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

bostonreview.net

21–30 of 77 posts

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

#21

Earlier quoted context omitted.

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

Really. Done all over the world.

It's also condemned by the World Health Organization unless totally altruistic because organ trafficking and human trafficking are intertwined with the politics of organ transplantation.

Living donor programs already exist in many states and hospitals - If you want to help reduce medicare spending by donating your organs, go for it! But don't expect to get paid for it any time soon.

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

#22
post #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?

allow doctors on H1B to come from india. That's what they do in UK.

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

#23
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.

I urge everyone to read these two fantastic papers:

It's The Prices, Stupid (2003): https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3....

It's Still The Prices, Stupid (2019): https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144

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

#24
Prices are high because of inefficiencies in the markets caused by bad laws attempting to subsidize one class of people by another.

Hospitals aren't able to refuse treatment to those that can't afford to pay for their services, insurance companies are forced to insure unprofitable people and the net effect is to try and coerce people into a redistribution of money from people that require more care from those that require less care to cover these expenditures.

Because there is no mechanism to coerce people to do this willingly both industries to give the invoices to the government (who created the problem) thereby getting rid of the requirement to think about how they will fund their expenditures - making it the governments problem to figure out.

This thereby allows them to continue uncontrolled expenditure in an ever increasing downward spiral to catastrophe as in effect they are spending 'other peoples money' in the hopes that "eventually these invoices will be paid" through some sort of government sponsored coercion mechanism forcing socialized heath care or some other such method with the same result.

Its really quite simple and clever.

-5% of the population accounts for more than half of all health spending. -50% of the population with the lowest spending accounts for only 3% of all total health spending.

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

#25
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…

It's easy to imagine someone being forced to sell a kidney because they're down on their luck. Doesn't seem ideal.

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

#26
post #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?

Medicare for All. Help try to get Bernie elected, as he’s the only candidate who actually backs the policy. Warren has back-pedaled now that she’s secured the top position as the moderate alternative.

https://jacobinmag.com/2019/09/elizabeth-warren-campaign-med...

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

#27
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…

>This is why, if you look where all the really rich rulers decide to go for surgery or other complicated care, it is the US.

If that were true, why would a US Senator go to Canada for surgery then?

https://www.courier-journal.com/story/news/politics/2019/01/...

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

#28
post #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?

I think tackling hospital / physician costs is even harder than drug pricing. Hospitals are major employers in almost every county. For a politician to break up hospital monopolies, they would be fighting against the one of the biggest employers in their constituency.

The American Hospital Association (the biggest hospital industry lobbying group) spends about as much as Phrma (the big pharma lobbying group) according to open secrets [0][1]. But the hospital industry has much more "soft power" because they are such a huge employer.

One solution is for payers to own more of their own providers, although that is challenging to implement and can lead to its own issues and bad incentives. I think one effective angle is to help more physicians stay independent -- there is probably a way to do this without legislation and i think some companies are working on this.

But i think one thing people can do is spread awareness of this issue -- you dont see it talked about in the media that much bc no group has an incentive to do so

[0] https://www.opensecrets.org/orgs/lobby.php?id=D000000116

[1] https://www.opensecrets.org/lobby/clientsum.php?id=d00000050...

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

#29
post #14

Earlier quoted context omitted.

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?

Medicare for All. Help try to get Bernie elected, as he’s the only candidate who actually backs the policy. Warren has back-pedaled now that she’s secured the top position as the moderate alternative. https://jacobinmag.com/2019/09/elizabeth-warren-campaign-med...

I believe Andrew Yang also supports this to some extent IIRC.

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

#30
post #14

Earlier quoted context omitted.

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?

allow doctors on H1B to come from india. That's what they do in UK.

Wouldn't that help the bottom lines of hospital conglomerates even more?
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