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Health care is turning into a consumer product

159 points by brimnes 5y ago

tanseydavid 5y ago
Seems more like "Health care is BEING FORCED into a consumer product." The forces that are driving this have little or nothing to do with healthcare outcomes.
tmamic 5y ago
Healthcare is consumer product. That is not the issue. The issues are: - information asymmetry & credence good - negative selection - lack of standards - lack of oversight
boraginaceae 5y ago
I really believe in this general category. Giving people healthcare that isn't a shitty experience will change the world. I'm not confident a typical telehealth-style consultation with one of these direct-to-consumer companies is that great, but by the same token, I am confident the medical care I get in a traditional setting is mediocre. For example, the time an MD tried to convince me I couldn't be feeling pain... after I told him I was specifically there for pain.
yesbut 5y ago
Turning into? I wonder what living under a rock is actually like.
- kerneloftruth 5y ago
  Exactly. It's been a recognizable trend since the 1970s, at least. Really, since the start of the medical insurance industry.
neuro_image2 5y ago
The greatest healthcare improvements in the US could be brought about by: - Dismantling the insurance/big hospital complex that milks the US population for the enrichment of c-suite executives. - Removing the capacity for lobbying by insurance companies, large hospital groups, device and pharma companies (so they're less able to price gouge consumers). - Price transparency on all links of the chain of healthcare delivery. - Changing the incentives for physicians and other providers towards expensive, often harmful and unnecessary interventions. - Facilitating improved therapeutic relationships between providers and patients (More time spent, more communication, more incentives for harm reduction). - Social changes including less stigma for things like drug use, greater emphasis on community cohesion and care. - Demilitarization (Not only are absurd amounts of money spent on the military that could be redirected to better community health services; but innumerable veterans (not to mention foreign and local civilians) are injured psychologically and physically annually in the absurd pursuit of 'global security'. - Better end of life care. I think something around 40% of healthcare expenditure is on patients in the last 2 years of life. Patients and families would benefit from earlier access to hospice care and less aggressive therapies that only prolong suffering. - A greater emphasis on preventative health and lifestyle choices (better diet, exercise and sleep regimes - ideally within the context of a long term health care provider relationship). Its very typical of modernism (especially in the US) to think that the way to address everything is a nice app with a better UI. This also facilitates the corporate narrative of marketing the shiny new thing to throw money at (make money for the company) to solve everything whilst digging the hole even deeper (and letting society absorb the collateral damage). EDIT* Thanks for the feedback, I have added some of the points made by others to the list above.
- Reichhardt 5y ago
  The simplest changes we could make would be to ban the addition of sugar to certain mainstream food categories (drinks, bread, sauces), and also to require nutritional information to be listed as per 100g, not per serving size. Follow that by banning burning of coal and oil, we also remove a significant amount of noise and air pollution. Next we can ban any hormone-disrupting chemicals (including as plastic additives) from being used in anything that will ever touch human food or drink, or ground water. Finally we can legaize euthanasia for anyone aged 70 or older and with a terminal health condition. With these changes you have a human population much healthier and less reliant on expensive healthcare.
  - ryanmccullagh 5y ago
    Sugar is a drug. Have you ever reflected on sugar cravings? It's actually as addicting as many scheduled drugs. But it's in EVERYTHING! Most things have added sugar in them.
    - refurb 5y ago
      Have you ever craved food? It's a drug too!
      - sophacles 5y ago
        There is a difference between being hungry and needing something sweet to satisfy a craving even though you're full. The later is called hedonic hunger and is (IIUC) very similar to addiction neurologically.
    - syspec 5y ago
      It blows my mind how hard it is to find basic ingredients without added sugar. Things you wouldn't think have sugar, and are not sweet, have sugar! Sauces, pickles, plain yogurt, it's ridiculous
  - neuro_image2 5y ago
    On the euthanasia point I would agree that this should be a legal option (but on a humanitarian rather than a financial basis). We definitely need do do a better job with end of life care/terminal diseases - in practice this would look like earlier/more hospice/compassionate care, less needless end of life treatments and interventions).
unixhero 5y ago
Healthcare in the Nordics is free. Just saying.
- DoingIsLearning 5y ago
  Healthcare in the Netherlands or Switzerland is not free and neither of them have the social disruption and problems you find in the US. There is no point in making broad generalizations, it is a complex issue were you have a multi-decade and multi-billion dollar business tightly coupled with the healthcare of millions of people.
  - mrsuprawsm 5y ago
    The cost of healthcare in the Netherlands is however extremely affordable, which I think is the most important difference between Europe and the US. In NL, you pay ~€110/month annually, with a max out-of-pocket cost of €385 per year. So, maximum €1600 cost annually. People with a low income, students, etc, get approximately the same amount of money as a cash benefit to cover these costs. I'm not saying this is good, it isn't, healthcare costs should be covered by general taxation like in the UK. But it's not very expensive. (It also seems pretty stupid in the Netherlands, because you have to pay an insurer for your health insurance, but they all charge pretty much the same, since it's highly regulated, and then out of pocket costs are capped. Seems much simpler to eliminate the insurance companies and let the state administer costs and pocket the profit that the insurance companies are extracting)
    - globalise83 5y ago
      There is a similar system in Germany. As someone who is from the UK and now living in Germany, I would say the health system is 5x better in Germany, so the highly regulated but private insurance and healthcare system seems to do a lot for improving things.
      - tgv 5y ago
        That's far too little evidence. German health care has always been good.
mrsuprawsm 5y ago
This seems more like a symptom of the wildly broken American health-care system than anything else. In countries with a more functioning healthcare system, disruption of the status quo (especially by VC-funded private companies seeking a large payday) is neither necessary or desirable, slow iterative improvements are the name of the game. Furthermore, the US spends far more per capita than every other country on healthcare, and receives worse healthcare outcomes as a result [1], [2]. If you think that the solution is throwing more VC money at the problem, well, I have a bridge to sell you. Sadly for Americans, the obvious solution that most (~70%) Americans apparently want (Medicare for all) seems very unlikely to happen anytime soon. [1] https://ourworldindata.org/grapher/life-expectancy-vs-health-expenditure https://ourworldindata.org/grapher/life-expectancy-vs-health... [2] https://www.nytimes.com/2021/04/08/learning/whats-going-on-in-this-graph-global-life-expectancy-health-expenditures.html https://www.nytimes.com/2021/04/08/learning/whats-going-on-i...
- UglyToad 5y ago
  To add to this, the absurdity of the 'healthcare' system in the US is made even more apparent as a non-US citizen buying health insurance for (long-term) international travel. Firstly (loosely regulated) insurance is an absolutely stupid way to provide healthcare. Pre-existing conditions? Maybe you just don't deserve to live, either way we're witholding life-saving care from you because our tables say so. Need to claim near the start of your cover? You must be lying about pre-existing conditions. Need to fix something that wasn't acute enough to seek care about previously? Nope, no cover for you. And on and on and on. Anyone who thinks an insurance market is a solution for healthcare is just an idiot, there's no way around that. (I realise some universal systems run on a private insurance basis but they're a lot more regulated) But then, even in that entirely messed up system, designed to cut you off from urgently needed medical care, all policies are divided into 'regions'. There's not much cost difference between regions until you get to any region "including the US". It's even named, the only country in the world they do that for. That's how badly those guys have messed up their healthcare system. And if you select that? It's at least double the cost, for no extra cover in terms of policy limits. That for me clarified that, no, I wasn't missing anything. Anyone who supports the current US system is so far removed from the commonly inhabited reality that none of their opinions are worth listening to.
mrweasel 5y ago
What prevents someone from setting up an affordable healtcare plan, porentially with it’s own chain of hospitals? Other than the startup capital? As broken as the US healthcare system appears from the outside, the free market SHOULD have pushed prices down, not up.
- rg111 5y ago
  > the free market This isn't. With the amount of lobbying, financial contributions to campaign funds, oligopoly, the market isn't free. This is also one of the market where you have to pay. You can choose to not go to vacations or not to buy an apartment (even if you live horribly); you cannot just not have an appendix operation or not fix your ankle if it is broken.
  - analyte123 5y ago
    You definitely can choose not to have an appendix operation in many cases: https://www.facs.org/media/press-releases/2021/coda-study-102521 https://www.facs.org/media/press-releases/2021/coda-study-10...
    - rg111 5y ago
      That isn't the point here. The point is, when you are sick, you have to get medical attention.
  - mrweasel 5y ago
    But wouldn’t a single “good” provider quickly undermind the business of the existing ones? Or is the entire thing rigged in favour of the current healthcare providers?
- spaetzleesser 5y ago
  Think about why it SHOULD but doesn’t.
  - mrweasel 5y ago
cntainer 5y ago
It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population. My hope is that this new-found energy in healthcare products doesn't follow the traditional VC-backed approach of building a product, taking over markets through aggressive marketing and shady closed-door dealings and operating at a loss only to then monetize the shit out of everything. Theranos really embodied some of these fears, and I'm not sure we'll live in a better world if our health will be in the hands of people that have a financial incentive to tell us we're more sick/healthy than we really are.
- merpnderp 5y ago
  I’m interested in this worst performing stat. By what measure? Because I’ve always read that when controlling for the relative poor health of the us population regarding diseases related to poor eating and exercise habits, the US was a top performer for heart and cancer treatments.
  - mdoms 5y ago
    So if you imagine that USA was healthy then health outcomes look great?
  - telxosser 5y ago
    I am pushing 50 years of age and one constant in my life is people shitting on the US healthcare system. I have family in Canada with family members the same age on both sides. Canada is great if you are a healthy broke college student. No one in their right mind would ever pick Canadian health care over the US though if you are 60+. There is no way you would rather have cancer in a country with free health care.
kkwteh 5y ago
https://archive.md/7yUyy https://archive.md/7yUyy
raspasov 5y ago
The article says Apple "plans" to add an oxygen sensor to the Apple Watch. It already has that. I am looking forward to blood glucose monitoring via the Watch.
deleted 5y ago
[deleted]
papito 5y ago
Which is an anti-pattern. Healthcare is not a product with supply and demand dynamics of, say, cars. Capitalism does not help with its delivery. Biotech, equipment manufacturing, yes, but not delivery. "I am just not going to get sick" is not a strategy. No one can control the inherent risk of life. Slipped, swiped by a car, and since we are talking about the United States, let's just go there - caught in a crossfire.
- xondono 5y ago
  > Which is an anti-pattern. According to you. I happen to live in a single payer, free healthcare system (Spain), and the claims about “how nice it is” are pure BS. All of my family has medical insurance, even when we could ill afford to pay extra. - I almost lost my brother on the public health system (they sent him home with some antibiotics, instead we took him to a private hospital were he got surgery that same day, he had internal necrotic tissue). - My mother needed a mammogram, the doctor suspected cancer. the appointment they gave her was in two years. We went private again, she ended her radio + chemo before the diagnostic appointment of the public sector. In the meantime, my effective tax rate is over 70%. I’ve had to visit a hospital in the US (San Francisco) for a recurring issue. It was way better than anything in my area.
  - papito 5y ago
    But you COULD go private. What if you couldn't? It's obviously not perfect, but that idea that health care is a privilege is pretty anti-social.
vhhn 5y ago
There are several factors that make healthcare a specific type of product that laissez-faire markets fail to efficiently produce by nature: * tight connection to insurance * typical consumer-producer relation relation broken into consumer(patient)-prescriber(doctor)-producer-payer(insurance or government) * large externalities These factors led to health care being provided by the public sector in most of the countries.
avgDev 5y ago
I don't know how any American can accept the pile of trash that the US healthcare is. The only good thing is that in some cases you will get state of the art care, this is "rare" and may not result in better outcomes. 1. The cost is insane. It doesn't matter how much money you have, if you stay long term in a hospital your bill will be insane and more than an average cost of a house. 2. Single ER visit? 10 different bills over the next few months. Apparently, there is a new law trying to tackle this but hospital can opt-out by having you sign paperwork. 3. If you have an illness and need to see many doctors and have many tests in a short period of time get ready for your insurance to fight you and deny claims. You will be calling them all the time. 4. There are now 3rd party businesses set up to "VERIFY" no other party is responsible for the care you received(meaning you did not have an accident). If you fail to respond to their letters, your claim will be denied. 5. MRI, X-rays, dental work, physician visits are SO MUCH more than other developed nations. It is a joke. I'm talking without insurance here, just going to a private clinic and paying out of pocket as these also exist in Poland even though it has socialized healthcare. 6. The insurance prices are out of control, and the insurance company don't give a shit. In fact, they welcome the high prices. Obamacare capped insurance companies profit margins at a percentage of money spent, this is the result. The more they pay out, the more they make. The cost falls on the policy holders. 7. Covid is really showing cracks in for-profit healthcare. I have friends who work in the field and are complaining about people coming in with positive covid tests because they are asymptomatic. If they don't want to come in they risk getting fired, and in some areas large hospital networks own many smaller clinics and being fired may result in not being able to find a job without relocating.
- toomuchtodo 5y ago
  Your average American doesn’t have the pull to effect change. The majority of Americans support government taking a greater role in healthcare (per Pew Research), but Congressional reps won’t vote for it, so you have to wait for people to age out for change. In the interim, everyone overpays and suffers.
- rkk3 5y ago
  > the pile of trash that the US healthcare is There are significant problems but whose Vaccine did you take for Covid-19? Pfizer (Us), Moderna (US), Johnson and Johnson (US)...
mythrwy 5y ago
The US has a strange relationship with healthcare. and by that I don't mean professionals in white coats, I mean people taking care of their health in general, of which visits to white coated professionals is only a small part. People seem to have this attitude they can spend money (or have someone else spend money) instead of taking care of themselves. Take a pill instead. Some think every little thing is an emergency or are otherwise unreasonably terrified (Recent Covid scare comes to mind. A very real and serious disease but some people inaccurately assess their risk and become neurotic). Unfortunately it doesn't work like buying a new car. Many years back I dated a girl who was a physical therapist. She loved going to the doctor and hospital. When she felt slightly sad she would get "sick" and go get some attention which she paid through the nose for. I'm exactly the opposite and likely to Steve Jobs myself to death in the end. I've read (don't know how true it is) that Americans take something like 60% of the worlds prescription drugs. The whole thing is completely unbalanced and I don't believe other areas of the world are like this. Because of this I don't see an easy solution for the US. The government taking over health care is likely to result in deep dissatisfaction but the current system is super wasteful and frankly just bonkers. The thing people don't want to understand for some reason is reality. Sometimes we feel bad. Sometimes we get sick. Eventually we will die. Sometimes medical professionals can help. Very often they cannot but that won't prevent them from billing you large sums of money. Also it's not rare for professionals to worsen the situation. Incentives are not always aligned and the body is a very complex system. Throw the US mid level manager hospital pharma insurance scam complex in the mix and incentives misalign even further. The best dentist I've ever been to was in Mexico. Light years ahead of what I'd experienced in the US without the ceremony. The best doctor I've ever been to is an old time country veterinarian in his 60's. But that was for my dogs. Real practical sense a and humility with an eye to results and the understanding of uncertainty involved. I've always thought that's who I would like to treat me in the event of serious illness and practically speaking there little no reason he couldn't in most cases because I'm not very different then my dogs physically. In neither case was the hospital-pharma-insurance scam complex involved. That groups has made things immensely worse and killed large numbers of people. Don't get me started on psych drug overuse in the US.
donatj 5y ago
What I want is going to the doctor to be more personal, more like it was in the 90s. Right now I go to the doctor, and they stare at the computer and take notes for 20 minutes before they can even actually look at me or look at at why I came in. Just dot the room with mics and record our conversations or something if you need it logged.
999900000999 5y ago
Turning ? In America this has always been the case. Anything that's not 100% your literally going to drop dead without it, isn't covered by insurance. Therapy is essentially a luxury good, around here none take insurance so if you don't have 1200 to 1600$ a month sucks to be you. It's comical, say your spending is out if control, unless your excess spending exceeds 1200$ a month your better off with a "Stupid" line item in your budget. As long as your spending less than 1200$ in the stupid category, your coming out ahead. In this space we've seen tons of quasi legal startups trying to capitalize. Who cares if these therapists are licensed to operate in the same state as their clients, we got money to make and vC funding to raise.
bell-cot 5y ago
At least in my mind, "consumer product" quite clearly implies that the price is advertised, or at least easily found. And it does not change during the transaction. Which is definitely not the case in American health care - unless you have "For the Top 1%" health insurance, or are buying at the bottom end (a bottle of aspirin, maybe an eye exam or dental cleaning).
jimt1234 5y ago
The current healthcare system in the US is just as bad for service providers as it is for service recipients, maybe even worse. My girlfriend has worked with children with special needs for around 20 years, mostly children with autism. A few years ago, the field began migrating from almost entirely state-funded to funding from private insurance (California, not sure about other states). The problems with private insurance funding began almost immediately and couldn't be clearer. Under the state-funded program that existed for decades, her company met monthly with the state funding agency, discussed individual cases, and got funded. Easy, efficient. With private insurance, well, the best way to describe it is that her small company had to hire a full-time person just to manage the billing/funding with the insurance companies. And this is not a do-nothing position. This position is responsible for much of the company's revenue, which is inherently important. Also, understanding all the different processes/procedures/BS of each insurance company is highly skilled. That might sound ridiculous, but it's totally true. I hear the stories about fighting with insurance companies, trying to get paid for services rendered months prior. Quick example: one private insurance company (a big one, you've heard of them) only accepts payment requests via fax. Yes, fax. But it gets better. The fax line is only "active" during regular business hours, and the line is almost always busy, because as you might expect, other companies are trying to get paid, too. </venting>
chrisgd 5y ago
I have to imagine my premium for my family plus HSA funding, plus deductible would be cheaper if it was taxed by the government.

159 points by brimnes 5y ago

Seems more like "Health care is BEING FORCED into a consumer product." The forces that are driving this have little or nothing to do with healthcare outcomes.

tmamic 5y ago

Healthcare is consumer product. That is not the issue. The issues are: - information asymmetry & credence good - negative selection - lack of standards - lack of oversight

boraginaceae 5y ago

I really believe in this general category. Giving people healthcare that isn't a shitty experience will change the world. I'm not confident a typical telehealth-style consultation with one of these direct-to-consumer companies is that great, but by the same token, I am confident the medical care I get in a traditional setting is mediocre. For example, the time an MD tried to convince me I couldn't be feeling pain... after I told him I was specifically there for pain.

yesbut 5y ago

Turning into? I wonder what living under a rock is actually like.

kerneloftruth 5y ago
Exactly. It's been a recognizable trend since the 1970s, at least. Really, since the start of the medical insurance industry.

neuro_image2 5y ago

The greatest healthcare improvements in the US could be brought about by: - Dismantling the insurance/big hospital complex that milks the US population for the enrichment of c-suite executives. - Removing the capacity for lobbying by insurance companies, large hospital groups, device and pharma companies (so they're less able to price gouge consumers). - Price transparency on all links of the chain of healthcare delivery. - Changing the incentives for physicians and other providers towards expensive, often harmful and unnecessary interventions. - Facilitating improved therapeutic relationships between providers and patients (More time spent, more communication, more incentives for harm reduction). - Social changes including less stigma for things like drug use, greater emphasis on community cohesion and care. - Demilitarization (Not only are absurd amounts of money spent on the military that could be redirected to better community health services; but innumerable veterans (not to mention foreign and local civilians) are injured psychologically and physically annually in the absurd pursuit of 'global security'. - Better end of life care. I think something around 40% of healthcare expenditure is on patients in the last 2 years of life. Patients and families would benefit from earlier access to hospice care and less aggressive therapies that only prolong suffering. - A greater emphasis on preventative health and lifestyle choices (better diet, exercise and sleep regimes - ideally within the context of a long term health care provider relationship). Its very typical of modernism (especially in the US) to think that the way to address everything is a nice app with a better UI. This also facilitates the corporate narrative of marketing the shiny new thing to throw money at (make money for the company) to solve everything whilst digging the hole even deeper (and letting society absorb the collateral damage). EDIT* Thanks for the feedback, I have added some of the points made by others to the list above.

Reichhardt 5y ago
The simplest changes we could make would be to ban the addition of sugar to certain mainstream food categories (drinks, bread, sauces), and also to require nutritional information to be listed as per 100g, not per serving size. Follow that by banning burning of coal and oil, we also remove a significant amount of noise and air pollution. Next we can ban any hormone-disrupting chemicals (including as plastic additives) from being used in anything that will ever touch human food or drink, or ground water. Finally we can legaize euthanasia for anyone aged 70 or older and with a terminal health condition. With these changes you have a human population much healthier and less reliant on expensive healthcare.
- ryanmccullagh 5y ago
  Sugar is a drug. Have you ever reflected on sugar cravings? It's actually as addicting as many scheduled drugs. But it's in EVERYTHING! Most things have added sugar in them.
  - refurb 5y ago
    Have you ever craved food? It's a drug too!
    - sophacles 5y ago
      There is a difference between being hungry and needing something sweet to satisfy a craving even though you're full. The later is called hedonic hunger and is (IIUC) very similar to addiction neurologically.
  - syspec 5y ago
    It blows my mind how hard it is to find basic ingredients without added sugar. Things you wouldn't think have sugar, and are not sweet, have sugar! Sauces, pickles, plain yogurt, it's ridiculous
- neuro_image2 5y ago
  On the euthanasia point I would agree that this should be a legal option (but on a humanitarian rather than a financial basis). We definitely need do do a better job with end of life care/terminal diseases - in practice this would look like earlier/more hospice/compassionate care, less needless end of life treatments and interventions).

unixhero 5y ago

Healthcare in the Nordics is free. Just saying.

DoingIsLearning 5y ago
Healthcare in the Netherlands or Switzerland is not free and neither of them have the social disruption and problems you find in the US. There is no point in making broad generalizations, it is a complex issue were you have a multi-decade and multi-billion dollar business tightly coupled with the healthcare of millions of people.
- mrsuprawsm 5y ago
  The cost of healthcare in the Netherlands is however extremely affordable, which I think is the most important difference between Europe and the US. In NL, you pay ~€110/month annually, with a max out-of-pocket cost of €385 per year. So, maximum €1600 cost annually. People with a low income, students, etc, get approximately the same amount of money as a cash benefit to cover these costs. I'm not saying this is good, it isn't, healthcare costs should be covered by general taxation like in the UK. But it's not very expensive. (It also seems pretty stupid in the Netherlands, because you have to pay an insurer for your health insurance, but they all charge pretty much the same, since it's highly regulated, and then out of pocket costs are capped. Seems much simpler to eliminate the insurance companies and let the state administer costs and pocket the profit that the insurance companies are extracting)
  - globalise83 5y ago
    There is a similar system in Germany. As someone who is from the UK and now living in Germany, I would say the health system is 5x better in Germany, so the highly regulated but private insurance and healthcare system seems to do a lot for improving things.
    - tgv 5y ago
      That's far too little evidence. German health care has always been good.

mrsuprawsm 5y ago

This seems more like a symptom of the wildly broken American health-care system than anything else. In countries with a more functioning healthcare system, disruption of the status quo (especially by VC-funded private companies seeking a large payday) is neither necessary or desirable, slow iterative improvements are the name of the game. Furthermore, the US spends far more per capita than every other country on healthcare, and receives worse healthcare outcomes as a result [1], [2]. If you think that the solution is throwing more VC money at the problem, well, I have a bridge to sell you. Sadly for Americans, the obvious solution that most (~70%) Americans apparently want (Medicare for all) seems very unlikely to happen anytime soon. [1] https://ourworldindata.org/grapher/life-expectancy-vs-health-expenditure https://ourworldindata.org/grapher/life-expectancy-vs-health... [2] https://www.nytimes.com/2021/04/08/learning/whats-going-on-in-this-graph-global-life-expectancy-health-expenditures.html https://www.nytimes.com/2021/04/08/learning/whats-going-on-i...

UglyToad 5y ago
To add to this, the absurdity of the 'healthcare' system in the US is made even more apparent as a non-US citizen buying health insurance for (long-term) international travel. Firstly (loosely regulated) insurance is an absolutely stupid way to provide healthcare. Pre-existing conditions? Maybe you just don't deserve to live, either way we're witholding life-saving care from you because our tables say so. Need to claim near the start of your cover? You must be lying about pre-existing conditions. Need to fix something that wasn't acute enough to seek care about previously? Nope, no cover for you. And on and on and on. Anyone who thinks an insurance market is a solution for healthcare is just an idiot, there's no way around that. (I realise some universal systems run on a private insurance basis but they're a lot more regulated) But then, even in that entirely messed up system, designed to cut you off from urgently needed medical care, all policies are divided into 'regions'. There's not much cost difference between regions until you get to any region "including the US". It's even named, the only country in the world they do that for. That's how badly those guys have messed up their healthcare system. And if you select that? It's at least double the cost, for no extra cover in terms of policy limits. That for me clarified that, no, I wasn't missing anything. Anyone who supports the current US system is so far removed from the commonly inhabited reality that none of their opinions are worth listening to.

mrweasel 5y ago

What prevents someone from setting up an affordable healtcare plan, porentially with it’s own chain of hospitals? Other than the startup capital? As broken as the US healthcare system appears from the outside, the free market SHOULD have pushed prices down, not up.

rg111 5y ago
> the free market This isn't. With the amount of lobbying, financial contributions to campaign funds, oligopoly, the market isn't free. This is also one of the market where you have to pay. You can choose to not go to vacations or not to buy an apartment (even if you live horribly); you cannot just not have an appendix operation or not fix your ankle if it is broken.
- analyte123 5y ago
  You definitely can choose not to have an appendix operation in many cases: https://www.facs.org/media/press-releases/2021/coda-study-102521 https://www.facs.org/media/press-releases/2021/coda-study-10...
  - rg111 5y ago
    That isn't the point here. The point is, when you are sick, you have to get medical attention.
- mrweasel 5y ago
  But wouldn’t a single “good” provider quickly undermind the business of the existing ones? Or is the entire thing rigged in favour of the current healthcare providers?
spaetzleesser 5y ago
Think about why it SHOULD but doesn’t.
- mrweasel 5y ago

cntainer 5y ago

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population. My hope is that this new-found energy in healthcare products doesn't follow the traditional VC-backed approach of building a product, taking over markets through aggressive marketing and shady closed-door dealings and operating at a loss only to then monetize the shit out of everything. Theranos really embodied some of these fears, and I'm not sure we'll live in a better world if our health will be in the hands of people that have a financial incentive to tell us we're more sick/healthy than we really are.

merpnderp 5y ago
I’m interested in this worst performing stat. By what measure? Because I’ve always read that when controlling for the relative poor health of the us population regarding diseases related to poor eating and exercise habits, the US was a top performer for heart and cancer treatments.
- mdoms 5y ago
  So if you imagine that USA was healthy then health outcomes look great?
- telxosser 5y ago
  I am pushing 50 years of age and one constant in my life is people shitting on the US healthcare system. I have family in Canada with family members the same age on both sides. Canada is great if you are a healthy broke college student. No one in their right mind would ever pick Canadian health care over the US though if you are 60+. There is no way you would rather have cancer in a country with free health care.

kkwteh 5y ago

https://archive.md/7yUyy https://archive.md/7yUyy

raspasov 5y ago

The article says Apple "plans" to add an oxygen sensor to the Apple Watch. It already has that. I am looking forward to blood glucose monitoring via the Watch.

deleted 5y ago

[deleted]

papito 5y ago

Which is an anti-pattern. Healthcare is not a product with supply and demand dynamics of, say, cars. Capitalism does not help with its delivery. Biotech, equipment manufacturing, yes, but not delivery. "I am just not going to get sick" is not a strategy. No one can control the inherent risk of life. Slipped, swiped by a car, and since we are talking about the United States, let's just go there - caught in a crossfire.

xondono 5y ago
> Which is an anti-pattern. According to you. I happen to live in a single payer, free healthcare system (Spain), and the claims about “how nice it is” are pure BS. All of my family has medical insurance, even when we could ill afford to pay extra. - I almost lost my brother on the public health system (they sent him home with some antibiotics, instead we took him to a private hospital were he got surgery that same day, he had internal necrotic tissue). - My mother needed a mammogram, the doctor suspected cancer. the appointment they gave her was in two years. We went private again, she ended her radio + chemo before the diagnostic appointment of the public sector. In the meantime, my effective tax rate is over 70%. I’ve had to visit a hospital in the US (San Francisco) for a recurring issue. It was way better than anything in my area.
- papito 5y ago
  But you COULD go private. What if you couldn't? It's obviously not perfect, but that idea that health care is a privilege is pretty anti-social.

vhhn 5y ago

There are several factors that make healthcare a specific type of product that laissez-faire markets fail to efficiently produce by nature: * tight connection to insurance * typical consumer-producer relation relation broken into consumer(patient)-prescriber(doctor)-producer-payer(insurance or government) * large externalities These factors led to health care being provided by the public sector in most of the countries.

avgDev 5y ago

I don't know how any American can accept the pile of trash that the US healthcare is. The only good thing is that in some cases you will get state of the art care, this is "rare" and may not result in better outcomes. 1. The cost is insane. It doesn't matter how much money you have, if you stay long term in a hospital your bill will be insane and more than an average cost of a house. 2. Single ER visit? 10 different bills over the next few months. Apparently, there is a new law trying to tackle this but hospital can opt-out by having you sign paperwork. 3. If you have an illness and need to see many doctors and have many tests in a short period of time get ready for your insurance to fight you and deny claims. You will be calling them all the time. 4. There are now 3rd party businesses set up to "VERIFY" no other party is responsible for the care you received(meaning you did not have an accident). If you fail to respond to their letters, your claim will be denied. 5. MRI, X-rays, dental work, physician visits are SO MUCH more than other developed nations. It is a joke. I'm talking without insurance here, just going to a private clinic and paying out of pocket as these also exist in Poland even though it has socialized healthcare. 6. The insurance prices are out of control, and the insurance company don't give a shit. In fact, they welcome the high prices. Obamacare capped insurance companies profit margins at a percentage of money spent, this is the result. The more they pay out, the more they make. The cost falls on the policy holders. 7. Covid is really showing cracks in for-profit healthcare. I have friends who work in the field and are complaining about people coming in with positive covid tests because they are asymptomatic. If they don't want to come in they risk getting fired, and in some areas large hospital networks own many smaller clinics and being fired may result in not being able to find a job without relocating.

toomuchtodo 5y ago
Your average American doesn’t have the pull to effect change. The majority of Americans support government taking a greater role in healthcare (per Pew Research), but Congressional reps won’t vote for it, so you have to wait for people to age out for change. In the interim, everyone overpays and suffers.
rkk3 5y ago
> the pile of trash that the US healthcare is There are significant problems but whose Vaccine did you take for Covid-19? Pfizer (Us), Moderna (US), Johnson and Johnson (US)...

mythrwy 5y ago

The US has a strange relationship with healthcare. and by that I don't mean professionals in white coats, I mean people taking care of their health in general, of which visits to white coated professionals is only a small part. People seem to have this attitude they can spend money (or have someone else spend money) instead of taking care of themselves. Take a pill instead. Some think every little thing is an emergency or are otherwise unreasonably terrified (Recent Covid scare comes to mind. A very real and serious disease but some people inaccurately assess their risk and become neurotic). Unfortunately it doesn't work like buying a new car. Many years back I dated a girl who was a physical therapist. She loved going to the doctor and hospital. When she felt slightly sad she would get "sick" and go get some attention which she paid through the nose for. I'm exactly the opposite and likely to Steve Jobs myself to death in the end. I've read (don't know how true it is) that Americans take something like 60% of the worlds prescription drugs. The whole thing is completely unbalanced and I don't believe other areas of the world are like this. Because of this I don't see an easy solution for the US. The government taking over health care is likely to result in deep dissatisfaction but the current system is super wasteful and frankly just bonkers. The thing people don't want to understand for some reason is reality. Sometimes we feel bad. Sometimes we get sick. Eventually we will die. Sometimes medical professionals can help. Very often they cannot but that won't prevent them from billing you large sums of money. Also it's not rare for professionals to worsen the situation. Incentives are not always aligned and the body is a very complex system. Throw the US mid level manager hospital pharma insurance scam complex in the mix and incentives misalign even further. The best dentist I've ever been to was in Mexico. Light years ahead of what I'd experienced in the US without the ceremony. The best doctor I've ever been to is an old time country veterinarian in his 60's. But that was for my dogs. Real practical sense a and humility with an eye to results and the understanding of uncertainty involved. I've always thought that's who I would like to treat me in the event of serious illness and practically speaking there little no reason he couldn't in most cases because I'm not very different then my dogs physically. In neither case was the hospital-pharma-insurance scam complex involved. That groups has made things immensely worse and killed large numbers of people. Don't get me started on psych drug overuse in the US.

donatj 5y ago

What I want is going to the doctor to be more personal, more like it was in the 90s. Right now I go to the doctor, and they stare at the computer and take notes for 20 minutes before they can even actually look at me or look at at why I came in. Just dot the room with mics and record our conversations or something if you need it logged.

999900000999 5y ago

Turning ? In America this has always been the case. Anything that's not 100% your literally going to drop dead without it, isn't covered by insurance. Therapy is essentially a luxury good, around here none take insurance so if you don't have 1200 to 1600$ a month sucks to be you. It's comical, say your spending is out if control, unless your excess spending exceeds 1200$ a month your better off with a "Stupid" line item in your budget. As long as your spending less than 1200$ in the stupid category, your coming out ahead. In this space we've seen tons of quasi legal startups trying to capitalize. Who cares if these therapists are licensed to operate in the same state as their clients, we got money to make and vC funding to raise.

bell-cot 5y ago

At least in my mind, "consumer product" quite clearly implies that the price is advertised, or at least easily found. And it does not change during the transaction. Which is definitely not the case in American health care - unless you have "For the Top 1%" health insurance, or are buying at the bottom end (a bottle of aspirin, maybe an eye exam or dental cleaning).

jimt1234 5y ago

The current healthcare system in the US is just as bad for service providers as it is for service recipients, maybe even worse. My girlfriend has worked with children with special needs for around 20 years, mostly children with autism. A few years ago, the field began migrating from almost entirely state-funded to funding from private insurance (California, not sure about other states). The problems with private insurance funding began almost immediately and couldn't be clearer. Under the state-funded program that existed for decades, her company met monthly with the state funding agency, discussed individual cases, and got funded. Easy, efficient. With private insurance, well, the best way to describe it is that her small company had to hire a full-time person just to manage the billing/funding with the insurance companies. And this is not a do-nothing position. This position is responsible for much of the company's revenue, which is inherently important. Also, understanding all the different processes/procedures/BS of each insurance company is highly skilled. That might sound ridiculous, but it's totally true. I hear the stories about fighting with insurance companies, trying to get paid for services rendered months prior. Quick example: one private insurance company (a big one, you've heard of them) only accepts payment requests via fax. Yes, fax. But it gets better. The fax line is only "active" during regular business hours, and the line is almost always busy, because as you might expect, other companies are trying to get paid, too. </venting>

chrisgd 5y ago

I have to imagine my premium for my family plus HSA funding, plus deductible would be cheaper if it was taxed by the government.