Earlier quoted context omitted.
I don't begin to understand the US health system (I live in the UK with its National Health), but didn't Obama try bring in compulsory health insurance to counteract just this sort of thing and it was defeated?
Not defeated, it just hasn't rolled out fully yet. States are figuring out how to implement everything, and of course the partisan foes of his health plan stage votes in Congress to repeal it (which never pass) every month or so.
Hacker News Folks Get Long Overdue Thanks
41–50 of 144 posts
Re: Hacker News Folks Get Long Overdue Thanks
#42Great story of compassion and triumph. So... How do we make it scale? Is it mandatory insurance? Insurance doesn't make everything affordable, but it probably wild have been helpful. Though maybe the co-pay would have been $50k. Universal tax-payer funded insurance? The term "tax payer" is interesting because politicians and pundits forget that we're all tax payers in one form or another. Granted some pay more, some…
I still can't decide what's more embarrassing: That the US have a third-world health care system or that people act like it is a hard, unsolved issue to implement something better.
Re: Hacker News Folks Get Long Overdue Thanks
#43Great story of compassion and triumph. So... How do we make it scale? Is it mandatory insurance? Insurance doesn't make everything affordable, but it probably wild have been helpful. Though maybe the co-pay would have been $50k. Universal tax-payer funded insurance? The term "tax payer" is interesting because politicians and pundits forget that we're all tax payers in one form or another. Granted some pay more, some…
Single-payer or government provided healthcare? Pretty sure that no one would identify the government as the picture perfect example of efficiency. Plus, putting elected officials or their appointees in charge of handing out goods and services doesnt seem to be sustainable. It seems odd to me that so many Americans seem pessimistic about their own government. I could understand if the attitude was, "We could make uni…
Re: Hacker News Folks Get Long Overdue Thanks
#44It's great that people here helped him out and that a life was saved, but it's also sad that some US citizens - in this case a veteran - have to beg for healthcare.
We have a very long way to go.
Re: Hacker News Folks Get Long Overdue Thanks
#45Great story of compassion and triumph. So... How do we make it scale? Is it mandatory insurance? Insurance doesn't make everything affordable, but it probably wild have been helpful. Though maybe the co-pay would have been $50k. Universal tax-payer funded insurance? The term "tax payer" is interesting because politicians and pundits forget that we're all tax payers in one form or another. Granted some pay more, some…
Single-payer or government provided healthcare? Pretty sure that no one would identify the government as the picture perfect example of efficiency. Plus, putting elected officials or their appointees in charge of handing out goods and services doesnt seem to be sustainable. It seems odd to me that so many Americans seem pessimistic about their own government. I could understand if the attitude was, "We could make uni…
The problem is the morass of laws we've accumulated around healthcare over the years for various reasons that now interact in complex ways that nobody foresaw. Like the law designed to make Medicare or Medicaid (I forget which) drugs cheaper that ended up making it illegal to give free birth control to college students.
We also have the laws from when people believed that competition increased costs and so tried to ban competition between hospitals. Or the committee that sets doctor's reimbursement rates for Medicare procedures based on the *$%@# labor theory of value. And the laws designed to prevent people from overcharging Medicare that means that everybody has to worry about those rates across the industry. Or the way that the makeup of that committee means that primary care physicians gets shafted.
And the fact that we allow so few schools to teach medicine means that they can charge an arm and a leg, which means that those poor shafted PCPs need the kickbacks they get for assigning specialist care in order to pay off their student loans and malpractice insurance.
And I could go on.
And now we have this system that's incomprehensibly complex. So Congress has no way of figuring how to fix it on their own. There are people who've spent years figuring out how all of this works, but that's their job and if the system was actually fixed their job would be gone and that understanding they spent years acquiring would be useless.
Which isn't to say that this is entirely hopeless. There have been some efforts at the hospital level like Kaiser Permanente's to ameliorate the perverse incentives in the system and capture some of the value unlocked by that. And there are some laws that could be changes or repealed (like the one against hospital competition) without really breaking anything. So I think that gradual reform might be possible, but it's going to be a long road that doesn't particularly involve the issues that people tend to talk about around healthcare.
Re: Hacker News Folks Get Long Overdue Thanks
#46Earlier quoted context omitted.
Single-payer or government provided healthcare? Pretty sure that no one would identify the government as the picture perfect example of efficiency. Plus, putting elected officials or their appointees in charge of handing out goods and services doesnt seem to be sustainable. It seems odd to me that so many Americans seem pessimistic about their own government. I could understand if the attitude was, "We could make uni…
I find that Americans hold the attitude that the government is not the picture perfect example of efficiency except in the case of the military. Spoiler alert: we have a quasi-single-payer system for the military.
Re: Hacker News Folks Get Long Overdue Thanks
#47Earlier quoted context omitted.
I still can't decide what's more embarrassing: That the US have a third-world health care system or that people act like it is a hard, unsolved issue to implement something better.
It's not third-world. If you have the money, it's first-class. It's just the 'if you have the money' part that causes issues.
Re: Hacker News Folks Get Long Overdue Thanks
#48Earlier quoted context omitted.
Not defeated, it just hasn't rolled out fully yet. States are figuring out how to implement everything, and of course the partisan foes of his health plan stage votes in Congress to repeal it (which never pass) every month or so.
It gets worse. According to CBO estimates, the plan underestimated the costs of the original rollout severalfold. Republicans are gleefully attempting to guarantee failure by refusing to approve any additional funds for that purpose.
I could have told them that.
I designed and implemented portable electronic medical records for 5 regional exchanges. Hospitals, clinics, pharmacies, ambulances, permanent stays (nursing homes), insurers, labs, etc.
Coordination was tough, because everyone thinks they own the data (and loathe to share) and are often competitors.
It's all about the incentives. The only fix I can think of is single payer, which will compel everyone to play nicely together.
That said...
Simply having the state by state insurance comparison portals seems to be very effective for price competition, better than I could have predicted. So on balance, it looks like the impact of Obamacare / ACA will be really good, if not perfect.
Re: Hacker News Folks Get Long Overdue Thanks
#49From wikipedia:
The United States life expectancy of 78.4 years at birth, up from 75.2 years in 1990, ranks it 50th among 221 nations, and 27th out of the 34 industrialized OECD countries, down from 20th in 1990. Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States had the highest or near-highest prevalence of infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides, and disability. Together, such issues place the U.S. at the bottom of the list for life expectancy. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country.
According to the World Health Organization (WHO), the United States spent more on health care per capita ($8,608), and more on health care as percentage of its GDP (17.9%), than any other nation in 2011. The Commonwealth Fund ranked the United States last in the quality of health care among similar countries, and notes U.S. care costs the most.
http://en.wikipedia.org/wiki/Health_care_in_the_United_State...
Re: Hacker News Folks Get Long Overdue Thanks
#50Great story of compassion and triumph. So... How do we make it scale? Is it mandatory insurance? Insurance doesn't make everything affordable, but it probably wild have been helpful. Though maybe the co-pay would have been $50k. Universal tax-payer funded insurance? The term "tax payer" is interesting because politicians and pundits forget that we're all tax payers in one form or another. Granted some pay more, some…
One note on efficiency - something like 30% (yes yes, citation needed) of American health dollars go towards insurance administration. A family member of mine works in Canadian health care and had a recent arrival (a physician, IIRC) from the States ask where the "billing floor" was because an out-of-country patient needed some sort of paperwork done. Well, Canadian hospitals don't have floors dedicated to processing payment. There was a small office.
On a second note, having your healthcare connected to your employment situation seems like insanity - I can't fathom anything that would argue in favour of that, unless you're an employer looking for additional leverage over your serfs.