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

Re: Post-apocalyptic life in American health care

#61

Post by trowawee » Tue, Jan 02, 2018, 7:35 PM UTC

conanbatt wrote: post #55

trowawee wrote: post #38

Earlier quoted context omitted.

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…

The link I posted does suggest that economies of scale do, in fact, work for other governments, and that despite covering 100% of their population, they see significantly better efficiencies than our system does. If you're going to claim that economies of scale don't apply here, you're going to have to provide some evidence that contradicts the lower per capita spending/better outcomes we see in other systems.

Re: Post-apocalyptic life in American health care

#62

Post by u801e » Tue, Jan 02, 2018, 7:36 PM UTC

NoGravitas wrote: post #42

jerf wrote: post #35

Earlier quoted context omitted.

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 p…

The ACA originally was going to have a public health option (but it was removed because a senator at the time threatened to filibuster). Had that been included, I believe it could have led to something very similar to a single-payer system.

Re: Post-apocalyptic life in American health care

#63

Post by nradov » Tue, Jan 02, 2018, 7:40 PM UTC

lovich wrote: post #59

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

Standardize what? With a complex medical condition like that every patient is different so it's tough to apply evidence-based medicine practices.

The technology for sharing patient records is gradually being standardized. But that won't help if the doctors don't actually take time for a detailed review of the patient's records.

Re: Post-apocalyptic life in American health care

#64

Post by trowawee » Tue, Jan 02, 2018, 7:42 PM UTC

ferongr wrote: post #54

trowawee wrote: post #38

Earlier quoted context omitted.

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.

I'm not sure where you live and you're not providing any links or statistics to back this claim up, so it's difficult for me to respond to what you're trying to claim here. If you read the link I provided, you would see that they use cancer, heart disease, and diabetes mortality as a shorthand for patient outcomes in significant health events, and that while the US healthcare system ranks reasonably well in cancer treatment, it is significantly behind other developed nations in treating heart disease and diabetes. They also provide statistics regarding mortality rates in various populations, and the US lags other developed nations in basically all of those populations.

Your point about dentistry is interesting, although also mostly unsupported, and I'm having a difficult time finding good statistics about dental care, spending, and outcomes. Anecdotally, dental care in the United States is sharply linked to money; people with money have good/great teeth and excellent dental care, people without it frequently have major issues with their teeth. I don't know how that compares to other countries.

Re: Post-apocalyptic life in American health care

#65

Post by mattchew » Tue, Jan 02, 2018, 7:45 PM UTC

Best article I've read this year. (Haha, but it's very good, if a little burdened with weird terminology.)

I have been through some similar experiences myself. Not as bad, but enough to find OP's story not-really-remarkable.

This is what we've got for healthcare in the USA. I wish it was fixable, but I do not believe it is. Powerful interests will resist or subvert any substantive change. (I do expect new "reforms" that will promise fixes and then pump even more money into the broken system, though.)

If you get sick, hope that it is something utterly routine that your applicable system will process without a hiccup. Failing that, expect this kind of craziness and prepare for it. Defensive record keeping and navigating bureaucracies will be necessary skills in 21st century USA.

Re: Post-apocalyptic life in American health care

#66

Post by JimboOmega » Tue, Jan 02, 2018, 7:45 PM UTC

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…

Theoretically, then, there should be a niche for an insurer who covers more, who treats you less shitty, but costs more.

Consider the example the OP gives is a patient who they're paying thousands of dollars a day for, rather than hundreds. They're paying several people to work for days just to figure out how the rules work. It's only marginally working for them.

And let's not forget that they are also fighting profiteering on the other side; is it inherently wrong that your insurance might not pay for a new brand-name medicine that costs 100x as much as a generic with only the barest minimum difference they could sneak past the FDA and get a patent for?

I have Kaiser. Kaiser is a special beast, but one thing it does do pretty well is talk to itself. Combining providers and insurance under one roof provides a lot of upside in knowing what will be covered (though it has the downside that you really don't have options if Kaiser isn't getting the job done).

I recently had the experience of setting up a procedure done by an entirely private (accepts no insurance) practice, because Kaiser wasn't coming through for me. I was shocked how easy it was.

In one phone call, I was able to set up a consult, and even a tentative date, for a fairly complicated (day-long) surgery. Craziest of all? I got a price estimate. (It was 5 figures, but I expected that)

That was something I thought just wasn't possible in the medical world. There's so many variables, they haven't seen my X-Rays, etc, etc, etc. But still they did that. Entirely for profit, though.

I'm not saying for profit is the answer to everything or anything - someone less fortunate than me wouldn't even be able to consider going outside of Kaiser. Just that there aren't any easy solutions. I'm surprised by the system almost every time I interact with it.

Re: Post-apocalyptic life in American health care

#67

Post by EliRivers » Tue, Jan 02, 2018, 7:46 PM UTC

It appears that 73% of the labor cost of a health care organization is spent on trying to communicate with other health care organizations that have no defined interface.

So if it worked properly, US healthcare would cost one quarter if what it does. Less, once the people engaged in trying to talk to each other are no longer required. That's quite a statement.

Re: Post-apocalyptic life in American health care

#68

Post by conanbatt » Tue, Jan 02, 2018, 7:50 PM UTC

dragonwriter wrote: post #49

conanbatt wrote: post #34

Earlier quoted context omitted.

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 consum…

I would argue that food escapes its measure of utility because otherwise, we would all be eating only the cheapest and healthiest option all the time, but our constant hunger also makes us purchase things against our long term interest. If so, you would expect the market to be really inefficient, but at least in terms of satisfying demand, its very hard to make money producing food.

Its true healthcare has less frequency so you cant be a sophisticated consumer: but its more frequent than a car, which is also a necessity in many cases, and the lack of sophistry does not make it an inefficient market.

Im not even sure healthcare is a special market, certainly not for infrequency, or because you must pay with your life (i.e. that you make a decision of life and death for resources). Not for restrictive application of labor (lawyers have that), not for the high costs of technology in its application (consumer tech? space exploration?).

I think at this point what makes the healthcare market unique is the common belief of the people that it is unique. It forces the consumer to consciously think of the cost of life, a question we are somehow bred all our lives to hate to ask, but that we answer every day unconsciously.

Re: Post-apocalyptic life in American health care

#69

Post by trowawee » Tue, Jan 02, 2018, 7:52 PM UTC

nradov wrote: post #63

lovich wrote: post #59

Earlier quoted context omitted.

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

Standardize what? With a complex medical condition like that every patient is different so it's tough to apply evidence-based medicine practices. The technology for sharing patient records is gradually being standardized. But that won't help if the doctors don't actually take time for a detailed review of the patient's records.

Personally, from my observations as a software engineer married to a doctor and friendly with lots of doctors, and as an occasional participant in the American healthcare system, the general inadequacy of electronic medical systems is one of the most maddening aspects of our system. Epic is a monstrosity and none of the other systems are much better. The tech is outdated, the interfaces are awful, they're incredibly difficult to get to communicate with each other, and it sometimes feels like every single provider is using a different system that won't integrate with any of the other systems. It makes me angry as person whose doctors are using those systems (and it kinda scares me), and it makes me angry as a professional, because whoever the members of our profession are who are building those systems are doing a crap job.

Re: Post-apocalyptic life in American health care

#70

Post by conanbatt » Tue, Jan 02, 2018, 7:53 PM UTC

frgtpsswrdlame wrote: post #43

conanbatt wrote: post #27

Earlier quoted context omitted.

>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 aro…

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

I didn't argue that regulations are good because there was a purpose to them nor its opposite. So it doesnt really apply to my stance so far.

> 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.

I disagree with that statement, and I am sure that you will find examples of private markets that are more efficient than public markets, of the which you only need 1 to disprove the idea that public > private on health.