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What Atul Gawande Got Wrong about U.S. Health Care Spending

bostonreview.net

11–20 of 77 posts

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#11
post #7

a) This article purports to answer the question of why medical care costs so much, collectively. Its answer: 'prices'. But it does basically nothing to interrogate why prices are high, despite claiming to at several points. b) One extraordinarily simple thing we could do to deflate medical costs in this country that would have essentially zero negative effects would be to create a market in kidneys. Medicare currentl…

a) You must not have read the piece: "the bills are high because of who is paying them"; "insurance companies spend some eighteen cents for every dollar they collect in premiums on administration costs: 'marketing, determining eligibility, utilization controls (e.g., prior authorization of particular procedures), claims processing, and negotiating fees with each and every physician, hospital, and other health care workers and facilities.'"

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#12
post #7

a) This article purports to answer the question of why medical care costs so much, collectively. Its answer: 'prices'. But it does basically nothing to interrogate why prices are high, despite claiming to at several points. b) One extraordinarily simple thing we could do to deflate medical costs in this country that would have essentially zero negative effects would be to create a market in kidneys. Medicare currentl…

Wow. Incentivizing people who need money to sell their organs has "zero negative effects"? Really?

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#13
post #7

a) This article purports to answer the question of why medical care costs so much, collectively. Its answer: 'prices'. But it does basically nothing to interrogate why prices are high, despite claiming to at several points. b) One extraordinarily simple thing we could do to deflate medical costs in this country that would have essentially zero negative effects would be to create a market in kidneys. Medicare currentl…

Wow. Incentivizing people who need money to sell their organs has "zero negative effects"? Really?

Really. Done all over the world.

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#14

30% of US healthcare spend goes to hospitals, and 20% to physicians (many of whom are employed by hospitals even if they are outpatient clinics -- the % of physicians employed by hospitals in the US is at an all time high) Hospital consolidation has been increasing the last few decades. Many hospitals are regional monopolies and have a ton of leverage in negotiations with insurers. Insurance companies put the squeeze…

How can we fight this, when so much money is on the line, to make sure that this golden goose keeps fleecing the middle class?

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#15
post #7

a) This article purports to answer the question of why medical care costs so much, collectively. Its answer: 'prices'. But it does basically nothing to interrogate why prices are high, despite claiming to at several points. b) One extraordinarily simple thing we could do to deflate medical costs in this country that would have essentially zero negative effects would be to create a market in kidneys. Medicare currentl…

a) You must not have read the piece: "the bills are high because of who is paying them"; "insurance companies spend some eighteen cents for every dollar they collect in premiums on administration costs: 'marketing, determining eligibility, utilization controls (e.g., prior authorization of particular procedures), claims processing, and negotiating fees with each and every physician, hospital, and other health care wo…

18% is surely not the whole issue with inflated medical bills. If medicine in the US were only 18% higher than elsewhere, we'd all call the problem 'solved'.

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#16
post #9

Earlier quoted context omitted.

When demand is inelastic, and you have no price controls, this is the result.

That's not really true, though. Prices are set by the intersection of supply and demand. Oil demand is relatively inelastic, for instance, but the price is quite reasonable because there is tremendous competition in supply. Prices are high in healthcare in part due to inelastic demand, but much moreso due to supply constriction. For just one, particularly egregious example of this: https://en.wikipedia.org/wiki/Certi…

If I didn't know how much I had to pay for gas until two months after I left the pump, my gas would cost $25/gallon, and I would count myself lucky that I'm buying it from a station that has a reputation for not swindling me.

That is, of course, after my 'gas insurer' comped the station anywhere between $0 and $25, that number being determined by the astrological position, and retrograde state of the planets.

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#17
post #16
post #9

Earlier quoted context omitted.

That's not really true, though. Prices are set by the intersection of supply and demand. Oil demand is relatively inelastic, for instance, but the price is quite reasonable because there is tremendous competition in supply. Prices are high in healthcare in part due to inelastic demand, but much moreso due to supply constriction. For just one, particularly egregious example of this: https://en.wikipedia.org/wiki/Certi…

If I didn't know how much I had to pay for gas until two months after I left the pump, my gas would cost $25/gallon, and I would count myself lucky that I'm buying it from a station that has a reputation for not swindling me. That is, of course, after my 'gas insurer' comped the station anywhere between $0 and $25, that number being determined by the astrological position, and retrograde state of the planets.

Sure, non-transparent pricing is a problem too. My point is just that inelastic demand is not on its own an explanation for the problem.

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#18
post #2

tldr: health care spending is high because prices are high That seems obvious in general, but should be extra obvious to anyone who has ever received a bill from anything in the US health system.

When you are designing a service, you can optimize for median latency or tail latency. Sometimes when you optimize for tail latency, median latency gets worse. It is similar to the health care systems. The US system is awesome at doing really crazy life saving stuff. For example US is probably the best in keeping premature babies alive. In addition it has a ton of resources. If you want an MRI scan, you can get one i…

You must be joking. When I needed a second MRI after a tumor was removed from my brain my very expensive health insurance denied the payment because it was medically unnecessary according to their contract quack Dr. Ramalamadingdong with a certificate from Bangladesh. I paid for it out of my own pocket.

Fuck the US health care system and fuck anyone who will defend any part of it.

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#19

Earlier quoted context omitted.

a) You must not have read the piece: "the bills are high because of who is paying them"; "insurance companies spend some eighteen cents for every dollar they collect in premiums on administration costs: 'marketing, determining eligibility, utilization controls (e.g., prior authorization of particular procedures), claims processing, and negotiating fees with each and every physician, hospital, and other health care wo…

18% is surely not the whole issue with inflated medical bills. If medicine in the US were only 18% higher than elsewhere, we'd all call the problem 'solved'.

The author doesn't say that's the whole issue. He also says the private system drives hospital consolidation, which in turn gives them higher bargaining power to demand higher prices. My point was, OP is wrong that the author "does basically nothing to interrogate why prices are high."

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#20
post #7

a) This article purports to answer the question of why medical care costs so much, collectively. Its answer: 'prices'. But it does basically nothing to interrogate why prices are high, despite claiming to at several points. b) One extraordinarily simple thing we could do to deflate medical costs in this country that would have essentially zero negative effects would be to create a market in kidneys. Medicare currentl…

Why draw the line at kidneys? Why not create a whole system of voluntary for-profit organ harvest? Anything you got two of, might as well sell one. No one needs two lungs, or two eyes.
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