3 ms·

Everyone knows how to fix the problem in the short/medium term. The solution is money. Specifically, money from the Federal Government. The real behind-the-sc

by nugget 10y ago

Everyone knows how to fix the problem in the short/medium term. The solution is money. Specifically, money from the Federal Government. The real behind-the-scenes debate in DC this month is about, first, the best mechanism to transfer funds (direct subsidies, state subsidies, Federal reinsurance pool for the sickest cases, etc ... each of which create distinct winners and losers whose lobbyists are currently out in force), and second, how much of an annual budget deficit the fiscal-hawk Republicans (now led by Rand Paul) are willing to tolerate. The longer-term solutions have much more to do with diet, lifestyle management, and other behavioral health issues than with access to providers and drugs (e.g. look up how much of last year's medicaid/medicare budget was spent on type 2 diabetes treatment alone). Unfortunately it doesn't seem like we can tackle these issues at scale until after the current debate on affordable universal access to care is settled.

belovedeagle 10y ago
> Specifically, money from the Federal Government. Excuse me? What money? The government does not generate net positive economic benefit, and therefore has no [real] money. You might be confused and talking about "taxpayer money" — but then why bother with the gov't at all, why not just say your plan amounts to "we should increase healthcare costs so we're, you know, throwing more money at the problem".
- the_gastropod 10y ago
  I think the point is that currently there's a profit motive for healthcare. There's no incentive to promote _health_. By putting the federal government (a proxy for the U.S. citizenry itself) in charge of healthcare, the incentives for maximizing health (minimizing sickness / our tax burden for healthcare) become clear.
  - belovedeagle 10y ago
    There's also a profit motive in food production, should we move to single-payer for that (hint: this means breadlines)? There's also a profit motive in housing; single-payer? Mobile phones? Internet access? Entertainment?
    - deleted 10y ago
      [deleted]
    - sjwright 10y ago
      Oh if only it were that easy. The competition in those other markets is much stronger and has proven to be reasonably efficient. Healthcare is different because consumers often don't know what anything ought to cost, rarely in a position to shop around, and will never be able to afford some big ticket items without insurance regardless. And the economic consequences are non-obvious. For example, many conditions are much cheaper to treat if caught early; if access to a doctor has an inconvenient cost attached, overall costs go up. The ability to see a doctor for cheap – ideally free – is the most effective way to lower the risk of expensive procedures in the future.
    - ch4s3 10y ago
      This is such a shallow argument. Healthcare is a service unlike any commodity or service you've mentioned. Healthcare demand is unpredictable on an individual level, and it grow on an individual level over time when it isn't met. That is to say you get sicker if you go untreated. If I skip a meal today, I don't need extra meals tomorrow. If I sleep on the street tonight, I don't need two houses tomorrow. This is to say that any random individual can be struck ill (demanding healthcare) at any time, to an unknown cost that snowballs the longer they go untreated. It's a thing unto itself and metaphors don't work well. Furthermore, there's an enormous information asymmetry in healthcare, so it's hard for it to function as a market. Because we already have "free" healthcare in the form of emergency rooms, this is ultimately a conversation about how to best allocate health spending. Emergency care is the absolute most expensive form of non end of life care, so we should focus on minimizing that send. There's a well known path for doing so, regular check ups, vaccinations, preventative care, and chronic disease management. All of which cost money now, but reduce future expenditure. And if we already pay for sick broke people in the emergency room, why not optimize the expenditure of those tax dollars by shifting it to more effective health interventions?
      - dnautics 10y ago
        If your concern is cost basis, and "allocating health spending well", then why are we subsidizing preventative care? You yourself admit that end of life care is incredibly expensive. Why are we pushing people to live longer, when it incurs a much much greater cost to keep people alive? Why not just let them die young? In part, this is a huge reason (the other reason is pregnancy cost) why pre-ACA healthcare prices were much much cheaper for <30 men than women - most things that seriously hurt men under 30 just completely off them, and dead boys don't incur major medical cost.
- nugget 10y ago
  Yes, of course it backs out to taxpayer money - and likely money from taxpayers who haven't even been born yet, to the extent that the Federal Government runs a deficit exceeding inflation. If you look at the Federal budget it's clear that the Federal Government, beyond national defense, is simply becoming a giant healthcare and pension fund administrator, re-distributing wealth via social security, medicaid, and medicare. All other expenses are dwarfed by these. I'd expect this trend to continue until the singularity occurs and we enter our long-awaited post-capitalist utopia.

by nugget 10y ago

belovedeagle 10y ago

> Specifically, money from the Federal Government. Excuse me? What money? The government does not generate net positive economic benefit, and therefore has no [real] money. You might be confused and talking about "taxpayer money" — but then why bother with the gov't at all, why not just say your plan amounts to "we should increase healthcare costs so we're, you know, throwing more money at the problem".

the_gastropod 10y ago
I think the point is that currently there's a profit motive for healthcare. There's no incentive to promote _health_. By putting the federal government (a proxy for the U.S. citizenry itself) in charge of healthcare, the incentives for maximizing health (minimizing sickness / our tax burden for healthcare) become clear.
- belovedeagle 10y ago
  There's also a profit motive in food production, should we move to single-payer for that (hint: this means breadlines)? There's also a profit motive in housing; single-payer? Mobile phones? Internet access? Entertainment?
  - deleted 10y ago
    [deleted]
  - sjwright 10y ago
    Oh if only it were that easy. The competition in those other markets is much stronger and has proven to be reasonably efficient. Healthcare is different because consumers often don't know what anything ought to cost, rarely in a position to shop around, and will never be able to afford some big ticket items without insurance regardless. And the economic consequences are non-obvious. For example, many conditions are much cheaper to treat if caught early; if access to a doctor has an inconvenient cost attached, overall costs go up. The ability to see a doctor for cheap – ideally free – is the most effective way to lower the risk of expensive procedures in the future.
  - ch4s3 10y ago
    This is such a shallow argument. Healthcare is a service unlike any commodity or service you've mentioned. Healthcare demand is unpredictable on an individual level, and it grow on an individual level over time when it isn't met. That is to say you get sicker if you go untreated. If I skip a meal today, I don't need extra meals tomorrow. If I sleep on the street tonight, I don't need two houses tomorrow. This is to say that any random individual can be struck ill (demanding healthcare) at any time, to an unknown cost that snowballs the longer they go untreated. It's a thing unto itself and metaphors don't work well. Furthermore, there's an enormous information asymmetry in healthcare, so it's hard for it to function as a market. Because we already have "free" healthcare in the form of emergency rooms, this is ultimately a conversation about how to best allocate health spending. Emergency care is the absolute most expensive form of non end of life care, so we should focus on minimizing that send. There's a well known path for doing so, regular check ups, vaccinations, preventative care, and chronic disease management. All of which cost money now, but reduce future expenditure. And if we already pay for sick broke people in the emergency room, why not optimize the expenditure of those tax dollars by shifting it to more effective health interventions?
    - dnautics 10y ago
      If your concern is cost basis, and "allocating health spending well", then why are we subsidizing preventative care? You yourself admit that end of life care is incredibly expensive. Why are we pushing people to live longer, when it incurs a much much greater cost to keep people alive? Why not just let them die young? In part, this is a huge reason (the other reason is pregnancy cost) why pre-ACA healthcare prices were much much cheaper for <30 men than women - most things that seriously hurt men under 30 just completely off them, and dead boys don't incur major medical cost.
nugget 10y ago
Yes, of course it backs out to taxpayer money - and likely money from taxpayers who haven't even been born yet, to the extent that the Federal Government runs a deficit exceeding inflation. If you look at the Federal budget it's clear that the Federal Government, beyond national defense, is simply becoming a giant healthcare and pension fund administrator, re-distributing wealth via social security, medicaid, and medicare. All other expenses are dwarfed by these. I'd expect this trend to continue until the singularity occurs and we enter our long-awaited post-capitalist utopia.