10 ms·

> Medical care is the most highly regulated industry in the economy, and so nothing you see happening is going to bear very much resemblance to reality. This i

by furyg3 15y ago

> Medical care is the most highly regulated industry in the economy, and so nothing you see happening is going to bear very much resemblance to reality. This is a pretty big logical jump. I'm American, but have been living in the Netherlands for a while. Health care is probably more regulated here than in the US, yet in all of the ER visits I've experienced (myself or friends/family) I've never seen bills like that. Regulation does not have to cause bills like that. Something is very wrong if sick people in life threatening situations are being charged hundreds (or thousands!) of times for the same care based on whether or not they have insurance. That screams "more regulation is necessary" to me.

dsplittgerber 15y ago
I'm from Germany and you do realize that over here (don't know about the exact differences) privately-insured patients (who opted out off the 'mandatory' insurance scheme) basically pay a LOT more for any given medical service just so that patients covered under the mandatory insurance can get treated at all? It's like a giant (inefficient) money redistribution scheme, in all the worst ways imaginable. Regulation does actually cause bills like that. It's just that in Europe, you don't ever see them.
- tankenmate 15y ago
  Actually I think you'll find that billing like the kind you see in the US doesn't happen in Germany. The US spends nearly twice as much per capita than Germany for a comparable level of service[1]; this is hard to judge but life expectancy is a reasonable proxy, people in Germany on average live about the same. The UK with near mandatory, see below, universal healthcare the cost of per capita is lower still [1 ibid]. In the UK if you opt out of public healthcare you can't mix and match services beyond the GP level, this may change in the future. Obviously with a mandatory universal care the overall cost to the public at large stands a high chance of being lower; efficiencies of scale. The downside is that at the individual level you may be subject to "postcode lottery" healthcare. In many countries this leads to individualism raising the costs of healthcare for everyone. Everyone wants to be treated the best; the problem is that regardless of the system you chose this is impossible. [1] http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita http://en.wikipedia.org/wiki/List_of_countries_by_total_heal...
  - CWuestefeld 15y ago
    life expectancy is a reasonable proxy I disagree. The USA differs significantly from Germany, both in cultural aspects and genetic/racial makeup. Different lifestyles contribute significantly to life expectancy differences, as does heredity.
    - krschultz 15y ago
      That is not actually important in the overall picture of healthcare spending - http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-red-herrings/ http://theincidentaleconomist.com/wordpress/what-makes-the-u...
  - arethuza 15y ago
    "In the UK if you opt out of public healthcare you can't mix and match services beyond the GP level, this may change in the future." What do you mean by this? You can have pretty much any health service privately in the UK if you want to pay for it e.g. from BUPA: http://www.bupa.co.uk/ http://www.bupa.co.uk/
    - tankenmate 15y ago
      If you choose to get elective surgery for a condition rather than waiting in the queue for the NHS your room isn't covered by the Govt, your post-op prescriptions aren't covered, etc. If you do wait however they are covered. If you need corrective surgery afterwards to fix something that went wrong in the first op you normally aren't covered for that by the NHS either.
      - rwmj 15y ago
        That's different from opting out, which would mean not paying for the NHS at all. This is buying additional coverage. You can't opt out of the NHS in the UK, except by not paying taxes, which usually results in a spell in prison.
      - arethuza 15y ago
- skurry 15y ago
  You forget to mention a few details: Younger privately insured patients actually generally pay less than their publicly insured counterparts (especially if they're male), since private insurance companies are allowed base premiums on risk (which grows with age). Private patients generally get better service, wait less and have access to more drugs and procedures. So yes, it's probably more expensive overall, but it's a voluntary decision and you get something in return.
sethg 15y ago
The American health-care system thrives in the uncanny valley between the government and the free market. There are all sorts of laws and regulations that prevent normal market procedures from working (for example, emergency rooms can’t turn someone away because they can’t pay), but at the same time, American anxiety over “socialism” has prevented Congress from letting the government take a more active role in actually managing the system. Instead you have this weird patchwork of nonprofit institutions, private companies, and public agencies. If I recall correctly, the United Kingdom, with its much-maligned National Health Service, spends about 40% of what the US spends per capita on health care, and yet when you measure things like life expectancy, Britons are as healthy as Americans. That gives you an idea of how much money is going down the tubes due to administrative inefficiency.
- yummyfajitas 15y ago
  ...when you measure things like life expectancy, Britons are as healthy as Americans. That gives you an idea of how much money is going down the tubes due to administrative inefficiency. It's hardly clear the money is going down the tubes due to administrative inefficiency. It might just be spent on unnecessary medicine, and costs might be higher in the US. According to one fairly decent source, administrative inefficiency is a pretty minor contributor - the biggest contributor is outpatient care. http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-%E2%80%93-conclusion/ http://theincidentaleconomist.com/wordpress/what-makes-the-u...
  - llimllib 15y ago
    I'm also certain that much of the unnecessary medicine is provided because of the legal climate in the US; doctors practice under the assumption that they will be sued if they don't provide unnecessary medicine.
    - jbooth 15y ago
      Also, if you pay a bajillion dollars for an MRI machine, then you amortize the cost over the number of times it's used. The times you use it, it's just the cost of electricity. So there's an incentive to use it a lot. That still doesn't explain being charged several thousand for an x-ray, though. That's 150 year old technology, this isn't like Dr. House and a team of neurosurgeons at work here.
noonespecial 15y ago
"You can't jump half-way across a gorge". Letting it be free market wouldn't work nearly as badly as most people expect. "Socializing" medicine and making it a fully planned section of the economy wouldn't work nearly as badly as most people expect. Half-assing it between the two will work far worse than most people expect.
- Symmetry 15y ago
  Well, there there are some places where the government messes about with the healthcare system about as much as we do, and it works out really well. Singapore for example http://en.wikipedia.org/wiki/Healthcare_in_Singapore http://en.wikipedia.org/wiki/Healthcare_in_Singapore I think the main problem with the US healthcare system is that it's a elephantine monstrosity, a system that tries to hit every corner case with an ad hoc exception, and which nobody can understand more than a fraction of. And there are various boneheaded implementation details, the equivalent of bubblesort - like using the frigging labor theory of value to set physician reimbursement rates. And complex interdependancies that cause different parts of the system to affect each other for very non-obvious reasons. For instance, a rule to prevent people from defrauding Medicare now prevents corporations from giving free birth control to college students like they used to. </rant>

by furyg3 15y ago

dsplittgerber 15y ago

I'm from Germany and you do realize that over here (don't know about the exact differences) privately-insured patients (who opted out off the 'mandatory' insurance scheme) basically pay a LOT more for any given medical service just so that patients covered under the mandatory insurance can get treated at all? It's like a giant (inefficient) money redistribution scheme, in all the worst ways imaginable. Regulation does actually cause bills like that. It's just that in Europe, you don't ever see them.

tankenmate 15y ago
Actually I think you'll find that billing like the kind you see in the US doesn't happen in Germany. The US spends nearly twice as much per capita than Germany for a comparable level of service[1]; this is hard to judge but life expectancy is a reasonable proxy, people in Germany on average live about the same. The UK with near mandatory, see below, universal healthcare the cost of per capita is lower still [1 ibid]. In the UK if you opt out of public healthcare you can't mix and match services beyond the GP level, this may change in the future. Obviously with a mandatory universal care the overall cost to the public at large stands a high chance of being lower; efficiencies of scale. The downside is that at the individual level you may be subject to "postcode lottery" healthcare. In many countries this leads to individualism raising the costs of healthcare for everyone. Everyone wants to be treated the best; the problem is that regardless of the system you chose this is impossible. [1] http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita http://en.wikipedia.org/wiki/List_of_countries_by_total_heal...
- CWuestefeld 15y ago
  life expectancy is a reasonable proxy I disagree. The USA differs significantly from Germany, both in cultural aspects and genetic/racial makeup. Different lifestyles contribute significantly to life expectancy differences, as does heredity.
  - krschultz 15y ago
    That is not actually important in the overall picture of healthcare spending - http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-red-herrings/ http://theincidentaleconomist.com/wordpress/what-makes-the-u...
- arethuza 15y ago
  "In the UK if you opt out of public healthcare you can't mix and match services beyond the GP level, this may change in the future." What do you mean by this? You can have pretty much any health service privately in the UK if you want to pay for it e.g. from BUPA: http://www.bupa.co.uk/ http://www.bupa.co.uk/
  - tankenmate 15y ago
    If you choose to get elective surgery for a condition rather than waiting in the queue for the NHS your room isn't covered by the Govt, your post-op prescriptions aren't covered, etc. If you do wait however they are covered. If you need corrective surgery afterwards to fix something that went wrong in the first op you normally aren't covered for that by the NHS either.
    - rwmj 15y ago
      That's different from opting out, which would mean not paying for the NHS at all. This is buying additional coverage. You can't opt out of the NHS in the UK, except by not paying taxes, which usually results in a spell in prison.
    - arethuza 15y ago
skurry 15y ago
You forget to mention a few details: Younger privately insured patients actually generally pay less than their publicly insured counterparts (especially if they're male), since private insurance companies are allowed base premiums on risk (which grows with age). Private patients generally get better service, wait less and have access to more drugs and procedures. So yes, it's probably more expensive overall, but it's a voluntary decision and you get something in return.

sethg 15y ago

The American health-care system thrives in the uncanny valley between the government and the free market. There are all sorts of laws and regulations that prevent normal market procedures from working (for example, emergency rooms can’t turn someone away because they can’t pay), but at the same time, American anxiety over “socialism” has prevented Congress from letting the government take a more active role in actually managing the system. Instead you have this weird patchwork of nonprofit institutions, private companies, and public agencies. If I recall correctly, the United Kingdom, with its much-maligned National Health Service, spends about 40% of what the US spends per capita on health care, and yet when you measure things like life expectancy, Britons are as healthy as Americans. That gives you an idea of how much money is going down the tubes due to administrative inefficiency.

yummyfajitas 15y ago
...when you measure things like life expectancy, Britons are as healthy as Americans. That gives you an idea of how much money is going down the tubes due to administrative inefficiency. It's hardly clear the money is going down the tubes due to administrative inefficiency. It might just be spent on unnecessary medicine, and costs might be higher in the US. According to one fairly decent source, administrative inefficiency is a pretty minor contributor - the biggest contributor is outpatient care. http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-%E2%80%93-conclusion/ http://theincidentaleconomist.com/wordpress/what-makes-the-u...
- llimllib 15y ago
  I'm also certain that much of the unnecessary medicine is provided because of the legal climate in the US; doctors practice under the assumption that they will be sued if they don't provide unnecessary medicine.
  - jbooth 15y ago
    Also, if you pay a bajillion dollars for an MRI machine, then you amortize the cost over the number of times it's used. The times you use it, it's just the cost of electricity. So there's an incentive to use it a lot. That still doesn't explain being charged several thousand for an x-ray, though. That's 150 year old technology, this isn't like Dr. House and a team of neurosurgeons at work here.

noonespecial 15y ago

"You can't jump half-way across a gorge". Letting it be free market wouldn't work nearly as badly as most people expect. "Socializing" medicine and making it a fully planned section of the economy wouldn't work nearly as badly as most people expect. Half-assing it between the two will work far worse than most people expect.

Symmetry 15y ago
Well, there there are some places where the government messes about with the healthcare system about as much as we do, and it works out really well. Singapore for example http://en.wikipedia.org/wiki/Healthcare_in_Singapore http://en.wikipedia.org/wiki/Healthcare_in_Singapore I think the main problem with the US healthcare system is that it's a elephantine monstrosity, a system that tries to hit every corner case with an ad hoc exception, and which nobody can understand more than a fraction of. And there are various boneheaded implementation details, the equivalent of bubblesort - like using the frigging labor theory of value to set physician reimbursement rates. And complex interdependancies that cause different parts of the system to affect each other for very non-obvious reasons. For instance, a rule to prevent people from defrauding Medicare now prevents corporations from giving free birth control to college students like they used to. </rant>