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

Re: Health care is turning into a consumer product

#201

Post by fatnoah » Mon, Jan 10, 2022, 4:21 PM UTC

mumblemumble wrote: post #189

dgb23 wrote: post #76

Earlier quoted context omitted.

I agree. The "everything is a market" ideology had a good run of almost half a century, but it should be heavily criticized in hindsight. Institutions like healthcare, education, public transport, prisons(!) and so on are more efficient, less corrupt and of higher quality when they are in large parts collectively and democratically organized and funded. The "in large parts" is important here: A community should agree…

One thing to note about US healthcare is that it seems almost deliberately engineered to not be a market. I've never received significant health care in another country, so I can't say how the US system differs from others with any expertise. But I can say how US health care differs from just about anything else I spend money on: 1. I don't really get to shop for health insurance providers. My employer picks one, may…

All good points. In my mind, a market lets me make informed choices and choose from multiple options for something that meets my needs. As you noted, the only real choice is whatever your employer offers, or something more fantastically expensive. In terms of care, there are lots of choices but not enough information to actually choose. It's more of a choose your own adventure where you have to guess and hope you got it right.

Re: Health care is turning into a consumer product

#202

Post by nradov » Mon, Jan 10, 2022, 4:23 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…

Unless there are some clear symptoms of deficiency, vitamin D or testosterone tests aren't usually justified from an evidence based medicine perspective. Insurance companies usually won't cover such tests unless the patient meets their medical necessity criteria. However in many countries you can order such lab tests yourself and pay for them out of pocket.

As a separate issue, there is now significant clinical evidence that hypovitaminosis D is a major risk factor for COVID-19. So I hope that medical guidelines will be updated to make those tests a routine part of preventive care screening, in the same way that we test for lipids and blood glucose levels.

https://vitamin-d-covid.shotwell.ca/

Re: Health care is turning into a consumer product

#203

Post by conductr » Mon, Jan 10, 2022, 4:30 PM UTC

neuro_image2 wrote: post #4

The greatest healthcare improvements in the US could be brought about by: - Dismantling the insurance/big hospital complex that milks the US population for the enrichment of c-suite executives. - Removing the capacity for lobbying by insurance companies, large hospital groups, device and pharma companies (so they're less able to price gouge consumers). - Price transparency on all links of the chain of healthcare deli…

> - Better end of life care. I think something around 40% of healthcare expenditure is on patients in the last 2 years of life. Patients and families would benefit from earlier access to hospice care and less aggressive therapies that only prolong suffering.

I feel like the choice has to be removed from families as our current system has proven that life will be extended regardless of quality simply due to the fact nobody wants to make a difficult choice. As the only quantitative item on the list and a very substantial one this should be ranked much higher in terms of priority (not sure if list was unordered or not).

Re: Health care is turning into a consumer product

#204

Post by gorbachev » Mon, Jan 10, 2022, 4:33 PM UTC

vorpalhex wrote: post #176

netizen-936824 wrote: post #86

Earlier quoted context omitted.

So we should just expect people to be greedy and try to ruin systems for their own benefit. That raises the question of how to make these systems more robust to defend against that sort of attack.

That is the pro of a market system. A market with a malbehaving dominant party is liable to be upset by a new contender who will undercut them, thus depriving the misbehaving party of income.

That's what would happen theoretically.

In the real world what will happen is the malbehaving dominant party will capture the market by any means available to them. In thoroughly corrupt countries they will bribe legislators, in less corrupt countries they donate to the legislators' election campaigns.

Re: Health care is turning into a consumer product

#205

Post by spaetzleesser » Mon, Jan 10, 2022, 4:38 PM UTC

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.

Think about why it SHOULD but doesn’t.

Re: Health care is turning into a consumer product

#206

Post by onlyrealcuzzo » Mon, Jan 10, 2022, 4:38 PM UTC

kgarten wrote: post #147

onlyrealcuzzo wrote: post #121

Earlier quoted context omitted.

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/

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

Access to healthcare is quite low in the US compared to most of the 50 countries ahead of us. We also have higher levels of poverty, ESPECIALLY for a lot of parents/children.

GDP is irrelevant. The paper says:

> In 2013, the US infant mortality rate (IMR) ranked 51st internationally, comparable to Croatia, despite an almost three-fold di erence in GDP per capita

If you have high GDP per capita, and more poor people per capita, and health care is not free - you're going to have more people not accessing health care and suffering the consequences.

In this world - I would expect infant mortality to be much higher even when the healthcare systems are equal.

Re: Health care is turning into a consumer product

#207

Post by ch4s3 » Mon, Jan 10, 2022, 4:39 PM UTC

nopenopenopeno wrote: post #178

dqpb wrote: post #111

Earlier quoted context omitted.

> The "everything is a market" ideology had a good run of almost half a century But that never actually happened. Externalities were never part of the market.

Employer-based healthcare was won by an alliance of corporate and healthcare industry lobbies against a state healthcare plan in the 1950s when the so-called “free market” healthcare system was failing the public. Prices were increasing and the New Deal corporate powers pacified the public with social security and employer-based healthcare. Edit: updated 1960s to 1950s per info in replies

In the US healthcare was intentionally tied to employment as a means of controlling wage inflation during the 1950s by Eisenhower. He had pushed for the "middle way" of private nonprofit health insurance that could be purchased individually or by employers. As inflation began to spike, the administration added new tax benefits to encourage employers to compete on providing benefits rather than higher base salaries.

Roosevelt also tried to institute a national scheme in the 30s but labor unions were split on notional vs. employer provided and it became a wedge issue that scuttled the plan. Truman's push for that same national health insurance plan was shot down in ~1949, partially killed by AMA lobbying.

Re: Health care is turning into a consumer product

#208

Post by standardUser » Mon, Jan 10, 2022, 4:44 PM UTC

telxosser wrote: post #196

merpnderp wrote: post #104

Earlier quoted context omitted.

I’m interested in this worst performing stat. By what measure? Because I’ve always read that when controlling for the relative poor health of the us population regarding diseases related to poor eating and exercise habits, the US was a top performer for heart and cancer treatments.

I am pushing 50 years of age and one constant in my life is people shitting on the US healthcare system. I have family in Canada with family members the same age on both sides. Canada is great if you are a healthy broke college student. No one in their right mind would ever pick Canadian health care over the US though if you are 60+. There is no way you would rather have cancer in a country with free health care.

"There is no way you would rather have cancer in a country with free health care."

Unless you can't afford for-profit healthcare. Then any sane person would 100% prefer one of the fifty or so developed nations with free healthcare.

Re: Health care is turning into a consumer product

#209

Post by Quinner » Mon, Jan 10, 2022, 4:44 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…

Much like US Defense spending subsidizes the rest of the globe, US for-profit healthcare spending spurs massive investment in pharma and biotech research that benefits the rest of the world. Are there inefficiencies and waste? Yes. But outcomes overall are much better for it.

Re: Health care is turning into a consumer product

#210

Post by lostcolony » Mon, Jan 10, 2022, 4:45 PM UTC

tablespoon wrote: post #197

donatj wrote: post #177

Earlier quoted context omitted.

I suspect the argument is "Healthcare has never been allowed to be a market" Given how many legal restrictions are placed on it, I tend to agree.

> I suspect the argument is "Healthcare has never been allowed to be a market" Given how many legal restrictions are placed on it, I tend to agree. Emergency services aren't a good fit for markets. For markets to work, people really need the luxury to shop around with some leisure. Wasn't there some Roman oligarch that ran a private fire department, and basically just used it to extort property owners when they had a…

I will also comment that when we talk about "healthcare being a market", we need to separate out providers of healthcare, with insurers of healthcare. Insurers of healthcare are much closer to a market (in that I can generally find out what the cost of the insurance is, and what it covers), but providers aren't (in that prices lists are hidden, it's not clear what is covered vs what isn't, etc). We talk about the cost of the insurance, but that's artificially high because of the practices of the providers (themselves incentivized to behave that way because of the insurers).

And that's the open market; it gets even more cloudy when we talk about employers being involved, so we have an agency problem as well.

It's a system unlike any other, and I don't think general theories really apply very well as such.