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

Re: Post-apocalyptic life in American health care

#51

Post by gech » Tue, Jan 02, 2018, 7:19 PM UTC

TheAdamAndChe wrote: post #28

ceejayoz wrote: post #22

Earlier quoted context omitted.

> Edit: To those downvoting me, can you please explain? What flaw do I have in my logic? The idea that we're in a "capitalistic society". Every country in the world lives somewhere on the spectrum between capitalism and socialism. The US is further towards the capitalistic side than Europe, but we've plenty of non-capitalist aspects of our society. We already accept a wide array of socialist policies in the form of M…

I'm not saying that we shouldn't continue pushing for reform. I'm just saying that our government has proven incapable of reformation, and we should be pushing towards non-governmental approaches until they can get their act together. If we can improve the way things are through capitalism, that's still better than just yelling at politicians that don't do anything.

Gosh I wonder why politicians don't do anything in the interest of the public?

Re: Post-apocalyptic life in American health care

#52

Post by ams6110 » Tue, Jan 02, 2018, 7:26 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…

I don't think it's controversial at all. Nobody gets out of life alive. If I make it to 65 or so, I feel I've had my share. It's all downhill after that point anyway, why would I want to prolong the misery?

Re: Post-apocalyptic life in American health care

#53

Post by pat2man » Tue, Jan 02, 2018, 7:28 PM UTC

thehardsphere wrote: post #44

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 freq…

One advantage we have is that other countries have systems we could copy. Its not a complete re-write.

Re: Post-apocalyptic life in American health care

#54

Post by ferongr » Tue, Jan 02, 2018, 7:28 PM UTC

trowawee wrote: post #38

conanbatt wrote: post #32

Earlier quoted context omitted.

I am from a partially socialist country that has free healthcare. I have had private healthcare, along with most of my socio-economic class, my entire life. Making it socialized does not mean it will be better. Coldly, see it as a different system with different consequences. Bringing it to the US: look at how much medicare costs today: 3.6% of gdp, servicing 56 million americans. If you extended medicare to the enti…

Actually, the first world nations that have socialized healthcare systems experience better outcomes than the United States with less per capita spending.[1] Medicare as it is currently formulated is specifically targeted towards at-risk populations that have higher incidences of medical usage than the general population; you can't just apply the exact same per capita spending across the American population. 80 year-…

I live in a "first world nation" and 10 years ago (before the global financial crisis even) public vs private healthcare meant the difference between leg amputation and implantation. The public system is only good for routine diagnosis and minor surgery. For everything else, care quality goes down the toilet. Not to mention on the effectively complete lack of dental care.

Re: Post-apocalyptic life in American health care

#55

Post by conanbatt » Tue, Jan 02, 2018, 7:29 PM UTC

trowawee wrote: post #38

conanbatt wrote: post #32

Earlier quoted context omitted.

I am from a partially socialist country that has free healthcare. I have had private healthcare, along with most of my socio-economic class, my entire life. Making it socialized does not mean it will be better. Coldly, see it as a different system with different consequences. Bringing it to the US: look at how much medicare costs today: 3.6% of gdp, servicing 56 million americans. If you extended medicare to the enti…

Actually, the first world nations that have socialized healthcare systems experience better outcomes than the United States with less per capita spending.[1] Medicare as it is currently formulated is specifically targeted towards at-risk populations that have higher incidences of medical usage than the general population; you can't just apply the exact same per capita spending across the American population. 80 year-…

> Actually, the first world nations that have socialized healthcare systems experience better outcomes than the United States with less per capita spending

It is beyond question that the healthcare market in the US is terrible, because its expensive and ineffective. That is out of discussion for any reasonable debate.

What is also out of debate are many reasons why is it so expensive today: restrictive immigration of doctors, importation restrictions on drugs, self imposed gov restrictions on bargaining, hospital building regulations, malpractice legal costs.

Government taking full control of the system fixes NONE of the problems listed above, which are by and large some of the biggest price drivers. It might make them worse, because all of the ones above are exclusively decisions of the government.

> you can't just apply the exact same per capita spending...

I agree, tho at the same time you cant expect the government to be more efficient as it increases its scope of scare. Economies of scale dont work for the government. 10x service might cost 50x. It should be clear however that its a reasonable order of magnitude: more than barely double digits. A 20% gdp cost on healthcare will come with cuts in service, I guarantee that.

Re: Post-apocalyptic life in American health care

#56

Post by carapace » Tue, Jan 02, 2018, 7:30 PM UTC

> In 2017, software is conspicuously not eating the cost-disease economic sectors: health care, education, housing, government. They are being eaten—by communal mode tribalism.

Software can't fix political problems...

Bucky Fuller predicted that we would describe our problems to the computer and it would calculate the optimal deployment of resources to solve them. He estimated that we would have the technology to supply everyone on Earth with a decent standard of living by sometime in the 1970's, provided that we used our resource and technology efficiently. In other words, if you accept Bucky's point, all of our problems now are psychological rather than technological. (We have all the technology we need.)

Standard of living problems have mathematical solutions, psychological problems don't.[1]

> hire an independent health care administration consultant

"Add another layer of abstraction."

But now the consultant has a clear disincentive ($150/hour!) to fix the problem.

The U.S. health system is pathetically broken, and I have no idea how to fix it. This seems like a poor solution, even though I can understand why the author would do it.

I really feel for the author. My mother has dementia and is slipping away fast. Thankfully my sister has the time and energy to move back in with our mother and care for her. She's also with Kaiser-Permanente which seems to let us avoid the worst of the systemic problems. So, in a way, we're really lucky.

[1] "psychological problems don't [have mathematical solutions]" Although... There is something called Neuro-Linguistic Programming (the other NLP) that is a kind of model of psychology that does admit of algorithm-like protocols for therapy. E.g. the "Five-Minute Phobia Cure" which is an algorithm that cures phobias.

Re: Post-apocalyptic life in American health care

#57

Post by SN76477 » Tue, Jan 02, 2018, 7:31 PM UTC

Florin_Andrei wrote: post #33

> the biggest failing of the American health care system is its fragmentation This flaw will be extremely difficult to fix for as long as its nature is perceived as "freedom" or "choice".

I am always looking for the most fundamental answer, I think this is it.

Re: Post-apocalyptic life in American health care

#58

Post by iaw » Tue, Jan 02, 2018, 7:32 PM UTC

conanbatt wrote: post #9

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…

It isn't profit-seeking what makes healthcare what it is. Its the incredibly burdensome regulation and restrictions. If profit-seeking destroyed markets for profit, we would all be starving.

Libertarian arguments only hold for free markets. Even eliminating all regulations and restrictions imposed by the government, healthcare does not become a free market for two reasons:

1) Information is not symmetric, contractual obligations are made before pricing information can be discovered (thereby compared and moving into market dynamics)

2) Services are requested under the duress of health problems without the ability to end the agreement.

Not everything is a free market.

Re: Post-apocalyptic life in American health care

#59

Post by lovich » Tue, Jan 02, 2018, 7:33 PM UTC

shrike wrote: post #25

About 8 years ago I broke my leg and eventually developed a methicillin-resistant infection where screws had been inserted. Fighting this type of infection in the bone is difficult. I spent 11 months in a hospital bed plus some time in a SNF. A total of 7 surgeries in the first 18 months and another 2 after that, the most recent 3 years ago. I can second the experience of the author. All in I had contact with over 40…

It sounds like the answer would be to standardize everything so that it wasn't 90% edge cases but there is no incentive for many of the players to do so

Re: Post-apocalyptic life in American health care

#60

Post by u801e » Tue, Jan 02, 2018, 7:34 PM UTC

maxxxxx wrote: post #3

"There is, in fact, no system. There are systems, but mostly they don’t talk to each other. I have to do that." That's something I have noticed too. My girlfriend had to visit several doctors for a problem. One was confused about the notes of the other doctor so I proposed to call and figure it out together. The doctor seemed really perplexed about this suggestion and instead ordered the same series of tests again.

Shouldn't the results of the previous tests be part of the medical record? If so, then the other doctor should have been able to view the results.