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> It's not just incentives, bureaucracies and inefficiencies that caused cost increases. This might be true if there weren't stark counterexamples, e.g. Singap

> It's not just incentives, bureaucracies and inefficiencies that caused cost increases. This might be true if there weren't stark counterexamples, e.g. Singapore at 1/4 the cost, with better outcomes. Notably there, government dollars flow through to consumers who choose among competitors by price and quality.

pmohun 7y ago
There is also a lower focus on end of life care in Singapore, which makes up the vast majority of spending in the American system. These issues are cultural, not just political or economic. I am looking forward to seeing what PC and TC can come up with for a common framework. This seems to be a tough problem.
- keenmaster 7y ago
  The healthcare sector constitutes 18% of our GDP, a truly insane amount. That is 7-8% (~1.5 trillion) more than it should be. Excessive end-of-life care explains almost none of that. The two biggest issues in American healthcare are: - Zero price transparency - Payment through intermediaries like insurance companies and your employer, who often pays half of your insurance premiums and other healthcare expenditures With no price transparency, prices are just made up with little connection to actual value delivered. Because of the middlemen, most patients don’t feel the full cost of healthcare. Patients in aggregate still pay for the full negotiated cost, just indirectly in the form of higher premiums and forgone wages (marginal premiums paid by the employer). At this point, Medicare for All is our best hope. A true market-based healthcare economy, as great as it may be, is a pipe dream. With Medicare for All, the government would set reimbursement rates in stone. Most doctors who want a substantial amount of patients would have to accept those rates. Unlike insurance companies, the government would not be able to aggressively increase its “premiums,” or taxes, every year and it won’t get kickbacks from hospitals for high cost care. The government would also set empirically backed standards of care that lower their cost burden with no impact on average lifespan. We could potentially allow for parallel “luxury care” purchased by the patient if they want to be able to expedite their non-emergency knee replacement from 6 months to 2 weeks. The government would be incentivized to launch health initiatives and laws that help lower the rates of obesity and diabetes in the population. Lastly, the government would also be incentivized to increase the supply of doctors. There are multiple instances in the past when medical organizations lobbied or misled Congress into over-limiting the supply of medical residencies. They also had a hand in restricting the number and size of medical schools. So yes, overpaid, scarce medical professionals are a big part of the cost burden, and their representative institutions are making sure they stay overpaid. Only recently have medical organizations lobbied to increase the number of residencies again. That’s just damage control. The American people should not accept compromise on healthcare any longer. That’s what the ACA was, and it did not do enough. Medicare for All will bring us in line with the rest of the developed world which has better health outcomes at a much lower cost. We can save >$1 trillion and put that money towards things like a national high speed rail network, anti-poverty efforts, government-subsidized corporate internships, and an accredited national online education and retraining platform with the best professors on every subject imaginable.
netcan 7y ago
Idk about Singapore specifically, and I'm not commenting on the us setup specifically either. Health costs, across advanced economies, are on the rise for several decades. The UK system, and others are constantly busting their budgets. The underlying cost base has grown, due to more types of medical things people are getting. That doesn't exclude inefficiency of a particular system. The US system is expensive, and a lot of that is probably due to the US system accelarating the trend to more and more expensive procedures.
asdfasgasdgasdg 7y ago
It might be interesting to note the difference in Singapore's age curve compared to western countries. They are certainly not 1/4 the cost after adjusting for age. They might still be less but this meme that price transparency is the sole cause has to stop.

pmohun 7y ago

There is also a lower focus on end of life care in Singapore, which makes up the vast majority of spending in the American system. These issues are cultural, not just political or economic. I am looking forward to seeing what PC and TC can come up with for a common framework. This seems to be a tough problem.

keenmaster 7y ago
The healthcare sector constitutes 18% of our GDP, a truly insane amount. That is 7-8% (~1.5 trillion) more than it should be. Excessive end-of-life care explains almost none of that. The two biggest issues in American healthcare are: - Zero price transparency - Payment through intermediaries like insurance companies and your employer, who often pays half of your insurance premiums and other healthcare expenditures With no price transparency, prices are just made up with little connection to actual value delivered. Because of the middlemen, most patients don’t feel the full cost of healthcare. Patients in aggregate still pay for the full negotiated cost, just indirectly in the form of higher premiums and forgone wages (marginal premiums paid by the employer). At this point, Medicare for All is our best hope. A true market-based healthcare economy, as great as it may be, is a pipe dream. With Medicare for All, the government would set reimbursement rates in stone. Most doctors who want a substantial amount of patients would have to accept those rates. Unlike insurance companies, the government would not be able to aggressively increase its “premiums,” or taxes, every year and it won’t get kickbacks from hospitals for high cost care. The government would also set empirically backed standards of care that lower their cost burden with no impact on average lifespan. We could potentially allow for parallel “luxury care” purchased by the patient if they want to be able to expedite their non-emergency knee replacement from 6 months to 2 weeks. The government would be incentivized to launch health initiatives and laws that help lower the rates of obesity and diabetes in the population. Lastly, the government would also be incentivized to increase the supply of doctors. There are multiple instances in the past when medical organizations lobbied or misled Congress into over-limiting the supply of medical residencies. They also had a hand in restricting the number and size of medical schools. So yes, overpaid, scarce medical professionals are a big part of the cost burden, and their representative institutions are making sure they stay overpaid. Only recently have medical organizations lobbied to increase the number of residencies again. That’s just damage control. The American people should not accept compromise on healthcare any longer. That’s what the ACA was, and it did not do enough. Medicare for All will bring us in line with the rest of the developed world which has better health outcomes at a much lower cost. We can save >$1 trillion and put that money towards things like a national high speed rail network, anti-poverty efforts, government-subsidized corporate internships, and an accredited national online education and retraining platform with the best professors on every subject imaginable.

netcan 7y ago

Idk about Singapore specifically, and I'm not commenting on the us setup specifically either. Health costs, across advanced economies, are on the rise for several decades. The UK system, and others are constantly busting their budgets. The underlying cost base has grown, due to more types of medical things people are getting. That doesn't exclude inefficiency of a particular system. The US system is expensive, and a lot of that is probably due to the US system accelarating the trend to more and more expensive procedures.

asdfasgasdgasdg 7y ago

It might be interesting to note the difference in Singapore's age curve compared to western countries. They are certainly not 1/4 the cost after adjusting for age. They might still be less but this meme that price transparency is the sole cause has to stop.