5 ms·

I have no problem, in theory, with socialized medicine that we drastically underfund. It's probably a great way to waste fewer resources on medicine. In practi

I have no problem, in theory, with socialized medicine that we drastically underfund. It's probably a great way to waste fewer resources on medicine. In practice that's just not politically feasible in the US. An illustrative example: a few years ago, a major study found that mammograms before age 50 are financially wasteful and medically harmful. Congress passed a law requiring insurance companies to pay for them anyway. https://www.bloomberg.com/view/articles/2012-07-31/in-mammogram-debate-politics-trounces-science https://www.bloomberg.com/view/articles/2012-07-31/in-mammog... http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening http://www.uspreventiveservicestaskforce.org/Page/Document/U...

maxerickson 10y ago
Medicare, Medicaid and the must stabilize mandate for ERs are underfunded. It's one of the reasons that out of pocket costs are so high.
- chimeracoder 10y ago
  > Medicare, Medicaid and the must stabilize mandate for ERs are underfunded. It's one of the reasons that out of pocket costs are so high. Exactly. This is the hidden secret about US healthcare that very few people are aware of. Even providers usually don't see this anymore, because they're so removed from the billing process (especially now that most providers are salaried and not running their own practices). Medicare and Medicaid are the reasons that sticker prices for treatment in the US are absurdly high. Incidentally - and most people don't know this - if you're uninsured and self-paying, you almost never have to pay the sticker price. Hospitals really don't care, and if you just tell them that you're self-paying and can only afford (say) 10% of what they billed you for, they'll almost always immediately agree to a 90% discount. The only reason they're showing you that bill is that they need to present high bills to private insurers (to make up for the loss on Medicare/Medicaid reimbursements) and they're not legally allowed to present differently-priced initial bills to patients based on their insurance status.
- yummyfajitas 10y ago
  No, they aren't underfunding. US government health care spending was $4,034/person. UK total health expenditures per person was $3,935. http://data.worldbank.org/indicator/SH.XPD.PCAP http://data.worldbank.org/indicator/SH.XPD.PCAP http://www.usgovernmentspending.com/year_spending_2014USbn_17bs2n_10#usgs302 http://www.usgovernmentspending.com/year_spending_2014USbn_1... For us to underfund it to UK levels, we'd have to expand medicare or medicaid to every single person while simultaneously cutting the total government budget for health care by 2.5%.
  - maxerickson 10y ago
    The UK system isn't competing with private US consumers for a limited pool of services. The comparison perhaps illustrates the poor value/dollar achieved in the US, it isn't instructive as to whether US government funded healthcare meets the costs of providing the services it mandates (a perfectly reasonable definition of underfunded).
    - yummyfajitas 10y ago
      To clarify, when I said I'd favor socialized medicine that we drastically underfund, the goal was to stop wasting resources on medicine. I.e., we should bring our health care utilization/spending down to UK levels, since evidently that doesn't significantly harm health. Using a definition like "meets the costs of providing the services it mandates" inherently contradicts this philosophy since in the US, all sorts of crazy services will be mandated. E.g., mammograms for women under 50.
shanacarp 10y ago
So I have read through the US Preventative Service Task Force Recommendation about 10 times in conjunction with Obamacare and preventative services, as well as been involved in some of the politics behind the data sets. The US government actually tracks mammograms in the US through the Breast Cancer Surveillance Consortium. http://www.bcsc-research.org/ http://www.bcsc-research.org/ Their research basically has it come down to a massive case of Simpson's Paradox among many important subgroups needing early screening (black women, ashkenazi women, previous radiation to the chest) that suddenly disappears when they are added together en masses. The US Preventative Service Task Force, however, is not in the business of explaining stats: it is basically a guidebook of what insurance will or will not cover, and they went with the rating they did as a compromise over the simpson paradox over the fear that these subgroups would lose coverage in high deductable plans In exchange, they actually did cause problems by not doing comprehensive DNA testing and ONLY covering BRCA testing - which is bad science.

maxerickson 10y ago

Medicare, Medicaid and the must stabilize mandate for ERs are underfunded. It's one of the reasons that out of pocket costs are so high.

chimeracoder 10y ago
> Medicare, Medicaid and the must stabilize mandate for ERs are underfunded. It's one of the reasons that out of pocket costs are so high. Exactly. This is the hidden secret about US healthcare that very few people are aware of. Even providers usually don't see this anymore, because they're so removed from the billing process (especially now that most providers are salaried and not running their own practices). Medicare and Medicaid are the reasons that sticker prices for treatment in the US are absurdly high. Incidentally - and most people don't know this - if you're uninsured and self-paying, you almost never have to pay the sticker price. Hospitals really don't care, and if you just tell them that you're self-paying and can only afford (say) 10% of what they billed you for, they'll almost always immediately agree to a 90% discount. The only reason they're showing you that bill is that they need to present high bills to private insurers (to make up for the loss on Medicare/Medicaid reimbursements) and they're not legally allowed to present differently-priced initial bills to patients based on their insurance status.
yummyfajitas 10y ago
No, they aren't underfunding. US government health care spending was $4,034/person. UK total health expenditures per person was $3,935. http://data.worldbank.org/indicator/SH.XPD.PCAP http://data.worldbank.org/indicator/SH.XPD.PCAP http://www.usgovernmentspending.com/year_spending_2014USbn_17bs2n_10#usgs302 http://www.usgovernmentspending.com/year_spending_2014USbn_1... For us to underfund it to UK levels, we'd have to expand medicare or medicaid to every single person while simultaneously cutting the total government budget for health care by 2.5%.
- maxerickson 10y ago
  The UK system isn't competing with private US consumers for a limited pool of services. The comparison perhaps illustrates the poor value/dollar achieved in the US, it isn't instructive as to whether US government funded healthcare meets the costs of providing the services it mandates (a perfectly reasonable definition of underfunded).
  - yummyfajitas 10y ago
    To clarify, when I said I'd favor socialized medicine that we drastically underfund, the goal was to stop wasting resources on medicine. I.e., we should bring our health care utilization/spending down to UK levels, since evidently that doesn't significantly harm health. Using a definition like "meets the costs of providing the services it mandates" inherently contradicts this philosophy since in the US, all sorts of crazy services will be mandated. E.g., mammograms for women under 50.

shanacarp 10y ago

So I have read through the US Preventative Service Task Force Recommendation about 10 times in conjunction with Obamacare and preventative services, as well as been involved in some of the politics behind the data sets. The US government actually tracks mammograms in the US through the Breast Cancer Surveillance Consortium. http://www.bcsc-research.org/ http://www.bcsc-research.org/ Their research basically has it come down to a massive case of Simpson's Paradox among many important subgroups needing early screening (black women, ashkenazi women, previous radiation to the chest) that suddenly disappears when they are added together en masses. The US Preventative Service Task Force, however, is not in the business of explaining stats: it is basically a guidebook of what insurance will or will not cover, and they went with the rating they did as a compromise over the simpson paradox over the fear that these subgroups would lose coverage in high deductable plans In exchange, they actually did cause problems by not doing comprehensive DNA testing and ONLY covering BRCA testing - which is bad science.