3 ms·

In the US, the consumer drives a lot of the healthcare decisions. This has positives, as consumers can be more active participants in their health, but can als

In the US, the consumer drives a lot of the healthcare decisions. This has positives, as consumers can be more active participants in their health, but can also lead to people shopping for doctors who will prescribe the drugs that they want based on flimsy research and marketing. Additionally, this is a great backdoor way for consumers to be "educated" about conditions they didn't know they had. Consumers then would go to their doctor to talk about these things. These advertisements are extremely effective at getting patients going to doctors about conditions they hadn't necessarily discussed with the doctor before.

toomuchtodo 11y ago
> This has positives, as consumers can be more active participants in their health, but can also lead to people shopping for doctors who will prescribe the drugs that they want based on flimsy research and marketing. Turns out, people suck at being intelligent healthcare consumers. Its not their fault though. http://www.nytimes.com/2015/11/02/upshot/why-consumers-often-err-in-choosing-health-plans.html http://www.nytimes.com/2015/11/02/upshot/why-consumers-often... http://www.nber.org/papers/w21160 http://www.nber.org/papers/w21160 Disclaimer: I am a strong advocate for single payer.
- vonmoltke 11y ago
  Demonstrating that consumers have trouble with insurance decisions implies nothing about their ability to make care decisions.
  - toomuchtodo 11y ago
    Most healthcare consumers don't shop around by cost for their healthcare, either because they can't (emergency services) or because its too damn hard (example below). I encourage you to call your three closest hospitals, pick three surgical procedures, and ask them what the cash rate is from their chargemaster. You may get an answer from one hospital, possibly.
    - nostromo 11y ago
      Most healthcare consumers don't shop around by cost for their healthcare because they don't pay the bills.
      - toomuchtodo 11y ago
        True! But the healthcare market is grossly inefficient. Prices are hidden from users. Drug makers can pitch straight to consumers, who aren't medical professionals. I'd agree that consumers would shop around given the proper incentives, and as long as those incentives didn't diminish the healthcare they receive (or their health in general). Single payer seems to be the better option. It streamlines collecting revenue for the program, and the program is large enough that it can bargain or set pricing with healthcare providers.
        bmelton 11y ago
        You could easily argue that "Most healthcare consumers don't shop around by cost for their healthcare because they don't pay the bills" is a good argument against single payer. Honestly, I think if we treated medical insurance more like we treated car insurance, home insurance, et al, then the cost of medical goods would go down.
    - vonmoltke 11y ago
      You seem fixated on price. "Active consumer" (the words in the post you were replying to) means more to me than finding the best deal. It means allowing the consumer to ultimately decide what is best for them, where price is one of several factors. As far as the specific price question, with respect to drugs I can easily get that information from my pharmacist, whether it is the cost difference between a name brand and generic or just the prospective cost of a medication.
- aianus 11y ago
  Have you ever lived in a country with single-payer healthcare? Let me tell you it's not all roses. - Months long waits for anything requiring a specialist unless you're literally about to die. - Arbitrary exclusions like dental and optical. - Doctors taking in ~50% of the entire provincial budget and whining that it's not enough. And at a typical tech worker salary this all this ends up being more expensive in additional taxes than just buying the insurance outright would be in the US. If you're not poor, there's really no reason to prefer single payer.
  - danans 11y ago
    Many (most?) private employer based healthcare plans in the US don't provide dental/optical. Those are each separate plans and premiums that you and/or your employer must pay for. Your point about doctors taking ~50% of the provincial budget seems exaggerated (please provide a reference to support it). Even if healthcare takes 50% of the budget, it's not all going to doctors, probably not even the majority of that. There are a lot of expenses other than doctors in a health system (nurses, administrators, buildings, equipment, materials, etc, etc, etc). In the US, the big "single-payer" system, Medicare, is far more cost efficient than private insurance: http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/ http://healthaffairs.org/blog/2011/09/20/medicare-is-more-ef... And I can think of at least one good reason to prefer single-payer if you are a not-poor tech worker: Job flexibility. Since insurance comes from the govt instead of the employer, employees don't jeopardize or destabilize their health coverage by switching employers or switching to being self employed. Edit: wording
    - aianus 11y ago
      > Your point about doctors taking ~50% of the provincial budget seems exaggerated (please provide a reference to support it). It's actually 42% in my province: http://wpmedia.news.nationalpost.com/2015/04/programexpensebreakdown1.jpg?w=620&h=425 http://wpmedia.news.nationalpost.com/2015/04/programexpenseb... The average doctor makes $350k and the medical association is suing the government because they think it's too little (http://www.theglobeandmail.com/news/national/ontario-medical-association-suing-province-over-cuts-to-doctors-fees/article27030534/ http://www.theglobeandmail.com/news/national/ontario-medical...).

toomuchtodo 11y ago

> This has positives, as consumers can be more active participants in their health, but can also lead to people shopping for doctors who will prescribe the drugs that they want based on flimsy research and marketing. Turns out, people suck at being intelligent healthcare consumers. Its not their fault though. http://www.nytimes.com/2015/11/02/upshot/why-consumers-often-err-in-choosing-health-plans.html http://www.nytimes.com/2015/11/02/upshot/why-consumers-often... http://www.nber.org/papers/w21160 http://www.nber.org/papers/w21160 Disclaimer: I am a strong advocate for single payer.

vonmoltke 11y ago
Demonstrating that consumers have trouble with insurance decisions implies nothing about their ability to make care decisions.
- toomuchtodo 11y ago
  Most healthcare consumers don't shop around by cost for their healthcare, either because they can't (emergency services) or because its too damn hard (example below). I encourage you to call your three closest hospitals, pick three surgical procedures, and ask them what the cash rate is from their chargemaster. You may get an answer from one hospital, possibly.
  - nostromo 11y ago
    Most healthcare consumers don't shop around by cost for their healthcare because they don't pay the bills.
    - toomuchtodo 11y ago
      True! But the healthcare market is grossly inefficient. Prices are hidden from users. Drug makers can pitch straight to consumers, who aren't medical professionals. I'd agree that consumers would shop around given the proper incentives, and as long as those incentives didn't diminish the healthcare they receive (or their health in general). Single payer seems to be the better option. It streamlines collecting revenue for the program, and the program is large enough that it can bargain or set pricing with healthcare providers.
      - bmelton 11y ago
        You could easily argue that "Most healthcare consumers don't shop around by cost for their healthcare because they don't pay the bills" is a good argument against single payer. Honestly, I think if we treated medical insurance more like we treated car insurance, home insurance, et al, then the cost of medical goods would go down.
  - vonmoltke 11y ago
    You seem fixated on price. "Active consumer" (the words in the post you were replying to) means more to me than finding the best deal. It means allowing the consumer to ultimately decide what is best for them, where price is one of several factors. As far as the specific price question, with respect to drugs I can easily get that information from my pharmacist, whether it is the cost difference between a name brand and generic or just the prospective cost of a medication.
aianus 11y ago
Have you ever lived in a country with single-payer healthcare? Let me tell you it's not all roses. - Months long waits for anything requiring a specialist unless you're literally about to die. - Arbitrary exclusions like dental and optical. - Doctors taking in ~50% of the entire provincial budget and whining that it's not enough. And at a typical tech worker salary this all this ends up being more expensive in additional taxes than just buying the insurance outright would be in the US. If you're not poor, there's really no reason to prefer single payer.
- danans 11y ago
  Many (most?) private employer based healthcare plans in the US don't provide dental/optical. Those are each separate plans and premiums that you and/or your employer must pay for. Your point about doctors taking ~50% of the provincial budget seems exaggerated (please provide a reference to support it). Even if healthcare takes 50% of the budget, it's not all going to doctors, probably not even the majority of that. There are a lot of expenses other than doctors in a health system (nurses, administrators, buildings, equipment, materials, etc, etc, etc). In the US, the big "single-payer" system, Medicare, is far more cost efficient than private insurance: http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/ http://healthaffairs.org/blog/2011/09/20/medicare-is-more-ef... And I can think of at least one good reason to prefer single-payer if you are a not-poor tech worker: Job flexibility. Since insurance comes from the govt instead of the employer, employees don't jeopardize or destabilize their health coverage by switching employers or switching to being self employed. Edit: wording
  - aianus 11y ago
    > Your point about doctors taking ~50% of the provincial budget seems exaggerated (please provide a reference to support it). It's actually 42% in my province: http://wpmedia.news.nationalpost.com/2015/04/programexpensebreakdown1.jpg?w=620&h=425 http://wpmedia.news.nationalpost.com/2015/04/programexpenseb... The average doctor makes $350k and the medical association is suing the government because they think it's too little (http://www.theglobeandmail.com/news/national/ontario-medical-association-suing-province-over-cuts-to-doctors-fees/article27030534/ http://www.theglobeandmail.com/news/national/ontario-medical...).