6 ms·

The US system really needs to be torn down and rebuilt from scratch. Stories like this simply shouldn’t happen. There is almost no way as a patient to ensure yo

The US system really needs to be torn down and rebuilt from scratch. Stories like this simply shouldn’t happen. There is almost no way as a patient to ensure your coverage is sufficient besides having a lot of money in case. It’s insane and hard to understand how anyone can defend this. With the lack of information the patient has nobody should talk about free markets. A functioning market requires that all participants have information available for making a decision.

sneak 7y ago
Torn down by whom? There is a whole system of laws and companies and staff that would object to such a dictatorial move. We agree that it’s fucked. We likely disagree on where it needs to go, and possibly on how it needs to get there. Actionable steps to improve are what is needed, especially now that stance on healthcare regulation has become a point of political identity in the USA. I think it will probably get worse before it gets better. FWIW, I agree totally on the lack of information part. The current system is the worst possible setup.
- toomuchtodo 7y ago
  60% of Americans believe the government (in some form) should ensure healthcare for its citizens (per Pew Research). 70% of Americans support Medicare for All. We’re going single payer (Medicare For All), it’s just a matter of when (the younger you are, the more you’re likely to support it). https://www.pewresearch.org/fact-tank/2018/10/03/most-continue-to-say-ensuring-health-care-coverage-is-governments-responsibility/ https://www.pewresearch.org/fact-tank/2018/10/03/most-contin... https://thehill.com/hilltv/what-americas-thinking/412545-70-percent-of-americans-support-medicare-for-all-health-care https://thehill.com/hilltv/what-americas-thinking/412545-70-...
  - godzillabrennus 7y ago
    Makes sense to go single payer (and I tend to be pretty libertarian over all). Insurance is about having a pool of payers large enough for offsetting costs. The larger the pool in a nation with population growth the higher probability that a larger pool will be better. The largest pool is everyone. I don’t like calling it a human right. That implies the doctors are enslaved to provide care. No rational and highly intelligent person will pursue medicine as a career if it’s going to require 12 years of education before conscription into unpaid labor.
    - deleted 7y ago
      [deleted]
    - blackflame7000 7y ago
      I like your argument, my only concern is that the government also operates the VA and the DMV which doesn't give me much confidence. The problem is also on the cost side of things. Hospitals charge astronomical for basic things like saline solution ($595 with insurance from personal experience). We have to get costs down because both of these industries are enriching themselves by privately negotiating rates.
    - seppin 7y ago
      > Makes sense to go single payer Government as a single buyer of services from private health care providers. What's the problem?
    - Ididntdothis 7y ago
      Somehow other countries have figured it out. Europe has a wide variety of systems from mostly private to completely public but none is even remotely as insane as the US.
    - Frondo 7y ago
      Of course they would be paid, just like doctors are paid everywhere there's universal health care available. Access to a functioning justice system, as it ensures everyone access to laws, is arguably a human right, and yet no one ever says police, judges, or public defenders are slaves. Why is health care different?
    - hwillis 7y ago
      > I don’t like calling it a human right. That implies the doctors are enslaved to provide care. No rational and highly intelligent person will pursue medicine as a career if it’s going to require 12 years of education before conscription into unpaid labor. That's a ridiculous Shapiro-esque take. Are programmers enslaved by accessibility requirements? Are constructors and building owners enslaved by handicapped bathrooms and wheelchair ramps? Not to mention, the thing you're describing already exists and is one of the least controversial parts of healthcare. Doctors are required to provide care, even above and beyond the Hippocratic oath. They cannot discriminate against their patients in many circumstances. Generally this is agreed to be a good thing. Healthcare as a human right does not mean that people are forced to become doctors and forced to provide care. It means that the available care should be distributed to everyone, just like the ADA means that available resources must also be distributed to give some level of equity to people born with disabilities. All humans deserve an equal footing, and should not be responsible for bad things happening to them which are not their fault. Disabilities are an obvious and clear example of that. Healthcare is similar. I have no particular stance on healthcare as a human right but you're being atrociously uncharitable in representing it.
  - remotecool 7y ago
    I don't look forward to this day. What many people don't realize is that the majority of new medicine is patented and created in the US. Once it's released, governments that have socialized health care create generics and get around these costs, mostly because they don't have to put any money into R&D. The world of medicine will be in trouble without our system, because govetnments are really not that good at innovation. Socialized medicine is great for simple checkups, but breaks down as you get older and need major surgery. I really don't want the government making these life or death decisions.
    - toomuchtodo 7y ago
      Private insurance makes those decisions already (care rationing), as does the government when you’re on Medicare (government run healthcare with very high approval ratings from those on it [per Gallup and AARP]). You’re hand wringing over a system that is already here, and your fears are unfounded. If you want more drug R&D, up the funding for the National Institute of Health; it’s then publicly owned, and you’ve cut out yet another middleman (drug companies).
    - roland00 7y ago
      >The world of medicine will be in trouble without our system, because govetnments are really not that good at innovation. Medicine is not like building a factory, completely different capital model for Medicine is about "discovery" there is a universal truth out there (yes there is differences in genes not making it perfectly universal) , and advances in medicine is figuring out this discovery. It actually appears most of our medicine discoveries use basic research that is governmentally funded and not privately funded. Pretty much you are applying top down ideology that government is bad no matter the situation or context.
      - remotecool 7y ago
        I`m applying top down ideology because I've never seen a socialized government industry out-compete any private pharma company by coming up with new/innovative medicine. The reason is because you need to risk lots of money for R&D well beyond "basic research" and historically, governments arent nearly efficient enough to accomplish this. Private industry/the free market is the perfect way to do this and historically has proven itself over and over again. Another problem is that FDA approval takes over a decade and many billions of dollars. We need to find a way to improve this, without sacrificing quality. A couple of good examples of the free market working in the free market is LASIK eye surgery. 20 years ago it was thousands of dollars. Competition brought it down to less than $500. You don't get this natural competition with the government monopolizing healthcare and price fixing. We all win with more competition, and government-run healthcare is the exact opposite of this.
- brian-armstrong 7y ago
  > Torn down by whom? Trump can and should do it. He's one of the few in Washington who isn't actually owned by the Pharma companies.
  - seppin 7y ago
    > He's one of the few in Washington who isn't actually owned by the Pharma companies. IF that's true, it's because they haven't offered him anything yet.
  - Ididntdothis 7y ago
    Excellent performance so far by him, right?
old-gregg 7y ago
> [US healthcare] needs to be torn down and rebuilt from scratch... Here are some numbers, just to provide perspective: [1] The worst recession in recent history (2008-09) featured a drop of US GDP by -2.5%. The US healthcare spending per capita is about twice as high than EU average. US healthcare spending is about 17% of GDP. Which means if we somehow manage to fix it and bring it to average European levels, that would represent a drop of -8.5% GDP We haven't seen GDP drops like this since WW2. So... I seriously doubt "rebuild from scratch" will work. We need a gradual, systematic cost cutting program spread over 10-15 years. And why aim at EU average? Let's make it the world's most efficient, while we're at it. [1] quoting from memory, feel free to google & correct me
- Ididntdothis 7y ago
  "nd why aim at EU average? Let's make it the world's most efficient, while we're at it." Yes setting impossible goals from the start is a good way to be successful. Not.
- alpineidyll3 7y ago
  You're confusing spending with production :P. This money would be spent elsewhere. Calling a number GDP is highly deceptive...
wutbrodo 7y ago
Honestly, a free market might even be better than what we have (though something like single-payer would be ideal). As usual, we have the weird half-assed worst of both works policy solution that comes from neither self-consistent solution being palatable to the electorate.
- AstralStorm 7y ago
  It's not just about free market. It has to be transparent to customers or you get the exact result you have now. This means at least a minimum amount of regulation is necessary.
- Ididntdothis 7y ago
  In my view a free market can only work if participation is optional. When you have a heart attack you can't really negotiate with the ambulance or the hospital. There needs to be some kind of regulations to keep costs in check. But I would advocate total price transparency so you can at least shop around before non-emergency treatments. Also, insured and uninsured patients need to be charged the same money.
  - kthejoker2 7y ago
    > When you have a heart attack you can't really negotiate with the ambulance or the hospital I mean, in some crazy alternate universe, this is exactly what insurance is for. I pay you a fixed premium ahead of time in exchange for you paying out the costs when it occurs. Truly we're in the darkest timeline.
  - wutbrodo 7y ago
    Right, my comment probably made it sound like I'm more in favor of a free market than I am. The point I was making that what we have now has so many deep flaws that it's likely that a free market would still be better, and a lot of the price stupidity you describe can be traced back to regulation encumbrance. Also note that I'm assuming some level of baseline regulation on the order of other industries, just as single-payer would still have some market characteristics (like choosing doctors etc).
- 7y ago

sneak 7y ago

Torn down by whom? There is a whole system of laws and companies and staff that would object to such a dictatorial move. We agree that it’s fucked. We likely disagree on where it needs to go, and possibly on how it needs to get there. Actionable steps to improve are what is needed, especially now that stance on healthcare regulation has become a point of political identity in the USA. I think it will probably get worse before it gets better. FWIW, I agree totally on the lack of information part. The current system is the worst possible setup.

toomuchtodo 7y ago
60% of Americans believe the government (in some form) should ensure healthcare for its citizens (per Pew Research). 70% of Americans support Medicare for All. We’re going single payer (Medicare For All), it’s just a matter of when (the younger you are, the more you’re likely to support it). https://www.pewresearch.org/fact-tank/2018/10/03/most-continue-to-say-ensuring-health-care-coverage-is-governments-responsibility/ https://www.pewresearch.org/fact-tank/2018/10/03/most-contin... https://thehill.com/hilltv/what-americas-thinking/412545-70-percent-of-americans-support-medicare-for-all-health-care https://thehill.com/hilltv/what-americas-thinking/412545-70-...
- godzillabrennus 7y ago
  Makes sense to go single payer (and I tend to be pretty libertarian over all). Insurance is about having a pool of payers large enough for offsetting costs. The larger the pool in a nation with population growth the higher probability that a larger pool will be better. The largest pool is everyone. I don’t like calling it a human right. That implies the doctors are enslaved to provide care. No rational and highly intelligent person will pursue medicine as a career if it’s going to require 12 years of education before conscription into unpaid labor.
  - deleted 7y ago
    [deleted]
  - blackflame7000 7y ago
    I like your argument, my only concern is that the government also operates the VA and the DMV which doesn't give me much confidence. The problem is also on the cost side of things. Hospitals charge astronomical for basic things like saline solution ($595 with insurance from personal experience). We have to get costs down because both of these industries are enriching themselves by privately negotiating rates.
  - seppin 7y ago
    > Makes sense to go single payer Government as a single buyer of services from private health care providers. What's the problem?
  - Ididntdothis 7y ago
    Somehow other countries have figured it out. Europe has a wide variety of systems from mostly private to completely public but none is even remotely as insane as the US.
  - Frondo 7y ago
    Of course they would be paid, just like doctors are paid everywhere there's universal health care available. Access to a functioning justice system, as it ensures everyone access to laws, is arguably a human right, and yet no one ever says police, judges, or public defenders are slaves. Why is health care different?
  - hwillis 7y ago
    > I don’t like calling it a human right. That implies the doctors are enslaved to provide care. No rational and highly intelligent person will pursue medicine as a career if it’s going to require 12 years of education before conscription into unpaid labor. That's a ridiculous Shapiro-esque take. Are programmers enslaved by accessibility requirements? Are constructors and building owners enslaved by handicapped bathrooms and wheelchair ramps? Not to mention, the thing you're describing already exists and is one of the least controversial parts of healthcare. Doctors are required to provide care, even above and beyond the Hippocratic oath. They cannot discriminate against their patients in many circumstances. Generally this is agreed to be a good thing. Healthcare as a human right does not mean that people are forced to become doctors and forced to provide care. It means that the available care should be distributed to everyone, just like the ADA means that available resources must also be distributed to give some level of equity to people born with disabilities. All humans deserve an equal footing, and should not be responsible for bad things happening to them which are not their fault. Disabilities are an obvious and clear example of that. Healthcare is similar. I have no particular stance on healthcare as a human right but you're being atrociously uncharitable in representing it.
- remotecool 7y ago
  I don't look forward to this day. What many people don't realize is that the majority of new medicine is patented and created in the US. Once it's released, governments that have socialized health care create generics and get around these costs, mostly because they don't have to put any money into R&D. The world of medicine will be in trouble without our system, because govetnments are really not that good at innovation. Socialized medicine is great for simple checkups, but breaks down as you get older and need major surgery. I really don't want the government making these life or death decisions.
  - toomuchtodo 7y ago
    Private insurance makes those decisions already (care rationing), as does the government when you’re on Medicare (government run healthcare with very high approval ratings from those on it [per Gallup and AARP]). You’re hand wringing over a system that is already here, and your fears are unfounded. If you want more drug R&D, up the funding for the National Institute of Health; it’s then publicly owned, and you’ve cut out yet another middleman (drug companies).
  - roland00 7y ago
    >The world of medicine will be in trouble without our system, because govetnments are really not that good at innovation. Medicine is not like building a factory, completely different capital model for Medicine is about "discovery" there is a universal truth out there (yes there is differences in genes not making it perfectly universal) , and advances in medicine is figuring out this discovery. It actually appears most of our medicine discoveries use basic research that is governmentally funded and not privately funded. Pretty much you are applying top down ideology that government is bad no matter the situation or context.
    - remotecool 7y ago
      I`m applying top down ideology because I've never seen a socialized government industry out-compete any private pharma company by coming up with new/innovative medicine. The reason is because you need to risk lots of money for R&D well beyond "basic research" and historically, governments arent nearly efficient enough to accomplish this. Private industry/the free market is the perfect way to do this and historically has proven itself over and over again. Another problem is that FDA approval takes over a decade and many billions of dollars. We need to find a way to improve this, without sacrificing quality. A couple of good examples of the free market working in the free market is LASIK eye surgery. 20 years ago it was thousands of dollars. Competition brought it down to less than $500. You don't get this natural competition with the government monopolizing healthcare and price fixing. We all win with more competition, and government-run healthcare is the exact opposite of this.
brian-armstrong 7y ago
> Torn down by whom? Trump can and should do it. He's one of the few in Washington who isn't actually owned by the Pharma companies.
- seppin 7y ago
  > He's one of the few in Washington who isn't actually owned by the Pharma companies. IF that's true, it's because they haven't offered him anything yet.
- Ididntdothis 7y ago
  Excellent performance so far by him, right?

old-gregg 7y ago

> [US healthcare] needs to be torn down and rebuilt from scratch... Here are some numbers, just to provide perspective: [1] The worst recession in recent history (2008-09) featured a drop of US GDP by -2.5%. The US healthcare spending per capita is about twice as high than EU average. US healthcare spending is about 17% of GDP. Which means if we somehow manage to fix it and bring it to average European levels, that would represent a drop of -8.5% GDP We haven't seen GDP drops like this since WW2. So... I seriously doubt "rebuild from scratch" will work. We need a gradual, systematic cost cutting program spread over 10-15 years. And why aim at EU average? Let's make it the world's most efficient, while we're at it. [1] quoting from memory, feel free to google & correct me

Ididntdothis 7y ago
"nd why aim at EU average? Let's make it the world's most efficient, while we're at it." Yes setting impossible goals from the start is a good way to be successful. Not.
alpineidyll3 7y ago
You're confusing spending with production :P. This money would be spent elsewhere. Calling a number GDP is highly deceptive...

wutbrodo 7y ago

Honestly, a free market might even be better than what we have (though something like single-payer would be ideal). As usual, we have the weird half-assed worst of both works policy solution that comes from neither self-consistent solution being palatable to the electorate.

AstralStorm 7y ago
It's not just about free market. It has to be transparent to customers or you get the exact result you have now. This means at least a minimum amount of regulation is necessary.
Ididntdothis 7y ago
In my view a free market can only work if participation is optional. When you have a heart attack you can't really negotiate with the ambulance or the hospital. There needs to be some kind of regulations to keep costs in check. But I would advocate total price transparency so you can at least shop around before non-emergency treatments. Also, insured and uninsured patients need to be charged the same money.
- kthejoker2 7y ago
  > When you have a heart attack you can't really negotiate with the ambulance or the hospital I mean, in some crazy alternate universe, this is exactly what insurance is for. I pay you a fixed premium ahead of time in exchange for you paying out the costs when it occurs. Truly we're in the darkest timeline.
- wutbrodo 7y ago
  Right, my comment probably made it sound like I'm more in favor of a free market than I am. The point I was making that what we have now has so many deep flaws that it's likely that a free market would still be better, and a lot of the price stupidity you describe can be traced back to regulation encumbrance. Also note that I'm assuming some level of baseline regulation on the order of other industries, just as single-payer would still have some market characteristics (like choosing doctors etc).
7y ago