151–160 of 206 posts
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They weren't worried about it, but it was happening anyway.
Your argument is that a nonprofit Japanese restaurant could have delivered a better experience to me?
This is pretty much the same argument that you make sidethread.
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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…
> As noble as being a doctor is, their individual contributions can never scale beyond a few people.
Nonsense. If you only scale into saving hundreds of users a few minutes each, you're maybe approaching one lifetime, and that's assuming that your time saving actually improves those users' lives. The vast majority of engineers don't scale beyond that.
Meanwhile, some doctors absolutely make contributions that scale, such as finding cures or vaccines, preventing spread of infectious diseases, or discovering ways to detect diseases earlier. Looking at percentages of world population, the black death killed more people than any of the FAANG companies have users, and that's only one of the diseases cured by the discovery of penicillin. If antibiotics resulting from penicillin didn't exist, it's quite reasonable to guess that more people would die of bacterial infections than FAANG has users.
The smallpox vaccine? A test for detecting HIV? Quarantining the Ebola outbreaks? Each of these saved millions of lives.
And let's not forget that the highest-scale engineers are pretty hit or miss as far as whether the way their work touches lives is even positive. Big pharma isn't innocent, but I don't think anyone would argue we should get rid of them entirely. In contrast, it's pretty unambiguous that the world would be better off without Facebook, and each of the AANG companies has some pretty large negative effects on i.e. small businesses, worker rights, attention, privacy.
In short, you're just comparing the highest-scale engineers to the lowest-scale doctors, and assuming that what engineers are doing is as positive as what doctors do.
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Sorry, I didn’t mean to suggest that you had taken this position. I just really want to move the conversation forward. So there are problems with Medicare, but you seem to know about this so I’m curious what you would suggest we do to provide coverage to millions of poor Americans currently going without. I’m no policy expert and I thought M4A is a great idea. Thanks!
I don't know. What I'm advocating is that any discussion of the US health care problem start with a breakdown of where the money is going in our system. There are competing breakdowns, but any of them would be better than the default presumption we seem to have that the problem with health care is "insurance companies and prescription drugs". No breakdown I've seen on any side of this debate shows that either of thos…
My priorities are just:
1) Ensure universal coverage for all Americans.
2) Structure it so costs are at least as reasonable as those in other countries with similar systems.
So for me, universal coverage immediately is a hard requirement and of course it must be done as fiscally responsible as we can manage. But we can always refine the system to lower cost later. We can’t replace the lives lost due to inadequate coverage.
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why estimate? i linked a study you must not have read that says: > After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States, as compared with 16.7 percent of health care expenditures in Canada. or did you have a problem with that study or something?
Sure. For starters, that paper is using 1999 numbers, and there has been a sea change in health costs since then --- we pay almost 3 times as much in total health costs today as we did in 1999. Intelligence Squared hosted a debate last week on M4A vs. private health insurance, and had two extremely motivated and well qualified debaters on the pro-M4A side, including Adam Gaffney, president of Physicians for a Nationa…
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If you’re referring to Medicare, it does control costs through its fee schedule, but is limited in efficacy because it doesn’t cover everyone. Nevertheless, the Trump administration is currently trying to jack up how much it pays out to non-Medicare levels to prevent even this downward pressure. And of course it’s barred from negotiating drug prices for the same reasons. As to why insurance companies don’t pursue evi…
Wait, Medicare covers the most expensive cohort of patients in the country, which you'll easily see in any breakdown of health costs by age. It already has responsibility and authority for prices in the most important segment of the market. Why hasn't it controlled their costs? I think your answer on evidence-based care is superficial and a little bit facile. For instance, a major component of evidence based care is…
As to your second question, fee for service is too perverse of an incentive. What you end up with is an arms race where healthcare providers try to extract as much value as possible through as many procedures as possible and healthcare providers, in turn, try to make money by denying as much as possible (as well as pushing sick people into the government plans). The result is poor quality, expensive care, as the two factions devote more and more resources to waging this battle and less and less on creating good quality and affordable care.
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Wait, Medicare covers the most expensive cohort of patients in the country, which you'll easily see in any breakdown of health costs by age. It already has responsibility and authority for prices in the most important segment of the market. Why hasn't it controlled their costs? I think your answer on evidence-based care is superficial and a little bit facile. For instance, a major component of evidence based care is…
Hasn’t done what? Apologies, you’ll have to elaborate. Medicare fee schedules do put downward pressure on costs, which is why they’re under attack, but lack sufficient power to push down prices because they are not universal and exclude drug costs. Japan has universal price controls (and cheaper healthcare) for precisely these reasons. As to your second question, fee for service is too perverse of an incentive. What…
"Excluding drug costs" can't be the problem, because drugs --- no matter what their provenance --- are a small fraction of total health care costs.
Your response to my second question doesn't respond to my point. I was specific. You've responded with abstractions. Can you be more specific about what you meant by evidence-based care, and Medicare's unique ability to provide it?
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> The public rhetoric frustrates me as someone who favors universal healthcare. Demonizing corporations and rich people is red meat for partisans, but it’s not a solution. How do we pay for this system? How do we cut costs? There are already two pieces of legislation, the Jayapal and Sanders bills, they account for their costs. Tim Faust’s new book likewise walks through all of these concerns in detail: https://www.m…
You're using "account for their costs" in a different sense than I think Rayiner meant. When Sanders "accounts for his costs", he means that they've added up the total projected costs of their plan and then accounted for it with tax revenue. That's fine, but it doesn't address the fundamental problem of US health care costs, which is --- regardless of "who pays" --- "why does it cost so fucking much". If all we do is…
A doctor named David Belk set out to find answers to this question. He presented what he found at http://truecostofhealthcare.org/. You can start with the introduction (http://truecostofhealthcare.org/introduction/) or skip straight to the conclusion (http://truecostofhealthcare.org/conclusion/), or explore his findings on a category-by-category basis.
Or, if you prefer, the LA Times ran an article a while back that examined the single case of a dislocated shoulder: https://www.latimes.com/business/story/2019-09-12/medical-eq...
A deep dive into the specifics is well outside the scope of a comment on an HN thread that's already gone off the front page, but the summary is that the US system has a large number of profit-motivated groups involved in every step of the health care system, and those costs balloon rapidly as a result, and health care recipients are the least powerful group politically so none of this is changing for the better.
Based on the findings like these and the plethora of other articles I've read on the subject, I'm extremely skeptical of a Either that, or all the US health care corporations are really impoverished, every article on the subject that has faulted obscene profits is wrong, and all other countries are somehow propping up a rather large section of their social services with tax rates only marginally higher than the US overall rate.
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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…
>> 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. There are many problems comparing software pay to healthcare pay. - A large portion of software jobs are in the Bay Area, you ar…
The multiplier of my salary to get a health insurance CEO's salary is also now, what, 200 or 300 instead of 100?
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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.
> 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 So then it's a good idea to remind people of the absurd, as in the post you answered. Dismissing the absurd as merely being a consequence of not 'thinking about winning' is an oversimplification. To me such a dismissive, one liner post is designed for ego-gratificat…
"When you read a HN article about some despot in a foreign land having the intellectuals lined up and shot it seems irrational. When you read the comments and you realize the despot might be on to something."
'Ironic' calls to do violence to others for their beliefs and words do not let one assume that the person calling for such pseudo-violence is trying to anything other than get a rise out of people. I'd suggest cat videos instead of wasting time with them.