4 ms·

The 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

The 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 ago
Big 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 ago
  Right, 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
    You say it won't come down, but that's because the US is in it's own ballgame. In most other advanced western country healthcare "only" accounts for 7~11% of GDP. The chart on [0] is incredible. I also shows how much that percentage has grown over the last 45 years. [0] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... [1] Source data OECD: https://stats.oecd.org/Index.aspx?DataSetCode=SHA https://stats.oecd.org/Index.aspx?DataSetCode=SHA
    - iguy 7y ago
      I agree it's higher, and while some of this is waste, some of the higher proportion is explained by the US being richer. Whether it will come down, I guess that's partly a forecasting guess. Will the healthcare sector be a smaller part of the economy in 10, 20 years? Employ fewer people? I would be extremely surprised if this happened in any advanced country.
Aloha 7y ago
Agreed, healthcare became a human right right around the time it changed from being mostly palliative care to curative care. I'll pinpoint it to somewhere between the invention of insulin and penicillin. It's at that point where healthcare outcomes really start to diverge between rich and poor. Something I'll note, Jay Gould, one of the wealthiest men of his time died of tuberculosis - something we now think of as a poor persons disease.
fock 7y ago
also we've thankfully left behind the age of caste systems, where you just were poor, because well, peasants be peasants. Today I don't see any rich people engaging in that kind of (really screw up, if you think about it) "philantrophy" anymore... Especially in America (with Amazon and Walmart-slavery) the attitude is more like: you're poor, because you are not putting enough effort in.
- jacobush 7y ago
  Since 1980 or so, the caste system is on a return. Not in rhetoric, but in outcome. "Social mobility" is down, down, down in the US.
  - fock 7y ago
    yeah, I reckon that. But compared to the old caste systems the people on top tend to show even less regard for the ones down (because they are so great and all selfmade!)
    - pnutjam 7y ago
      Behind the bastards has a good podcast about the lady who mainstreamed adoption. She convinced rich people that they could adopt poor children and they wouldn't be genetically inferior, to be blunt. She also stole kids and let babies die from lack of care...
- 0-O-0 7y ago
  What's screwed up about philantrophy? And it's still here, Bill & Melinda Gates Foundation is a most prominent example.
  - fock 7y ago
    the one where people somehow think, the status quo is god-given and that it's their godly duty to give alms. And no, Bill Gates is not an example for that - I think it's basically limited to the 3rd world, people in the US are still supposed to get their life together ;).
runamok 7y ago
I see what you are saying but prices are completely out of control precisely because an insurance company will pay a 6 or 7 digit bill. If insurance was gone tomorrow and there was a cap on how much a single payer system would pay I am pretty sure million dollar surgeries would go down significantly in price. I mean surgeons are paid well but a million dollars for a few hours of their labor? Constraints on how many people are permitted to become doctor's also reinforce this issue.

hash872 7y ago

Big 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 ago
Right, 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
  You say it won't come down, but that's because the US is in it's own ballgame. In most other advanced western country healthcare "only" accounts for 7~11% of GDP. The chart on [0] is incredible. I also shows how much that percentage has grown over the last 45 years. [0] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... [1] Source data OECD: https://stats.oecd.org/Index.aspx?DataSetCode=SHA https://stats.oecd.org/Index.aspx?DataSetCode=SHA
  - iguy 7y ago
    I agree it's higher, and while some of this is waste, some of the higher proportion is explained by the US being richer. Whether it will come down, I guess that's partly a forecasting guess. Will the healthcare sector be a smaller part of the economy in 10, 20 years? Employ fewer people? I would be extremely surprised if this happened in any advanced country.

Aloha 7y ago

Agreed, healthcare became a human right right around the time it changed from being mostly palliative care to curative care. I'll pinpoint it to somewhere between the invention of insulin and penicillin. It's at that point where healthcare outcomes really start to diverge between rich and poor. Something I'll note, Jay Gould, one of the wealthiest men of his time died of tuberculosis - something we now think of as a poor persons disease.

fock 7y ago

also we've thankfully left behind the age of caste systems, where you just were poor, because well, peasants be peasants. Today I don't see any rich people engaging in that kind of (really screw up, if you think about it) "philantrophy" anymore... Especially in America (with Amazon and Walmart-slavery) the attitude is more like: you're poor, because you are not putting enough effort in.

jacobush 7y ago
Since 1980 or so, the caste system is on a return. Not in rhetoric, but in outcome. "Social mobility" is down, down, down in the US.
- fock 7y ago
  yeah, I reckon that. But compared to the old caste systems the people on top tend to show even less regard for the ones down (because they are so great and all selfmade!)
  - pnutjam 7y ago
    Behind the bastards has a good podcast about the lady who mainstreamed adoption. She convinced rich people that they could adopt poor children and they wouldn't be genetically inferior, to be blunt. She also stole kids and let babies die from lack of care...
0-O-0 7y ago
What's screwed up about philantrophy? And it's still here, Bill & Melinda Gates Foundation is a most prominent example.
- fock 7y ago
  the one where people somehow think, the status quo is god-given and that it's their godly duty to give alms. And no, Bill Gates is not an example for that - I think it's basically limited to the 3rd world, people in the US are still supposed to get their life together ;).

runamok 7y ago

I see what you are saying but prices are completely out of control precisely because an insurance company will pay a 6 or 7 digit bill. If insurance was gone tomorrow and there was a cap on how much a single payer system would pay I am pretty sure million dollar surgeries would go down significantly in price. I mean surgeons are paid well but a million dollars for a few hours of their labor? Constraints on how many people are permitted to become doctor's also reinforce this issue.