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The problem with this is in how you classify different types of care. For example, is end of life care voluntary and thus should not be covered by insurance or

The problem with this is in how you classify different types of care. For example, is end of life care voluntary and thus should not be covered by insurance or is it emergency? If you say it’s the former and go to a national healthcare setup, people lose their minds shouting about death panels. If you say it’s the latter, healthcare costs go up 10-12%.

cheald 7y ago
Absolutely. There are a zillion different problems to solve like this, but I don't think they're necessarily unsolvable, though. On the one hand, you do really want people to be relatively insensitive to the cost of medical care they actually need. When you need it, you get it. On the other hand, that price insensitivity, applied indiscriminately, leads to the massive ballooning costs we've all seen. I don't think there's a way to have full price insensitivity and to keep prices in check - which means that we either just spend whatever our doctors ask (I'm not interested in that), or we start making people more price-sensitive to allow those downward pricing pressures to be exerted. Fundamentally, you don't get away with increased price sensitivity without someone yelling about death panels. Prices are how we allocate scarce resources, which means they determine who doesn't get things. We can either pretend prices don't exist (and get the status quo), or we can acknowledge that they do and that sometimes, people can't or won't pay those prices. Neither is emotionally attractive, but I think being realistic about the existence of prices and allowing consumers to actually exert some market pressures is preferable than just being held hostage to whatever the insurers demand we pay this year, just so that we don't have to think about costs at the point of service.
- secabeen 7y ago
  > Absolutely. There are a zillion different problems to solve like this, but I don't think they're necessarily unsolvable, though. They are solvable, but with regulation, and they will sometimes get an edge case here or there wrong, which will inevitably result in a low-effort, sensationalist news article which will decry the situation, degrade people's support of the systems, and damage the institution.
- anoncake 7y ago
  > I don't think there's a way to have full price insensitivity and to keep prices in check Maybe I've misunderstood you but how can there be no way to achieve what almost every other country has achieved?
  - cheald 7y ago
    Well, I don't think other countries have achieved actual price insensitivity, in the sense of "fully inelastic demand". Fundamentally, for any scarce resource, supply, demand, and price are necessarily linked. Medical care is scarce - consuming a unit of medication or a time slot with a doctor precludes someone else from consuming the same. The allocation mechanism can be monetary (price), temporal (wait times/backlogs), or regulatory (restriction from certain services or treatments), but there must be an allocation mechanism. As far as I know, there's no country in the world where you can get all the medical care you demand when you demand it without consideration of price; if you're not paying monetarily, you're subject to rationing or restrictions that otherwise limit the demand you can place on the system. In Singapore, for example, Medisave only covers drugs that the government has deemed cost-effective. Need a high-cost experimental medication? Not permitted. Denmark has notably bad cancer survival rates, much a consequence of long wait times for screenings and treatments. The US, by comparison, has some of the highest cancer survival rates in the developed world, arguably because Americans can (and do) spend on tests and screenings at far higher rates than other countries. IIRC, Americans get medical imaging scans at a rate roughly 100-1000% higher than patients in other first-world nations. Most of those scans don't find anything, and if you're a government bean counter deciding how to allocate this year's medical budget, they're going to be high on the list to cut or ration - but when they find something, those early warnings and immediate access to aggressive (and expensive) treatment make a significant difference.
toasterlovin 7y ago
What if you offer the option of a lump sum payment upon death to anybody who is faced with a disease that will most likely end in imminent death? So, if it costs $250k for treatment of a cancer where the patient is going to die in, at most, a few years, then offer them $125k payable heirs upon their death (where it would then go to heirs). In return, they elect to have only end-of-life care performed. I bet there's a lot of people who would take this. And it would both save money and make a pretty big difference in the lives of people who still have a lot of life left to live.

cheald 7y ago

Absolutely. There are a zillion different problems to solve like this, but I don't think they're necessarily unsolvable, though. On the one hand, you do really want people to be relatively insensitive to the cost of medical care they actually need. When you need it, you get it. On the other hand, that price insensitivity, applied indiscriminately, leads to the massive ballooning costs we've all seen. I don't think there's a way to have full price insensitivity and to keep prices in check - which means that we either just spend whatever our doctors ask (I'm not interested in that), or we start making people more price-sensitive to allow those downward pricing pressures to be exerted. Fundamentally, you don't get away with increased price sensitivity without someone yelling about death panels. Prices are how we allocate scarce resources, which means they determine who doesn't get things. We can either pretend prices don't exist (and get the status quo), or we can acknowledge that they do and that sometimes, people can't or won't pay those prices. Neither is emotionally attractive, but I think being realistic about the existence of prices and allowing consumers to actually exert some market pressures is preferable than just being held hostage to whatever the insurers demand we pay this year, just so that we don't have to think about costs at the point of service.

secabeen 7y ago
> Absolutely. There are a zillion different problems to solve like this, but I don't think they're necessarily unsolvable, though. They are solvable, but with regulation, and they will sometimes get an edge case here or there wrong, which will inevitably result in a low-effort, sensationalist news article which will decry the situation, degrade people's support of the systems, and damage the institution.
anoncake 7y ago
> I don't think there's a way to have full price insensitivity and to keep prices in check Maybe I've misunderstood you but how can there be no way to achieve what almost every other country has achieved?
- cheald 7y ago
  Well, I don't think other countries have achieved actual price insensitivity, in the sense of "fully inelastic demand". Fundamentally, for any scarce resource, supply, demand, and price are necessarily linked. Medical care is scarce - consuming a unit of medication or a time slot with a doctor precludes someone else from consuming the same. The allocation mechanism can be monetary (price), temporal (wait times/backlogs), or regulatory (restriction from certain services or treatments), but there must be an allocation mechanism. As far as I know, there's no country in the world where you can get all the medical care you demand when you demand it without consideration of price; if you're not paying monetarily, you're subject to rationing or restrictions that otherwise limit the demand you can place on the system. In Singapore, for example, Medisave only covers drugs that the government has deemed cost-effective. Need a high-cost experimental medication? Not permitted. Denmark has notably bad cancer survival rates, much a consequence of long wait times for screenings and treatments. The US, by comparison, has some of the highest cancer survival rates in the developed world, arguably because Americans can (and do) spend on tests and screenings at far higher rates than other countries. IIRC, Americans get medical imaging scans at a rate roughly 100-1000% higher than patients in other first-world nations. Most of those scans don't find anything, and if you're a government bean counter deciding how to allocate this year's medical budget, they're going to be high on the list to cut or ration - but when they find something, those early warnings and immediate access to aggressive (and expensive) treatment make a significant difference.

toasterlovin 7y ago

What if you offer the option of a lump sum payment upon death to anybody who is faced with a disease that will most likely end in imminent death? So, if it costs $250k for treatment of a cancer where the patient is going to die in, at most, a few years, then offer them $125k payable heirs upon their death (where it would then go to heirs). In return, they elect to have only end-of-life care performed. I bet there's a lot of people who would take this. And it would both save money and make a pretty big difference in the lives of people who still have a lot of life left to live.