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> You know people who take insulin are on it for the rest of their lives, but that doesn't make it the fault of their doctors. The bet on diabetes has to happe

> You know people who take insulin are on it for the rest of their lives, but that doesn't make it the fault of their doctors. The bet on diabetes has to happen before it is diagnosed to make actuarial analysis. If you want to guarantee that all diabetes patients get access to insulin, what you want is charity, not insurance. Insurance is risk pooling. > This is a very strange American perspective on health care. If it was suddenly available to everyone, there's a perception that we'd all be like kids in the candy store getting 1 of everything at the doctors office The science has already shown that is true. Over and underutilization of healthcare are studied effects, ones insurance companies pay very close attention to because if they don't, they will go bust. That is also why countries with free healthcare also have copays. > People go to doctors because they're sick, and they need treatment and would rather be literally anywhere else. I think you are have an outsider's view on how healthcare provision works. No doctor i met would ever agree with this statement.

arcticbull 7y ago
> The bet on diabetes has to happen before it is diagnosed to make actuarial analysis. If you want to guarantee that all diabetes patients get access to insulin, what you want is charity, not insurance. Insurance is risk pooling. Yep! That's why health insurance is a misnomer. There's no guarantee my house will catch fire, so I insure against it. There is a 100% chance each and every human will catch a terminal illness. That makes it at best a structured payout program. The amount of the payout can be reduced through preventative care, and yes, maintenance drugs like insulin. That's the best case for why it should be socialized. It's not insurance, and it's not charity, it's a service in the public interest. And of course people should have access to the medication they need to live, we're not savages. > The science has already shown that is true. Over and underutilization of healthcare are studied effects, ones insurance companies pay very close attention to because if they don't, they will go bust. That is also why countries with free healthcare also have copays. Insurance companies get paid in advance, and their goal is not to provide the best care but to return the largest amount possible to their shareholders. Co-pays keep people out of hospital, especially lower-income folks, which allows insurance companies to make more money. Same with high deductibles. Their goal is not care, it's profit. The UK and Canada (the systems I know best) don't really have co-payments, certainly not like in the US. The vast majority of services are co-payment free [1] (UK: "Out-of-pocket payments for general practice are limited to some services, such as examinations for employment or insurance purposes and the provision of certificates for travel or insurance", in Ontario going to the hospital you only pay for parking or 'upgrades' like private rooms - [2], [3] is the entire fee schedule). Same with Australia [4] who in 2015 rebelled over an AU$7 co-pay. You get sick, you go to the doctor, they take care of it. Think about it, if you could access any procedure right now, what would you get done? Nothing, because it's not fun, it's not rewarding. If it's medically necessary, you'll get it done one way or the other, if it's not, literally why are you at the hospital? Yes, use goes up a bit. IMO, that can be offset by creating clinics and guiding people to them for minor ailments as in the UK. > I think you are have an outsider's view on how healthcare provision works. No doctor i met would ever agree with this statement. Respectfully disagree. Both my parents are doctors, and I grew up in numerous medical systems all over the world. I've benefitted hugely from socialized medical systems and not having one right now is downright terrifying even though I'm well 'insured'. My dad refused to work in the US because he felt the healthcare system here was inhumane. He wanted to provide people care based on their needs not what they could afford. It took me until I lived here to understand he was exactly right. There's a lot of this apologist: "there must be some reason the American system is better" -- sorry, it's just not better. [1] https://international.commonwealthfund.org/countries/england/ https://international.commonwealthfund.org/countries/england... [2] https://www.qch.on.ca/hospitalcharges https://www.qch.on.ca/hospitalcharges [3] https://www.qch.on.ca/uploads/Finance/Hospital%20fees%20Website%20version%20for%20Insured%20Res%20April%201%202019%20NewLogo.pdf https://www.qch.on.ca/uploads/Finance/Hospital%20fees%20Webs... [4] https://transferwise.com/au/blog/healthcare-system-in-australia https://transferwise.com/au/blog/healthcare-system-in-austra...
- conanbatt 7y ago
  > That makes it at best a structured payout program. This is what prepay's are, and HMO's. You have 2 opinions on HMO: they love it because pricing is transparent, they dislike it because they ration service. An example of that with Kaiser: they put severe barriers on their own mental health services. An industry gossip for you: one of the biggest consumer of mental health services at Kaiser is Kaiser doctors. > Insurance companies get paid in advance, and their goal is not to provide the best care but to return the largest amount possible to their shareholders... At the same time, insurance has an interest in controlling how much the insurance is used, something governments can fail at pretty hard. Remember Medicare insurance already costs 1k per person per month. That's the socialized system america has now, and it won't be more efficient by being bigger. > Think about it, if you could access any procedure right now, what would you get done? Nothing, because it's not fun, it's not rewarding. This is just not the reality. It's a well studied effect, denying it is depriving the science behind policy analysis from any legitimacy. > Respectfully disagree. Both my parents are doctors, and I grew up in numerous medical systems all over the world. I've benefitted hugely from socialized medical systems and not having one right now is downright terrifying even though I'm well 'insured'. They told you that patients never go to the doctor for superfluous reasons? I won't believe it. I am in the industry and I can see every case imaginable. We have had this argument before. The U.S. socializing healthcare will not bring out-of-us healthcare results. It will get something else, because what makes healthcare suck is not private vs public, it's the regulatory framework.
  - arcticbull 7y ago
    > This is just not the reality. It's a well studied effect, denying it is depriving the science behind policy analysis from any legitimacy. You are correct. People do go more often, and to counter it programs exist in the UK which drive people with less severe issues to local centers where they can get looked at without taxing the hospital system to the same extent. [1] It's not that big an issue. All that and they still deliver better health outcomes for a much lower price. FWIW the NHS actually offers free mental health services with no co-pays too [2]. It looks like it's managed via GP which is a good middle ground IMO between co-pays and unlimited fee-free access. Canada does not as a rule, though it's an active conversation [3] and has been for years -- and it enjoys a (razor thin) majority of support with 51% in favor. Psychiatry is covered today, therapy is not. > They told you that patients never go to the doctor for superfluous reasons? I won't believe it. I am in the industry and I can see every case imaginable. No, they told me the US healthcare system is inhumane. I may have misread your post if I wasn't replying to the right section :) > We have had this argument before. The U.S. socializing healthcare will not bring out-of-us healthcare results. It will get something else, because what makes healthcare suck is not private vs public, it's the regulatory framework. The US is already at the bottom of the OECD, do you have reason to believe it'll get worse? We've got a lot of models that show it'll be better and really nothing to point to that shows it'll get worse. Socialized systems are cheaper and control costs better, even here. [1] https://www.newdevonccg.nhs.uk/file/?rid=109734 https://www.newdevonccg.nhs.uk/file/?rid=109734 [2] https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/how-to-access-mental-health-services/ https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-... [3] https://globalnews.ca/news/5276022/canadians-mental-health-services-provincial-health-plans-ipsos-poll/ https://globalnews.ca/news/5276022/canadians-mental-health-s...

arcticbull 7y ago

> The bet on diabetes has to happen before it is diagnosed to make actuarial analysis. If you want to guarantee that all diabetes patients get access to insulin, what you want is charity, not insurance. Insurance is risk pooling. Yep! That's why health insurance is a misnomer. There's no guarantee my house will catch fire, so I insure against it. There is a 100% chance each and every human will catch a terminal illness. That makes it at best a structured payout program. The amount of the payout can be reduced through preventative care, and yes, maintenance drugs like insulin. That's the best case for why it should be socialized. It's not insurance, and it's not charity, it's a service in the public interest. And of course people should have access to the medication they need to live, we're not savages. > The science has already shown that is true. Over and underutilization of healthcare are studied effects, ones insurance companies pay very close attention to because if they don't, they will go bust. That is also why countries with free healthcare also have copays. Insurance companies get paid in advance, and their goal is not to provide the best care but to return the largest amount possible to their shareholders. Co-pays keep people out of hospital, especially lower-income folks, which allows insurance companies to make more money. Same with high deductibles. Their goal is not care, it's profit. The UK and Canada (the systems I know best) don't really have co-payments, certainly not like in the US. The vast majority of services are co-payment free [1] (UK: "Out-of-pocket payments for general practice are limited to some services, such as examinations for employment or insurance purposes and the provision of certificates for travel or insurance", in Ontario going to the hospital you only pay for parking or 'upgrades' like private rooms - [2], [3] is the entire fee schedule). Same with Australia [4] who in 2015 rebelled over an AU$7 co-pay. You get sick, you go to the doctor, they take care of it. Think about it, if you could access any procedure right now, what would you get done? Nothing, because it's not fun, it's not rewarding. If it's medically necessary, you'll get it done one way or the other, if it's not, literally why are you at the hospital? Yes, use goes up a bit. IMO, that can be offset by creating clinics and guiding people to them for minor ailments as in the UK. > I think you are have an outsider's view on how healthcare provision works. No doctor i met would ever agree with this statement. Respectfully disagree. Both my parents are doctors, and I grew up in numerous medical systems all over the world. I've benefitted hugely from socialized medical systems and not having one right now is downright terrifying even though I'm well 'insured'. My dad refused to work in the US because he felt the healthcare system here was inhumane. He wanted to provide people care based on their needs not what they could afford. It took me until I lived here to understand he was exactly right. There's a lot of this apologist: "there must be some reason the American system is better" -- sorry, it's just not better. [1] https://international.commonwealthfund.org/countries/england/ https://international.commonwealthfund.org/countries/england... [2] https://www.qch.on.ca/hospitalcharges https://www.qch.on.ca/hospitalcharges [3] https://www.qch.on.ca/uploads/Finance/Hospital%20fees%20Website%20version%20for%20Insured%20Res%20April%201%202019%20NewLogo.pdf https://www.qch.on.ca/uploads/Finance/Hospital%20fees%20Webs... [4] https://transferwise.com/au/blog/healthcare-system-in-australia https://transferwise.com/au/blog/healthcare-system-in-austra...

conanbatt 7y ago
> That makes it at best a structured payout program. This is what prepay's are, and HMO's. You have 2 opinions on HMO: they love it because pricing is transparent, they dislike it because they ration service. An example of that with Kaiser: they put severe barriers on their own mental health services. An industry gossip for you: one of the biggest consumer of mental health services at Kaiser is Kaiser doctors. > Insurance companies get paid in advance, and their goal is not to provide the best care but to return the largest amount possible to their shareholders... At the same time, insurance has an interest in controlling how much the insurance is used, something governments can fail at pretty hard. Remember Medicare insurance already costs 1k per person per month. That's the socialized system america has now, and it won't be more efficient by being bigger. > Think about it, if you could access any procedure right now, what would you get done? Nothing, because it's not fun, it's not rewarding. This is just not the reality. It's a well studied effect, denying it is depriving the science behind policy analysis from any legitimacy. > Respectfully disagree. Both my parents are doctors, and I grew up in numerous medical systems all over the world. I've benefitted hugely from socialized medical systems and not having one right now is downright terrifying even though I'm well 'insured'. They told you that patients never go to the doctor for superfluous reasons? I won't believe it. I am in the industry and I can see every case imaginable. We have had this argument before. The U.S. socializing healthcare will not bring out-of-us healthcare results. It will get something else, because what makes healthcare suck is not private vs public, it's the regulatory framework.
- arcticbull 7y ago
  > This is just not the reality. It's a well studied effect, denying it is depriving the science behind policy analysis from any legitimacy. You are correct. People do go more often, and to counter it programs exist in the UK which drive people with less severe issues to local centers where they can get looked at without taxing the hospital system to the same extent. [1] It's not that big an issue. All that and they still deliver better health outcomes for a much lower price. FWIW the NHS actually offers free mental health services with no co-pays too [2]. It looks like it's managed via GP which is a good middle ground IMO between co-pays and unlimited fee-free access. Canada does not as a rule, though it's an active conversation [3] and has been for years -- and it enjoys a (razor thin) majority of support with 51% in favor. Psychiatry is covered today, therapy is not. > They told you that patients never go to the doctor for superfluous reasons? I won't believe it. I am in the industry and I can see every case imaginable. No, they told me the US healthcare system is inhumane. I may have misread your post if I wasn't replying to the right section :) > We have had this argument before. The U.S. socializing healthcare will not bring out-of-us healthcare results. It will get something else, because what makes healthcare suck is not private vs public, it's the regulatory framework. The US is already at the bottom of the OECD, do you have reason to believe it'll get worse? We've got a lot of models that show it'll be better and really nothing to point to that shows it'll get worse. Socialized systems are cheaper and control costs better, even here. [1] https://www.newdevonccg.nhs.uk/file/?rid=109734 https://www.newdevonccg.nhs.uk/file/?rid=109734 [2] https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/how-to-access-mental-health-services/ https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-... [3] https://globalnews.ca/news/5276022/canadians-mental-health-services-provincial-health-plans-ipsos-poll/ https://globalnews.ca/news/5276022/canadians-mental-health-s...