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Medicare is what pays for that btw. Dialysis is covered, as is any life saving treatment (like heart attack). What ends up happening is hospitals then charge o
by lettergram 4y ago
Medicare is what pays for that btw. Dialysis is covered, as is any life saving treatment (like heart attack).
What ends up happening is hospitals then charge others to cover their costs (hence high rates). Granted hospitals do take a bigger cut imo than they deserve, as do pharma, doctors, etc.
Let’s not forget the number of doctors is intentionally restricted. They also seem to have a political bias imo (how much volunteer work and what kind you’ve done).
Then you have regulations around drugs (FDA), hospitals / practice insurance, etc
Combined, the entire industry is over regulated and captured effectively by cartels (what is Johnson and Johnson but a legal cartel). You can’t even sue for vaccine (any vaccine) injury. Think about that for a moment and explain it.
Fixing the medical industry can only be done by deregulating it. I don’t think it would even be that hard; but people would lose their minds. I’ve spent a lot of time in one of the largest medical billing companies in the US. My family worked in this space for decades. The issue is really just fear.
Regulatory / legislative changes:
1. Remove any protections pharma has against lawsuits
2. Remove bloated credentialing for doctors, instead have an apprenticeship program (at least for military and gov doctors)
3. phase out Medicare, no one under 60 will ever receive it again.
4. Completely defund the FDA
5. Remove much of the requirements around drugs. Enable easy purchasing of medication. Could just be consultation with pharmacist. Or maybe nurse. Or no one.
Do that and overnight the cost of medicine would drop massively. The medical costs in the US would be less than Mexico.
- hattmall 4y agoIt's not fear, it's money. All of those unnecessary things are huge profit centers for certain people. Health care is middle-manned to death, and not just insurance. There are loads of other middle men at every step.
- lettergram 4y agoI mean fear of deregulation. The truth is that we push politicians to do what we want. As it stands, people are afraid to completely deregulate healthcare. Funny enough, even though imo it is the only way. I do think money would stop it from becoming a movement. When’s the last time you saw a leader stand up and say “let’s dissolve XXX three letter agency!”? You don’t see it. Wonder why? Last one I recall was Trump. Media did a number on him, so much so we can’t even discuss him without worrying about being attacked. Isn’t that something?
- EricE 4y agoNegotiate to pay for medical services with cash - the price difference is astonishing. The overhead of the insurance companies is insane!
- Ekaros 4y agoOverhead itself might not be the problem. But it is process it leads to. One way I could see is to mandate one single list price. No discounts. If hospital wants to do charity they can setup fund that pays the bill or part of it back to itself.
- semi-extrinsic 4y agoWhy this obsession with deregulation, it seems to be inconsistent with empirical evidence? Basically every first world country other than the US has better and cheaper healthcare, but they don't have any less regulation.
- notriddle 4y ago> As it stands, people are afraid to completely deregulate healthcare. The countries that America is compared to and found wanting aren't running completely deregulated healthcare. What makes them different?
- erosenbe0 4y agoIt varies. But often it is less regulated or more efficient. There will be 10 suppliers of a generic medication rather than 2 or 3. 8 years for college and med school won't literally include 2 to 3 years of vacation. And so on.
- stetrain 4y agoA much simpler first step that I think would be really helpful is: 1) Prevent any group discounts or employer discounts for health insurance 2) Possibly, to go even farther, ban health insurance as employee compensation Benefits: 1) People see the actual cost of their health insurance 2) People can choose insurance on a competitive market instead of picking between 3 packages their employer subsidizes, so insurance companies actually have to be competitive 3) People aren't forced to pick a difference insurance company every time their employer renegotiates with a different provider, which can also change their healthcare network 4) Lower barrier to leave or change jobs since you can keep paying the same known amount for health insurance and receive the same service 5) Lower barrier to self-employment since you are no longer at a disadvantage for health care costs
- diffeomorphism 4y agoFor 2) it is much simpler to say something like "employer pays half of the monthly rate up to $X", while you freely pick which insurance. That is how it works in Germany by the way. Concerning the competition I would caution that from my experience some American insurances lack standards. For example insane copay, cancer not covered or other crazy exceptions. So to have actual competition you should also require by law that all essentials have to be covered with a limited copay and not discriminate. The insurances can still compete on non-essentials (e.g. fitness, cheaper checkups). Otherwise you run into the issue that poor people are forced to buy scam insurance.
- stetrain 4y agoAgreed. We actually have some of those standards for insurance packages in the “Obamacare” market. But many people don’t participate in that market because they get a much better deal with their employer’s negotiated and subsidized option.
- Auracle 4y agoStep 1 should be “every health plan is a high deductible health plan.” Step 2 should be “Absolute price transparency.” We need to make patients cost-sensitive. It’s utterly ridiculous that there’s a pill to treat low testosterone that’s $1,000 a month when a weekly injection costs $20 a month. Sure, taking a pill is easier and less painful. 99.9% of people would still choose the needle if they actually had to pay for it - and that would mean the manufacturer of the pills would have to lower the cost. The same thing goes for many other medications and treatments. Why bother trying to price out that MRI if you’re hitting your deductible either way? Not like they’d tell you the cost up front anyways.
- Supermancho 4y ago> Completely defund the FDA Deconstructing a necessary regulatory agency isn't the solution. Best case, you end up creating a worse version of the same thing.
- diffeomorphism 4y agoEr, "best case" you end up creating a better version of the thing. We are on HN where you always see "Rewrite from scratch in rust, go,..." or "Version 3.0 drops backward compatibility and greatly improves ....". After multiple decades large agencies probably need big reforms. If you can implement these within the agency, great. If not, splitting off some of the work to a new agency with these changes is a practical option.
- erosenbe0 4y agoFDA 2.0 the complete rewrite is a good idea. Things used to get overhauled more regularly. The last however was probably 20 years ago with the creation of the Department of Homeland Security. Since then, crickets.
- Supermancho 4y agoYou cannot simply reenact the same policies in a different organization and not get the same problems. Politically, you have to start over on many established political policies. While there would be an opportunity to split the org chart, then introduce new shortcuts and workarounds to the previous implementation, you just restart the same divisive issues with new contexts. This approach makes no sense to start on. You want an overhaul of FDA policies, then advocate for that unless you have some plan other than throw everything away and let someone else deal with the practicalities.
- eternityforest 4y agoPhase out medicare? How will poor people afford any kind of care? No matter how efficiently you do things, it's still going to be somewhat expensive to provide modern standards of care. And the poorest people get a lot of injuries, germs, and pollutants.
- deleted 4y ago[deleted]