10 ms·

>> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't A l

>> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't A lot of people against socialized healthcare are perfectly aware of this cost shifting.

toomuchtodo 9y ago
[removed]
- dotancohen 9y ago
  GP is implying that it is those who would abuse such a system (or represent people who would abuse such a system) that are making those decisions.
  - deleted 9y ago
    [deleted]
  - topspin 9y ago
    I'll speak for myself. I meant what I wrote; putative opponents of 'socialized' healthcare are not, in fact, ignorant of the endemic cost shifting that occurs in medicine. My intent was to satisfy my probably foolish urge to disabuse people on the Internet of their cherished strawmen. Unfortunately I haven't the time today to indulge that compulsion further, so I'll bid you all adieu.
- adventured 9y ago
  > I’m just surprised their voice is so loud. It's a voice backed with $3.7 trillion in total economic value per year (18.x% of the $20 trillion US economy). In terms of size, it would just about be the fourth largest economy on earth, comparable to Germany. There are millions of very well paid hands in that pot of gold, from doctors & nurses to scientists and pharma sales reps, hospital admin and insurance industry employees. Consider for a moment that US drug costs - the most notorious example of abuse in US healthcare costs - are about 10-11% of the total US healthcare expenditure, and our per capita spending is about 2x what it should be: ie nearly everyone in healthcare is partaking in the plunder. That makes for a very loud voice.
darkerside 9y ago
Is there a reasonable alternative? I'm not trolling, but letting people die of treatable maladies doesn't seem like the right move.
- derefr 9y ago
  Make every hospital into two separate corporations, one a for-profit and the other a not-for-profit. Budget their revenue and expenses entirely separately. Intake government-enforced "charity cases" only to the not-for-profit. And then, don't allow the for-profit to loan or grant or shift any resources over to the not-for-profit. In fact, ensure they're not owned by the same parent corporation or even the same shareholders. Keep the logistics consolidated—everything flows through the for-profit's buyer—but then, have the for-profit rent its facilities and machinery, and provide its pre-acquired drugs and materials, to the not-for-profit at market price. And have the for-profit and not-for-profit hire the same employees and split their shifts; or perhaps, have the for-profit hire them, with the option to volunteer as many hours as they wish to the not-for-profit. (This would lower the expenses of the not-for-profit considerably.) In other words, leave the not-for-profit "twisting in the wind", where it's still running but nobody's paying for it, so it's just running at more and more of a loss each year. Try to minimize its costs—in fact, have people working for the not-for-profit entirely dedicated to trying to minimize its costs (successful strategies for which can be rolled back into the for-profit.) But also, treat the not-for-profit as a thing which needs to raise money, rather than just making revenue. A thing like a University, which has entire departments dedicated to getting funding from its alumni. Maybe even work with other not-for-profit hospitals in a Public Advocacy Coalition to build a social norm that if one of these not-for-profit hospitals saved your life, and you went on to great [monetary] success, you should donate to that hospital (and it will, in turn, privilege your family while pretending not to, just like Universities do.) A fun effect of this is that the not-for-profit will now be a large, visible advocate for cost-minimization in the for-profit's purchasing—since those costs will be passed on to them (so they'll be incentivized to lower them), but they can't just lower them by buying cheaper themselves (because they don't have their own purchasing/facilities management/IT/etc. departments), they'll instead have to figure out how the hospital as a whole can lower costs, in order for them to save any money. Essentially, this is doing the same thing that creating municipal vote districts along income lines does: the rich voters and the poor voters each get their own voices in how the city should be run, and so the poor voters (through their representative) get the chance to argue against proposals that would benefit the rich voters but hurt them. Right now, hospitals don't have any such representative for their "poor voters." --- (Yes, I know that a lot of hospitals are already not-for-profits. They're still run on a model that tries to maximize revenue, though, because they need that money. If you split the unprofitable patients out, suddenly the for-profit hospital can lower its prices, while the not-for-profit is forced to lower its costs.)
mulmen 9y ago
Isn't this a great argument for socialized (single-payer) systems? There is no price shifting in such a system, we all just pay in according to our ability as defined by the tax code.

toomuchtodo 9y ago

[removed]

dotancohen 9y ago
GP is implying that it is those who would abuse such a system (or represent people who would abuse such a system) that are making those decisions.
- deleted 9y ago
  [deleted]
- topspin 9y ago
  I'll speak for myself. I meant what I wrote; putative opponents of 'socialized' healthcare are not, in fact, ignorant of the endemic cost shifting that occurs in medicine. My intent was to satisfy my probably foolish urge to disabuse people on the Internet of their cherished strawmen. Unfortunately I haven't the time today to indulge that compulsion further, so I'll bid you all adieu.
adventured 9y ago
> I’m just surprised their voice is so loud. It's a voice backed with $3.7 trillion in total economic value per year (18.x% of the $20 trillion US economy). In terms of size, it would just about be the fourth largest economy on earth, comparable to Germany. There are millions of very well paid hands in that pot of gold, from doctors & nurses to scientists and pharma sales reps, hospital admin and insurance industry employees. Consider for a moment that US drug costs - the most notorious example of abuse in US healthcare costs - are about 10-11% of the total US healthcare expenditure, and our per capita spending is about 2x what it should be: ie nearly everyone in healthcare is partaking in the plunder. That makes for a very loud voice.

darkerside 9y ago

Is there a reasonable alternative? I'm not trolling, but letting people die of treatable maladies doesn't seem like the right move.

derefr 9y ago
Make every hospital into two separate corporations, one a for-profit and the other a not-for-profit. Budget their revenue and expenses entirely separately. Intake government-enforced "charity cases" only to the not-for-profit. And then, don't allow the for-profit to loan or grant or shift any resources over to the not-for-profit. In fact, ensure they're not owned by the same parent corporation or even the same shareholders. Keep the logistics consolidated—everything flows through the for-profit's buyer—but then, have the for-profit rent its facilities and machinery, and provide its pre-acquired drugs and materials, to the not-for-profit at market price. And have the for-profit and not-for-profit hire the same employees and split their shifts; or perhaps, have the for-profit hire them, with the option to volunteer as many hours as they wish to the not-for-profit. (This would lower the expenses of the not-for-profit considerably.) In other words, leave the not-for-profit "twisting in the wind", where it's still running but nobody's paying for it, so it's just running at more and more of a loss each year. Try to minimize its costs—in fact, have people working for the not-for-profit entirely dedicated to trying to minimize its costs (successful strategies for which can be rolled back into the for-profit.) But also, treat the not-for-profit as a thing which needs to raise money, rather than just making revenue. A thing like a University, which has entire departments dedicated to getting funding from its alumni. Maybe even work with other not-for-profit hospitals in a Public Advocacy Coalition to build a social norm that if one of these not-for-profit hospitals saved your life, and you went on to great [monetary] success, you should donate to that hospital (and it will, in turn, privilege your family while pretending not to, just like Universities do.) A fun effect of this is that the not-for-profit will now be a large, visible advocate for cost-minimization in the for-profit's purchasing—since those costs will be passed on to them (so they'll be incentivized to lower them), but they can't just lower them by buying cheaper themselves (because they don't have their own purchasing/facilities management/IT/etc. departments), they'll instead have to figure out how the hospital as a whole can lower costs, in order for them to save any money. Essentially, this is doing the same thing that creating municipal vote districts along income lines does: the rich voters and the poor voters each get their own voices in how the city should be run, and so the poor voters (through their representative) get the chance to argue against proposals that would benefit the rich voters but hurt them. Right now, hospitals don't have any such representative for their "poor voters." --- (Yes, I know that a lot of hospitals are already not-for-profits. They're still run on a model that tries to maximize revenue, though, because they need that money. If you split the unprofitable patients out, suddenly the for-profit hospital can lower its prices, while the not-for-profit is forced to lower its costs.)

mulmen 9y ago

Isn't this a great argument for socialized (single-payer) systems? There is no price shifting in such a system, we all just pay in according to our ability as defined by the tax code.