8 ms·

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, somet

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy. There are legions of people around the USA bribing doctors to prescribe expensive generics. Until that practise is stopped the US system is sunk. For insurance to work, US doctors must follow national guidelines laid out by a scientific body (ie NICE in the UK) any deviation without justification would/should lead to fines and censure. They would set out a list of drugs that work for certain conditions, anything else is either poor value for money, or the wrong drug. The very fact that medicare is legally barred from negotiating volume discount tells you that some deeply wrong has happened.

ameister14 8y ago
>For insurance to work, US doctors must follow national guidelines laid out by a scientific body (ie NICE in the UK) any deviation without justification would/should lead to fines and censure. I don't think that's necessary for insurance to work - I think it's necessary for medicine to get cheaper. If I want a specialist to treat me as an individual and potentially prescribe something outside the norm, I should be able to pay a premium for that, and the doctor should be allowed to do it if it is going to work without threat of fines or censure because they didn't choose the cheaper option.
- SmellyGeekBoy 8y ago
  This sounds like private healthcare in the UK. Many treatments and drugs that haven't been approved yet or deemed cost effective for the NHS are available from private providers and can be paid for out-of-pocket or by insurance - relatively cheap insurance because it has to compete with free (at point of use, lets not get into that debate).
- deleted 8y ago
  [deleted]
will_brown 8y ago
>The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy Unknown to almost everyone in the US is that if you are a Medicare patient, when you go to fill a Rx before the pharmacist fills the therapy, insurance software suggests cheaper generics to the pharmacist and requires the pharmacist to do the leg work of asking the doctor to change the Rx based on what the insurance company wants (ie the cheaper medication). So the question might be..why would a pharmacist do what the insurance company software tells them... or why would a doctor second guess their initial Rx at the request of an insurance company trying to minimize their costs? Because if the pharmacist/pharmacy doesn’t do what insurance says or if the doctor doesn’t do what insurance says, they get dropped from the insurance network.
- patmcc 8y ago
  While I agree insurance companies do harm, encouraging generics is probably a net benefit. Doctors, just like anyone else, respond to marketing, so they remember 'viagra' more easily than 'sildenafil' and write prescriptions accordingly. There's often no medical reason a generic isn't 100% suitable.
  - will_brown 8y ago
    The insurance companies are not recommending generics because it’s cheaper for the patient...they do it because it’s cheaper for them. There are many reasons generics, especially in the case of Medicare patients with chronic conditions, are worse for a patient. Generally if you have a Medicare patientwith chronic conditions such as diabeties and/or high blood pressure, and their physician has successfully been managing their conditions using a name brand therapy, it’s not good practice to switch their therapy to a generic because it helps the insurance company. More importantly, it’s only the active ingredients in name brand drugs and generics that are the same. coloring agents, binders, etc... are different and those can have significant negative side effects. There is no shortage of examples of generics having worse outcomes in the case of chronic conditions. Also it’s not just the therapy the insurance is changing, they also change the quantity. So again say you are a Medicare patient with type 2 diabetes and your doc prescribed 30 day Rx so you come back for the doc to check your blood work between fills, insurance is demanding the doctor change the Rx from 30 days to 90 days, because they don’t want to pay for the additional doctor appointment/blood work. They are watering down care and interfering with doctor/patient treatments.
fwip 8y ago
There isn't always an objective best treatment for a patient. Doctors should have license to use their knowledge of the patient and accumulated wisdom to prescribe what they think would be most helpful. We have a list of drugs that work, it's the list of FDA-approved drugs. Insurance will already try to get out of paying for anything that doesn't seem "normal."
- Wowfunhappy 8y ago
  > We have a list of drugs that work, it's the list of FDA-approved drugs. Which doesn't take price into account. And there's no reason for the patient or doctor to take price into account when insurance is paying for 95%+ of the cost. This is the classic "someone else's money" problem.
Ericson2314 8y ago
It's not quite insurance. Firstly, this is a relationship between the government/insurance companies and the drug companies. The people (however flawed) already have insurance. For those organizations, drugs aren't risk, and they are paying in bigger lumps, so this is closer to the opposite of insurance. It's constant price gouging mitigation. There's a slight difference since nexflix entirely covers the marginal cost per item consumed. If we had drug bounties, the drug companies could become entirely R&D outfits, with boring old chemical companies doing the pill manufacturering. Over time, if the existing companies lose their manufacturing ability, they will need more dependent on this arrangement. Finally, it removes the perverse incentive against cures/innoculations and for rest-of-your-life migrations.
tathougies 8y ago
> US doctors must follow national guidelines laid out by a scientific body No thanks. My daughter is alive today thanks to a therapy that would not be sanctioned by 'standards bodies'. I'm good. Thank goodness her doctor was a professional that was able to make professional judgements. If you want to reduce doctoring to looking up values in a dictionary, I suggest you try that with you and yours first, before forcing it on everyone else.
- simonebrunozzi 8y ago
  Do you mind sharing some details, without naming names? I'm curious to know more about the specific issue.
  - tathougies 8y ago
    Sure. My wife had lost several pregnancies, including late losses. All sudden. There was no explanation ... tests all normal. Went to several MFMs at UCSF, Stanford, Mayo Clinic, etc, who told us that there was no evidence backed treatment to offer. Her obstetrician (been in practice almost 50 years) told my wife that she had a blood clotting disorder (although the tests certainly did not indicate that, at all). She was rather confident in this given the way we lost babies (hearts stopped overnight), but again, this was not evidence backed, because of a lack of diagnostic tests showing a clotting disorder. However, her OB came from a time when medicine meant looking at symptoms, not just tests. Her OB told her that since the time she was in practice many of her patients who lost babies this way ended up being diagnosed with clotting disorders many decades after the fact, because we are always discovering new thrombophilia risks, but that either way, they were successful in just using anti-clotting agents. The treatment for clots during pregnancy is a daily injection called enoxaparin, which is rather expensive ($400/wk for 40 weeks), so insurance certainly does not want to pay. Well, long story short, after seven pregnancy losses, she did the injections, and had a pretty textbook pregnancy. Of course, after we had the baby, all the 'evidence-based' doctors changed their tune and now insist that enoxaparin is a necessity if she wants to get pregnant again. Not just for the baby either, but for her health (since blood clots can lead to pretty sudden death for mothers). So, yeah, basically her OBs advice, which was based entirely on intuition and five decades of actual clinical practice, saved both the lives of my daughter and in some ways my wife (again, she may have been at risk of clots during previous pregnancies). Ultimately, medicine is not just about knowing what's in a book. These days, most medical knowledge is available for free online. When we went to UCSF, Stanford, and the Mayo Clinic, the 'care' we received included having the various conditions that can harm second-trimester fetuses listed for us and then we were explained why my wife did not have them. Of course, all these conditions we already knew about because of reading comprehension. I would not classify the information we got there as 'professional', because it was really a simple matter of looking up data in an index. On the other hand, her OBs care was actual professional care. We pay our doctors to give their opinion on our care based not just on what the books say but also based on what they have learned. An insistence on 'evidence-based' care reduces the ability for doctors to actually treat patients, and will -- inevitably, even if it takes some decades -- lead to a lack of evidence as new generations of doctors become less trusting of their intuition and more reliant on external validation. EDIT: to be clear, it's not just a lack of evidence this treatment works. Several large-scale studies have been done in the United States and Europe (esp Britain) to see whether this therapy works at all. In Britain, where the NHS was considering this as a treatment for recurrent loss in the absence of diagnosis, the studies showed that the treatment was not effective, hence the NHS wouldn't cover it. Her OB knew of these studies and insisted they work, and also pointed out that studies done in other countries (like countries in the Middle East and Southeast Asia, where the demographics more closely fit those of my wife) did show an improvement. However, those studies weren't taken into account to help British mothers by their own national system. Thus, if my wife were British (or even in her parent's country of Canada), her treatment would not have been covered, but, because American insurance mostly pays for what the doctor prescribes, ours was paid for.
alkibiades 8y ago
just curious, do you think it’s just a coincidence that US companies are responsible for the vast majority of medical innovation?
- decebalus1 8y ago
  Coincidence on what? What are you trying to say? Which facts correlate with that statement? That the US has the largest influx of educated immigrants? That the US has the shittiest medical system? That the US has the largest health insurance administrative overhead in history? That free market capitalism applied to healthcare has birthed the opioid epidemic? All of the above?
  - deleted 8y ago
    [deleted]
Alex3917 8y ago
> The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy. We should just have single payer that covers A) drugs not under patent B) drugs with breakthrough designation. If people want other drugs that are patented they should then just have to get supplemental private insurance.
- pkaye 8y ago
  I think this is a good idea. Quite a bit of drugs we take are already generic. I'm a dialysis patient and 10 out of the 12 drugs I take daily are generic. The remaining 2 will become generic within a year. I think having access ti cheap generics will make a huge difference to everyone.
evoloution 8y ago
Your statement sounds pseudocorrect but the underlying assumptions are that: a) we are currently able to diagnose all nosological entities efficiently, b) we know which treatments are working for each of said entities and c) all people react the same to the same medications, d) all medications that are indicated to treat a disorder are equal. Oh boy, wouldn't that be nice... In reality you have an army of paper pushers that are hired and have their salaries paid to restrict what can be prescribed. For patients that fit well in proper diagnoses and are otherwise typical it is sometimes annoying but for the 1-2% of patient that rules do not apply (for so many reasons that I cannot possibly enumerate here) it is detrimental. The people who are actually doing this job are not happy with it, the doctors are not happy with it. Every step of the prior authorization process is designed to irritate the doctor or provider (like saying all the patients information again when the representative changes or not accepting the case id to pull out the patient information or "sorry Dr. we only accept this application by fax, we don't do this online" or "this patient's plan does not support peer review") and discourage him from doing it. I know patients that were turned away because their doctors didn't want to handle specific prior auths for them. "But doctor why don't you want to prescribe medication A that is as effective as medication B but it has more side effects?" As your advocate, I feel obliged to recommend the best medication, if your insurance does not want to cover it then they should take the risk and the legal responsibility of their policy not force me to change my recommendation based on price. Of course, I will not start with the bazooka antibiotic for your tonsillitis but there is a medical reason for not doing that (resistance development). Right now, I have to spend extra time to even justify why a patient should stay on a good medication yearly even if it works great for them. The doctor is your medical scientist consultant, he shouldn't be burdened with saving money from the system, he will tell you what is best, if you want them to give you a value-for-money determination they can do that as well. If two medications work exactly the same, I would happily give the older and cheaper one - it has been longer in the market so it has been more extensively tested.
- KaiserPro 8y ago
  in reply to point a), b), c) and d): it already exists: https://bnf.nice.org.uk/ https://bnf.nice.org.uk/ There is a companion to the BNF that has the prices of all the brand/generic versions of the drug. Doctors don't just randomly prescribe anything, they already _have_ guidelines. and based on actual patient information (like interactions or lack of improvement) they will change drug type based on the evidence. Again, look at the BNF for interactions and contra-indications for example look at this for nose infection: https://bnf.nice.org.uk/treatment-summary/nose-infections-antibacterial-therapy.html https://bnf.nice.org.uk/treatment-summary/nose-infections-an... a list of four drugs and an order to try. Notice that its drub clases, not brands. Doctors should not be allowed to prescribe brands in the states until the corruption is under control
cwyers 8y ago
> There are legions of people around the USA bribing doctors to prescribe expensive generics. Expensive... generics?
cryptonector 8y ago
So many things are wrong with healthcare in the U.S. Where to start? Low- or no-deductible insurance makes it difficult for consumers to be price conscious. Networks and co-pays make it difficult for anyone to ascertain the price of any good or service until after it has been provided and consumed. Doctors don't know list prices or any prices. Insured consumers don't have incentives to ask, let alone shop. Too little or no price signalling -> disfunctional market -> over-consumption -> inflation. The Trump administration's push for hospitals to publish prices is a surprisingly good idea, provided no way around it is found by the industry. This needs to be pushed all the way down to clinics -- don't stop at hospitals. Other things that are wrong include: protectionism -- wanna build a hospital?? first you'll have to get a "certificate of need", and that's a very political thing protectionism -- it's too hard to become a doctor protectionism -- the FDA helps pharmaceuticals defend their profit margins even when drug patents expire All of this needs fixing. A single-payer system would simply fix pricing, but would not be sufficiently dynamic (only markets can be decently efficient at discovering pricing), and it would impose rationing. I would prefer to fix the market's price signaling issues first and then also reduce the protectionism, then a healthy market can emerge and can increase supply to reduce prices (or reduce prices if supply were already high enough).
wavepruner 8y ago
Censuring healthcare options unfortunately stifles a patients' ability to pursue experimental treatments. This is an essential option for surviving an illness that is poorly understood by the mainstream. Experimental does not mean lack of scientific rigor. On the contrary, experiments are science. National guidelines will always be behind the most cutting edge treatments, because treatments need to be proved before they become widely accepted. Proving takes time--sometimes decades that a sick person does not have. Someone who is dying from a complex illness need the option to pursue experimental treatments. National guidelines are important, but need to be voluntary in order for sick people to have every chance to beat their illness.

ameister14 8y ago

>For insurance to work, US doctors must follow national guidelines laid out by a scientific body (ie NICE in the UK) any deviation without justification would/should lead to fines and censure. I don't think that's necessary for insurance to work - I think it's necessary for medicine to get cheaper. If I want a specialist to treat me as an individual and potentially prescribe something outside the norm, I should be able to pay a premium for that, and the doctor should be allowed to do it if it is going to work without threat of fines or censure because they didn't choose the cheaper option.

SmellyGeekBoy 8y ago
This sounds like private healthcare in the UK. Many treatments and drugs that haven't been approved yet or deemed cost effective for the NHS are available from private providers and can be paid for out-of-pocket or by insurance - relatively cheap insurance because it has to compete with free (at point of use, lets not get into that debate).
deleted 8y ago
[deleted]

will_brown 8y ago

>The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy Unknown to almost everyone in the US is that if you are a Medicare patient, when you go to fill a Rx before the pharmacist fills the therapy, insurance software suggests cheaper generics to the pharmacist and requires the pharmacist to do the leg work of asking the doctor to change the Rx based on what the insurance company wants (ie the cheaper medication). So the question might be..why would a pharmacist do what the insurance company software tells them... or why would a doctor second guess their initial Rx at the request of an insurance company trying to minimize their costs? Because if the pharmacist/pharmacy doesn’t do what insurance says or if the doctor doesn’t do what insurance says, they get dropped from the insurance network.

patmcc 8y ago
While I agree insurance companies do harm, encouraging generics is probably a net benefit. Doctors, just like anyone else, respond to marketing, so they remember 'viagra' more easily than 'sildenafil' and write prescriptions accordingly. There's often no medical reason a generic isn't 100% suitable.
- will_brown 8y ago
  The insurance companies are not recommending generics because it’s cheaper for the patient...they do it because it’s cheaper for them. There are many reasons generics, especially in the case of Medicare patients with chronic conditions, are worse for a patient. Generally if you have a Medicare patientwith chronic conditions such as diabeties and/or high blood pressure, and their physician has successfully been managing their conditions using a name brand therapy, it’s not good practice to switch their therapy to a generic because it helps the insurance company. More importantly, it’s only the active ingredients in name brand drugs and generics that are the same. coloring agents, binders, etc... are different and those can have significant negative side effects. There is no shortage of examples of generics having worse outcomes in the case of chronic conditions. Also it’s not just the therapy the insurance is changing, they also change the quantity. So again say you are a Medicare patient with type 2 diabetes and your doc prescribed 30 day Rx so you come back for the doc to check your blood work between fills, insurance is demanding the doctor change the Rx from 30 days to 90 days, because they don’t want to pay for the additional doctor appointment/blood work. They are watering down care and interfering with doctor/patient treatments.

fwip 8y ago

There isn't always an objective best treatment for a patient. Doctors should have license to use their knowledge of the patient and accumulated wisdom to prescribe what they think would be most helpful. We have a list of drugs that work, it's the list of FDA-approved drugs. Insurance will already try to get out of paying for anything that doesn't seem "normal."

Wowfunhappy 8y ago
> We have a list of drugs that work, it's the list of FDA-approved drugs. Which doesn't take price into account. And there's no reason for the patient or doctor to take price into account when insurance is paying for 95%+ of the cost. This is the classic "someone else's money" problem.

Ericson2314 8y ago

It's not quite insurance. Firstly, this is a relationship between the government/insurance companies and the drug companies. The people (however flawed) already have insurance. For those organizations, drugs aren't risk, and they are paying in bigger lumps, so this is closer to the opposite of insurance. It's constant price gouging mitigation. There's a slight difference since nexflix entirely covers the marginal cost per item consumed. If we had drug bounties, the drug companies could become entirely R&D outfits, with boring old chemical companies doing the pill manufacturering. Over time, if the existing companies lose their manufacturing ability, they will need more dependent on this arrangement. Finally, it removes the perverse incentive against cures/innoculations and for rest-of-your-life migrations.

tathougies 8y ago

> US doctors must follow national guidelines laid out by a scientific body No thanks. My daughter is alive today thanks to a therapy that would not be sanctioned by 'standards bodies'. I'm good. Thank goodness her doctor was a professional that was able to make professional judgements. If you want to reduce doctoring to looking up values in a dictionary, I suggest you try that with you and yours first, before forcing it on everyone else.

simonebrunozzi 8y ago
Do you mind sharing some details, without naming names? I'm curious to know more about the specific issue.
- tathougies 8y ago
  Sure. My wife had lost several pregnancies, including late losses. All sudden. There was no explanation ... tests all normal. Went to several MFMs at UCSF, Stanford, Mayo Clinic, etc, who told us that there was no evidence backed treatment to offer. Her obstetrician (been in practice almost 50 years) told my wife that she had a blood clotting disorder (although the tests certainly did not indicate that, at all). She was rather confident in this given the way we lost babies (hearts stopped overnight), but again, this was not evidence backed, because of a lack of diagnostic tests showing a clotting disorder. However, her OB came from a time when medicine meant looking at symptoms, not just tests. Her OB told her that since the time she was in practice many of her patients who lost babies this way ended up being diagnosed with clotting disorders many decades after the fact, because we are always discovering new thrombophilia risks, but that either way, they were successful in just using anti-clotting agents. The treatment for clots during pregnancy is a daily injection called enoxaparin, which is rather expensive ($400/wk for 40 weeks), so insurance certainly does not want to pay. Well, long story short, after seven pregnancy losses, she did the injections, and had a pretty textbook pregnancy. Of course, after we had the baby, all the 'evidence-based' doctors changed their tune and now insist that enoxaparin is a necessity if she wants to get pregnant again. Not just for the baby either, but for her health (since blood clots can lead to pretty sudden death for mothers). So, yeah, basically her OBs advice, which was based entirely on intuition and five decades of actual clinical practice, saved both the lives of my daughter and in some ways my wife (again, she may have been at risk of clots during previous pregnancies). Ultimately, medicine is not just about knowing what's in a book. These days, most medical knowledge is available for free online. When we went to UCSF, Stanford, and the Mayo Clinic, the 'care' we received included having the various conditions that can harm second-trimester fetuses listed for us and then we were explained why my wife did not have them. Of course, all these conditions we already knew about because of reading comprehension. I would not classify the information we got there as 'professional', because it was really a simple matter of looking up data in an index. On the other hand, her OBs care was actual professional care. We pay our doctors to give their opinion on our care based not just on what the books say but also based on what they have learned. An insistence on 'evidence-based' care reduces the ability for doctors to actually treat patients, and will -- inevitably, even if it takes some decades -- lead to a lack of evidence as new generations of doctors become less trusting of their intuition and more reliant on external validation. EDIT: to be clear, it's not just a lack of evidence this treatment works. Several large-scale studies have been done in the United States and Europe (esp Britain) to see whether this therapy works at all. In Britain, where the NHS was considering this as a treatment for recurrent loss in the absence of diagnosis, the studies showed that the treatment was not effective, hence the NHS wouldn't cover it. Her OB knew of these studies and insisted they work, and also pointed out that studies done in other countries (like countries in the Middle East and Southeast Asia, where the demographics more closely fit those of my wife) did show an improvement. However, those studies weren't taken into account to help British mothers by their own national system. Thus, if my wife were British (or even in her parent's country of Canada), her treatment would not have been covered, but, because American insurance mostly pays for what the doctor prescribes, ours was paid for.

alkibiades 8y ago

just curious, do you think it’s just a coincidence that US companies are responsible for the vast majority of medical innovation?

decebalus1 8y ago
Coincidence on what? What are you trying to say? Which facts correlate with that statement? That the US has the largest influx of educated immigrants? That the US has the shittiest medical system? That the US has the largest health insurance administrative overhead in history? That free market capitalism applied to healthcare has birthed the opioid epidemic? All of the above?
- deleted 8y ago
  [deleted]

Alex3917 8y ago

> The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy. We should just have single payer that covers A) drugs not under patent B) drugs with breakthrough designation. If people want other drugs that are patented they should then just have to get supplemental private insurance.

pkaye 8y ago
I think this is a good idea. Quite a bit of drugs we take are already generic. I'm a dialysis patient and 10 out of the 12 drugs I take daily are generic. The remaining 2 will become generic within a year. I think having access ti cheap generics will make a huge difference to everyone.

evoloution 8y ago

Your statement sounds pseudocorrect but the underlying assumptions are that: a) we are currently able to diagnose all nosological entities efficiently, b) we know which treatments are working for each of said entities and c) all people react the same to the same medications, d) all medications that are indicated to treat a disorder are equal. Oh boy, wouldn't that be nice... In reality you have an army of paper pushers that are hired and have their salaries paid to restrict what can be prescribed. For patients that fit well in proper diagnoses and are otherwise typical it is sometimes annoying but for the 1-2% of patient that rules do not apply (for so many reasons that I cannot possibly enumerate here) it is detrimental. The people who are actually doing this job are not happy with it, the doctors are not happy with it. Every step of the prior authorization process is designed to irritate the doctor or provider (like saying all the patients information again when the representative changes or not accepting the case id to pull out the patient information or "sorry Dr. we only accept this application by fax, we don't do this online" or "this patient's plan does not support peer review") and discourage him from doing it. I know patients that were turned away because their doctors didn't want to handle specific prior auths for them. "But doctor why don't you want to prescribe medication A that is as effective as medication B but it has more side effects?" As your advocate, I feel obliged to recommend the best medication, if your insurance does not want to cover it then they should take the risk and the legal responsibility of their policy not force me to change my recommendation based on price. Of course, I will not start with the bazooka antibiotic for your tonsillitis but there is a medical reason for not doing that (resistance development). Right now, I have to spend extra time to even justify why a patient should stay on a good medication yearly even if it works great for them. The doctor is your medical scientist consultant, he shouldn't be burdened with saving money from the system, he will tell you what is best, if you want them to give you a value-for-money determination they can do that as well. If two medications work exactly the same, I would happily give the older and cheaper one - it has been longer in the market so it has been more extensively tested.

KaiserPro 8y ago
in reply to point a), b), c) and d): it already exists: https://bnf.nice.org.uk/ https://bnf.nice.org.uk/ There is a companion to the BNF that has the prices of all the brand/generic versions of the drug. Doctors don't just randomly prescribe anything, they already _have_ guidelines. and based on actual patient information (like interactions or lack of improvement) they will change drug type based on the evidence. Again, look at the BNF for interactions and contra-indications for example look at this for nose infection: https://bnf.nice.org.uk/treatment-summary/nose-infections-antibacterial-therapy.html https://bnf.nice.org.uk/treatment-summary/nose-infections-an... a list of four drugs and an order to try. Notice that its drub clases, not brands. Doctors should not be allowed to prescribe brands in the states until the corruption is under control

cwyers 8y ago

> There are legions of people around the USA bribing doctors to prescribe expensive generics. Expensive... generics?

cryptonector 8y ago

So many things are wrong with healthcare in the U.S. Where to start? Low- or no-deductible insurance makes it difficult for consumers to be price conscious. Networks and co-pays make it difficult for anyone to ascertain the price of any good or service until after it has been provided and consumed. Doctors don't know list prices or any prices. Insured consumers don't have incentives to ask, let alone shop. Too little or no price signalling -> disfunctional market -> over-consumption -> inflation. The Trump administration's push for hospitals to publish prices is a surprisingly good idea, provided no way around it is found by the industry. This needs to be pushed all the way down to clinics -- don't stop at hospitals. Other things that are wrong include: protectionism -- wanna build a hospital?? first you'll have to get a "certificate of need", and that's a very political thing protectionism -- it's too hard to become a doctor protectionism -- the FDA helps pharmaceuticals defend their profit margins even when drug patents expire All of this needs fixing. A single-payer system would simply fix pricing, but would not be sufficiently dynamic (only markets can be decently efficient at discovering pricing), and it would impose rationing. I would prefer to fix the market's price signaling issues first and then also reduce the protectionism, then a healthy market can emerge and can increase supply to reduce prices (or reduce prices if supply were already high enough).

wavepruner 8y ago

Censuring healthcare options unfortunately stifles a patients' ability to pursue experimental treatments. This is an essential option for surviving an illness that is poorly understood by the mainstream. Experimental does not mean lack of scientific rigor. On the contrary, experiments are science. National guidelines will always be behind the most cutting edge treatments, because treatments need to be proved before they become widely accepted. Proving takes time--sometimes decades that a sick person does not have. Someone who is dying from a complex illness need the option to pursue experimental treatments. National guidelines are important, but need to be voluntary in order for sick people to have every chance to beat their illness.