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I think the hardest thing for the American political system to grasp about our medical system is that spending more money is not the answer. We already spend 1

I think the hardest thing for the American political system to grasp about our medical system is that spending more money is not the answer. We already spend 16% of GDP, about double what almost all other countries spend on health care and have worse outcomes. I'm glad that there's some new thinking going on here that may lead to some movement. Unfortunately, all the incentives are aligned such that everyone who is making a ton of money off the system lobbies to make even more.

x5n1 11y ago
At the same time doctor's income is actually decreasing. So America has a lot of parasitic Capitalists adding little value but sucking billions of dollars out of the system. This sort of Capitalism does no one any good. A lot of that money is being sucked out by regulatory capture. Spending more money will lead to yet more money being lost to the same parasites which will simply find ways of increasing their ability to leech money from the system.
- maxerickson 11y ago
  It's likely that doctors earning less is an important component of reducing heath care costs in the US. Of course we should try to make that happen by increasing the supply of doctors rather than mismanagement.
  - jessriedel 11y ago
    Doctors make up less than 9% of total health care spending. The idea that you're going to make a dent in spending by cutting doctor salaries further is insane. They are the only fully knowledgable people in hospital, and because they are so overloaded they are making thousands of key decisions everyday in a rush. It's already conventional wisdom that you can't make nearly as much money as a doctor as you use to, and so the best and brightest students are skipping it for more lucrative fields. This damage will take decades to be undone, even if we were to raise salaries immediately, because of the long training.
    - maxerickson 11y ago
      Yeah, I said we should work to increase the supply of doctors, not that we should fix their compensation. Reducing the undergraduate requirement and subsidizing medical school would both be reasonable ways to do that.
      - jessriedel 11y ago
        Reducing the undergraduate requirements does not seem like a very good way to reduce spending without decreasing quality.
        maxerickson 11y ago
        Med school admissions require a small number of classes and then consider GPA and MCAT scores. I don't expect 2 years of GPA to be much less informative than 4 or 5 years of GPA.
xlm1717 11y ago
The insurance system is itself a racket. Putting even more people into the insurance system only makes insurance companies richer, doesn't do much for the average American.
- CamperBob2 11y ago
  True, that. If pressed to name the single stupidest concept I've ever encountered in over forty years of life, I'd have to say it's the notion of selling "insurance" in a market where you know perfectly well that 99.9% of participants will eventually have to file expensive claims. Communism is way up there, along with smoking, and religion, and then there's the time that Circuit City tried to sell their own proprietary brand of self-destructing DVDs. But none of them can compare, in terms of sheer forehead-slapping stupidity, to the idea of "health insurance."
  - frandroid 11y ago
    So what you're saying is that you're for communist single-payer healthcare, right?
    - CamperBob2 11y ago
      Well, it's certainly not a valid area for market economics to address, since everyone is forced to participate by virtue of being mortal. Single-payer is probably the optimum model for any advanced society, regardless of its political alignment. The thing is, our glorious capitalistic, market-based health care system already costs us as much as a single-payer system would. We just don't get the benefits.
      - prostoalex 11y ago
        > Single-payer is probably the optimum model for any advanced society If single payer system dispenses sufficient cash, the providers are happy. But if you look in places like Eastern Europe, they started with single payer, and it's still around, but the providers figured out they could set additional fees for higher priority, nicer treatment, less crowded hospital rooms, etc. At which point the incentives got switched to the point where single-payer doesn't get you much except a place in the back of the line and access to generics. How do you build a system that's single-payer and avoids corruption from providers' side? Providers grow to despise monopsony, and have market forces at their disposal.
gozur88 11y ago
>We already spend 16% of GDP, about double what almost all other countries spend on health care and have worse outcomes. The medical system is not the primary influence on a population's health. It's probably about third behind public health systems (sewage, water, and food inspection) and the health habits of the population. You're never going to have a health system that can compensate for four hundred pound diabetics who didn't realize they were pregnant for six months.
- thecosas 11y ago
  I have been a Type 1 diabetic since I was eight years old. I am now 31 and am not and have never been obese. In Type 1 diabetes, the immune system attacks the beta cells in the pancreas which would normally produce insulin. It is a lifelong autoimmune disorder, not a lifestyle choice. It also happens to be the population of diabetics most likely to be impacted by the cost of insulin, as our bodies do not produce any. I understand that the last sentence was meant as a quip/jab at the clear obesity problem which the United States in particular is dealing with, along with the epidemic of type 2 diabetes that is resulting. It is real and needs to be fought on many fronts. Your argument, however, implies that ALL diabetics are overweight, irresponsible people, which is simply not the case for type 1's at all and for many (if not most) type 2's.
  - gozur88 11y ago
    I have no idea what your comment has to do with mine. If you read it again you'll see I imply nothing beyond the fact that Americans, as a group, suffer from poor health choices.
  - 1123581321 11y ago
    I'm type 1 and I don't mind jabs about weight. Diabetes isn't a completely random autoimmune disease; some of us have it because of our mothers' diets, bad periods of sickness during childhood and so on. Late adult type 1 diabetics can often point to overwork, bad diet and some type 1s likely have issues with fatty pancreas disease (those with very low, but existent, c peptide, for example.) I believe we would have fewer type 1 diabetics in a healthier country. I also think that, though type 1s aren't as obese as type 2s on average, we can always do better at reducing our need for insulin and keeping ourselves fit and mostly well-functioning. I don't believe we have much to gain from telling people not to lump us in with pure type 2s as if we are a protected class.
merpnderp 11y ago
We don't have worse outcomes for the largest most serious illnesses, cancer and heart disease. The US medical system is top tier in those for one of the largest, most obese, generally unhealthy and diverse populations in the world. It's actually a miracle to have these kinds of outcomes.
- Synaesthesia 11y ago
  Never thought about that, however the costs are still far to high and the amount of paperwork and administration that patients are subjected to is just a nightmare.

x5n1 11y ago

At the same time doctor's income is actually decreasing. So America has a lot of parasitic Capitalists adding little value but sucking billions of dollars out of the system. This sort of Capitalism does no one any good. A lot of that money is being sucked out by regulatory capture. Spending more money will lead to yet more money being lost to the same parasites which will simply find ways of increasing their ability to leech money from the system.

maxerickson 11y ago
It's likely that doctors earning less is an important component of reducing heath care costs in the US. Of course we should try to make that happen by increasing the supply of doctors rather than mismanagement.
- jessriedel 11y ago
  Doctors make up less than 9% of total health care spending. The idea that you're going to make a dent in spending by cutting doctor salaries further is insane. They are the only fully knowledgable people in hospital, and because they are so overloaded they are making thousands of key decisions everyday in a rush. It's already conventional wisdom that you can't make nearly as much money as a doctor as you use to, and so the best and brightest students are skipping it for more lucrative fields. This damage will take decades to be undone, even if we were to raise salaries immediately, because of the long training.
  - maxerickson 11y ago
    Yeah, I said we should work to increase the supply of doctors, not that we should fix their compensation. Reducing the undergraduate requirement and subsidizing medical school would both be reasonable ways to do that.
    - jessriedel 11y ago
      Reducing the undergraduate requirements does not seem like a very good way to reduce spending without decreasing quality.
      - maxerickson 11y ago
        Med school admissions require a small number of classes and then consider GPA and MCAT scores. I don't expect 2 years of GPA to be much less informative than 4 or 5 years of GPA.

xlm1717 11y ago

The insurance system is itself a racket. Putting even more people into the insurance system only makes insurance companies richer, doesn't do much for the average American.

CamperBob2 11y ago
True, that. If pressed to name the single stupidest concept I've ever encountered in over forty years of life, I'd have to say it's the notion of selling "insurance" in a market where you know perfectly well that 99.9% of participants will eventually have to file expensive claims. Communism is way up there, along with smoking, and religion, and then there's the time that Circuit City tried to sell their own proprietary brand of self-destructing DVDs. But none of them can compare, in terms of sheer forehead-slapping stupidity, to the idea of "health insurance."
- frandroid 11y ago
  So what you're saying is that you're for communist single-payer healthcare, right?
  - CamperBob2 11y ago
    Well, it's certainly not a valid area for market economics to address, since everyone is forced to participate by virtue of being mortal. Single-payer is probably the optimum model for any advanced society, regardless of its political alignment. The thing is, our glorious capitalistic, market-based health care system already costs us as much as a single-payer system would. We just don't get the benefits.
    - prostoalex 11y ago
      > Single-payer is probably the optimum model for any advanced society If single payer system dispenses sufficient cash, the providers are happy. But if you look in places like Eastern Europe, they started with single payer, and it's still around, but the providers figured out they could set additional fees for higher priority, nicer treatment, less crowded hospital rooms, etc. At which point the incentives got switched to the point where single-payer doesn't get you much except a place in the back of the line and access to generics. How do you build a system that's single-payer and avoids corruption from providers' side? Providers grow to despise monopsony, and have market forces at their disposal.

gozur88 11y ago

>We already spend 16% of GDP, about double what almost all other countries spend on health care and have worse outcomes. The medical system is not the primary influence on a population's health. It's probably about third behind public health systems (sewage, water, and food inspection) and the health habits of the population. You're never going to have a health system that can compensate for four hundred pound diabetics who didn't realize they were pregnant for six months.

thecosas 11y ago
I have been a Type 1 diabetic since I was eight years old. I am now 31 and am not and have never been obese. In Type 1 diabetes, the immune system attacks the beta cells in the pancreas which would normally produce insulin. It is a lifelong autoimmune disorder, not a lifestyle choice. It also happens to be the population of diabetics most likely to be impacted by the cost of insulin, as our bodies do not produce any. I understand that the last sentence was meant as a quip/jab at the clear obesity problem which the United States in particular is dealing with, along with the epidemic of type 2 diabetes that is resulting. It is real and needs to be fought on many fronts. Your argument, however, implies that ALL diabetics are overweight, irresponsible people, which is simply not the case for type 1's at all and for many (if not most) type 2's.
- gozur88 11y ago
  I have no idea what your comment has to do with mine. If you read it again you'll see I imply nothing beyond the fact that Americans, as a group, suffer from poor health choices.
- 1123581321 11y ago
  I'm type 1 and I don't mind jabs about weight. Diabetes isn't a completely random autoimmune disease; some of us have it because of our mothers' diets, bad periods of sickness during childhood and so on. Late adult type 1 diabetics can often point to overwork, bad diet and some type 1s likely have issues with fatty pancreas disease (those with very low, but existent, c peptide, for example.) I believe we would have fewer type 1 diabetics in a healthier country. I also think that, though type 1s aren't as obese as type 2s on average, we can always do better at reducing our need for insulin and keeping ourselves fit and mostly well-functioning. I don't believe we have much to gain from telling people not to lump us in with pure type 2s as if we are a protected class.

merpnderp 11y ago

We don't have worse outcomes for the largest most serious illnesses, cancer and heart disease. The US medical system is top tier in those for one of the largest, most obese, generally unhealthy and diverse populations in the world. It's actually a miracle to have these kinds of outcomes.

Synaesthesia 11y ago
Never thought about that, however the costs are still far to high and the amount of paperwork and administration that patients are subjected to is just a nightmare.