4 ms·

The main thing I take on faith is that people are different and one-size fits all solutions don't produce good outcomes. We have different car brands, grocery

The main thing I take on faith is that people are different and one-size fits all solutions don't produce good outcomes. We have different car brands, grocery stores, non-health insurance companies, package delivery companies, retailers, and housing options. Some people want fast and cheap. Others want to drive an hour to save a few bucks. This isn't some technical academic point. Without a range of choices, you actually can't know what people truly want. So things don't get better. People can't signal what's truly important by voting with their wallet. > If we want to benefit from market forces here, it's probably much more effective to have large (or single) payers who understand what the standard of care should be, and can encourage price competition from providers. I don't get this at all. There are so many markets where complex, highly-paid specialists do work customers might not understand: estate/trust lawyers, auto repair, even dental care. We don't have nearly the same problems as in medicine due to this culture of treating doctors like God. They aren't. They're just a person doing a service, just like a chef or a guy painting a house. What actually bothers me most about this whole thing is that nobody is willing to get serious about the tradeoffs their system entails. Health care in the US is failing right now. Companies are trying to stay beneath ACA limits because health insurance would crush them. My premiums are $380/month as a healthy, 36-year old nonsmoker with no rare conditions. That is INSANE. There's ever-more incentive to keep people off of W2 employment because premiums have gotten so out of control. If you take the current system, where bankruptcies are the norm, this monster is devouring almost 20% of our GDP, and every time I go to the doctor it's a major hassle, I'll come out and say that yes, maybe I'd prefer to fix that even if someone can't get a $150,000 drug anymore. >aside: Singapore is a weird case and probably not a good comparitor for most healthcare systems. Umm...why not? You can't just hand-wave that away.

ska 6y ago
> Umm...why not? You can't just hand-wave that away. Sorry, I should have elaborated. It's a city state with unusually high levels of both social compliance and government control, population is fairly wealthy and fairly evenly distributed. So - small population is a very small area simplifies logistics a ton. Especially ignoring problems related to migrant workers (it's own set of problems), most people have both high social support and some financial depth, there is also little to no housing insecurity. It's basically unclear if you can successfully scale the Singapore model, nobody has tried. As against, e.g. , the several universal models that are outperforming the US currently, with more comparable populations etc.
- onlinebaba 6y ago
  Sidecar Health's website exactly what their insurance pays for a procedure/doctor-visit/Rx -> https://app.sidecarhealth.com/previewCoverage https://app.sidecarhealth.com/previewCoverage
ska 6y ago
> I don't get this at all. I think this is why I suggested looking it as two markets. Your examples (estate lawyers, auto repair, dental care) look a bit like a visit to your GP's office. None of it looks much like some of the other things healthcare provides for us (e.g. many major and emergency procedures). And it's not like all of those markets are working particularly well currently (auto /house sales/ opticians/ etc. suck) I don't think anyone would disagree that one-size-fits-all is the right approach, which is why nobody really tries that. What you are essentially saying is that you think is that you will get more flexibility if you open that market further, and that it will be both a better solution for more people, and not a horribly worse for any significant number of them (which is probably not acceptable here). I'd agree with the first part, but the second requires faith - that in practice the signalling that you are talking about is clear enough (in both directions) and the response time short enough that you arrive at a better solution and in a reasonable amount of time. This is not at all clear. This isn't about treating doctors as "gods" either, they aren't able to make the systemic decisions well either, individually. > What actually bothers me most about this whole thing is that nobody is willing to get serious about the tradeoffs their system entails. This I agree with entirely. Two big ones come to mind - we need to have a conversation about appropriate end-of-life care and costs, and we have to be very transparent that our current level of medical capability means that there is an appreciable risk that (to a first approximation) anyone may end up with a medical condition that (a) we know how to cure or mitigate and (b) that person will never be able to afford. To me paying for these (or choosing not to) is quite different than making sure you can get antibiotics when you get strep throat. You point out some symptoms of the problem currently, but I'm a bit curious about why you are resistant to pursue know solutions that look more like, say France (or Canada, etc.) , than Singapore. Is it just ideological? I'd rather take some known improvements and then iterate to improve rather than NIH syndrome.

ska 6y ago

> Umm...why not? You can't just hand-wave that away. Sorry, I should have elaborated. It's a city state with unusually high levels of both social compliance and government control, population is fairly wealthy and fairly evenly distributed. So - small population is a very small area simplifies logistics a ton. Especially ignoring problems related to migrant workers (it's own set of problems), most people have both high social support and some financial depth, there is also little to no housing insecurity. It's basically unclear if you can successfully scale the Singapore model, nobody has tried. As against, e.g. , the several universal models that are outperforming the US currently, with more comparable populations etc.

onlinebaba 6y ago
Sidecar Health's website exactly what their insurance pays for a procedure/doctor-visit/Rx -> https://app.sidecarhealth.com/previewCoverage https://app.sidecarhealth.com/previewCoverage

ska 6y ago

> I don't get this at all. I think this is why I suggested looking it as two markets. Your examples (estate lawyers, auto repair, dental care) look a bit like a visit to your GP's office. None of it looks much like some of the other things healthcare provides for us (e.g. many major and emergency procedures). And it's not like all of those markets are working particularly well currently (auto /house sales/ opticians/ etc. suck) I don't think anyone would disagree that one-size-fits-all is the right approach, which is why nobody really tries that. What you are essentially saying is that you think is that you will get more flexibility if you open that market further, and that it will be both a better solution for more people, and not a horribly worse for any significant number of them (which is probably not acceptable here). I'd agree with the first part, but the second requires faith - that in practice the signalling that you are talking about is clear enough (in both directions) and the response time short enough that you arrive at a better solution and in a reasonable amount of time. This is not at all clear. This isn't about treating doctors as "gods" either, they aren't able to make the systemic decisions well either, individually. > What actually bothers me most about this whole thing is that nobody is willing to get serious about the tradeoffs their system entails. This I agree with entirely. Two big ones come to mind - we need to have a conversation about appropriate end-of-life care and costs, and we have to be very transparent that our current level of medical capability means that there is an appreciable risk that (to a first approximation) anyone may end up with a medical condition that (a) we know how to cure or mitigate and (b) that person will never be able to afford. To me paying for these (or choosing not to) is quite different than making sure you can get antibiotics when you get strep throat. You point out some symptoms of the problem currently, but I'm a bit curious about why you are resistant to pursue know solutions that look more like, say France (or Canada, etc.) , than Singapore. Is it just ideological? I'd rather take some known improvements and then iterate to improve rather than NIH syndrome.