We Need to Design Health Care Reform That Puts Patients Before Profits • Hacker News Board

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#71

Post by screye » Fri, Oct 18, 2019, 6:33 PM UTC

kerkeslager wrote: post #32

helpPeople wrote: post #6

Until Americans find Physicians (and Pharmacists) as the enemy, it will never happen. They(AMA and APA) are top lobbyists that entrench themselves using monopolistic practices. Sure school can cost 500k, but with 200 to 300k+ per year salaries, they can kill that debt. (This is their common defense)

With my skillset (software engineer) I can easily pull low six figures. And I'm confident that doctors provide more value than I do. I'm pretty sure I've never saved anyone's life. So I have zero problem paying doctors 2 or 3 times my pay, which is about what you're saying they get paid. Health insurance CEOs make, in some cases, literally hundreds of times my salary, while literally killing people for profit. I'm go…

I think engineers really underestimate the value of their work.

An engineer's impact on a single person might be low, but at scale, it can add up to a lot.

As noble as being a doctor is, their individual contributions can never scale beyond a few people.

While I am at it, can someone explain why being a doctor needs a person to go through 4 years of undergrad in field completely useless in their domain ?

> The entire raison d'être of capitalism is that it's supposedly meritocratic

Not it is not. It may be sold to us like that, but it is more like : "Those who succeed in Capitalism, do so only by the means of their merit....and the infinite privilege or luck that might have instead put them there. "

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#72

Post by TaylorAlexander » Fri, Oct 18, 2019, 6:34 PM UTC

tptacek wrote: post #66

The problem with US health care is that it costs too much. The elephant in the room in US health care costs is inefficiency on the provider side. Payer-side reforms have limited impact, because contrary to rhetoric from both sides of the debate, we could probably zero out administrative costs entirely and still deliver little more than a grocery store discount to American consumers. However we structure payment, we'r…

There’s always room for critique, but millions of Americans need something to change. How can we get coverage to the poorest people effectively?

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#73

Post by tptacek » Fri, Oct 18, 2019, 6:34 PM UTC

kerkeslager wrote: post #32

helpPeople wrote: post #6

Until Americans find Physicians (and Pharmacists) as the enemy, it will never happen. They(AMA and APA) are top lobbyists that entrench themselves using monopolistic practices. Sure school can cost 500k, but with 200 to 300k+ per year salaries, they can kill that debt. (This is their common defense)

With my skillset (software engineer) I can easily pull low six figures. And I'm confident that doctors provide more value than I do. I'm pretty sure I've never saved anyone's life. So I have zero problem paying doctors 2 or 3 times my pay, which is about what you're saying they get paid. Health insurance CEOs make, in some cases, literally hundreds of times my salary, while literally killing people for profit. I'm go…

I don't understand the axioms you're trying to draw on to derive just compensation for physicians. Why not just look at the worldwide market? Compare US physicians to those in other countries; we pay ours drastically more, and we are not generally more satisfied with the care we receive.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#74

Post by edm0nd » Fri, Oct 18, 2019, 6:35 PM UTC

megiddo wrote: post #62

rayiner wrote: post #34

The U.S. spends $3.5 trillion annually on healthcare. Worldwide profits for the 112 publicly traded healthcare industry companies amount to $50 billion per quarter: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar... . Even if all those profits are allocated to the U.S., that's about 5.7% of healthcare spending. (And completely consistent with most other industries.) Hyper-focusing on profits is misguided…

What a strangely factual response on this forum.

HN is a lot better and level headed than places like reddit.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#75

Post by disabled » Fri, Oct 18, 2019, 6:36 PM UTC

As an American with 2 rare immune-mediated neurological diseases, that affect my peripheral nervous system, I can almost guarantee you that decent health care reform will not happen in the foreseeable future.

By the way, both of these diseases are in pharmaceutical remission, due to taking a blood product that has immunomodulatory properties. I will have to take it for life. My medical insurance literally pays hundreds of thousands of dollars per year, under contract, for it.

The Affordable Care Act is practically guaranteed to be either partially or completely overturned next year (Summer 2020), based on previous rare cases in modern history where the Solicitor General did not defend a case at the Supreme Court.

My whole life is literally riding on whatever the Supreme Court churns out next year, due to the complexity of my care. In the case of a partial or complete overturn, I will most likely have to leave the US. But, I am fortunate to be an EU citizen.

I have been making plans for leaving the US for a couple of years now. The matter is extremely complicated with my health care needs, and I literally cannot afford to make a mistake.

Frankly, I do not feel welcome anymore in my homeland (the United States) either.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#76

Post by TheOtherHobbes » Fri, Oct 18, 2019, 6:37 PM UTC

kerkeslager wrote: post #28

balls187 wrote: post #19

Earlier quoted context omitted.

What if we pay for affordable preventative care, and the government covers the cost of traumatic events?

What about chronic diseases that require frequent treatment?

What about them? The point of collaborative health care is that risks, benefits, and costs are spread out, to everyone's benefit.

There is no magic market finger threatening to push you into bankruptcy and/or an early grave just because cancer picked you instead of someone else, and your co-pays are higher than you can afford. Ditto for chronic congenital conditions. It's all the same.

Yes, you're probably contributing to someone else's care, especially when you're young and healthy.

So what? You won't be young forever, and you probably won't be healthy forever either. Meanwhile whatever care you need is provided to you at lower individual cost than a privatised system - with the added benefit that it also provides significant employment, supports medical research, and provides private-sector opportunities for specialised suppliers of technology, consulting, and other solutions.

The only people who appear to lose out are shareholders. They have to make their money elsewhere. In fact their opportunities are enhanced rather than diminished, because affordable low-risk public health care leaves more money on the table for investment and new business development.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#77

Post by killjoywashere » Fri, Oct 18, 2019, 6:37 PM UTC

cmsonger wrote: post #38

It maybe is obvious, or maybe it's controversial, but patients will never be put before profits by for profit corporations.

You know, my wife holds the contract for occupational therapy services for the school district we're in, which is fairly remote. When she picks me up from work, the drive home is mainly her venting about how no one in the district seems to care about the kids. She routinely underbills and works crazy hours (I know she underbills because she documents her hours on the timesheet I designed for her). As an example, a couple days ago, I got the following text:

"We're going to Thai for dinner with the social worker so I can meet this girl's mom and schedule a home visit. She doesn't have a phone so we're meeting her at her work. They live in a container."

The previous contract awardee was a shell company that charged the district the same per-hour rate for services, but so vastly underpaid their therapist (by a factor of ~7) that she quit and my wife refused to work for them. So no children got services the remainder of that year, until the district worked out my wife's award.

Now, my wife's business is set up as an S-corp, so I guess she's a terrible person?

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#78

Post by kshacker » Fri, Oct 18, 2019, 6:38 PM UTC

rayiner wrote: post #34

The U.S. spends $3.5 trillion annually on healthcare. Worldwide profits for the 112 publicly traded healthcare industry companies amount to $50 billion per quarter: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar... . Even if all those profits are allocated to the U.S., that's about 5.7% of healthcare spending. (And completely consistent with most other industries.) Hyper-focusing on profits is misguided…

Hmmm. What is profit? If a company pays its CEO 10 million dollars, it is not stated profit, but that's a cost we could live without. If a CEO can write off a few million, a few 10s of millions in corporate gala spending, it is not stated profit, but that's a cost we could live without. I am sure if we dig deeper into cost per patient between Medicare and between lets pick a company, you will realize that you can do without maybe 20% of this 3.5 trillion easily. And that is before we start looking at many other factors such as abuses in the system (looking from the other side and looking at freeloaders to say it very bluntly and quickly).

While I look at the CEO's multi-million salary, I also wonder how much tax they pay. Did the 10 million salary lead to 3-3.5 million in taxes or ... we probably can guess the answer. It is a double / triple whammy.

Message: Look at the total loot, not the stated profit.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#79

Post by tptacek » Fri, Oct 18, 2019, 6:38 PM UTC

TaylorAlexander wrote: post #72

tptacek wrote: post #66

The problem with US health care is that it costs too much. The elephant in the room in US health care costs is inefficiency on the provider side. Payer-side reforms have limited impact, because contrary to rhetoric from both sides of the debate, we could probably zero out administrative costs entirely and still deliver little more than a grocery store discount to American consumers. However we structure payment, we'r…

There’s always room for critique, but millions of Americans need something to change. How can we get coverage to the poorest people effectively?

I think it's easy to misread what I wrote as saying that the current system is OK, or there aren't giant, urgent problems that need to be addressed. There are huge problems. The concern I have is that payer-side reforms are a sideshow.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#80

Post by maximente » Fri, Oct 18, 2019, 6:39 PM UTC

snowwrestler wrote: post #29

jostmey wrote: post #9

Earlier quoted context omitted.

I think you're stumbling on a root cause of America's healthcare crisis. I think most American's don't understand just how much physicians make--and where did you get those figures because clinicians I know make a good deal more than 200-300k

It's an uncomfortable subject because the vast majority of front-line medical professionals like doctors, specialists, surgeons, nurses etc. are doing that job with passion and honesty to help people. But it's also true, and I think well-known at least in a vague sense, that one can make a pretty good living in the medical field. For-profit insurance companies come in for the most hate since they are in the position…

> It's an uncomfortable subject because the vast majority of front-line medical professionals like doctors, specialists, surgeons, nurses etc. are doing that job with passion and honesty to help people.

don't take this personally, but: this is an oft repeated meme that, in my experience, not really true, at least for MDs and nurses (to include doctors, specialists and surgeons). it certainly contributes to the sort of hero status of health care workers though.

physicians in the US earn a ton for a high-prestige, high social power, high earnings, generally safe career. in return they must sacrifice these earnings and social status for most of their 20s due to ridiculous quotas and standards in medical school, propped up by AMA; this makes the system higher prestige and sought after, a nice vicious (or virtuous for them) cycle.

the AMA also has them on the hook in a debt-slavery sort of way, because normal wages would never repay their ridiculous medical debt (see e.g. mid/low tier lawyers and law school outcomes when that got popular)

nursing, likewise, is seen as a j o b that offers some safety/consistency in return for investing time into education.

that these individuals """help people""" is generally of tertiary or lesser concern; much more "help" could be done by opening an affordable grocery store in a food desert. all but the most naive students either readily admit this or cop to it once asked.