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Some cruel reality: you need to ration healthcare to reduce spending significantly. The iron triangle of healthcare: Quality, Access, Cost. That said, there ar

Some cruel reality: you need to ration healthcare to reduce spending significantly. The iron triangle of healthcare: Quality, Access, Cost. That said, there are definite things that increase the cost disproportionately, and the way the government subsidizes insurance through an employer makes a major disconnect between patients and providers. If the subsidy were eliminated and insurance untied to employer you would have a huge step in the direction of unleashing market forces.

Amezarak 7y ago
The cruel reality appears to be that you ration health care without reducing spending, because medical administration and bureaucratic costs eat the savings and more. Untying insurance from employment is a great idea, but it won't solve this. With HDHPs being so common the 'disconnect' between providers and patients is already not a real thing. Neither will single payer fix the underlying problem, although at least individuals will be better off. At any rate, entrusting laymen to understand when they should and should not seek emergency medical attention means that people will die through entirely preventable causes in an attempt to ration their health care spending. Your cure sounds worse than the disease. There are no effective market forces you can 'unleash' in the case of health care. It wouldn't matter if you removed all government regulation and subsidies tomorrow. Even in a world where it all somehow works out, do you want medical providers in a race to the bottom? In the absence of meaningful quality of care information (impossible), consumers are incredibly sensitive to one thing: price. What you will end up with is cheap(ish) providers providing incredibly substandard care by cutting corners and killing people.
- ultrarunner 7y ago
  I seem to remember a comment on here complaining about $30 pacifiers. Why do pacifiers cost $30 when they’re post paid from a hospital and not when they’re bought literally anywhere else if not for the presence of market forces? I can assure you this effect is not just limited to pacifiers.
- 0815test 7y ago
  > In the absence of meaningful quality of care information Except that quality information gets provided quite satisfactorily in plenty of industries, even ones that might appear otherwise quite opaque. Sure, sometimes it is done in distorted and counterintuitive ways (many marketing practices, including many kinds of advertising, are ultimately reputational games that are designed to signal quality), but meaningful info is far from "absent"!
- conanbatt 7y ago
  > With HDHPs being so common the 'disconnect' between providers and patients is already not a real thing. Long way to go for HDHP to take over the market. But its definitely the way to go. It will however attack mostly the primary care market, not the hospitals which are 40% of the national health spending. > At any rate, entrusting laymen to understand when they should and should not seek emergency medical attention means that people will die through entirely preventable causes in an attempt to ration their health care spending. Your cure sounds worse than the disease. Not my "cure" thats the economic reality. Unfettered access to healthcare will give you skyrocketing costs. You cant complain about both at the same time, they are a trade-off. I do think that cost is the single most important thing to attack, and the policies to do so are very easy to enact. They are just very unpopular, because the democratic party wants to increase the state, not make healthcare cheaper, and because republicas have their head up their ass on this topic for reasons I dont understand.
  - Amezarak 7y ago
    According to Kaiser, HDHPs are the second most common health insurance plan and account for 28% of all insurance plans. > Not my "cure" thats the economic reality. Unfettered access to healthcare will give you skyrocketing costs. You cant complain about both at the same time, they are a trade-off. Yes, if the problem is skyrocketing demand. But it isn't. Yes, if we waved a magic wand and provided unlimited free access to medical care, demand would rise somewhat. But demand is not the reason for the current high prices, and it's not the reason costs are outpacing inflation. Medical care in the US is much more expensive than in comparable countries, but demand is not appreciably different. As long as people keep looking at this through a "market" lens, or through a "just make it single payer" lens, the problem will never be solved. The fundamental problem isn't that demand is too high. The problem is cost disease, the root of which consists of dozens of different factors. This is a decent article, albeit one that barely scratches the surface. https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/ https://slatestarcodex.com/2017/02/09/considerations-on-cost... Look at those graphs! It's mindblowing! Medical costs have increased ten times more than inflation, while doctor and nurse salaries were flat (actually worse, since now their salary goes to paying off educational debt) over the same time period. If there's a demand problem, why aren't salaries of medical professionals rising faster than inflation? Lastly, I think most people would disagree that cutting costs is the most important thing. Going bankrupt is better than dying of pneumonia because you were worried about wasting money on a doctor visit.
jfengel 7y ago
I'd be all in favor of that, but it's not quite as easy as it sounds. A lot of labor relations has resulted in health care being used as part of the total compensation package, a carefully negotiated, hard-fought conclusion. To wipe that benefit away would be a step backwards for a lot of people. It should be possible to reopen those negotiations and reach a fair conclusion, but there's going to be a lot of fighting on a case-by-case basis (with a lot of cases). I believe it would ultimately work out better for everybody, but the "ultimate" would be years -- if not decades -- away.
- conanbatt 7y ago
  > To wipe that benefit away would be a step backwards for a lot of people. Welcome to vested interests. > It should be possible to reopen those negotiations and reach a fair conclusion As much as Uber can negotiate with taxis. The solution here is to cut all the bs out and dereg. Import free doctors from all the world for cheap, by allowing them to practice medicine and to apply to a Doctor visa. US can triple its doctoral staff in 5 years with no educational cost by simply doing less things.
bad-joke 7y ago
> If the subsidy were eliminated and insurance untied to employer you would have a huge step in the direction of unleashing market forces. That's exactly how things were in the 1930s. Healthcare was unaffordable to the degree of public outcry, which is why universal healthcare legislation was introduced repeatedly and stifled by the AMA every time. In fact, early health insurance programs were designed to bypass pay-as-you-go medical fees because they weren't meeting the needs of the hospital or patients. It wasn't a tenable system. It seems we're regressing.
- conanbatt 7y ago
  In 1930's the national spending of healthcare was like 4% of GDP, while now it is like 17%. If we could go back to the 1930's on that I'd take it. The problem is not that the AMA was able to attack socialized healthcare, but that the AMA was able to dictate who would be able to practice medicine, what their education should be, how much they should charge and how they would organize. Any american could go abroad to a country like say, Argentina, get free medical education and come back and treat patients without half a million dollars debt. But its illegal.
  - hodr 7y ago
    Are you sure it's illegal? Like 80+ percent of the doctors in my metro area got their degrees in India (where they immigrated from). There is some form of reciprocity going on.
    - conanbatt 7y ago
      I don't know what india has, but i can assure you that India's doctors would all emigrate to the US if they could work as a doctor there.
    - coredog64 7y ago
      Foreign doctors still need a US residency. The number of slots for residencies is capped. I could imagine a world where the US signs reciprocal agreements with EU countries to honor their medical professional training without a residency. I cannot imagine the same for India or Argentina.

Amezarak 7y ago

The cruel reality appears to be that you ration health care without reducing spending, because medical administration and bureaucratic costs eat the savings and more. Untying insurance from employment is a great idea, but it won't solve this. With HDHPs being so common the 'disconnect' between providers and patients is already not a real thing. Neither will single payer fix the underlying problem, although at least individuals will be better off. At any rate, entrusting laymen to understand when they should and should not seek emergency medical attention means that people will die through entirely preventable causes in an attempt to ration their health care spending. Your cure sounds worse than the disease. There are no effective market forces you can 'unleash' in the case of health care. It wouldn't matter if you removed all government regulation and subsidies tomorrow. Even in a world where it all somehow works out, do you want medical providers in a race to the bottom? In the absence of meaningful quality of care information (impossible), consumers are incredibly sensitive to one thing: price. What you will end up with is cheap(ish) providers providing incredibly substandard care by cutting corners and killing people.

ultrarunner 7y ago
I seem to remember a comment on here complaining about $30 pacifiers. Why do pacifiers cost $30 when they’re post paid from a hospital and not when they’re bought literally anywhere else if not for the presence of market forces? I can assure you this effect is not just limited to pacifiers.
0815test 7y ago
> In the absence of meaningful quality of care information Except that quality information gets provided quite satisfactorily in plenty of industries, even ones that might appear otherwise quite opaque. Sure, sometimes it is done in distorted and counterintuitive ways (many marketing practices, including many kinds of advertising, are ultimately reputational games that are designed to signal quality), but meaningful info is far from "absent"!
conanbatt 7y ago
> With HDHPs being so common the 'disconnect' between providers and patients is already not a real thing. Long way to go for HDHP to take over the market. But its definitely the way to go. It will however attack mostly the primary care market, not the hospitals which are 40% of the national health spending. > At any rate, entrusting laymen to understand when they should and should not seek emergency medical attention means that people will die through entirely preventable causes in an attempt to ration their health care spending. Your cure sounds worse than the disease. Not my "cure" thats the economic reality. Unfettered access to healthcare will give you skyrocketing costs. You cant complain about both at the same time, they are a trade-off. I do think that cost is the single most important thing to attack, and the policies to do so are very easy to enact. They are just very unpopular, because the democratic party wants to increase the state, not make healthcare cheaper, and because republicas have their head up their ass on this topic for reasons I dont understand.
- Amezarak 7y ago
  According to Kaiser, HDHPs are the second most common health insurance plan and account for 28% of all insurance plans. > Not my "cure" thats the economic reality. Unfettered access to healthcare will give you skyrocketing costs. You cant complain about both at the same time, they are a trade-off. Yes, if the problem is skyrocketing demand. But it isn't. Yes, if we waved a magic wand and provided unlimited free access to medical care, demand would rise somewhat. But demand is not the reason for the current high prices, and it's not the reason costs are outpacing inflation. Medical care in the US is much more expensive than in comparable countries, but demand is not appreciably different. As long as people keep looking at this through a "market" lens, or through a "just make it single payer" lens, the problem will never be solved. The fundamental problem isn't that demand is too high. The problem is cost disease, the root of which consists of dozens of different factors. This is a decent article, albeit one that barely scratches the surface. https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/ https://slatestarcodex.com/2017/02/09/considerations-on-cost... Look at those graphs! It's mindblowing! Medical costs have increased ten times more than inflation, while doctor and nurse salaries were flat (actually worse, since now their salary goes to paying off educational debt) over the same time period. If there's a demand problem, why aren't salaries of medical professionals rising faster than inflation? Lastly, I think most people would disagree that cutting costs is the most important thing. Going bankrupt is better than dying of pneumonia because you were worried about wasting money on a doctor visit.

jfengel 7y ago

I'd be all in favor of that, but it's not quite as easy as it sounds. A lot of labor relations has resulted in health care being used as part of the total compensation package, a carefully negotiated, hard-fought conclusion. To wipe that benefit away would be a step backwards for a lot of people. It should be possible to reopen those negotiations and reach a fair conclusion, but there's going to be a lot of fighting on a case-by-case basis (with a lot of cases). I believe it would ultimately work out better for everybody, but the "ultimate" would be years -- if not decades -- away.

conanbatt 7y ago
> To wipe that benefit away would be a step backwards for a lot of people. Welcome to vested interests. > It should be possible to reopen those negotiations and reach a fair conclusion As much as Uber can negotiate with taxis. The solution here is to cut all the bs out and dereg. Import free doctors from all the world for cheap, by allowing them to practice medicine and to apply to a Doctor visa. US can triple its doctoral staff in 5 years with no educational cost by simply doing less things.

bad-joke 7y ago

> If the subsidy were eliminated and insurance untied to employer you would have a huge step in the direction of unleashing market forces. That's exactly how things were in the 1930s. Healthcare was unaffordable to the degree of public outcry, which is why universal healthcare legislation was introduced repeatedly and stifled by the AMA every time. In fact, early health insurance programs were designed to bypass pay-as-you-go medical fees because they weren't meeting the needs of the hospital or patients. It wasn't a tenable system. It seems we're regressing.

conanbatt 7y ago
In 1930's the national spending of healthcare was like 4% of GDP, while now it is like 17%. If we could go back to the 1930's on that I'd take it. The problem is not that the AMA was able to attack socialized healthcare, but that the AMA was able to dictate who would be able to practice medicine, what their education should be, how much they should charge and how they would organize. Any american could go abroad to a country like say, Argentina, get free medical education and come back and treat patients without half a million dollars debt. But its illegal.
- hodr 7y ago
  Are you sure it's illegal? Like 80+ percent of the doctors in my metro area got their degrees in India (where they immigrated from). There is some form of reciprocity going on.
  - conanbatt 7y ago
    I don't know what india has, but i can assure you that India's doctors would all emigrate to the US if they could work as a doctor there.
  - coredog64 7y ago
    Foreign doctors still need a US residency. The number of slots for residencies is capped. I could imagine a world where the US signs reciprocal agreements with EU countries to honor their medical professional training without a residency. I cannot imagine the same for India or Argentina.