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And yet the data shows that when you leave the decision to regulators and bureaucrats, you seem to get better value for the healthcare dollar than if you let in

And yet the data shows that when you leave the decision to regulators and bureaucrats, you seem to get better value for the healthcare dollar than if you let individuals make their own decisions. The US, in particular, spends more and sees worse outcomes than other counties. This shouldn't be a surprise. An individual is going to not make very good decisions about how healthcare dollars are allocated over the course of their life. They're going to usually tend to underspend on preventative care (which has the highest ROI) and tend to overspend on end-of-life care (which has a lower ROI). You can see this played out in things like the US's infant mortality rate (3X other developed nations) and life expectancy (31st worldwide, declining).

pdonis 9y ago
> The US, in particular, spends more and sees worse outcomes than other counties. I think this "conclusion" depends strongly on how you define "worse outcomes". > An individual is going to not make very good decisions about how healthcare dollars are allocated over the course of their life. Not if they have no incentive to learn how, no. And our current system gives them no such incentive, since they don't control the dollars to begin with. In other words, the system complains that people don't do something that the system prevents them from doing.
- tomkarlo 9y ago
  It's not very hard to define "worse outcomes"... the US trails other developed nations in just about every wide-reaching healthcare metric at this point. If you have counter-examples, feel free to raise them. > In other words, the system complains that people don't do something that the system prevents them from doing. Uh, this has nothing to do with the system, and mostly everything to do with behavioral economics and risk pooling. People are poor at investing in preventative care, because the benefit is extremely hard to perceive at the individual level. And they over-invest in end of life care, because, well, they don't want to die. That's not the result of "the system", that's human nature. Attempting to build a healthcare system on how we "should" act instead of how we actually do isn't a plan.
  - emodendroket 9y ago
    In addition, the "market-based" proposals to address this problem mostly exacerbate it. The suggestion is always that patients need more "skin in the game" -- in other words, that they need to be responsible for even more costs out-of-pocket -- and yet it's completely predictable that fewer people are going to seek preventative care if they have trouble paying for medicine now. This also ends up being a pretty unfair way to apportion care because a rich man couldn't care less about a $100 fee and a poor man can find it prohibitive.
- s_kilk 9y ago
  > I think this "conclusion" depends strongly on how you define "worse outcomes". One example would be how the US has one of the worst infant mortality rates in the developed world.
  - noir_lord 9y ago
    Not to mention higher rates of preventable diseases, lower life expectancy and these are averages across the country. If you stratify by income then the lower end of the income scale have it far worse than equivalent cohorts in many other developed countries. I mean sure if you are upper middle class and work for a large national or international company then healthcare is probably up there with world class but that's not a lot of people percentage wise.
humanrebar 9y ago
> The US, in particular, spends more and sees worse outcomes than other counties. The person who has the most skin I the game, the patient and premium-payer, is not in the room when payments are negotiated. I don't think the U.S. is an example of enforcing skin-in-the-game.
- tomkarlo 9y ago
  What are you going to do, pre-negotiate rates for every possible medical procedure you might ever need? Because if you wait until you need it, it's going to be a pretty bad time to negotiate.
  - humanrebar 9y ago
    I didn't claim anything of the sort. I was just saying the current system is full of moral hazards and hardly market based.
    - emodendroket 9y ago
      I contend that the United States is the closest to an unregulated free-market system of any country in the OECD. It seems to me that if having a totally free market is a "cure-all," then a more free market ought to be a "cure-some," and yet we observe the opposite. Further, "skin in the game" is mostly a euphemism for increasing out-of-pocket prices for care to encourage patients to be "discriminating consumers," a concept I've already detailed my objection to.
      - humanrebar 9y ago
        I don't know why people keep setting up false equivalences and false dichotomies in these discussions. Just because single-payer systems are not market based doesn't mean other systems are. > Further, "skin in the game" is mostly a euphemism for increasing out-of-pocket prices for care to encourage patients to be "discriminating consumers," a concept I've already detailed my objection to. First "euphemism" implies some ulterior motive. I don't think people are trying to make people poorer. Hanlon's Razor would have us presume everyone at least thinks they have a mostly good idea. Next, if people were somehow using their own money, they'd also have the option of choosing something 10 or 20 percent more affordable, keeping the difference for other valuable things, like paying off a house, paying for grandkids' college, buying those plane tickets to see their cousins, etc. The reason there is no downward pressure to save on individual things (even predictable, non-emergency things like deviated septums) is because there's no best viable alternative. We don't keep the three grand we save by saying, "Hmmm... maybe I'll just lose 15 pounds instead." That's how things are supposed to work.

pdonis 9y ago

> The US, in particular, spends more and sees worse outcomes than other counties. I think this "conclusion" depends strongly on how you define "worse outcomes". > An individual is going to not make very good decisions about how healthcare dollars are allocated over the course of their life. Not if they have no incentive to learn how, no. And our current system gives them no such incentive, since they don't control the dollars to begin with. In other words, the system complains that people don't do something that the system prevents them from doing.

tomkarlo 9y ago
It's not very hard to define "worse outcomes"... the US trails other developed nations in just about every wide-reaching healthcare metric at this point. If you have counter-examples, feel free to raise them. > In other words, the system complains that people don't do something that the system prevents them from doing. Uh, this has nothing to do with the system, and mostly everything to do with behavioral economics and risk pooling. People are poor at investing in preventative care, because the benefit is extremely hard to perceive at the individual level. And they over-invest in end of life care, because, well, they don't want to die. That's not the result of "the system", that's human nature. Attempting to build a healthcare system on how we "should" act instead of how we actually do isn't a plan.
- emodendroket 9y ago
  In addition, the "market-based" proposals to address this problem mostly exacerbate it. The suggestion is always that patients need more "skin in the game" -- in other words, that they need to be responsible for even more costs out-of-pocket -- and yet it's completely predictable that fewer people are going to seek preventative care if they have trouble paying for medicine now. This also ends up being a pretty unfair way to apportion care because a rich man couldn't care less about a $100 fee and a poor man can find it prohibitive.
s_kilk 9y ago
> I think this "conclusion" depends strongly on how you define "worse outcomes". One example would be how the US has one of the worst infant mortality rates in the developed world.
- noir_lord 9y ago
  Not to mention higher rates of preventable diseases, lower life expectancy and these are averages across the country. If you stratify by income then the lower end of the income scale have it far worse than equivalent cohorts in many other developed countries. I mean sure if you are upper middle class and work for a large national or international company then healthcare is probably up there with world class but that's not a lot of people percentage wise.

humanrebar 9y ago

> The US, in particular, spends more and sees worse outcomes than other counties. The person who has the most skin I the game, the patient and premium-payer, is not in the room when payments are negotiated. I don't think the U.S. is an example of enforcing skin-in-the-game.

tomkarlo 9y ago
What are you going to do, pre-negotiate rates for every possible medical procedure you might ever need? Because if you wait until you need it, it's going to be a pretty bad time to negotiate.
- humanrebar 9y ago
  I didn't claim anything of the sort. I was just saying the current system is full of moral hazards and hardly market based.
  - emodendroket 9y ago
    I contend that the United States is the closest to an unregulated free-market system of any country in the OECD. It seems to me that if having a totally free market is a "cure-all," then a more free market ought to be a "cure-some," and yet we observe the opposite. Further, "skin in the game" is mostly a euphemism for increasing out-of-pocket prices for care to encourage patients to be "discriminating consumers," a concept I've already detailed my objection to.
    - humanrebar 9y ago
      I don't know why people keep setting up false equivalences and false dichotomies in these discussions. Just because single-payer systems are not market based doesn't mean other systems are. > Further, "skin in the game" is mostly a euphemism for increasing out-of-pocket prices for care to encourage patients to be "discriminating consumers," a concept I've already detailed my objection to. First "euphemism" implies some ulterior motive. I don't think people are trying to make people poorer. Hanlon's Razor would have us presume everyone at least thinks they have a mostly good idea. Next, if people were somehow using their own money, they'd also have the option of choosing something 10 or 20 percent more affordable, keeping the difference for other valuable things, like paying off a house, paying for grandkids' college, buying those plane tickets to see their cousins, etc. The reason there is no downward pressure to save on individual things (even predictable, non-emergency things like deviated septums) is because there's no best viable alternative. We don't keep the three grand we save by saying, "Hmmm... maybe I'll just lose 15 pounds instead." That's how things are supposed to work.