We Need to Design Health Care Reform That Puts Patients Before Profits • Hacker News Board

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#131

Post by kerkeslager » Fri, Oct 18, 2019, 7:22 PM UTC

tptacek wrote: post #73

kerkeslager wrote: post #32

Earlier quoted context omitted.

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 don't understand the axioms you're trying to draw on to derive just compensation for physicians. Why not just look at the worldwide market? Compare US physicians to those in other countries; we pay ours drastically more, and we are not generally more satisfied with the care we receive.

If we look at the worldwide market, health insurance CEOs salaries stand out even more starkly.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#132

Post by leetcrew » Fri, Oct 18, 2019, 7:24 PM UTC

EpicEng wrote: post #125

leetcrew wrote: post #122

Earlier quoted context omitted.

> Why are you assuming that I would spend less time with e.g. my wife if she were less efficient in performing some menial task? because "helping many people allocate their time towards activities they actually value" was an important premise I stated in the post you originally replied to? I deliberately excluded stuff that merely improves productivity at work (although not everyone is fortunate enough to have a job…

Then you're going to have to give me some examples. All in all I think doctors and medical scientists are more important to the world than the vast majority of us (since we have to make it an either/or for the sake of argument), so get specific.

I for one am quite grateful to the engineers who implement electronic automatic billing. when I was a kid, it seemed like my dad spent a lot of time sorting through mail and writing/mailing individual checks for services. now it's automatically billed to the credit card, the credit card gets autopaid from checking, and he just has to make sure there's enough in his checking at the end of the month. that's not a huge amount of time and thought saved, but it's not nothing either. there's a lot of this stuff that we take advantage of in our lives without really noticing, I think.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#133

Post by darksaints » Fri, Oct 18, 2019, 7:25 PM UTC

rayiner wrote: post #34

The U.S. spends $3.5 trillion annually on healthcare. Worldwide profits for the 112 publicly traded healthcare industry companies amount to $50 billion per quarter: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar... . Even if all those profits are allocated to the U.S., that's about 5.7% of healthcare spending. (And completely consistent with most other industries.) Hyper-focusing on profits is misguided…

Publicly traded is a tiny fraction of the healthcare industry. Of the dozen or so hospitals in Seattle, for example, only one is owned by a publicly traded company.

Even if they're technically non-profit, that doesn't mean they don't realize a profit. It just means that the profit needs to be spent elsewhere. This is model that most university medical centers use: make a shit ton of money in healthcare, and then use it on the school or pay fat paychecks to the board of directors.

I think when people talk about profits they aren't talking about GAAP profits, they're talking about rent seeking. There is a shit ton of that everywhere. For example, when I went to the ER for a kidney stone at a non-profit hospital, I ended up getting 8 bills. One was from the hospital. Then I got one from the lab that ran the CT Scanner, one from the Radiologist that analyzed the ct scan, one from the pharmacy that provided the drugs I was given, and four bills from the four ER doctors making their rounds through the ER, asking how I was feeling, and then checking a box on the chart. Each 5 minute visit was rounded up to the hour. That's all "profit" in the colloquial sense, but it wouldn't show up in the P&L of a publicly traded company even if the organization was publicly traded.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#134

Post by vharuck » Fri, Oct 18, 2019, 7:25 PM UTC

kerkeslager wrote: post #32

helpPeople wrote: post #6

Until Americans find Physicians (and Pharmacists) as the enemy, it will never happen. They(AMA and APA) are top lobbyists that entrench themselves using monopolistic practices. Sure school can cost 500k, but with 200 to 300k+ per year salaries, they can kill that debt. (This is their common defense)

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…

Your logic will work if you put a price tag on a healthy and enjoyable life.

Which is basically impossible for somebody to do for themself, because that's most people's goal in how they use money. If somebody said, "The value of a healthy and enjoyable life for me or my loved one is $X," that'd mean they wouldn't spend their money if it cost over $X. Which is a ridiculous idea, and we've all seen it play out where people or their families shell out most of their wealth for the chance of living another month.

The only two ways I can see around this are:

1. Have an objective evaluator of life (maybe even accounting for differences in each person's value to society, if you really want to be accurate and don't mind the mobs with pitchforks).

2. Drop the idea of including health in the regular economy. Not totally possible, but public healthcare might be close enough.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#135

Post by tptacek » Fri, Oct 18, 2019, 7:26 PM UTC

maximente wrote: post #127

tptacek wrote: post #120

Earlier quoted context omitted.

Administration on both the provider and payer side of this system accounts for, depending on the estimates I've seen, 12-17% of total health care costs. You can't in reality zero those costs out (even Medicare's much-vaunted 2% administration cost would shoot up if it had to deal with every patient in the country), but even if you could, you wouldn't have made health care in the US affordable.

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 National Health System; their central argument was that Medicare has a lower administrative cost than private insurance, and their estimates were Medicare at 2%, private insurance in the teens. Not 30%.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#136

Post by claudeganon » Fri, Oct 18, 2019, 7:26 PM UTC

tptacek wrote: post #130

claudeganon wrote: post #113

Earlier quoted context omitted.

> 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…

As I mentioned to Raiyner, you should really read Tim Faust’s book to understand how single-payer can drive down costs, but I’ll highlight this from one of his articles:

“ As the sole purchaser, the federal government is immediately able to set just prices for health care services (for example, by negotiating the cost of drugs). With the weight of the full cost of health care falling squarely on its shoulders, it has an incentive to develop infrastructure and provide accessible primary care for all people, diverting money from low-frequency crisis care to high-frequency primary and preventive medicine.

It can also create evidence-driven guidelines for how to handle episodes of complex care and adjust payments based on adherence to these guidelines. This promotes good care for all patients and respects providers’ agency to provide the best care they can, instead of the current mess, where payment per-service can incentivize unscrupulous providers to bilk payers by either ratcheting up individual unnecessary services (when paid per-service) or providing less care (when paid per-patient).”

https://www.jacobinmag.com/2017/10/single-payer-medicare-for...

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#137

Post by [deleted] » Fri, Oct 18, 2019, 7:27 PM UTC

[deleted]

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#138

Post by tptacek » Fri, Oct 18, 2019, 7:28 PM UTC

claudeganon wrote: post #136

tptacek wrote: post #130

Earlier quoted context omitted.

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…

As I mentioned to Raiyner, you should really read Tim Faust’s book to understand how single-payer can drive down costs, but I’ll highlight this from one of his articles: “ As the sole purchaser, the federal government is immediately able to set just prices for health care services (for example, by negotiating the cost of drugs). With the weight of the full cost of health care falling squarely on its shoulders, it has…

I'm very familiar with this argument, but it's unpersuasive, because we already have a national health insurance system for the (huge) most expensive cohort of Americans, and it has been unable to contain these costs, despite playing a powerful role in the structure of the system itself.

Why aren't private health insurance systems incentivized to create evidence-based care plans? Wouldn't they, if anything, be more incentivized to do that?

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#139

Post by tptacek » Fri, Oct 18, 2019, 7:29 PM UTC

kerkeslager wrote: post #131

tptacek wrote: post #73

Earlier quoted context omitted.

I don't understand the axioms you're trying to draw on to derive just compensation for physicians. Why not just look at the worldwide market? Compare US physicians to those in other countries; we pay ours drastically more, and we are not generally more satisfied with the care we receive.

If we look at the worldwide market, health insurance CEOs salaries stand out even more starkly.

It's not clear to me what CEO salaries have to do with anything. Zero them out, and how much money has the American family saved? I haven't done the math, but I presume it's pennies, if that.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#140

Post by EpicEng » Fri, Oct 18, 2019, 7:31 PM UTC

leetcrew wrote: post #132

EpicEng wrote: post #125

Earlier quoted context omitted.

Then you're going to have to give me some examples. All in all I think doctors and medical scientists are more important to the world than the vast majority of us (since we have to make it an either/or for the sake of argument), so get specific.

I for one am quite grateful to the engineers who implement electronic automatic billing. when I was a kid, it seemed like my dad spent a lot of time sorting through mail and writing/mailing individual checks for services. now it's automatically billed to the credit card, the credit card gets autopaid from checking, and he just has to make sure there's enough in his checking at the end of the month. that's not a huge…

Automatic billing...

Meanwhile, median life expectancy has skyrocketed, in large part due to new medical treatments and early detection methods. Unless your father was spending 20-30% of each day paying bills, I don't think that's going to do it. I remain unconvinced.

Let's also not forget the drain on interpersonal relations that software has brought about. If your father would have spent that time ok on FB instead I'm not sure we gained anything.