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Post-apocalyptic life in American health care

metarationality.com

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Re: Post-apocalyptic life in American health care

#181
post #141

Earlier quoted context omitted.

> extreme inefficiency and much higher labor costs Which is mooted with single payer. Roughly 1/3rd of costs eliminated. Last time I checked (mid 2000s). Probably more now.

> Which is mooted with single payer. As in doctors, nurses, and other personnel will accept lower salaries because they won't have any choice? I'm not sure that would work in the US. Also, there are relatively efficient non-single-payer systems in Europe (e.g., IIRC, Switzerland and the Netherlands don't have the equivalents of Medicare/Medicaid). Proper regulation, including price transparency and regulation, would…

The Dutch system is largely private with a very reasonable out of pocket/copay each year. This year, it’s around 450€ per person. In a calendar year, you cannot, by law, be charged more than your premium + this out of pocket max per year. For minors, all coverage is completely free until they turn 18, including comprehensive dental.

Limiting the US spending per citizen to roughly $2k/year per adult seems impossible in the current climate. It should happen but it won’t. If current health spending trends are to be believed, the number of people using less than 2k/yr in services are less than 20% of the population. There just aren’t enough young people in the US to make up for it, and the feds will never get approval to cover the gap.

The only hope I see for US healthcare is to open government funded hospitals and clinics and offer it as another insurance option. They can compete in the market and hope they have enough funding to eventually convince people that they aren’t going anywhere. This will take a lot of capital to weather the first few years of insanity and shenanigans that we will see from traditional insurance companies. Anything less than competition will be lauded as communism (it will anyway, who am I kidding) but for some poor red states, opening a few clinics in rural areas might actually work for them come time for re-election.

I’m saying all of this as an American living in the Netherlands.

Re: Post-apocalyptic life in American health care

#182

Earlier quoted context omitted.

>Would passing an extended ACA II with way fewer compromises and more effective regulation than the Obamacare version be really harder than instituting Medicare for All (so either a significant increase in federal income tax or a new tax altogether)? My marginal rate in California is 53+%. That IMO is ludicrous given the horrendous condition of California and its budgetary planning. But... I don't think the marginal…

> higher than most of the world* including most European I'm not sure that's true in general. e.g. at around 300k the effective income tax rate in CA is ~34% (26% + 8.0% state) +5% (SS etc.) = 39%. That's quite low by European standards, if you go down to 150k the total is just 35%. In Germany for instance you'd already be paying ~42% on 100k Anyway, that wasn't my point at all, I'm just unsure how politically feasib…

>Anyway, that wasn't my point at all, I'm just unsure how politically feasible it would be to accomplish this on the federal level.

Sure, every so often, someone publishes an article about how to balance the federal budget and it always comes down to neither being a republican nor a democrat. And that's why it won't happen. Compromise is dead.

Re: Post-apocalyptic life in American health care

#183
post #141

Earlier quoted context omitted.

> extreme inefficiency and much higher labor costs Which is mooted with single payer. Roughly 1/3rd of costs eliminated. Last time I checked (mid 2000s). Probably more now.

> Which is mooted with single payer. As in doctors, nurses, and other personnel will accept lower salaries because they won't have any choice? I'm not sure that would work in the US. Also, there are relatively efficient non-single-payer systems in Europe (e.g., IIRC, Switzerland and the Netherlands don't have the equivalents of Medicare/Medicaid). Proper regulation, including price transparency and regulation, would…

The 1/3rd savings (off the top) is from eliminating administrative overhead that insurance (claims & billing) imposes.

Administrative burden (makework) on caregivers would be much reduced.

Re: Post-apocalyptic life in American health care

#184
post #141

Earlier quoted context omitted.

> Which is mooted with single payer. As in doctors, nurses, and other personnel will accept lower salaries because they won't have any choice? I'm not sure that would work in the US. Also, there are relatively efficient non-single-payer systems in Europe (e.g., IIRC, Switzerland and the Netherlands don't have the equivalents of Medicare/Medicaid). Proper regulation, including price transparency and regulation, would…

The Dutch system is largely private with a very reasonable out of pocket/copay each year. This year, it’s around 450€ per person. In a calendar year, you cannot, by law, be charged more than your premium + this out of pocket max per year. For minors, all coverage is completely free until they turn 18, including comprehensive dental. Limiting the US spending per citizen to roughly $2k/year per adult seems impossible i…

> open government funded hospitals and clinics and offer it as another insurance option

Agreed. This or/and some other variant of the public option.

I've been discussing this with local politicos and orgs. Socializing the notion. Most everyone is receptive once it's explained.

Some day I hope to muster the gumption to do my own lobbying.

Re: Post-apocalyptic life in American health care

#185

Earlier quoted context omitted.

People know what the singular "they" is. It has been a common feature of English for centuries. It's just difficult to parse a writing where the same pronoun is used throughout for multiple different entities. This exact same issue commonly crops up with "he", "she", and "it" as well. The solution in these instances is to limit usage of the pronoun altogether and just use the noun directly wherever there may be any a…

This is a good example of where they is extra confusing too. It would be better if English had separate singular/plural versions of they. If Sarah goes by ‘they’, “They was pissed” sounds wrong and most people would actually speak “they were pissed”… but now it is a three way ambiguity: Julia pissed, Sarah pissed, both pissed. This feels like an example of a bigger failure mode, but I can’t nail it down. Something li…

Ya. I preferred the sci-fi narratives with zir, zim, etc. But nobody asked for my opinion.

The history of pronouns for female, male, neuter, and none-of-above tracks with cultural notions. English's pronouns will mosdef evolve to accommodate the new norms. We're merely in a transitional phase.

Re: Post-apocalyptic life in American health care

#186

Earlier quoted context omitted.

> You would just pare n profit-seeking entities down to one principally administrative entity. If you wish to pay for your own medical procedures out of pocket there will be nothing stopping you. Nothing except that it creates a monopoly and a monoculture. There are many procedures you may not be able to afford out of pocket, so the only way to get them is to choose a provider that covers it. If there is only one pro…

This is a really thoughtful and useful comment! Worth calling your representative about. I love the observation that price transparency starts with providers, I so rarely hear that mentioned.

People keep talking about this and it's a clear sign that people don't know what they're talking about. Price transparency has been the law for 3 years now. [1]

Here's a 226 MB csv file from the Mayo Clinic with... lots of prices [2] and a human friendly search tool [3]

It is extraordinarily frustrating trying to discuss these things with people when folks just make things up and have no idea what they're talking about.

1. https://www.cms.gov/priorities/key-initiatives/hospital-pric...

2. https://mcorgstatic.blob.core.windows.net/cms-price/41094460...

3. https://estimator.mayoclinic.org/mychartguestpay/GuestEstima...

Re: Post-apocalyptic life in American health care

#187

Earlier quoted context omitted.

This has been my experience as well. My wife has end-stage kidney disease, and we have found that the system works (for us!) when we stay within our hospital system. We don't travel much, we keep to within a certain radius of the hospital we trust, and we make sure any new specialists are inside or at least connected to the same (Epic) system. That has solved the "no interface" issue and the issues described in the "…

I've found that doctors (at least, good ones) tend to light up when you demonstrate that you're not an idiot. I don't mean to suggest that "I'm a dum dum" is a bad approach - in fact I think it's great for getting past any cynical defenses that have built up. But I'll never forget taking my son to the ER and getting to have an actual conversation with a doc. When he was a toddler he would get nasty respiratory infect…

Absolutely. Doctors are highly trained professionals who are used to having to translate and simplify, and nowadays even deal with patients who’ve way over-Googled or over-Fox-Newsed and come in stubbornly misinformed, so they may develop a default setting that’s a little reserved and even defensive. Think of working a helpdesk for some system that’s barely understood even by experts, but where all problems are urgent.

If you are able to come across as rational, observant, practical, respectful of their expertise and experience, but also confident that you are the only one seeing the complete picture, 90% of the time this unlocks a much more collaborative interaction. And yes, it’s usually a huge relief to the doctor!

Re: Post-apocalyptic life in American health care

#188
post #128
post #19

My boyfriend woke up one day to find out they couldn't pee. After a few ER visits and an MRI, they determined he had Stage 2 bladder cancer. However, because they had the audacity to seek immediate medical treatment for a life threatening health issue, they have now been saddled with thousands of dollars in medical debt. I had to personally dip into my earnings from my Big Tech internship to help pay some of it off.…

Not an ad hominem attack or a microaggression, but hopefully constructive criticism. Your use of the "them" pronoun makes the post confusing. Does it refer to "they," presumably the doctors, the employer (job), the insurance, UT Southwestern, or to the gendered "boyfriend." Since you already decided to use a gendered noun, perhaps use it instead of the "they/them" or use a matching gendered pronoun "he/him" to distin…

Oddly, the writer used "he" in "they determined he had Stage 2 bladder cancer" because they had already used the plural "they" in the same clause – showing that they know how confusing the singular "they" can be. Sometimes ツ

Re: Post-apocalyptic life in American health care

#189
post #166
post #163

Earlier quoted context omitted.

Then perhaps you should use your words and explain what you actually mean, lest it be assumed to be ill-informed snark.

Why would I bother arguing with someone who misconstrues what I say?

In a typical conversation, if someone misunderstood you, you wouldn’t give them an angry middle finger, you’d clarify your meaning. But you do you.
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