Post-apocalyptic life in American health care • Hacker News Board

Re: Post-apocalyptic life in American health care

#151

Post by frgtpsswrdlame » Wed, Jan 03, 2018, 2:52 AM UTC

conanbatt wrote: post #124

frgtpsswrdlame wrote: post #96

Earlier quoted context omitted.

>Mine is that lightly regulated free healthcare markets will be efficient (though might not be equitable). And what is 'efficient'? I think a major component of a well functioning healthcare system is that it's equitable. Our problem with healthcare is driven by the generalized problem of 'economization.' A rich person doesn't have some intrinsic quality that makes them more deserving of quality healthcare. A healthc…

> What I'd say is that the US is pretty terrible at both and that's sad. Right, inefficiency tends to harm both equitability and value/cost(loose efficiency definition), but the US market is not what it is because it is efficient or because it is equitable, which is a classic dichotomy of microeconomics. > Some evidence that shows that mostly private healthcare systems generally function better than mostly public one…

>Right, inefficiency tends to harm both equitability and value/cost(loose efficiency definition)

Well no... Inefficiency is totally independent of equitability.

>For example, healthcare in the US was relatively very cheap 50 years ago, where it was still private.

This increase in healthcare expenditure across time has happened in all western countries has it not?

>Instead of looking so broadly at private vs public, its better i think to focus on why its expensive.

Broadly looking at private vs public is a very good way to guide our focus to what makes our healthcare in the US so expensive.

>And I can assure you that the top 5 reasons why healthcare in the us is expensive is due to government irresponsibilities.

You mean how the government has failed to regulate more? How the government has failed to de-privatize certain portions of the American healthcare system? How the government has hamstringed public options (like Medicare) to prevent the american public from realizing how much cheaper the government can provide care than can a private system? Totally agreed!

>If the government cant even fix its own mistakes, how is it going to handle a much larger responsibility?

What are you talking about? Private healthcare companies make mistakes all the damn time. The reason we trust government is because we get a voice in it. If your point is that american government needs to be more democratic and responsive to the wishes of individuals and cut the crap when it comes to sponsorship by large insurance conglomerates then I'm all with you.

>I did.

Did I miss it? Maybe you could post it again here. I'm just looking for what could change your mind.

Re: Post-apocalyptic life in American health care

#152

Post by thisrod » Wed, Jan 03, 2018, 2:59 AM UTC

grecy wrote: post #98

shrike wrote: post #25

About 8 years ago I broke my leg and eventually developed a methicillin-resistant infection where screws had been inserted. Fighting this type of infection in the bone is difficult. I spent 11 months in a hospital bed plus some time in a SNF. A total of 7 surgeries in the first 18 months and another 2 after that, the most recent 3 years ago. I can second the experience of the author. All in I had contact with over 40…

A few years ago my brother broke his leg horribly. The Ambulance drivers said it was the worst break they had ever seen. Multiple surgeries, months in hospital, rehab, got addicted to morphine in the process etc. etc. At the end of it all was a handshake and "get well soon". There was no bill. Australia.

I worry that this is path dependent. Recently, I went to a talk by a guy from New Zealand with an expensively manageable disability. I asked him what it would take to get the NZ accident compensation scheme to happen in Australia. The answer was, "Start funding it 30 years ago. It's great, but there is no way that NZ could afford it today."

It's a bit scary how much Australians owe to Neal Blewett.

Re: Post-apocalyptic life in American health care

#153

Post by xkcd-sucks » Wed, Jan 03, 2018, 4:42 AM UTC

EvanAnderson wrote: post #101

shrike wrote: post #25

About 8 years ago I broke my leg and eventually developed a methicillin-resistant infection where screws had been inserted. Fighting this type of infection in the bone is difficult. I spent 11 months in a hospital bed plus some time in a SNF. A total of 7 surgeries in the first 18 months and another 2 after that, the most recent 3 years ago. I can second the experience of the author. All in I had contact with over 40…

More and more I am becoming convinced "killing people" is an intended "feature" rather than a bug. I'm sure it's not an explicit goal of any but a tiny fraction of participants in the "system", but, cynically, I am becoming convinced it is somebody's goal.

Well yeah, if something bad happens one can complain about it or figure out how to profit from it

Re: Post-apocalyptic life in American health care

#154

Post by conanbatt » Wed, Jan 03, 2018, 4:49 AM UTC

frgtpsswrdlame wrote: post #150

conanbatt wrote: post #148

Earlier quoted context omitted.

No matter how much money in lobbying anthem might have spent, the ultimate responsiblity for the law as written is of government. Government should fix the current problems it has before asking for more responsibility.

I don't understand how your comment relates to mine. Care to elucidate?

"Anthem should do their best to explain the complex rules set forth by government"

Re: Post-apocalyptic life in American health care

#155

Post by conanbatt » Wed, Jan 03, 2018, 4:56 AM UTC

frgtpsswrdlame wrote: post #151

conanbatt wrote: post #124

Earlier quoted context omitted.

> What I'd say is that the US is pretty terrible at both and that's sad. Right, inefficiency tends to harm both equitability and value/cost(loose efficiency definition), but the US market is not what it is because it is efficient or because it is equitable, which is a classic dichotomy of microeconomics. > Some evidence that shows that mostly private healthcare systems generally function better than mostly public one…

>Right, inefficiency tends to harm both equitability and value/cost(loose efficiency definition) Well no... Inefficiency is totally independent of equitability. >For example, healthcare in the US was relatively very cheap 50 years ago, where it was still private. This increase in healthcare expenditure across time has happened in all western countries has it not? >Instead of looking so broadly at private vs public, i…

> Well no... Inefficiency is totally independent of equitability.

The reason why inefficiency is tied to equitability in the real world is because equitability is enforced, which means you spend resources to achieve it, and that is the successful case of enforcement. i.e. forcing everyone to take insurance to give coverage to the sickest can increase sickness because there is no economical consequence to unhealthiness.

> This increase in healthcare expenditure across time has happened in all western countries has it not?

No..if it had, we wouldnt be talking about a problem of healthcare in the US. Its grown disproportionately here. But the whole point is that 50-60 years ago, healthcare was cheap and it was private.

> You mean how the government has failed to regulate more? How the government has failed to de-privatize certain portions of the American healthcare system? How the government has hamstringed public options (like Medicare) to prevent the american public from realizing how much cheaper the government can provide care than can a private system? Totally agreed!

I will be more practical then. What do you think are the top 3 issues that make healthcare expensive? Concretely, not abstractly. What are the 3 things that if didn't happen, healthcare would be much cheaper, and I challenge that all 3 of them are the result of regulation. That is, the government made it expensive.

> Did I miss it? Maybe you could post it again here. I'm just looking for what could change your mind.

->

> what would change your mind in the general? > Mine is that lightly regulated free healthcare markets will be efficient (though might not be equitable).

Re: Post-apocalyptic life in American health care

#156

Post by pcurve » Wed, Jan 03, 2018, 5:05 AM UTC

conanbatt wrote: post #85

shrike wrote: post #25

About 8 years ago I broke my leg and eventually developed a methicillin-resistant infection where screws had been inserted. Fighting this type of infection in the bone is difficult. I spent 11 months in a hospital bed plus some time in a SNF. A total of 7 surgeries in the first 18 months and another 2 after that, the most recent 3 years ago. I can second the experience of the author. All in I had contact with over 40…

> It's broken and I am sure it's killing people. I also don't see a technology fix. Anything that requires more than two or three providers is an edge case, this space is 90% edge cases. Vertical integration is the biggest hope. With vertical integration, there is no billing.

i guess Kaiser Permanente is the closest to the vertical integration we're ever going to get here.

I cannot wrap my head around how that would even happen in North East region with fragmented hospital systems. They would need to join together to form a single hospital system, and/or buy out primary care practices, then merge with a large insurance company and PBM.

Re: Post-apocalyptic life in American health care

#157

Post by dang » Wed, Jan 03, 2018, 5:19 AM UTC

TheAdamAndChe wrote: post #108

dang wrote: post #78

Earlier quoted context omitted.

The problem is that you have a marked tendency to turn HN threads into generic ideological tangents, as you've done here, and this takes them in a direction of lower quality. If there's any generalization about HN threads that holds up, it's that one, so would you please take this in and stop doing this here? This isn't an observation for or against capitalism. It's an observation about ideological arguments on the i…

I was responding to a comment that starts "It's amazing that someone can go through this and come to the conclusion, at the end, that the solution is that this is a business opportunity that would make a lot of money if someone could just make it more efficient." It's a pretty direct critique of the use of capitalism in the healthcare industry. How did I make it any more of a generic ideological argument than my pare…

These things are relative. You're right that the parent comment was turning toward an ideological tangent, but at least it was still moored to the original topic. Yours became unmoored and went fully generic. In both cases it would be better not to do this and to stay more substantive, but we only tend to post moderation comments in the second case, it being the more egregious.

I greatly appreciate your intention to avoid ideological squabble in the future. If only everyone would do the same our happiness would be complete! On that scale at least.

Re: Post-apocalyptic life in American health care

#158

Post by byzin » Wed, Jan 03, 2018, 6:31 AM UTC

knightofmars wrote: post #121

trowawee wrote: post #69

Earlier quoted context omitted.

Personally, from my observations as a software engineer married to a doctor and friendly with lots of doctors, and as an occasional participant in the American healthcare system, the general inadequacy of electronic medical systems is one of the most maddening aspects of our system. Epic is a monstrosity and none of the other systems are much better. The tech is outdated, the interfaces are awful, they're incredibly…

Maxander is correct. As they say, "Don't judge a person till you've walk a mile in his shoes." As a someone who has been writing healthcare software (not EPIC but close enough) for nearly 10 years I can tell you it's not the software engineers. The regulations (often vague and open to interpretation by the customer) often play a part in creating the monstrosities that power our healthcare systems. Because of the subj…

I've worked as a healthcare professional provider in a major medical center in a major metro area. My parents are both physicians and my wife is also a professional provider. I've used EPIC during an initial rollout, and my wife has used it during two rollouts. I've also used other EHRs in smaller clinics since then, and have used the VA system.

My sense is that EHR mandates were colossal screwup. They should have never happened. No matter how good they seem in the ideal, mandating them should have never been the case.

The reason why is because each hospital had a very well-tuned staff with a system that was designed for that hospital, in-house, over years. Implementation of EHRs should have been done the same way, ground-up, on a site-by-site basis, in a way that allowed for more gradual, flexible adoption with complete autonomy by each site. If they wanted to buy into something like EPIC, great. If they wanted to develop something in-house, great. If they wanted to contribute to an open source project, great. That sort of system would have been much better in the long run.

As it happened, EHRs were just sort of slapped on, top down, with the providers being forced to adapt to them rather than vice versa. It was horrible, and a perfect example of government regulations fucking things up. I'm very pro-public sector, nonprofit, etc. but also think that regulations (in terms of restrictive licensing laws, FDA nonsense, things like EHR mandates, etc.) are the unrecognized disease in American healthcare systems.

EHR mandates at each hospital system I or my spouse worked at to resulted in cost overruns of billions of dollars. Those are just two systems in the US, and believe me, neither of those hospital systems--which were very successful, well-run enterprises, without EHRs--would have never implemented them when they did without the mandates.

The most egregiously stupid thing about the mandate is that EHRs would have been implemented in both these hospitals relatively soon anyway, but it would have happened on a much better timeline, in a much more sane way.

Re: Post-apocalyptic life in American health care

#159

Post by bradknowles » Wed, Jan 03, 2018, 8:19 AM UTC

mnm1 wrote: post #145

yodsanklai wrote: post #130

I'm wondering, is the American health care bad for (upper) middle-class too? let say you have a good job in a big corporation, do you have to worry about healthcare? can you go to a decent hospital for any problem you may have and get appropriate care without spending any dime?

Yes, it's horrifically terrible. The hospitals/doctors you can go to are dictated by your insurance. Having a good job does not equal having good insurance. It's hit or miss. Having a good job does not guarantee you have someone to help you out with the paperwork and the stress from that can and will kill you even if you survive the actual hell that is the healthcare itself (topic of the article). If you get injured…

But if you have a bad job, or maybe just one that is less than perfect, it can be almost impossible to get good insurance.

Re: Post-apocalyptic life in American health care

#160

Post by nradov » Wed, Jan 03, 2018, 1:54 PM UTC

byzin wrote: post #158

knightofmars wrote: post #121

Earlier quoted context omitted.

Maxander is correct. As they say, "Don't judge a person till you've walk a mile in his shoes." As a someone who has been writing healthcare software (not EPIC but close enough) for nearly 10 years I can tell you it's not the software engineers. The regulations (often vague and open to interpretation by the customer) often play a part in creating the monstrosities that power our healthcare systems. Because of the subj…

I've worked as a healthcare professional provider in a major medical center in a major metro area. My parents are both physicians and my wife is also a professional provider. I've used EPIC during an initial rollout, and my wife has used it during two rollouts. I've also used other EHRs in smaller clinics since then, and have used the VA system. My sense is that EHR mandates were colossal screwup. They should have ne…

The EHR mandates were very loose and had long deadlines. Hospitals had plenty of time to buy or build whatever they wanted. But it would be ridiculous for almost any hospital to develop something in house; they don't have the engineering resources or a core competency in software development, and it would be a huge duplication in efforts. Some hospital administrators like to think their institutions are unique and special snowflakes, but the reality is that most of them are the same and would operate more efficiently with standardized tools and processes instead of something customized.

While a single hospital might be able to operate reasonably well without an EHR that's just no longer sustainable in the broader healthcare ecosystem. Hospitals can't be islands. They have to be able to share data with payers, public health agencies, other hospitals, outpatient clinics, researchers, etc. Doing that requires an EHR now.