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No one wants to hear the truth. There’s near-infinite demand for healthcare and a constrained (mostly artificially) supply. Insurance, people and government c

No one wants to hear the truth. There’s near-infinite demand for healthcare and a constrained (mostly artificially) supply. Insurance, people and government can’t solve the problem of the supply and demand by throwing money on it. You either expand supply or remove demand. Given removing demand is... not desirable. The only alternative to fix the issue is remove regulation and expand supply. That’s it. Insurance makes the issue worse by increasing demand and in a way limiting supply through requirements and procedures. Government limits supply through regulation AND expands demand by paying for procedures. An approach is to deregulate, such as removing government licensing, remove Medicare, etc. Imo Prices would drop >95% within a 2-5 years (to India or Mexico levels). I worked in medical billing for a few years and the issues are beyond obvious.

lefstathiou 5y ago
I think there needs to be some new approach to how medical services are being paid for. My 70yo father fell off a ladder and drove himself to the hospital in Calhoun Georgia (2 hours north of Atlanta, a small town) with a bruised eye and a broken wrist. He got in late afternoon, left the next day, and the bill to insurance (which of course they won't pay) was $69,000... more than per capita income in the US. The system is ridiculous. In my opinion, healthcare has reached the state where the people who receive the benefit are too far removed from the people who pay for it and given there is no "victim" of price gauging, the prices will just keep going up up and way. I defer to those wiser than me for the solution. I don't like complaining without being constructive so here is my ignorant pass at it. This will require a few key steps: 1) Yes, we need more supply (by deregulating the profession) 2) I personally think a more effective solution would be to gradually eliminate insurance except for catastrophic risk (like emergency medical care from a car accident). #2 will shift responsibility to the individual and the system will be capped at what they can charge based on the average person's ability to pay for it (which is how it works in many parts of the world).
- lettergram 5y ago
  > left the next day, and the bill to insurance (which of course they won't pay) was $69,000 I agree with you and the quote above is because of insurance. Medicare will pay 10% of that total and your father would be charged 2-5%. If he has private insurance you’ll see something different, maybe 15% and your father would be charged 3-6%. If he’s going out of network could be 100%. Hospitals / practices charge insane bills because people pay just a small fraction typically. It really impacts those without insurance or private insurance the worst. It is insane. This is why I have suggested deregulation, particularly around licensing. It drives down the cost. Insurance may cover doctor X, but if nurse Y can do it for 5% the price... well use the nurse. All doctors would have to reduce prices and insurance would have to raise the coverage amount to compete. It’s what is done elsewhere in the world.
- ClumsyPilot 5y ago
  > Yes, we need more supply (by deregulating the profession) So it looks like software development? Are you comfortable for your life to be in the hands of a rando who just finished a 6-months bootcamp?
  - lefstathiou 5y ago
    I don't think it has to be binary. For situations that are life threatening, I'll opt for a premium service and for situations that are not, I may opt for an alternative. I think almost anyone at our company can be trained to reliably operate and interpret an x-ray machine for the vast majority of use cases.
    - ClumsyPilot 5y ago
      'For situations that are life threatening, I'll opt for a premium service' 1 - what does the 'non-premium', i.e. bottomn of the barrel service look like, is that incompetent people offering rock bottom prices (resulting in death?). 2 - are you sure you can identify a life threatening situation correctly? Because my father did not. 3 - how do you know the 'premium' provider in question results in better outcomes, rather than being the same rubbish well presented in fancy packaging?
      - lefstathiou 5y ago
        Re #1 and 3: you have this problem with or without my system (take a look at plastic surgery clinics in Miami for example). Doctors can be incompetent too and the system is so opaque you can’t readily identify or measure the outcome. I think markets are efficient here and there are plenty of services we operate in now with similar spectrums of quality (food, airlines, general contracting, dental work, etc). The gap between my position and yours i believe fundamentally is that I believe people can and ultimately should be accountable for their decisions. I suspect you believe they need to be protected by a system of accreditation. I guess I don’t put too much weight into that. When you own the outcome, you are far more likely to do research, ask questions, compare etc. 2- I’m very sorry to hear that. I believe most people can most of the time. The more people are tasked with doing this, the more likely they will be to invest the time and effort to understand their health choices, seek counsel of others and potentially lead healthier lives. I too am a bit scarred by the medical system. My sister was diagnosed with colon cancer at 33 and it was discovered “just in time” because she kept rejecting the quick diagnoses multiple doctors in Boston gave her. Had she not self advocated she’d likely be dead. I made a similar mistake when my son was born during Covid. We went into an nyc hospital foolishly thinking that if you are nice, quiet and well mannered you will be treated with respect. My wife went into labor alone in a waiting room where she was abandoned for hours despite us telling them how long she was already in labor and her ringing the help button numerous times. I wasn’t allowed until she went into the delivery room but she never made it there. The lesson for me was clear 1- do your research 2- be prepared to self advocate 3- doctors are humans. Humans make mistake, they have limited and often flawed memories but unlike software development professionals, they do not have the benefit of being able to deploy state of the art systems, technologies and libraries Happy to take this offline if you care to. My email is in the profile.
mola 5y ago
You should educate yourself about how most of the western world manages to have a functioning semi social health care system. US is broken because of this blind fantaic faith in free markets deregulation simplifications. The problem is a large swath of the population that believe in all earnestly that squeezing profit is some magical tool for a functioning economy. Too bad US is so good at PR, this mind virus is wreaking havoc all over the world.
- lettergram 5y ago
  > You should educate yourself about how most of the western world manages to have a functioning semi social health care system. US is broken because of this blind fantaic faith in free markets deregulation simplifications Most healthcare in the west is subsidized by the US. The US market is far more lucrative, so companies do R&D and make capital from the US. The US also subsidizes in terms of both military and energy almost every western country. Even then, Europe has a higher tax rate and on average is far poorer. I’m well educated on this subject and worked in this area in the US and spent time in other countries. You have no idea what you’re taking about.
  - ClumsyPilot 5y ago
    "The US also subsidizes in terms of .. energy almost every western country" These claims are outrageous and totally unsubstantiated. How does US subsidise energy of France or Japan? "Most healthcare in the west is subsidized by the US." "The US market is far more lucrative, so companies do R&D and make capital from the US. " You are subsidising the companies, not my healthcare. And they pay out this money in dividends to shareholders. I am sure they are very gratefull, maybe you should ask them for a rebate. Stop subsidising them and overpaying - do you think healthcare costs in Europe will rise? If you do, I've got a wager.
- spaniard89277 5y ago
  I would say that most western countries do have both public and private healthcare. I did have private insurance here in Spain and it's nothing like in the US, as far as I can tell. Service was excelent and I didn't felt everyone was stressed. In france your public insurance allows you to walk in a private clinic or hospital too, as a relative did and they cover her post-cancer treatment better than in the public hospital (by her account at least). So yeah, "free market deregulation" may be an oversimplification but you have a problem in the US that's also far more than just being for-profit. We have for-profit over here and it works. And that includes private & public institution doing medical R&D and selling their products to the national health services and private clinics, like quite a bunch of spanish companies do, for example. I say this becase it weirdly pops as an argument when it's totally unrelated, and it may be only a tiny fraction of the total cost.
jodrellblank 5y ago
> "An approach is to deregulate, such as removing government licensing, remove Medicare, etc." This worked so well for Rosemary Kennedy when she could be prescribed an ice pick lobotomy. And so well for Eben Byers when his doctor prescribed him radioactive water, and he drank so much his jaw rotted off. It works brilliantly for this woman[1] and her cheap Turkish dentist work leaving her in pain. And for, well all of this junk: https://en.wikipedia.org/wiki/List_of_unproven_and_disproven_cancer_treatments https://en.wikipedia.org/wiki/List_of_unproven_and_disproven... Deregulation is what we had when things were terrible. Regulation and licensing is what we use to block the most obvious junk 'treatments' and the worst con artists. > "Given removing demand is... not desirable." Removing demand is enormously desirable. Regulate the shit out of CocaCola, Marlboro, and all the other health destroying parasites and their advertising, tax them, rework town and city planning to remove driving as the primary transport in life and all the associated exhaust fumes, rework public schooling and rebuild trust in the government and medics so people aren't anti-health-advice on principle, rework employment so that employees have some rights and aren't stressed out all the time with no sick breaks. Rework medical access so people can see medical professionals, and sickness can be caught and treated early, which reduces demand on seeing much sicker people later. > "Insurance makes the issue worse by increasing demand and in a way limiting supply through requirements and procedures." Insurance makes the issue worse by driving up costs to patients and at the same time driving down pay to medical staff, by insurance taking as much as possible. Without insurance, supply and demand could remain the same, medical staff earn more, patients pay less, and services be more efficient with less time wasted fighting insurance companies and filling in insurance paperwork. [1] https://old.reddit.com/r/northernireland/comments/ua9me9/easily_one_of_the_stupidest_trends_in_recent/ https://old.reddit.com/r/northernireland/comments/ua9me9/eas...

lefstathiou 5y ago

I think there needs to be some new approach to how medical services are being paid for. My 70yo father fell off a ladder and drove himself to the hospital in Calhoun Georgia (2 hours north of Atlanta, a small town) with a bruised eye and a broken wrist. He got in late afternoon, left the next day, and the bill to insurance (which of course they won't pay) was $69,000... more than per capita income in the US. The system is ridiculous. In my opinion, healthcare has reached the state where the people who receive the benefit are too far removed from the people who pay for it and given there is no "victim" of price gauging, the prices will just keep going up up and way. I defer to those wiser than me for the solution. I don't like complaining without being constructive so here is my ignorant pass at it. This will require a few key steps: 1) Yes, we need more supply (by deregulating the profession) 2) I personally think a more effective solution would be to gradually eliminate insurance except for catastrophic risk (like emergency medical care from a car accident). #2 will shift responsibility to the individual and the system will be capped at what they can charge based on the average person's ability to pay for it (which is how it works in many parts of the world).

lettergram 5y ago
> left the next day, and the bill to insurance (which of course they won't pay) was $69,000 I agree with you and the quote above is because of insurance. Medicare will pay 10% of that total and your father would be charged 2-5%. If he has private insurance you’ll see something different, maybe 15% and your father would be charged 3-6%. If he’s going out of network could be 100%. Hospitals / practices charge insane bills because people pay just a small fraction typically. It really impacts those without insurance or private insurance the worst. It is insane. This is why I have suggested deregulation, particularly around licensing. It drives down the cost. Insurance may cover doctor X, but if nurse Y can do it for 5% the price... well use the nurse. All doctors would have to reduce prices and insurance would have to raise the coverage amount to compete. It’s what is done elsewhere in the world.
ClumsyPilot 5y ago
> Yes, we need more supply (by deregulating the profession) So it looks like software development? Are you comfortable for your life to be in the hands of a rando who just finished a 6-months bootcamp?
- lefstathiou 5y ago
  I don't think it has to be binary. For situations that are life threatening, I'll opt for a premium service and for situations that are not, I may opt for an alternative. I think almost anyone at our company can be trained to reliably operate and interpret an x-ray machine for the vast majority of use cases.
  - ClumsyPilot 5y ago
    'For situations that are life threatening, I'll opt for a premium service' 1 - what does the 'non-premium', i.e. bottomn of the barrel service look like, is that incompetent people offering rock bottom prices (resulting in death?). 2 - are you sure you can identify a life threatening situation correctly? Because my father did not. 3 - how do you know the 'premium' provider in question results in better outcomes, rather than being the same rubbish well presented in fancy packaging?
    - lefstathiou 5y ago
      Re #1 and 3: you have this problem with or without my system (take a look at plastic surgery clinics in Miami for example). Doctors can be incompetent too and the system is so opaque you can’t readily identify or measure the outcome. I think markets are efficient here and there are plenty of services we operate in now with similar spectrums of quality (food, airlines, general contracting, dental work, etc). The gap between my position and yours i believe fundamentally is that I believe people can and ultimately should be accountable for their decisions. I suspect you believe they need to be protected by a system of accreditation. I guess I don’t put too much weight into that. When you own the outcome, you are far more likely to do research, ask questions, compare etc. 2- I’m very sorry to hear that. I believe most people can most of the time. The more people are tasked with doing this, the more likely they will be to invest the time and effort to understand their health choices, seek counsel of others and potentially lead healthier lives. I too am a bit scarred by the medical system. My sister was diagnosed with colon cancer at 33 and it was discovered “just in time” because she kept rejecting the quick diagnoses multiple doctors in Boston gave her. Had she not self advocated she’d likely be dead. I made a similar mistake when my son was born during Covid. We went into an nyc hospital foolishly thinking that if you are nice, quiet and well mannered you will be treated with respect. My wife went into labor alone in a waiting room where she was abandoned for hours despite us telling them how long she was already in labor and her ringing the help button numerous times. I wasn’t allowed until she went into the delivery room but she never made it there. The lesson for me was clear 1- do your research 2- be prepared to self advocate 3- doctors are humans. Humans make mistake, they have limited and often flawed memories but unlike software development professionals, they do not have the benefit of being able to deploy state of the art systems, technologies and libraries Happy to take this offline if you care to. My email is in the profile.

mola 5y ago

You should educate yourself about how most of the western world manages to have a functioning semi social health care system. US is broken because of this blind fantaic faith in free markets deregulation simplifications. The problem is a large swath of the population that believe in all earnestly that squeezing profit is some magical tool for a functioning economy. Too bad US is so good at PR, this mind virus is wreaking havoc all over the world.

lettergram 5y ago
> You should educate yourself about how most of the western world manages to have a functioning semi social health care system. US is broken because of this blind fantaic faith in free markets deregulation simplifications Most healthcare in the west is subsidized by the US. The US market is far more lucrative, so companies do R&D and make capital from the US. The US also subsidizes in terms of both military and energy almost every western country. Even then, Europe has a higher tax rate and on average is far poorer. I’m well educated on this subject and worked in this area in the US and spent time in other countries. You have no idea what you’re taking about.
- ClumsyPilot 5y ago
  "The US also subsidizes in terms of .. energy almost every western country" These claims are outrageous and totally unsubstantiated. How does US subsidise energy of France or Japan? "Most healthcare in the west is subsidized by the US." "The US market is far more lucrative, so companies do R&D and make capital from the US. " You are subsidising the companies, not my healthcare. And they pay out this money in dividends to shareholders. I am sure they are very gratefull, maybe you should ask them for a rebate. Stop subsidising them and overpaying - do you think healthcare costs in Europe will rise? If you do, I've got a wager.
spaniard89277 5y ago
I would say that most western countries do have both public and private healthcare. I did have private insurance here in Spain and it's nothing like in the US, as far as I can tell. Service was excelent and I didn't felt everyone was stressed. In france your public insurance allows you to walk in a private clinic or hospital too, as a relative did and they cover her post-cancer treatment better than in the public hospital (by her account at least). So yeah, "free market deregulation" may be an oversimplification but you have a problem in the US that's also far more than just being for-profit. We have for-profit over here and it works. And that includes private & public institution doing medical R&D and selling their products to the national health services and private clinics, like quite a bunch of spanish companies do, for example. I say this becase it weirdly pops as an argument when it's totally unrelated, and it may be only a tiny fraction of the total cost.

jodrellblank 5y ago

> "An approach is to deregulate, such as removing government licensing, remove Medicare, etc." This worked so well for Rosemary Kennedy when she could be prescribed an ice pick lobotomy. And so well for Eben Byers when his doctor prescribed him radioactive water, and he drank so much his jaw rotted off. It works brilliantly for this woman[1] and her cheap Turkish dentist work leaving her in pain. And for, well all of this junk: https://en.wikipedia.org/wiki/List_of_unproven_and_disproven_cancer_treatments https://en.wikipedia.org/wiki/List_of_unproven_and_disproven... Deregulation is what we had when things were terrible. Regulation and licensing is what we use to block the most obvious junk 'treatments' and the worst con artists. > "Given removing demand is... not desirable." Removing demand is enormously desirable. Regulate the shit out of CocaCola, Marlboro, and all the other health destroying parasites and their advertising, tax them, rework town and city planning to remove driving as the primary transport in life and all the associated exhaust fumes, rework public schooling and rebuild trust in the government and medics so people aren't anti-health-advice on principle, rework employment so that employees have some rights and aren't stressed out all the time with no sick breaks. Rework medical access so people can see medical professionals, and sickness can be caught and treated early, which reduces demand on seeing much sicker people later. > "Insurance makes the issue worse by increasing demand and in a way limiting supply through requirements and procedures." Insurance makes the issue worse by driving up costs to patients and at the same time driving down pay to medical staff, by insurance taking as much as possible. Without insurance, supply and demand could remain the same, medical staff earn more, patients pay less, and services be more efficient with less time wasted fighting insurance companies and filling in insurance paperwork. [1] https://old.reddit.com/r/northernireland/comments/ua9me9/easily_one_of_the_stupidest_trends_in_recent/ https://old.reddit.com/r/northernireland/comments/ua9me9/eas...