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Health care is turning into a consumer product

economist.com

211–220 of 334 posts

Re: Health care is turning into a consumer product

#211
post #180

Earlier quoted context omitted.

> You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power). In principle, you're correct. In practice the fact that they're the only buyer, means in many cases that they pay at whatever a drugs company sells at since there's no "but company X is only paying Y, why are you charging us Z…

>In principle, you're correct. In practice ... It sounds like you are disputing empirical evidence as well as standard economic theory regarding monopsonies. >The UK public might "adore" the NHS, but they have a pretty poor understanding of how it is funded. Not really. It's mostly funded with taxation. They are not so aware of the corruption going on underneath with taxpayer money. >If the government kept funding th…

> It sounds like you are disputing empirical evidence as well as standard economic theory regarding monopsonies.

When there are multiple sellers of generic drugs, you're correct. When there is one seller of a non-generic, life saving drug with no alternative, the NHS is going to pay whatever the one seller, which by definition is a monopoly, is going to charge. [1]

> What is even the point of that sentence?

That we cannot keep increasing NHS funding exponentially. Some people seem to find that fact hard to grasp - there's an upper limit. Another commenter talks about the UK raising debt to fund the NHS. Thank goodness there's a set of rules for government borrowing in the capital markets.

> A) If it is a majority of years it's a fairly slim majority and B) they werent there when it was set up.

Both parties campaigned for the NHS in the 1940s. Labour won. Blair, in power for over a decade promised to "fix the NHS" whatever that meant, but he didn't do it. Thatcher/Cameron/Johnson, all in charge for 2 decades or so, still haven't "sold it off".

> Somebody who knew that they could start charging either customers or government through the nose and make it fantastically profitable.

Except it will never happen. The government would not introduce a commensurate tax cut since they're no longer funding the NHS, so your cost of living would go up, and even in the UK, I think people would get rather upset.

> Branson is one example (Virgin Healthcare sucked £2 billion out of NHS coffers, yay for crony capitalism).

Did he really? Evidence? 2 billion of private money paid by companies into Virgin Healthcare, sure. But did he take £2bn from the NHS?

> They are not so aware of the corruption going on underneath with taxpayer money.

What corruption? Surely the police should be involved if there's true corruption?

I won't defend the NHS. I'll defend the staff that treated my father, but the organization itself needs fixing.

[1] https://www.bmj.com/content/368/bmj.l4627

Re: Health care is turning into a consumer product

#212

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…

But isn't it the government that allows the healthcare system to hold you financially accountable for opaque and arbitrary bills?

Re: Health care is turning into a consumer product

#213

Earlier quoted context omitted.

The simplest changes we could make would be to ban the addition of sugar to certain mainstream food categories (drinks, bread, sauces), and also to require nutritional information to be listed as per 100g, not per serving size. Follow that by banning burning of coal and oil, we also remove a significant amount of noise and air pollution. Next we can ban any hormone-disrupting chemicals (including as plastic additives…

Sugar is a drug. Have you ever reflected on sugar cravings? It's actually as addicting as many scheduled drugs. But it's in EVERYTHING! Most things have added sugar in them.

It blows my mind how hard it is to find basic ingredients without added sugar.

Things you wouldn't think have sugar, and are not sweet, have sugar!

Sauces, pickles, plain yogurt, it's ridiculous

Re: Health care is turning into a consumer product

#214

This seems more like a symptom of the wildly broken American health-care system than anything else. In countries with a more functioning healthcare system, disruption of the status quo (especially by VC-funded private companies seeking a large payday) is neither necessary or desirable, slow iterative improvements are the name of the game. Furthermore, the US spends far more per capita than every other country on heal…

Yep. This is like writing an article about the increasing prevalence of gas generators and storage batteries, and saying that "electricity generation is turning into a consumer product". Really the centralized providers are failing with no hope in sight, so people are opting for distributed means to take care of their needs. If you tell someone they can pay a well-defined price for a device that might help them, or they can spend hours on the phone to make an appointment three months out that will result in indeterminate bills and likely further cycles through the bureaucracy, obviously they'll prefer the straightforward option!

Re: Health care is turning into a consumer product

#215

Earlier quoted context omitted.

> You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power). In principle, you're correct. In practice the fact that they're the only buyer, means in many cases that they pay at whatever a drugs company sells at since there's no "but company X is only paying Y, why are you charging us Z…

>> If the government kept funding the NHS by an extra X percent every year, we run out of public funds Lets say the uk gov allocated 10x to the nhs in the next budget - to be clear, this would put just nhs spending at more than total govt income for the year. If this were a company we’re talking about, they’d be insolvent. But we’re talking about a govt with a sovereign currency. So what would happen in this scenario…

The govt has rules for borrowing from the capital market, and that's (mostly?) for national infrastructure projects. It will never (hopefully) borrow from the capital markets to fund the NHS, and then continually pay it off.

That leaves tax or private money to fund the NHS, and we can't tax people much more. So in your comment "how is the money created?" Answer, tax, and there's a maximum limit to how much we can fund the NHS.

Re: Health care is turning into a consumer product

#216

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.

That was kinda my point. I can see why you’d do health like the US does, but I fail to understand why it doesn’t work in the US. In theory it could be much cheaper, but is the US seriously so corrupt that it underminds the free market that is values so highly.

Seriously, I don’t know.

Re: Health care is turning into a consumer product

#217
post #207

Earlier quoted context omitted.

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. R…

You’re right. It was earlier than I thought. I updated my comment per your reply.

Heaven forbid “wage inflation!”

Was the AFL pushing for employer-based and the CIO pushing for national? I don’t even know where to find history like this. It’s virtually impossible for an average person to learn about the history of the American labor movement.

Re: Health care is turning into a consumer product

#218
post #84

Earlier quoted context omitted.

> a full state-run system, which is vulnerable to undercapacity (which the UK is currently suffering from) That's more because we've had decades of deliberate underfunding due to the "austerity"/"capitalism++" lunatics in charge than a natural consequence of a state-run system though.

But how is that not "expected"? Feels like the argument that "communism is good, it just wasn't implemented well anywhere so far". Well, sorry, but by this point I chose to believe that a full state-run system is vulnerable to under-funding in the long term.

Long term everything fails, Malthusian pressure gets us all.

But in the medium term, the NHS was doing pretty well until Austerity became the dominant U.K. policy:

https://fullfact.org/election-2019/ask-fullfact-nhs-waiting-...

https://ifs.org.uk/publications/15557

(That said, I don’t have longer graphs to hand, and I am slightly concerned by the convenient start date on the graph in the second link).

Re: Health care is turning into a consumer product

#219

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…

in 2019 I would have agreed with you. In iceland you will not be charged for cancer treatment, but the medical costs of getting a long term illness in Iceland are not trivial. Add that to loss of income and the situation for many chronically ill is actually so terrible that laughing at the US is not something Iceland can afford. And covid has painfully displayed exactly how poorly managed the hospitals are and how starved the health care system really is. The equivalent of a bus accident will put the healthcare system on its knees or 80 people needing intensive care.

of course Iceland has more hospital beds than 80, but it cannot handle a disease that may put 80 people in ICU ( not counting ventialtion here at all, just intensive care ).

I think many in Iceland, myself included, are a bit in shock of exactly how poorly managed and starved the health care system is.

Up until 2019 I laughed at the dumb americans and their awful health care, man did I get my sit-upon whopped in the past 2 years.

Icelands is so bad that we are regularily filling hospital break rooms and garages with patients. THat is on a normal non-influenze season. Let alone sars-cov-2 introduction.

I suspect Canada is having a similar realization as we are. Free care in all its honour. Starved free care, heh...... Shame on us. Really. Shame on us.

Re: Health care is turning into a consumer product

#220

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…

There is so much wrong with the US healthcare system, from physical therapy centers, ambulance companies and prosthetists, to hospitals and surgery centers, to doctors, to insurance companies, to drug companies, to laws, patents, and the US government. Maybe you don't know the system well?
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