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I think the problem with never-ending healthcare costs is that it isn’t run enough like a business. Any normal business decreases costs to survive. It appears h

I think the problem with never-ending healthcare costs is that it isn’t run enough like a business. Any normal business decreases costs to survive. It appears healthcare is at 20% of GDP and rising forever.

MereInterest 7y ago
There are three options. I'll call them options E, S, and G. Option E is to run healthcare entirely as a business. Payment up front, and refusal to treat anyone without payment. Option S is to take option E, but avoid immediately attributable deaths. Treat somebody at the emergency room, even if they don't have a line of credit with them. Patch them up enough to walk out the door, but don't treat the underlying issues without additional payment. Option G is to treat patients before they reach death's door, when it is cheaper to do so. To give the preventative care that keeps costs down, even if somebody isn't able to pay for it. To treat public health as a public good, rather than as a series of purchases. Option E is evil, to let people die unnecessarily. Option S isn't openly evil, but is stupid. It is where the US is now, and inflates the costs tremendously. Option G is to actually be good.
- chipperyman573 7y ago
  Preventative care doesn't actually save money (source: https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html https://www.nytimes.com/2018/01/29/upshot/preventive-health-... ) But a moral argument could certainly be made for option G.
  - gav 7y ago
    Preventative care might not save money, but in a nationalized system which is funded by tax collection, having participants healthy so that they can live longer and pay more taxes sounds like a good idea. I feel like it's not only a moral argument, instead it's a better alignment of those who pay and are served by the system. At present, the goals of insurers and providers are very different from patients, partly due to profit-seeking, partly due to the disconnect in who pays for it (49% of US population receives employer-covered healthcare).
  - MereInterest 7y ago
    Huh, thank you. I hadn't known that. I tend to go with the monetary argument first, since it helps to convince people who are primarily self-interested. I definitely think that there is a moral argument for option G, and will stick to those arguments overall in the future.
- maximente 7y ago
  you've inappropriately reduced this into three bins, ignoring all nuance which is the actual hard part of the problem. in option G, how much $ do we spend on terminally ill patients in order for them to have a few more days with their loved ones? or how about smokers who will as a result of their actions will cost spades more than "good souls"? or type 2 diabetics on dialysis? this false trilemma is largely useless and only presents one side of a moral choice and even then ignores the other prickly of it (read: the people paying for this glorious utopia and where the lines are drawn when it comes to saying no)
  - jdashg 7y ago
    Either the system we have today works because we put enough money into it, and therefore would continue to work if we nationalized; or our system has unjust failures that we should seek to rectify. We already pay for our healthcare in the US, we just do it predominantly via employer-contributed job benefits, and existing Medicare/Medicaid. The money for the bulk of healthcare is already there, but there are people falling through cracks all the time. Is your position that bringing everyone's healthcare up to Medicare's baseline is too expensive? Where is the extra cost coming from?
    - darawk 7y ago
      > Either the system we have today works because we put enough money into it, and therefore would continue to work if we nationalized; or our system has unjust failures that we should seek to rectify. That is very bad reasoning. Most things don't get cheaper when they get nationalized. There is some evidence healthcare may be different in this regard, but the point is: costs are not invariant under nationalization. > Is your position that bringing everyone's healthcare up to Medicare's baseline is too expensive? Where is the extra cost coming from? Cost of providing the existing service is not the only cost worth considering. The other issue is opportunity cost of innovation. Right now there are powerful incentives for people to innovate in the healthcare space, particularly in pharmaceuticals. But also in prosthetics and the procedural space. Nationalization is likely to crimp those incentives, and thereby lead to less innovation over time.
  - 7y ago
Firadeoclus 7y ago
I would argue that dedicating a larger part of a nation's output to healthcare is not bad in itself. In fact the better futures I can imagine all have very significantly broader healthcare provision. And we'd be spending more on health because we can. Efficiency matters, of course, and a higher fraction of GDP spent on healthcare isn't per se better, either. One problem with private provision of anything is that a company only cares about the revenue it can actually capture itself. Nationalised provision, using tax as a revenue stream, can look at whether something is beneficial on the whole even if it isn't directly paid for.

MereInterest 7y ago

There are three options. I'll call them options E, S, and G. Option E is to run healthcare entirely as a business. Payment up front, and refusal to treat anyone without payment. Option S is to take option E, but avoid immediately attributable deaths. Treat somebody at the emergency room, even if they don't have a line of credit with them. Patch them up enough to walk out the door, but don't treat the underlying issues without additional payment. Option G is to treat patients before they reach death's door, when it is cheaper to do so. To give the preventative care that keeps costs down, even if somebody isn't able to pay for it. To treat public health as a public good, rather than as a series of purchases. Option E is evil, to let people die unnecessarily. Option S isn't openly evil, but is stupid. It is where the US is now, and inflates the costs tremendously. Option G is to actually be good.

chipperyman573 7y ago
Preventative care doesn't actually save money (source: https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html https://www.nytimes.com/2018/01/29/upshot/preventive-health-... ) But a moral argument could certainly be made for option G.
- gav 7y ago
  Preventative care might not save money, but in a nationalized system which is funded by tax collection, having participants healthy so that they can live longer and pay more taxes sounds like a good idea. I feel like it's not only a moral argument, instead it's a better alignment of those who pay and are served by the system. At present, the goals of insurers and providers are very different from patients, partly due to profit-seeking, partly due to the disconnect in who pays for it (49% of US population receives employer-covered healthcare).
- MereInterest 7y ago
  Huh, thank you. I hadn't known that. I tend to go with the monetary argument first, since it helps to convince people who are primarily self-interested. I definitely think that there is a moral argument for option G, and will stick to those arguments overall in the future.
maximente 7y ago
you've inappropriately reduced this into three bins, ignoring all nuance which is the actual hard part of the problem. in option G, how much $ do we spend on terminally ill patients in order for them to have a few more days with their loved ones? or how about smokers who will as a result of their actions will cost spades more than "good souls"? or type 2 diabetics on dialysis? this false trilemma is largely useless and only presents one side of a moral choice and even then ignores the other prickly of it (read: the people paying for this glorious utopia and where the lines are drawn when it comes to saying no)
- jdashg 7y ago
  Either the system we have today works because we put enough money into it, and therefore would continue to work if we nationalized; or our system has unjust failures that we should seek to rectify. We already pay for our healthcare in the US, we just do it predominantly via employer-contributed job benefits, and existing Medicare/Medicaid. The money for the bulk of healthcare is already there, but there are people falling through cracks all the time. Is your position that bringing everyone's healthcare up to Medicare's baseline is too expensive? Where is the extra cost coming from?
  - darawk 7y ago
    > Either the system we have today works because we put enough money into it, and therefore would continue to work if we nationalized; or our system has unjust failures that we should seek to rectify. That is very bad reasoning. Most things don't get cheaper when they get nationalized. There is some evidence healthcare may be different in this regard, but the point is: costs are not invariant under nationalization. > Is your position that bringing everyone's healthcare up to Medicare's baseline is too expensive? Where is the extra cost coming from? Cost of providing the existing service is not the only cost worth considering. The other issue is opportunity cost of innovation. Right now there are powerful incentives for people to innovate in the healthcare space, particularly in pharmaceuticals. But also in prosthetics and the procedural space. Nationalization is likely to crimp those incentives, and thereby lead to less innovation over time.
- 7y ago

Firadeoclus 7y ago

I would argue that dedicating a larger part of a nation's output to healthcare is not bad in itself. In fact the better futures I can imagine all have very significantly broader healthcare provision. And we'd be spending more on health because we can. Efficiency matters, of course, and a higher fraction of GDP spent on healthcare isn't per se better, either. One problem with private provision of anything is that a company only cares about the revenue it can actually capture itself. Nationalised provision, using tax as a revenue stream, can look at whether something is beneficial on the whole even if it isn't directly paid for.