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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

#31

Post by underlipton »

mdorazio wrote: post #13
underlipton wrote: post #9

Earlier quoted context omitted.

The problem is that a public option must necessarily spend a lot more of its focus on preventative care that keeps people from developing serious chronic illness in the first place, for budgetary reasons. There are a lot of people staking their career prestige, high pay, and lifestyles on Americans having the freedom to get sick, seriously sick, on a regular and consistent basis. I'm happy to throw them under the bus…

Every single study I have seen refutes your point, which was commonly brought up during the Obamacare discussion days and never had any merit to begin with. Here's the NIH itself estimating a 13% savings compared to today: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572548/ What you're missing is that the current "system" is so utterly wasteful and inefficient that even if we cover people's shitty lifestyle habits…

Fair, though we're generally in agreement. My point is that there are many who don't want the savings, because the over-payment is what fills their bank accounts. I was trying to point out that their last refuge, even when things improve objectively and across the board for the vast majority of Americans, is that single-payer or even a public option would hurt their pocketbooks. Like I said, I'm happy to throw insurers under the bus.

Re: Post-apocalyptic life in American health care

#32

Post by scotty79 »

I recently heard that hospitals still benefit from people who don't pay off their medical debt. They sell it for fraction of the amount and use the loss to offset earnings to dodge taxes. Prices of their services are inflated for this purpose (among others). It's better to have triple price, have insurer pay third of it and sell the debt of remaining two thirds as half-price. This way you get all the income and zero taxes. And if some chump patient decides to actually pay them they get ahead even more.

Does it sound plausible?

Re: Post-apocalyptic life in American health care

#34

Post by Spivak »

monero-xmr wrote: post #14

After thinking about this a long time, and doing a lot of reading on the subject, here is my solution to American healthcare and perhaps in other countries with collapsing healthcare like the UK and Canada: Most medical interventions, even ones that are serious like hip replacements, can be scheduled. It’s annoying while you are waiting, but it’s the rare case where emergency medical attention must be applied immedia…

I can be down for this. To anyone who doesn't deal with the innards of US health insurance, this is better coverage than every health insurance plan in America despite the bar seeming so low.

I do think your bar for catastrophic is far too high and should probably be ~$10k cumulative spent in any span of time less than 12 months because $49k is ruinous to almost every American.

Re: Post-apocalyptic life in American health care

#35

Post by BeefDinnerPurge »

jmye wrote: post #6
BeefDinnerPurge wrote: post #2

I'd be great with a baseline medicare for all system publicly funded across the board with the option to pay more for privately funded better options. Not going to get that, or anything close to that, are we? I give up America, you get the health care you're willing to prioritize. Not my problem any more. That said, going out of network if you can and going to the places with the cases if you can are the only real cu…

Medicare for all is not a panacea and would cause dramatic breaks in care in other places. The fragmented private model sucks, but the belief that single-payer would fix much of anything is faulty. Reform should happen, but it shouldn’t be based on a bumper sticker, and it should be thoughtful about the vast differences between SF, NYC, West Texas and Southern South Dakota. “Fixing” things for people in major cities…

[flagged]

Re: Post-apocalyptic life in American health care

#36

Post by lbotos »

ksec wrote: post #30

I am not the one who normally says this, and I will admit I know little about US Health system ( I assume the complexity of it means no one really knows ) Given the insanity of it, and US being capitalist in nature, may be the best way to fix all of these isn't more regulation, but to deregulate the market so they could compete? And on the topic, I am wondering if anyone knows a good site that compares the Medical Sy…

I’m young enough to not have cared about healthcare pre Obama, but my understanding is the risk of less regulation is the “preexisting condition” trap where insurance companies basically price you out if you need a lot of medical attention.

So basically if you are poor you just… suffer

Re: Post-apocalyptic life in American health care

#37

Post by monero-xmr »

Spivak wrote: post #34
monero-xmr wrote: post #14

After thinking about this a long time, and doing a lot of reading on the subject, here is my solution to American healthcare and perhaps in other countries with collapsing healthcare like the UK and Canada: Most medical interventions, even ones that are serious like hip replacements, can be scheduled. It’s annoying while you are waiting, but it’s the rare case where emergency medical attention must be applied immedia…

I can be down for this. To anyone who doesn't deal with the innards of US health insurance, this is better coverage than every health insurance plan in America despite the bar seeming so low. I do think your bar for catastrophic is far too high and should probably be ~$10k cumulative spent in any span of time less than 12 months because $49k is ruinous to almost every American.

My counterpoint is that for a family of 4 it’s $28k total per employee at my company for health insurance. If even half of that was put directly into an HSA the bar could be hit quickly. It’s just amazing how unbelievably expensive and wasteful US healthcare is.

Re: Post-apocalyptic life in American health care

#38

Post by BeefDinnerPurge »

fzeroracer wrote: post #22
jmye wrote: post #6

Earlier quoted context omitted.

Medicare for all is not a panacea and would cause dramatic breaks in care in other places. The fragmented private model sucks, but the belief that single-payer would fix much of anything is faulty. Reform should happen, but it shouldn’t be based on a bumper sticker, and it should be thoughtful about the vast differences between SF, NYC, West Texas and Southern South Dakota. “Fixing” things for people in major cities…

Rural healthcare is being crippled in part due to state politicians posturing for political clout. Major reforms like medicare for all shouldn't be held back because they're not perfect, because otherwise we're going to continue having the same problems we've been having where compromised half-assed bills make the system overall worse.

[flagged]

Re: Post-apocalyptic life in American health care

#39

Post by ethbr1 »

fzeroracer wrote: post #18
brenschluss wrote: post #7

Knowing little about this - a genuine suspicion is - is this a feature, not a bug? As in - doesn’t this arise out of an incentive for health insurance companies NOT to cover procedures? I can only imagine that this bureaucratic tangle reduces insurance coverage by a very significant percentage. Aka - the kind of communication inefficiency must be profitable, no?

It is a feature. People need to look at this from the same angle as dark patterns. The goal with all of these interconnected but disjointed systems is so that the person holding the bag is constantly changed. It's unfortunate that the author of this article in question manages to take away the wrong impression. > It’s obvious how to fix health care. Just make everything run systematically, like FedEx or Amazon. There…

> You look at other countries and how their healthcare systems work and you will see a vast difference in functionality and efficiency. Because they know healthcare being a for-profit driven industry with weak government controls leads to the shitshow we have in America.

You can't boil healthcare down to a single reason.

At minimum, there are supply (providers and facilities) and demand (insurers and patients) sides, each of which have their issues and solutions.

There is no magic bullet that any country has found to solve the problem, other than -- have enough providers and facilities for patient demand and find a way to make it worth their while.

Re: Post-apocalyptic life in American health care

#40

Post by ars »

ggm wrote: post #4

I'd be interested what one, single change might help. Something intangible like independently curated complete health record in some normative form on a smart card. Or, a legalism of a "first do no harm" nature which demands once a qualified professional determines you have cover and it's just an argument about who pays between competing covers, you get no-worse-off service choices immediately until they decide which…

The one change I would suggest is switching to the HMO Capitation model.

The nice thing about it is that it can be done a bit at a time, you don't have to change the entire US at the same time.

No more fee for service, Doctors would go on salary, and without fee for service an entire insurance complication (making sure to pay exactly the right amount for services, no more, no less) evaporates.

The downside: You can only see Doctors inside the HMO network. A second downside is handling emergency out-of-network care (this part would get better as more of them exist, as they would sign sharing agreements with each other).

Note: The capitation part is critical, HMO without capitation is worthless.

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