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Post-apocalyptic life in American health care

metarationality.com

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Re: Post-apocalyptic life in American health care

#61

Post by colechristensen »

justin66 wrote: post #51
colechristensen wrote: post #48

Earlier quoted context omitted.

Why with single payer would there not still be instances of treatment being denied? >rather than deal with faceless automata at health insurance companies Would this not be replaced with faceless automata in government? Just look at how the VA is run and complains about it. Looking at that I have exactly zero confidence in the government being able to run things better than the shit show at the insurance companies. B…

What was your experience like with the VA?

Hearing first or second hand stories of veterans waiting months or years for important care or struggling to get something addressed at all.

Re: Post-apocalyptic life in American health care

#62

Post by flatline »

colechristensen wrote: post #48
andutu wrote: post #19

My boyfriend woke up one day to find out they couldn't pee. After a few ER visits and an MRI, they determined he had Stage 2 bladder cancer. However, because they had the audacity to seek immediate medical treatment for a life threatening health issue, they have now been saddled with thousands of dollars in medical debt. I had to personally dip into my earnings from my Big Tech internship to help pay some of it off.…

Why with single payer would there not still be instances of treatment being denied? >rather than deal with faceless automata at health insurance companies Would this not be replaced with faceless automata in government? Just look at how the VA is run and complains about it. Looking at that I have exactly zero confidence in the government being able to run things better than the shit show at the insurance companies. B…

The government is mostly just there to manage contracts, the actual work would be done by the same doctors that are doing it today. You would just pare n profit-seeking entities down to one principally administrative entity. If you wish to pay for your own medical procedures out of pocket there will be nothing stopping you. That is not to say this does not have problems.

Insurance is anti-competitive on top of that. You have a Sophie’s choice of who you want to pay to buy into this crazy system. There’s no transparency in how services are priced or provided. You as a consumer have no insight into how prices are negotiated between the insurer and providers, nor how providers are paid out. Good luck making an informed decision.

Re: Post-apocalyptic life in American health care

#63

Post by gdegxdrgr »

btbuildem wrote: post #52

I hate to be so cynical, but I'll suggest an alternate thesis to the article: the American for-profit healthcare system is functioning exactly as designed. If you consider its primary goal being extraction of capital instead of taking care of people's health, everything that was confusing starts to make sense. > at least seven experts spent roughly ten full-time days trying to find out a basic fact about my mother’s…

it’s more complex. The patient is at a higher level of care but they also aren’t paying a single penny for the additional stay. And the money isn’t coming from anthem to the hospital per se because they likely are paying under a diagnosis code and a lesser rate for additional days. The hospital is losing out on some opportunity costs possibly but if they needed the bed meaning they had patients to replace the current one being discharged suddenly the problem would be fixed after one manager phoned another.

Re: Post-apocalyptic life in American health care

#64

Post by Waterluvian »

mikem170 wrote: post #42
tekla wrote: post #23

Earlier quoted context omitted.

One of the things I've observed from lots of interaction with Doctors is that that US health care is FUCKING AMAZING, and that drives up cost. Everyone wants top quality health care, everyone wants tests, everyone wants scans, everyone wants to cover their fucking ass. Take multiple X-Rays when there is no good reason to, to prevent lawsuits. the guy who lied about taking Heroin gets a full lab workup for no good rea…

> USA has top tier health care. It's simply not economical to give it to everyone who demands it I've always thought that this is something basic that we need to address as part of any health care reform. We can't afford to give everyone unlimited health care, so how do we determine the limits? I assume that a lot of socialized health care systems end up using waiting lists, perhaps based on the patient's age, treatm…

I think for-profit healthcare can do a lot of unnecessary tests and treatments that fall far into diminishing returns or worse.

It’s not necessarily a good thing to want unlimited healthcare for all. Proper use of a scarce resource doesn’t necessarily mean it’s about rationing it with waiting lists and selective treatment. You can probably get quite far by first not overtreating a lot of people.

Re: Post-apocalyptic life in American health care

#65

Post by colechristensen »

cyberax wrote: post #56
colechristensen wrote: post #48

Earlier quoted context omitted.

Why with single payer would there not still be instances of treatment being denied? >rather than deal with faceless automata at health insurance companies Would this not be replaced with faceless automata in government? Just look at how the VA is run and complains about it. Looking at that I have exactly zero confidence in the government being able to run things better than the shit show at the insurance companies. B…

> Just look at how the VA is run and complains about it. The VA system has on average delivers better outcomes than private insurance: https://www.rand.org/news/press/2018/04/26.html It's the usual "review effect", you only see negatives about the VA, not positives.

>when compared to commercial HMOs, Medicaid HMOs and Medicare HMOs.

That's not all private insurance, just some of it.

That's also talking about the average.

>although there is high variation in quality across individual VA facilities

...

>It's the usual "review effect", you only see negatives about the VA, not positives.

You're saying in rebuttal to a negative review of private insurance, which isn't even what's at issue. Difficulties getting things covered and being buried in beurocratic nonsense isn't really connected to "health outcomes on average".

Your source doesn't make the argument well.

Re: Post-apocalyptic life in American health care

#66

Post by colechristensen »

cyberax wrote: post #54
colechristensen wrote: post #48

Earlier quoted context omitted.

Why with single payer would there not still be instances of treatment being denied? >rather than deal with faceless automata at health insurance companies Would this not be replaced with faceless automata in government? Just look at how the VA is run and complains about it. Looking at that I have exactly zero confidence in the government being able to run things better than the shit show at the insurance companies. B…

> Why with single payer would there not still be instances of treatment being denied? The most common failure mode for single-payer is scarcity. You won't be denied, but you'll have to wait many months for an appointment. > Would this not be replaced with faceless automata in government? They are controlled by politicians, who are directly responsible to their electorate. Brexit is a good example, using money sent to…

>They are controlled by politicians, who are directly responsible to their electorate. Brexit is a good example, using money sent to EU for NHS was one of the more influential ads. Of course, the outcome turned out to be... different.

Calling out Brexit is an... interesting way to argue here.

If you're proposing my options for heath care are going to be taken away and given to the single option controlled by the electorate who are liable to do things like Brexit... no thank you, I'll take marketplace competition where I can "vote out" the idiots by making a different choice for myself.

People here are like "isn't it awful that personal medical choices are being made by politicians and popular vote" with respect to abortion, gender-affirming care, etc... and those same folks are damn near excited to give away all of their health choices to a government entity.

Do you want your health care options to be dictated by an executive order the first day a new president enters office?

Re: Post-apocalyptic life in American health care

#67

Post by jmye »

fzeroracer wrote: post #22
jmye wrote: post #6

Earlier quoted context omitted.

Medicare for all is not a panacea and would cause dramatic breaks in care in other places. The fragmented private model sucks, but the belief that single-payer would fix much of anything is faulty. Reform should happen, but it shouldn’t be based on a bumper sticker, and it should be thoughtful about the vast differences between SF, NYC, West Texas and Southern South Dakota. “Fixing” things for people in major cities…

Rural healthcare is being crippled in part due to state politicians posturing for political clout. Major reforms like medicare for all shouldn't be held back because they're not perfect, because otherwise we're going to continue having the same problems we've been having where compromised half-assed bills make the system overall worse.

I’m not saying we shouldn’t reform - I’m saying we should be careful about what that reform is, and what its goals are. I would generally suggest that CMMI and provider groups is/are more heavily involved than big city voters who know very little about a very, very complicated issue.

Lastly, rural healthcare is in trouble because reimbursements are bad (especially Medicare reimbursements), FFS (fee-for-service) is a failed model, there’s a massive credential shortage, and given those, the credentials that exist would prefer to work in desirable places, not Pine Ridge, SD. If you’re serious about fixing healthcare, you should start by fixing education. State politics, specifically around Medicaid, are, generally, not driving the hospital closures and OB/GYN deserts.

Re: Post-apocalyptic life in American health care

#68

Post by secabeen »

ars wrote: post #40
ggm wrote: post #4

I'd be interested what one, single change might help. Something intangible like independently curated complete health record in some normative form on a smart card. Or, a legalism of a "first do no harm" nature which demands once a qualified professional determines you have cover and it's just an argument about who pays between competing covers, you get no-worse-off service choices immediately until they decide which…

The one change I would suggest is switching to the HMO Capitation model. The nice thing about it is that it can be done a bit at a time, you don't have to change the entire US at the same time. No more fee for service, Doctors would go on salary, and without fee for service an entire insurance complication (making sure to pay exactly the right amount for services, no more, no less) evaporates. The downside: You can o…

Is this the Kaiser Permanente model? I think it's a fairly good model, but they do pay pretty mid-level on Physician salary. It's not a place you can clear $500k+.

Re: Post-apocalyptic life in American health care

#69

Post by pitaj »

ggm wrote: post #4

I'd be interested what one, single change might help. Something intangible like independently curated complete health record in some normative form on a smart card. Or, a legalism of a "first do no harm" nature which demands once a qualified professional determines you have cover and it's just an argument about who pays between competing covers, you get no-worse-off service choices immediately until they decide which…

What do you mean "return to an NHS model"? The US never had anything of the sort.

To answer your question: Ban employers from paying for health insurance as a benefit. If individuals see directly how much it costs, that will put much more pressure on prices. And employees don't have to worry about losing their insurance if they lose their job.

Some other gradual options:

- end the AMA licensure monopoly, making doctors more plentiful lowers prices and increases quality

- reform the FDA approval process to make developing drugs and equipment cheaper

- cover preexisting conditions under Medicaid instead of forcing private insurers to

Re: Post-apocalyptic life in American health care

#70

Post by ars »

secabeen wrote: post #68
ars wrote: post #40

Earlier quoted context omitted.

The one change I would suggest is switching to the HMO Capitation model. The nice thing about it is that it can be done a bit at a time, you don't have to change the entire US at the same time. No more fee for service, Doctors would go on salary, and without fee for service an entire insurance complication (making sure to pay exactly the right amount for services, no more, no less) evaporates. The downside: You can o…

Is this the Kaiser Permanente model? I think it's a fairly good model, but they do pay pretty mid-level on Physician salary. It's not a place you can clear $500k+.

> but they do pay pretty mid-level on Physician salary. It's not a place you can clear $500k+.

That's the goal!!

Very high doctor pay is the number 1 cause of skyrocketing medical expenses.

The model should be coupled with them opening a lower cost university and training 10 times as many medical people as we do today. Along with better supply lowering prices, it also means a Doctor could have normal working hours, so would not need the insanely high salary they need to pay for all the stuff they don't have time to do themselves.

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