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Private healthcare makes industries less innovative. It's time for change

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Re: Private healthcare makes industries less innovative. It's time for change

#31

Private healthcare isn't the problem, lack of free healthcare is the problem. I would much rather live in the UK where private healthcare is good and reasonably priced than Canada where in most places it's simply not available.

All doctor's offices in Canada are in fact private businesses. It's not actually a fully socialized system. It's just there's a single payer. Those businesses bill the provincial government instead of you. Most of the dysfunctions in the Canadian system come down to provinces screw around with billing and payment and funding. Take your dissatisfaction with the way the government manages payments to the voting booth i…

> Take your dissatisfaction with the way the government manages payments to the voting booth

And vote for who? I have yet to hear a compelling solution from any party. At most, politicians advocate for throwing more money at the problem.

> The system is underfunded

Hot take: the system will always be underfunded. The demand for healthcare is nearly infinite in practice. What stops people from going to the doctor for every sniffle is either cost (in a private system) or waiting times (in a public system). If you had infinite resources to offer services, there are some folks who would be going in for MRIs every year "just in case" and getting prescriptions for every flu they have.

Re: Private healthcare makes industries less innovative. It's time for change

#32
post #6

Why is this news? As a European this seems totally obvious.

The European/"Socialist" solutions are never obvious to Americans. It is like parliamentarianism, campaign financing regulations, gun control, multiple political parties, etc. Americans call these things "Socialism" and then freak out about them and refuse to see any good on them.

... and "Chat Control" and Digital ID and forcing digital currency and persistent digital surveillance and conceding your national sovereignty to a council that can pass binding laws without your consent and ....

Let's not pretend either system is perfect, or that the _underlying principles_ that both systems hold are the absolute correct way to organize a society.

Americans have be primed with _decades_ of rugged individualism and the idea that collective action is inherently weaker/flawed (just don't think about Social Security). It might have been reasonably true 100 years ago that everyone could pay for their own health care, but we're now in a world where the average person is perpetually on medications that are expensive to produce, and will demand increasingly expensive medical interventions throughout their life (heart health, cancer care, etc.). Combine that with AI probably wiping out a ton of industries/jobs - something has to change. I'm not going to pretend to have a solution, but I think it is disingenuous to suggest any EU nation has it figured out either and is obviously correct.

Re: Private healthcare makes industries less innovative. It's time for change

#33
I'd love to decouple insurance form employment and I'd also love to do away with the private insurance system in the US. I've always had insurance and the experience has been as uniformly poor, regardless of provider, as it is continuous. Any positive interactions and outcomes have felt like happy accidents, not the system working.

Remove the private actors, the adversarial billing, the friction with providers. It, at its best, ranges from bad to outright awful.

(I'd also love to do away with tax prep — the government knows what is owed, so why make folks prepare their own count and hope it matches?)

Re: Private healthcare makes industries less innovative. It's time for change

#34
We could easily do this and it would actually be significantly cheaper.

But I can’t imagine it happening nationwide. Maybe cities can create their own public options, say a flat 3% income tax and you get health insurance.

So much progress isn’t made in the US due to the welfare queen myth. Heavily intertwined with racism, many imagine “lazy” people getting something they didn’t absolutely earn.

Re: Private healthcare makes industries less innovative. It's time for change

#35
post #27

Earlier quoted context omitted.

Yup. Recently drove 6 hours (each way, twice) to get to a Canadian private clinic to get treatment. This saved approximately a year (or more) of waiting in the public system for a routine outpatient procedure that takes 30 minutes to perform. I was lucky this option was even available within driving distance though. Canada's public healthcare system is massively overloaded and it seems to be getting worse. I really d…

You're describing a provincial issue, not a national one.

This is like the Canadian version of "no true Scotsman". When the province in question has 1/3 of the population of the country, what's the difference?

Re: Private healthcare makes industries less innovative. It's time for change

#36
post #25

In the US market, where union participation is also very low, it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but: - job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point - except when subject to some kind of union negotiated contract, the employer can…

>- there's no standard metric on "how much do our employees pay on healthcare" (i.e. employee premium contributions, deductibles, copays), "how much time do employees spend on the phone with the insurance company", and certainly no way to feed in your last year's records of health-care to see "on plan Y you would have paid C"

"how much companies/employees pay for healthcare" is a poor metric too, because it would depend on the demographics of the company. You'd expect a startup of 30-somethings would have lower premiums than a company of boomers, even for the same coverage.

Re: Private healthcare makes industries less innovative. It's time for change

#37
post #25

In the US market, where union participation is also very low, it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but: - job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point - except when subject to some kind of union negotiated contract, the employer can…

At the high end in tech it’s just assumed it’s all good plus you can make choices on what plan of several offered.

But for many normal jobs it’s very normal to use health care coverage as a negotiation or decision point.

Re: Private healthcare makes industries less innovative. It's time for change

#38

Private healthcare isn't the problem, lack of free healthcare is the problem. I would much rather live in the UK where private healthcare is good and reasonably priced than Canada where in most places it's simply not available.

Nothing is free. We want both low cost and high quality healthcare.

This means we need to have ways in incentivize innovation (AI diagnostics, robotic procedures, drug discovery, deeper R&D).

Free Markets (with government controls against monopoly) are generally better than governments at delivering cost and quality improvements, but healthcare in most countries is somewhere between “100% not a market” and “70% not a market” (the US). In many cases, governments also actively create and enforce monopolies (eg AMA or local hospitals in the US).

There are a million other things but part of what is required for markets to work is skin in the game, which the UK, Canada, and the US all do bad jobs of in their own ways.

Some say medicine has no elasticity. I don’t think that is true for 90% of spend (for gunshot wounds, maybe, but most spending is on chronic diseases where multiple providers and approaches are available and people could price shop).

I would like to see more countries experiment with more free market healthcare. It’s remarkably effective for many pieces of healthcare.

Re: Private healthcare makes industries less innovative. It's time for change

#39
post #25

In the US market, where union participation is also very low, it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but: - job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point - except when subject to some kind of union negotiated contract, the employer can…

Not to mention that tying your insurance to your job is a *huge* pain. If you switch jobs or get fired you need to deal with coverage gaps, considering individual coverage for the duration, and you may need to switch care providers depending on what your new coverage is.

It is just a really awful system overall.

Re: Private healthcare makes industries less innovative. It's time for change

#40

One thing that's never been clear to me is how either system plans on scaling healthcare. You have X doctors who can see (just a guess) 30X patients. Unless the number of doctors increase, some patients are going to be left out. In the current system it's those without employment. I'm other countries there's a waitlist. How can we make sure there's enough staff to provide adequate healthcare for everyone?

Forced labour? Poland has doctors on 32 hour shifts. Worker comes on monday morning, leaves tuesday evening. The night is spend on ER, with a few naps between patients. Perfectly legal!
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