4 ms·

Honestly, I'm happier to see an article talking about efficiency problems rather than just how to pay for it. I'd much rather our efforts on healthcare reform r

Honestly, I'm happier to see an article talking about efficiency problems rather than just how to pay for it. I'd much rather our efforts on healthcare reform revolve around fixing the problems than paying for them.

mcv 7y ago
They're related. The way healthcare is paid causes inefficiencies. If you first need to check whether a patient is insured, and how they're insured, before you can start saving their life, that can cost valuable time and reduce life expectancy. But there's no single problem hampering US healthcare, and therefore there's no single silver bullet that will fix it. Many healthcare systems have some problems, but US health care has a lot, and many of them need to be fixed in order to improve the situation. But if I could point to a single underlying problem that causes many of the other problems, it's that the system is primarily designed to make profit, rather than to heal people.
- Ididntdothis 7y ago
  “But there's no single problem hampering US healthcare, and therefore there's no single silver bullet that will fix it” Exactly. In a lot of discussions someone will point out a problem and the response is “that’s not the real problem. The real problem is XYZ”. And the result is that nothing gets done. There are many problems in US healthcare that all need to be tackled independently. And most of them are around some people making a lot of money off these inefficiencies.
- UnpossibleJim 7y ago
  I think that depends on which "healthcare" you're discussing. If you're talking about emergency services, they administer services first and then talk about billing second. The doctors are removed from the billing process, for the most post (other than keeping a scan of what they use). They aren't thinking, "I'm going to use this more expensive surgical thread to get this poor drunk fool who crashed his car into a playground to pay more, because then the thread industry will pay me more!" While twirling his mustaches. Now when it comes to pharmaceuticals, there are the distributors who make the pricing out of control. Agreed. But the whole system isn't designed to make a profit, rather the supply chain is, and the equation of the two has been spread and the blame has been laid (often) as mistrust at the feet of doctors and nurses who are the face of the healthcare system to most people.
  - mcv 7y ago
    > They aren't thinking, "I'm going to use this more expensive surgical thread to get this poor drunk fool who crashed his car into a playground to pay more, because then the thread industry will pay me more!" Actually, kickbacks are not exactly unheard of. Maybe not for thread, but certainly for some kinds of medication. And yes, in some ways the system is most definitely designed to generate profit. Medicare, for example, is by law not allowed to negotiate for lower prices. Insurers have a reputation for trying not to pay out. Some hospitals don't want to tell you the price of treatment you need before you choose whether you want it. It's an extremely opaque and dysfunctional market, which makes it a great place to charge extortionate prices for treatments that are far cheaper in other countries.
- kirRoyale 7y ago
  Are you saying the people who manufacture/engineer drugs should work for free?
  - black_puppydog 7y ago
    Looks like someone's allergic to commie talk, eh? Don't worry, that's not what they're saying. All of the countries in that article do pay for healthcare. It's just that the US pays an imperial shit-ton, and doesn't get all that much for it. So no, not for for free. And the people working in the sector should probably make more if anything. Just investors and CEOs might have to make less to make this system resemble anything like the meritocracy that people like to pretend it is.
  - SketchySeaBeast 7y ago
    How does Canada get it's insulin so cheap?
  - mcv 7y ago
    There's a lot of room between extortion and free. In other countries, drug manufacturers still make money without charging the extortionate prices you often see in the US.
- dragonwriter 7y ago
  > Many healthcare systems have some problems, but US health care has a lot, and many of them need to be fixed in order to improve the situation. The US system has lots of problems, but reducing them by even 1 improves the situation. It may take fixing many to make the situation “good” by some standard, but not to merely improve it.
  - dllthomas 7y ago
    I think that's likely true. But interestingly it doesn't, theoretically, have to be. In principle the combination of a multiple factors, each of which would move us significantly away from the global maximum (therefore constituting "problems"), might put us at a local maximum where removing any small number of them might leave us worse off.
  - mcv 7y ago
    You're absolutely right. Even the Affordable Care Act, for all its faults, is saving real lives. It is a very real improvement over the situation before, but it's not the end point yet. More steps need to be taken. All at once or one at a time, whichever works.
- Scoundreller 7y ago
  In other words: you don’t solve big problems. You only replace them with smaller problems. No matter what you do, you will make some group worse off. If you can ignore that, you can succeed. If you can’t, your change will fail.

mcv 7y ago

They're related. The way healthcare is paid causes inefficiencies. If you first need to check whether a patient is insured, and how they're insured, before you can start saving their life, that can cost valuable time and reduce life expectancy. But there's no single problem hampering US healthcare, and therefore there's no single silver bullet that will fix it. Many healthcare systems have some problems, but US health care has a lot, and many of them need to be fixed in order to improve the situation. But if I could point to a single underlying problem that causes many of the other problems, it's that the system is primarily designed to make profit, rather than to heal people.

Ididntdothis 7y ago
“But there's no single problem hampering US healthcare, and therefore there's no single silver bullet that will fix it” Exactly. In a lot of discussions someone will point out a problem and the response is “that’s not the real problem. The real problem is XYZ”. And the result is that nothing gets done. There are many problems in US healthcare that all need to be tackled independently. And most of them are around some people making a lot of money off these inefficiencies.
UnpossibleJim 7y ago
I think that depends on which "healthcare" you're discussing. If you're talking about emergency services, they administer services first and then talk about billing second. The doctors are removed from the billing process, for the most post (other than keeping a scan of what they use). They aren't thinking, "I'm going to use this more expensive surgical thread to get this poor drunk fool who crashed his car into a playground to pay more, because then the thread industry will pay me more!" While twirling his mustaches. Now when it comes to pharmaceuticals, there are the distributors who make the pricing out of control. Agreed. But the whole system isn't designed to make a profit, rather the supply chain is, and the equation of the two has been spread and the blame has been laid (often) as mistrust at the feet of doctors and nurses who are the face of the healthcare system to most people.
- mcv 7y ago
  > They aren't thinking, "I'm going to use this more expensive surgical thread to get this poor drunk fool who crashed his car into a playground to pay more, because then the thread industry will pay me more!" Actually, kickbacks are not exactly unheard of. Maybe not for thread, but certainly for some kinds of medication. And yes, in some ways the system is most definitely designed to generate profit. Medicare, for example, is by law not allowed to negotiate for lower prices. Insurers have a reputation for trying not to pay out. Some hospitals don't want to tell you the price of treatment you need before you choose whether you want it. It's an extremely opaque and dysfunctional market, which makes it a great place to charge extortionate prices for treatments that are far cheaper in other countries.
kirRoyale 7y ago
Are you saying the people who manufacture/engineer drugs should work for free?
- black_puppydog 7y ago
  Looks like someone's allergic to commie talk, eh? Don't worry, that's not what they're saying. All of the countries in that article do pay for healthcare. It's just that the US pays an imperial shit-ton, and doesn't get all that much for it. So no, not for for free. And the people working in the sector should probably make more if anything. Just investors and CEOs might have to make less to make this system resemble anything like the meritocracy that people like to pretend it is.
- SketchySeaBeast 7y ago
  How does Canada get it's insulin so cheap?
- mcv 7y ago
  There's a lot of room between extortion and free. In other countries, drug manufacturers still make money without charging the extortionate prices you often see in the US.
dragonwriter 7y ago
> Many healthcare systems have some problems, but US health care has a lot, and many of them need to be fixed in order to improve the situation. The US system has lots of problems, but reducing them by even 1 improves the situation. It may take fixing many to make the situation “good” by some standard, but not to merely improve it.
- dllthomas 7y ago
  I think that's likely true. But interestingly it doesn't, theoretically, have to be. In principle the combination of a multiple factors, each of which would move us significantly away from the global maximum (therefore constituting "problems"), might put us at a local maximum where removing any small number of them might leave us worse off.
- mcv 7y ago
  You're absolutely right. Even the Affordable Care Act, for all its faults, is saving real lives. It is a very real improvement over the situation before, but it's not the end point yet. More steps need to be taken. All at once or one at a time, whichever works.
Scoundreller 7y ago
In other words: you don’t solve big problems. You only replace them with smaller problems. No matter what you do, you will make some group worse off. If you can ignore that, you can succeed. If you can’t, your change will fail.