Health care is turning into a consumer product • Hacker News Board

Re: Health care is turning into a consumer product

#141

Post by stefan_ » Mon, Jan 10, 2022, 2:52 PM UTC

toolz wrote: post #97

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

I'm curious how you can suggest the US government spends the most money in the world, by far, on healthcare and the simultaneously suggest there's less government involvement. The government is involved in every step of American healthcare. As you can imagine of a system that gets all of its funding thru companies completely overseen by regulatory bodies or thru social programs.

There is some crazy amnesia here about the US healthcare system. Some 40% of the US are already covered through Medicaid/Medicare - "socialism" is long here!

Re: Health care is turning into a consumer product

#142

Post by rg111 » Mon, Jan 10, 2022, 2:52 PM UTC

analyte123 wrote: post #106

rg111 wrote: post #77

Earlier quoted context omitted.

> the free market This isn't. With the amount of lobbying, financial contributions to campaign funds, oligopoly, the market isn't free. This is also one of the market where you have to pay. You can choose to not go to vacations or not to buy an apartment (even if you live horribly); you cannot just not have an appendix operation or not fix your ankle if it is broken.

You definitely can choose not to have an appendix operation in many cases: https://www.facs.org/media/press-releases/2021/coda-study-10...

That isn't the point here. The point is, when you are sick, you have to get medical attention.

Re: Health care is turning into a consumer product

#143

Post by refurb » Mon, Jan 10, 2022, 2:53 PM UTC

SkyPuncher wrote: post #103

refurb wrote: post #13

Earlier quoted context omitted.

There can be instances where physicians are paid the same or more outside the US (I've heard family practice can pay better in Canada), but overall US physicians earn much more . https://www.physiciansweekly.com/how-do-us-physician-salarie...

It's worth noting the debt burden that different medical education systems place on physicians. Debt load and lost income are huge in the US medical education systems. Many people that browse this forum will likely have lifetime income similar to that of a physician.

Average debt is like $500,000 and average wage (across all specialities) is $250,000. The debt burden isn’t that high.

And sure, comparing it to Silicon Valley looks bad, but so does every other job. “Amazing how bad other jobs look when you compare them to the top 1%”

Re: Health care is turning into a consumer product

#144

Post by pjc50 » Mon, Jan 10, 2022, 2:59 PM UTC

throwaway0a5e wrote: post #57

pjc50 wrote: post #54

Earlier quoted context omitted.

The problem is that "market" is a really bad fit for meeting healthcare needs, and doubly so when it's intermediated by insurers. People get the amount of healthcare they can afford from their discretionary budget and work their insurers for - not the amount they need. So they may get "more" (or at least more expensive) care than they need, or less. Note that many of the European systems are semi-private, so you reta…

Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. Using insurance, government or some other centralizing layer (e.g. the church) for routine activity would raise massive "you're pissing money away" red flags in literally any other context. We shoehorn so much economic activity (healthcare) though a middle man (…

> routine activity

But as you observe yourself, that's not the majority of healthcare, which is emergencies and unforseeable needs. Hence there has to be an insurer of some kind.

> There's no reason someone shouldn't be able to get a physical or a colonoscopy the same way cosmetic surgery and dental care are done. These are cookie cutter outpatient services. The deviation from instance to instance is small and predictable so insurance should not be needed on the consumer side.

Sure, whatever, the small part of the healthcare market that actually functions like a market - consumer choice, legible prices - can be left to get on with it. Let's not let that get in the way of a functioning provision of necessary care to the majority of people.

Re: Health care is turning into a consumer product

#145

Post by wreath » Mon, Jan 10, 2022, 3:02 PM UTC

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

> Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries.

In what way is it the worst-performing? I mean, what are the outcomes that are measured to determine its performance?

Yes, healthcare is a lot cheaper in Europe (even if your employer wouldn't pay their part) compared to the US, but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance.

Re: Health care is turning into a consumer product

#146

Post by mrweasel » Mon, Jan 10, 2022, 3:03 PM UTC

rg111 wrote: post #77

mrweasel wrote: post #42

What prevents someone from setting up an affordable healtcare plan, porentially with it’s own chain of hospitals? Other than the startup capital? As broken as the US healthcare system appears from the outside, the free market SHOULD have pushed prices down, not up.

> the free market This isn't. With the amount of lobbying, financial contributions to campaign funds, oligopoly, the market isn't free. This is also one of the market where you have to pay. You can choose to not go to vacations or not to buy an apartment (even if you live horribly); you cannot just not have an appendix operation or not fix your ankle if it is broken.

But wouldn’t a single “good” provider quickly undermind the business of the existing ones? Or is the entire thing rigged in favour of the current healthcare providers?

Re: Health care is turning into a consumer product

#147

Post by kgarten » Mon, Jan 10, 2022, 3:04 PM UTC

onlyrealcuzzo wrote: post #121

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

One point that gets skipped over a lot - the US is also one of the most unhealthy countries in the advanced world. This is a big /part/ of the "worst outcomes" in the "highest cost, worst outcomes". It is possible that you can spend a ton of money on healthcare - yet smoke and drink, drive everywhere and not exercise at all, and eat trash - that the healthcare spending is doomed to fail. Europeans walk & bike more an…

Obesity is also very high in the United Kingdom (~27 % versus ~35 % ) and not the same problems ( https://www.bbc.com/news/uk-42950587 ).

US is also a super bad infant mortality rate compared to other countries:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844390/

Re: Health care is turning into a consumer product

#148

Post by tristor » Mon, Jan 10, 2022, 3:07 PM UTC

onlyrealcuzzo wrote: post #121

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

One point that gets skipped over a lot - the US is also one of the most unhealthy countries in the advanced world. This is a big /part/ of the "worst outcomes" in the "highest cost, worst outcomes". It is possible that you can spend a ton of money on healthcare - yet smoke and drink, drive everywhere and not exercise at all, and eat trash - that the healthcare spending is doomed to fail. Europeans walk & bike more an…

> This never seems to be a talking point. Have the statisticians controlled for all this when they come to these conclusions??

I never see this as a talking point of folks who are in favor of universal / state-funded healthcare, but it is often a talking point for those who are opposed. They point to the links between state-funded healthcare and the soda tax in the UK as an example of how allowing the government to control your healthcare results in more aggressive and manipulative social policy to control health outcomes societally. Many people opposed to state-funded healthcare feel rather strongly that you should be able to do pretty much whatever you like with your body as long as you're paying for it yourself. I consider this take to be missing quite a lot, but it does seem to be a common one. I am personally in favor of universal single-payer healthcare systems, so I've had this conversation a lot due to my surroundings and have heard just such this argument many times.

Re: Health care is turning into a consumer product

#149

Post by dragonwriter » Mon, Jan 10, 2022, 3:10 PM UTC

wreath wrote: post #145

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

> Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. In what way is it the worst-performing? I mean, what are the outcomes that are measured to determine its performance? Yes, healthcare is a lot cheaper in Europe (even if your employer wouldn't pay their part) compared to the US, but the quality of the service is r…

> but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance.

That's exactly like US healthcare if you aren't either a wealthy private-pay client or someone with top-flight private insurance; we just pay twice as large a share of GDP and even a higher multiple per capita to have the same normal experience and many more people uninsured than any other developed economy (and we've only recently through the ACA, gotten it so the that your top-flight insurance plan wouldn't look to retroactively cancel your insurance when you got an expensive-to-treat condition, leaving you uninsured and uninsurable.)

Re: Health care is turning into a consumer product

#150

Post by vhhn » Mon, Jan 10, 2022, 3:16 PM UTC

There are several factors that make healthcare a specific type of product that laissez-faire markets fail to efficiently produce by nature:

* tight connection to insurance

* typical consumer-producer relation relation broken into consumer(patient)-prescriber(doctor)-producer-payer(insurance or government)

* large externalities

These factors led to health care being provided by the public sector in most of the countries.