Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Health care is turning into a consumer product

economist.com

Post reply on HN
Print view View original

321–330 of 334 posts

Re: Health care is turning into a consumer product

#321

Post by neuro_image2 »

refurb wrote: post #143
SkyPuncher wrote: post #103

Earlier quoted context omitted.

It's worth noting the debt burden that different medical education systems place on physicians. Debt load and lost income are huge in the US medical education systems. Many people that browse this forum will likely have lifetime income similar to that of a physician.

Average debt is like $500,000 and average wage (across all specialities) is $250,000. The debt burden isn’t that high. And sure, comparing it to Silicon Valley looks bad, but so does every other job. “Amazing how bad other jobs look when you compare them to the top 1%”

I'm curious, you seam to have a particular animosity towards physicians. (Or at least animosity towards the idea that physicians should be well reimbursed.)

Is there a particular reason for this?

In a world where people are making billions for photo-sharing apps and financial rent seeking, is it really that egregious for people that treat disease to do well financially?

Re: Health care is turning into a consumer product

#322

Post by ben_w »

virgilp wrote: post #277
ben_w wrote: post #218

Earlier quoted context omitted.

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).

NHS was a great initiative and idea!! I'm not advocating against public healthcare, at all. I'm saying is that it's not surprising it became underfunded - there needs to be constant effort to prevent (or compensate) that tendency, because it _is_ the natural tendency of such systems.

Fair enough, I assumed you were trying to differentiate it from private sector given the use of the quote about communism :)

Re: Health care is turning into a consumer product

#323

Post by TMWNN »

DrBazza wrote: post #127
CraigJPerry wrote: post #56

Earlier quoted context omitted.

Counter point: the NHS in the UK has more government involvement than the US healthcare system. The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. “Better outcomes” needs more detail: Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an…

> The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. It really isn't underfunded. It's grossly inefficient, which is what happens to most if not all publicly funded bodies. It is actually ok to criticise the NHS organization. They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. They (currently?) refused to recycle crutches, plastic…

>I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed.

Relevant: Private Eye on "24 Hours to Save the NHS": (https://twitter.com/KulganofCrydee/status/833654730849136641>)

Re: Health care is turning into a consumer product

#324

Post by nicoburns »

nmhancoc wrote: post #237
throwaway0a5e wrote: post #57

Earlier quoted context omitted.

Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. Using insurance, government or some other centralizing layer (e.g. the church) for routine activity would raise massive "you're pissing money away" red flags in literally any other context. We shoehorn so much economic activity (healthcare) though a middle man (…

I misunderstood your comment on first read, and looking at other replies others did as well. > Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. I think most people are interpreting this as “market is a fine fit for every healthcare need [except for those that start in the ER] which is the overwhelming majority…

> ~20% which doesn’t seem ridiculous for an insurance business.

I think the issue with healthcare insurance companies in the US is that they collude with the hospitals to artificially inflate the cost of things so that their 20% is 20% of 10x the actual value of the treatment.

Re: Health care is turning into a consumer product

#325

Post by virgilp »

ben_w wrote: post #322
virgilp wrote: post #277

Earlier quoted context omitted.

NHS was a great initiative and idea!! I'm not advocating against public healthcare, at all. I'm saying is that it's not surprising it became underfunded - there needs to be constant effort to prevent (or compensate) that tendency, because it _is_ the natural tendency of such systems.

Fair enough, I assumed you were trying to differentiate it from private sector given the use of the quote about communism :)

It's clear that a strong public system is needed, to keep the private ones in check. But e.g. Italy shows that they can co-exist well, and maybe that's a better solution?

Re: Health care is turning into a consumer product

#326

Post by ben_w »

virgilp wrote: post #325
ben_w wrote: post #322

Earlier quoted context omitted.

Fair enough, I assumed you were trying to differentiate it from private sector given the use of the quote about communism :)

It's clear that a strong public system is needed, to keep the private ones in check. But e.g. Italy shows that they can co-exist well, and maybe that's a better solution?

No doubt. I know nothing of the Italian system; I’m in Germany now, which seems to be not just what all the left wingers I know in the U.K. are afraid the Tories want to do to the NHS, and what all the right wingers in the USA have been complaining about when they say Obamacare is too socialist, and what the one British anarcho-capitalist I knew didn’t like about UK National insurance: there are a bunch of private healthcare providers, insurance of some sort is mandatory, the providers don’t have clear differences beyond branding, it’s not called “a tax” despite being on end of year tax forms, and rich people are allowed to do some sort of shenanigans that makes it cheaper.

But… it works.

The NHS is cheaper, but — and here I wander dangerously into opinion — I suspect that’s short-term benefits with long-term problems which will bite the U.K. in the backside rather than better overall cost-benefit decisions.

Re: Health care is turning into a consumer product

#327

Post by Aldrynt »

CryptoPunk wrote: post #37
jltsiren wrote: post #33

Earlier quoted context omitted.

> Other countries healthcare systems are growing increasingly more inefficient as well, with the proportion of GDP expended on healthcare rapidly rising, with many seeing it double over the last 40 years. There are two (mostly) unrelated issues: the efficiency of the healthcare system and increasing availability of effective but expensive treatments. I believe we have already reached the point where even 100% of GDP…

There is in fact a correlation between per capita GDP, and the proportion of GDP expended on healthcare, so you may be correct. It's worth noting that the US has much higher per capita GDP than most OECD countries. In any case, the price inflation seen in highly regulated vs lightly unregulated markets is, to me, telling: https://www.aei.org/carpe-diem/chart-of-the-day-or-century-3...

No post body was provided.

Re: Health care is turning into a consumer product

#328

Post by SkyPuncher »

refurb wrote: post #143
SkyPuncher wrote: post #103

Earlier quoted context omitted.

It's worth noting the debt burden that different medical education systems place on physicians. Debt load and lost income are huge in the US medical education systems. Many people that browse this forum will likely have lifetime income similar to that of a physician.

Average debt is like $500,000 and average wage (across all specialities) is $250,000. The debt burden isn’t that high. And sure, comparing it to Silicon Valley looks bad, but so does every other job. “Amazing how bad other jobs look when you compare them to the top 1%”

> The debt burden isn’t that high.

It's much higher than other countries. There's also a 7 to 10 year period of medical school and residency where you're making no wage or a poor wage. People tend to get fixated on the attending-level annual salary while ignoring that piece. That's 7 to 10 years where you're not really building any savings, retirement, or wealth.

My wife (a doctor) and I (a non-SV software engineering who's career has taken a backseat to hers) ran the math. On an hourly basis, she will likely never come out ahead of me. She just has too many unpaid and low-paid hours in med school and residency to overcome. In aggregate, she will likely out-earn me - but that break-even point will be in our 50's with her having worked many more hours than me. That's 30 years into our careers.

Re: Health care is turning into a consumer product

#329

Post by papito »

xondono wrote: post #236
papito wrote: post #113

Which is an anti-pattern. Healthcare is not a product with supply and demand dynamics of, say, cars. Capitalism does not help with its delivery. Biotech, equipment manufacturing, yes, but not delivery . "I am just not going to get sick" is not a strategy. No one can control the inherent risk of life. Slipped, swiped by a car, and since we are talking about the United States, let's just go there - caught in a crossfir…

> Which is an anti-pattern. According to you. I happen to live in a single payer, free healthcare system (Spain), and the claims about “how nice it is” are pure BS. All of my family has medical insurance, even when we could ill afford to pay extra. - I almost lost my brother on the public health system (they sent him home with some antibiotics, instead we took him to a private hospital were he got surgery that same d…

But you COULD go private. What if you couldn't? It's obviously not perfect, but that idea that health care is a privilege is pretty anti-social.

Re: Health care is turning into a consumer product

#330

Post by analog31 »

neuro_image2 wrote: post #307
analog31 wrote: post #98

Earlier quoted context omitted.

Indeed, I think the deal should be: You go to medical school for free, then you work for the government for a nice professional salary. Malpractice insurance can be a government function. An interesting side effect might be to change the demographics of who can become a doctor, maybe attracting more people from middle class or blue collar backgrounds.

Not sure the opportunity to work for the federal government is a great way to incentivize the best and the brightest. Doctors already come from a variety of different backgrounds.

As opposed to working for the insurance industry? My knee jerk response is that incentivizing the best and brightest has gotten us to where we're at now. I've read that doctors are deluged in paperwork and bureaucracy, and incentivized to choose treatment options based on insurance coverage. I've had more than one doctor say to me: "The insurance says I can do X but not Y," and "your treatment ends when your coverage runs out." Of the several doctors among my friends, those who are not also professors or entrepreneurs have opted for part-time status, or have retired early.

Incentivizing the best and brightest in the software industry has gotten us to where we have to give new computer science graduates a coding exam, to find out if they can program.

Post reply on HN