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If everybody in Canada has realistic access to essential healthcare (including dental and vision), you’re already doing better than we are in America. A lot of

If everybody in Canada has realistic access to essential healthcare (including dental and vision), you’re already doing better than we are in America. A lot of your complaints apply to our system, too—in the sense that I’ve experienced them firsthand—but I honestly consider myself lucky just in that I can afford care (cushy tech job) and I’ve never caught a hospital bill large enough to clean me out (at least, not since I was a kid without a lot of money). Seriously. There are people in America who literally have to choose between fixing the constant pain of mouths full of rotten teeth and caring for their children. It’s not like there are no bright spots, but our outcomes are some of the worst (if not the worst) out of (ostensibly) first-world countries by most (if not all) attempts at objective measurement I’ve seen, and that’s generally not even including non-health outcomes like medical bankruptcy. I wouldn’t say extant socialized systems couldn’t be improved upon, but I tend to think people complaining about those systems are either a) in a position where they could afford care in America, which absolutely isn’t everyone, or b) just don’t know how good they have it.

robomartin 6y ago
> There are people in America who literally have to choose between fixing the constant pain of mouths full of rotten teeth and caring for their children And if government got out of the business of healthcare --other than ensuring a fair and safe market-- these people would not have to make that choice. Take corrective eye surgery as a very simple single-variable example. It used to cost tens of thousands of dollars to have your eyesight corrected with laser surgery. I think we are down to $500 or $1,000 these days. Imagine that, with different scales, applied across the entirety of healthcare. Let entrepreneurs do what they do best. It has proven to lift more lives than anything else in our history.
- ClumsyPilot 6y ago
  Interesting example: you are arguing government is the problem. In what way is eye surgery is regulated less than dentistry? On the other hand laser technology has hugely improved in the past couple of decades. Much of it thanks to publically funded research. Science and technology has lifted lives out of dirt and poverty, not abstract 'enterpreneurship'. Our Nobel prise winners do not become businesmen, and do not die billionairs. They give away fruits of their labour in public reports, they keep no IP or patents.
- caconym_ 6y ago
  > And if government got out of the business of healthcare --other than ensuring a fair and safe market-- these people would not have to make that choice. I don't follow. As far as the people I'm talking about are concerned, the government is not in the dentistry business, so what business are you imagining them getting out of? And how would said getting-out make dental treatment affordable for these people? In fact, dentistry seems to be managed more or less on the same basis as vision in this country, i.e. the ceiling on cost is relatively constrained and either you pay for it yourself or you have insurance that's separate from any standard health insurance you may or may not have. With regard to your LASIK example, as far as I can tell, lots of things in dentistry—e.g. orthodontic treatment—have gotten easier and cheaper and more effective, but they haven't invented an automated dentist-bot yet, and I am very skeptical of your (apparent) implicit claim that government meddling in the dentistry industry is to blame for that. It seems a lot more likely that different problems are different, and some are less amenable to technological breakthroughs and automation than others.
  - robomartin 6y ago
    Please think this through. I have already said the variables, or points of influence, are significantly greater and deeper than just one item. Government has its paws in dentistry and eye care just as much as it does everywhere else in the medical field. Let's take three of those layers. First: By guaranteeing exorbitant student loans it causes people to graduate with $300K+ in hard costs for their degrees. Medical education is not a free market in that sense. Universities can charge whatever they want because they have guarantees from the federal government. It's easy for an 18 year old to enter into a $300K+ commitment without having a clue what that means in the long term. Second: Government has known that our tort laws are in real need of modification. The cost of malpractice insurance varies from specialty to specialty, yet it can be in the tens of thousands of dollars per year. It is important to note that, when you walk into a hospital, the entire medical staff has to be on malpractice insurance and the hospital itself has a set of umbrella policies. Third: If you are going to face attorneys, you need attorneys of your own. Hospitals have expensive law firms, attorneys on staff or more. Fourth. Medical device and drug regulatory costs are insane. I tried to develop a simple hearing assist device years ago. The FDA costs to get this super-simple device (that would have potentially helped tons of people) was easily in the tens of millions of dollars. Massive. It also required years of pounding your head into the FDA wall to push it through. This is one of the reasons for which we have lots of bright engineers working on how to get people to click on ads rather than on developing medical solutions. Fifth: The tort reform issue extends into the medical device and pharmaceutical industries. Let's say I did make that simple hearing assist device. Well, I would have had to have a sizable amount of cash devoted to both liability insurance and simply paying attorneys a ton of cash to defend from lawsuits. This is a sad reality of any industry in the US and it is particularly worse in the medical domain. Our companies get sued all the time, and it cost a ton of money to defend yourself and your company. This is why most of them try to settle and avoid courts. It's expensive, yet cheaper. In fact, this could be a sixth point, how the government has fucked-up courts, but I'll leave that one out. There's more, a lot more. I haven't just had a casual look at this. I've been running businesses my entire life. I am very much used to deep analysis of the cost structure of things before reaching conclusions. Most people don't do this. They look at something like "raise minimum wage" and think of it as a single variable problem rather than the complex multivariate system of equations it represents. The medical industry is governed by financial equations as well. And just like in any other industry, the cost of goods sold (COGS) drives the cost of products and services end-users pay. Just like nobody is going to sell you a laptop or an iPhone at a loss, nobody is going to perform surgery or see a patient at a loss. Each layer in the chain has costs, families, loans, responsibilities to look after. At the most basic level the problem is simple: If you increase COGS, prices go up. And then there's the need for profit. Yes, I did say "need". I know some think profit is evil. Well, get over it. It is a necessity. Have you ever had to keep people employed, leases and rents paid, mortgages paid, student loans paid, for, say, six months or a year because of some event that led to an economic downturn? Most people only think of this pandemic as such an event. Not so. This kind of thing happens every so often in business due to a range of reasons. I had to take a second mortgage on my home and fill-up a bunch of credit cards to keep people at my company employed back in 2008~2010. We had a bunch of money (from profits) saved-up, yes. It wasn't enough. We were coming out of a couple of years of capital intensive R&D and were not ready for what happened with the economy. Profit --business and personal-- leads to savings which leads to stability. In a nutshell, a person graduating with hundreds of thousands of dollars in student loans, needing tens of thousands of dollars per year in malpractice insurance, with hundreds of thousands of dollars (or more) in additional debt (home, cars), etc., will demand a high salary. Not because they are greedy, because they could not live without it. When your base burn is $15K to $20K per month, you can't work for minimum wage. This leads to healthcare costs being high. You have millions of medical professionals and millions of medical clinics of all kinds who's financial equations are driven by exorbitant costs that are a direct result of government action or inaction for decades. These are not new problems. They've been talking about them every election for as long as I can remember. It's just talk. Nobody does a thing about it. Just like gun control. Talk, talk, talk. People vote for you and then you do nothing about it. I don't understand why millions of people don't rise up and protest the abject incompetence and dishonesty of our elected officials. They have been talking about fixing this and fixing that for over fifty years and do nothing. Our political system is badly broken. And we pay for it in more ways than one. You might disagree with me because, perhaps, you like government to run everything. Yes, government is necessary, and yet it has to be controlled and in moderation. Reality doesn't change because you don't like what you just read. And our reality is that our healthcare system has the government's fingerprint all the way to the starting point, when a well-intentioned 18 year old decides they want to become a medical professional. We have friends who have literally sent their children to other countries to study medicine (they can because they have dual citizenship) because they can graduate with a good medical degree at a small fraction of the cost of what the equivalent education would be here in the US. That, to me, says it all.
- FpUser 6y ago
  >"Let entrepreneurs do what they do best" When market is saturated enough and there are 2.5 big companies serving it suddenly there is no room for entrepreneurs. The companies would rape their customers when not enough competition.
dham 6y ago
Related to that, I would be for starting off with a state by state or federal Dental coverage for all. Overall health starts in the mouth. A lot of people don't know that. If we start treating people for simple things (before they get bad) in the mouth we will save a lot of money when trying to do Medical coverage for all.
cal5k 6y ago
Nope, vision and dental aren’t part of our system - and thank god because they’re much more pleasant to deal with. I’ve experienced our healthcare system both as a patient and as an entrepreneur trying to innovate. On both counts it has been brutal - the best experience I’ve had by far was when I had orthognathic surgery, which falls under dentistry and is therefore private pay and subject to market conditions. It was night and day. I could email my orthognathic surgeon when I had questions, where my family doctor is an inaccessible black box that can barely be assed to fax (yes, fax) a prescription renewal to the pharmacy after a week of hounding his secretary. I started a telemedicine company that was treated with downright hostility by government bureaucrats who had their own vested interests in competing with the private sector. If you think what Canada has is great and I’m just a complainer it’s because you haven’t looked at how the rest of the world organizes care. A competently regulated private insurance market can deliver the same broad coverage at a lower cost and with better patient experience than our incompetently-run crapfest of a system.
- caconym_ 6y ago
  > If you think what Canada has is great and I’m just a complainer it’s because you haven’t looked at how the rest of the world organizes care. I think a system where everybody has access to healthcare is better than one where they don't, assuming the outcomes are comparable. For Canada vs. America, the data I've seen do not bear out a claim that Canada has worse outcomes in aggregate. Furthermore, from what I understand of it, Canada's system guarantees everybody healthcare. On that basis I'm claiming that it has a significant advantage over the American system. If you'd like to argue that it's not important that everybody has access to healthcare, do that. Otherwise, I'm glad you have the money to pay, and I'm certainly glad I have the money to pay (up to a point), but I don't see that as a good reason to ignore those who don't. I'm not married to any particular way of setting it up. I just care about outcomes, and it's obvious to anybody who's paying attention that healthcare in America is fundamentally broken with respect to outcomes. Vague claims that the free market will fix everything if we just let it work its magic (as seen in other replies to my comment) are not convincing to me, because why should they be? Saying something doesn't make it true. People say a lot of crazy things, and a lot of it doesn't even pretend to try to make sense.

robomartin 6y ago

> There are people in America who literally have to choose between fixing the constant pain of mouths full of rotten teeth and caring for their children And if government got out of the business of healthcare --other than ensuring a fair and safe market-- these people would not have to make that choice. Take corrective eye surgery as a very simple single-variable example. It used to cost tens of thousands of dollars to have your eyesight corrected with laser surgery. I think we are down to $500 or $1,000 these days. Imagine that, with different scales, applied across the entirety of healthcare. Let entrepreneurs do what they do best. It has proven to lift more lives than anything else in our history.

ClumsyPilot 6y ago
Interesting example: you are arguing government is the problem. In what way is eye surgery is regulated less than dentistry? On the other hand laser technology has hugely improved in the past couple of decades. Much of it thanks to publically funded research. Science and technology has lifted lives out of dirt and poverty, not abstract 'enterpreneurship'. Our Nobel prise winners do not become businesmen, and do not die billionairs. They give away fruits of their labour in public reports, they keep no IP or patents.
caconym_ 6y ago
> And if government got out of the business of healthcare --other than ensuring a fair and safe market-- these people would not have to make that choice. I don't follow. As far as the people I'm talking about are concerned, the government is not in the dentistry business, so what business are you imagining them getting out of? And how would said getting-out make dental treatment affordable for these people? In fact, dentistry seems to be managed more or less on the same basis as vision in this country, i.e. the ceiling on cost is relatively constrained and either you pay for it yourself or you have insurance that's separate from any standard health insurance you may or may not have. With regard to your LASIK example, as far as I can tell, lots of things in dentistry—e.g. orthodontic treatment—have gotten easier and cheaper and more effective, but they haven't invented an automated dentist-bot yet, and I am very skeptical of your (apparent) implicit claim that government meddling in the dentistry industry is to blame for that. It seems a lot more likely that different problems are different, and some are less amenable to technological breakthroughs and automation than others.
- robomartin 6y ago
  Please think this through. I have already said the variables, or points of influence, are significantly greater and deeper than just one item. Government has its paws in dentistry and eye care just as much as it does everywhere else in the medical field. Let's take three of those layers. First: By guaranteeing exorbitant student loans it causes people to graduate with $300K+ in hard costs for their degrees. Medical education is not a free market in that sense. Universities can charge whatever they want because they have guarantees from the federal government. It's easy for an 18 year old to enter into a $300K+ commitment without having a clue what that means in the long term. Second: Government has known that our tort laws are in real need of modification. The cost of malpractice insurance varies from specialty to specialty, yet it can be in the tens of thousands of dollars per year. It is important to note that, when you walk into a hospital, the entire medical staff has to be on malpractice insurance and the hospital itself has a set of umbrella policies. Third: If you are going to face attorneys, you need attorneys of your own. Hospitals have expensive law firms, attorneys on staff or more. Fourth. Medical device and drug regulatory costs are insane. I tried to develop a simple hearing assist device years ago. The FDA costs to get this super-simple device (that would have potentially helped tons of people) was easily in the tens of millions of dollars. Massive. It also required years of pounding your head into the FDA wall to push it through. This is one of the reasons for which we have lots of bright engineers working on how to get people to click on ads rather than on developing medical solutions. Fifth: The tort reform issue extends into the medical device and pharmaceutical industries. Let's say I did make that simple hearing assist device. Well, I would have had to have a sizable amount of cash devoted to both liability insurance and simply paying attorneys a ton of cash to defend from lawsuits. This is a sad reality of any industry in the US and it is particularly worse in the medical domain. Our companies get sued all the time, and it cost a ton of money to defend yourself and your company. This is why most of them try to settle and avoid courts. It's expensive, yet cheaper. In fact, this could be a sixth point, how the government has fucked-up courts, but I'll leave that one out. There's more, a lot more. I haven't just had a casual look at this. I've been running businesses my entire life. I am very much used to deep analysis of the cost structure of things before reaching conclusions. Most people don't do this. They look at something like "raise minimum wage" and think of it as a single variable problem rather than the complex multivariate system of equations it represents. The medical industry is governed by financial equations as well. And just like in any other industry, the cost of goods sold (COGS) drives the cost of products and services end-users pay. Just like nobody is going to sell you a laptop or an iPhone at a loss, nobody is going to perform surgery or see a patient at a loss. Each layer in the chain has costs, families, loans, responsibilities to look after. At the most basic level the problem is simple: If you increase COGS, prices go up. And then there's the need for profit. Yes, I did say "need". I know some think profit is evil. Well, get over it. It is a necessity. Have you ever had to keep people employed, leases and rents paid, mortgages paid, student loans paid, for, say, six months or a year because of some event that led to an economic downturn? Most people only think of this pandemic as such an event. Not so. This kind of thing happens every so often in business due to a range of reasons. I had to take a second mortgage on my home and fill-up a bunch of credit cards to keep people at my company employed back in 2008~2010. We had a bunch of money (from profits) saved-up, yes. It wasn't enough. We were coming out of a couple of years of capital intensive R&D and were not ready for what happened with the economy. Profit --business and personal-- leads to savings which leads to stability. In a nutshell, a person graduating with hundreds of thousands of dollars in student loans, needing tens of thousands of dollars per year in malpractice insurance, with hundreds of thousands of dollars (or more) in additional debt (home, cars), etc., will demand a high salary. Not because they are greedy, because they could not live without it. When your base burn is $15K to $20K per month, you can't work for minimum wage. This leads to healthcare costs being high. You have millions of medical professionals and millions of medical clinics of all kinds who's financial equations are driven by exorbitant costs that are a direct result of government action or inaction for decades. These are not new problems. They've been talking about them every election for as long as I can remember. It's just talk. Nobody does a thing about it. Just like gun control. Talk, talk, talk. People vote for you and then you do nothing about it. I don't understand why millions of people don't rise up and protest the abject incompetence and dishonesty of our elected officials. They have been talking about fixing this and fixing that for over fifty years and do nothing. Our political system is badly broken. And we pay for it in more ways than one. You might disagree with me because, perhaps, you like government to run everything. Yes, government is necessary, and yet it has to be controlled and in moderation. Reality doesn't change because you don't like what you just read. And our reality is that our healthcare system has the government's fingerprint all the way to the starting point, when a well-intentioned 18 year old decides they want to become a medical professional. We have friends who have literally sent their children to other countries to study medicine (they can because they have dual citizenship) because they can graduate with a good medical degree at a small fraction of the cost of what the equivalent education would be here in the US. That, to me, says it all.
FpUser 6y ago
>"Let entrepreneurs do what they do best" When market is saturated enough and there are 2.5 big companies serving it suddenly there is no room for entrepreneurs. The companies would rape their customers when not enough competition.

dham 6y ago

Related to that, I would be for starting off with a state by state or federal Dental coverage for all. Overall health starts in the mouth. A lot of people don't know that. If we start treating people for simple things (before they get bad) in the mouth we will save a lot of money when trying to do Medical coverage for all.

cal5k 6y ago

Nope, vision and dental aren’t part of our system - and thank god because they’re much more pleasant to deal with. I’ve experienced our healthcare system both as a patient and as an entrepreneur trying to innovate. On both counts it has been brutal - the best experience I’ve had by far was when I had orthognathic surgery, which falls under dentistry and is therefore private pay and subject to market conditions. It was night and day. I could email my orthognathic surgeon when I had questions, where my family doctor is an inaccessible black box that can barely be assed to fax (yes, fax) a prescription renewal to the pharmacy after a week of hounding his secretary. I started a telemedicine company that was treated with downright hostility by government bureaucrats who had their own vested interests in competing with the private sector. If you think what Canada has is great and I’m just a complainer it’s because you haven’t looked at how the rest of the world organizes care. A competently regulated private insurance market can deliver the same broad coverage at a lower cost and with better patient experience than our incompetently-run crapfest of a system.

caconym_ 6y ago
> If you think what Canada has is great and I’m just a complainer it’s because you haven’t looked at how the rest of the world organizes care. I think a system where everybody has access to healthcare is better than one where they don't, assuming the outcomes are comparable. For Canada vs. America, the data I've seen do not bear out a claim that Canada has worse outcomes in aggregate. Furthermore, from what I understand of it, Canada's system guarantees everybody healthcare. On that basis I'm claiming that it has a significant advantage over the American system. If you'd like to argue that it's not important that everybody has access to healthcare, do that. Otherwise, I'm glad you have the money to pay, and I'm certainly glad I have the money to pay (up to a point), but I don't see that as a good reason to ignore those who don't. I'm not married to any particular way of setting it up. I just care about outcomes, and it's obvious to anybody who's paying attention that healthcare in America is fundamentally broken with respect to outcomes. Vague claims that the free market will fix everything if we just let it work its magic (as seen in other replies to my comment) are not convincing to me, because why should they be? Saying something doesn't make it true. People say a lot of crazy things, and a lot of it doesn't even pretend to try to make sense.