8 ms·

Strange how the US healthcare setup is largely unchanged over many years, yet the general perception is that it's suddenly total chaos. I'm not saying the statu

Strange how the US healthcare setup is largely unchanged over many years, yet the general perception is that it's suddenly total chaos. I'm not saying the status quo is best, but we didn't suddenly plunge into a crisis.

jerf 9y ago
Almost everyone is politically motivated in some way to slam the healthcare system; nobody is politically motivated to defend it. Personally I'd offer the somewhat-feeble defense that it isn't as bad as people say it is, but I'd stop far short of calling it good... because I've got my own political axes to grind too, even if they are nearly diametrically opposed to the local consensus. But it isn't actually true that the American health system requires you to sign into indentured servitude the moment you walk in the emergency room door, and injects you with strychnine and tosses you out the door if you can't pay enough to satisfy the bureaucracy this week. Ambulance crews do not prowl the street and abduct unsuspecting European tourists and force them to donate blood before they're allowed to escape. Doctors do not actually giggle with glee and make "chaching!" noises when giving you bad diagnoses.
- chimeracoder 9y ago
  > Ambulance crews do not prowl the street and abduct unsuspecting European tourists and force them to donate blood before they're allowed to escape. Why would they? The US produces a surplus of blood and tissue, to the point that many other countries (particularly in Europe) have to purchase to from the US to address their own shortages.
ashark 9y ago
It's been incredibly bad for at least ~3 decades. A sick person with insurance without a dedicated advocate (relative or friend) watching out for them non-stop will likely end up having several care screw-ups occur to them, and with a bill ludicrously rather than just insanely large and probably a few things in collections (even if they can pay them) if said advocate doesn't spend a couple hundred hours fighting insurance and hospital billing and mailing regulators and wrestling a mountain of paperwork and bills. Watched this process with sick relatives in the 90s, and it was already fucked-up then. Gone through it with my wife's 3 pregnancies and a couple family illnesses in the last 5ish years. Same thing. It's a broken, evil system that ruthlessly exploits and crushes anyone without the time, wits, and wherewithal to fight it every step, and it has been for a long time. I think what changed is we have much better exposure to what it's like elsewhere, so more of us are aware that there is no reason whatsoever to keep hurting people this way.
- deleted 9y ago
  [deleted]
- dogruck 9y ago
  Good points. Which leads to the question, when everybody has "free" healthcare, who gets the top docs, and who gets the bottom and average docs?
  - ashark 9y ago
    Not sure. How's it work in the entire rest of the OECD?
    - dogruck 9y ago
      The people with inside connections, more power, or who make extra payments get the top docs. Regular folk get the rest.
      - ashark 9y ago
        If that's true, then it's more or less the same, no?
        dogruck 9y ago
        Agreed. Except I think the "free" setup is much more expensive.
        _Tev 9y ago
        Are you kidding? Look up how much US spends on healthcare and how much rest of the world does.
        dogruck 9y ago
        That's an impossible comparison -- "rest of the world." Is your point, "we spend so much today that we couldn't possibly spend more under a different legislative regime."?? Do you have a reference?
dfabulich 9y ago
It's a lot more expensive than it used to be. https://data.worldbank.org/indicator/SH.XPD.PCAP?locations=US https://data.worldbank.org/indicator/SH.XPD.PCAP?locations=U...
- dogruck 9y ago
  Ok, the price increased. And, let's ignore related factors such as the increased cost of medical education and advances in medical care (my aunt got a new heart a year ago!) My view of the mainstream story is that things went from ok to chaos within the past, say, 3 years. Instead, the costs have been steadily rising while voters have repeatedly opted not to make changes. Thought experiment: what if gas or milk prices had increased at the same rate? Education cost has increased a lot, but that's mostly inflated by student loans that I predict will implode like subprime mortgages.
  - nto8e90nt3 9y ago
    > Instead, the costs have been steadily rising while voters have repeatedly opted not to make changes. Have voters done that, though? I mean look at the trouble Republicans are having repealing the ACA. Voters seem to not want to repeal it. It seems like only the Republican leadership actually wants it repealed. My understanding is that when you ask individual voters of all stripes, they agree that pre-existing conditions should not stop you from getting affordable healthcare, and that lifetime limits are unfair across the board. But those are the things the Republican leadership wants to axe first.
    - dogruck 9y ago
      Look at all the congressional seats the Democrats lost (and the POTUS seat) after Obama pushed through his plan. It's always harder to repeal a law, versus blocking it from passing. As soon as a law is passed, it's the new status quo. And recall how close the recent repeal vote was. Why haven't we repealed the laws against weed and poker yet?
      - 9y ago
typomatic 9y ago
People are getting relatively poorer in comparison to their health care costs. So yes, we have been getting worse, and at some point the character of a problem changes into a crisis, which can seem "sudden".
- chimeracoder 9y ago
  > People are getting relatively poorer in comparison to their health care costs. That's not really true; total expenditures have increased, but that's largely because the treatments and care that people are choosing are different (and more expensive) than previous ones. Put another way: today you can still get the same type and quality of care that was available in the 1960s, and it'll be cheaper than it was in the 1960s (measured in 2017 dollars). You just probably don't want it, because it's nowhere near the current expectations and standards of quality of care.
  - dragonwriter 9y ago
    > Put another way: today you can still get the same type and quality of care that was available in the 1960s, No, in many cases you can't because the techniques and absence of procedural and other safeguards are no longer up to the standard of care in the profession, older drugs are no longer produced, etc.
dragonwriter 9y ago
> Strange how the US healthcare setup is largely unchanged over many years, yet the general perception is that it's suddenly total chaos. It's been horrible for a long time (and there's been outrage for a long-time: while it got derailed and we got nothing out of it but HIPAA, the bad state of healthcare and plans to reform it were central to the Clinton campaign in 1992—and while Clinton tried for a complicated scheme involving insurance companies, polling showed majority support for single-payer even then; the ACA is often pointed out to be a copy of Romneycare in Massachusetts, but what is less commonly pointed out is that both are copies of something proposed by the insurance industry and embraced by the Republican Party as a desirable national reform direction shortly after Clinton's reform effort failed, because even then it was widely perceived that something had to be done.) > I'm not saying the status quo is best, but we didn't suddenly plunge into a crisis. No, we've been in a crisis for more than a generation.
- chimeracoder 9y ago
  > what is less commonly pointed out is that both are copies of something proposed by the insurance industry and embraced by the Republican Party as a desirable national reform direction shortly after Clinton's reform effort failed It's less-commonly pointed out because it's not really true. It's true that there was one bill, in 1993, that was proposed by a Republican and which happened to somewhat resemble the Affordable Care Act at a very high level. However: a) It was proposed by a Republican senator from a very blue state (Rhode Island) b) That Republican senator lost his next re-election bid c) The bill never received a vote e) The bill was only one of many GOP-sponsored healthcare bills that year f) Conservative and moderate Republicans strongly criticized the bill g) While it bore some resemblance to the ACA at a very high level, it was a very different bill in details and implementation, so it's misleading to suggest that supporting one and not the other would be hypocritical. There were a lot of things Democrats like about the ACA that weren't in Chafee's bill, and there are a lot of things that Republicans might like in Chafee's bill (or the ANHRA in the House) that were not present in the ACA.
  - dragonwriter 9y ago
    Sure, there were a number of different subsidized-private-insurance schemes over the years (including the one briefly rhetorically embraced by George W. Bush but, again, that never went far legislatively) that differed from the ACA model in that only HDHP/HSA plans would be subsdized. > so it's misleading to suggest that supporting one and not the other would be hypocritical I wasn't suggesting that, I was illustrating that the perceived problem and many elements of the potential solution space have been part of the national dialogue for a long time.
unclepresent 9y ago
Price of healthcare is driven by a luck of supply (medical professionals, hospitals, affordable drugs) and supply is limited by regulation (expensive and ridiculously long educational process for physicians, huge liability and regulatory burden for practitioners and hospitals, very long and expensive approval process for moving a new drug through FDA, plus again liability cost) . Regulation in turn is driven by lobbying efforts of large professional groups (trial lawyers, AMA, large pharma etc). In another word it is a corrupted system that manages stay afloat as people in power legally able to get their cut through lobbying.
- deleted 9y ago
  [deleted]

jerf 9y ago

Almost everyone is politically motivated in some way to slam the healthcare system; nobody is politically motivated to defend it. Personally I'd offer the somewhat-feeble defense that it isn't as bad as people say it is, but I'd stop far short of calling it good... because I've got my own political axes to grind too, even if they are nearly diametrically opposed to the local consensus. But it isn't actually true that the American health system requires you to sign into indentured servitude the moment you walk in the emergency room door, and injects you with strychnine and tosses you out the door if you can't pay enough to satisfy the bureaucracy this week. Ambulance crews do not prowl the street and abduct unsuspecting European tourists and force them to donate blood before they're allowed to escape. Doctors do not actually giggle with glee and make "chaching!" noises when giving you bad diagnoses.

chimeracoder 9y ago
> Ambulance crews do not prowl the street and abduct unsuspecting European tourists and force them to donate blood before they're allowed to escape. Why would they? The US produces a surplus of blood and tissue, to the point that many other countries (particularly in Europe) have to purchase to from the US to address their own shortages.

ashark 9y ago

It's been incredibly bad for at least ~3 decades. A sick person with insurance without a dedicated advocate (relative or friend) watching out for them non-stop will likely end up having several care screw-ups occur to them, and with a bill ludicrously rather than just insanely large and probably a few things in collections (even if they can pay them) if said advocate doesn't spend a couple hundred hours fighting insurance and hospital billing and mailing regulators and wrestling a mountain of paperwork and bills. Watched this process with sick relatives in the 90s, and it was already fucked-up then. Gone through it with my wife's 3 pregnancies and a couple family illnesses in the last 5ish years. Same thing. It's a broken, evil system that ruthlessly exploits and crushes anyone without the time, wits, and wherewithal to fight it every step, and it has been for a long time. I think what changed is we have much better exposure to what it's like elsewhere, so more of us are aware that there is no reason whatsoever to keep hurting people this way.

deleted 9y ago
[deleted]
dogruck 9y ago
Good points. Which leads to the question, when everybody has "free" healthcare, who gets the top docs, and who gets the bottom and average docs?
- ashark 9y ago
  Not sure. How's it work in the entire rest of the OECD?
  - dogruck 9y ago
    The people with inside connections, more power, or who make extra payments get the top docs. Regular folk get the rest.
    - ashark 9y ago
      If that's true, then it's more or less the same, no?
      - dogruck 9y ago
        Agreed. Except I think the "free" setup is much more expensive.
        _Tev 9y ago
        Are you kidding? Look up how much US spends on healthcare and how much rest of the world does.
        dogruck 9y ago
        That's an impossible comparison -- "rest of the world." Is your point, "we spend so much today that we couldn't possibly spend more under a different legislative regime."?? Do you have a reference?

dfabulich 9y ago

It's a lot more expensive than it used to be. https://data.worldbank.org/indicator/SH.XPD.PCAP?locations=US https://data.worldbank.org/indicator/SH.XPD.PCAP?locations=U...

dogruck 9y ago
Ok, the price increased. And, let's ignore related factors such as the increased cost of medical education and advances in medical care (my aunt got a new heart a year ago!) My view of the mainstream story is that things went from ok to chaos within the past, say, 3 years. Instead, the costs have been steadily rising while voters have repeatedly opted not to make changes. Thought experiment: what if gas or milk prices had increased at the same rate? Education cost has increased a lot, but that's mostly inflated by student loans that I predict will implode like subprime mortgages.
- nto8e90nt3 9y ago
  > Instead, the costs have been steadily rising while voters have repeatedly opted not to make changes. Have voters done that, though? I mean look at the trouble Republicans are having repealing the ACA. Voters seem to not want to repeal it. It seems like only the Republican leadership actually wants it repealed. My understanding is that when you ask individual voters of all stripes, they agree that pre-existing conditions should not stop you from getting affordable healthcare, and that lifetime limits are unfair across the board. But those are the things the Republican leadership wants to axe first.
  - dogruck 9y ago
    Look at all the congressional seats the Democrats lost (and the POTUS seat) after Obama pushed through his plan. It's always harder to repeal a law, versus blocking it from passing. As soon as a law is passed, it's the new status quo. And recall how close the recent repeal vote was. Why haven't we repealed the laws against weed and poker yet?
    - 9y ago

typomatic 9y ago

People are getting relatively poorer in comparison to their health care costs. So yes, we have been getting worse, and at some point the character of a problem changes into a crisis, which can seem "sudden".

chimeracoder 9y ago
> People are getting relatively poorer in comparison to their health care costs. That's not really true; total expenditures have increased, but that's largely because the treatments and care that people are choosing are different (and more expensive) than previous ones. Put another way: today you can still get the same type and quality of care that was available in the 1960s, and it'll be cheaper than it was in the 1960s (measured in 2017 dollars). You just probably don't want it, because it's nowhere near the current expectations and standards of quality of care.
- dragonwriter 9y ago
  > Put another way: today you can still get the same type and quality of care that was available in the 1960s, No, in many cases you can't because the techniques and absence of procedural and other safeguards are no longer up to the standard of care in the profession, older drugs are no longer produced, etc.

dragonwriter 9y ago

> Strange how the US healthcare setup is largely unchanged over many years, yet the general perception is that it's suddenly total chaos. It's been horrible for a long time (and there's been outrage for a long-time: while it got derailed and we got nothing out of it but HIPAA, the bad state of healthcare and plans to reform it were central to the Clinton campaign in 1992—and while Clinton tried for a complicated scheme involving insurance companies, polling showed majority support for single-payer even then; the ACA is often pointed out to be a copy of Romneycare in Massachusetts, but what is less commonly pointed out is that both are copies of something proposed by the insurance industry and embraced by the Republican Party as a desirable national reform direction shortly after Clinton's reform effort failed, because even then it was widely perceived that something had to be done.) > I'm not saying the status quo is best, but we didn't suddenly plunge into a crisis. No, we've been in a crisis for more than a generation.

chimeracoder 9y ago
> what is less commonly pointed out is that both are copies of something proposed by the insurance industry and embraced by the Republican Party as a desirable national reform direction shortly after Clinton's reform effort failed It's less-commonly pointed out because it's not really true. It's true that there was one bill, in 1993, that was proposed by a Republican and which happened to somewhat resemble the Affordable Care Act at a very high level. However: a) It was proposed by a Republican senator from a very blue state (Rhode Island) b) That Republican senator lost his next re-election bid c) The bill never received a vote e) The bill was only one of many GOP-sponsored healthcare bills that year f) Conservative and moderate Republicans strongly criticized the bill g) While it bore some resemblance to the ACA at a very high level, it was a very different bill in details and implementation, so it's misleading to suggest that supporting one and not the other would be hypocritical. There were a lot of things Democrats like about the ACA that weren't in Chafee's bill, and there are a lot of things that Republicans might like in Chafee's bill (or the ANHRA in the House) that were not present in the ACA.
- dragonwriter 9y ago
  Sure, there were a number of different subsidized-private-insurance schemes over the years (including the one briefly rhetorically embraced by George W. Bush but, again, that never went far legislatively) that differed from the ACA model in that only HDHP/HSA plans would be subsdized. > so it's misleading to suggest that supporting one and not the other would be hypocritical I wasn't suggesting that, I was illustrating that the perceived problem and many elements of the potential solution space have been part of the national dialogue for a long time.

unclepresent 9y ago

Price of healthcare is driven by a luck of supply (medical professionals, hospitals, affordable drugs) and supply is limited by regulation (expensive and ridiculously long educational process for physicians, huge liability and regulatory burden for practitioners and hospitals, very long and expensive approval process for moving a new drug through FDA, plus again liability cost) . Regulation in turn is driven by lobbying efforts of large professional groups (trial lawyers, AMA, large pharma etc). In another word it is a corrupted system that manages stay afloat as people in power legally able to get their cut through lobbying.

deleted 9y ago
[deleted]