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The Amish health care system

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Re: The Amish health care system

#241

Post by fat-chunk »

specialist wrote: post #232
asdkjh345fd wrote: post #223

Earlier quoted context omitted.

Canada has single payer and rising administrative overhead is a major problem here too. Looking at spending on medical staff vs spending on administrative staff, the former has barely gone up at all while the later has gone up over 500%. Plus we deal with the serious problems of lack of care. I know several people who have waited over 2 years for important surgeries like hip replacements. My mother died because they…

Damn. I am very sorry for your loss. Thanks for tip re Canada's admin overhead. Will research.

The NHS in the UK is suffering from huge administrative problems as well, due to ageing digital and organisational infrastructure which is becoming increasingly difficult to replace or modernise.

The government tried to centralise and digitise the whole thing but because it was mismanaged, most of the project was abandoned and cost billions to the taxpayer https://en.wikipedia.org/wiki/NHS_Connecting_for_Health

Now we are in a bit of a catch 22 where the costs keep increasing, and the government is always under pressure to spend more but there doesn't seem to be a solution to slowing down the increasing costs.

Re: The Amish health care system

#242

Post by specialist »

AzzieElbab wrote: post #231
lippel82 wrote: post #222

Earlier quoted context omitted.

What do you mean, the numbers don't add up? From the article: "Insurers’ overhead, the largest category, totaled $275.4 billion in the U.S. in 2017, or 7.9% of all national health expenditures, compared with $5.36 billion in Canada, or 2.8% of national health expenditures."

What I meant is that if insurance costs disappear completely, US healthcare will remain 5 times more expensive than Canadian. It is percentage based markup on already super overpriced system. Therefore, real reasons for why it is so expensive are elsewhere

Thanks. I've reluctantly come to agree with your conclusion. There is no silver bullet.

Repeating myself:

Another low hanging fruit is transition from free-for-service to rewarding wellness (capitation). Some are already doing this.

I'd like to understand if, how, why cost disease is a factor. https://en.wikipedia.org/wiki/Baumol's_cost_disease I have zero understanding, intuition about this. Feels like black magic. But some of the experts I've read say it's important.

There's no shortage of management efficiency and quality of care innovations to explore. In the spirit of Atul Gawanda's book Better, like specialized clinics for cystic fibrosis, diabetes, and whatnot. And whatever we're calling people traveling for procedures. Like USA people going to Thailand and Mexico clinics.

USA's R&D and regulatory overhead (FDA) carries the world. That first adopter expense might be easier to accept if the accounting was transparent.

Any way.

I designed, implemented, supported 5 regional healthcare exchanges. Even in our little corner of the problem space, there was so much room for improvement. Alas, most of it was prevented, because our participants were competitors, so the incentives were all wrong. A single payer system (or rough equivalent) completely moot most of those roadblocks.

Re: The Amish health care system

#243

Post by philjohn »

bookofjoe wrote: post #228

I just read every word of the 220 comments on this post and not once did I encounter the word "rationing" when it came to debating the merits and negatives of single payer. It is the elephant in the room: people pretend it's not there by saying things like "there's a long wait, sometimes over two years for such things as elective hip replacement."

Except it's not rationing per se, it's demand outstripping supply. You'll still get your elective procedure, but since it's not life-saving in the strictest sense you may have to wait a bit longer for it.

But the flip side of that is a bout of cancer, a heart attack, baby needing to spend a month in NICU doesn't bankrupt you.

Re: The Amish health care system

#244

Post by AndrewDucker »

zaarn wrote: post #216
int_19h wrote: post #190

Earlier quoted context omitted.

They still pay taxes, though. Germany allows people to opt out entirely, although there are a bunch of conditions and limitations. Most people don't, so the public system can still pay for itself.

Sadly in germany it's rather difficult to switch between public and private or no insurance. Or rather, it's very difficult to get back on a public insurance once you're private or self-insured. The best you can hope for is pulling it off once, maybe twice.

That doesn't seem unreasonable.

If you're avoiding paying into a system because you don't want to claim from it then letting you hop back on whenever you need it would destroy the system very quickly.

Re: The Amish health care system

#245

Post by bookofjoe »

philjohn wrote: post #243
bookofjoe wrote: post #228

I just read every word of the 220 comments on this post and not once did I encounter the word "rationing" when it came to debating the merits and negatives of single payer. It is the elephant in the room: people pretend it's not there by saying things like "there's a long wait, sometimes over two years for such things as elective hip replacement."

Except it's not rationing per se, it's demand outstripping supply. You'll still get your elective procedure, but since it's not life-saving in the strictest sense you may have to wait a bit longer for it. But the flip side of that is a bout of cancer, a heart attack, baby needing to spend a month in NICU doesn't bankrupt you.

a bit longer ≠ 2 years IMHO

>But the flip side of that is a bout of cancer, a heart attack, baby needing to spend a month in NICU doesn't bankrupt you.

>Cancer services may be rationed to those most likely to survive, says NHS report

>National Health Service insist limited care for cancer patients is 'unlikely scenario'

https://www.telegraph.co.uk/news/2020/03/22/cancer-services-...

Re: The Amish health care system

#246

Post by Consultant32452 »

Moru wrote: post #236
empira wrote: post #196

Earlier quoted context omitted.

On the other hand, right now, only the rich, or those with good enough medical insurance (if your co-pay is more than you make in 6 months, are you really insured ?), have access to the expensive treatments. On a universal heathcase system, whatever the form it may take, more people would have access those expensive options. Is it better to sell your treatment to more people but at a smaller price tag, or to fewer pe…

The peace of mind and knowledge that everyone gets taken care of no matter what is worth the world to me.

The "no matter what" in this case is that more people suffer and die for all time into the future so that fewer people can suffer and die today. That's a steep price to pay because the future and the amount of suffering people in it is functionally infinite. I think as long as you're willing to say that out loud and really mean it we've had a principled and honest discussion.

Re: The Amish health care system

#247

Post by bookofjoe »

philjohn wrote: post #243
bookofjoe wrote: post #228

I just read every word of the 220 comments on this post and not once did I encounter the word "rationing" when it came to debating the merits and negatives of single payer. It is the elephant in the room: people pretend it's not there by saying things like "there's a long wait, sometimes over two years for such things as elective hip replacement."

Except it's not rationing per se, it's demand outstripping supply. You'll still get your elective procedure, but since it's not life-saving in the strictest sense you may have to wait a bit longer for it. But the flip side of that is a bout of cancer, a heart attack, baby needing to spend a month in NICU doesn't bankrupt you.

If you die waiting, the fact that it's free doesn't offer much solace.

Re: The Amish health care system

#248

Post by elithrar »

throwaway894345 wrote: post #239
pmiller2 wrote: post #4

Earlier quoted context omitted.

That inequality is still present, except that now, the system is: * Poor people either get hit with huge bills because they're uninsured, or, if they know how to navigate the system, sometimes get these bills written off through "financial aid." * Middle class people frequently have insurance, but get hammered by deductibles and out of pocket maximums, rarely qualifying for "financial aid." This can be ruinous. * The…

> Middle class people frequently have insurance, but get hammered by deductibles and out of pocket maximums, rarely qualifying for "financial aid." This can be ruinous. How large are these OOP maximums and deductibles on average? I’ve always kept an emergency fund that’s well in excess of my OOP max. Is this unusual? Also, I’m off the impression that you can get onto payment plans if you can’t pay your bills right aw…

> I’ve always kept an emergency fund that’s well in excess of my OOP max.

29% of households have $1000 disappears almost immediately given deductibles, and $11,700 isn’t that far off either. People just don’t have the chance to “get ahead” when making [1]: https://www.google.com/amp/s/www.cnbc.com/amp/2018/09/27/her...

Re: The Amish health care system

#249

Post by specialist »

ajuc wrote: post #238
specialist wrote: post #233

Earlier quoted context omitted.

Am keen to hear your thoughts. One such common thread is the financialization of consumer debt. I recently learned (from Michael Lewis' Against The Rules podcast) that removing ban on usury debt (high interest rates) opened the flood gates. Sorry, I forget which episode. https://atrpodcast.com

Well - first you have absurdly expansive universities required to be a doctor. They can be absurdly expansive because there is an expectation that students will indebt themselves with this one kind of debt you can't default on. So doctors have to earn more to be able to pay it back. Then you have lawsuits where cost of lawsuit is paid by both sides, no matter who is at fault. So if it takes 2 years and costs 100 000…

Thanks.

re lawsuits, I advocate a specialized healthcare court for adjudicating those cases.

Our current system of legal precedent does not recognize progress of science. So we end up with nonsense like unnecessary c-sections for decades because a jury of laypersons determined vaginal births increases cerebral palsy.

https://web.archive.org/web/20090424115607/http://www.nytime...

We already have separate specialized courts. Bankruptcy, youth, etc. My local judges have innovated by creating separate courts for vets, addicts, and so forth. Much more fair, efficient, and effective.

re education. Yup, totally on board. We (society) need more healthcare workers, of all flavors.

re big pharma. I don't know enough to comment.

Re: The Amish health care system

#250

Post by pnutjam »

grandinj wrote: post #215
_fq4v wrote: post #2

I thought the most interesting part was the commentary on non-Amish care in the past > I asked my literal grandmother, a 95 year old former nurse, how health care worked in her day. She said it just wasn’t a problem. Hospitals were supported by wealthy philanthropists and religious organizations. Poor people got treated for free. Middle class people paid as much as they could afford, which was often the whole bill, b…

that hides a lot of detail. Like just chopping off a leg instead of spending a 12 hour operation and months of physiotherapy to save it. Letting people die from chronic conditions instead of managing them. Letting old people die, because the cost of medical treatment was too high. Not performing operations for heart disease, so people got one heart attack and then died a year later. Which we could totally go back to,…

That's American healthcare for the majority of Americans. Luckily most old people don't worry about this because of Medicare.
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