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

#101

Post by EpicEng » Fri, Oct 18, 2019, 6:53 PM UTC

leetcrew wrote: post #89

EpicEng wrote: post #81

Earlier quoted context omitted.

>I would argue that helping many people allocate their time towards activities they actually value is just as important as saving individual lives. I think you'd pretty easily get trounced making that argument. People would much rather be alive to do something less efficiently than to... not be alive at all. This argument is a bit insane to me.

think about the people you care about. would you rather live more years or spend more time with them over a shorter life? what would they prefer? it's an inherently subjective question, and I don't think the answer is obvious. I certainly don't think one of the answers is "insane".

Why are you assuming that I would spend less time with e.g. my wife if she were less efficient in performing some menial task? It would take her longer _to complete_, but that doesn't mean she wouldn't still quit working at 5. Besides, most of the software we write is pretty inconsequential as far as most people are concerned.

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

#102

Post by kerkeslager » Fri, Oct 18, 2019, 6:55 PM UTC

leetcrew wrote: post #40

kerkeslager wrote: post #32

Earlier quoted context omitted.

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…

not sure what kind of work you do, but if you make tools that save people time and you have many users, it could add up to many lifetimes not spent on some menial task. not quite the same, but I would argue that helping many people allocate their time towards activities they actually value is just as important as saving individual lives.

I'm a freelancer, so I've worked on a lot of stuff. I charge a reduced rate to nonprofits, which has gotten me some genuinely rewarding work, and my software has also had some small part in keeping innocent people out of jail. So I really have no regrets about my career, at least not from a "was what I did meritable?" standpoint. I don't feel like my comment is asking anybody to make me feel better about what I've done with my life. :)

But I'm still going to stand firm on my stance that a doctor, even if they only save a few lives in their career, is providing a more valuable service than I am. There's just no way the time I've saved people has added up to even a few lifetimes.

If we look at the software industry as a whole, it's just very obvious. We're an industry that likes to think we're saving the world, but the reality is that the results of software have been a very mixed bag. Facebook, for example, is pretty much just bad, and there isn't a major company out there that I wouldn't look at as being in some grey area, where it's hard to tell if they are a net positive or negative.

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

#103

Post by tptacek » Fri, Oct 18, 2019, 6:55 PM UTC

TheOtherHobbes wrote: post #56

thaumasiotes wrote: post #48

Earlier quoted context omitted.

They weren't worried about it, but it was happening anyway.

I doubt the restaurant was a monopoly with literal powers of life, death, and bankruptcy over its patrons.

Why do other life-or-death markets --- the markets for food, say, or for housing and clothing --- manage to function effectively as markets? Why do we give section 8 vouchers to people to afford private housing instead of continuing to build housing projects, and SNAP benefits instead of government cheese? If anything, those other markets are more critical to life and death than health care, which is needed situationally.

Because message boards are a fertile breeding ground for fundamental attribution fallacies, I'll lay my cards on the table here and point out that I'm an activist Democrat and health care is, after public schools (which I am not in favor of privatizing), one of my most important motivating policy concerns. My problem isn't that I think conservatives are right about health insurance; it's that the countervailing arguments don't cohere.

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

#104

Post by jcranberry » Fri, Oct 18, 2019, 6:56 PM UTC

aaavl2821 wrote: post #33

Zelphyr wrote: post #16

I know a medical provider who works for a small family medicine practice recently purchased by a large hospital group in our area. They're being told, "You guys need to be sending more people to our hospitals." So for these organizations, patients who are sick and suffering are seen as a product. A day of reckoning is coming for these organizations because the sick and suffering are getting fed up with being treated…

Large hospitals systems have been forming regional monopolies for the last few decades. First they would buy other hospitals to increase negotiating leverage with insurers, then they started buying outpatient clinics to control patient flow. They can also increase the amount they charge at outpatient clinics once the larger hospital system buys them. Hospital spend represents 30% of US healthcare spend, and physician…

Are you sure that we should be going after hospitals rather than the insurance companies? I've been told by a doctor friend of mine that the price of treatment in hospitals are often affected by how much insurers are willing to pay. They bill an insurance company X, the insurance company only a fraction of that and the hospitals just have to deal with it. So suppose they get more leverage and they increase how much they charge--is that an increase in how much insurance companies pay or how much patients pay? Or both? And how does this compare to the actual costs of treatments before and after such an acquisition?

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

#105

Post by dsfyu404ed » Fri, Oct 18, 2019, 6:56 PM UTC

4ntonius8lock wrote: post #61

dsfyu404ed wrote: post #44

Earlier quoted context omitted.

>It seems that these highly complex topics are dealt at the ideological level only. Which is absurd If you take the view that the goal is winning instead of solving the problem it ceases to be quite as absurd.

Except it isn't only about winning. Otherwise, we'd have no objective advancements in medicine. Saying it's ONLY about winning is just as absurd as thinking it's only about solving the problem. It's about solving problems within the system. That includes winning and a lot of other elements.

I didn't say that was the only goal.

The politicians, the newspaper editors, the online trolls, etc. are all people too and probably want to see everyone get good healthcare at good prices but they're so busy advancing their vision of how that should happen that we can't actually have productive discourse because nobody can change their opinion on any detail.

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

#106

Post by ivraatiems » Fri, Oct 18, 2019, 6:57 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…

The problem is not the raw number for how much profit is made; it's how much waste is generated in pursuit of that profit.

For example, the entire concept of "negotiated rates" as they apply to the US healthcare system is based around various entities trying to maximize profit, rather than maximize provision of care.[1][2][3] This results in patients being stuck with enormous bills, and services not being provided, or being provided at unreasonable costs.

And this is just one area where this is the case. Costs for prescription drugs (especially new/non-generic ones) are another great example. Because of the system's desire for profit, much of that $3.5 trillion is being spent to try to pump up that $50 billion -- and it's not even doing a particularly good job, as you note yourself, since other nations with for-profit systems have much lower costs.

I'm not saying that no for-profit system could exist that wouldn't be better. But whether that theoretical new system is for-profit or not-for-profit (or, as it most likely would be, a hybrid as we see in many developed countries), we'd have to rip out a substantial amount of the current system to get it.

[1] https://www.policygenius.com/health-insurance/what-is-a-nego...

[2] https://www.americanprogress.org/press/release/2019/06/26/47... (note: American Progress is a liberal-skewed source, but their stats should be good)

[3] https://www.bu.edu/questrom/2018/12/04/insurers-negotiated-r...

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

#107

Post by pimmen » Fri, Oct 18, 2019, 6:58 PM UTC

I don’t understand the American obsession with designing new systems yourselves when there’s already plenty of alternatives out there that have been tried and true for generations. Health care that’s affordable, offers longer life expectancy, costs less as a percentage of GDP and available to even the poorest citizens have already been implemented in countries across the globe, in Europe and East Asia in particular but also in Canada and Australia.

Why is it that if a US politician says ”our system is bad, the system from France/Germany/UK/Sweden/Japan is beating us in almost every metric, let’s switch” is met with boos but someone who says ”I have an completely untested idea that’s our old system with some quirks that looks like it was designed by a committee without a vision, let’s try it” is met with cheers?

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

#108

Post by throwaway_law » Fri, Oct 18, 2019, 6:58 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?

>How can we get coverage to the poorest people effectively?

Reform the entire economy so there aren't 10s of millions of people who can't afford health care insurance. The current medicaid solution for the poor is a joke like all governmental welfare programs for the poor, they exist so that the rich can benefit from this distribution of taxpayer dollars (like snap/food stamps, section 8 housing, etc..), meanwhile it gives the politicians enough examples of success to point at and pat each other on the back. Meanwhile for the poor who need these services, because to these services often function more like a lottery which you may or may not get the benefits, rather than acting as a program you can depend on.

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

#109

Post by AimForTheBushes » Fri, Oct 18, 2019, 6:58 PM UTC

claudeganon wrote: post #2

> We can and must design the next round of insurance reforms with patients as a priority. With low deductibles that actually facilitate the consumption of care, our health care system can directly benefit the well-being of low- and middle-income people—not just the holders of for-profit hospital stock. No, we need to get rid of private insurance with Medicare for All. The amount of money, corruption, and lobbying ins…

I disagree with this. While it may be sometimes true, it is certainly a good thing that there are checks and balances to treatment. Otherwise providers of care are able to get a blank check. That is part of the problem now- say a physical therapist prescribes 5 sessions a week @ $300 per session but in reality the patient only needs 2 sessions a week. Insurance companies provide a checks/balance system with the ability for care providers to fight back when insurance companies deny care.

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

#110

Post by refurb » Fri, Oct 18, 2019, 6:59 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?

The poorest people generally have public coverage, Medicaid.