7 ms·

I’ve been working in the health tech space for awhile now and it’s sad how you’re not alone in noticing this. It’s the dirty secret of the entire industry, and

by orbz 4y ago

I’ve been working in the health tech space for awhile now and it’s sad how you’re not alone in noticing this. It’s the dirty secret of the entire industry, and there’s too many things disincentivizing any fixes. The more I witness this the more I realize that having a single payer is necessary to actually break up enough of the monopoly to get some traction on this problem. Until then there are too many middle men and bureaucrats blocking this change. Thanks for fighting the good fight so far.

AnimalMuppet 4y ago
I could see a single payer system having the same problems. All it would take is a system with some incentive to save money, and a bureaucracy. I could easily see Congress designing a single payer system that had both of those. Would it be as bad? Hard to say. In one way it would be worse: There would be no alternative. You couldn't switch insurance providers to get something better. And, in fact, just today I saw stuff about a lady in Canada who had to wait 7 hours (+/- a small amount, don't have it in front of me) for the ER, and wound up dying. People were saying "The system is broken." Well, isn't Canada single payer? So maybe single payer isn't a magic solution. Maybe we should look at what's going wrong in Canada before we design such a system ourselves. (Single payer may still be the answer, but it's going to have to be a well-designed single payer system.)
- sfuller808 4y ago
  [dead]
- lotsofpulp 4y ago
  >I could see a single payer system having the same problems. You can look at the UK right now. The root problem has nothing to do with health insurance companies or who is paying. The problem is drastic increases in net benefit recipients relative to net payers/labor providers into the system. I.e. declining proportions of healthy, working people willing to provide labor at a sufficiently low price, such that in order to keep providing the same level of service, more and more of the country’s resources have to go towards healthcare. The other problem is also advancements in medicine that keep people alive longer and longer while utilizing ever more healthcare services.
  - bruce511 4y ago
    To be fair, the current govt is preciding over a (self inflicted) economic collapse in all areas, not just the NHS. And ultimately voters have no-one to blame but themselves. (or half of them anyway.) leaving the EU is epically dumb on a truly impressive scale. So now looking at the NHS, complaining about under-funding and under-staffing, when those were completely predictable outcomes of Brexit isn't going to inform good health system forces. Japan might be a better place to look if you want examples. In truth the US has plenty of money in the pot to implement effecient health care. But for-profit companies will not go quietly into the night.
    - vladvasiliu 4y ago
      > So now looking at the NHS, complaining about under-funding and under-staffing, when those were completely predictable outcomes of Brexit isn't going to inform good health system forces. I don't agree with this. I don't live in Britain, so I'm not fully aware of how Brexit has affected things over there. I live in France. Didn't leave the EU, as a matter of fact it's one of the countries pushing the most for it. Same issues with the health system. A few months ago we were rationing paracetamol. Now we're back to not allowing sales of it online because of shortages. I'm not saying Brexit helped, but I doubt it was the main cause, seeing how the same exact effect happened elsewhere, at the same time, while staying in the EU. It would seem to me that, for whatever reason, many countries chose efficiency of the healthcare system above all else. Meaning closure of hospital beds, reduction of medical staff, etc. This may be great for producing cheap Toyotas. No one cares if theirs is one week late because something unforeseen came up. It doesn't work as well for medical emergencies.
      - bruce511 4y ago
        Its pretty easy to find shortages and flaws in any system. And yes, national health is always tempting for budget cuts because its a huge number, and trimming it 5% gives real returns. Shortages of drugs and equipment are often tied to supply-chain issues more than budget, and again that's a barrel of worms best left for another thread. Clearly single-payer can work, but it does need the single-payer to, well, pay. Brexit is a large factor because the UK was a net-importer of aid from Europe. And Europe was the biggest trading partner. Predictably leaving has decreased the economy such that tax revenues are down, which in turn means less to spend on social services. Then we can talk about freedom of movement, and the number of Europeans who staffed the NHS and who no longer do so, and cannot be replaced by other Europeans. So sure, the global economy is taking strain at the moment. Brexit is not the only cause. But its a pretty big sucking chest wound.
verdenti 4y ago
Single payer is good but it doesn’t solve the problem of really sick old people running up the bill for everyone. I don’t even see what the way out is. Really old people that are subjectively classified as irrecoverable have to get private insurance on top of single payer maybe otherwise you get cut off. That subjective decision maker will get called a “death panel” though. Someone’s got to make some hard decisions somewhere.
a-user-you-like 4y ago
We already have a ridiculously regulated, stifling environment. More stifling is not the answer, just look at the wait times and patients being denied basic care in Canada and the UK. We need to end the ridiculous grip the AMA has on the # of doctors; get rid of the hospital certificates of need, and encourage a new industry of medical professionals who specialize in certain areas without unneeded training in other areas.
- bu7w41t 4y ago
  “… encourage a new industry of medical professionals who specialize in certain areas without unneeded training in other areas.” Sounds stifling. What’s the problem with holistic training? Except some admin does not want to pay for it? Extreme division of labor will just create backups for some specialists and time to twiddle thumbs for others. The opposite across society seems necessary; people need to become more self reliant across contexts. Remove industrial manufacture pipelines so more raw materials are available to the general public and make more holistic and well rounded people.
  - derbOac 4y ago
    I don't know. In my opinion there's nothing wrong with holistic training but I think there's also nothing wrong with different training paths. Better to let them all flourish and find their way in the system. It all needs to happen in my opinion though: let the current provider models stay, but let in lots of other educational models, and empower people to take more care of themselves by giving them access to what they need. Everything is far too overregulated in medicine, or at least is regulated in the wrong way. Even within the physician model it's broken and overregulated. Board certification is ridiculous and insane in some specialties. I think medicine is just an amplified version of a lot of problems in the US, but it also has significant consequences for life and wellbeing.
- noobermin 4y ago
  https://en.wikipedia.org/wiki/Jim_(horse) https://en.wikipedia.org/wiki/Jim_(horse)
- 4y ago
wrp 4y ago
I've read that a single-payer system is very unlikely in the USA, due to political forces. The tremendous inefficiency of the American medical system increases costs, but also provides more jobs, and those job-holders vote.
- bruce511 4y ago
  In the USA its all about the money. Those "political forces" are not a grassroots movement, people in the street demanding insurance-based healthcare. No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. And make no mistake, they're not going to roll over. And sure, doctors are depressed because they're finally coming to realise that medical care (in the US) is not about "helping sick people" (despite their good intentions.) Doctors and nurses set out with the noblest goals, then find themselves inside a system where the one true goal is to separate people from their money. They rile against "adminustrators" while at the same time failing to note that those administrators are the _reason_ for yhd business, and actual doctoring is just medical janitoring. Yay free markets!
  - dmitrygr 4y ago
    > are not a grassroots movement, people in the street demanding insurance-based healthcare. > No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. I am not a lobbyist or an owner of an insurance company. I am a "person on the street". I do not want single payer.
    - asdff 4y ago
      Can I ask why? Even right wing think tanks agree that medicare for all would save 2 billion a year in healthcare costs at least https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money/ https://thehill.com/blogs/congress-blog/healthcare/484301-22...
      - 4y ago
vladvasiliu 4y ago
> The more I witness this the more I realize that having a single payer is necessary to actually break up enough of the monopoly to get some traction on this problem. Until then there are too many middle men and bureaucrats blocking this change. By "single payer" do you mean the European model of "socialized" healthcare? That may be necessary (I don't know) but it's clearly not enough. I'm in France, and I hear the exact same complaints from physicians here [0], and the hospitals seem to be in terrible shape. People quitting or being on leave, hence understaffing, so more people quitting because of burnout, etc. [0] Basically, the gist is that for some time, hospitals have been run "like an enterprise", seeking (cash) efficiency above all. There was absolutely no slack in the system, so when COVID hit, medical professionals ended up in a terrible situation. This situation has not subsided even after the epidemic became less of an issue.
- derekp7 4y ago
  I'd like to see a different take on single payer. First, allow anyone to buy into medicare for their insurance provider (at a market reasonable price for younger people, subsidized like it is now for seniors). This could act as a nation-wide insurer without any "funny business" such as getting charged thousands because an assistant that wasn't in-network showed up the day of your surgery. Second, if an employee isn't covered by employer healthcare, the employer side of FICA should be increased to provide for employee coverage. That way if someone is working 40 hours a week, but for multiple part-time employers, they still get the same medical coverage as a full-time employee. Third, when I go in for a procedure, I want all bills to go to the insurance provider, they pay everything. Then the insurance sends me a bill for my co-pay. Make that a law. That way I'm not stuck with getting dozens of separate bills up to years after a procedure, with no way of really knowing what should have been covered by insurance or not.
  - jeffdn 4y ago
    This is essentially what the “public option” in the original Obamacare proposal was — an opt-in publicly owned insurance company, which would compete with all the other insurers, but not have the overhead of their business models. Unfortunately, it was axed alone with much of the other important aspects of that bill. The great irony is that the initial Obamacare proposal was a Republican policy — originally proposed in the mid-‘90s as an alternative to the proposal from the Clinton White House, and implemented in Massachusetts by Mitt Romney when he was the governor. The Republican congress and conservative media machine were so invested in seeing Obama fail that they instead branded it socialism and fought it tooth and nail. It would’ve been a fantastic opportunity for a resurgence in bipartisanship in government, and could potentially have averted the subsequent 14 years of animosity and bitter obstructionism. Ah well, so it goes.

by orbz 4y ago

AnimalMuppet 4y ago

I could see a single payer system having the same problems. All it would take is a system with some incentive to save money, and a bureaucracy. I could easily see Congress designing a single payer system that had both of those. Would it be as bad? Hard to say. In one way it would be worse: There would be no alternative. You couldn't switch insurance providers to get something better. And, in fact, just today I saw stuff about a lady in Canada who had to wait 7 hours (+/- a small amount, don't have it in front of me) for the ER, and wound up dying. People were saying "The system is broken." Well, isn't Canada single payer? So maybe single payer isn't a magic solution. Maybe we should look at what's going wrong in Canada before we design such a system ourselves. (Single payer may still be the answer, but it's going to have to be a well-designed single payer system.)

sfuller808 4y ago
[dead]
lotsofpulp 4y ago
>I could see a single payer system having the same problems. You can look at the UK right now. The root problem has nothing to do with health insurance companies or who is paying. The problem is drastic increases in net benefit recipients relative to net payers/labor providers into the system. I.e. declining proportions of healthy, working people willing to provide labor at a sufficiently low price, such that in order to keep providing the same level of service, more and more of the country’s resources have to go towards healthcare. The other problem is also advancements in medicine that keep people alive longer and longer while utilizing ever more healthcare services.
- bruce511 4y ago
  To be fair, the current govt is preciding over a (self inflicted) economic collapse in all areas, not just the NHS. And ultimately voters have no-one to blame but themselves. (or half of them anyway.) leaving the EU is epically dumb on a truly impressive scale. So now looking at the NHS, complaining about under-funding and under-staffing, when those were completely predictable outcomes of Brexit isn't going to inform good health system forces. Japan might be a better place to look if you want examples. In truth the US has plenty of money in the pot to implement effecient health care. But for-profit companies will not go quietly into the night.
  - vladvasiliu 4y ago
    > So now looking at the NHS, complaining about under-funding and under-staffing, when those were completely predictable outcomes of Brexit isn't going to inform good health system forces. I don't agree with this. I don't live in Britain, so I'm not fully aware of how Brexit has affected things over there. I live in France. Didn't leave the EU, as a matter of fact it's one of the countries pushing the most for it. Same issues with the health system. A few months ago we were rationing paracetamol. Now we're back to not allowing sales of it online because of shortages. I'm not saying Brexit helped, but I doubt it was the main cause, seeing how the same exact effect happened elsewhere, at the same time, while staying in the EU. It would seem to me that, for whatever reason, many countries chose efficiency of the healthcare system above all else. Meaning closure of hospital beds, reduction of medical staff, etc. This may be great for producing cheap Toyotas. No one cares if theirs is one week late because something unforeseen came up. It doesn't work as well for medical emergencies.
    - bruce511 4y ago
      Its pretty easy to find shortages and flaws in any system. And yes, national health is always tempting for budget cuts because its a huge number, and trimming it 5% gives real returns. Shortages of drugs and equipment are often tied to supply-chain issues more than budget, and again that's a barrel of worms best left for another thread. Clearly single-payer can work, but it does need the single-payer to, well, pay. Brexit is a large factor because the UK was a net-importer of aid from Europe. And Europe was the biggest trading partner. Predictably leaving has decreased the economy such that tax revenues are down, which in turn means less to spend on social services. Then we can talk about freedom of movement, and the number of Europeans who staffed the NHS and who no longer do so, and cannot be replaced by other Europeans. So sure, the global economy is taking strain at the moment. Brexit is not the only cause. But its a pretty big sucking chest wound.

verdenti 4y ago

Single payer is good but it doesn’t solve the problem of really sick old people running up the bill for everyone. I don’t even see what the way out is. Really old people that are subjectively classified as irrecoverable have to get private insurance on top of single payer maybe otherwise you get cut off. That subjective decision maker will get called a “death panel” though. Someone’s got to make some hard decisions somewhere.

a-user-you-like 4y ago

We already have a ridiculously regulated, stifling environment. More stifling is not the answer, just look at the wait times and patients being denied basic care in Canada and the UK. We need to end the ridiculous grip the AMA has on the # of doctors; get rid of the hospital certificates of need, and encourage a new industry of medical professionals who specialize in certain areas without unneeded training in other areas.

bu7w41t 4y ago
“… encourage a new industry of medical professionals who specialize in certain areas without unneeded training in other areas.” Sounds stifling. What’s the problem with holistic training? Except some admin does not want to pay for it? Extreme division of labor will just create backups for some specialists and time to twiddle thumbs for others. The opposite across society seems necessary; people need to become more self reliant across contexts. Remove industrial manufacture pipelines so more raw materials are available to the general public and make more holistic and well rounded people.
- derbOac 4y ago
  I don't know. In my opinion there's nothing wrong with holistic training but I think there's also nothing wrong with different training paths. Better to let them all flourish and find their way in the system. It all needs to happen in my opinion though: let the current provider models stay, but let in lots of other educational models, and empower people to take more care of themselves by giving them access to what they need. Everything is far too overregulated in medicine, or at least is regulated in the wrong way. Even within the physician model it's broken and overregulated. Board certification is ridiculous and insane in some specialties. I think medicine is just an amplified version of a lot of problems in the US, but it also has significant consequences for life and wellbeing.
noobermin 4y ago
https://en.wikipedia.org/wiki/Jim_(horse) https://en.wikipedia.org/wiki/Jim_(horse)
4y ago

wrp 4y ago

I've read that a single-payer system is very unlikely in the USA, due to political forces. The tremendous inefficiency of the American medical system increases costs, but also provides more jobs, and those job-holders vote.

bruce511 4y ago
In the USA its all about the money. Those "political forces" are not a grassroots movement, people in the street demanding insurance-based healthcare. No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. And make no mistake, they're not going to roll over. And sure, doctors are depressed because they're finally coming to realise that medical care (in the US) is not about "helping sick people" (despite their good intentions.) Doctors and nurses set out with the noblest goals, then find themselves inside a system where the one true goal is to separate people from their money. They rile against "adminustrators" while at the same time failing to note that those administrators are the _reason_ for yhd business, and actual doctoring is just medical janitoring. Yay free markets!
- dmitrygr 4y ago
  > are not a grassroots movement, people in the street demanding insurance-based healthcare. > No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. I am not a lobbyist or an owner of an insurance company. I am a "person on the street". I do not want single payer.
  - asdff 4y ago
    Can I ask why? Even right wing think tanks agree that medicare for all would save 2 billion a year in healthcare costs at least https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money/ https://thehill.com/blogs/congress-blog/healthcare/484301-22...
    - 4y ago

vladvasiliu 4y ago

> The more I witness this the more I realize that having a single payer is necessary to actually break up enough of the monopoly to get some traction on this problem. Until then there are too many middle men and bureaucrats blocking this change. By "single payer" do you mean the European model of "socialized" healthcare? That may be necessary (I don't know) but it's clearly not enough. I'm in France, and I hear the exact same complaints from physicians here [0], and the hospitals seem to be in terrible shape. People quitting or being on leave, hence understaffing, so more people quitting because of burnout, etc. [0] Basically, the gist is that for some time, hospitals have been run "like an enterprise", seeking (cash) efficiency above all. There was absolutely no slack in the system, so when COVID hit, medical professionals ended up in a terrible situation. This situation has not subsided even after the epidemic became less of an issue.

derekp7 4y ago
I'd like to see a different take on single payer. First, allow anyone to buy into medicare for their insurance provider (at a market reasonable price for younger people, subsidized like it is now for seniors). This could act as a nation-wide insurer without any "funny business" such as getting charged thousands because an assistant that wasn't in-network showed up the day of your surgery. Second, if an employee isn't covered by employer healthcare, the employer side of FICA should be increased to provide for employee coverage. That way if someone is working 40 hours a week, but for multiple part-time employers, they still get the same medical coverage as a full-time employee. Third, when I go in for a procedure, I want all bills to go to the insurance provider, they pay everything. Then the insurance sends me a bill for my co-pay. Make that a law. That way I'm not stuck with getting dozens of separate bills up to years after a procedure, with no way of really knowing what should have been covered by insurance or not.
- jeffdn 4y ago
  This is essentially what the “public option” in the original Obamacare proposal was — an opt-in publicly owned insurance company, which would compete with all the other insurers, but not have the overhead of their business models. Unfortunately, it was axed alone with much of the other important aspects of that bill. The great irony is that the initial Obamacare proposal was a Republican policy — originally proposed in the mid-‘90s as an alternative to the proposal from the Clinton White House, and implemented in Massachusetts by Mitt Romney when he was the governor. The Republican congress and conservative media machine were so invested in seeing Obama fail that they instead branded it socialism and fought it tooth and nail. It would’ve been a fantastic opportunity for a resurgence in bipartisanship in government, and could potentially have averted the subsequent 14 years of animosity and bitter obstructionism. Ah well, so it goes.