4 ms·

I think this is far too facile. It's like saying half your taxes go to government waste. I mean sure, OK, but how do you get rid of government waste? So far no

by rsj_hn 5y ago

I think this is far too facile. It's like saying half your taxes go to government waste. I mean sure, OK, but how do you get rid of government waste? So far no one has been able to do it. So this is really an unwillingness to engage in the problem, which is absolutely endemic in the current discourse. The key problem is that 20% of our GDP goes to healthcare, and similarly 20% of our population is employed in healthcare provision. This isn't just people sitting around doing nothing. It's nurses, doctors, administrators, etc. If you want to reduce healthcare costs in half, so that it is only 10% of GDP, then expect to throw 10% of the population out of work. That will include nurses, doctors, EMT personnel as well as administrators. Sure, you can try to shift that and fire a bit more administrators than nurses, but you will soon discover that's about as easy as eliminating government waste. This inability to address the core issue arisies from people approaching these difficult problems in administration and systems science from a facile moral point of view. "it's wrong!" they say, to be given a big bill for a snake bite. Well, OK, it's wrong. But that same attitude will tell you "it's wrong" to fire a hard working nurse, or to reduce the pay of a doctor, etc. So now you are left with boogeymen like greedy insurance companies and fat cat CEOs. This is like the person who insists on a tax cut funded by reducing government waste. It's not a serious proposal. And what we have in the US healthcare debate is two sides, the first side is just lying and obfuscating (that is the side opposed to reform) and the second side is so bound in the chain of moralizing that they are unable to make any serious proposals. They can only go after the fat cats, and not the nurses. Thus their proposals will never work. Same thing for education -- you need to fire most of the university staff and reduce the pay or fire many of the teachers. Same thing for all the difficult problems in life where we complain that things cost too much. It is not shadowy fat cats that are causing these problems, it is too many people employed in the provision of services who are earning too much. Ordinary professionals. The biggest problems of modern life are that professionals have too much power and are extracting too much from the society as a whole. Whether it is hospital workers or government workers or teachers, the issues of skyrocketing costs and bureaucratic bloat are very similar across these areas, and they cannot be solved by getting rid of shadowy fat cats or employees that "do nothing".

CPLX 5y ago
> So far no one has been able to do it. But that's the problem with your argument. Of course people have done it, nearly every developed country has. > If you want to reduce healthcare costs in half, so that it is only 10% of GDP, then expect to throw 10% of the population out of work. That will include nurses, doctors, EMT personnel as well as administrators. No, it won't. I'm talking about eliminating the positions that would only exist because of the private insurance system. Which is a massive amount of dead weight loss. It's not remotely hard to understand conceptually, I mean EVERY dollar that's devoted to arguing over insurance bills is completely wasted. As are all the dollars spent on insurance advertising and marketing, and so on. Every dollar paid back to health care companies as dividends, or used for stock buybacks. That's a lot of dollars. Every time this argument comes up people in the US start talking about it like "Oh yeah? Sure but what's YOUR solution then smart guy? Stumped you didn't I?" Um, no. My solution is the NHS. Like you can go there and look at it I swear it's a real thing, they have buildings and everything, just book a flight to London and see for yourself. Or, in US terms, Medicare for all, which is also a real understandable thing that exists, except for the "for all" part.
- topkai22 5y ago
  The NHS/UK isn't cheaper (just) because of insurance related dead weight though- they also just pay everyone less. The US Government estiamtes the total adminstration and health insurance expenditure cost $288B in 2019. Total health consumption was $3.69T. Thats about 7.5% of total health spending. Even if you assume a 2 or 3x multiplier to the effect of eliminating insurance companies you STILL don't get US healthcare spending on a GDP basis in line with international norms. Insurance companies are awful, but they alone are not the cause of American's health care spening problems.
- rsj_hn 5y ago
  To believe that administrative overhead would significantly reduce healthcare costs is just obviously false. We spend 20% of GDP on healthcare and UK spends 10%. Total spend is employees * average salary per employee. Let's take a look: * For doctors, there are roughly the same number, ~2.8 per 1000, but US doctors earn three times as much as UK doctors[1]. 294K/year US versus 66K/year (UK). * The US has twice as many nurses[2] per 1000 people (17.4 per 1000) as the UK does (9.8 per 1000), and the US pays its nurses much more. The US pays 77K/year for an RN and 112K/year for an PN and 181K/year average salary for a nurse anasthesologist[3]. Nurses in the UK earn about 1/3 less, a total average of 33K/year[4] * The US has 315K pharmacists (not assistants) or roughly 1 per 1000, whereas the UK has 43K or .65 per 1000. US pharmacists make average of 140K/year[7]. UK pharmacists make an average salary of 58K per year[8]. * The US has 23,200 microbiologists (earning 69K/year). The UK has 490 (earning 52K/yr) * The US has 40 MRI machines per million. The UK has 6. * Now let's generally talk about staffing. The US employs 20 million healthcare workers with a payroll of 1 Trillion (2018)[5] an average wage of 70K (and median wage of 42K/year). This is occupational data from BLS (https://www.bls.gov/ooh/healthcare/home.htm https://www.bls.gov/ooh/healthcare/home.htm), so you can't complain about insurance employees at hospitals being included. The UK has 1.3 Million[5] in both hospitals and clinics counting both NHS and Independents, with an average salary of 24.7K/year. That means, relative to population, that the US employs 60 per 100,000 healthcare employees while the UK employs 20 per 1000. We have triple the number of healthcare workers and our health care workers earn double what the do in the UK. Now let's talk about this enormous waste in insurance that will make healthcare affordable if only we got rid of it. Total insurance overhead in the US is 7% of healthcare expenditures[8]. So if we reduced it to zero, we would pay 7% less. Whoppee. Thinking that you can keep paying doctors and nurses triple and have so many more staff and keep their high wages but merely with insurance reforms reduce healthcare spending by half is so wrong I am amazed I even need to say it. It's a terrible, misleading, evasive non-answer. What we need to cut are salaries and employment. If you don't acknowledge that, then you are not a serious participant in this discussion because you are refusing to acknowledge that this problem has tough trade offs. You are not going to solve it by "cutting waste". And this is important, because our problem, as a nation, is the general problem of professional guilds extracting too much from the rest of society. We have this problem with higher education, with finance, with healthcare. A large chunk of our professional middle class is employed by these sectors, and their well-being would be threatened if we significantly cut their wages and employment. It is not evil insurance companies, it is not shadowy billionaires, but our neighbors down the street -- the nurses, the college professors, and the X-ray technicians -- who are the ones blocking meaningful reform. And until we are willing to face that and recognize what must be done, then we will not get affordable healthcare. The incurable diseases of the modern west are all due to the professional classes extracting too much. It is not due to excessive "waste". --- [1] https://revisingrubies.com/us-vs-uk-doctors-salary/ https://revisingrubies.com/us-vs-uk-doctors-salary/ [2] https://www.healthsystemtracker.org/chart-collection/u-s-health-care-resources-compare-countries/#item-number-of-professionals-working-in-mental-health-per-100000-population-2016 https://www.healthsystemtracker.org/chart-collection/u-s-hea... [3] https://nursinglicensemap.com/resources/nurse-salary/ https://nursinglicensemap.com/resources/nurse-salary/ [4] https://www.bls.gov/opub/ted/2020/number-of-hospitals-and-hospital-employment-in-each-state-in-2019.htm https://www.bls.gov/opub/ted/2020/number-of-hospitals-and-ho... [5] https://digital.nhs.uk/data-and-information/publications/statistical/healthcare-workforce-statistics/march-2018-experimental/content https://digital.nhs.uk/data-and-information/publications/sta... [6] https://www.census.gov/library/stories/2020/10/health-care-still-largest-united-states-employer.html https://www.census.gov/library/stories/2020/10/health-care-s... [7] https://www.salary.com/research/salary/benchmark/pharmacist-salary https://www.salary.com/research/salary/benchmark/pharmacist-... [8] https://uk.indeed.com/career/pharmacist/salaries https://uk.indeed.com/career/pharmacist/salaries [9] https://time.com/5759972/health-care-administrative-costs/#:~:text=Insurers'%20overhead%2C%20the%20largest%20category,2.8%25%20of%20national%20health%20expenditures https://time.com/5759972/health-care-administrative-costs/#:....

by rsj_hn 5y ago

CPLX 5y ago

> So far no one has been able to do it. But that's the problem with your argument. Of course people have done it, nearly every developed country has. > If you want to reduce healthcare costs in half, so that it is only 10% of GDP, then expect to throw 10% of the population out of work. That will include nurses, doctors, EMT personnel as well as administrators. No, it won't. I'm talking about eliminating the positions that would only exist because of the private insurance system. Which is a massive amount of dead weight loss. It's not remotely hard to understand conceptually, I mean EVERY dollar that's devoted to arguing over insurance bills is completely wasted. As are all the dollars spent on insurance advertising and marketing, and so on. Every dollar paid back to health care companies as dividends, or used for stock buybacks. That's a lot of dollars. Every time this argument comes up people in the US start talking about it like "Oh yeah? Sure but what's YOUR solution then smart guy? Stumped you didn't I?" Um, no. My solution is the NHS. Like you can go there and look at it I swear it's a real thing, they have buildings and everything, just book a flight to London and see for yourself. Or, in US terms, Medicare for all, which is also a real understandable thing that exists, except for the "for all" part.

topkai22 5y ago
The NHS/UK isn't cheaper (just) because of insurance related dead weight though- they also just pay everyone less. The US Government estiamtes the total adminstration and health insurance expenditure cost $288B in 2019. Total health consumption was $3.69T. Thats about 7.5% of total health spending. Even if you assume a 2 or 3x multiplier to the effect of eliminating insurance companies you STILL don't get US healthcare spending on a GDP basis in line with international norms. Insurance companies are awful, but they alone are not the cause of American's health care spening problems.
rsj_hn 5y ago
To believe that administrative overhead would significantly reduce healthcare costs is just obviously false. We spend 20% of GDP on healthcare and UK spends 10%. Total spend is employees * average salary per employee. Let's take a look: * For doctors, there are roughly the same number, ~2.8 per 1000, but US doctors earn three times as much as UK doctors[1]. 294K/year US versus 66K/year (UK). * The US has twice as many nurses[2] per 1000 people (17.4 per 1000) as the UK does (9.8 per 1000), and the US pays its nurses much more. The US pays 77K/year for an RN and 112K/year for an PN and 181K/year average salary for a nurse anasthesologist[3]. Nurses in the UK earn about 1/3 less, a total average of 33K/year[4] * The US has 315K pharmacists (not assistants) or roughly 1 per 1000, whereas the UK has 43K or .65 per 1000. US pharmacists make average of 140K/year[7]. UK pharmacists make an average salary of 58K per year[8]. * The US has 23,200 microbiologists (earning 69K/year). The UK has 490 (earning 52K/yr) * The US has 40 MRI machines per million. The UK has 6. * Now let's generally talk about staffing. The US employs 20 million healthcare workers with a payroll of 1 Trillion (2018)[5] an average wage of 70K (and median wage of 42K/year). This is occupational data from BLS (https://www.bls.gov/ooh/healthcare/home.htm https://www.bls.gov/ooh/healthcare/home.htm), so you can't complain about insurance employees at hospitals being included. The UK has 1.3 Million[5] in both hospitals and clinics counting both NHS and Independents, with an average salary of 24.7K/year. That means, relative to population, that the US employs 60 per 100,000 healthcare employees while the UK employs 20 per 1000. We have triple the number of healthcare workers and our health care workers earn double what the do in the UK. Now let's talk about this enormous waste in insurance that will make healthcare affordable if only we got rid of it. Total insurance overhead in the US is 7% of healthcare expenditures[8]. So if we reduced it to zero, we would pay 7% less. Whoppee. Thinking that you can keep paying doctors and nurses triple and have so many more staff and keep their high wages but merely with insurance reforms reduce healthcare spending by half is so wrong I am amazed I even need to say it. It's a terrible, misleading, evasive non-answer. What we need to cut are salaries and employment. If you don't acknowledge that, then you are not a serious participant in this discussion because you are refusing to acknowledge that this problem has tough trade offs. You are not going to solve it by "cutting waste". And this is important, because our problem, as a nation, is the general problem of professional guilds extracting too much from the rest of society. We have this problem with higher education, with finance, with healthcare. A large chunk of our professional middle class is employed by these sectors, and their well-being would be threatened if we significantly cut their wages and employment. It is not evil insurance companies, it is not shadowy billionaires, but our neighbors down the street -- the nurses, the college professors, and the X-ray technicians -- who are the ones blocking meaningful reform. And until we are willing to face that and recognize what must be done, then we will not get affordable healthcare. The incurable diseases of the modern west are all due to the professional classes extracting too much. It is not due to excessive "waste". --- [1] https://revisingrubies.com/us-vs-uk-doctors-salary/ https://revisingrubies.com/us-vs-uk-doctors-salary/ [2] https://www.healthsystemtracker.org/chart-collection/u-s-health-care-resources-compare-countries/#item-number-of-professionals-working-in-mental-health-per-100000-population-2016 https://www.healthsystemtracker.org/chart-collection/u-s-hea... [3] https://nursinglicensemap.com/resources/nurse-salary/ https://nursinglicensemap.com/resources/nurse-salary/ [4] https://www.bls.gov/opub/ted/2020/number-of-hospitals-and-hospital-employment-in-each-state-in-2019.htm https://www.bls.gov/opub/ted/2020/number-of-hospitals-and-ho... [5] https://digital.nhs.uk/data-and-information/publications/statistical/healthcare-workforce-statistics/march-2018-experimental/content https://digital.nhs.uk/data-and-information/publications/sta... [6] https://www.census.gov/library/stories/2020/10/health-care-still-largest-united-states-employer.html https://www.census.gov/library/stories/2020/10/health-care-s... [7] https://www.salary.com/research/salary/benchmark/pharmacist-salary https://www.salary.com/research/salary/benchmark/pharmacist-... [8] https://uk.indeed.com/career/pharmacist/salaries https://uk.indeed.com/career/pharmacist/salaries [9] https://time.com/5759972/health-care-administrative-costs/#:~:text=Insurers'%20overhead%2C%20the%20largest%20category,2.8%25%20of%20national%20health%20expenditures https://time.com/5759972/health-care-administrative-costs/#:....