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Post-apocalyptic life in American health care

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Re: Post-apocalyptic life in American health care

#71

Post by thehardsphere »

pat2man wrote: post #53
thehardsphere wrote: post #44

Earlier quoted context omitted.

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.

This is like saying that Netscape can re-write Navigator because they can copy Internet Explorer. It ignores that Netscape and Microsoft had totally different reasons for the choices they made, and that changing those choices in a re-write was very non-trivial for Netscape, to the point where it ceased to be a company.

You will likely find similar problems with this in attempting to replicate other health care systems. Indeed, you could complain that the mess we are in now is the result of doing a poor job replicating Switzerland's health insurance laws.

Re: Post-apocalyptic life in American health care

#72

Post by jerf »

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…

I think you sort of misunderstood my point. My point was that you'd have an easier time of selling me on it if Obamacare had actually simplified things. Which was one of the promises it made, after all. Explaining why it failed to do so does not contradict my point, it reinforces it.

In terms of Obamacare not simplifying things, my engineering answer is "Then why did we implement it?" If a goal is impossible for some reason, then the correct solution is not to try to obtain it, not to just cruft up the system harder anyhow. How many people can tell the same story of failure in their engineering jobs? Since this is the same set of people who want to bring us nationalized healthcare and want to write all the regulations for it, it does not encourage me to think well of their judgment in doing so.

I am abundantly confident that our current ruling class would find some way to muck it up. Even if we handed them The Pristine National Healthcare System Act of 2018, they'd have regulated it to death in just a handful of years. Our current ruling class doesn't seem to be able to sneeze in anything less than 50 pages of legislation and several hundred pages of accompanying regulations.

Re: Post-apocalyptic life in American health care

#73

Post by baobrain »

JimboOmega wrote: post #66
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 profi…

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

There is something like this for the wealthy [0]. Obviously, concierge medical services are very expensive, and morally questionable imo.

[0] https://www.nytimes.com/2017/06/03/business/economy/high-end...

Re: Post-apocalyptic life in American health care

#74

Post by davidw »

TheAdamAndChe wrote: post #14
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…

We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a…

Didn't downvote you, but I do want to point out that health care providers earn a good living in places like Italy, where I lived for some time. My wife's family friend is a local doctor. He's got a nice house, a place in the mountains, a boat... he's doing well.

What's different is all the insurance BS we have in the US is missing.

Also worth reposting this: https://journal.dedasys.com/2017/02/22/entrepreneurship-and-...

Re: Post-apocalyptic life in American health care

#75

Post by frgtpsswrdlame »

conanbatt wrote: post #70
frgtpsswrdlame wrote: post #43

Earlier quoted context omitted.

>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…

>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.

I mean 'the road to hell is paved' is just an argument against trying to do anything good, it's not exactly relevant.

>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.

Well no, because I'm speaking in general. But I'd love to know your example.

Re: Post-apocalyptic life in American health care

#76

Post by cmiles74 »

TheAdamAndChe wrote: post #14
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…

We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a…

I don't feel comfortable laying the abysmal and depressing tar pit of money and productivity that is the US healthcare system at the feet of "capitalism". In my opinion, the clumsy and inefficient interplay between health care providers, insurance companies, employers, the state and (lastly) individual people strikes me as one of the least capitalist-like situations we see today. It's almost a thought experiment: what would the US look like if people could afford to choose an affordable insurance company, peruse the various healthcare providers and choose among them and, lastly, be able to predict (with some amount of reliability) their healthcare costs over time?

Personally, I can't imagine it. All I know is that it wouldn't look like what we have now. Likewise, this argument that any criticism of the US healthcare system is somehow a criticism of capitalism strikes me as particularly unhelpful.

Re: Post-apocalyptic life in American health care

#77

Post by conanbatt »

trowawee wrote: post #61
conanbatt wrote: post #55

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 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.

Medicare has more patients than the population of england, or spain, or many of the european first world countries.

It is already visible that medicare is not efficient.

Re: Post-apocalyptic life in American health care

#78

Post by dang »

TheAdamAndChe wrote: post #14
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…

We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a…

The problem is that you have a marked tendency to turn HN threads into generic ideological tangents, as you've done here, and this takes them in a direction of lower quality. If there's any generalization about HN threads that holds up, it's that one, so would you please take this in and stop doing this here?

This isn't an observation for or against capitalism. It's an observation about ideological arguments on the internet. The specific ideological flavor doesn't matter; it works the same dismal way regardless.

https://news.ycombinator.com/newsguidelines.html

Re: Post-apocalyptic life in American health care

#79

Post by conanbatt »

iaw wrote: post #58
conanbatt wrote: post #9

Earlier quoted context omitted.

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…

I think we can agree that there are degrees of freedom in a market, and that the us healthcare market is far from a the freest possible version of healthcare.

Im not sure about the information asymmetry argument: insurance companies also lack lots of information. And some of that the patient knows and the insurance doesn't. (pre-existing conditions for example). Also, there's plenty of markets with information asymmetry that dont show the backwardness of US Health care.

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

That is the nature of any insurance market. You cant bargain with your fire insurance when your house is burning down. Well, not effectively, if you look at the richest man in old rome.

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