up does not solve complexity, it just makes it look like it is not happening, but it is still out there.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#269

Post by arcticbull »

conanbatt wrote: post #266
maxxxxx wrote: post #195

Earlier quoted context omitted.

Countries with universal care also usually have tight regulations on what can be charged and how. A first step would be to make all prices transparent so people can actually compare. In my view the biggest problem in the US is that the billing aspect of health care is intentionally opaque.

Medicare is justs as opaque, and also distortive: Medicare costs 11k a year, but retirees pay less than half its cost as it is. The main reason pricing is opaque is because patients dont have freedom to compare between insurance companies, and because insurance companies are not a good model for frequent care. If you had High-deductible plans, you would make a much better system but people hate those plans. You need…

Most Americans can’t afford $500 in case of an emergency, which is why high deductible plans are a non starter to provide coverage. For them a $5000 deductible is as good as not being covered in the first place.

Re: GoFundMe CEO: ‘Gigantic Gaps’ in Health System Showing Up in Crowdfunding

#270

Post by conanbatt »

arcticbull wrote: post #209
conanbatt wrote: post #184

Earlier quoted context omitted.

How is universal care going to reduce the shortage of primary care doctors? How is universal care going to eliminate patents for pharma? How is universal care going to make non-profit hospitals cheaper? How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers? How is universal care going to reduce healthcare spending?

(1) How is universal care going to reduce the shortage of primary care doctors? I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough. (2) How is universal care going to eliminate patents for pharma? It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere el…

> I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough.

So not cheaper.

> It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere else.

So not cheaper.

> By regulating fees for services, by lowering the price of drugs via negotiation and bulk purchase agreements, by eliminating marketing budgets, by eliminating insurance billing departments and by capping executive compensation. Hospitals and doctors are public servants elsewhere in the world, not elite rockstars who can bill as they so choose. That doesn't mean they're not well compensated.

Rationing. (It makes it cheaper, but also reduces the amount of care given out). Shutting down hospitals is probably not the way to go on the space, but its one way to reduce spending.

> By having a single table of rates that apply to everyone. Ideally with a single payer. This makes billing much, much easier.

Also rationing. If you have a single table of rates, you can get 3 results: you pay less than today, and thus you will have rationing of services (for example, less convenient locations, less services, etc), you pay the same (so no gain) or you pay more (more spending). Billing is a big pain, but billing medicare is the biggest pain of all. Medicare pays less and has more admin costs for providers, which is a big part of why its not covered.

Its virtually impossible in the US to force doctors into single rates, so what you would get is that insurance has very low coverage, and cash-pay will dominate healthcare services.

> Everything I indicated above put together. If you want a concrete example Medicare does most of the above (they can't negotiate drug prices, and they're not single payer, and they haven't socialized malpractice insurance) but they're substantially more efficient. Medicare spends 2-5% of the budget on administrative, where private plans spend 12-18%. That's without recognizing some of the other savings I pointed out. [2]

Medicare uses these statistics with great trickery. First of all, medicare does not do collections administration: its hidden in other government agencies that collect the payroll tax. Second of all, these statistics have some other biases like using total cost of spending but not per patient, where medicare is actually not that much ahead. And finally but not least, what people will always love about medicare is that its dirt cheap to the patient: the average social security benefit is 1400~, and the standard premium of medicare is 135. But turns out that medicare costs about 11k a year per patient: if you took away 1000 out of those 400, you would not find great support for medicare from retired people!

Finally but not least, medicare services have severe rationining elements, and potentially cost shifting: doctors make 1/2 with medicare than without. This means that: doctors that offer medicare are the ones starving for patients, and doctors that take a bit of medicare are actually putting some of the cost unto regular insurances.

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