4 ms·

This is IMO the "simple solution" to healthcare - nothing will bring down healthcare costs faster than the following - be allowed to choose - know how much s

This is IMO the "simple solution" to healthcare - nothing will bring down healthcare costs faster than the following - be allowed to choose - know how much something costs - pay some of the cost themselves (co-pay, health savings account) etc.

triceratops 7y ago
Americans already have co-pays, deductibles, coinsurance and whatever other terms the insurance industry has cooked up, with no visible effects on costs. In addition to your other changes the following would also help: - Allow competition. Don't give hospitals the power to veto new hospitals in their area. - Disallow regional consolidation of hospital systems and medical practices. Regional monopolies are bad. - Increase resident slots and supply of doctors. Make foreign degrees easier to transfer to the US. - Outright ban pharmaceutical advertising. Nothing whatsoever of importance would be lost and all the pharma companies would save millions every year.
- eutropia 7y ago
  There's an argument to be made with respect to advertising to physicians, but not the general public. Doctors have limited time and they ought to know what meds are available somehow..
  - triceratops 7y ago
    I thought that was called pharma marketing, not advertising. That too has had corruption and perverse incentives in the past. However, I did mean banning advertising to the general public. Doctors have the knowledge and expertise to critically evaluate statements presented to them by marketing materials (whether they do so or not is a different story). The general public, modulo the odd autodidactic genius, largely does not. If someone from the general public wants this information, they are free to find it on the Internet. In fact maybe we could make it mandatory that any materials presented to doctors are also posted on the company's website for anyone to see.
  - authoritarian 7y ago
    If pharmaceutical reps were "advertising to physicians" in that they provide medical information on how a drug works, why a doctor should prescribe it, potential risks, etc. then I might agree. However, it seems like more often than not pharma reps buy doctors a fancy steak dinner and a lap dance in exchange for pushing legal heroin on every person that walks through the door. I would rather pharmaceutical marketing be made illegal, and instead require doctors to do some kind of continued education on advancements in medication and other relevant info. https://apnews.com/82f638d6dfcf4193ad28ddf0e65897e1 https://apnews.com/82f638d6dfcf4193ad28ddf0e65897e1 https://www.washingtonpost.com/business/2019/01/30/stripper-turned-pharma-exec-gave-doctor-lap-dance-get-him-prescribe-drugs-officials-say/ https://www.washingtonpost.com/business/2019/01/30/stripper-...
- dannyw 7y ago
  Copays aren’t transparent and essentially do nothing to support comparison shopping.
  - triceratops 7y ago
    That's true, you are right. I guess they're meant as a "brake" to prevent hypochondriacs from spamming doctors.
- jakobegger 7y ago
  Or, you could do what other developed countries do: Don't rely on private for profit hospitals. Here, most hospitals are run either by cities or counties, or by the public insurance companies themselves. This ensures that hospitals have an incentive to be efficient. There are private hospitals, but only very few people go there, since they are very expensive, and you get good care in the public hospitals.
  - whb07 7y ago
    So a quick way to check reality is by looking at behavior, so say you wanted the "best" care for something no matter the costs. Most people would fly to the U.S from wherever. That is telling you something. I agree the "general" care like broken bones etc its probably all the same, but healthcare innovation is done in the U.S. So it is kind of moot to say "its good here"... yes after the innovation trickles its way over to your country. Lastly, one of my best friends is studying to become a doctor, in fact is a resident now. He is getting paid the princely salary of $55k after 15 years of studying and he has many years to go before he's able to really realize any gains. To make the profession a civil servant's position is insanity.
    - DanBC 7y ago
      > Most people would fly to the U.S from wherever. That is telling you something. > but healthcare innovation is done in the U.S These are assertions without much evidence. Don't forget that the US does well on relatively meaningless measures (5 year survival rates for cancer) but poorly on all cause mortality. Why do US citizens die younger than people of other countries if the US healthcare system is so innovative?
      - whb07 7y ago
        Uh okay, I’ll snipe your questions with an obvious one: Lifespan/mortality In the US includes things like drug overdoses and suicides, of which many countries don’t count towards or keep bad record of. Also cancer survival rate for the US is mostly the best in the world [0]. I’m here for more easy volleys if you want to keep this going https://www.cdc.gov/cancer/dcpc/research/articles/concord-2.htm https://www.cdc.gov/cancer/dcpc/research/articles/concord-2....
- mark-r 7y ago
  > all the pharma companies would save millions every year. Their savings would never be passed on to the customer. And it's hard to believe there would be any savings overall, because the advertising must be bringing in more money than it costs or they wouldn't be doing it.
  - triceratops 7y ago
    I'm not disputing pharma advertising is profitable for individual products. I'm skeptical if it's profitable in aggregate. Drug demand is a function of the occurrence of disease. Advertising can increase profits by: 1. Taking market share away from a competitors. Profitable for that product, zero-sum for the industry. Competitors respond by increasing their ad spend, equilibrium returns (unless one drug is genuinely superior to another) 2. Increasing demand for unnecessary medicines. Profitable for the market, bad for society. Advertising is an arms race. Even if I don't want to advertise, I have to because my competitors do. If it's banned, everyone saves the expense of advertising. Unless pharma companies are engaging in cartel-like price-fixing some of that money will definitely go to lower prices (some will also go to R&D, dividends/buybacks, and exec pay). It only takes one company to do it and the rest have to follow.
    - jonlucc 7y ago
      There are two niches in which your analysis is incomplete. First, There are underdiagnosed diseases for which patients don't seek care, sometimes because they do not believe there to be a treatment. The lack of treatment means that it isn't as vital for physicians or patients to pursue diagnosis. Those patients might see an ad and return to a physician to ask if that treatment is a fit. Second, not all physicians are as on top of new treatment options as we expect. It might have slipped their notice or be in a field with which they aren't the most familiar, and those patients might benefit from revisiting whether a new treatment is a good fit. I don't really think these two cases make up for all of the advertising, but they might be missed if advertising is cut or abolished. It might have some fairly large drawbacks, but I think it would be good for pharma and biotech companies to put some amount of money into a fund based on the disease and have awareness campaigns around the diseases. For example, companies with diabetes treatments could form a group that puts out diabetes ads urging patients to talk to their physicians. It gets dicey for first-in-market treatments, but I think it would be an overall improvement from the current system. Disclaimer: I work in big pharma biology research; pricing and advertising are done in a fancier building with more marble floors, so I've thought about this a bit, but it isn't my department.
noelsusman 7y ago
There is no simple solution to healthcare. This will have a minor effect, if any effect at all.
Ididntdothis 7y ago
That’s just a bunch of platitudes.
DanBC 7y ago
Americans are allowed to chose whether they get certain tests or not; and whether they get treatment or not for stuff found by those tests. America has a problem with over-testing, over-diagnosis, and over-treatment. It seems that merely giving people a choice, telling them the cost, and getting them to pay a contribution isn't enough to prevent this. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708862/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708862/ https://jamanetwork.com/journals/jama/fullarticle/2662877 https://jamanetwork.com/journals/jama/fullarticle/2662877
AtlasBarfed 7y ago
- you can't choose in emergency care, so the libertarian pipe dream goes out the window when your supply is fixed and your demand is urgent - cost discovery will be inefficient and time-consuming, which is why single-payer with standard costs is so much more efficient - who doesn't have copays and out of pocket in the US?
AnimalMuppet 7y ago
I think a bit more is needed. Let's say it's 1990, and I'm in the market for a car. A Yugo costs a lot less than some other cars. But I'm getting a lot less for it, too - it's less reliable, won't last as long, and is less comfortable. But, as a car buyer, I can kind of tell that. It doesn't feel like it's as solid a car as some of the other options. Now say I'm trying to have a hip replacement. Here's a place that costs 20% less than the other place. Sounds great, but... what are their rates of complications. How about if you go out 20 years? Without that kind of information, I can't compare on price, because I don't know whether I'm buying equivalent things.
- frogperson 7y ago
  What you say is correct, but you also have to admit there are plenty of shitty doctors today. The shitty doctor problem isn't going away no matter what they are paid.

triceratops 7y ago

Americans already have co-pays, deductibles, coinsurance and whatever other terms the insurance industry has cooked up, with no visible effects on costs. In addition to your other changes the following would also help: - Allow competition. Don't give hospitals the power to veto new hospitals in their area. - Disallow regional consolidation of hospital systems and medical practices. Regional monopolies are bad. - Increase resident slots and supply of doctors. Make foreign degrees easier to transfer to the US. - Outright ban pharmaceutical advertising. Nothing whatsoever of importance would be lost and all the pharma companies would save millions every year.

eutropia 7y ago
There's an argument to be made with respect to advertising to physicians, but not the general public. Doctors have limited time and they ought to know what meds are available somehow..
- triceratops 7y ago
  I thought that was called pharma marketing, not advertising. That too has had corruption and perverse incentives in the past. However, I did mean banning advertising to the general public. Doctors have the knowledge and expertise to critically evaluate statements presented to them by marketing materials (whether they do so or not is a different story). The general public, modulo the odd autodidactic genius, largely does not. If someone from the general public wants this information, they are free to find it on the Internet. In fact maybe we could make it mandatory that any materials presented to doctors are also posted on the company's website for anyone to see.
- authoritarian 7y ago
  If pharmaceutical reps were "advertising to physicians" in that they provide medical information on how a drug works, why a doctor should prescribe it, potential risks, etc. then I might agree. However, it seems like more often than not pharma reps buy doctors a fancy steak dinner and a lap dance in exchange for pushing legal heroin on every person that walks through the door. I would rather pharmaceutical marketing be made illegal, and instead require doctors to do some kind of continued education on advancements in medication and other relevant info. https://apnews.com/82f638d6dfcf4193ad28ddf0e65897e1 https://apnews.com/82f638d6dfcf4193ad28ddf0e65897e1 https://www.washingtonpost.com/business/2019/01/30/stripper-turned-pharma-exec-gave-doctor-lap-dance-get-him-prescribe-drugs-officials-say/ https://www.washingtonpost.com/business/2019/01/30/stripper-...
dannyw 7y ago
Copays aren’t transparent and essentially do nothing to support comparison shopping.
- triceratops 7y ago
  That's true, you are right. I guess they're meant as a "brake" to prevent hypochondriacs from spamming doctors.
jakobegger 7y ago
Or, you could do what other developed countries do: Don't rely on private for profit hospitals. Here, most hospitals are run either by cities or counties, or by the public insurance companies themselves. This ensures that hospitals have an incentive to be efficient. There are private hospitals, but only very few people go there, since they are very expensive, and you get good care in the public hospitals.
- whb07 7y ago
  So a quick way to check reality is by looking at behavior, so say you wanted the "best" care for something no matter the costs. Most people would fly to the U.S from wherever. That is telling you something. I agree the "general" care like broken bones etc its probably all the same, but healthcare innovation is done in the U.S. So it is kind of moot to say "its good here"... yes after the innovation trickles its way over to your country. Lastly, one of my best friends is studying to become a doctor, in fact is a resident now. He is getting paid the princely salary of $55k after 15 years of studying and he has many years to go before he's able to really realize any gains. To make the profession a civil servant's position is insanity.
  - DanBC 7y ago
    > Most people would fly to the U.S from wherever. That is telling you something. > but healthcare innovation is done in the U.S These are assertions without much evidence. Don't forget that the US does well on relatively meaningless measures (5 year survival rates for cancer) but poorly on all cause mortality. Why do US citizens die younger than people of other countries if the US healthcare system is so innovative?
    - whb07 7y ago
      Uh okay, I’ll snipe your questions with an obvious one: Lifespan/mortality In the US includes things like drug overdoses and suicides, of which many countries don’t count towards or keep bad record of. Also cancer survival rate for the US is mostly the best in the world [0]. I’m here for more easy volleys if you want to keep this going https://www.cdc.gov/cancer/dcpc/research/articles/concord-2.htm https://www.cdc.gov/cancer/dcpc/research/articles/concord-2....
mark-r 7y ago
> all the pharma companies would save millions every year. Their savings would never be passed on to the customer. And it's hard to believe there would be any savings overall, because the advertising must be bringing in more money than it costs or they wouldn't be doing it.
- triceratops 7y ago
  I'm not disputing pharma advertising is profitable for individual products. I'm skeptical if it's profitable in aggregate. Drug demand is a function of the occurrence of disease. Advertising can increase profits by: 1. Taking market share away from a competitors. Profitable for that product, zero-sum for the industry. Competitors respond by increasing their ad spend, equilibrium returns (unless one drug is genuinely superior to another) 2. Increasing demand for unnecessary medicines. Profitable for the market, bad for society. Advertising is an arms race. Even if I don't want to advertise, I have to because my competitors do. If it's banned, everyone saves the expense of advertising. Unless pharma companies are engaging in cartel-like price-fixing some of that money will definitely go to lower prices (some will also go to R&D, dividends/buybacks, and exec pay). It only takes one company to do it and the rest have to follow.
  - jonlucc 7y ago
    There are two niches in which your analysis is incomplete. First, There are underdiagnosed diseases for which patients don't seek care, sometimes because they do not believe there to be a treatment. The lack of treatment means that it isn't as vital for physicians or patients to pursue diagnosis. Those patients might see an ad and return to a physician to ask if that treatment is a fit. Second, not all physicians are as on top of new treatment options as we expect. It might have slipped their notice or be in a field with which they aren't the most familiar, and those patients might benefit from revisiting whether a new treatment is a good fit. I don't really think these two cases make up for all of the advertising, but they might be missed if advertising is cut or abolished. It might have some fairly large drawbacks, but I think it would be good for pharma and biotech companies to put some amount of money into a fund based on the disease and have awareness campaigns around the diseases. For example, companies with diabetes treatments could form a group that puts out diabetes ads urging patients to talk to their physicians. It gets dicey for first-in-market treatments, but I think it would be an overall improvement from the current system. Disclaimer: I work in big pharma biology research; pricing and advertising are done in a fancier building with more marble floors, so I've thought about this a bit, but it isn't my department.

noelsusman 7y ago

There is no simple solution to healthcare. This will have a minor effect, if any effect at all.

Ididntdothis 7y ago

That’s just a bunch of platitudes.

DanBC 7y ago

Americans are allowed to chose whether they get certain tests or not; and whether they get treatment or not for stuff found by those tests. America has a problem with over-testing, over-diagnosis, and over-treatment. It seems that merely giving people a choice, telling them the cost, and getting them to pay a contribution isn't enough to prevent this. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708862/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708862/ https://jamanetwork.com/journals/jama/fullarticle/2662877 https://jamanetwork.com/journals/jama/fullarticle/2662877

AtlasBarfed 7y ago

- you can't choose in emergency care, so the libertarian pipe dream goes out the window when your supply is fixed and your demand is urgent - cost discovery will be inefficient and time-consuming, which is why single-payer with standard costs is so much more efficient - who doesn't have copays and out of pocket in the US?

AnimalMuppet 7y ago

I think a bit more is needed. Let's say it's 1990, and I'm in the market for a car. A Yugo costs a lot less than some other cars. But I'm getting a lot less for it, too - it's less reliable, won't last as long, and is less comfortable. But, as a car buyer, I can kind of tell that. It doesn't feel like it's as solid a car as some of the other options. Now say I'm trying to have a hip replacement. Here's a place that costs 20% less than the other place. Sounds great, but... what are their rates of complications. How about if you go out 20 years? Without that kind of information, I can't compare on price, because I don't know whether I'm buying equivalent things.

frogperson 7y ago
What you say is correct, but you also have to admit there are plenty of shitty doctors today. The shitty doctor problem isn't going away no matter what they are paid.