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The profit-obsessed monster destroying American emergency rooms

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Re: The profit-obsessed monster destroying American emergency rooms

#81

Post by AnthonyMouse »

skhunted wrote: post #73
AnthonyMouse wrote: post #67

Earlier quoted context omitted.

Healthcare is cheaper in every country everywhere regardless of whether they have public or private coverage. This implies that the difference isn't public vs. private, it's some other regulatory differences which are driving up costs in the US.

… it's some other regulatory differences which are driving up costs in the US. It suggests regulatory capture and/or lack of proper governmental oversight.

"Regulatory capture" is the regulations the people complaining about regulations are complaining about.

"Lack of government oversight" almost never leads to high consumer prices. It can lead to externalities, but if there are no regulations preventing anyone else from competing with the incumbents, it's very hard to sustain monopoly rents.

Re: The profit-obsessed monster destroying American emergency rooms

#83

Post by skhunted »

victorbjorklund wrote: post #77
skhunted wrote: post #41

Earlier quoted context omitted.

The fact that healthcare is far cheaper in every European country that has universal healthcare suggests that you are wrong.

But not sure americans would be okay with the limits on healthcare you got in europe. I'm from sweden and here you often have to wait several months to see a doctor if it isnt "im dying right now"-urgent. And if you got something complicated that isnt easy to diagnos but isnt killing you they will just not do anything about it. The healthcare is good if you got something well defined and urgent like a hearth attack o…

The healthcare outcomes in most European countries are better than in the U.S. The wait time of someone without access to the healthcare system is infinity. In all healthcare systems there is rationing of care. In the U.S. we ration in an immoral way.

Re: The profit-obsessed monster destroying American emergency rooms

#84

Post by JamesBarney »

jaco6 wrote: post #68

The problem with American healthcare is the attempt to compromise between healthcare as a universally available public utility and healthcare as a commodity on the private market. (Arguably this is a legacy of pre-modern healthcare, where hospitals were operated by charities run by nuns and funded by aristocrats and royal families, hence all the “Saint” names in hospitals nowadays). There’s a variety of weird example…

> It would be more efficient to pay for it using taxes, both income and sales taxes, rather than letting some groups—the poor and the elderly—off the hook arbitrarily.

I don't think this is true. Some countries with public healthcare are far more efficient than our system.

But there are countries that have systems similar to ours that are far more efficient as well.

We just have a really shitty system, and who pays for it isn't going to change that. It's a hard technocratic problem that doesn't have any easy answers. (Besides increasing the number of residency slots, removing the bachelor degree requirements and allowing foreign physicians to practice which are basically freebies.)

Re: The profit-obsessed monster destroying American emergency rooms

#85

Post by phil21 »

titanomachy wrote: post #25
404mm wrote: post #18

I live in north Texas, and the situation here is pretty much on par with the article. Urgent Care & Emergency Room combos are here on every corner. It’s a lucrative business, so it makes sense that private equity firms are gobbling it up. But I think the more interesting problem here is one level up. Why are there so many of them? I see two possible reasons: 1. Anytime one of my family members gets sick, it’s rather…

$300 is your part of a regular doctor visit? Or the total bill? Do you have one of those high-deductible plans designed to discourage people from seeking any healthcare?

High deductible plans are great. They are designed to allow you to take pretax money out and use it to either invest like an IRA or spend it on healthcare.

In other words they are actually insurance. Not a prepaid healthcare plan. No one should be using “insurance” to cover every day expected expenses like random doctor visits for the flu.

They are a small fight against the massive principal agent problem which is the sole issue anyone should be focusing on if they care about healthcare costs.

Re: The profit-obsessed monster destroying American emergency rooms

#86

Post by swatcoder »

ryandrake wrote: post #74
swatcoder wrote: post #40

Earlier quoted context omitted.

3. Demand for immediate care is high. The next "one level up" might explore how much is because the community is quite morbid and unwell, because modern culture has displaced traditional home/self care with consumerized services, or because of other things. There are people I know who are largely healthy and who consult paid medical services many times per year for everyday disturbances, and others who take decades t…

> traditional home/self care Not sure what you mean by this? If I have a broken bone, I'm not going to set it myself at home and take a few aspirin. Same if I'm puking my guts out. If you just mean getting exercise and eating healthy then I fully agree with you. But, when you're actually sick, and need to see a professional, that is the right time for "consumerized services".

You're welcome to take it as foolish pre-modern ignorance if it strikes you that way, but actually yes: many people do not think to go to a doctor for minor bone injuries or vomiting, and many more than that wouldn't think to do so for more common everyday illnesses like a familiar sore throat, rash, nosebleed, fever, etc

For some, this is rooted in a confidence in their own personal-community care, for others its an insight into what few actions a doctor might take themselves for these issues, etc

There's lots of ways to explain it, and certainly many of them can be easily criticized by people who see professionalized medicine differently, but you may as well let go of the idea that everybody out there approaches it in the same way that you do. It's probably not even all that consistent among your own circle of family, friends, and acquaintences.

We're still only in the beginning of what seems to be a sweeping cultural transformation around how people see health and medicine and the perspectives people bring are still quite diverse.

At the same time, the overall direction in recent decades is definitely towards seeking commercial medical care for more concerns as well asserting that this is an entitlement that all people should have access to.

Re: The profit-obsessed monster destroying American emergency rooms

#87

Post by jerrycabbage »

alan-hn wrote: post #24
robertlagrant wrote: post #16

Earlier quoted context omitted.

> Money needs to be redistributed so the ratio of dollars to brain cells is more balanced. It will likely do that naturally unless something gets in the way in the name of progress.

Money and greed naturally get in the way. Is that not obvious? People are finding any way to game the system just to get more money You're thinking of using money as a measure but everyone else is using it as a target...

The answer is a wealth tax. The inequality grows leading into a need for investments like these. If all other assets weren't so inflated then we could at least wish PE wouldn't need to do things like this but this is what will happen. Excess capital keeps buying up assets lower classes need due to lack of options otherwise.

Re: The profit-obsessed monster destroying American emergency rooms

#88

Post by skhunted »

AnthonyMouse wrote: post #81
skhunted wrote: post #73

Earlier quoted context omitted.

… it's some other regulatory differences which are driving up costs in the US. It suggests regulatory capture and/or lack of proper governmental oversight.

"Regulatory capture" is the regulations the people complaining about regulations are complaining about. "Lack of government oversight" almost never leads to high consumer prices. It can lead to externalities , but if there are no regulations preventing anyone else from competing with the incumbents, it's very hard to sustain monopoly rents.

Most people in the U.S. think regulations are bad in and of themselves. Regulations as a concept are the wrong target.

Lack of government oversight and regulations almost always leads, eventually, to cartel pricing and/or monopolistic type pricing.

Re: The profit-obsessed monster destroying American emergency rooms

#89

Post by phil21 »

ryandrake wrote: post #79
philwelch wrote: post #57

Earlier quoted context omitted.

I’ve long been a proponent of high deductible plans. The part you’re missing is that you also get the opportunity to contribute pre-tax money to a Health Savings Account, which is money that you get to keep (and even invest) over the long term. You can spend that HSA money on medical expenses but if you save it, it turns into another tax-advantaged savings account like your IRA and 401(k).

It's kind of silly they tie these together. Why can't I also open an HSA if I'm on a traditional PPO plan? Or if I have no health insurance as all.

Because a healthcare plan isn’t insurance. You used the correct term. If you want a prepaid healthcare plan that’s fine, just stop calling it insurance since it’s not.

Totally agree it should be available for cash pay.

Re: The profit-obsessed monster destroying American emergency rooms

#90

Post by JamesBarney »

ryandrake wrote: post #11
giantg2 wrote: post #7

The thing that doesn't get mentioned much in these conversations that I've personally seen play a big role is the regulation. When you have highly complex regulations, you end up consolidating practices. As regulations increase, the number of distinct providers/owners decrease. Many individuals don't want to run their own practice due to the complexities (insurance, etc) that exist beyond the work (treating people).…

> The thing that doesn't get mentioned much This gets mentioned every time. The regulation boogeyman always shows up. If only there were fewer rules... everyone could make more money, the little guy would be able to enter and play fast and loose, and nobody would do the wrongdoing those rules were meant to correct/prevent. Yes, there are regulations in health care. There are regulations in almost every industry, and…

Everyone knows the US healthcare system sucks. But the United states medical system is not uniquely under regulated compared to the rest of the world. It's uniquely poorly regulated.
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