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I thought the most interesting part was the commentary on non-Amish care in the past > I asked my literal grandmother, a 95 year old former nurse, how health
by tathougies 7y ago
I thought the most interesting part was the commentary on non-Amish care in the past
> I asked my literal grandmother, a 95 year old former nurse, how health care worked in her day. She said it just wasn’t a problem. Hospitals were supported by wealthy philanthropists and religious organizations. Poor people got treated for free. Middle class people paid as much as they could afford, which was often the whole bill, because bills were cheap. Rich people paid extra for fancy hospital suites and helped subsidize everyone else.
In other words... allow rampant inequality in the healthcare system. The rich would pay for their designer surgeries, and let that subsidize the rest.
- itsrajju 7y agoSomething like this happens in Indian Railways too. Lower class tickets are dirt cheap -- around 20 cents for a 100km journey. Whereas an air-conditioned first class ticket costs about 10 dollars.
- api 7y agoMedicine was also way less tech-heavy, so the costs were objectively less. Invasive surgeries and similarly advanced treatments are incredibly complex high-tech and high-skill undertakings. If you look at the high end of medicine it's like they're routinely pulling off moon shots: carefully excising brain tumors, separating conjoined twins, transplanting living organs, etc. I am not suggesting this explains all of it. Our health care system is definitely overpriced and overloaded with badly designed bureaucracy, but it definitely explains some of it.
- pmiller2 7y agoThat inequality is still present, except that now, the system is: * Poor people either get hit with huge bills because they're uninsured, or, if they know how to navigate the system, sometimes get these bills written off through "financial aid." * Middle class people frequently have insurance, but get hammered by deductibles and out of pocket maximums, rarely qualifying for "financial aid." This can be ruinous. * The rich still get what they want. If the rich are "subsidizing" things anymore, it's not to a great enough extent to benefit the poor and middle class. The system has been broken over the past 40 years by medical and insurance costs that have risen much faster than the rate of wage growth for the average worker.
- specialist 7y agoI currently believe rising administrative overhead accounts for most of the cost increase. Single payer is a straightforward proven solution. Switching from fee-for-service to prevention (capitation) would give us another 25% savings. But I'm newly interested in notions related to cost disease. Am keen to hear anything anyone has to say about mitigation.
- ineedasername 7y agoThe biggest administrative costs in health care are the insurance companies' costs. [0] To the tune of more than $200 billion dollars/year. [0] https://time.com/5759972/health-care-administrative-costs/ https://time.com/5759972/health-care-administrative-costs/
- ashtonkem 7y agoOne snare is that that a lot of overhead takes the form of jobs in the insurance industry. Any reasonable plan to reduce that overhead means eliminating all of those jobs.
- ilikehurdles 7y agoThe hospitals I'm familiar with have VIP suites for the "haves". The only difference is everyone else gets into a lifetime of debt now too. Ability to afford medication and insurance is a question that is brought up during liver transplant panels. An alcoholic physician, politician, or celebrity is much more likely to get an organ transplant than any other alcoholic. Inequality of health is still rife here.
- dariusj18 7y agoI cannot imagine this covers access issues. There are a great number of communities without wealthy people near them.
- pkaye 7y agoIts already an issue in some areas where the Medicaid patients dominate over private insurance patients. Often times hospitals balance things by overcharging those they think they can.
- Ididntdothis 7y agoI think there is much more expensive tech in medicine today. But in general I would be fine If I had affordable health care that’s maybe a few years behind the cutting edge. In most markets things get commoditized and cheaper but this doesn’t seem to happen in health care.
- pasquinelli 7y agoPerhaps a market analysis of medicine in the u.s. doesn't work because it isn't really a market, but more like a cartel. This also provides a good frame for understanding how it is that nothing improves: how do other cartels interact with governments?
- jimmaswell 7y agoHow do you come away with an inequality issue from a setup where everyone got treated at a fair price and the rich subsidized others?
- bluejekyll 7y agoI believe the inequality is that the more wealthy purchase better care, or conditions, at the hospital. Therefor not everyone gets the same care. I’m not sure how that’s different from today, other than the exorbitant costs that exist today.
- tathougies 7y agoIt's not an 'inequality issue'. I don't have much problem with inequality of wealth or inequality of experience. It's just my experience that most people do and would rather pull down those who can afford better even if it hurts themself.
- refurb 7y agoThat's what some universal systems already do. I was reading up on Singapore. There is a baseline of insurance for hospital stays, but it's in a ward with 6 other patients in the same room. If you want something better (and there are tiers), you pay more. You can buy insurance policies that pay for the more comfortable stay.
- hateMyIdeas 7y agoThat's not how insurance works, expensive insurance has a lower max out of pocket. What you are talking about is that rich people don't need insurance at all. They just pay out of pocket.
- robocat 7y agoThat is how health insurance works in New Zealand. If you want private health insurance for say $50 a month[1], then insurance gives access to procedures more quickly and the rooms are much nicer than the public health care system. It may give access to rare but expensive procedures. If you don’t want insurance, then the default is the public healthcare system, which is paid for by taxes. You will usually be in a ward with other patients. You pay small amounts on use (to prevent abuse, and even those amounts are reduced to nearly free if you are poor). The level of care is reasonable, but can be slow for non-urgent elective surgery, and extremely expensive procedures are not available. The public healthcare system handles ongoing chronic conditions much better than a private system could. [1] You can see a quote from https://www.southerncross.co.nz/ https://www.southerncross.co.nz/ if you give your age, gender and tick whether you smoke. Note that Southern Cross is a nonprofit co-op, most premiums get returned to members (on average, less an approx 10% administrative overhead).
- karmicthreat 7y agoThat system looks terrible for handling cancer and pre-existing conditions.
- kevin_thibedeau 7y ago
- voldacar 7y agoBelieve it or not, if you have a lot of money you can purchase nicer things than most people can afford
- thebean11 7y agoWe still have the rampant inequality today. I believe NYU Langone let's people pay a large yearly sum for access to a special phone number and "skipping the line" on appointments.
- mannykannot 7y agoThe past is not a useful guide, because until recently, there was relatively little that could be done medically, and costs were commensurably low. The elephant in the room is that medical technology has advanced to the point where any person's needs can potentially greatly exceed their lifetime's ability to produce. When there are relatively few who find themselves in this state, insurance (and what is described in both Alexander's article and tathougies' post are informal forms of it) works, but not when it is a majority.
- hash872 7y agoBig agree with this. Also there's no all-encompassing definition of 'healthcare' that will cover all categories, the way there is for groceries or cars or servers. As people get more disposable income to spend, they'll gravitate towards what is not so much medicine as improving their bodies (speaking as an older athlete who's spent significant money to repair shoulder, hip injuries & stay relatively young- my grandparent's generation would've said 'your shoulder's done, you're not young anymore, it's over', etc.) And then also end of life care- some amazing % of our healthcare costs go into the last 6 months of life, which is all totally optional care and we don't 'have' to have- but we want to because we have the disposable cash for it. We want the $27,000 cancer drug or the $100k for an extra two weeks of life on the backend
- iguy 7y agoRight, this difference of scale is enormous. Back when hospitals couldn't do that much, and were not far from being hotels with better hygiene & worse food, then how to pay for them wasn't such a hard problem. But now US healthcare is 17% of GDP (if I recall correctly) and this proportion rises with GPD, unsurprisingly, as more other needs are already met. It isn't going to go down. Pensions are in a way similar. When steelworkers retiring at 65 could expect on average a few golden years, then deciding how to pay for that wasn't such a huge deal. When they can expect a third of their lifetime to be in retirement, then it's very different.
- andruby 7y ago
- JordanFarmer 7y agoWhy do I always see articles like this? I am pretty sure that everyone knows that Amish eat healthier, exercise more (very low obesity - the cause of 60% of Western health problems), don't drink or smoke, ingest and inhale far less plastics and chemicals and a large portion of their health care money isn't wasted on health care system overhead (administration). Oh one more thing, 80% of doctor visits and filled prescriptions today are completely unnecessary and unhelpful, also 20% of surgeries. The Amish only use health care or get surgeries or see a doctor when they really need too. Cut out the cost for that too. It's funny how today's most complex problems are so simply avoided by simple people.
- wilg 7y agoOther problems are not so simply avoided! https://www.cosmopolitan.com/lifestyle/a30284631/amish-sexual-abuse-incest-me-too/ https://www.cosmopolitan.com/lifestyle/a30284631/amish-sexua...
- Angostura 7y ago> 80% of doctor visits and filled prescriptions today are completely unnecessary and unhelpful Source?
- fock 7y agooxy? gimme some oxy, I've paaain, soo much pain.
- asdkjh345fd 7y ago>I am pretty sure that everyone knows that Amish eat healthier By what definition? According to mainstream health organizations and even still government guidelines, they eat very poorly. Their diet is very high in saturated fat, which although healthy in reality, is not healthy according to the government. They also eat plenty of sugar, the other common scapegoat for dietary problems. >don't drink or smoke, They drink and smoke at lower rates, but they absolutely do drink and smoke.
- asdff 7y agoI'd be fine if it was akin to airlines. More private suites, if you are willing to pay a massive premium. Pricier food. I would find it abhorrent if standard of care is any more economically stratified than it already is.
- ajuc 7y agoMedicine was much cheaper then, mostly because if you had any of the sicknesses that require 100 000 USD drugs now - you just died. Part of it is patent law, part of it is dysfunctional American healthcare system that drives prices up, but big part of that is that medicine just got much better and much more inherently expansive.
- grandinj 7y agothat hides a lot of detail. Like just chopping off a leg instead of spending a 12 hour operation and months of physiotherapy to save it. Letting people die from chronic conditions instead of managing them. Letting old people die, because the cost of medical treatment was too high. Not performing operations for heart disease, so people got one heart attack and then died a year later. Which we could totally go back to, it really is a lot cheaper.
- pnutjam 7y agoThat's American healthcare for the majority of Americans. Luckily most old people don't worry about this because of Medicare.