7 ms·

As always the issue with privatized social services is that the goal is to make money, not to provide a service so the incentives are fundamentally misaligned.

As always the issue with privatized social services is that the goal is to make money, not to provide a service so the incentives are fundamentally misaligned. For-profit care providers make money when the fail to provide care. When they fail to cover procedures. When they can substitute lower-quality or less effective goods and services. When they can sell you catastrophic cover with deductibles and co-pays too high for you to actually afford to use it - the way a gym membership makes money selling subscriptions they know you won't use. This is by definition an improvement over what America has, so I welcome it. That doesn't change the fact it's an umbrella in a hurricane, so it's really not that interesting. Socializing the whole thing is significantly better. Remember America already has socialized medicine for 40% of the population. It is long past time to up that to 100%.

daniel-cussen 4y ago
That's pretty much it, but I would add that since medicine in the American sphere of influence is a cornered market the goal is always to deny care, so the patients are more desperate and pay higher prices. Endgame is a billionaire paying his whole billion-dollar fortune for a loaf of bread because he's starving. First you have to corner the market, then deny food, then eventually yes, eventually he will in fact pay a billion dollars for a loaf of bread, I fucking guarantee it.
- arcticbull 4y ago
  Indeed there's no reason that Cuban won't, like Uber, wake up one day and 5X prices - or bring in the recently-released Pharma Bro Shkrelli. Good will and brand alone isn't sufficient to build a medical system on.
  - deleted 4y ago
    [deleted]
  - trident5000 4y ago
    Maybe, but increased competition never hurt the consumer.
    - maerF0x0 4y ago
      I'm curious if this is literally always true? I agree that competition often helps improve pricing and quality, of course. But I wonder if at times competition leads to a net degradation such as "race to the bottom" scenarios?
  - edgefield 4y ago
    And I’m not so worried about Cuban. I’m worried about when he exits. The next owner(s) will certainly have a different agenda.
  - TuringNYC 4y ago
    >> Indeed there's no reason that Cuban won't, like Uber, wake up one day and 5X prices Perhaps, but until then, I welcome the value he'd create for us
an9n 4y ago
Let's hope you make a better fist of it than the UK - the NHS is currently unreformable to any significant degree, due to it being weaponised by the left.
- mousetree 4y ago
  Could you share more? Curious to understand the issues of the NHS and why it can't be reformed and what it means to be weaponised by the left
  - an9n 4y ago
    See my comment above - the weaponise term is from a quote that was disavowed by the Labour leader-before-last, but that he certainly seems to have spoken. Here's an article on the topic - from a socialist source: https://www.sochealth.co.uk/2015/04/28/weaponizing-the-nhs-isnt-helping-it/ https://www.sochealth.co.uk/2015/04/28/weaponizing-the-nhs-i... 'many campaigners who want to “Save” the NHS seem to want to do the opposite – to politicise the NHS so far that reform becomes a practical impossibility. They create alarm about cuts to local services, privatization, postcode lotteries and TTIP. They seem more motivated by anger, and fixated on political totems, than on trying to promote progress within the NHS.' 'The problem with Labour’s campaign to “weaponize” the NHS and turn it into a key political battleground, and its politically motivated and gimmicky manifesto pledges, is that it distracts from the real work that is needed: devolved reforms led by clinicians. We could have yet another 2 year hiatus. The NHS can ill-afford that.' The kneejerk downvotes on HN are so depressing, especially when they are borne out of ignorance (not you btw, your comment is good).
- arcticbull 4y ago
  UK per capita health expenditure: $4650USD (#17). US per capita health expenditure: $11000USD (#1). I don't know what the 'left' is doing there but it seems very efficient.
  - cpach 4y ago
    Would be interesting to compare also with countries like Germany, Sweden, Netherlands, Singapore etc.
baby_wipe 4y ago
If for-profit companies keep doing all these awful things, why people keep paying them money?
- scythe 4y ago
  > If for-profit companies keep doing all these awful things, why people keep paying them money? Healthcare privacy laws make it extremely difficult to evaluate the value proposition of care providers. You can't just, like, look up a list of their previous patients' medical histories.
- nrmitchi 4y ago
  Because at the moment the only real alternative is “dying”?
  - xyzzyz 4y ago
    This is only true for a fraction of all healthcare that’s actually consumed. For my family, over past 4 years, maybe 10% of our healthcare consumption carried a significant risk of death if we elected to not consume it. As an explicit example, my wife took our infant daughter to a doctor the other day, because she was coughing and sneezing for a week already, and she wanted him to confirm that it’s most likely nothing to worry about. The doctor agreed. Insurance was billed $200, with $10 paid by us out of pocket. If we had to pay $200 out of pocket, we’d probably wait another week (and ended up not paying anything at all, because the coughing indeed disappeared before the end of the second week).
- bgia 4y ago
  Because their lives depend on it? Why do people keep paying ransoms? Does it mean that ransoming them is a good thing?
  - maerF0x0 4y ago
    But the point was that they're doing things that either are unneeded or not effective. If either of those are true, their lives do not depend on those procedures.
specialp 4y ago
One thing lost on people is the "for-profit" motive is not solely with insurers or plan providers. Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are. This results in often legitimate procedures being denied. But make no mistake, the care providers billing insurance are just as likely or more likely to try to grab money in any way possible. I was once involved in a company that would place laboratories and other diagnostic machinery in physician's offices. They would always be very interested in what the insurance reimburses and how many patients they can run it on. There would always be some gimmick like Oh, homocystine we can run on every patient for $5 and be reimbursed $30, and then you would see that ran on every single patient they could to make that money. Eventually insurers would have to shut it down. High sensitivity CRP was another one until medicare locked it to being run once in a patient's lifetime.
- pc86 4y ago
  > Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are. The shitty ones, maybe. I know many physicians who acknowledge that unnecessary tests lead to unnecessary interventions, which is proven to reduce quality of life and decrease outcomes.
- maerF0x0 4y ago
  > Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are. I've personally found this particularly common and suspect within the Dental industry. https://health.sunnybrook.ca/navigator/too-many-dental-x-rays/ https://health.sunnybrook.ca/navigator/too-many-dental-x-ray...
- maxerickson 4y ago
  All the people complaining that they went in for an included annual checkup and got billed for asking a question are running into this, it's the provider that changes or adds the billing code. (Maybe not the practitioner directly, the providing organization)
- 4y ago
maerF0x0 4y ago
> Socializing the whole thing is significantly better. As a Canadian I highly disagree. And anecdotally many health care providers from Canada agree with my take. People frequently die, or get sicker, as they wait their turn in months long queues or lack of supply due to government quotas. There is nothing stopping the government from substituting lower-quality, less effective procedures when their MBAs come in an consult about how to reduce costs.
- arcticbull 4y ago
  Canada has substantially the same health outcomes, or better, than the US. This is simply not true. I'm also Canadian, and have lived under both systems. My father fell off a ladder and had a pretty severe head injury, and had both an MRI and a CT scan within a half hour, at no cost. Yes, lower-priority conditions may have to wait, but it's also by definition because they're lower priority - and they'll have to wait in America too. The idea that the Canadian healthcare system is somehow leaving people to wait and die in a way the American system is not, is a falsehood propagated by major American insurers and their lobbying group AHIP. Here's a Cigna executive apologizing for doing just that. [1] [1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-former-cigna-executive-praises-canadas-health-care-system https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
  - maerF0x0 4y ago
    This article has a couple immediately glaring flaws that lead me to not invest the time to deeply analyze it on the whole... > because of having the kind of health care system you have in making sure that everyone who needs to be treated is treated That's completely false, Canada has a presupplied quota system set by government forecasting and limited by budgets. If you need treatment you will be treated eventually but you might die or get sicker in the interim. Using a COVID-19 based article to discuss the merits of single payer single provider completely ignores the massive cultural mentality differences -- the US focuses on individual freedoms, Canada focuses on collective good. This makes a big difference when it comes to adherence things like social distancing and masks. They're taking a multivariate system and claiming it's a single variable that caused the outcome. Edit: and I might add that it appears that Canada is always intentionally undersupplied such that a moderate wait is guaranteed. Whereas it seems that due to market competition the US system is inherently oversupplied (at least in many areas) such that they can provide to those who can pay essentially on demand.
tomp 4y ago
Um, what? In theory, free market healthcare should improve alignment. Insurance companies pay procedures and make money when people are less sick. Hospitals make money when they perform procedures. Insurance companies are therefore incentivised to only pay procedures from competent hospitals, the ones that won’t result in more follow-up costs. The problem is, of course, it’s not a free market - neither on the hospital side (prices are not public) nor on the insurance side (it’s much more affordable through employment)
- arcticbull 4y ago
  'A key feature of free markets is the absence of coerced (forced) transactions or conditions on transactions.' [1] Healthcare is not such a market. If you have a stab wound and you're bleeding out, there's no supply and demand, there's no ability for you to have market participants compete for your business. It's 'pay me or die.' Ditto substantially any major medical issue. This is, in my opinion a coerced transaction, and therefore, not a free market. This is true of prisons (you can't exactly have private prisons compete for your business). Of fire departments (I'm not going to call for quotes while my house burns down). Of police departments. If it's not a free market, it should be socialized, imo. [1] https://www.investopedia.com/terms/f/freemarket.asp https://www.investopedia.com/terms/f/freemarket.asp
  - tomp 4y ago
    I’m a huge advocate for private (non-socialized) healthcare. People always twist this into “you’d have to pay so much more for healthcare”. No! I never had to pay anything substantial for healthcare. I pay for insurance. But I prefer private insurance (to improve competition, performance, quality, accessibility, …)
  - deleted 4y ago
    [deleted]
- criddell 4y ago
  > Insurance companies pay procedures and make money when people are less sick. It's not as simple as that. Insurers are regulated. They can't keep any more than 20% of the money they collect. It sets up an incentive for them to collect and spend more money.
UnpossibleJim 4y ago
Just before I ask this question, I want to let it be known I am for base healthcare as a public right, as well as public 4 year universities (4 year community colleges, basically) and a low UBI - I've basically become a hippy, somehow, in my old age... I'm not sure how that happened. But with that out of the way, on to my question... Do you think that part of the reason that America is so attractive to pharmaceutical innovation is because of the obscene profits that can be made in the prescription space that is not only allowed by our laws, but encouraged by our politicians? If we were to socialize our pharmaceutical sector, which would involve putting caps on pricing, do you think this would make innovation into treatment which involves huge upfront costs in research a non-starter? Would neutering the profit motive and corporate greed in our pharmaceutical sectors revert our pharma studies back to university programs and corporate tax write offs/good will programs and the occasional government budget surplus when they've decided to not funnel it towards another uneccessary war?
knubie 4y ago
> the goal is to make money, not to provide a service I think your entire premise is flawed here. Businesses make money by providing services that people want / need.
- antisthenes 4y ago
  Businesses also make money by reducing the inputs that go into services (e.g. lowering the quality of the service), thus achieving a higher profit margin. It's not a flawed premise. It just doesn't occur 100% of the time. It tends to occur in industries with poor competition (mono/oligo-polies)

daniel-cussen 4y ago

That's pretty much it, but I would add that since medicine in the American sphere of influence is a cornered market the goal is always to deny care, so the patients are more desperate and pay higher prices. Endgame is a billionaire paying his whole billion-dollar fortune for a loaf of bread because he's starving. First you have to corner the market, then deny food, then eventually yes, eventually he will in fact pay a billion dollars for a loaf of bread, I fucking guarantee it.

arcticbull 4y ago
Indeed there's no reason that Cuban won't, like Uber, wake up one day and 5X prices - or bring in the recently-released Pharma Bro Shkrelli. Good will and brand alone isn't sufficient to build a medical system on.
- deleted 4y ago
  [deleted]
- trident5000 4y ago
  Maybe, but increased competition never hurt the consumer.
  - maerF0x0 4y ago
    I'm curious if this is literally always true? I agree that competition often helps improve pricing and quality, of course. But I wonder if at times competition leads to a net degradation such as "race to the bottom" scenarios?
- edgefield 4y ago
  And I’m not so worried about Cuban. I’m worried about when he exits. The next owner(s) will certainly have a different agenda.
- TuringNYC 4y ago
  >> Indeed there's no reason that Cuban won't, like Uber, wake up one day and 5X prices Perhaps, but until then, I welcome the value he'd create for us

an9n 4y ago

Let's hope you make a better fist of it than the UK - the NHS is currently unreformable to any significant degree, due to it being weaponised by the left.

mousetree 4y ago
Could you share more? Curious to understand the issues of the NHS and why it can't be reformed and what it means to be weaponised by the left
- an9n 4y ago
  See my comment above - the weaponise term is from a quote that was disavowed by the Labour leader-before-last, but that he certainly seems to have spoken. Here's an article on the topic - from a socialist source: https://www.sochealth.co.uk/2015/04/28/weaponizing-the-nhs-isnt-helping-it/ https://www.sochealth.co.uk/2015/04/28/weaponizing-the-nhs-i... 'many campaigners who want to “Save” the NHS seem to want to do the opposite – to politicise the NHS so far that reform becomes a practical impossibility. They create alarm about cuts to local services, privatization, postcode lotteries and TTIP. They seem more motivated by anger, and fixated on political totems, than on trying to promote progress within the NHS.' 'The problem with Labour’s campaign to “weaponize” the NHS and turn it into a key political battleground, and its politically motivated and gimmicky manifesto pledges, is that it distracts from the real work that is needed: devolved reforms led by clinicians. We could have yet another 2 year hiatus. The NHS can ill-afford that.' The kneejerk downvotes on HN are so depressing, especially when they are borne out of ignorance (not you btw, your comment is good).
arcticbull 4y ago
UK per capita health expenditure: $4650USD (#17). US per capita health expenditure: $11000USD (#1). I don't know what the 'left' is doing there but it seems very efficient.
- cpach 4y ago
  Would be interesting to compare also with countries like Germany, Sweden, Netherlands, Singapore etc.

baby_wipe 4y ago

If for-profit companies keep doing all these awful things, why people keep paying them money?

scythe 4y ago
> If for-profit companies keep doing all these awful things, why people keep paying them money? Healthcare privacy laws make it extremely difficult to evaluate the value proposition of care providers. You can't just, like, look up a list of their previous patients' medical histories.
nrmitchi 4y ago
Because at the moment the only real alternative is “dying”?
- xyzzyz 4y ago
  This is only true for a fraction of all healthcare that’s actually consumed. For my family, over past 4 years, maybe 10% of our healthcare consumption carried a significant risk of death if we elected to not consume it. As an explicit example, my wife took our infant daughter to a doctor the other day, because she was coughing and sneezing for a week already, and she wanted him to confirm that it’s most likely nothing to worry about. The doctor agreed. Insurance was billed $200, with $10 paid by us out of pocket. If we had to pay $200 out of pocket, we’d probably wait another week (and ended up not paying anything at all, because the coughing indeed disappeared before the end of the second week).
bgia 4y ago
Because their lives depend on it? Why do people keep paying ransoms? Does it mean that ransoming them is a good thing?
- maerF0x0 4y ago
  But the point was that they're doing things that either are unneeded or not effective. If either of those are true, their lives do not depend on those procedures.

specialp 4y ago

One thing lost on people is the "for-profit" motive is not solely with insurers or plan providers. Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are. This results in often legitimate procedures being denied. But make no mistake, the care providers billing insurance are just as likely or more likely to try to grab money in any way possible. I was once involved in a company that would place laboratories and other diagnostic machinery in physician's offices. They would always be very interested in what the insurance reimburses and how many patients they can run it on. There would always be some gimmick like Oh, homocystine we can run on every patient for $5 and be reimbursed $30, and then you would see that ran on every single patient they could to make that money. Eventually insurers would have to shut it down. High sensitivity CRP was another one until medicare locked it to being run once in a patient's lifetime.

pc86 4y ago
> Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are. The shitty ones, maybe. I know many physicians who acknowledge that unnecessary tests lead to unnecessary interventions, which is proven to reduce quality of life and decrease outcomes.
maerF0x0 4y ago
> Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are. I've personally found this particularly common and suspect within the Dental industry. https://health.sunnybrook.ca/navigator/too-many-dental-x-rays/ https://health.sunnybrook.ca/navigator/too-many-dental-x-ray...
maxerickson 4y ago
All the people complaining that they went in for an included annual checkup and got billed for asking a question are running into this, it's the provider that changes or adds the billing code. (Maybe not the practitioner directly, the providing organization)
4y ago

maerF0x0 4y ago

> Socializing the whole thing is significantly better. As a Canadian I highly disagree. And anecdotally many health care providers from Canada agree with my take. People frequently die, or get sicker, as they wait their turn in months long queues or lack of supply due to government quotas. There is nothing stopping the government from substituting lower-quality, less effective procedures when their MBAs come in an consult about how to reduce costs.

arcticbull 4y ago
Canada has substantially the same health outcomes, or better, than the US. This is simply not true. I'm also Canadian, and have lived under both systems. My father fell off a ladder and had a pretty severe head injury, and had both an MRI and a CT scan within a half hour, at no cost. Yes, lower-priority conditions may have to wait, but it's also by definition because they're lower priority - and they'll have to wait in America too. The idea that the Canadian healthcare system is somehow leaving people to wait and die in a way the American system is not, is a falsehood propagated by major American insurers and their lobbying group AHIP. Here's a Cigna executive apologizing for doing just that. [1] [1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-former-cigna-executive-praises-canadas-health-care-system https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
- maerF0x0 4y ago
  This article has a couple immediately glaring flaws that lead me to not invest the time to deeply analyze it on the whole... > because of having the kind of health care system you have in making sure that everyone who needs to be treated is treated That's completely false, Canada has a presupplied quota system set by government forecasting and limited by budgets. If you need treatment you will be treated eventually but you might die or get sicker in the interim. Using a COVID-19 based article to discuss the merits of single payer single provider completely ignores the massive cultural mentality differences -- the US focuses on individual freedoms, Canada focuses on collective good. This makes a big difference when it comes to adherence things like social distancing and masks. They're taking a multivariate system and claiming it's a single variable that caused the outcome. Edit: and I might add that it appears that Canada is always intentionally undersupplied such that a moderate wait is guaranteed. Whereas it seems that due to market competition the US system is inherently oversupplied (at least in many areas) such that they can provide to those who can pay essentially on demand.

tomp 4y ago

Um, what? In theory, free market healthcare should improve alignment. Insurance companies pay procedures and make money when people are less sick. Hospitals make money when they perform procedures. Insurance companies are therefore incentivised to only pay procedures from competent hospitals, the ones that won’t result in more follow-up costs. The problem is, of course, it’s not a free market - neither on the hospital side (prices are not public) nor on the insurance side (it’s much more affordable through employment)

arcticbull 4y ago
'A key feature of free markets is the absence of coerced (forced) transactions or conditions on transactions.' [1] Healthcare is not such a market. If you have a stab wound and you're bleeding out, there's no supply and demand, there's no ability for you to have market participants compete for your business. It's 'pay me or die.' Ditto substantially any major medical issue. This is, in my opinion a coerced transaction, and therefore, not a free market. This is true of prisons (you can't exactly have private prisons compete for your business). Of fire departments (I'm not going to call for quotes while my house burns down). Of police departments. If it's not a free market, it should be socialized, imo. [1] https://www.investopedia.com/terms/f/freemarket.asp https://www.investopedia.com/terms/f/freemarket.asp
- tomp 4y ago
  I’m a huge advocate for private (non-socialized) healthcare. People always twist this into “you’d have to pay so much more for healthcare”. No! I never had to pay anything substantial for healthcare. I pay for insurance. But I prefer private insurance (to improve competition, performance, quality, accessibility, …)
- deleted 4y ago
  [deleted]
criddell 4y ago
> Insurance companies pay procedures and make money when people are less sick. It's not as simple as that. Insurers are regulated. They can't keep any more than 20% of the money they collect. It sets up an incentive for them to collect and spend more money.

UnpossibleJim 4y ago

Just before I ask this question, I want to let it be known I am for base healthcare as a public right, as well as public 4 year universities (4 year community colleges, basically) and a low UBI - I've basically become a hippy, somehow, in my old age... I'm not sure how that happened. But with that out of the way, on to my question... Do you think that part of the reason that America is so attractive to pharmaceutical innovation is because of the obscene profits that can be made in the prescription space that is not only allowed by our laws, but encouraged by our politicians? If we were to socialize our pharmaceutical sector, which would involve putting caps on pricing, do you think this would make innovation into treatment which involves huge upfront costs in research a non-starter? Would neutering the profit motive and corporate greed in our pharmaceutical sectors revert our pharma studies back to university programs and corporate tax write offs/good will programs and the occasional government budget surplus when they've decided to not funnel it towards another uneccessary war?

knubie 4y ago

> the goal is to make money, not to provide a service I think your entire premise is flawed here. Businesses make money by providing services that people want / need.

antisthenes 4y ago
Businesses also make money by reducing the inputs that go into services (e.g. lowering the quality of the service), thus achieving a higher profit margin. It's not a flawed premise. It just doesn't occur 100% of the time. It tends to occur in industries with poor competition (mono/oligo-polies)