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America’s Looming Primary-Care Crisis

newyorker.com

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Re: America’s Looming Primary-Care Crisis

#71

Post by Reelin »

gruez wrote: post #62
mandelbrotwurst wrote: post #53

Earlier quoted context omitted.

Who is going to decide which activities are "non-essential" ? How will they go about determining whether there are more benefits or costs associated with a particular activity? Rock climbers can fall - they also build physical and mental fitness as well as learn to work together with and trust others in a high pressure environment. Motorcyclists can crash, but they're choosing a form of transport that is far more eff…

>Who is going to decide which activities are "non-essential" ? A nonpartisan government panel of scientists. I realize with the current political climate in the us, that might be a tall order, but that doesn't immediately mean the idea should be dismissed. >How will they go about determining whether there are more benefits or costs associated with a particular activity? Cost benefit analysis based on empirical eviden…

What you describe is the polar opposite of freedom. It should be immediately dismissed not due to the current political climate but instead because it would establish the ultimate nanny state full of red tape and bureaucracy.

No one should be arbitrating personal activities unless they directly and immediately impact those around you.

(And for the record, I vehemently disagree with sin taxes such as those for alcohol and tobacco. Legally requiring health warnings on the packaging, on the other hand, makes a lot of sense to me. Also note that alcohol and tobacco have much more consistent and severe health impacts than, say, refined sugar.)

Re: America’s Looming Primary-Care Crisis

#72

Post by jyounker »

MattGaiser wrote: post #66
cortesoft wrote: post #26

Earlier quoted context omitted.

I think you are misunderstanding the incentives that drive politicians if you think extra health care costs would make them change their subsidy policy. They subsidize because the recipients are powerful donors who want them. It isn’t because it is sound fiscal policy.

Yes, because cheap food is not something that would otherwise interest lots of people... Increasing corn production also does not play to a crucial constituency in the Presidential elections... This obsession with “rich donors” ignores that voters will also get mad at politicians for the consequences of eliminating those subsidies.

The smaller your donor base, the fewer people you have to make happy. My personal belief is that this is why income inequality is inversely correlated with democratic representation.

Re: America’s Looming Primary-Care Crisis

#73

Post by refurb »

maxerickson wrote: post #40
tesmar2 wrote: post #30

Earlier quoted context omitted.

AFAIK due to regulation, hospitals can prevent other, new hospitals from being built and it happens often. Get rid of the regulation.

In many places, the government prevents new hospitals from being built. The existing hospital doesn't have to do anything.

https://en.wikipedia.org/wiki/Certificate_of_need

Re: America’s Looming Primary-Care Crisis

#74

Post by qserasera »

DoreenMichele wrote: post #41
pengaru wrote: post #24

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. The argument I've heard smarter, better informed people than me make is: If healthcare were nationalized, it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. When the government subsidizes farming corn on a massive scale, and…

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. That's only one factor. Another is car dependence and lack of pedestrian-friendly built environments. There is a lot of research on just how much harm it does us to sit all day, every day. We sit in a car to make a long commute to work. We sit our desks. We sit in the car again. And hitting the gym occasionally d…

Our metabolism increase from walking 5-15 minutes every day is significant. With individual car transportation there is little want or little ability to do so. Many schedules do not allow for daily 60 minute exercise routines at the gym which take 10-15 min to get there by car.

Every day US citizens waste hours life with transportation. I do believe in cars but I also believe we need to reshape how we live. If the US government allows our time to be wasted repeatedly by a variety of lobbies building infrastructure for a variety of interests it shows how little our leadership values the time of our citizens. I almost find it more egregious that government wants to waste the time of our citizens than wanting to eventually kill ourselves with emissions.

The US currently has an oversupply of labour and I suggest the US does something with it to reshape infrastructure to be less energy reliant.

The world should look into outfit and create houses with manditory natural cooling/heating, increase density in cities and towns to reduce habitat distruction and sprawl, reduce emissions of high GWP chemicals, and create a global political situation to reduce reliance on a failing economic system that incentivizes people to hide pandemics.

Re: America’s Looming Primary-Care Crisis

#75

Post by neutronman »

roenxi wrote: post #55
cortesoft wrote: post #26

Earlier quoted context omitted.

I think you are misunderstanding the incentives that drive politicians if you think extra health care costs would make them change their subsidy policy. They subsidize because the recipients are powerful donors who want them. It isn’t because it is sound fiscal policy.

Adding to this; there is also no evidence that the US's politicians care about financial incentives as applied to the US government. If it affects them personally then they'd jump like a cat on a stove; but if it only affects the budget they aren't going to respond to any incentive. If the US was being influenced by financial incentives it wouldn't be doing many of the things it does. Like tax cuts or spending more m…

The monetary policy of the USA is insane these days. Tax cut and spend is here for the moment. Taxes will go up but so will spending...

Re: America’s Looming Primary-Care Crisis

#76

Post by creato »

mandelbrotwurst wrote: post #53
gruez wrote: post #45

Earlier quoted context omitted.

>It would also incentivize the government to restrict all manor of activities in the name of “health.” Want to go rock climbing? Pay a tax. Want to ride a motorcycle? Pay a tax. Okay I'll bite. Why shouldn't we do that? If you're going to 28x your death risk[1] by participating in a purely non-essential activity, why should you be able to externalize the costs to others? >Perhaps instead of taxing food, we instead ta…

Who is going to decide which activities are "non-essential" ? How will they go about determining whether there are more benefits or costs associated with a particular activity? Rock climbers can fall - they also build physical and mental fitness as well as learn to work together with and trust others in a high pressure environment. Motorcyclists can crash, but they're choosing a form of transport that is far more eff…

Why does anyone even need to decide? Just look at the amortized costs for any activity, whether it is "essential" or not. Essential things still cost money. The only thing you might want to do is provide a rebate for taxes on "essential" activities. This still provides the market pressure for people to minimize costly activities (but doesn't ban it), while being net zero impact to revenue.

Someone mentioned there are 200 climbing accidents a year. Figure out how much that costs, and bake it into the cost of some climbing specific requirement (climbing permits? equipment? gym memberships?). I doubt the cost will be significant. And if it is, maybe we should rethink climbing as an activity.

Same with sugar. Figure out how much added sugar actually costs in terms of health impacts, and tax sugar appropriately. A key point of this strategy is that if you aren't consuming a large amount of e.g. soda, as a parent post claimed, then the tax is negligible anyways.

> Motorcyclists can crash, but they're choosing a form of transport that is far more efficient than a single passenger vehicle in many ways (fuel consumption, parking requirements, traffic impact).

Motorcycles aren't actually that efficient. A prius gets better gas milage than many (most?) motorcycles: https://www.latimes.com/news/la-hy-throttle2apr02-story.html

At least a prius has a chance of carrying more than one person.

Re: America’s Looming Primary-Care Crisis

#77

Post by kevin_thibedeau »

bluedino wrote: post #60
baix777 wrote: post #48

Earlier quoted context omitted.

Canada is similar to the US in terms of food consumption, and yet Canada has much better health care outcomes and lower health care expenditures. I'm not saying food isn't a factor, I'm just wondering how big a factor it is compared to universal access to health care.

It’s the food. The USA has 40% obesity rate vs 15% of Canada. We just eat more here, and we eat more garbage. Funny enough, if you chopped off the fattest 5-6 states, the USA would compare more favorably.

Or it's not the food and people have just adopted a lifestyle where all energy expenditure is minimized.

That is self evident in social behavior. Your theory is just an easily trotted out bogeyman.

Re: America’s Looming Primary-Care Crisis

#79

Post by reducesuffering »

cortesoft wrote: post #26
pengaru wrote: post #24

My understanding is that a major cause of America's burgeoning healthcare burden is the food environment. The argument I've heard smarter, better informed people than me make is: If healthcare were nationalized, it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies. When the government subsidizes farming corn on a massive scale, and…

I think you are misunderstanding the incentives that drive politicians if you think extra health care costs would make them change their subsidy policy. They subsidize because the recipients are powerful donors who want them. It isn’t because it is sound fiscal policy.

Food subsidies poll extremely well and the US votes for them. They are one of the least controversial public policies and not because of "powerful donors." Almost all countries subsidize food production and there are strong reasons why this is so. Primarily, countries want a robust domestic food surplus for social stability. High food prices or lack of food leading to famine are one of the highest causes of social unrest.

Re: America’s Looming Primary-Care Crisis

#80

Post by Coldgamr »

ackbar03 wrote: post #70
Coldgamr wrote: post #59

Earlier quoted context omitted.

Thank you for sharing this anecdote. I don’t think enough people understand the value of direct primary care. Of note, concierge primary care is more associated with something like one medical where you pay a membership in addition to your regular insurance co-pays. Direct primary care, or DPC, is full stop no insurance, only membership. And the doctor will limit their patient panel (the patients they see) to about 6…

How does this work with the insurance dynamics though? You say no insurance full stop, does that make the cost prohibitively high for some? I feel like insurance in a way is similar to a membership model for the patient in terms of cash flow although definitely not the same for the doctors. I'm not in the US so I don't really understand how medicaid works over there

The average price for a DPC membership is about $65/month. In most states, the doctor can even dispense prescriptions at or near wholesale cost.

The idea is that higher utilization of primary care results in lower hospitalizations and specialist visits, which are very expensive for all parties. This has actually been proven in studies comparing total health spend by large employers before and after adding DPC for their employees. So spend a bit more in primary care, get high touch service, and lower cost in the long run.

Medicaid, btw, is our social safety net health insurance program. Most Americans have insurance though their employer which is usually a high deductible plan. Meaning, you have to spend thousands of dollars before insurance will start helping to cover the cost of healthcare for you.

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