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Should be, perhaps, but nothing requires the voters in a democracy to think so, or even to put that very high on their priority list. Viewed from my armchair,

by Arnt 5y ago

Should be, perhaps, but nothing requires the voters in a democracy to think so, or even to put that very high on their priority list. Viewed from my armchair, the American voters appear to really want some kind of health system that does not involve any form of the word "social". Given that constraint, what they have seems to be quite good.

s1artibartfast 5y ago
The problem is that federal policy is what is driving healthcare costs in the US. 45% of costs are paid by the government with no check on pricing, essentially a blank check. Similarly, private insurance is mandated to cover procedures not matter the cost. Given this, is it surprising that healthcare costs continue to expand? https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet#:~:text=Medicare%20spending%20grew%206.7%25%20to,31%20percent%20of%20total%20NHE https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta....
- Arnt 5y ago
  If the US federal government were to assume an active role in setting prices, that could plausibly be called socialist medicine, no? And is therefore verboten.
  - s1artibartfast 5y ago
    I don't think so. Setting a pice you are willing to pay is fundamental to a functional capitalist market. The status now is no cap on coats, so I don't see how adding them to existing programs is more socialist. The key here is I'm not proposing the gov set a cap on prices across the board, just on what they are willing to pay for through their own programs. They should be able to say the ROI on X treatment is too low for the gov to pay for it, but someone with gold played insurance can still get it.
- TheCoelacanth 5y ago
  How are government programs a blank check? I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers pay for Medicare and substantially below what most private insurers pay for Medicaid.
  - dragonwriter 5y ago
    > I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers pay for Medicare and substantially below what most private insurers pay for Medicaid. Its a whole lot more complicated than that, especially for Medicaid which is a bunch of different state programs with different rules, lots of which are exceptions from even the baseline federal rules due to waivers, and which is sometimes fee-for-service and sometimes capitated (and sometimes a mix of both for different services in the same state, and sometimes variable by geographic areas within a state.)
  - s1artibartfast 5y ago
    Indeed, Medicare and Medicaid base their pricing on what private insurers pay. This is the problem. Instead, they should base their decision on $X/QALY (quality adjusted life years) like most of the world with socialized medicine. Just because someone with private insurance can pay 500k for a cancer treatment to extend their life 1 day, doesn't mean that it is a valuable use of tax dollars and that Medicare or Medicaid should cover that treatment.

by Arnt 5y ago

s1artibartfast 5y ago

The problem is that federal policy is what is driving healthcare costs in the US. 45% of costs are paid by the government with no check on pricing, essentially a blank check. Similarly, private insurance is mandated to cover procedures not matter the cost. Given this, is it surprising that healthcare costs continue to expand? https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet#:~:text=Medicare%20spending%20grew%206.7%25%20to,31%20percent%20of%20total%20NHE https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta....

Arnt 5y ago
If the US federal government were to assume an active role in setting prices, that could plausibly be called socialist medicine, no? And is therefore verboten.
- s1artibartfast 5y ago
  I don't think so. Setting a pice you are willing to pay is fundamental to a functional capitalist market. The status now is no cap on coats, so I don't see how adding them to existing programs is more socialist. The key here is I'm not proposing the gov set a cap on prices across the board, just on what they are willing to pay for through their own programs. They should be able to say the ROI on X treatment is too low for the gov to pay for it, but someone with gold played insurance can still get it.
TheCoelacanth 5y ago
How are government programs a blank check? I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers pay for Medicare and substantially below what most private insurers pay for Medicaid.
- dragonwriter 5y ago
  > I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers pay for Medicare and substantially below what most private insurers pay for Medicaid. Its a whole lot more complicated than that, especially for Medicaid which is a bunch of different state programs with different rules, lots of which are exceptions from even the baseline federal rules due to waivers, and which is sometimes fee-for-service and sometimes capitated (and sometimes a mix of both for different services in the same state, and sometimes variable by geographic areas within a state.)
- s1artibartfast 5y ago
  Indeed, Medicare and Medicaid base their pricing on what private insurers pay. This is the problem. Instead, they should base their decision on $X/QALY (quality adjusted life years) like most of the world with socialized medicine. Just because someone with private insurance can pay 500k for a cancer treatment to extend their life 1 day, doesn't mean that it is a valuable use of tax dollars and that Medicare or Medicaid should cover that treatment.