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Health care is turning into a consumer product

economist.com

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Re: Health care is turning into a consumer product

#81

Post by netizen-936824 »

throwaway0a5e wrote: post #57
pjc50 wrote: post #54

Earlier quoted context omitted.

The problem is that "market" is a really bad fit for meeting healthcare needs, and doubly so when it's intermediated by insurers. People get the amount of healthcare they can afford from their discretionary budget and work their insurers for - not the amount they need. So they may get "more" (or at least more expensive) care than they need, or less. Note that many of the European systems are semi-private, so you reta…

Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. Using insurance, government or some other centralizing layer (e.g. the church) for routine activity would raise massive "you're pissing money away" red flags in literally any other context. We shoehorn so much economic activity (healthcare) though a middle man (…

The healthcare industry already pisses away huge amounts of money. Its evident in all those stories we hear about people getting a huge $5000+ medical bill, then calling the hospital and suddenly its $100 or less. That $4900 is literally all wasted

Re: Health care is turning into a consumer product

#82

Post by andrekandre »

throwaway0a5e wrote: post #57
pjc50 wrote: post #54

Earlier quoted context omitted.

The problem is that "market" is a really bad fit for meeting healthcare needs, and doubly so when it's intermediated by insurers. People get the amount of healthcare they can afford from their discretionary budget and work their insurers for - not the amount they need. So they may get "more" (or at least more expensive) care than they need, or less. Note that many of the European systems are semi-private, so you reta…

Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. Using insurance, government or some other centralizing layer (e.g. the church) for routine activity would raise massive "you're pissing money away" red flags in literally any other context. We shoehorn so much economic activity (healthcare) though a middle man (…

  > Edit: Anyone wanna do me the courtesy of explaining why I'm so wrong?
just a guess, but it might be because of...

  Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US.
... one of the reasons most visits in the us is the er is precisely because preventative care is so expensive/hard-to-get in the u.s and people put off visiting the doctor regularly since its so expensive... the market isn't very amenable to these extra costs in the short run, whereas a state-run system might not have the same short-term cost concerns and encourage/subsidize regular visitation/preventative-care...

Re: Health care is turning into a consumer product

#83

Post by snarfy »

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

> Which doesn't really fit the view that less government involvement results in a more efficient system

The government may not pay for the actual service but there is huge government involvement and mountains of regulations to climb.

Re: Health care is turning into a consumer product

#84

Post by virgilp »

zimpenfish wrote: post #70
pjc50 wrote: post #54

Earlier quoted context omitted.

The problem is that "market" is a really bad fit for meeting healthcare needs, and doubly so when it's intermediated by insurers. People get the amount of healthcare they can afford from their discretionary budget and work their insurers for - not the amount they need. So they may get "more" (or at least more expensive) care than they need, or less. Note that many of the European systems are semi-private, so you reta…

> a full state-run system, which is vulnerable to undercapacity (which the UK is currently suffering from) That's more because we've had decades of deliberate underfunding due to the "austerity"/"capitalism++" lunatics in charge than a natural consequence of a state-run system though.

But how is that not "expected"? Feels like the argument that "communism is good, it just wasn't implemented well anywhere so far". Well, sorry, but by this point I chose to believe that a full state-run system is vulnerable to under-funding in the long term.

Re: Health care is turning into a consumer product

#85

Post by andrekandre »

bluGill wrote: post #61
CraigJPerry wrote: post #56

Earlier quoted context omitted.

Counter point: the NHS in the UK has more government involvement than the US healthcare system. The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. “Better outcomes” needs more detail: Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an…

The US government is involved in ways that make it inefficient. For example, I don't get to choose my insurance, the government has ensured that instead my company does for me. While I can in theory get insurance elsewhere I lose a large subsidy in doing so, no insurance I can buy can possibly be a better deal for me, even the company insurance is bad. The incentives for insurance are to ensure that I don't quit, not…

  > I don't get to choose my insurance, the government has ensured that instead my company does for me.
how did that happen?

Re: Health care is turning into a consumer product

#86

Post by netizen-936824 »

virgilp wrote: post #84
zimpenfish wrote: post #70

Earlier quoted context omitted.

> a full state-run system, which is vulnerable to undercapacity (which the UK is currently suffering from) That's more because we've had decades of deliberate underfunding due to the "austerity"/"capitalism++" lunatics in charge than a natural consequence of a state-run system though.

But how is that not "expected"? Feels like the argument that "communism is good, it just wasn't implemented well anywhere so far". Well, sorry, but by this point I chose to believe that a full state-run system is vulnerable to under-funding in the long term.

So we should just expect people to be greedy and try to ruin systems for their own benefit. That raises the question of how to make these systems more robust to defend against that sort of attack.

Re: Health care is turning into a consumer product

#87

Post by SamoyedFurFluff »

snarfy wrote: post #83
cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

> Which doesn't really fit the view that less government involvement results in a more efficient system The government may not pay for the actual service but there is huge government involvement and mountains of regulations to climb.

I would argue some of those regulations are moat building explicitly to ensure healthcare as a commodity.

Re: Health care is turning into a consumer product

#88

Post by ErikVandeWater »

pydry wrote: post #63
ErikVandeWater wrote: post #51

Earlier quoted context omitted.

> So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. The US healthcare is an example of the government being massively over-involved and creating massive inefficiencies.

As opposed to what, the Singaporean system where you get sent to jail for charging above government mandated price caps? American healthcare has the least involved government of any first world country. Only an overly credulous interpretation of Koch-style market-knows-best propaganda would make you think that the "level" of government involvement was the root cause of its problems.

Less involved, more corrupt. It's over-involved because it's corrupt. Giving the government more power will only increase corruption.

> Only an overly credulous interpretation of Koch-style market-knows-best propaganda would make you think that the "level" of government involvement was the root cause of its problems.

Not an appropriate tone for HN discussion.

Re: Health care is turning into a consumer product

#89

Post by nicoburns »

throwaway0a5e wrote: post #57
pjc50 wrote: post #54

Earlier quoted context omitted.

The problem is that "market" is a really bad fit for meeting healthcare needs, and doubly so when it's intermediated by insurers. People get the amount of healthcare they can afford from their discretionary budget and work their insurers for - not the amount they need. So they may get "more" (or at least more expensive) care than they need, or less. Note that many of the European systems are semi-private, so you reta…

Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. Using insurance, government or some other centralizing layer (e.g. the church) for routine activity would raise massive "you're pissing money away" red flags in literally any other context. We shoehorn so much economic activity (healthcare) though a middle man (…

What about treatment for severe conditions such as cancer or chronic conditions such as life-long disabilities where the expense is significant to the point that it may well be crippling for an individual but is rare enough that it's only a moderate cost spread across a society?

These are the cases where insurance is a perfect fit. The issue with letting it be market-based insurance is that (as you say) it allows insurance providers to take a fat cut. The obvious solution is to regulate insurance costs. At which point you might as well state fund it. Which leads us to the system we have in most of Europe.

As these system seem to work quite well, why do you think a market-based approach would be better?

Re: Health care is turning into a consumer product

#90

Post by SamoyedFurFluff »

JumpCrisscross wrote: post #60
CraigJPerry wrote: post #56

Earlier quoted context omitted.

Counter point: the NHS in the UK has more government involvement than the US healthcare system. The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. “Better outcomes” needs more detail: Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an…

> NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US The American system’s problem is exclusion, not quality of care. If you get care in America, your outcomes are among the best in the world.

I would argue a care that is beyond my affordability is bad quality of care.
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