Healthcare in the United States

Discussion in 'Politics, Etc. (Archived)' started by keithburgun, Mar 9, 2017.

  1. Kdansky

    Kdansky Well-Known Member

    https://www.nytimes.com/2017/03/16/opinion/and-jesus-said-unto-paul-of-ryan.html?_r=0

    And Jesus Said Unto Paul Of Ryan.

    That's just insane. I recently had a similar experience: About 5 hours in the emergency center. Less than $3000 (covered through insurance): We did take up a room for a couple hours, three doctors had a look, half a dozen pictures were taken (CT and XRay), a dentist was woken and spent an hour fixing broken teeth.

    It's not that Switzerland is cheap here. Taking an XRay in Japan costs $25, and in Switzerland ist $150+. And still, $60k is rather ludicrous if you haven't spent a week at the hospital and had a couple surgeries.

    My conclusion is fairly simple: The US has a pricing issue, and seeing as none of the other countries I know of have this, but they all have public healthcare, I see no link between public healthcare and pricing. In fact, the correlation points the other way: The US is the only country with pricing issues, and also the only country without public health care.

    So when someone says private care is cheaper: Why would you say that? Europe is public health care, and cheaper than the US.

    As far as I know, literally every single point of data that we have contradicts the Ryan/Republican narrative. It's basically the same as with "trickle-down" economy: A blatant lie for profit.

    This sums it up:
    "We have to paint the cars red, so they get cheaper. Red is cheap and efficient."
    "But every car that is sold in every other shop is more expensive when it's red."
    "Doesn't matter, I know red is cheaper, there is a known correlation."
    "But really, the correlation is the other way!"
     
    Last edited: Mar 17, 2017
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  2. Juli

    Juli Well-Known Member

    fwiu hospitals in the U.S. will actually just stick on bullshit charges to a bill, and part of what insurance does when handling claims is say to the hospital "okay that's bullshit, we know it's bullshit, you know it's bullshit, you're not getting paid for that."

    That being said, this is just stuff I've heard from time to time talking to people, I've never read any articles or anything about it, so it's just hearsay.
     
  3. Waterd

    Waterd Well-Known Member

    I agree if it's private or not, it's not important, what's important is how taxed, regulated and subsidized it is and the infrastructure and technology in the zone.

    Now in many contexts some of those qualities define how private the property is, so i can see how confussion can be generated.
     
    Last edited: Mar 17, 2017
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  4. Bucky

    Bucky Well-Known Member

    As I mentioned upthread, parts of the United States get the worst of both worlds for hospital care. Rather than having a poorly run public monopoly, the government enforces rent-seeking private monopolies.

    A government monopoly would lead to an improvement in pricing, and probably a lower quality of service. Actual competition would lead to a larger improvement in pricing and a high quality of service.
     
  5. SwiftSpear

    SwiftSpear Active Member

    Medicine is a really difficult business to encourage competition in. When you chop off your arm with a chainsaw, you're not going to go shop around for the best hospital to go get it reattached at. The only metric that matters is how close a hospital is to people who need a hospital. They don't have to compete on any other metric, so they just price emergency services at whatever they want to. %1300 profit? who's going to refuse to buy?
     
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  6. Erenan

    Erenan Well-Known Member

    That wouldn't apply to non-emergency healthcare though.
     
  7. SwiftSpear

    SwiftSpear Active Member

    Yeah, but emergency care is huge business. Most of the hospital bill horror stories involve some emergency care.
     
  8. Bucky

    Bucky Well-Known Member

    On the flip side, since emergency rooms don't turn away people for nonpayment, a lot of the extra burden for their care falls on other patients in the same emergency room.
     
  9. Batlad

    Batlad Well-Known Member

    Single payer public health insurance isn't the same as a public healthcare system. I know of no reason to think that quality of care would decline if the government, rather than individuals paid for their healthcare. In fact with the payment security offered under a single player system, medical practitioners would have a secure income and wouldn't need to involve repayment companies in chasing debt, assuming they could entice customers with good service. Better yet single payer could shift the incentive system which as Juli pointed out is often based on fake charges and price gouging. Which is at least partially due to the current private insurance system.

    Thursday's Majority report episode had Christy Ford Chapin as a guest and they discussed the historical context for why the US system is the way it is, its bad incentives and alternatives, that even the staunchest libertarians here would probably approve of.
     
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  10. Erenan

    Erenan Well-Known Member

    If govt pays for everyone's healthcare, how does it decide which care providers it's willing to pay for? I mean, if you're going to have the govt pay for your healthcare, can you just pick any provider you want regardless of the price? Surely there are limits, no?
     
  11. Kdansky

    Kdansky Well-Known Member

    Considering that whether any health issue you have gets cured is never 100% under the control of the hospital, it's impossible to do proper free market competition anyway. An unhappy customer can't just say "next time I'll get my cancer meds somewhere else", because he's dead. That's why it doesn't work to begin with.

    You can do it for cosmetic surgery, and it works just perfectly well there, but for health care, a private system is bound to utterly fail: The least inhumane hospital will be the one that makes less money than the one that employs a bouncer at the front gate and tells any patient who is bleeding to death that they can bugger off.
     
  12. Erenan

    Erenan Well-Known Member

    I dunno. I think you can kinda go off reputation, word of mouth, and all that. Also, rating agencies evaluate hospitals and create reports and so on. That's something that's not only compatible with free markets, but a part of how they work best.

    When we were having our babies, we selected our OB-GYNs based on reputation and private research. We also ditched our first OB-GYN after we were unhappy with her approach to babying.
     
  13. Bucky

    Bucky Well-Known Member

    One thing the federal government could do to improve health care, basically for free, is to allow medical residents to act as free agents rather than requiring them to go through the National Resident Matching Program. Also effective would be to have a floating pool of additional Medicaid funding for residencies in fields where the number of medical students exceeds the number of available residencies.

    Basically, residencies have become a major bottleneck in our doctor-licensing system. Unstopper that and prices will fall.
     
    Last edited: May 20, 2017
  14. ALavaVatChild

    ALavaVatChild Well-Known Member

    The NRMP isn't a government program so what exactly are you proposing?
     
  15. Bucky

    Bucky Well-Known Member

    Repealing its official monopoly status.
     
  16. ALavaVatChild

    ALavaVatChild Well-Known Member

    I'm still a little confused, are you talking about their exemption from the Sherman Act? The complaint brought against the NRMP was that it was artificially lowering resident salaries. So even if we accept that this exemption constitutes a state-sponsored monopoly, I've no idea why you think repealing it will serve to reduce costs.

    US Gastroenterology fellowships actually transitioned from matching to no matching and back fairly recently and can serve as a case study. There's a paper here and informal discussion here that I think are worth reading.
     
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  17. Bucky

    Bucky Well-Known Member

    Good reading, thanks for linking it. It appears that my earlier analysis was overly simplified; some problems I ascribed to the NRMP are actually the result of ACGME policy.

    My original proposal's logic was that a higher number of accredited physicians would lead to lower costs via competition. The limiting factor to accrediting new physicians in some fields is residencies. The NRMP controls the number of residencies (although the ACGME is arguably more responsible). Attrition among residents further reduces the number of available supervising physicians.

    The NRMP's monopoly (and monopsony) status is directly relevant in two areas. First, artificially lowering resident salaries means dropping out of medicine for a job in another field is more attractive. Second, in cases where the match fails - either a resident doesn't get along with their employer or the match fails to assign them at all - there is no realistic second chance to find another internship outside the match.
     
    Last edited: May 21, 2017
  18. Kdansky

    Kdansky Well-Known Member

    While I don't understand the specifics of these regulations (I have never even heard of them), one thing:

    Competition does not properly work for health care. Competition can only function when the customer can correctly identify the causality between spending money and result.

    Examples:
    • When I want to buy a car, I can compare price and performance (mileage, size, comfort) easily, or even return it if my expectations are not fulfilled.
    • When I read seventy 1-star reviews on trip advisor about a restaurant, I know to avoid it.
    But when I get sick, and go to two doctors, which offer me different "services" for different price points, I cannot sensibly choose: I know nothing about the problem, nor about the validity of either treatment. Neither can I do something about getting cheated: When the treatment didn't work, and I died, getting back my money doesn't work! And quite often, it's not even the doctor's fault at all. Cancer is just randomly deadly about half the time... Competition never happens.

    Free Market does not work for health care, because the patient is not a "customer", and the doctor is not a "vendor". That is not a overstatement, this is a fundamental truth.

    Even Gevlon (famously arrogant selfish free-market capitalist) agrees on this: http://greedygoblin.blogspot.ch/2016/05/health-care-cant-be-for-profit.html
     
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  19. Bucky

    Bucky Well-Known Member

    Looked at the Gevlon article. To the extent that he has a point, it's a narrow one.

    Most medical services can be evaluated fairly, and have common standards. Blood tests? There are already labs competing behind the scenes, each certified to some minimum competence. X-rays? There are several facilities capable of performing them in most cities and you can see the results right away. Diagnosis? The "second opinion" rule is there for a reason. Reconstructive surgery? Gevlon claims that "If the doctor fails to save your legs and you have to live in wheelchair, you probably can't get your money back" but I don't see any reason why you couldn't.

    And we already have medical malpractice lawsuits as a last resort for dealing with "negligent omissions".

    Cancer and similar partly-incurable conditions might be an exception; I'll need to look into that more.
     
  20. Kdansky

    Kdansky Well-Known Member

    A while ago, my wife had a bicycle crash, and lost a tooth. The dentist told us that the usual first treatment (signed off by insurers and doctors) is to put it back in (and do a bunch of shit to it), because it sometimes takes hold again, and that's much easier for the patient than having to get surgery to replace it with a screw and ceramics. He insisted very much that this is not guaranteed for success. When I asked him about the chances, he first didn't want to answer, and when pressed, he offered "chances of this working is about 40%".

    Turns out it worked fine this time. I would have another very similar story which is a bit long, but there it was a similar "maybe this will work but it might not" case, and there it did not work out, ending up with an extra surgery.

    But there is no reasonable malpractice suit to be found in either case, and we cannot ascertain whether either of the two doctors were any good. It went fine once, and badly once.

    This example alone proves that you cannot pay doctors by success, because you cannot know whether they were responsible for the success. You don't need to look at unusual things like cancer, just falling from your bike and losing a tooth is enough to show it.

    Going with a malpractice suit makes everything worse, not better! It moves money from doctors towards lawyers, and from solving the problem (people are sick) towards economics and contracts (which we already established cannot buy health). Nothing feels more silly than having to sign multiple pages of documents that state: "Surgery is risky and you might die" when you are guaranteed to die if you don't get the surgery in the first place. This is a ridiculous and dumb side-effect of too much free market bullcrap in health care where it does not belong.

    As for "unusual" cancer: Cancer is not unusual. Nearly half the people I know above age 60 have had cancer at some point. The reason? The only things killing us are accidents and cancer. Everything else we have figured out. That skews statistics. Also note that all cancer treatments are silly expensive, and unreliable. Even well researched types like breast cancer (statistically one in ten women gets it at some point) still have a significant mortality rate: https://xkcd.com/931/

    Free Market is a failure for health services.
     
    Last edited: May 29, 2017
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