Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The Amish health care system

slatestarcodex.com

Post reply on HN
Print view View original

151–160 of 327 posts

Re: The Amish health care system

#151

Post by fzeroracer »

virmundi wrote: post #131
amiga_500 wrote: post #122

Earlier quoted context omitted.

Go back a step further. Why do they need a big income? Because they took on lots of education debt. Why did they take on so much? Why is it so expensive? Because the usurers extend that much credit. The free market in shampoo is okay, sort of. For a lot of other stuff "free market" + fiat looks like a mess.

We don’t have a free market in healthcare. We have a highly regulated one. Free market healthcare is lasik and boob jobs. Both have come down in price because they are not part of the insurance system. They’ve also gone up in quality due to competition and demand.

Dental care is also a 'free market' and I don't think I need to say how much of a disaster getting any sort of dental work can be in the US.

Why haven't dental costs fallen through the floor if it's a free market?

Re: The Amish health care system

#152

Post by lardo »

ashtonkem wrote: post #150
ineedasername wrote: post #90

Earlier quoted context omitted.

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.

That sounds like a good thing.

Re: The Amish health care system

#153

Post by erentz »

ashtonkem wrote: post #150
ineedasername wrote: post #90

Earlier quoted context omitted.

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.

1. FWIW this is a recognized problem under M4A plans those people would be taken care of.

2. Nobody has a right to earn a living by causing suffering to others.

Re: The Amish health care system

#154

Post by erentz »

philwelch wrote: post #79
markdown wrote: post #13

Earlier quoted context omitted.

The same in Fiji. We have universal health care, but anyone is of course free to forego that and pay (or use their private insurance) for a private room rather than a ward, or just go to a private hospital instead. I don't understand the debate about this in the US. It's as if the rich assume that things will change for the worse for them if universal health care is enacted.

Part of it is because the “Medicare for All” proposal outlaws private insurance.

M4A gives everyone, rich or poor, the same base standard of coverage. And if you want coverage for other things that aren’t included under Medicare then you can get supplemental private insurance for it. That’s absolutely not outlawed.

Re: The Amish health care system

#155

Post by vxNsr »

bpfrh wrote: post #41
prime_factor wrote: post #15

Earlier quoted context omitted.

What about middle class people who can't afford private care but fear that the socialized healthcare system will be of worse quality than what they currently have?

You can look at austria to see that that doesn't happen. An MRI cost me about 0€. A 4000€ test which tests for nearly any rheutmatic diseases markers and the visit to the hospital for that test cost me 0€, both things got done within two weeks. Even if you are poor and want to go to a private doctor it will cost you not nearly as much as in the usa. For me it was about 100€, for one visit and that was on the higher e…

I can buy an out of pocket (uninsured) MRI test in the US for less than $500. With a little bit of negotiation I could probably get it down to $300. An insured MRI can be free too depending on the plan.

My mom is a doctor, she worked ICU, ER, etc, board certified in 10 states and holds a medical license in 3 countries(yes, she did residency three times, it's a long fascinating story for another time). Eventually she decided to open a private practice for family medicine bec it was less stress, but she's got tons of experience, and is highly regarded, and she charged less than $40 a visit for the uninsured. She would spend ages talking patients out of procedures that were harmful or simply unnecessary. You got high end care from her each time.

The gist of this is: you have no idea what you're talking about and individual anecdotes don't prove one system is better then another.

I'll just add as food for thought: nothing is free, avg effective tax rate in EU is 50%

Avg ETR in the US is less than 30%.

Re: The Amish health care system

#156

Post by ggreer »

mrtksn wrote: post #146
drdeca wrote: post #143

Earlier quoted context omitted.

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.

I would argue that bus drivers have a much larger impact in terms of lives lost if things go wrong, yet they have significantly lower wages and require less training. The same goes for pilots and air traffic controllers.

Re: The Amish health care system

#157

Post by sacred_numbers »

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…

I think that there are certainly some issues with an artificial scarcity of doctors as well as overly restrictive regulations requiring MDs for certain procedures that don't require MD training, but the evidence shows that this is not the main driver of high costs. Physician salaries are only about 8% of healthcare spending[1] and according to my own research, only about 20% is due to all healthcare worker salaries (including physicians, nurses, physician assistants, etc. The remaining 80% is medicine, medical supplies, capital costs (MRI machines, hospitals) and administrative costs. Unfortunately there's no single cost that could instantly solve everything if eliminated; there's just a lot of middlemen each taking a tiny portion that add up to a huge total cost.

[1]https://www.npr.org/sections/money/2019/03/12/702500408/are-...

Re: The Amish health care system

#158

Post by AzzieElbab »

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/

You have to be able to see that the numbers do not add up, right? 200b is how much out of 3+ trillions? Also, just because Canadian adminstrative costs are hidden, does not mean they are proportionally lower than in the US

Re: The Amish health care system

#159

Post by pasquinelli »

specialist wrote: post #74
prime_factor wrote: post #15

Earlier quoted context omitted.

What about middle class people who can't afford private care but fear that the socialized healthcare system will be of worse quality than what they currently have?

The bulk of the (public) opposition is from people who like their employer provided insurance. We'll soon learn if the mood changes, due to pandemic induced high unemployment.

It doesn't matter if the mood changes. Democratic voters are in the mood for medicare for all already and biden is the democratic candidate. This is america, the public mood isn't a factor.

Re: The Amish health care system

#160

Post by mrtksn »

ggreer wrote: post #156
mrtksn wrote: post #146

Earlier quoted context omitted.

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.

I would argue that bus drivers have a much larger impact in terms of lives lost if things go wrong, yet they have significantly lower wages and require less training. The same goes for pilots and air traffic controllers.

You can argue that but what’s your point? The current truck driver training system works well enough AFAIK. Do you demand more training?
Post reply on HN