10 ms·

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.)
- oconnor663 9y ago
  Finding a way to just give needy people money, and then have them participate in the same system as everyone else, seems much simpler than trying to build 2 systems in 1. Granted there are plenty of problems in getting for-profit medicine to work for people with average income, but assuming you could wave a magic wand and solve those problems...
  - derefr 9y ago
    The problem as it stands is that no agent in the system sees an incentive to do so, because the people having problems are invisible to their preference functions. Consider the aphorism "the squeaky wheel gets the grease." Why is this an aphorism? Because squeaky wheels are annoying. If the people who use the wheels have to hear them squeak, they'll soon oil them. So if you hear a squeaky wheel (for example, on a shopping cart), that's usually because the people with the oil don't ever have to get close enough to hear that squeak. Proposals like Basic Income, or even welfare, basically translate to "greasing all the wheels on a regular schedule, whether you've heard them squeak or not"—i.e., fixing problems that aren't actually bothering you personally. It's nearly impossible to incentivize anyone to do that. My proposal here is more in terms of "ensuring when manufacturing wheels that they will squeak as loudly as possible when they've begun failing." You want to solve the shopping-cart case, where the person with the oil isn't the person who has to use the cart. And the best way to do that is to ensure that the customers will be too irritated by the squeaking to actually use the carts; and therefore the carts will go disused; and therefore the customers will complain to the cashiers that there are no carts, and people will buy less than they would with a cart, and revenue will go down, and some stakeholder will notice, and gather information, and figure out that it's that all the carts are squeaking horribly, and so oil them. Or, in other words, you want the squeak of "people not getting treated because they don't have the money" to be loud enough to actually make it all the way up to the hospital's CFO, where the squeaking will cause cost-cutting; and even further, to the city surrounding the hospital, where the squeaking will cause donating. In fact, if you oil the carts regularly, you might not realize that your wheels are badly-made and are rusting prematurely; or that your parking lot needs a regular dust-blower-ing; or whatever else. Sensitive components—canaries in coal mines, or people with no money in poor health—show you where your system is weakest. If you eliminate them (by just providing UBI, or even just public healthcare), you eliminate the chance to observe where your system fails. In a country with more money than it knows what to do with, this is probably a sensible approach—it has fewer people suffer over the short term, after all, at the expense of a bloated, bureaucratic medical system. But if you're trying to figure out how to cut those costs, you need the squeaking.
creaghpatr 9y ago
Would you rather the market or the government make that choice for you?
- 8note 9y ago
  I want somebody who benefits from me being healthy on a long term to choose for me.
- cycrutchfield 9y ago
  False dichotomy. Please try to avoid logical fallacies when posting.
  - creaghpatr 9y ago
    People seem awfully confused about who pays for healthcare in the US so let's be clear: either the government or the market (consumers) pays for healthcare, or they do it in tandem. I don't have a view on who should pay for it, but there are only 3 categories of payers in healthcare: 1 government and 2 private (insurance and self-pay). The compensation is funded by one of those sources.
    - pessimizer 9y ago
      People also seem awfully confused about how much the government currently spends on healthcare: the US government currently spends roughly as much per-capita on healthcare as socialized systems that cover the entire cost of healthcare for their citizens, and have better measured outcomes. The crippling healthcare costs borne by individuals entirely consist of rent-seeking. It's also important to say that a lot of that money comes back out in salaries for the massive workforce required for the unnecessary administrative overhead, adding to the economy, and of course in non-imported luxury goods purchased by the rent-seekers themselves.
    - cycrutchfield 9y ago
      So, to summarize, the person you replied to above asked what is the reasonable alternative to socialized healthcare that does not include people dying in the streets of treatable maladies. And through your explanation it appears as though you replied with a tautological statement that had no bearing on the question being asked. So, what is it that you are actually trying to say?
kendallpark 9y ago
I don't understand why you're getting downvoted. The way the system works right now, I don't think the hospitals really have a choice. I'm hoping this new cost-transparency will raise more awareness at the patient-level which will in turn push for more discussion. There ARE a lot of alternatives to the current system. Canada, France, the Netherlands, and Singapore are good examples to look at--very different systems, all far more cost-effective than ours.
- dv_dt 9y ago
  All first world and many second world systems are more cost effective than the US healthcare system...
- ksenzee 9y ago
  If we're looking for good examples, let's keep France and toss Canada. I maintain that Canada's system is one of the main reasons the US doesn't go single-payer. We're close enough to see how bad it is, and people assume all single-payer systems are like that. I'd rather have single-payer than the mess we have now, but not if we end up like Canada. Three months wait for an MRI? No prescription coverage? No mental health coverage? No thank you.
  - Garfgon 9y ago
    And the US system is one of the main reasons there's resistance to loosening single-payer in Canada. Wait times for MRIs (and other procedures) depends on need -- low priority cases will get bumped for more immediate issues. Psychiatrists _are_ covered under MSP (with a referral), although psychologists & counselors are (generally) not. But non-government insurance plans will often cover them as well as prescriptions and other non covered services. Such extended medical plans are often a work benefit (like in the US).
sampo 9y ago
> Is there a reasonable alternative? What most other countries are doing: Fund healthcare from tax money. The middle class will anyway pay for the healthcare of those who can't pay for themselves. In other countries they pay in taxes, in the US they pay for it in their own higher medical bills. This is a matter of an opinion of course. But most Europeans would opine that the American model is the unreasonable alternative.
- narrator 9y ago
  The American health care system also costs double as a percent of GDP vs every other modern country's health care system so spending more money on it is not going to fix things. Arguing about who pays is easy.
  - kittiepryde 9y ago
    Paying for more preventative care, instead of the care required in the ER after the health issue became too serious, should help bring costs down.
    - ksenzee 9y ago
      Possibly. There was a study on this in Oregon, and the data suggested that people who use the ER for their primary medical care keep doing so even after they're insured: https://www.npr.org/sections/health-shots/2016/10/19/498526110/emergency-room-use-stays-high-in-oregon-medicaid-study https://www.npr.org/sections/health-shots/2016/10/19/4985261...
      - vilmosi 9y ago
        Insurance has co-pays, does it not? People who use ER as their primary medical care would avoid that if possible.
      - lowbloodsugar 9y ago
        "People who self selected to apply for free medical care used it", study finds. More at 11. People who self selected for free medical care didn't have much better health outcome than others who were not selected, except that they didn't go bankrupt. So, the group that didn't get paid for didn't go to the ER, while the group that did get paid for went to the ER but didn't have better health outcomes than those that didn't. Surely that says something about the private, for profit institutions that run the ER business.
tedunangst 9y ago
Are grocery stores required to give free food to the hungry?
- DanBC 9y ago
  1) It's coming https://www.theguardian.com/world/2016/feb/04/french-law-forbids-food-waste-by-supermarkets https://www.theguardian.com/world/2016/feb/04/french-law-for... 2) Many shops in UK (especially London), run by Muslim or Seikh owners, have been feeding hungry people for years.
  - tathougies 9y ago
    Most American grocery stores (at least in California, which is what I know of) run by anyone give their food away for free, as it approaches expiry. Choosing to do so is a lot different than being mandated to.
- jdavis703 9y ago
  No, but most grocery stores do take EBT (for those outside the U.S., it's food assistance).
- yborg 9y ago
  Most grocery stores aren't non-profits that are exempt from taxes. Many hospitals are.
Symmetry 9y ago
If there's some social good the government is pursuing it should, as much as possible, be done through taxation and spending rather than rules that the government hopes will accomplish the same thing in a way where they hope voters don't notice the indirect costs.

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.)

oconnor663 9y ago
Finding a way to just give needy people money, and then have them participate in the same system as everyone else, seems much simpler than trying to build 2 systems in 1. Granted there are plenty of problems in getting for-profit medicine to work for people with average income, but assuming you could wave a magic wand and solve those problems...
- derefr 9y ago
  The problem as it stands is that no agent in the system sees an incentive to do so, because the people having problems are invisible to their preference functions. Consider the aphorism "the squeaky wheel gets the grease." Why is this an aphorism? Because squeaky wheels are annoying. If the people who use the wheels have to hear them squeak, they'll soon oil them. So if you hear a squeaky wheel (for example, on a shopping cart), that's usually because the people with the oil don't ever have to get close enough to hear that squeak. Proposals like Basic Income, or even welfare, basically translate to "greasing all the wheels on a regular schedule, whether you've heard them squeak or not"—i.e., fixing problems that aren't actually bothering you personally. It's nearly impossible to incentivize anyone to do that. My proposal here is more in terms of "ensuring when manufacturing wheels that they will squeak as loudly as possible when they've begun failing." You want to solve the shopping-cart case, where the person with the oil isn't the person who has to use the cart. And the best way to do that is to ensure that the customers will be too irritated by the squeaking to actually use the carts; and therefore the carts will go disused; and therefore the customers will complain to the cashiers that there are no carts, and people will buy less than they would with a cart, and revenue will go down, and some stakeholder will notice, and gather information, and figure out that it's that all the carts are squeaking horribly, and so oil them. Or, in other words, you want the squeak of "people not getting treated because they don't have the money" to be loud enough to actually make it all the way up to the hospital's CFO, where the squeaking will cause cost-cutting; and even further, to the city surrounding the hospital, where the squeaking will cause donating. In fact, if you oil the carts regularly, you might not realize that your wheels are badly-made and are rusting prematurely; or that your parking lot needs a regular dust-blower-ing; or whatever else. Sensitive components—canaries in coal mines, or people with no money in poor health—show you where your system is weakest. If you eliminate them (by just providing UBI, or even just public healthcare), you eliminate the chance to observe where your system fails. In a country with more money than it knows what to do with, this is probably a sensible approach—it has fewer people suffer over the short term, after all, at the expense of a bloated, bureaucratic medical system. But if you're trying to figure out how to cut those costs, you need the squeaking.

creaghpatr 9y ago

Would you rather the market or the government make that choice for you?

8note 9y ago
I want somebody who benefits from me being healthy on a long term to choose for me.
cycrutchfield 9y ago
False dichotomy. Please try to avoid logical fallacies when posting.
- creaghpatr 9y ago
  People seem awfully confused about who pays for healthcare in the US so let's be clear: either the government or the market (consumers) pays for healthcare, or they do it in tandem. I don't have a view on who should pay for it, but there are only 3 categories of payers in healthcare: 1 government and 2 private (insurance and self-pay). The compensation is funded by one of those sources.
  - pessimizer 9y ago
    People also seem awfully confused about how much the government currently spends on healthcare: the US government currently spends roughly as much per-capita on healthcare as socialized systems that cover the entire cost of healthcare for their citizens, and have better measured outcomes. The crippling healthcare costs borne by individuals entirely consist of rent-seeking. It's also important to say that a lot of that money comes back out in salaries for the massive workforce required for the unnecessary administrative overhead, adding to the economy, and of course in non-imported luxury goods purchased by the rent-seekers themselves.
  - cycrutchfield 9y ago
    So, to summarize, the person you replied to above asked what is the reasonable alternative to socialized healthcare that does not include people dying in the streets of treatable maladies. And through your explanation it appears as though you replied with a tautological statement that had no bearing on the question being asked. So, what is it that you are actually trying to say?

kendallpark 9y ago

I don't understand why you're getting downvoted. The way the system works right now, I don't think the hospitals really have a choice. I'm hoping this new cost-transparency will raise more awareness at the patient-level which will in turn push for more discussion. There ARE a lot of alternatives to the current system. Canada, France, the Netherlands, and Singapore are good examples to look at--very different systems, all far more cost-effective than ours.

dv_dt 9y ago
All first world and many second world systems are more cost effective than the US healthcare system...
ksenzee 9y ago
If we're looking for good examples, let's keep France and toss Canada. I maintain that Canada's system is one of the main reasons the US doesn't go single-payer. We're close enough to see how bad it is, and people assume all single-payer systems are like that. I'd rather have single-payer than the mess we have now, but not if we end up like Canada. Three months wait for an MRI? No prescription coverage? No mental health coverage? No thank you.
- Garfgon 9y ago
  And the US system is one of the main reasons there's resistance to loosening single-payer in Canada. Wait times for MRIs (and other procedures) depends on need -- low priority cases will get bumped for more immediate issues. Psychiatrists _are_ covered under MSP (with a referral), although psychologists & counselors are (generally) not. But non-government insurance plans will often cover them as well as prescriptions and other non covered services. Such extended medical plans are often a work benefit (like in the US).

sampo 9y ago

> Is there a reasonable alternative? What most other countries are doing: Fund healthcare from tax money. The middle class will anyway pay for the healthcare of those who can't pay for themselves. In other countries they pay in taxes, in the US they pay for it in their own higher medical bills. This is a matter of an opinion of course. But most Europeans would opine that the American model is the unreasonable alternative.

narrator 9y ago
The American health care system also costs double as a percent of GDP vs every other modern country's health care system so spending more money on it is not going to fix things. Arguing about who pays is easy.
- kittiepryde 9y ago
  Paying for more preventative care, instead of the care required in the ER after the health issue became too serious, should help bring costs down.
  - ksenzee 9y ago
    Possibly. There was a study on this in Oregon, and the data suggested that people who use the ER for their primary medical care keep doing so even after they're insured: https://www.npr.org/sections/health-shots/2016/10/19/498526110/emergency-room-use-stays-high-in-oregon-medicaid-study https://www.npr.org/sections/health-shots/2016/10/19/4985261...
    - vilmosi 9y ago
      Insurance has co-pays, does it not? People who use ER as their primary medical care would avoid that if possible.
    - lowbloodsugar 9y ago
      "People who self selected to apply for free medical care used it", study finds. More at 11. People who self selected for free medical care didn't have much better health outcome than others who were not selected, except that they didn't go bankrupt. So, the group that didn't get paid for didn't go to the ER, while the group that did get paid for went to the ER but didn't have better health outcomes than those that didn't. Surely that says something about the private, for profit institutions that run the ER business.

tedunangst 9y ago

Are grocery stores required to give free food to the hungry?

DanBC 9y ago
1) It's coming https://www.theguardian.com/world/2016/feb/04/french-law-forbids-food-waste-by-supermarkets https://www.theguardian.com/world/2016/feb/04/french-law-for... 2) Many shops in UK (especially London), run by Muslim or Seikh owners, have been feeding hungry people for years.
- tathougies 9y ago
  Most American grocery stores (at least in California, which is what I know of) run by anyone give their food away for free, as it approaches expiry. Choosing to do so is a lot different than being mandated to.
jdavis703 9y ago
No, but most grocery stores do take EBT (for those outside the U.S., it's food assistance).
yborg 9y ago
Most grocery stores aren't non-profits that are exempt from taxes. Many hospitals are.

Symmetry 9y ago

If there's some social good the government is pursuing it should, as much as possible, be done through taxation and spending rather than rules that the government hopes will accomplish the same thing in a way where they hope voters don't notice the indirect costs.