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

bostonreview.net

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

#51

Post by darawk »

gregw134 wrote: post #25
darawk wrote: 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.

Ok. So a person is forced to sell a kidney because they're down on their luck. That person then becomes less down on their luck because they have received money for their kidney. Where do the problems start?

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

#52

Post by darawk »

SketchySeaBeast wrote: post #20
darawk wrote: 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.

I think that'd be great. But kidneys are an easy starting place because you genuinely do not require two kidneys.

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

#53

Post by j8014 »

geodel wrote: post #47
j8014 wrote: post #38

I really wish we had transparent pricing, it's maddening, outrageous and needs to be required by law.

First step towards transparent pricing would to hospital turn back patients who cannot pay. Without that they roughly need to collect payment from those who pay for those who don't.

Hospitals manage uncompensated care right now, its not as if its an unknown.

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

#54

Post by cmiles74 »

RcouF1uZ4gsC wrote: post #37
cmiles74 wrote: post #10

Earlier quoted context omitted.

I do not believe that this is accurate, in my opinion this assertion requires some documentation. I looked up the survival rate of premature babies and the neonatal mortality rate (28 days after birth) is higher in the US than in Canada.[0] I'm having trouble finding numbers on other procedures, in my opinion it may be because because the US is falling behind on them as well. [0]: https://www.healthsystemtracker.org/…

I am talking about premature infants. The one study I could find from 2000 that compares them showed >Relative risks for infant death from all causes among singletons born at 32 through 33 gestational weeks were 6.6 (95% confidence interval [CI], 6.1-7.0) in the United States in 1995 and 15.2 (95% CI, 13.2-17.5) in Canada in 1992-1994; https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&as_vis...

I'm not entirely sure that this paper supports your theory. While they do establish that the risks for this subset of premature babies is higher in Canada than in the US, they do not attribute this to a better level of care from US hospitals or the US healthcare system. Reading through their conclusions, it sounds like they didn't even think that was an issue worth investigating. Instead they looked for population differences and end up theorizing that the difference might be due to age estimation errors.

The fact that the births of premature children in this category is lower in Canada could, perhaps, point to the opposite conclusion: because health care in Canada is less driven by profit, we are seeing better care before birth which could be lowering this number.

"Our results were fairly consistent between the United States and Canada. The RRs of mortality associated with mild and moderate preterm birth were generally higher in Canada. A small part of these differences in gestational age–specific mortality was explained by the lower absolute and relative mortality risks among US black vs white preterm infants, but the RRs for Canada remained substantially higher than those for the United States even after restricting the US analysis to non-Hispanic whites (ie, 8.1 vs 15.2 at 32-33 gestational weeks and 3.3 vs 4.5 at 34-36 gestational weeks for total infant mortality among all singleton live births). An even smaller part of the difference was the result of the slightly lower absolute risks for term (birth at ≥37 gestational weeks) births in Canada (ie, total infant mortality of 3.0 vs 3.1 per 1000 live births for Canada in 1992-1994 vs the United States in 1995). We are currently investigating other potential explanations and particularly whether the differences might be artifacts caused by errors in estimation of gestational age. Regardless of the explanation, however, the prevalence of births in these gestational age categories was much lower in Canada than in the United States, and the EFs were therefore similar in the 2 countries."

https://jamanetwork.com/journals/jama/article-abstract/19299...

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

#55

Post by SketchySeaBeast »

darawk wrote: post #52
SketchySeaBeast wrote: post #20

Earlier quoted context omitted.

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.

I think that'd be great. But kidneys are an easy starting place because you genuinely do not require two kidneys.

A major surgery like that isn't low risk - the chance of major complications is quite high. You're asking people to put their lives at risk in a very real way to make a quick buck, which probably isn't actually solving any long term problems as it's a single cash infusion and not any sort of actual revenue stream they can rely on.

And, as I asked elsewhere - how much money are you expecting these organs to be sold for? There are far, far, far more desperate individuals than those who need kidneys - it'd be a buyers market for human organs.

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

#56

Post by SketchySeaBeast »

darawk wrote: post #51
gregw134 wrote: post #25

Earlier quoted context omitted.

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

Ok. So a person is forced to sell a kidney because they're down on their luck. That person then becomes less down on their luck because they have received money for their kidney. Where do the problems start?

What sort of money are we assuming these individuals will get? In your plan is this $100? $1,000? $10,000? With the ratio of the desperate to people who require kidneys, suddenly organs become a buyers market.

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

#57

Post by cmiles74 »

darawk wrote: post #9
toomuchtodo wrote: post #4

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…

While this is true and it's difficult to open a new hospital in the US, it strikes me as unlikely that this could be blamed for the high cost of care. In fact, US hospitals have been merging and this seems to be a trend that is continuing to this day.[0]

I entirely agree that hospitals are part of the problem, but I think that casting this as a supply and demand issue is oversimplifying the issue. People who need health care very often cannot choose to "shop around" for their provider, the increase in mergers make it less likely there are any competitors in their area. Agreements between hospitals and insurance companies often place other health care providers "outside network", thus artificially increasing their costs. In the same way consumers do not choose their hospital, they also frequently cannot choose their insurance provider; often the health insurance comes along with their employment.

In my opinion, the tangled co-dependency between hospitals, insurance companies, pharmaceutical companies and all of the lesser industries that depend on them are all factors in the rising costs. Every step of the way along the chain, profit is maximized at the expense of the patient. We will need large scale change in order to address the issue and I don't think it will be easy.

I hope that some kind of "medicare for all" system will start moving things in the right direction. In my opinion, this system is failing everyone except the very wealthy.

[0]: https://www.pwc.com/us/en/industries/health-industries/libra...

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

#58

Post by darawk »

SketchySeaBeast wrote: post #56
darawk wrote: post #51

Earlier quoted context omitted.

Ok. So a person is forced to sell a kidney because they're down on their luck. That person then becomes less down on their luck because they have received money for their kidney. Where do the problems start?

What sort of money are we assuming these individuals will get? In your plan is this $100? $1,000? $10,000? With the ratio of the desperate to people who require kidneys, suddenly organs become a buyers market.

Ok, again. Let's play this all the way through. Let's say they get $1. If I choose to sell you my kidney for $1, because i'm desperate and I think that that $1 is worth more to me than my kidney, where do the problems start?

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

#59

Post by darawk »

SketchySeaBeast wrote: post #55
darawk wrote: post #52

Earlier quoted context omitted.

I think that'd be great. But kidneys are an easy starting place because you genuinely do not require two kidneys.

A major surgery like that isn't low risk - the chance of major complications is quite high. You're asking people to put their lives at risk in a very real way to make a quick buck, which probably isn't actually solving any long term problems as it's a single cash infusion and not any sort of actual revenue stream they can rely on. And, as I asked elsewhere - how much money are you expecting these organs to be sold fo…

> A major surgery like that isn't low risk - the chance of major complications is quite high. You're asking people to put their lives at risk in a very real way to make a quick buck, which probably isn't actually solving any long term problems as it's a single cash infusion and not any sort of actual revenue stream they can rely on.

So, you think people are incapable of making this decision for themselves? Or perhaps that, in general, the government should step in to prevent people from taking undue risks in exchange for money? Should we therefore criminalize dangerous jobs like alaskan crab fishing too?

> And, as I asked elsewhere - how much money are you expecting these organs to be sold for? There are far, far, far more desperate individuals than those who need kidneys - it'd be a buyers market for human organs.

a) It doesn't really matter what the equilibrium price ends up being.

b) We don't need to speculate. Iran has a legal market in kidneys: https://en.wikipedia.org/wiki/Kidney_trade_in_Iran Their equilibrium price is about $4,000.

$4,000 seems like a perfectly reasonable and fair price for someone to undertake the risks associated with kidney donation.

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

#60

Post by dominotw »

basementcat wrote: post #30
dominotw wrote: post #22

Earlier quoted context omitted.

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?

Yea i guess its helping the bottom lines of tax payers in UK.
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