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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

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).
- Broken_Hippo 5y ago
  So, folks under 70 get out of suffering, but someone dying in their 30's can't get euthanasia? This seems cruel, especially so given the number of folks that suffer and die before they reach 70. And it shouldn't be for financial reasons. I fully support someone's right to death, but I do not support creating systems that might encourage it. I also don't realistically care if the health condition is terminal: I care more that folks are suffering and want death to escape it.
Griffinsauce 5y ago
"- Removing the capacity for lobbying by insurance companies, large hospital groups, device and pharma companies." This should be step one, always. While those perverse incentives exist everything else is an uphill battle.
- qwerty456127 5y ago
  This probably also is the hardest part. And the most alien to the whole American model of which lobbying is an integral part. IMHO you can only counter lobbying by allocating more to fact checking so it would be harder for them lobby things which are objectively wrong.
  - jounker 5y ago
    We had such a congressional fact check organization. It was called the OTA (Office of Technology Assessment). Sadly it stood in the way of institutionalized lobbying (The K Street Project), so the Republicans eliminated it shortly after they came to power in congress in 1994.
    - throwaway0a5e 5y ago
      It was on borrowed time anyway. The OTA was a threat to the fiefdom of literally every other agency. Their job was to butt in and ruin everyone's gravy trains of "not quite graft". Imagine the OTA weighing in on the recent net neutrality shitshow. Wouldn't have made the FCC look to smart would it have? That same threat existed for every agency and congress and the executive. Literally everyone wanted them gone.
  - roenxi 5y ago
    Why would fact checking have an influence on lobbying? Everyone knows what is going on. It isn't like the politicians, lobbyists, technical experts or public are in the dark about what is happening. If anything, a fact checking organisation has incentives to align with or even become a lobby group. We've seen what happens to "fact checking" in the political sphere.
refurb 5y ago
You think it’s the c-suite reaping all the financial gains?
- neuro_image2 5y ago
  Predominantly (there's also general overall bureaucratic bloat with absurd numbers of administrators at all levels) . It's certainly not the majority of healthcare workers. Physicians are often scapegoated as responsible for healthcare costs when in reality physicians in Canada, New Zealand and Australia earn similar salaries without the massive cost blowout.
  - refurb 5y ago
    There can be instances where physicians are paid the same or more outside the US (I've heard family practice can pay better in Canada), but overall US physicians earn much more. https://www.physiciansweekly.com/how-do-us-physician-salaries-compare-with-those-abroad https://www.physiciansweekly.com/how-do-us-physician-salarie...
    - neuro_image2 5y ago
      I guess it depends on your comparison - that article didn't include Australia, NZ or Canada. Also if you factor in earnings and expenses over a lifetime (including cost of studying and the fact that many of the countries mentioned have free healthcare and education and far lower insurance requirements) it evens out substantially. More importantly, even the highest physician salaries are orders of magnitude less than insurance company CEO salaries. Disclosure: I'm a physician, currently practicing in the US, previously in New Zealand and the UK.
      - refurb 5y ago
        I’ve got several friends who specifically moved to the US from Canada because the pay was so much better. No doubt it varies by circumstance, but docs ive known in the US pay off their $500k in student debt pretty quickly if they specialize. And sure insurance CEOs are paid more, but there are also a several magnitude more doctors than insurance CEOs. You could pay all the CEOs $1 and the cost of healthcare isn’t going to budget much.
Ericson2314 5y ago
May this new California attempt succeed
amelius 5y ago
> 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. I'd be happy if the app could show medical expenses before the treatment.
- diordiderot 5y ago
  Yes check the app while your limp unconscious body is shoved into the back of an ambulance. Type in appendectomy near me while you're writhing in pain in the passenger seat and decided, the hospital the next town over is a better deal
  - amcoastal 5y ago
    You use an absurd scenario, not sure why, but we both know there are tons of times you go to a medical provider where if you could pay less for a slightly longer car ride, you'd do it. But that information isn't even available now. The only fucking industry that is allowed to sell you stuff without telling you how much it will cost.
    - MomoXenosaga 5y ago
      Who cares how much it costs if your health insurance cover it? The reality is that healthcare is so expensive that it can bankrupt anyone who isn't a millionaire- which is why it needs to be mandatory and comprehensive. Right now millions of Americans are basically committing fraud: they go to a doctor who has taken an oath to help you. The bill is not getting paid so the government has to step in anyway. May as well make it official.
      - DavidPeiffer 5y ago
        >Who cares how much it costs if your health insurance cover it? At least under the current model, many people don't hit their deductible or max out of pocket. I know some older retired couples who are buying insurance on the market with 10k+ deductibles because they're generally in really good health, and the cost of insurance isn't absolutely insane with that level of deductible. They would absolutely drive an hour rather than 5 minutes for non-emergency situations!
CryptoPunk 5y ago
From what I've seen, subsidies and regulations are the primary cause of inefficiency in healthcare: https://www.athenahealth.com/knowledge-hub/practice-management/expert-forum-rise-and-rise-healthcare-administrator https://www.athenahealth.com/knowledge-hub/practice-manageme... >>Here's some food for thought: The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200 percent for the same time period. * >>Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. (To cite just a few industry-disrupting regulations, consider the Prospective Payment System of 1983 [1]; the Health Insurance Portability & Accountability Act of 1996 [2]; and the Health Information Technology for Economic and Clinical Act of 2009. [3]) In contrast, areas of medicine which are subject to much fewer subsidies and regulations, as a consequence of being electives, have seen prices actually decline in inflation adjusted terms. [4] [1] https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/index.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... [2] https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg... [3] https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/h... [4] http://healthblog.ncpathinktank.org/why-cant-the-market-for-medical-care-work-like-cosmetic-surgery/ http://healthblog.ncpathinktank.org/why-cant-the-market-for-...
- Broken_Hippo 5y ago
  Regulations and subsidies do not seem to make other countries' systems inefficient. They make it so that folks are safe and that they can actually get health care. I really want regulation in health care. I do not want medication to be a free-for-all like supplements are in the US. I'm not a doctor, after all, and they are slow to take supplements off the market even if they are harming or killing folks (take a look at diet pills to see this effect). I do not want average folks to be able to get antibiotics willy-nilly because I want to be able to take them when I'm old. And so on.
robbiep 5y ago
Better end of life care would revolutionise healthcare. No country does this well
- sokoloff 5y ago
  Not everyone agrees on what “better” means though. When you start putting dollars and days into formulae around dying, many people lose their damn minds…
  - throwaway6734 5y ago
    As long as it doesn't involve Covid, then "death panels" are fine
  - supertrope 5y ago
    Failing to plan is planning to fail. Those formula already exist and they're used at insurance companies.
anovikov 5y ago
It is 100% obvious that amounts spent on the military in the U.S. today are insufficient and will have to go much, MUCH higher than they are today. Probably 5x higher - to the Cold War 10-12% levels - because of standoff with China and Russia at same time. It will still not be enough to win over China, but at least enough to keep the free world in existence. Otherwise democracy will be just simply gone from the world altogether in one generation.
- neuro_image2 5y ago
  I encourage you to rethink this stance. https://worldbeyondwar.org/ https://worldbeyondwar.org/ - is an organization dedicated to the abolition of war. I encourage you and anyone reading this to take a look. Also take a look at possible alternatives. (A global security system that doesn't require violence) - there's an ebook discussing this system in full. https://worldbeyondwar.org/alternative/ https://worldbeyondwar.org/alternative/ Continuing to head in the direction of militarism, will continue the disaster of a world that we live in, and almost certainly guarantee the end of mankind.
  - ryan93 5y ago
    Posts about permanently ending war are basically spam
    - neuro_image2 5y ago
      Says the guy commenting with no explanation or reference. Stick to watching fox news.
      - ryan93 5y ago
        A reference for why war can’t be stopped? Lol. https://en.m.wikipedia.org/wiki/History https://en.m.wikipedia.org/wiki/History
micromacrofoot 5y ago
The app thing is very true and so ridiculous, I at one point contracted for a health insurance company (with a team of 10 people) for over a year working on an app that never saw the light of day. It was essentially a calorie and exercise tracker that also displayed your health insurance info, absolutely nothing special compared to fitness apps already out there, but millions of dollars down the drain.
conductr 5y ago
> - 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. I feel like the choice has to be removed from families as our current system has proven that life will be extended regardless of quality simply due to the fact nobody wants to make a difficult choice. As the only quantitative item on the list and a very substantial one this should be ranked much higher in terms of priority (not sure if list was unordered or not).

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).
Broken_Hippo 5y ago
So, folks under 70 get out of suffering, but someone dying in their 30's can't get euthanasia? This seems cruel, especially so given the number of folks that suffer and die before they reach 70. And it shouldn't be for financial reasons. I fully support someone's right to death, but I do not support creating systems that might encourage it. I also don't realistically care if the health condition is terminal: I care more that folks are suffering and want death to escape it.

Griffinsauce 5y ago

"- Removing the capacity for lobbying by insurance companies, large hospital groups, device and pharma companies." This should be step one, always. While those perverse incentives exist everything else is an uphill battle.

qwerty456127 5y ago
This probably also is the hardest part. And the most alien to the whole American model of which lobbying is an integral part. IMHO you can only counter lobbying by allocating more to fact checking so it would be harder for them lobby things which are objectively wrong.
- jounker 5y ago
  We had such a congressional fact check organization. It was called the OTA (Office of Technology Assessment). Sadly it stood in the way of institutionalized lobbying (The K Street Project), so the Republicans eliminated it shortly after they came to power in congress in 1994.
  - throwaway0a5e 5y ago
    It was on borrowed time anyway. The OTA was a threat to the fiefdom of literally every other agency. Their job was to butt in and ruin everyone's gravy trains of "not quite graft". Imagine the OTA weighing in on the recent net neutrality shitshow. Wouldn't have made the FCC look to smart would it have? That same threat existed for every agency and congress and the executive. Literally everyone wanted them gone.
- roenxi 5y ago
  Why would fact checking have an influence on lobbying? Everyone knows what is going on. It isn't like the politicians, lobbyists, technical experts or public are in the dark about what is happening. If anything, a fact checking organisation has incentives to align with or even become a lobby group. We've seen what happens to "fact checking" in the political sphere.

refurb 5y ago

You think it’s the c-suite reaping all the financial gains?

neuro_image2 5y ago
Predominantly (there's also general overall bureaucratic bloat with absurd numbers of administrators at all levels) . It's certainly not the majority of healthcare workers. Physicians are often scapegoated as responsible for healthcare costs when in reality physicians in Canada, New Zealand and Australia earn similar salaries without the massive cost blowout.
- refurb 5y ago
  There can be instances where physicians are paid the same or more outside the US (I've heard family practice can pay better in Canada), but overall US physicians earn much more. https://www.physiciansweekly.com/how-do-us-physician-salaries-compare-with-those-abroad https://www.physiciansweekly.com/how-do-us-physician-salarie...
  - neuro_image2 5y ago
    I guess it depends on your comparison - that article didn't include Australia, NZ or Canada. Also if you factor in earnings and expenses over a lifetime (including cost of studying and the fact that many of the countries mentioned have free healthcare and education and far lower insurance requirements) it evens out substantially. More importantly, even the highest physician salaries are orders of magnitude less than insurance company CEO salaries. Disclosure: I'm a physician, currently practicing in the US, previously in New Zealand and the UK.
    - refurb 5y ago
      I’ve got several friends who specifically moved to the US from Canada because the pay was so much better. No doubt it varies by circumstance, but docs ive known in the US pay off their $500k in student debt pretty quickly if they specialize. And sure insurance CEOs are paid more, but there are also a several magnitude more doctors than insurance CEOs. You could pay all the CEOs $1 and the cost of healthcare isn’t going to budget much.

Ericson2314 5y ago

May this new California attempt succeed

amelius 5y ago

> 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. I'd be happy if the app could show medical expenses before the treatment.

diordiderot 5y ago
Yes check the app while your limp unconscious body is shoved into the back of an ambulance. Type in appendectomy near me while you're writhing in pain in the passenger seat and decided, the hospital the next town over is a better deal
- amcoastal 5y ago
  You use an absurd scenario, not sure why, but we both know there are tons of times you go to a medical provider where if you could pay less for a slightly longer car ride, you'd do it. But that information isn't even available now. The only fucking industry that is allowed to sell you stuff without telling you how much it will cost.
  - MomoXenosaga 5y ago
    Who cares how much it costs if your health insurance cover it? The reality is that healthcare is so expensive that it can bankrupt anyone who isn't a millionaire- which is why it needs to be mandatory and comprehensive. Right now millions of Americans are basically committing fraud: they go to a doctor who has taken an oath to help you. The bill is not getting paid so the government has to step in anyway. May as well make it official.
    - DavidPeiffer 5y ago
      >Who cares how much it costs if your health insurance cover it? At least under the current model, many people don't hit their deductible or max out of pocket. I know some older retired couples who are buying insurance on the market with 10k+ deductibles because they're generally in really good health, and the cost of insurance isn't absolutely insane with that level of deductible. They would absolutely drive an hour rather than 5 minutes for non-emergency situations!

CryptoPunk 5y ago

From what I've seen, subsidies and regulations are the primary cause of inefficiency in healthcare: https://www.athenahealth.com/knowledge-hub/practice-management/expert-forum-rise-and-rise-healthcare-administrator https://www.athenahealth.com/knowledge-hub/practice-manageme... >>Here's some food for thought: The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200 percent for the same time period. * >>Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. (To cite just a few industry-disrupting regulations, consider the Prospective Payment System of 1983 [1]; the Health Insurance Portability & Accountability Act of 1996 [2]; and the Health Information Technology for Economic and Clinical Act of 2009. [3]) In contrast, areas of medicine which are subject to much fewer subsidies and regulations, as a consequence of being electives, have seen prices actually decline in inflation adjusted terms. [4] [1] https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/index.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... [2] https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg... [3] https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/h... [4] http://healthblog.ncpathinktank.org/why-cant-the-market-for-medical-care-work-like-cosmetic-surgery/ http://healthblog.ncpathinktank.org/why-cant-the-market-for-...

Broken_Hippo 5y ago
Regulations and subsidies do not seem to make other countries' systems inefficient. They make it so that folks are safe and that they can actually get health care. I really want regulation in health care. I do not want medication to be a free-for-all like supplements are in the US. I'm not a doctor, after all, and they are slow to take supplements off the market even if they are harming or killing folks (take a look at diet pills to see this effect). I do not want average folks to be able to get antibiotics willy-nilly because I want to be able to take them when I'm old. And so on.

robbiep 5y ago

Better end of life care would revolutionise healthcare. No country does this well

sokoloff 5y ago
Not everyone agrees on what “better” means though. When you start putting dollars and days into formulae around dying, many people lose their damn minds…
- throwaway6734 5y ago
  As long as it doesn't involve Covid, then "death panels" are fine
- supertrope 5y ago
  Failing to plan is planning to fail. Those formula already exist and they're used at insurance companies.

anovikov 5y ago

It is 100% obvious that amounts spent on the military in the U.S. today are insufficient and will have to go much, MUCH higher than they are today. Probably 5x higher - to the Cold War 10-12% levels - because of standoff with China and Russia at same time. It will still not be enough to win over China, but at least enough to keep the free world in existence. Otherwise democracy will be just simply gone from the world altogether in one generation.

neuro_image2 5y ago
I encourage you to rethink this stance. https://worldbeyondwar.org/ https://worldbeyondwar.org/ - is an organization dedicated to the abolition of war. I encourage you and anyone reading this to take a look. Also take a look at possible alternatives. (A global security system that doesn't require violence) - there's an ebook discussing this system in full. https://worldbeyondwar.org/alternative/ https://worldbeyondwar.org/alternative/ Continuing to head in the direction of militarism, will continue the disaster of a world that we live in, and almost certainly guarantee the end of mankind.
- ryan93 5y ago
  Posts about permanently ending war are basically spam
  - neuro_image2 5y ago
    Says the guy commenting with no explanation or reference. Stick to watching fox news.
    - ryan93 5y ago
      A reference for why war can’t be stopped? Lol. https://en.m.wikipedia.org/wiki/History https://en.m.wikipedia.org/wiki/History

micromacrofoot 5y ago

The app thing is very true and so ridiculous, I at one point contracted for a health insurance company (with a team of 10 people) for over a year working on an app that never saw the light of day. It was essentially a calorie and exercise tracker that also displayed your health insurance info, absolutely nothing special compared to fitness apps already out there, but millions of dollars down the drain.

conductr 5y ago

> - 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. I feel like the choice has to be removed from families as our current system has proven that life will be extended regardless of quality simply due to the fact nobody wants to make a difficult choice. As the only quantitative item on the list and a very substantial one this should be ranked much higher in terms of priority (not sure if list was unordered or not).