4 ms·

Sounds like fear-based decision making there. If things are that bad, that difficult to get right, then the government isn't going to save you. Sorry. The go

by krupan 7y ago

Sounds like fear-based decision making there. If things are that bad, that difficult to get right, then the government isn't going to save you. Sorry. The good news, whether you choose to believe it or not, is that things are not that bad. We can do this.

joe_the_user 7y ago
Sounds like fear-based decision making there. If things are that bad, that difficult to get right, then the government isn't going to save you. Most advanced industrialized nations have a state-run health care system and pay on average half of what the US pays. Health is naturally quite complicated but it isn't impossible to get right. The fundamental problem is that an adversarial system, where every provider has an incentive to wrangle their presentation and to wrangle their position in the regulator system, means, in the specific case of health care, pseudo-competition plus regulation as we have now, doesn't lower costs or increase productivity, it just produces a tide of dubious opportunism as one can see from current conditions. And a look at present US health would show things are pretty bad - costs are approaching 20% of GDP and given that this is double that of equivalent advanced industrialized nation, that means we're spending 10% of the entire GDP on some combination of waste and inefficiency.
- lliamander 7y ago
  > Most advanced industrialized nations have a state-run health care system and pay on average half of what the US pays. The U.S. is not an outlier with regard to healthcare consumption when you factor in household income[1]. GDP is the wrong metric to measure against. [1]https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-about-healthcare-is-wrong-in-one-million-charts-a-response-to-noah-smith/ https://randomcriticalanalysis.com/2018/11/19/why-everything...
  - joe_the_user 7y ago
    This argument uses average income as proxy for what health care spending in the US should be. That seems clearly wrong given that with US now having a GINI coefficient, high level of income inequality, median household income would be a better thing to measure health care spending, since every individual has to spend money on staying healthy. The argument generally seems wrong too. The need for health care isn't elastic - if someone need care, they need care and people going without needed health care is a humanitarian crisis (a situation that the US is arguable in - see the people giving free dental in a stadium a few years back).
    - lliamander 7y ago
      > This argument uses average income as proxy for what health care spending in the US should be. > That seems clearly wrong given that with US now having a GINI coefficient, high level of income inequality, median household income would be a better thing to measure health care spending, since every individual has to spend money on staying healthy. The author responds to that criticism in the following comment[1]: >> Two, I don’t understand why you’re using mean rather than median AIC throughout. > Several reasons. > 1) We don’t have good internationally comparable statistics for income or consumption at various points in the distribution... > 2) When I’ve looked into this I have not found measured differences in the distribution or the median to be particularly informative... > 3) This makes sense because there is approximately no relationship between individual income and health spending in the developed world, including the United States... As for your second argument: > The argument generally seems wrong too. The need for health care isn't elastic - if someone need care, they need care and people going without needed health care is a humanitarian crisis (a situation that the US is arguable in - see the people giving free dental in a stadium a few years back). I'm not sure I follow your argument. RCA is saying that, as a country, the U.S. spends more on healthcare because we consume more health care than other countries. The U.K. kept their prices low for a long time only because the NHS engaged in intense rationing[2]. [1]https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-about-healthcare-is-wrong-in-one-million-charts-a-response-to-noah-smith/#comment-1231 https://randomcriticalanalysis.com/2018/11/19/why-everything... [2] https://i1.wp.com/randomcriticalanalysis.com/wp-content/uploads/2018/11/rcafdm_uk_nhs_trend_2015_comparisons_aic.png?ssl=1 https://i1.wp.com/randomcriticalanalysis.com/wp-content/uplo...
      - joe_the_user 7y ago
        1) Using average income, a clearly bad statistic, can't be justified by saying you could not find a good statistic. Unless you use a good statistic, your argument isn't justified. (cue story of drunk looking for glasses under lamp post etc). Also, if there's no measured difference in individual household income versus health care spending, well then maybe his pet theory comparing average household income and health care spending isn't very applicable either. 2) "RCA is saying that, as a country, the U.S. spends more on healthcare because we consume more health care than other countries." That argument is either wrong or tautological. The US spends more on health care for worse outcomes, as many studies have shown. If this person means we buy better outcomes, they are wrong. If they are saying we buy more stuff labeled health care, maybe true but that's because the system is bad, not good.
- mgkimsal 7y ago
  > Health is naturally quite complicated but it isn't impossible to get right We may never get it 'right' but we can aim for 'better', and have consensus on what the metrics are. By many measures the US isn't even in the top 10 for health metrics. Given what we pay (hard dollars and % comparison against other countries), that's crazy.

by krupan 7y ago

joe_the_user 7y ago

Sounds like fear-based decision making there. If things are that bad, that difficult to get right, then the government isn't going to save you. Most advanced industrialized nations have a state-run health care system and pay on average half of what the US pays. Health is naturally quite complicated but it isn't impossible to get right. The fundamental problem is that an adversarial system, where every provider has an incentive to wrangle their presentation and to wrangle their position in the regulator system, means, in the specific case of health care, pseudo-competition plus regulation as we have now, doesn't lower costs or increase productivity, it just produces a tide of dubious opportunism as one can see from current conditions. And a look at present US health would show things are pretty bad - costs are approaching 20% of GDP and given that this is double that of equivalent advanced industrialized nation, that means we're spending 10% of the entire GDP on some combination of waste and inefficiency.

lliamander 7y ago
> Most advanced industrialized nations have a state-run health care system and pay on average half of what the US pays. The U.S. is not an outlier with regard to healthcare consumption when you factor in household income[1]. GDP is the wrong metric to measure against. [1]https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-about-healthcare-is-wrong-in-one-million-charts-a-response-to-noah-smith/ https://randomcriticalanalysis.com/2018/11/19/why-everything...
- joe_the_user 7y ago
  This argument uses average income as proxy for what health care spending in the US should be. That seems clearly wrong given that with US now having a GINI coefficient, high level of income inequality, median household income would be a better thing to measure health care spending, since every individual has to spend money on staying healthy. The argument generally seems wrong too. The need for health care isn't elastic - if someone need care, they need care and people going without needed health care is a humanitarian crisis (a situation that the US is arguable in - see the people giving free dental in a stadium a few years back).
  - lliamander 7y ago
    > This argument uses average income as proxy for what health care spending in the US should be. > That seems clearly wrong given that with US now having a GINI coefficient, high level of income inequality, median household income would be a better thing to measure health care spending, since every individual has to spend money on staying healthy. The author responds to that criticism in the following comment[1]: >> Two, I don’t understand why you’re using mean rather than median AIC throughout. > Several reasons. > 1) We don’t have good internationally comparable statistics for income or consumption at various points in the distribution... > 2) When I’ve looked into this I have not found measured differences in the distribution or the median to be particularly informative... > 3) This makes sense because there is approximately no relationship between individual income and health spending in the developed world, including the United States... As for your second argument: > The argument generally seems wrong too. The need for health care isn't elastic - if someone need care, they need care and people going without needed health care is a humanitarian crisis (a situation that the US is arguable in - see the people giving free dental in a stadium a few years back). I'm not sure I follow your argument. RCA is saying that, as a country, the U.S. spends more on healthcare because we consume more health care than other countries. The U.K. kept their prices low for a long time only because the NHS engaged in intense rationing[2]. [1]https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-about-healthcare-is-wrong-in-one-million-charts-a-response-to-noah-smith/#comment-1231 https://randomcriticalanalysis.com/2018/11/19/why-everything... [2] https://i1.wp.com/randomcriticalanalysis.com/wp-content/uploads/2018/11/rcafdm_uk_nhs_trend_2015_comparisons_aic.png?ssl=1 https://i1.wp.com/randomcriticalanalysis.com/wp-content/uplo...
    - joe_the_user 7y ago
      1) Using average income, a clearly bad statistic, can't be justified by saying you could not find a good statistic. Unless you use a good statistic, your argument isn't justified. (cue story of drunk looking for glasses under lamp post etc). Also, if there's no measured difference in individual household income versus health care spending, well then maybe his pet theory comparing average household income and health care spending isn't very applicable either. 2) "RCA is saying that, as a country, the U.S. spends more on healthcare because we consume more health care than other countries." That argument is either wrong or tautological. The US spends more on health care for worse outcomes, as many studies have shown. If this person means we buy better outcomes, they are wrong. If they are saying we buy more stuff labeled health care, maybe true but that's because the system is bad, not good.
mgkimsal 7y ago
> Health is naturally quite complicated but it isn't impossible to get right We may never get it 'right' but we can aim for 'better', and have consensus on what the metrics are. By many measures the US isn't even in the top 10 for health metrics. Given what we pay (hard dollars and % comparison against other countries), that's crazy.