3 ms·

The primary mechanism by which money is saved is price controls, under a single payer system. This should be extremely scary. And I'm saying this as someone who

The primary mechanism by which money is saved is price controls, under a single payer system. This should be extremely scary. And I'm saying this as someone who voted for Obama in 08, 12 and HRC in 16. Healthcare products are complicated. Getting the price right is a very hard problem. Markets, generally speaking, have proven to be a fairly effective way of settling on price. This is basic economics.

divbit 9y ago
At one point I read that the british universal system is actually cheaper per-person than the US market determined system. Sorry I don't have a reference for that, but anecdotally, I can recall several stories of simple items like "saline solution" receiving excessive markup in the market system because it would all be covered by the insurance anyway. I wish some more knowledgeable healthcare people can comment here.
- fatbird 9y ago
  https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... backed up by lots of solid references. TL;DR for 2015, US per capita spending was $9,451; Canada was $4,608; U.K. was $4,003. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Using life expectancy as a basket proxy for average effectiveness of care, Canada is 12th, the U.K. 20th, and the United States 31st. It's broadly accepted that on average, medical outcomes are generally better for pretty much every indicator (infant mortality, length of hospital stay, etc.) in countries with effective universal health care, at much less the price.
  - divbit 9y ago
    Ah thank you.
maxxxxx 9y ago
From my experience the US health care market is not a functioning market. No price transparency, widely variable prices for the same thing, huge and inefficient bureaucracy. It would be interesting to see if there was regulation for open pricing, billing standards and others. If that doesn't happen, Medicare for all is definitely a good option.
- methodover 9y ago
  I totally agree with everything you said except that last sentence. Insurance seems to be something of a failure as is. That said, MFA seems like just another insurance system. Except customers can never opt out of it, never develop a competing system, and are now bound to its inefficiencies forever.
  - slamdance 9y ago
    Medicare & Medicaid has always been an option for everyone - its just that if you made too much money, then you didn't qualify. It was a safety net for the poorest people. It was not meant for students just out of school (who presumably had skills to get a job with benefits) or people who are perfectly happy not progressing or producing in their lives (which is fine, just don't demand that "society" pays for everything).
0xbear 9y ago
It's a low information market with zero competition. Allow import of drugs. Allow insurance to operate across state lines. That's what Trump was suggesting during his campaign. I'd go further, though, and stimulate the flow of information. Picking a doctor right now is a freaking nightmare, all you have to go on is what the doctor says about herself, yet insurance companies sit on tons of data they are unable to use and unwilling to share. Costs, outcomes, malpractice rates - it's all there, you just need to give a shit, which insurance companies do not.
- maxxxxx 9y ago
  If there was one useful regulation it would be to mandate opening up all costs and quality data. A lot of people won't like that but until then the US health market doesn't deserve the name "market"

divbit 9y ago

At one point I read that the british universal system is actually cheaper per-person than the US market determined system. Sorry I don't have a reference for that, but anecdotally, I can recall several stories of simple items like "saline solution" receiving excessive markup in the market system because it would all be covered by the insurance anyway. I wish some more knowledgeable healthcare people can comment here.

fatbird 9y ago
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... backed up by lots of solid references. TL;DR for 2015, US per capita spending was $9,451; Canada was $4,608; U.K. was $4,003. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Using life expectancy as a basket proxy for average effectiveness of care, Canada is 12th, the U.K. 20th, and the United States 31st. It's broadly accepted that on average, medical outcomes are generally better for pretty much every indicator (infant mortality, length of hospital stay, etc.) in countries with effective universal health care, at much less the price.
- divbit 9y ago
  Ah thank you.

maxxxxx 9y ago

From my experience the US health care market is not a functioning market. No price transparency, widely variable prices for the same thing, huge and inefficient bureaucracy. It would be interesting to see if there was regulation for open pricing, billing standards and others. If that doesn't happen, Medicare for all is definitely a good option.

methodover 9y ago
I totally agree with everything you said except that last sentence. Insurance seems to be something of a failure as is. That said, MFA seems like just another insurance system. Except customers can never opt out of it, never develop a competing system, and are now bound to its inefficiencies forever.
- slamdance 9y ago
  Medicare & Medicaid has always been an option for everyone - its just that if you made too much money, then you didn't qualify. It was a safety net for the poorest people. It was not meant for students just out of school (who presumably had skills to get a job with benefits) or people who are perfectly happy not progressing or producing in their lives (which is fine, just don't demand that "society" pays for everything).

0xbear 9y ago

It's a low information market with zero competition. Allow import of drugs. Allow insurance to operate across state lines. That's what Trump was suggesting during his campaign. I'd go further, though, and stimulate the flow of information. Picking a doctor right now is a freaking nightmare, all you have to go on is what the doctor says about herself, yet insurance companies sit on tons of data they are unable to use and unwilling to share. Costs, outcomes, malpractice rates - it's all there, you just need to give a shit, which insurance companies do not.

maxxxxx 9y ago
If there was one useful regulation it would be to mandate opening up all costs and quality data. A lot of people won't like that but until then the US health market doesn't deserve the name "market"