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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

#271

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…

With a high deductible plan they still will give you no estimate or something like "between 1000 and 200000 dollar". All actual prices that got paid need to be published.

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

#272
post #259

Earlier quoted context omitted.

> 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 happ…

I don't think it makes it look like it's not happening, but it is easier to manage some things at higher levels than others. If you're a business, every single governmental entity you have to deal with adds complexity into the system. You need to keep track of various sales taxes, regulations, etc. Increasing the number of jurisdictions you have to deal with increases the complexity quite a bit.

To reduce that complexity, you might get a lot of jurisdictions to band together and decide 'hey, businesses must interact with us via this standard way we all agree on." Congratulations, they have just created a government.

I think managing this complexity is incredibly difficult, no matter which strategy is used, and I don't think there is any one strategy available that solves these problems.

In some cases, it makes sense to keep the jurisdictions as small as possible. In other cases, the opposite is true, especially when considering things related to the Problem of the Commons and the like.

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

#273

Earlier quoted context omitted.

(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 agree…

You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills? Better. They’re also cheaper. Your opinions do not line up with reality.

America’s at the bottom of the OECD for many of these things, and at the top by a country mile for cost. [1]

There's no medicare statistics trickery lol, all those government services being leveraged have to do almost nothing incrementally to support medical fees. They're still collecting payroll taxes, they're still collecting income taxes, one way or the other. By your own measure this makes the work they do duplicative of the insurance industry making the insurance industry the wasteful one. This is also failing to take into account the waste of employers managing employee healthcare -- why on earth are they doing that?

OF COURSE medicare is expensive we already addressed that in another thread. The US doesn't have free market healthcare. The young, healthy and cheap are forced into expensive market plans, privatizing the gains, while the old, sick and poor are handed off to the government to look after, socializing the losses. It's absurd. The young, healthy and wealthy should be paying for the old, sick and poor. You can’t saddle the socialized program with all the worst customers, hamstring it’s ability to negotiate drug prices then point to how much it costs.

Doctors in Canada make hundreds of thousands of dollars per year providing socialized cover. They're civil servants. They do fine. So what if it's less than doctors are paid now, the question is are they compensated fairly, and they are.

Last I couldn’t help but notice you totally sidestepped my point about reduced costs by offering preventative care.

[1] https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Ke...

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

#274

Earlier quoted context omitted.

Give an example

It wasn't an example. Instead of answering, you moved goalposts and asked "why don't you import stuff from Canada". However you look at your "example", it's not good for the US. - Canada has universal healthcare - Canada has government regulations - Despite all that, insulin in Canada costs less than in the US So the original question still remains and is valid: why is insulin in the States so damn expensive? Given t…

Because the government grants the insulin manufacturer a monopoly over its citizens and enforces it with the law.

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

#275

Earlier quoted context omitted.

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…

With a high deductible plan they still will give you no estimate or something like "between 1000 and 200000 dollar". All actual prices that got paid need to be published.

Above the deductible it doesn't matter. Below the deductible is easier to manage. Primary care generally has public pricing.

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

#276

Earlier quoted context omitted.

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.

Health insurance costs 800$ a month so not having 500$ means you dont have insurance. Thats another level of poverty, for the which there is medicaid and a different set of programs and way to deal with those cases.

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

#277

Earlier quoted context omitted.

> 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 agree…

You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills?…

> You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills? Better. They’re also cheaper. Your opinions do not line up with reality.

Why doesn't medicare, the already socialized medicine of the US, have the same results as socialized medicine in other countries?

> There's no medicare statistics trickery lol, all those government services being leveraged have to do almost nothing incrementally to support medical fees

You could also use payroll taxes to pay private insurance, that's not a benefit of medicare, it's a benefit of the current tax implementation that is granted monopolistically to medicare. I know of at least one country that collects payroll taxes that go to private health companies. The question is: is medicare administration truly cheaper that private administration for the same service.

> This is also failing to take into account the waste of employers managing employee healthcare -- why on earth are they doing that?

Because the federal government makes it tax exempt to give healthcare through the employer, which is a 260 billion a year regressive tax benefit, denounced and criticized decades ago by prominent economists. You dont need to socialize medicine to stop that, you just need to stop handing out federal money. In fact, the tax-subsidy is higher than the combined profits of all insurance companies together.

> The US doesn't have free market healthcare.

Glad we agree on that one!

> The young, healthy and cheap are forced into expensive market plans, privatizing the gains, while the old, sick and poor are handed off to the government to look after, socializing the losses. It's absurd.

The poor also pay medicare taxes for the rich. The sick that don't make it to retirement ages pay medicare tax their entire life and die before receiving any benefit. Taxes always have this thing that they make things unfair for someone by law.

Adverse selection and information asymmetry are real issues, but socialized medicine brings other issues like reduced coverage, rationing, etc. I am always surprised how the debate over healthcare ends up being arguing about capitalism as a method of efficient economic organization. It works for almost everything else, yet the arguments for socialized medicine are like arguing capitalism doesn't work. Its bonkers, and easy to refute because otherwise you would have to argue the same for food, for education, for transport, for everything, and none of those work better run by the government.

> ...Doctors in Canada make hundreds of thousands of dollars per year

To make doctors in the US root for socialized medicine, the state will have to offer greatly increased income. Thats how it happened historically in europe a century ago. Considering the AMA has killed socialized medicine laws multiple times in history, I would say the "screw the doctors" policy has a high chance of failure.

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

#278

Earlier quoted context omitted.

It wasn't an example. Instead of answering, you moved goalposts and asked "why don't you import stuff from Canada". However you look at your "example", it's not good for the US. - Canada has universal healthcare - Canada has government regulations - Despite all that, insulin in Canada costs less than in the US So the original question still remains and is valid: why is insulin in the States so damn expensive? Given t…

Because the government grants the insulin manufacturer a monopoly over its citizens and enforces it with the law.

The same monopoly exists everywhere because there are very few insulin manufacturers in the world.

Try again.

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

#279

Earlier quoted context omitted.

With a high deductible plan they still will give you no estimate or something like "between 1000 and 200000 dollar". All actual prices that got paid need to be published.

Above the deductible it doesn't matter. Below the deductible is easier to manage. Primary care generally has public pricing.

That doesn't match my experience. Do you have direct experience? Your other responses sound more ideological than direct experience.

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

#280

Earlier quoted context omitted.

You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills?…

> You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bill…

>>> Why doesn't medicare, the already socialized medicine of the US, have the same results as socialized medicine in other countries?

Again, we addressed this. It's literally all the old, sick and dying in a single pool allowing private insurers to be profitable. It's not comparable. It's like asking why a government-run fire insurance program that takes in only buildings that are already on fire is expensive. They only insure buildings already on fire against fire damage and they're not allowed to negotiate the price of water used to put the fires out. That's not how risk pooling works. It's not insurance, it's just a structured payouts program for the country's worst customers.

>>> You could also use payroll taxes to pay private insurance, that's not a benefit of medicare, it's a benefit of the current tax implementation that is granted monopolistically to medicare. I know of at least one country that collects payroll taxes that go to private health companies. The question is: is medicare administration truly cheaper that private administration for the same service.

Now the government is being leveraged to further enrich private industry instead of the people. The incremental cost is almost nothing. The only distortion of statistics here is that the private insurers don't have to deal with bad customers because they get socialized away (poor to Medicaid, old and sick to Medicare). I'm pretty sure you're thinking of Switzerland, which is the second-most expensive country in the OECD (they still manage to cover everyone, though).

And yes, it's cheaper, every other country shows that. Even the "$32T" cost estimate of medicare for all is actually lower than what's being spent today over the same time period.

>>> Because the federal government makes it tax exempt to give healthcare through the employer, which is a 260 billion a year regressive tax benefit, denounced and criticized decades ago by prominent economists. You dont need to socialize medicine to stop that, you just need to stop handing out federal money. In fact, the tax-subsidy is higher than the combined profits of all insurance companies together.

Yes I agree, it's regressive and should be removed. Socializing cover is good for other reasons as stated above.

>>> Glad we agree on that one!

Definitely :)

>>> The poor also pay medicare taxes for the rich. The sick that don't make it to retirement ages pay medicare tax their entire life and die before receiving any benefit. Taxes always have this thing that they make things unfair for someone by law.

Yep, that's not ideal. It should be charged progressively like it is in other countries.

>>> Adverse selection and information asymmetry are real issues, but socialized medicine brings other issues like reduced coverage, rationing, etc.

It doesn't, though. Rationing is fine. There's either not enough to go around or you make the pool bigger, both are options. It's explicit, it's done fairly and it's done impartially. Rationing by making care too expensive is cold and unfair. I'm also unclear on why you think there's a finite pool of medical care.

Either way your argument holds no water when every other program in the OECD is socialized, cheaper, and performs better on every metric.

>>> To make doctors in the US root for socialized medicine, the state will have to offer greatly increased income. Thats how it happened historically in europe a century ago. Considering the AMA has killed socialized medicine laws multiple times in history, I would say the "screw the doctors" policy has a high chance of failure.

Doctors in Canada hated the idea of socialized medicine in the 1970s too. You won't find a single one speaking out against it today. It was a huge fight. And yet, the entire country loves their system. Everyone in America hates theirs. There's something to this. Take a deep breath, it'll be okay. 60-75% of Americans are now interested in a public plan [2].

Tommy Douglas who championed socialized medicine in Canada was in 2004 named the greatest Canadian haha. [1]

FWIW, a socialized option does not preclude private care. Single payer isn't the only way forward, many European countries offer two-tier care. Australia offers two-tier care. If you're so sure that private care is less expensive, better and more efficient, why not allow it to compete with a government run plan? I speculate that it's because it's just not.

Sorry, man, you're on the wrong side of this one. The evidence shows it.

[1] https://en.wikipedia.org/wiki/Tommy_Douglas

[2] https://www.kff.org/health-costs/poll-finding/kaiser-health-...

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