461–470 of 549 posts
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There's no point pretending you know what people's motivations are. Conservatives I've read/heard seem to generally want similar outcomes, but disagree drastically on the methods.
First sentence: don’t guess people’s motivations Second sentence: explain people’s motivations
Pricing transparency is only one piece of the puzzle. It is a tremendously antiquated industry. Fax is still state of the art -- welcome to the 1980s!
[1] CMS. https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
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>>* CMS (medicare/medicaid) sets a low price for a procedure that's overly common in a particular facility, now that facility loses money for each occurrence. They choose other procedures to raise the price to try to break even. This is precisely why most Doctors I speak with are abhorrently against a single payer system.
Most doctors I talk to vaguely run around the answer before mumbling that a huge way to cut costs (which will surely happen) is to cut doctors salaries. Source: once engaged to a doctor who had doctor friends and doctor parents/family.
Doctors’ salaries account for only about 8% of U.S. healthcare costs. A 40% cut in these salaries would reduce healthcare spending by only about 3% [1][2].
Doctor salaries are not a huge way to cut costs. If anything this would make the problem worse.
[1] https://www.latimes.com/opinion/story/2021-09-14/dont-blame-...
[2] https://pnhp.org/news/doctors-salaries-are-not-the-big-cost/
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I was using obesity as a standin for metabolic syndrome to compare populations. Not sure if measure how many ppl have 'metabolic syndrome. https://www.nhlbi.nih.gov/health/metabolic-syndrome metabolic disease = all things that can be fixed by lifestyle modifications ( unless you are too far gone, ie). see my reply here: https://news.ycombinator.com/item?id=32744868
Metabolic syndrome is often a side effect of medication or symptom of other diseases that can't be fixed with lifestyle modifications alone. For example, there are a lot of people on psychiatric medications that can cause metabolic syndrome as a primary side effect.
Would be interesting to know how often.
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The NHS's difficulty lies in the simple fact that it is understaffed ( https://www.express.co.uk/life-style/health/1633058/general-... ) and the staff are underpaid ( https://www.bbc.com/news/newsbeat-62290577 ) — leading to unprecedented wait times. This is because the "list prices" that the NHS pays for GP, nurses, and services are not subject to market forces, they are set by the government. The government is curr…
> The NHS's difficulty lies in the simple fact that it is understaffed and underpaid — leading to unprecedented wait times. This is because the "list prices" that the NHS pays for GP, nurses, and services are not subject to market forces, they are set by the government. The government is currently failing to address the supply loss with little political will to increase list prices. And the US's problem is that the l…
Yeah that's completely untrue; the list prices that insurers pay for GPs are heavily inflated by the market distortions introduced by the Federal government. I don't know if you read any of what I've written up-thread, but I'll paste the relevant parts here for your benefit:
"First of all, the non-Medicare private insurance industry is heavily regulated, often more so than Medicare Advantage private insurers. In fact, you raise an important point: it's important to consider which specific regulations are helping and which are hurting. Outside of Medicare Advantage, there are regulations that strictly control insurance company's profit margins, how much of premiums can be spent on collecting medical claims (see: the 80/20 rule and Medical Loss Ratio rules), the fact that every beneficiary must be treated exactly the same (ERISA, parts of ACA), a minimum amount of coverage required (the ACA added this), the employer mandate (ACA), etc.
To give you a sense for some of the unintended consequences that have been created by regulations on non-Medicare Advantage health insurance plans, due to Federal mandates and tax incentives, health insurance is predominately provided by employers rather than the individual market (unlike Switzerland, Germany, or the Netherlands). What we're seeing in healthcare costs is analogous to what you might see happen to airline ticket costs if we all got our air tickets through our employers: the vast majority of us would fly business class, while the unemployed would be simply unable to pay for business class fares out of pocket. A big reason for this is that employers (especially medium-to-large businesses) have a much higher purchasing power (and hence, willingness to pay) than individuals. If you take this behavior and combine it with the fact that health insurers' profit margins are capped by law, insurers pay more absolute dollars for treatments (which doctors happily accept), charge more to employers (who are generally less price conscious vs individuals), thus bring in more absolute revenue, and therefore more profit because a capped profit percentage of a higher revenue is higher than a capped percentage of lower revenue. It's somewhat counter-intuitive, but the policy combination of an employer mandate and insurance profit cap results in increased prices."
Put simply, the US healthcare industry is not subject to traditional market forces.
> The government is currently failing to address the service provision loss with little political will to decrease list prices (even though they would propagate through to consumers as decreased costs).
It's quite clear that the reason the government is not doing this is because it would further exacerbate the staffing shortage and lead to even higher wait times. That's not a political problem, that's a hard economics problem.
> It seems to me that there's no getting around the need for good governance here. And that lack of it is no excuse for not governing at all.
There is a key governance difference between making the decision to lift distortionary regulations once & up-front so as to unblock efficient resources allocation vs actively having to continuously adjust resource allocation. With the former, you just have to trust that the "good governance" happens once, whereas with the latter, you have to trust that "good governance" happens forever (politics notwithstanding). The Swiss chose the former, whereas the UK struggles with the latter. Domestically in the US, Medicare Advantage is a proven model — and the governance prescription here is to have the entire private insurance industry look more like Medicare Advantage.
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As a heads up, ‘deficitary’ doesn’t mean ‘deficit running’ in English. It is closer to the word ‘deficient’ which I don’t think is your intended meaning. Thanks for the insightful comments.
Thanks for the comment! I was meaning the former (under debt). The intention of my comments was to make clear that in that regard, Switzerland is not an efficient free market private insurance paradise. There are lots of nuances to it, and the private insurance system in fact brings in inefficiencies, namely, a very complex and costly cost itemization and enormous amounts of paperwork and stress for doctors, customer…
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I understand you're the relative expert here, but even so I must disagree with your general thrust. I've been hospitalized in four different countries. The least sane was America. The sanest was a private hospital in England, but the public hospital in England was fine too. My home country of Canada is sane, reliable, and reliably slow and mediocre bordering on subpar. Cyprus lacked toilet seats, but at least the foo…
You're coping. Americans are responsible for about half of the world's medical research.
https://en.wikipedia.org/wiki/List_of_countries_by_research_...
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see: page 20 https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221... > We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous. How so? Only recommendation for all these chronic conditions is 'diet and exercise' is it not ? Obesity isn't the only one. I am not obese , not even close, but I have hyperlipidemia. I am managing it with 'diet and exercise' after initia…
No, "diet and exercise" is not the only recommendation. I don't even know what point you're trying to make there - if that were the only recommendation, health care costs would be fairly low. And it's not just mental health issues (~25% of all chronic health issues), it's also respiratory issues (~10%). Then add to that the fact that many metabolic diseases have long lists of causes that amount to "not really sure".…
What else is there though? I consulted many physicians for my hyperlipidemia and all of them suggested 'diet and exercise' as the only solution. It is the only thing that worked for me.
yes 'not all' high cholesterol can be managed by lifestyle modifications( eg: your genetics might predispose you to high cholesterol. Do you know how much of healthcare spend goes to to the exceptions you are talking about. I certainly couldn't find any data about this, not sure why.
> Hypertension? Being older than 65 is a cause.
Yes we don't know the cause but we do know the fix even if you are over 65.
AHA recommendation
https://www.heart.org/en/health-topics/high-blood-pressure/c...
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That's a pretty good deal considering US federal spending alone amounts to 7.3 trillion dollars.
Lobbying American reps has the highest ROI of any investment in human history. Ted Cruz would probably cosign a bill to 'throw all puppies off a mountain' for an all inclusive trip to Tulum
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> countries without that or with less generally have better outcomes at less cost. > Looking for evidence to the contrary There was no evidence behind your claim either. 90% of US healthcare costs go to managing ( not treating ) obesity/metabolic disease . Yes 90% [1]. Which country with similar metabolic disease rate has better outcomes with less costs? 1. https://www.cdc.gov/chronicdisease/about/costs/index.htm
The link you posted says that the 90% is to treat all "chronic and mental health conditions," which is a much larger grouping than just obesity/metabolic disease.
yes we don't measure this and is impossible to measure.