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The US spends more on healthcare for no gain says new report from Johns Hopkins

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Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#421

Post by entity345 »

fsloth wrote: post #417
entity345 wrote: post #392

Earlier quoted context omitted.

Healthcare is broadly a service and thus what hospitals, GP surgeries, etc. produce in the economy. The NHS is a socialised system based on socialist ideas and indeed can be seen as a socialist construct within a capitalist overall economy. Nothing inherently wrong with that, that's just objectively the way it is. Bevan just said it the way it is. Now, the military and police are regalian functions of the state. The…

"regalian functions of the state" Sorry to nitpick, but does "regalian" mean something else than emblems or insignia of royalty? A credible sovereign state generally needs some force projection capability within it's political domain, hereditary monarchy or not. Hence military is definetly in a different category than healthcare.

The etymology of the term indeed comes from the prerogatives of the sovereign.

"Regalian functions of the state" is a common term that means the basic powers of the state (monarchy or not) that used to be the prerogative of the sovereign. I.e. law & order, military, and taxation. You could also call these "inherent powers of the state".

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#422

Post by foldr »

DennisP wrote: post #418
luckydata wrote: post #196

Earlier quoted context omitted.

Ok but why focusing on the insurance systems that are still sub-par compared to Italy, UK and Spain where the single payer system yields even better results for less money?

The book did cover the UK and Canada, and found they did not get better results for less money. The author didn't visit Italy or Spain. For quality results, the book used rankings by international organizations, based on statistics like "cure rate after diagnosis of major disease." For cost, it used percentage of GDP and cost per capita. Germany, France, and Japan were tops in quality, and Japan was also the cheapest…

GPs are not really employed directly by the NHS.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#423

Post by tboyd47 »

Here's a simple, free-market solution that no one seems to have thought of: start a health insurance company that pays for medical tourism. That would provide consumers a cost-effective alternative and put pressure on the American hospital systems to bring down costs. Why wouldn't this work?

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#424

Post by dsfyu404ed »

hannasanarion wrote: post #398
cteague wrote: post #355

Earlier quoted context omitted.

Every market has information asymmetry. Software is probably the biggest one today. Yet software keeps getting better and better... I agree there are needs for regulations--more like proper norms though and a good tort system.

No it doesn't. You can negotiate the price of software before you buy it, and you can shop around and choose between alternatives, or choose not to buy at all. If you need a piece of rebar removed from your chest, then you need a piece of rebar removed from your chest. The price doesn't matter, the choice of provider doesn't matter. The "consumer" is completely at the whim of whatever provider happens to be closest.…

There's plenty of industries where the customer often needs something done quickly or in an emergency and they still don't get screwed like they do in medical. Plumbers, septic pumping, auto repair, all have a substantial portion of their customers needing "emergency" services that they could charge whatever they want for. They don't though because there's price transparency and if you get screwed you'll never call them again and tell all your friends they ripped you off.

With medical there's no way to know when you got ripped off because prices vary wildly for the same services and there's no price transparency.

If I broke my leg doing something stupid you can bet your ass I'd call around and get quotes if I could. It only takes ~10min, far less than the EMT response time where I live. The problem is I can't even get quotes.

Sometimes you have no options and you get screwed but the vast majority of medical care is not people who will bleed out if they don't go to the nearest hospital ASAP. If normal services didn't cost an arm and a leg and you could reasonably shop around then healthcare and therefore health insurance wouldn't cost nearly as much because the lions share of services would be priced competitively.

Furthermore, price transparency is not incompatible with any other approach to healthcare since that information necessarily needs to exist.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#425

Post by rscho »

DennisP wrote: post #410
rscho wrote: post #373

Earlier quoted context omitted.

Indeed, I think so too. Ironically, people essentially tend to ask for freedom of choice above all in the US healthcare system (I want complete price info, yada yada...) when the US system is evidently already the one offering the highest level of patient autonomy, probably worldwide (regarding the ethics principles of beneficence, nonmaleficience, Justice and autonomy). But guess what? That has a price, who would ha…

People want complete price information because we don't have price controls, like they have in Germany, France, and Japan. Having a "free market" in healthcare without showing prices in advance of providing services is sort of obviously the worst way to get a reasonably priced healthcare system. That's somewhat mitigated by negotiations between insurers and providers, but not entirely given out-of-network charges.

Agreed, however there is a solid base of evidence (as solid as medical evidence can be, which is not saying much) that health can't humanely be handled as a commodity.

Plus, providing complete price info itself is not free. Talk about administrative inflation!

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#426

Post by locklock »

slx26 wrote: post #334

I speak for myself, but I'm pretty sure many people would share the thought: healthcare is the number one reason for which I'd never move to America. And there are a billion things for which you might want/not want to move to another country. And I'm healthy, and there are many other things that might seem crazy about America. I don't know, maybe I'm just paranoid, but I do seriously hope for the sake of everyone (an…

Having moved out of America, it's the one thing that would have to change before I ever returned.

Especially now, having spoken to people from all over the world (Europe, mainly), who simply never worry about any of this. Six-digit bills, insurance premiums, copays, in- vs. out-of-network doctors, these are all things that are completely unknown to people who live in countries with functional healthcare systems. I would suggest that any difference in care quality--which it seems like doesn't exist, but if it did--is immediately ruined by the emotional and economic overhead of having to worry about all of the aforementioned.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#427

Post by dragonwriter »

dsfyu404ed wrote: post #424
hannasanarion wrote: post #398

Earlier quoted context omitted.

No it doesn't. You can negotiate the price of software before you buy it, and you can shop around and choose between alternatives, or choose not to buy at all. If you need a piece of rebar removed from your chest, then you need a piece of rebar removed from your chest. The price doesn't matter, the choice of provider doesn't matter. The "consumer" is completely at the whim of whatever provider happens to be closest.…

There's plenty of industries where the customer often needs something done quickly or in an emergency and they still don't get screwed like they do in medical. Plumbers, septic pumping, auto repair, all have a substantial portion of their customers needing "emergency" services that they could charge whatever they want for. They don't though because there's price transparency and if you get screwed you'll never call t…

> If I broke my leg doing something stupid you can bet your ass I'd call around and get quotes if I could.

Quotes for...what? Even with price transparency on actual services, “I broke my leg” doesn't tell you with much specificity what services you need. And that's not even to discuss, “I'm having chest pain and dizziness”.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#428

Post by DanBC »

DennisP wrote: post #418
luckydata wrote: post #196

Earlier quoted context omitted.

Ok but why focusing on the insurance systems that are still sub-par compared to Italy, UK and Spain where the single payer system yields even better results for less money?

The book did cover the UK and Canada, and found they did not get better results for less money. The author didn't visit Italy or Spain. For quality results, the book used rankings by international organizations, based on statistics like "cure rate after diagnosis of major disease." For cost, it used percentage of GDP and cost per capita. Germany, France, and Japan were tops in quality, and Japan was also the cheapest…

> It's also single provider.

For England that's completely incorrect.

Services are commissioned mostly by local clinical commissioning groups (There are about 195 of these across England), but sometimes centrally by NHS England, but they are provided by a range of different organisations. Some of these are NHS organisations, but they don't have to be. It's possible that NHSEngland and CCGS commission NHS services from non-NHS providers.

Doctors (and all other healthcare staff, and all manager, and all admin staff) are employed by NHS Trusts, or by other provider organisations.

Some examples of non-NHS providers who are commissioned to provide NHS services might be-

Livewell South West, a large community interest company that provides a range of in-patient and outpatient treatment. https://www.livewellsouthwest.co.uk/

Priory Group, a large private provider that also provides some in-patient NHS treatment, especially around in-patient eating disorder treatment or inpatient learning disability "care". https://www.priorygroup.com/

(Note that LiveWellSW are pretty good, and Priory Group are piss-poor and often abusive.)

Even NHS Trusts aren't single provider. They are their own organisation, with their own executive boards and accounts, working independantly from other NHS Trusts. If they're a foundation trust they have a bit more freedom with their budgets and staffing.

Here's a nice description of what the NHS is and how it works: https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-eng...

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#429

Post by growlist »

laurencerowe wrote: post #303
DennisP wrote: post #104

Earlier quoted context omitted.

I read that book too, and agree it's phenomenal. It's not just about capping insurance profits. The countries doing the best also have price controls on the healthcare providers. Doctors make a lot less money. On the other hand they generally don't have to pay for medical school. France, Germany, and Japan all have similar systems, according to the book. They have private nonprofit insurance, some kind of mandate to…

Germany and the UK have very similar health outcomes [1] but the UK spends significantly less - 9.7% vs 11% GDP [2]. The UK probably should spend some more on healthcare but it's an open question whether that would be more effective at improving health outcomes vs spending the money on reducing poverty. [1] https://www.commonwealthfund.org/chart/2017/mortality-amenab... (2014 figures) [2] https://data.oecd.org/health…

> The UK probably should spend some more on healthcare but it's an open question whether that would be more effective at improving health outcomes vs spending the money on reducing poverty.

There are other policy interventions that could also make a big difference to health e.g. making our urban environment friendlier for exercise by reducing traffic, reducing emissions, introducing dedicated separate cycle lanes, stricter punishment for speeding, and making our mental environment less hostile by e.g. stricter controls on advertising, control of body fetishism e.g. Love Island etc. in the media, limiting development/improving access to nature, etc.

Re: The US spends more on healthcare for no gain says new report from Johns Hopkins

#430

Post by vonmoltke »

dd36 wrote: post #419
kasey_junk wrote: post #402

Earlier quoted context omitted.

I’ve been to the ER twice in the last 2 years. Once at the hospital blocks from my house & once while traveling for work 800 miles away. In neither case did I get charged out of network charges. In fact in the 25 years I’ve paid for mine or my families health care I’ve never seen what you describe over lots of ER visits. There are lots of things wrong with the US health system, providers systematically trying to get…

Your experience is the only experience. Good point.

Not what kasey_junk said at all. It was responding to someone who said:

> It is basically impossible not to get fleeced by "health care" in the US.

The experience is evidence against this very strong statement. You have uncharitably decided it was making an equally strong statement in the opposite direction.

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