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Administrative = bureaucratic. Government-run healthcare has the same problems associated with heavily regulated sectors like our current healthcare system, bu

Administrative = bureaucratic. Government-run healthcare has the same problems associated with heavily regulated sectors like our current healthcare system, but to a much larger degree because of lack of incentives to improve performance. The way to decrease cost is decrease regulation and get rid of all the unnecessary paper pushers we have right now.

jjoonathan 8y ago
Back in Health Care Policy class I dug through these numbers and the opposite was true: bureaucratic overhead was much larger in the US system. The US system also wound up being twice as expensive overall. Has that changed or are you just repeating a talking point you heard somewhere? Markets serve the person with bargaining power. If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do -- why do you think a free-er market will give you a better deal?
- assblaster 8y ago
  The US system is a combination of heavily regulated private industry and government-run healthcare. The US is ridiculously more expensive than other countries precisely because of regulations and government-run bureaucracy (and defensive medicine, and poorly run bidding for drugs and equipment, and fraud). Government-run healthcare actually puts all the bargaining power in themselves, but they don't try to cut costs because that's not an incentive in government. Actually with government, the more you spend in one year, the more you get budgeted the next year. The worst way to run a government agency, in the eyes of bureaucrats is to run leaner than budget because your budget will be cut the next year. Doctors have very close to no bargaining power.
  - ionised 8y ago
    The US healthcare industry is more expensive simply because it is run for profit. There are plenty of other developed nations with regulation that manage to grant healthcare to all their citizens without the cluster-fuck the US makes out of the situation.
    - assblaster 8y ago
      Do these other countries ration their healthcare in any fashion? In other words, do they deny services in the name of cost savings? The United States rations health care, albeit covertly, but other countries ostensibly do it. Will Americans be ok with being denied services just to save money?
- chimeracoder 8y ago
  > Markets serve the person with bargaining power. If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do -- why do you think a free-er market will give you a better deal? Contrary to popular opinion, doctors have close to zero bargaining power in the US. That's why private practices have been rapidly shutting their doors over the last 10-15 years - they've been losing money, so they've had to sell their practices to large provider networks. But even those hospital networks don't have much bargaining power, which is why many of those have been going out of business and either shutting their doors or consolidating in the last 5-10 years.
  - randysavage 8y ago
    Anecdotal, but I worked for a specialty EMR and consolidation was the big trend at the time (~2010). Lots of one-offs and small chains getting acquired and folded into larger networks. Many of these smaller providers were either not or barely profitable and we saw plenty of others go under. Long term strategy for the EMR was focusing on the hospital networks because the trend seemed clear at the time.
  - jjoonathan 8y ago
    My point: the consumers are powerless. Whether doctors are individually powerful or only powerful as a member of an organization is entirely tangential, except in that the consumer is even less powerful in the second case. EDIT: I now have two people providing evidence that actually reinforces my core point in order to argue with me about a synechdoche. I don't know whether to laugh or cry.
    - chimeracoder 8y ago
      > My point: the consumers are powerless. Yes, but that's a far cry from saying the doctors are powerful. They're not. They're powerless too. > Whether doctors are individually powerful or only powerful as a member of an organization is entirely tangential. Doctors are neither powerful as individuals nor as members of any organization. Despite common misconception, they have almost as little power as patients do.
- Someone 8y ago
  ”If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do” Not everywhere. It’s miles away from what people in the USA think they want, but governments can intervene on behalf of patients. https://www.government.nl/topics/medicines/keeping-medicines-affordable https://www.government.nl/topics/medicines/keeping-medicines...: ”The Ministry of Health, Welfare and Sport and the Healthcare Institute of the Netherlands decide what drugs fall under the standard health insurance package […] The Netherlands and Belgium are going to jointly negotiate lower drug prices with pharmaceutical companies. Together, the two countries represent a larger group of patients. This will make it easier for them to negotiate lower prices with drug companies. They will especially try to negotiate lower prices for expensive medicines, including orphan drugs which are used to treat rare diseases.“
- wu-ikkyu 8y ago
  >If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do -- why do you think a free-er market will give you a better deal? Much of that bargaining power has been given to them by the government which denies your human right to medicine without their blessing. Patent laws, forcing you to go to a doctor to get medicine, and the arbitrary prohibition of unprofitable/unpatentable medicines like cannabis all contribute to their bargaining power.
wpdev_63 8y ago
Ideally you would be able to get a cash based health insurance policy where they would have a doctor diagnose you quickly/cheaply and then give you the cash to pay the doctor yourself. This way you could fly to different countries for cheaper care. That's what I would do anyways.

jjoonathan 8y ago

Back in Health Care Policy class I dug through these numbers and the opposite was true: bureaucratic overhead was much larger in the US system. The US system also wound up being twice as expensive overall. Has that changed or are you just repeating a talking point you heard somewhere? Markets serve the person with bargaining power. If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do -- why do you think a free-er market will give you a better deal?

assblaster 8y ago
The US system is a combination of heavily regulated private industry and government-run healthcare. The US is ridiculously more expensive than other countries precisely because of regulations and government-run bureaucracy (and defensive medicine, and poorly run bidding for drugs and equipment, and fraud). Government-run healthcare actually puts all the bargaining power in themselves, but they don't try to cut costs because that's not an incentive in government. Actually with government, the more you spend in one year, the more you get budgeted the next year. The worst way to run a government agency, in the eyes of bureaucrats is to run leaner than budget because your budget will be cut the next year. Doctors have very close to no bargaining power.
- ionised 8y ago
  The US healthcare industry is more expensive simply because it is run for profit. There are plenty of other developed nations with regulation that manage to grant healthcare to all their citizens without the cluster-fuck the US makes out of the situation.
  - assblaster 8y ago
    Do these other countries ration their healthcare in any fashion? In other words, do they deny services in the name of cost savings? The United States rations health care, albeit covertly, but other countries ostensibly do it. Will Americans be ok with being denied services just to save money?
chimeracoder 8y ago
> Markets serve the person with bargaining power. If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do -- why do you think a free-er market will give you a better deal? Contrary to popular opinion, doctors have close to zero bargaining power in the US. That's why private practices have been rapidly shutting their doors over the last 10-15 years - they've been losing money, so they've had to sell their practices to large provider networks. But even those hospital networks don't have much bargaining power, which is why many of those have been going out of business and either shutting their doors or consolidating in the last 5-10 years.
- randysavage 8y ago
  Anecdotal, but I worked for a specialty EMR and consolidation was the big trend at the time (~2010). Lots of one-offs and small chains getting acquired and folded into larger networks. Many of these smaller providers were either not or barely profitable and we saw plenty of others go under. Long term strategy for the EMR was focusing on the hospital networks because the trend seemed clear at the time.
- jjoonathan 8y ago
  My point: the consumers are powerless. Whether doctors are individually powerful or only powerful as a member of an organization is entirely tangential, except in that the consumer is even less powerful in the second case. EDIT: I now have two people providing evidence that actually reinforces my core point in order to argue with me about a synechdoche. I don't know whether to laugh or cry.
  - chimeracoder 8y ago
    > My point: the consumers are powerless. Yes, but that's a far cry from saying the doctors are powerful. They're not. They're powerless too. > Whether doctors are individually powerful or only powerful as a member of an organization is entirely tangential. Doctors are neither powerful as individuals nor as members of any organization. Despite common misconception, they have almost as little power as patients do.
Someone 8y ago
”If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do” Not everywhere. It’s miles away from what people in the USA think they want, but governments can intervene on behalf of patients. https://www.government.nl/topics/medicines/keeping-medicines-affordable https://www.government.nl/topics/medicines/keeping-medicines...: ”The Ministry of Health, Welfare and Sport and the Healthcare Institute of the Netherlands decide what drugs fall under the standard health insurance package […] The Netherlands and Belgium are going to jointly negotiate lower drug prices with pharmaceutical companies. Together, the two countries represent a larger group of patients. This will make it easier for them to negotiate lower prices with drug companies. They will especially try to negotiate lower prices for expensive medicines, including orphan drugs which are used to treat rare diseases.“
wu-ikkyu 8y ago
>If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do -- why do you think a free-er market will give you a better deal? Much of that bargaining power has been given to them by the government which denies your human right to medicine without their blessing. Patent laws, forcing you to go to a doctor to get medicine, and the arbitrary prohibition of unprofitable/unpatentable medicines like cannabis all contribute to their bargaining power.

wpdev_63 8y ago

Ideally you would be able to get a cash based health insurance policy where they would have a doctor diagnose you quickly/cheaply and then give you the cash to pay the doctor yourself. This way you could fly to different countries for cheaper care. That's what I would do anyways.