The Amish health care system • Hacker News Board

Re: The Amish health care system

#141

Post by armenarmen » Thu, Apr 23, 2020, 5:18 AM UTC

hannasanarion wrote: post #118

motohagiography wrote: post #97

Why does nobody look at the medical profession as the racket it is? You don't need to be an MD to handle %80 of hospital visits, and you can train trades people to handle most emergencies. Insurance companies are awful, but seriously, we can train field medics to do stitches and set bones, why should it cost $3000 to have an MD do it? Listening the hand wringing about it is infuriating when you realize that the reaso…

Yeah, it's definitely not the insurance companies that extort everyone for outrageous fees under threat of death thus creating most profitable industry in the world, yet producing nothing of value whatsoever who are the problem, it's all the doctors fault.

This. Insurance companies want medical procedures to cost more so that they can charge higher fees and punish those who don’t choose to participate in their industry.

Re: The Amish health care system

#142

Post by robomartin » Thu, Apr 23, 2020, 5:19 AM UTC

motohagiography wrote: post #97

Why does nobody look at the medical profession as the racket it is? You don't need to be an MD to handle %80 of hospital visits, and you can train trades people to handle most emergencies. Insurance companies are awful, but seriously, we can train field medics to do stitches and set bones, why should it cost $3000 to have an MD do it? Listening the hand wringing about it is infuriating when you realize that the reaso…

> why should it cost $3000 to have an MD do it?

Let me suggest you fire-up a spreadsheet and start to calculate the cost structures surrounding healthcare in the US. I don't think you have enough information yet to fully understand the subject enough to answer the question you posed.

I'll suggest you model something like a team conducting surgery at a mid size hospital.

You have to model the cost structure each person in that room is subjected to. Three simple items are the cost of their education, malpractice insurance and taxes.

The next step is to estimate the number of people who support that team within that hospital. From administration to nurses and janitors.

Add to that external services such as labs.

Now calculate the equipment costs. You could dig deeper and understand the regulatory costs, taxation and liability equipment manufacturers are subjected to. Interesting point to note: The Trump administration had to guarantee protection from liability before anyone was willing to make even something as simple as an N95 mask for use in hospitals.

Now calculate the cost structure for the hospital. Again, regulatory, liability/malpractice, taxation, etc. If the ambulance service is independent, add them to the exercise.

If you run through the above exercise you will actually be surprised that it only costs $3,000 for an MD to perform a procedure.

Notice insurance isn't anywhere in these calculation. Health insurance is an easy to point to evil, yet it is perhaps the most insignificant portion of the cost matrix that drives the cost of healthcare in the US. In fact, health insurance is NOT a driver, it's a symptom. You cannot fix our medical system by manipulating insurance. If the costs are high, care will be expensive. If the costs are lower, care will become more affordable. And this will drive insurance costs down as a result. Insurance isn't the cause, it's the effect. Remember that next time you hear a politician claim that they can improve things by screwing with insurance. They are lying to you. Don't allow that to happen. Be informed.

Re: The Amish health care system

#143

Post by drdeca » Thu, Apr 23, 2020, 5:20 AM UTC

mrtksn wrote: post #139

motohagiography wrote: post #97

Why does nobody look at the medical profession as the racket it is? You don't need to be an MD to handle %80 of hospital visits, and you can train trades people to handle most emergencies. Insurance companies are awful, but seriously, we can train field medics to do stitches and set bones, why should it cost $3000 to have an MD do it? Listening the hand wringing about it is infuriating when you realize that the reaso…

So does the developers. Anyone can code and do %90 of what a developer can do with a very little training. Yet, these are highly paid jobs because It’s not about being able to do it, it’s about understanding what they are doing. This way, they don’t just know how to do it but why to do it and what are the implications of doings it and how to debug it when the outcome is not the expected one. Any junior can probably d…

There isn’t a legal requirement to have gone to programming school before one can practice software development. (And a good thing too!)

If someone wants to hire someone who can kinda program a little, because they charge less, and are likely able to accomplish the task the person has in mind, then they should be free to do that.

(Of course, if the task is one where failure causes a big problem, then one should get someone more qualified.)

Re: The Amish health care system

#144

Post by armenarmen » Thu, Apr 23, 2020, 5:23 AM UTC

unsrsly wrote: post #114

motohagiography wrote: post #97

Why does nobody look at the medical profession as the racket it is? You don't need to be an MD to handle %80 of hospital visits, and you can train trades people to handle most emergencies. Insurance companies are awful, but seriously, we can train field medics to do stitches and set bones, why should it cost $3000 to have an MD do it? Listening the hand wringing about it is infuriating when you realize that the reaso…

LOL. I agree with you- healthcare should be way more accessible and affordable. But I suspect that if you looked at what it costs to train and deploy a field medic in today's military, you would find that it is a lot. And the many reasons for that very high expense probably echo some of the issues that also exist in healthcare. Hint: the MD isn't getting anywhere near $3000 to do your stitches.

If you were to drop the arms training and all that stuff from a “civilian field medic’s” training surely the cost would come down. Not to mention that the Airfoce purchasing $10k toilet seats and related financially irresponsible decisions would probably be less likely to happen in any non governmental org

Re: The Amish health care system

#145

Post by svieira » Thu, Apr 23, 2020, 5:24 AM UTC

kamfc wrote: post #38

daenz wrote: post #14

>How do the Amish keep costs so low? R&D (plus a few other sources) identify some key strategies. >...the Amish are honorable customers. This separates them from insurance companies, who are constantly trying to scam providers however they can. Much of the increase in health care costs is “administrative expenses”, and much of these administrative expenses is hiring an army of lawyers, clerks, and billing professiona…

is there a list of recommended writings i can study on morals?

Start with _The Gorgias_ by Plato - does Justice exist? Then move on to _Orthodoxy_ by G. K. Chesterton (why does Justice require free will and the soul). Finish up with the Gospel of John.

For a more detailed breakdown, take a look at _The Four Cardinal Virtues_ by Josef Pieper

Re: The Amish health care system

#146

Post by mrtksn » Thu, Apr 23, 2020, 5:30 AM UTC

drdeca wrote: post #143

mrtksn wrote: post #139

Earlier quoted context omitted.

So does the developers. Anyone can code and do %90 of what a developer can do with a very little training. Yet, these are highly paid jobs because It’s not about being able to do it, it’s about understanding what they are doing. This way, they don’t just know how to do it but why to do it and what are the implications of doings it and how to debug it when the outcome is not the expected one. Any junior can probably d…

There isn’t a legal requirement to have gone to programming school before one can practice software development. (And a good thing too!) If someone wants to hire someone who can kinda program a little, because they charge less, and are likely able to accomplish the task the person has in mind, then they should be free to do that. (Of course, if the task is one where failure causes a big problem, then one should get s…

That’s only because of the size if the impact if things go wrong. You need a license too to build a house or drive a truck because it’s actually very easy to do it %99 of the time well but you can’t afford that %1.

Low affordance causes spilled blood, blood causes regulations.

Re: The Amish health care system

#147

Post by svieira » Thu, Apr 23, 2020, 5:30 AM UTC

zajio1am wrote: post #78

daenz wrote: post #14

>How do the Amish keep costs so low? R&D (plus a few other sources) identify some key strategies. >...the Amish are honorable customers. This separates them from insurance companies, who are constantly trying to scam providers however they can. Much of the increase in health care costs is “administrative expenses”, and much of these administrative expenses is hiring an army of lawyers, clerks, and billing professiona…

> I'm not a religious person, but the thing that the anti-religion movements have failed spectacularly at is providing a universal, teachable framework for basic morality. Because no such framework exists? If we remove totalitarian pressure to enforce one coherent moral framework (either religious or secular) to all, we end up with pluralistic society in which various persons have fundamentally different moral intuit…

Fundamentally different moral intuitions cannot be resolved except by conversion or war. There is no middle ground between "burn the witch" and "save the woman". Taking your own last sentence, participating in an "extensive formal system" assumes a shared morality that prefers "cooperation and conflict solving" to strength and conquest.

Re: The Amish health care system

#148

Post by onei » Thu, Apr 23, 2020, 5:33 AM UTC

drdeca wrote: post #143

mrtksn wrote: post #139

Earlier quoted context omitted.

So does the developers. Anyone can code and do %90 of what a developer can do with a very little training. Yet, these are highly paid jobs because It’s not about being able to do it, it’s about understanding what they are doing. This way, they don’t just know how to do it but why to do it and what are the implications of doings it and how to debug it when the outcome is not the expected one. Any junior can probably d…

There isn’t a legal requirement to have gone to programming school before one can practice software development. (And a good thing too!) If someone wants to hire someone who can kinda program a little, because they charge less, and are likely able to accomplish the task the person has in mind, then they should be free to do that. (Of course, if the task is one where failure causes a big problem, then one should get s…

> There isn’t a legal requirement to have gone to programming school before one can practice software development. (And a good thing too!)

The vast majority of developers cannot kill you if they screw up. In the cases where that isn't true, e.g. software for medical equipment, I'd expect to find some significantly higher hurdles to get past before you can release that software.

We don't generally require developers to have certain qualifications, but their output can be measured in other standardised ways nonetheless.

Re: The Amish health care system

#149

Post by fzeroracer » Thu, Apr 23, 2020, 5:41 AM UTC

robomartin wrote: post #142

motohagiography wrote: post #97

Why does nobody look at the medical profession as the racket it is? You don't need to be an MD to handle %80 of hospital visits, and you can train trades people to handle most emergencies. Insurance companies are awful, but seriously, we can train field medics to do stitches and set bones, why should it cost $3000 to have an MD do it? Listening the hand wringing about it is infuriating when you realize that the reaso…

> why should it cost $3000 to have an MD do it? Let me suggest you fire-up a spreadsheet and start to calculate the cost structures surrounding healthcare in the US. I don't think you have enough information yet to fully understand the subject enough to answer the question you posed. I'll suggest you model something like a team conducting surgery at a mid size hospital. You have to model the cost structure each perso…

Logically this may make sense, but in reality it does not. Other countries with more sane healthcare systems have costs that are fractional compared to ours despite having the exact same costs you mention.

If the equipment is the same, the admin overhead is the same and the education is the same, then that leaves only one real difference between us and other countries. And that's our Byzantine insurance system.

Re: The Amish health care system

#150

Post by ashtonkem » Thu, Apr 23, 2020, 5:41 AM UTC

ineedasername wrote: post #90

specialist wrote: post #73

Earlier quoted context omitted.

I currently believe rising administrative overhead accounts for most of the cost increase. Single payer is a straightforward proven solution. Switching from fee-for-service to prevention (capitation) would give us another 25% savings. But I'm newly interested in notions related to cost disease. Am keen to hear anything anyone has to say about mitigation.

The biggest administrative costs in health care are the insurance companies' costs. [0] To the tune of more than $200 billion dollars/year. [0] https://time.com/5759972/health-care-administrative-costs/

One snare is that that a lot of overhead takes the form of jobs in the insurance industry. Any reasonable plan to reduce that overhead means eliminating all of those jobs.