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I don’t disagree but I think we should also be demanding more capacity from our hospitals and maybe just maybe demanding actual universal healthcare. It’s so bi

I don’t disagree but I think we should also be demanding more capacity from our hospitals and maybe just maybe demanding actual universal healthcare. It’s so bizarre to me that that’s not even on the table but it’s because most just assume we have to have a for-profit medical system.

ericd 5y ago
Isn't Germany's healthcare system already universal, and their support for elderly people quite generous?
- MandieD 5y ago
  Nearly universal: there is a universal legal requirement that you have health insurance, and about 90% of the population is a member of one of the very strictly regulated Krankenkasse (the "public" option), with most of the remaining 10% is covered by more loosely-regulated (but still strict by US standards) private insurance. Nearly universal: there are, by many estimates, at least tens of thousands of people who fall through the cracks - mostly (former) small business owners, other independent contractors, and widows of government employees who cannot afford their private insurance anymore, and are too old/unemployed to require a Krankenkasse to take them in. Doctors own their own practices, or are employed by practices or hospitals. They have the choice to not accept Krankenkasse repayment rates, in which case they can only accept private patients (privately insured, or self-paying). Germany's health economy looks more like the US than it does the UK. Overall, it is less expensive for similar quality, and American-style ruinous 6-figure bills are unheard of.
  - ericd 5y ago
    Thanks for the explanation! With the exception of the implication that Krakenkasses aren’t required to be available to all (why? Strange that there would be age/employment requirements), that sounds excellent, at least from a US perspective. I think a public option that can negotiate and isn’t just a price taker goes a long way to reining in the excesses of the private options and the providers, if they want to remain competitive. We don’t really have that normalizing force in the US. But it’s nice to retain the private options so you have the option to pay more for better/quicker service.
SamoyedFurFluff 5y ago
Increasing capacity for hospitals is actually a hard problem, because the time it takes to train people to fill the capacity is quite high.
- diogenescynic 5y ago
  I agree but we should have started a recruitment campaign for more nurses etc. We’re not really doing anything it seems. We should be trying to do more. My relatives in the healthcare industry are all overworked and complain about staffing shortages. Seems like this is a bigger issue than just COVID. It’s out for-profit healthcare system…
  - vineyardmike 5y ago
    > recruitment campaign for more nurses etc In the US you realistically need a 4y education to be a nurse, so we're looking at a really slow change even if it existed.
gumby 5y ago
Hospitals build out capacity based on projections of need. So they look at the population of their catchment area, other hospitals, demographics of the locals, and calculate that they’ll need about X icu beds / maternity rooms etc etc and then build in a small overcapacity for surges. If they routinely overbuilt then cost would go up even more. I think this approach is reasonable for any business,* whether private or public hospital. The Covid surge isn’t something you can plan for, nor could you really build ICU capacity quickly enough for. Also there’s a systems issue: the ICU pressure shouldn’t even exist to the degree it does as we have a “defense in depth”: vaccination. But for some reason people aren’t using that defense, which simply makes things worse for the rest of us. * not getting into the cost issues in general, just addressing your specific comment.
- diogenescynic 5y ago
  I generally agree but just to clarify I didn’t say overbuild—just more than our current capacity which seems to be admittedly inadequate for the current crisis. We have no flexibility. Look at how many fewer deaths there are in countries with universal healthcare. Maybe when we don’t have to pay useless middlemen like insurers then we can spend the money to hire more healthcare workers. I think it’s just our for-profit healthcare is always going to provide the bare minimum for the highest cost—-and is woefully unprepared for this pandemic.
  - gumby 5y ago
    I think the difference in those countries is vaccination rate, which renders the built out capacity more reasonable.
- smus 5y ago
  >I think this approach is reasonable for any business It's reasonable for business, but not reasonable for society (because healthcare should be more risk adverse than a business). That's why the hospital system for op of this thread, which is German, isn't a business, and why they get to complain about how it's deployed
  - 5y ago

ericd 5y ago

Isn't Germany's healthcare system already universal, and their support for elderly people quite generous?

MandieD 5y ago
Nearly universal: there is a universal legal requirement that you have health insurance, and about 90% of the population is a member of one of the very strictly regulated Krankenkasse (the "public" option), with most of the remaining 10% is covered by more loosely-regulated (but still strict by US standards) private insurance. Nearly universal: there are, by many estimates, at least tens of thousands of people who fall through the cracks - mostly (former) small business owners, other independent contractors, and widows of government employees who cannot afford their private insurance anymore, and are too old/unemployed to require a Krankenkasse to take them in. Doctors own their own practices, or are employed by practices or hospitals. They have the choice to not accept Krankenkasse repayment rates, in which case they can only accept private patients (privately insured, or self-paying). Germany's health economy looks more like the US than it does the UK. Overall, it is less expensive for similar quality, and American-style ruinous 6-figure bills are unheard of.
- ericd 5y ago
  Thanks for the explanation! With the exception of the implication that Krakenkasses aren’t required to be available to all (why? Strange that there would be age/employment requirements), that sounds excellent, at least from a US perspective. I think a public option that can negotiate and isn’t just a price taker goes a long way to reining in the excesses of the private options and the providers, if they want to remain competitive. We don’t really have that normalizing force in the US. But it’s nice to retain the private options so you have the option to pay more for better/quicker service.

SamoyedFurFluff 5y ago

Increasing capacity for hospitals is actually a hard problem, because the time it takes to train people to fill the capacity is quite high.

diogenescynic 5y ago
I agree but we should have started a recruitment campaign for more nurses etc. We’re not really doing anything it seems. We should be trying to do more. My relatives in the healthcare industry are all overworked and complain about staffing shortages. Seems like this is a bigger issue than just COVID. It’s out for-profit healthcare system…
- vineyardmike 5y ago
  > recruitment campaign for more nurses etc In the US you realistically need a 4y education to be a nurse, so we're looking at a really slow change even if it existed.

gumby 5y ago

Hospitals build out capacity based on projections of need. So they look at the population of their catchment area, other hospitals, demographics of the locals, and calculate that they’ll need about X icu beds / maternity rooms etc etc and then build in a small overcapacity for surges. If they routinely overbuilt then cost would go up even more. I think this approach is reasonable for any business,* whether private or public hospital. The Covid surge isn’t something you can plan for, nor could you really build ICU capacity quickly enough for. Also there’s a systems issue: the ICU pressure shouldn’t even exist to the degree it does as we have a “defense in depth”: vaccination. But for some reason people aren’t using that defense, which simply makes things worse for the rest of us. * not getting into the cost issues in general, just addressing your specific comment.

diogenescynic 5y ago
I generally agree but just to clarify I didn’t say overbuild—just more than our current capacity which seems to be admittedly inadequate for the current crisis. We have no flexibility. Look at how many fewer deaths there are in countries with universal healthcare. Maybe when we don’t have to pay useless middlemen like insurers then we can spend the money to hire more healthcare workers. I think it’s just our for-profit healthcare is always going to provide the bare minimum for the highest cost—-and is woefully unprepared for this pandemic.
- gumby 5y ago
  I think the difference in those countries is vaccination rate, which renders the built out capacity more reasonable.
smus 5y ago
>I think this approach is reasonable for any business It's reasonable for business, but not reasonable for society (because healthcare should be more risk adverse than a business). That's why the hospital system for op of this thread, which is German, isn't a business, and why they get to complain about how it's deployed
- 5y ago