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America doesn't need healthcare innovation. Every developed country in the world has better and cheaper healthcare already. They need policy innovation and a fu

America doesn't need healthcare innovation. Every developed country in the world has better and cheaper healthcare already. They need policy innovation and a functioning political system.

notmenope 6y ago
Better? Not even close.
testfoobar 6y ago
A few things drive major medical costs in the United States. 1. End of life costs. Americans spend an enormous amount of medical dollars in the last 12-18 months of life. 2. Medical Malpractice insurance. This drives aggressive testing and monitoring. 3. Obesity, diabetes, metabolic syndrome. These are the result of subsidized farming and sugar. All three are entrenched and would take a massive lift to pacify.
- medium_burrito 6y ago
  4. Insurance is state-level. This entrenches big players.
- slothtrop 6y ago
  > 3. Obesity, diabetes, metabolic syndrome. These are the result of subsidized farming and sugar. This is true in Canada, the U.K., and elsewhere in the world with Universal healthcare. You could have have summed the above as "insurance".
- theptip 6y ago
  You missed the most obvious one - lack of public health insurance. The Western European countries pay half as much per capita for healthcare as the US, and get the same average healthcare outcomes. Sure, the population is more unhealthy, so you’d not expect to get down to European levels just by implementing healthcare reform, but it’s the big difference.
  - testfoobar 6y ago
    Public health insurance in the US without reforming the delivery, cost, and regulatory structures would be exceedingly expensive. Lets say that you want to start public health clinics to treat non-emergency, routine care. Imagine your system of clinics misdiagnoses a few patients who later get very sick and die. Those patients' families will sue for vast amounts of money from the clinic. The mere threat of these lawsuits requires every interaction, every medical history change, every diagnosis update, all of it to be meticulously documented and tracked. It leads to doctors agreeing with patients asking for expensive and invasive testing. It leads to doctors agreeing with patients who request medication, etc. At end of life, it leads to doctors agreeing to many, many expensive interventions. How does end-of-life care/cost compare in Europe with the US?
    - theptip 6y ago
      Worth noting that "public health insurance" ("single payer" or "public option") is different than "public healthcare" ("socialized medicine"); I'm advocating for the former, not the latter. If I'm following you correctly it seems like you're analyzing the public healthcare option, which is a much more substantial change. I agree with your point that you'd need to dramatically overhaul the regulatory framework to implement socialized medicine (i.e. the government opening clinics), but I think you would need to do significantly less work if the healthcare delivery remained privatized. Of course in both approaches you could reduce healthcare costs by reforming liability laws. The main decision in my opinion is between true "single payer" (i.e. private health insurance is not permitted for services covered by the public insurance) and "public option" where private insurance can compete with the public option for coverage on core services. The details here are pretty complex and there are options all across the spectrum in the EU to compare; e.g. Germany has a hybrid approach where below a certain income you must take the public option, and above the threshold you can buy private coverage. Canada has a true single-payer system it seems (though you can supplement for additional coverage that the core single payer system doesn't cover). Etc. (See for example https://www.griffinbenefits.com/blog/how-does-healthcare-in-europe-work https://www.griffinbenefits.com/blog/how-does-healthcare-in-... for a bit more detail). Either way there's extremely high support for some sort of public option in the US; it's around 80% supporting medicare for everyone who wants it, and that reduces to something like 60% if you ask specifically about "medicare replacing your insurance" i.e. true single payer. > How does end-of-life care/cost compare in Europe with the US? I'm not familiar with those numbers, would be interested in comparisons if anyone has data they can link. I'd guess at low confidence that it's better in the EU, since they are more likely to use utilitarian measures like QALY for allocating healthcare spending, and that framework should discourage excessive end-of-life care expenditures.

America doesn't need healthcare innovation. Every developed country in the world has better and cheaper healthcare already. They need policy innovation and a functioning political system.

notmenope 6y ago

Better? Not even close.

testfoobar 6y ago

A few things drive major medical costs in the United States. 1. End of life costs. Americans spend an enormous amount of medical dollars in the last 12-18 months of life. 2. Medical Malpractice insurance. This drives aggressive testing and monitoring. 3. Obesity, diabetes, metabolic syndrome. These are the result of subsidized farming and sugar. All three are entrenched and would take a massive lift to pacify.

medium_burrito 6y ago
4. Insurance is state-level. This entrenches big players.
slothtrop 6y ago
> 3. Obesity, diabetes, metabolic syndrome. These are the result of subsidized farming and sugar. This is true in Canada, the U.K., and elsewhere in the world with Universal healthcare. You could have have summed the above as "insurance".
theptip 6y ago
You missed the most obvious one - lack of public health insurance. The Western European countries pay half as much per capita for healthcare as the US, and get the same average healthcare outcomes. Sure, the population is more unhealthy, so you’d not expect to get down to European levels just by implementing healthcare reform, but it’s the big difference.
- testfoobar 6y ago
  Public health insurance in the US without reforming the delivery, cost, and regulatory structures would be exceedingly expensive. Lets say that you want to start public health clinics to treat non-emergency, routine care. Imagine your system of clinics misdiagnoses a few patients who later get very sick and die. Those patients' families will sue for vast amounts of money from the clinic. The mere threat of these lawsuits requires every interaction, every medical history change, every diagnosis update, all of it to be meticulously documented and tracked. It leads to doctors agreeing with patients asking for expensive and invasive testing. It leads to doctors agreeing with patients who request medication, etc. At end of life, it leads to doctors agreeing to many, many expensive interventions. How does end-of-life care/cost compare in Europe with the US?
  - theptip 6y ago
    Worth noting that "public health insurance" ("single payer" or "public option") is different than "public healthcare" ("socialized medicine"); I'm advocating for the former, not the latter. If I'm following you correctly it seems like you're analyzing the public healthcare option, which is a much more substantial change. I agree with your point that you'd need to dramatically overhaul the regulatory framework to implement socialized medicine (i.e. the government opening clinics), but I think you would need to do significantly less work if the healthcare delivery remained privatized. Of course in both approaches you could reduce healthcare costs by reforming liability laws. The main decision in my opinion is between true "single payer" (i.e. private health insurance is not permitted for services covered by the public insurance) and "public option" where private insurance can compete with the public option for coverage on core services. The details here are pretty complex and there are options all across the spectrum in the EU to compare; e.g. Germany has a hybrid approach where below a certain income you must take the public option, and above the threshold you can buy private coverage. Canada has a true single-payer system it seems (though you can supplement for additional coverage that the core single payer system doesn't cover). Etc. (See for example https://www.griffinbenefits.com/blog/how-does-healthcare-in-europe-work https://www.griffinbenefits.com/blog/how-does-healthcare-in-... for a bit more detail). Either way there's extremely high support for some sort of public option in the US; it's around 80% supporting medicare for everyone who wants it, and that reduces to something like 60% if you ask specifically about "medicare replacing your insurance" i.e. true single payer. > How does end-of-life care/cost compare in Europe with the US? I'm not familiar with those numbers, would be interested in comparisons if anyone has data they can link. I'd guess at low confidence that it's better in the EU, since they are more likely to use utilitarian measures like QALY for allocating healthcare spending, and that framework should discourage excessive end-of-life care expenditures.