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> 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 refu

by CPLX 5y ago

> 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". Yes I agree. Take the windfall profit motive out of the system and you’ll see quite a bit of change. Paying doctors less sounds like a great plan. But we can start with the truly staggering amount of deadweight loss. Do you actually interact with the US health care system? Is it really that hard to understand just how much energy is wasted fucking around with just the billing component alone?

wwtrv 5y ago
But is it substantially lower percent wise in single payer systems like the NHS? Assuming the 7% figure is correct that does not seem like an excessive amount and event cutting it by half would only result in a marginal decrease in prices.
rsj_hn 5y ago
The problem with eliminating "waste" is the bang for the buck. It would take massive restructuring to cut the 7% administration in half. But then you've only saved 3.5%! So when addressing a problem, you start with the first order stuff, and then go to the second order stuff, and you do this in terms of impact, not in terms of conceptual clarity. Cut nurses and doctors, medical staff wages in half, and you save 40%. The real point here is that you can't have affordable healthcare if nurses are earning 6 figures. That's why nurses in the UK earn 40K/year. It's the price of affordable healthcare. That's the core trade off between affordable healthcare and US style healthcare. But all of a sudden now we do not have the same moral clarity as we did when we were only talking about "waste". So let's have that debate right now - the real healthcare debate, not the fake healthcare debate -- and stop pretending this is a problem that can be solved with waste while allowing nurses to keep their 6 figure salaries. It is what we call cheap moralism to decry how unfair high healthcare costs are in the US and then avoid raising any of the tough issues of what would happen to people whose livelihoods depend on those costs being so high.

by CPLX 5y ago

wwtrv 5y ago

But is it substantially lower percent wise in single payer systems like the NHS? Assuming the 7% figure is correct that does not seem like an excessive amount and event cutting it by half would only result in a marginal decrease in prices.

rsj_hn 5y ago

The problem with eliminating "waste" is the bang for the buck. It would take massive restructuring to cut the 7% administration in half. But then you've only saved 3.5%! So when addressing a problem, you start with the first order stuff, and then go to the second order stuff, and you do this in terms of impact, not in terms of conceptual clarity. Cut nurses and doctors, medical staff wages in half, and you save 40%. The real point here is that you can't have affordable healthcare if nurses are earning 6 figures. That's why nurses in the UK earn 40K/year. It's the price of affordable healthcare. That's the core trade off between affordable healthcare and US style healthcare. But all of a sudden now we do not have the same moral clarity as we did when we were only talking about "waste". So let's have that debate right now - the real healthcare debate, not the fake healthcare debate -- and stop pretending this is a problem that can be solved with waste while allowing nurses to keep their 6 figure salaries. It is what we call cheap moralism to decry how unfair high healthcare costs are in the US and then avoid raising any of the tough issues of what would happen to people whose livelihoods depend on those costs being so high.