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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

#91

Post by nicoburns »

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 think you're mostly right. Although there are exceptions. Consider to opioid crisis. That's a case where profit motive directly leads to poorer quality care.

Regardless of that, high quality care isn't much good if you can't access it.

Re: Health care is turning into a consumer product

#92

Post by Ensorceled »

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…

> the government has ensured that instead my company does for me.

How does the government ensure that?

Re: Health care is turning into a consumer product

#93

Post by imglorp »

causi wrote: post #50
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…

Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. Not that your thesis isn't correct but be careful there. You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. The quality of care for Americans who can afford care is excellent.

> the people who get care

There is a sad trend where the small doctors -- who can't survive without group power -- join conglomerates, the conglomerates buy hospitals, and finally the conglomerates close the less performant facilities. You get large states with vast underserved geographies.

The OP headline is we are careening towards a luxury retail arrangement like Trader Joes: they will only have "outlets" in the richest areas. There's no regulation around closing hospitals so this is coming fast. Two in my county closed this year and I am far from rural.

Re: Health care is turning into a consumer product

#94

Post by analog31 »

refurb wrote: post #8
neuro_image2 wrote: post #4

The greatest healthcare improvements in the US could be brought about by: - Dismantling the insurance/big hospital complex that milks the US population for the enrichment of c-suite executives. - Removing the capacity for lobbying by insurance companies, large hospital groups, device and pharma companies (so they're less able to price gouge consumers). - Price transparency on all links of the chain of healthcare deli…

You think it’s the c-suite reaping all the financial gains?

In my view, the fact that we don't know, is a major part of the problem. Our system is such an entangled web of business entities, that we probably have no idea where the money is coming from and going to. Everybody says that somebody else is gouging us, which means that they're all probably gouging us.

And they are all invested in each others bags. For instance I've read that doctors are major investors in health providers, are often the owners of the expensive equipment, and also heavily invested in the malpractice insurance industry.

Half of billing is multiple businesses billing one another.

It seems quite possible that what makes government health care more efficient is simply knowing where the money is going, if it's all coming out of one checkbook.

Re: Health care is turning into a consumer product

#95

Post by nicoburns »

globalise83 wrote: post #41
mrsuprawsm wrote: post #36

Earlier quoted context omitted.

The cost of healthcare in the Netherlands is however extremely affordable, which I think is the most important difference between Europe and the US. In NL, you pay ~€110/month annually, with a max out-of-pocket cost of €385 per year. So, maximum €1600 cost annually. People with a low income, students, etc, get approximately the same amount of money as a cash benefit to cover these costs. I'm not saying this is good,…

There is a similar system in Germany. As someone who is from the UK and now living in Germany, I would say the health system is 5x better in Germany, so the highly regulated but private insurance and healthcare system seems to do a lot for improving things.

Worth noting that Germany also spends more on healthcare than the UK does: $6,646 per capita vs $4,653 per capita in 2019 [0]. That's quite a significant difference.

[0]: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

Re: Health care is turning into a consumer product

#96

Post by A4ET8a8uTh0 »

cntainer wrote: post #68
causi wrote: post #50

Earlier quoted context omitted.

Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. Not that your thesis isn't correct but be careful there. You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. The quality of care for Americans who can afford care is excellent.

> You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. Well that's the point, I think everybody should be taken into account in order to paint a comprehensive picture of the quality of the system at country level. The resulting stats reflect the health of a society as a whole not just of the part that can afford it. Not having universal healthc…

Yes, but anyone in US that has healthcare in US and reads the paragraph above will come to a conclusion along the lines of 'Wait, my experience wasn't bad; what am I missing?'. As a result, you may end up making an opposite of the point you are trying to make.

Re: Health care is turning into a consumer product

#97

Post by toolz »

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…

I'm curious how you can suggest the US government spends the most money in the world, by far, on healthcare and the simultaneously suggest there's less government involvement.

The government is involved in every step of American healthcare. As you can imagine of a system that gets all of its funding thru companies completely overseen by regulatory bodies or thru social programs.

Re: Health care is turning into a consumer product

#98

Post by analog31 »

neuro_image2 wrote: post #15
refurb wrote: post #13

Earlier quoted context omitted.

There can be instances where physicians are paid the same or more outside the US (I've heard family practice can pay better in Canada), but overall US physicians earn much more . https://www.physiciansweekly.com/how-do-us-physician-salarie...

I guess it depends on your comparison - that article didn't include Australia, NZ or Canada. Also if you factor in earnings and expenses over a lifetime (including cost of studying and the fact that many of the countries mentioned have free healthcare and education and far lower insurance requirements) it evens out substantially. More importantly, even the highest physician salaries are orders of magnitude less than…

Indeed, I think the deal should be: You go to medical school for free, then you work for the government for a nice professional salary. Malpractice insurance can be a government function.

An interesting side effect might be to change the demographics of who can become a doctor, maybe attracting more people from middle class or blue collar backgrounds.

Re: Health care is turning into a consumer product

#99

Post by kayodelycaon »

cntainer wrote: post #68
causi wrote: post #50

Earlier quoted context omitted.

Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. Not that your thesis isn't correct but be careful there. You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. The quality of care for Americans who can afford care is excellent.

> You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. Well that's the point, I think everybody should be taken into account in order to paint a comprehensive picture of the quality of the system at country level. The resulting stats reflect the health of a society as a whole not just of the part that can afford it. Not having universal healthc…

When it comes to healthcare in the US, a lot of people who can afford it don't care about people who can't afford it. Hence the common belief by the middle class that the US has the best healthcare in the world. (That's before you add in a large dose of American exceptionalism.)

Re: Health care is turning into a consumer product

#100

Post by A4ET8a8uTh0 »

roenxi wrote: post #27
qwerty456127 wrote: post #10

Earlier quoted context omitted.

This probably also is the hardest part. And the most alien to the whole American model of which lobbying is an integral part. IMHO you can only counter lobbying by allocating more to fact checking so it would be harder for them lobby things which are objectively wrong.

Why would fact checking have an influence on lobbying? Everyone knows what is going on. It isn't like the politicians, lobbyists, technical experts or public are in the dark about what is happening. If anything, a fact checking organisation has incentives to align with or even become a lobby group. We've seen what happens to "fact checking" in the political sphere.

Not everyone. I will grant you that congress holds a low rating for Americans suggesting some level of understanding that they are being taken for a ride, but I genuinely think that if people in general population understood what is going on, there would be a lot more people taking action ( even if it is just taking it to FB and organizing a local page ). Sadly, I agree on the sentiment on 'fact checking'.
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