Post-apocalyptic life in American health care • Hacker News Board

Re: Post-apocalyptic life in American health care

#41

Post by ForHackernews » Tue, Jan 02, 2018, 7:03 PM UTC

TheAdamAndChe wrote: post #14

dbpatterson wrote: post #8

It's amazing that someone can go through this and come to the conclusion, at the end, that the solution is that this is a business opportunity that would make a lot of money if someone could just make it more efficient. Trying to make money off of healthcare is exactly how we have gotten the absolute mess that is the American medical system. All the incredibly complex rules exist so that health insurance companies ca…

We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a…

> Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness

Massive unsupported assertion. Medicare is very efficient.

Re: Post-apocalyptic life in American health care

#42

Post by NoGravitas » Tue, Jan 02, 2018, 7:05 PM UTC

jerf wrote: post #35

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…

Obamacare complicated health care because it was designed to preserve the existing system of insurance companies, employer-provided insurance, and patchwork regulations. So, of course, it introduced more patchwork regulations, along with subsidies to the existing players.

A single-payer system (Canadian style) would greatly simplify the health care system, largely by cutting out the insurance-company layer for most people. A British NHS-style system would arguably be even simpler, but is even more of a political non-starter in the US.

Re: Post-apocalyptic life in American health care

#43

Post by frgtpsswrdlame » Tue, Jan 02, 2018, 7:09 PM UTC

conanbatt wrote: post #27

frgtpsswrdlame wrote: post #17

Earlier quoted context omitted.

You know those regulations are there for a reason right? Would you like to go back to the days where people are kicked off insurance for extremely dubious pre-existing conditions? >If profit-seeking destroyed markets for profit, we would all be starving. It depends on what you mean by 'destroy markets.' The market is functioning well in the sense that healthcare stocks keep going up. It's functioning poorly in the se…

>You know those regulations are there for a reason right? The road to hell is paved with good intentions. > It depends on what you mean by 'destroy markets.' The market is functioning well in the sense that healthcare stocks keep going up. It's functioning poorly in the sense that it's the ill who have to die or go bankrupt to support it. The measure of the health of a market is not the profits of the industry in it.…

>The road to hell is paved with good intentions.

Oh come on, this platitude applies to people saying 'less regulation' just as much as it does me.

>The measure of the health of a market is not the profits of the industry in it. A better rule of thumb would be how many people get serviced and at what relative cost. In that sense, the american healthcare market is very unhealthy.

Sure, but in that sense we can look around and see that healthcare markets are generally less healthy when they are (1) more private and (2) less regulated.

Re: Post-apocalyptic life in American health care

#44

Post by thehardsphere » Tue, Jan 02, 2018, 7:11 PM UTC

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…

It's arrogant to assume that a new system will be better than the old one merely because it was re-written from scratch. Many companies died because someone said "let's rewrite this bit of software" and the project ended up failing because people vastly underestimated the difficulty of the re-write. Even though they were smart professionals who knew how to write software well.

Considering that software companies frequently fail to succeed at re-writes with something as inconsequential as software, what makes you think society can do it with something as consequential as healthcare? Especially considering that healthcare is in many ways much harder and more poorly understood than software?

Re: Post-apocalyptic life in American health care

#45

Post by jf » Tue, Jan 02, 2018, 7:15 PM UTC

I switched to Kaiser after my own dealings with the kafkaesque world of healthcare that this article describes.

Kaiser is amazing in comparison.

With Kaiser, I no longer have to stare into the abyss of the "post-systematic atomized era" of healthcare. I don't have to use CPT codes to compare prices on bills with Medi-Cal rates, study legal agreements to find discrepancies, or repeat myself to every different medical provider I visit. Instead, I can go about my life and focus on the things I care about. Kaiser isn't perfect by any means, but it's astonishingly better than the alternative.

Re: Post-apocalyptic life in American health care

#46

Post by TheAdamAndChe » Tue, Jan 02, 2018, 7:15 PM UTC

ForHackernews wrote: post #41

TheAdamAndChe wrote: post #14

Earlier quoted context omitted.

We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a…

> Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness Massive unsupported assertion. Medicare is very efficient.

Yes, but that doesn't mean that the American healthcare system is efficient overall.

Re: Post-apocalyptic life in American health care

#47

Post by astura » Tue, Jan 02, 2018, 7:15 PM UTC

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…

Hospice and palliative care are not somehow "separate" from the medical system, they are a part of it.

Re: Post-apocalyptic life in American health care

#48

Post by ams6110 » Tue, Jan 02, 2018, 7:16 PM UTC

ForHackernews wrote: post #41

TheAdamAndChe wrote: post #14

Earlier quoted context omitted.

We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a…

> Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness Massive unsupported assertion. Medicare is very efficient.

Medicare doesn't cover "everything" though -- nor could it. No health "insurance" whether it is single-payer, private, public, can just open the checkbook for every patient.

Re: Post-apocalyptic life in American health care

#49

Post by dragonwriter » Tue, Jan 02, 2018, 7:17 PM UTC

conanbatt wrote: post #34

dragonwriter wrote: post #18

Earlier quoted context omitted.

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.

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

Food is a frequently repeated purchase with significant immediately-apparent utility and disutility, and so discovery of utilities is quick and the market reasonably efficient in terms of immediate utilities. (There are long-term utilities and disutilities that are less immediately experienced with consumption, and the food market is hardly efficient in terms of those.)

Healthcare products are infrequently purchased, and the relative utilities of different options are far from apparent. It's not at all similar to the aspects of the food market that can reasonably be described as relatively efficient.

Re: Post-apocalyptic life in American health care

#50

Post by maxerickson » Tue, Jan 02, 2018, 7:17 PM UTC

ForHackernews wrote: post #41

TheAdamAndChe wrote: post #14

Earlier quoted context omitted.

We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a…

> Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness Massive unsupported assertion. Medicare is very efficient.

Whether Medicare covers the cost of services provided is at least controversial.

If it doesn't, then it just gets the benefit of being mandated to look efficient.