4 ms·

> My only notion for healthcare is to change the incentives. That's only a recipe for lobbying over what bureaucrats designate "wellness" and "disease". The b

> My only notion for healthcare is to change the incentives. That's only a recipe for lobbying over what bureaucrats designate "wellness" and "disease". The best way to fix healthcare is to cut out more middlemen. The person whose health is being cared for (or their loved ones) needs to decide when another $10k scan or $65k pill regimen is worth it compared to using the cash to pay off their (grand)kids' student loans. If all of this is filtered through insurers, lawyers, and government officials, there is incentives to meet budgets and increase revenue, but there's no win for the actual people and families all this is supposed to be taking care of.

specialist 9y ago
Wellness is easily measured. Life expectancy, sick days, patient surveys. The fight happens during rationing (bureaucratic triage). So you'd eliminate pharmacy benefit management companies? https://en.wikipedia.org/wiki/Pharmacy_benefit_management#Litigation_and_controversies https://en.wikipedia.org/wiki/Pharmacy_benefit_management#Li... Or are you saying eliminate insurers (insurance) altogether?
- humanrebar 9y ago
  The government can't be rational about what a balanced meal looks like or how tomatoes (fruit? veg?) fit in the picture. There's a reason food lobbying groups exist. > Or are you saying eliminate insurers (insurance) altogether? I'm not saying there's an easy answer, but as long as all health transactions are paying for one party's health with another party's money, we'll have bad outcomes. If the problem is that it's expensive to live, then let's talk about that problem (negative income tax credit, minimum income, optimize for cost of living, etc.) instead of trying to bureaucracy (private or public) our way into utopia.
  - koolba 9y ago
    According to the government a slice of pizza counts as a serving of vegetables because of the tomato sauce.
- jessaustin 9y ago
  This may not be what you mean, but this comment triggered a thought. If it were possible to really measure wellness and reward or punish providers accordingly, the new "health insurance" would be a sort of reinsurance that such providers purchased to control risks related to their patients' health. No, it wouldn't be cheap, and yes, the costs would be passed on to someone.
selllikesybok 9y ago
Who has 65k cash to toss around like that? :) If the doctor can't effectively predict what benefit said scan or pill regimen will provide (50% chance of 10 year life extension,90% chance of 2 years...? not even getting into quality of life), how does the consumer make informed choices? This approach devolves to if you have money you get care, if not, you don't, regardless of need or efficacy. Similar to any other market. There or some easy decisions to make in medical care (set the broken bone, stop the bleeding), but less so when it comes to areas driving price increases. Adding layers is potentially problematic, as is removing them. Single payer and no-payer are attractive solutions due to ideological simplicity. I wonder if a tax funded provision of care rationed similarly to the organ transplant system would be workable...
- humanrebar 9y ago
  > Who has 65k cash to toss around like that? :) Most people who are paying that much for pills are retired middle class people trying to stay healthy into old age. Or alive for a few more years. But people should be able to pay for typical levels of healthcare. The fact that this isn't true is a question of economics and employment opportunities, not entirely problem with the "healthcare system" itself. > There or some easy decisions to make in medical care (set the broken bone, stop the bleeding), but less so when it comes to areas driving price increases. > Single payer and no-payer are attractive solutions due to ideological simplicity. I agree with this first sentence more than the second. These decisions are never all that simple. And they are made even more complicated or perverse when you ignore that the best alternative for a bureaucrat (private or public) approving treatments is saying "no" and going home for a Scotch. The best alternative for the patient is saying "yes" and spending $300k and live another year in diapers. If people were spending their own money, they would also think about: - grandkids that want to go to college - underfunded soup kitchens in their neighborhoods - not reverse mortgaging the family home they wanted to pass down to their loved ones - going on a "farewell" cruise And that's just one category of health care decisions. There are more mundane ones like "Should I try the generic treatment for a week to see if it helps? Or should I put $3k into the boutique one and save the hassle?" I wouldn't know how a (even highly qualified, well meaning) bureaucrat in Atlanta would make a better decision than the person getting treated.
selllikesybok 9y ago
Who has 65k cash to toss around like that? :) If the doctor can't effectively predict what benefit said scan or pill regimen will provide (50% chance of 10 year life extension,90% chance of 2 years...? not even getting into quality of life), how does the consumer make informed choices? This approach devolves to if you have money you get care, if not, you don't, regardless of need or efficacy. Similar to any other market. There or some easy decisions to make in medical care (set the broken bone, stop the bleeding), but less so when it comes to areas driving price increases. Adding layers is potentially problematic, as is removing them. Single payer and no-payer are attractive solutions due to ideological simplicity. I wonder if a tax funded provision of care rationed similarly to the organ transplant system would be workable...

specialist 9y ago

Wellness is easily measured. Life expectancy, sick days, patient surveys. The fight happens during rationing (bureaucratic triage). So you'd eliminate pharmacy benefit management companies? https://en.wikipedia.org/wiki/Pharmacy_benefit_management#Litigation_and_controversies https://en.wikipedia.org/wiki/Pharmacy_benefit_management#Li... Or are you saying eliminate insurers (insurance) altogether?

humanrebar 9y ago
The government can't be rational about what a balanced meal looks like or how tomatoes (fruit? veg?) fit in the picture. There's a reason food lobbying groups exist. > Or are you saying eliminate insurers (insurance) altogether? I'm not saying there's an easy answer, but as long as all health transactions are paying for one party's health with another party's money, we'll have bad outcomes. If the problem is that it's expensive to live, then let's talk about that problem (negative income tax credit, minimum income, optimize for cost of living, etc.) instead of trying to bureaucracy (private or public) our way into utopia.
- koolba 9y ago
  According to the government a slice of pizza counts as a serving of vegetables because of the tomato sauce.
jessaustin 9y ago
This may not be what you mean, but this comment triggered a thought. If it were possible to really measure wellness and reward or punish providers accordingly, the new "health insurance" would be a sort of reinsurance that such providers purchased to control risks related to their patients' health. No, it wouldn't be cheap, and yes, the costs would be passed on to someone.

selllikesybok 9y ago

Who has 65k cash to toss around like that? :) If the doctor can't effectively predict what benefit said scan or pill regimen will provide (50% chance of 10 year life extension,90% chance of 2 years...? not even getting into quality of life), how does the consumer make informed choices? This approach devolves to if you have money you get care, if not, you don't, regardless of need or efficacy. Similar to any other market. There or some easy decisions to make in medical care (set the broken bone, stop the bleeding), but less so when it comes to areas driving price increases. Adding layers is potentially problematic, as is removing them. Single payer and no-payer are attractive solutions due to ideological simplicity. I wonder if a tax funded provision of care rationed similarly to the organ transplant system would be workable...

humanrebar 9y ago
> Who has 65k cash to toss around like that? :) Most people who are paying that much for pills are retired middle class people trying to stay healthy into old age. Or alive for a few more years. But people should be able to pay for typical levels of healthcare. The fact that this isn't true is a question of economics and employment opportunities, not entirely problem with the "healthcare system" itself. > There or some easy decisions to make in medical care (set the broken bone, stop the bleeding), but less so when it comes to areas driving price increases. > Single payer and no-payer are attractive solutions due to ideological simplicity. I agree with this first sentence more than the second. These decisions are never all that simple. And they are made even more complicated or perverse when you ignore that the best alternative for a bureaucrat (private or public) approving treatments is saying "no" and going home for a Scotch. The best alternative for the patient is saying "yes" and spending $300k and live another year in diapers. If people were spending their own money, they would also think about: - grandkids that want to go to college - underfunded soup kitchens in their neighborhoods - not reverse mortgaging the family home they wanted to pass down to their loved ones - going on a "farewell" cruise And that's just one category of health care decisions. There are more mundane ones like "Should I try the generic treatment for a week to see if it helps? Or should I put $3k into the boutique one and save the hassle?" I wouldn't know how a (even highly qualified, well meaning) bureaucrat in Atlanta would make a better decision than the person getting treated.

selllikesybok 9y ago