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Post-apocalyptic life in American health care

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Re: Post-apocalyptic life in American health care

#31

Post by toomuchtodo »

TheAdamAndChe wrote: post #28
ceejayoz wrote: post #22

Earlier quoted context omitted.

> Edit: To those downvoting me, can you please explain? What flaw do I have in my logic? The idea that we're in a "capitalistic society". Every country in the world lives somewhere on the spectrum between capitalism and socialism. The US is further towards the capitalistic side than Europe, but we've plenty of non-capitalist aspects of our society. We already accept a wide array of socialist policies in the form of M…

I'm not saying that we shouldn't continue pushing for reform. I'm just saying that our government has proven incapable of reformation, and we should be pushing towards non-governmental approaches until they can get their act together. If we can improve the way things are through capitalism, that's still better than just yelling at politicians that don't do anything.

Can you explain your logic about pushing for non-government reform if "government has proven incapable of reformation"? There is no healthcare fix without government reform. If you provide healthcare, you must adhere to government regulation. You must accept Medicare/Medicaid reimbursement rates. If you provide insurance, you are at the whim of the government and what each new year brings [+].

> If we can improve the way things are through capitalism, that's still better than just yelling at politicians that don't do anything.

You cannot improve this with capitalism. You can only improve this by replacing politicians who are married to a broken system through vested interests.

[+] Healthcare startup Oscar is going through the grinder: https://www.bloomberg.com/news/articles/2017-08-15/obamacare...

Re: Post-apocalyptic life in American health care

#32

Post by conanbatt »

evgen wrote: post #16
conanbatt wrote: post #9

Earlier quoted context omitted.

It isn't profit-seeking what makes healthcare what it is. Its the incredibly burdensome regulation and restrictions. If profit-seeking destroyed markets for profit, we would all be starving.

No, it is profit-seeking that created this cluster-fuck. It only seems to be a problem in third-world nations like the US; the rest of the world seems to be blissfully free of broken profit-seeking institutions that cannot talk to other profit-seeking institutions so that they can collectively figure out the least amount of healthcare they can provide to the patient (so that both can maintain their profit.)

I am from a partially socialist country that has free healthcare. I have had private healthcare, along with most of my socio-economic class, my entire life.

Making it socialized does not mean it will be better. Coldly, see it as a different system with different consequences. Bringing it to the US: look at how much medicare costs today: 3.6% of gdp, servicing 56 million americans. If you extended medicare to the entire population at the same per capita, it would be 26% of GDP.

Re: Post-apocalyptic life in American health care

#34

Post by conanbatt »

dragonwriter wrote: post #18
conanbatt wrote: post #9

Earlier quoted context omitted.

It isn't profit-seeking what makes healthcare what it is. Its the incredibly burdensome regulation and restrictions. If profit-seeking destroyed markets for profit, we would all be starving.

Profit seeking destroys markets with large externalities or where utility isn't readily discernable at low relative cost, and where for either or both of those reasons the rational choice model doesn't reasonably approximate actual behavior in the market. Lots of real goods don't face that problem, but healthcare definitely does.

Whats the externality of providing healthcare, and in regards to the diffuseness of utility, food has the same problem and its a relatively very efficient market.

Re: Post-apocalyptic life in American health care

#35

Post by jerf »

nathanaldensr wrote: post #11

I love this article. I feel like it gets down to the real root of the problems with the complexity of Western culture. I feel like this perspective applies to a lot more than healthcare. It matches my own thoughts that technological complexity is getting so high that eventually it will be beyond our own understanding, both individually or in a group of any size. We as a species simply won't be able to make use of our…

I'm as guilty as some people of just citing "excessive regulations" as a problem without mentioning the mechanics that make that a problem, since so many people see "regulation" as a good thing by just thinking of it as "regulating away the bad outcomes". But this article gets to one of the mechanisms I think of when I cite regulation as a problem; regulation casts in concrete a particular way of doing business, and makes it literally illegal to do it any other way. Can't even try something new as a one-off; it's illegal to do anything else. Doesn't matter how brilliant your idea is; it's illegal. Doesn't matter if you've got a startup with the software all ready to go; it's illegal. Are two regulations either interacting poorly, or outright contradictory? Not only is it illegal to not conform to both of them, now we've introduced an adhoc meta-regulatory regime with regard to how to address the overlaps, with the de facto force of law behind this unwritten metaregulation, and/or impedance mismatches between two bits of the industry resolving them in different ways.

Even if we stipulate that The Hypothetical Medical Regulation Act of 1983 was somehow the miraculous embodiment of perfect medical regulation for 1983, it would be causing major problems for the medical system today. Mere time would be enough to cause problems with medical regulations, and alas, they aren't perfect to start with, and they seem to be ever-growing in size, and there's no way the complexity growth is merely O(n). We've almost certainly passed the point where regulations are appearing for the sole purpose (if one did a full cause analysis) of dealing with the fact that regulations are blocking the system up.

(My biggest objection to "national healthcare" is that unless you find me some different authors to write it than our current Congress and current regulatory state, I have approximately 0.001% confidence that "nationalizing healthcare" will fix this. Advocates of nationalizing healthcare would have a much easier time convincing me if Obamacare had simplified health care, instead of massively adding to the pile of regulations and massively empowering more regulations going forward.)

Re: Post-apocalyptic life in American health care

#36

Post by delinka »

testplzignore wrote: post #30

In the software world, we would fork or rewrite, and deprecate the old version. I think we should do the same for healthcare. The existing system is unmaintainable spaghetti code that needs to be deleted. Create a new single payer healthcare system that is completely separate from anything existing now. Don't attempt to incorporate any existing insurance, regulations, medical records, etc. Allow the new system to ign…

There is some old "baggage" that you'll necessarily need: written procedures; the experience of, uh, experienced medical staff; and patients' histories. If you can bring those along without polluting the new system, you might be onto something.

Re: Post-apocalyptic life in American health care

#38

Post by trowawee »

conanbatt wrote: post #32
evgen wrote: post #16

Earlier quoted context omitted.

No, it is profit-seeking that created this cluster-fuck. It only seems to be a problem in third-world nations like the US; the rest of the world seems to be blissfully free of broken profit-seeking institutions that cannot talk to other profit-seeking institutions so that they can collectively figure out the least amount of healthcare they can provide to the patient (so that both can maintain their profit.)

I am from a partially socialist country that has free healthcare. I have had private healthcare, along with most of my socio-economic class, my entire life. Making it socialized does not mean it will be better. Coldly, see it as a different system with different consequences. Bringing it to the US: look at how much medicare costs today: 3.6% of gdp, servicing 56 million americans. If you extended medicare to the enti…

Actually, the first world nations that have socialized healthcare systems experience better outcomes than the United States with less per capita spending.[1] Medicare as it is currently formulated is specifically targeted towards at-risk populations that have higher incidences of medical usage than the general population; you can't just apply the exact same per capita spending across the American population. 80 year-olds use more health care than 25 year-olds.

[1]: http://www.commonwealthfund.org/publications/issue-briefs/20...

Re: Post-apocalyptic life in American health care

#39

Post by crispyambulance »

jbob2000 wrote: post #12

I know this is going to be controversial, but at this point: > My mother’s mild dementia began accelerating rapidly a year ago. I’ve been picking up pieces of her life as she drops them. That has grown from a part-time job to a full-time job. In the past month, as she’s developed unrelated serious medical issues, it’s become a way-more-than-full-time job. I would have kept my mother out of the healthcare system and l…

I understand what you're getting at but it's not that easy: it is not a clear-cut decision when it happens to your family.

Usually, old folks develop an ever growing list of aliments which add up over time, usually one serious medical crisis every few months to a year until their number is called.

Moreover, many of aliments of old folks aren't "terminal". You can't take your octogenarian mother to the hospice, for instance, because she broke a hip, had a stroke, got sepsis from a UTI, or suffered a venous ulcer that put her in a wheelchair (all those happened to my mother in a span of 2 years).

Also, "dementia" (not to be confused with Alzheimer's) is a side-effect of something else rather than a condition in itself. A simple infection is enough for an elderly person to develop dementia to the point where she does not know where she is. Even a pain-killer regimen requires careful management to keep the patient on a knife-edge between lucidity and la-la-land.

Re: Post-apocalyptic life in American health care

#40

Post by ForHackernews »

testplzignore wrote: post #30

In the software world, we would fork or rewrite, and deprecate the old version. I think we should do the same for healthcare. The existing system is unmaintainable spaghetti code that needs to be deleted. Create a new single payer healthcare system that is completely separate from anything existing now. Don't attempt to incorporate any existing insurance, regulations, medical records, etc. Allow the new system to ign…

> Create a new single payer healthcare system that is completely separate from anything existing now.

We don't have to create some new system from scratch. Medicare already exists, and it's extremely efficient[0]. Medicare-for-everyone is arguably the best path forward to a national healthcare system.

[0] https://www.healthaffairs.org/do/10.1377/hblog20110920.01339...

> According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.

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