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We used to have much less medical care available; the best treatment for most diseases was "do nothing". That is no longer the case. We buy car insurance and f

We used to have much less medical care available; the best treatment for most diseases was "do nothing". That is no longer the case. We buy car insurance and fire insurance expecting to never or rarely make a claim. We buy health insurance knowing we definitely will be making claims. Supply and demand only works when you can establish a price equilibrium which absolutely requires that some people are priced out of the market. In healthcare that means massive disability and/or death. I don't think a fully free market in healthcare is in any way ethical. Like infrastructure or universal mail/electricity/water, healthcare is one of those things where at least some elements cannot be efficiently delivered by a free market.

dredmorbius 10y ago
And yet, the most dramtic improvements in healthcare outcomes (life expectency, mortality), came in the period before intensive medicine. Robert Gordon's The Rise and Fall of American Growth (2016) describes this in detail. Progress since 1970 has been particularly abysmal and almost totally due to increased access for the most under-served populations. It turns out that there are very sharply diminishing returns to intensive medical care. And that getting the basics right -- pre-natal care, effective childbirth, well-mother-and-baby care, vaccinations, good nutrition, an environment clear of pollution and contamination (especially lead, mercury, asbestos, smoke, and miscellaneous hazards) has a tremendous effect on improving infant survival and adult capabilities in both physical and mental health. The same precise services which lack of healthcare limit. There are also specific interventions which can be hugely impressively. One doctor I know entered the profession after witnessing what a single dose of narcan could do to an ODing heroin junkie. (Mind, you've still got an addict to deal with after ripping them out of Death's Cold Hands, but you've got a live addict, not a dead one.) Wound care, reconstructive surgery, bonesetting, and treatments for at least some diseases and conditions are pretty amazing. But people still eventually die, and putting of the inevitable is extremely expensive. The share of Medicare (and total) healthcare expenditures invoked in the last 12 months of life are quite high, though I've not the specific figures. And the US healthcare industry, in cost for outcomes achieved, is horrendously inefficient. It remains unavailable for far, far too many people.

dredmorbius 10y ago

And yet, the most dramtic improvements in healthcare outcomes (life expectency, mortality), came in the period before intensive medicine. Robert Gordon's The Rise and Fall of American Growth (2016) describes this in detail. Progress since 1970 has been particularly abysmal and almost totally due to increased access for the most under-served populations. It turns out that there are very sharply diminishing returns to intensive medical care. And that getting the basics right -- pre-natal care, effective childbirth, well-mother-and-baby care, vaccinations, good nutrition, an environment clear of pollution and contamination (especially lead, mercury, asbestos, smoke, and miscellaneous hazards) has a tremendous effect on improving infant survival and adult capabilities in both physical and mental health. The same precise services which lack of healthcare limit. There are also specific interventions which can be hugely impressively. One doctor I know entered the profession after witnessing what a single dose of narcan could do to an ODing heroin junkie. (Mind, you've still got an addict to deal with after ripping them out of Death's Cold Hands, but you've got a live addict, not a dead one.) Wound care, reconstructive surgery, bonesetting, and treatments for at least some diseases and conditions are pretty amazing. But people still eventually die, and putting of the inevitable is extremely expensive. The share of Medicare (and total) healthcare expenditures invoked in the last 12 months of life are quite high, though I've not the specific figures. And the US healthcare industry, in cost for outcomes achieved, is horrendously inefficient. It remains unavailable for far, far too many people.