7 ms·

This is the part that gets me every time this topic comes up: > "the U.S.... spends far more on healthcare than comparable nations both on a per-person basis a

This is the part that gets me every time this topic comes up: > "the U.S.... spends far more on healthcare than comparable nations both on a per-person basis and as a share of gross domestic product. And it's not just "on a per-person basis." We spend more public funds per person; there are countries doing socialized medicine spend less public funds. And then of course we additionally spend our private funds on insurance premiums and out-of-pocket costs. And we don't have better outcomes. There are some ways I'm glad medicine is a way for people to build wealth. It seems more reasonable to reward good physicians and health-related product creators than, say, pro athletes and maybe even SaaS providers. But on the other hand, if financial incentives were all it took to build an exceptional healthcare system, we'd have one.

lokar 4y ago
But at least we don’t have death panels!
- johnea 4y ago
  Instead we have the idiot herd... Did you not read the part about 10,000+ unnecessary deaths per year due to financial inaccessability?
  - lokar 4y ago
    You won’t get very far in the Ayn Rand club with that redistributive attitude.
  - kevviiinn 4y ago
    People in the US tend to ignore systemic issues while hyper focusing on individual cases. Talk about missing the forest for the trees
  - lostlogin 4y ago
    I read the comment you’re replying to as intensely sarcastic.
  - amluto 4y ago
    And there are even what are, effectively, “death panels”! Doctor prescribes potentially lifesaving (or life extending, or quality of life improving) medicine. Drug maker sets outrageous price. Patient and doctor argue with the insurer (the death panel!) over whether the patient actually gets to buy the medicine. Meanwhile, the drug seller engages in the utterly corrupt practice of offering a kickback (sorry, I mean coupon) to help give the patient an incentive to win the argument with the insurer.
s1artibartfast 4y ago
The problem is that there are no incentives to optimize benefit versus price. Socialized systems, the state looks at each new drug and decides if the benefit is worth the additional cost. They will either agree to Buy it, not buy it, or negotiate the price. When private individuals purchase Healthcare out of pocket, they do the same. It is only in an insurance Market with mandatory treatment coverage where drugs and Medicine get purchased no matter what the cost is. If you asked a private individual or socialized system to pay 500K to extend someone's life 2 months, both would refuse. Someone with insurance that they've been paying for has no reason to put the brakes on
- rayiner 4y ago
  > Someone with insurance that they've been paying for has no reason to put the brakes on Especially when the insurance company itself can just pass the costs along in the form of higher premiums because people are legally required to buy insurance.
  - lotsofpulp 4y ago
    The 2017 TCJA repealed all federal penalties for not having health insurance, making the individual mandate to have health insurance moot since 2019. https://www.commonwealthfund.org/publications/fund-reports/2018/jul/eliminating-individual-mandate-penalty-behavioral-factors https://www.commonwealthfund.org/publications/fund-reports/2...
    - toomuchtodo 4y ago
      These people still get indirectly subsidized when they receive healthcare they can’t pay for and providers have to collectively eat the cost. Removing the penalty simply enables inefficient freeloading on the system (as these folks are likely to be stuck with medical debt or have to declare bankruptcy from medical bills they will never be able to repay).
      - sanp 4y ago
rayiner 4y ago
Most countries with universal healthcare don't have "socialized medicine." The UK has a socialized system, with public insurance and public healthcare providers. But only a third of hospitals are publicly owned/managed, and even there most doctors are private practitioners. And in the Netherlands and Switzerland, both the insurance and hospitals are private. Changing "who pays" won't solve anything in the U.S. system, which is obvious because if that mattered Medicare and Medicaid would be a dramatically better system than private insurance. What's different in all those countries is higher supply of medical providers, lower compensation for medical providers,[1] and aggressive price controls not just for drugs, but for all procedures. [1] It's notable that in the U.S., being a nurse or even a nursing assistant is a great middle class job for non-college educated people. In the U.K., where nurses are public employees, nurses are literally on strike right now because of their extremely low wages.
- dumpsterlid 4y ago
  [dead]
- tptacek 4y ago
  The US is moving towards requiring a bachelors degree to maintain an RN license, and the majority of US nurses have one already.
  - rayiner 4y ago
    More of elite America’s war on the working class.
    - tptacek 4y ago
      In the main I agree with this sentiment, but you're being reflexive here, which gets you into trouble. The movement towards BSN degrees follows a significant amount of research showing that BSN degrees correlate with superior patient outcomes. You wouldn't call a degree credentialing requirement for an MD "an elite war on the working class", nor would you visit a doctor without a degree. You're happy to throw a little culture war barb at nursing credentials because: you don't respect the profession. It is much, much harder than it looks. Its biggest problem is that it has a stupid name; they should be called "associate physicians". You can reasonably disagree with state statutes requiring BSNs for RN licensure! But you can't pretend that the notion is risible, the way you have here. It is not.
savanaly 4y ago
>And we don't have better outcomes. It's apples and oranges though, yeah? Do we have worse health outcomes after controlling for the health-related demographics of our population? That's like saying I live a ten minute walk from my job in Manhattan's financial district and you live a ten minute walk from your job in New Jersey; I pay more in rent but have the same commuting outcome! Therefore it's the fault of the overpriced sidewalks in Manhattan??
- dumpsterlid 4y ago
  [dead]
- lostlogin 4y ago
  If you ignore those pesky poor people and those that died, the stats look amazing. You realise that comparing countries and the amount they paid is as good as it gets? It’s a direct comparison.
- kashunstva 4y ago
  > Do we have worse health outcomes after controlling for the health-related demographics of our population? Health outcomes in the U.S. do track socioeconomic and regional factors. But should the system not meet the needs of whomever walks through the clinic door? I mean, some of the difference is not just the direct effects of poverty or social disadvantage on physiologic parameters but also on access to healthcare itself. We can control for socioeconomic factors and make the data look better but it doesn’t entirely exculpate the system which makes it incredibly difficult to get state-of-the-art care if you haven’t got ample resources to gain access.
- wwweston 4y ago
  We're talking about other industrialized mixed market democratic nation states. At that level, demographics fade into the background, to the point where it's not even clear that we're talking Granny Smith vs Red Delicious, it's more like Fuji vs Pink Lady. If there's citrus in the basket of fruit under examination, it's policy.
refuse 4y ago
Also of interest is that R&D costs are often used to justify exorbitant drug costs, but it's been pretty widely reported that pharma spends much more on marketing drugs than developing them. Don't forget that these drugs are funded in large part by tax dollars. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/ https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...
cscurmudgeon 4y ago
US does have an exceptional health care system if you are moderately rich or moderately powerful. There is a reason an Indian communist leader that hates the US came to the US flying halfway around the world on tax payer money for medical treatment. https://swarajyamag.com/amp/story/insta%2Fkerala-chief-minister-pinarayi-vijayan-to-visit-us-again-this-time-for-health-check-up https://swarajyamag.com/amp/story/insta%2Fkerala-chief-minis...
- gorbachev 4y ago
  I just read this article earlier today about NYU Langone ER prioritizing treatment of VIP patients (politicians, celebrities, donors, trustees of the hospital): https://www.nytimes.com/2022/12/22/health/nyu-langone-emergency-room-vip.html https://www.nytimes.com/2022/12/22/health/nyu-langone-emerge...
  - metadat 4y ago
    JS-free archive link: https://archive.today/eds69 https://archive.today/eds69
  - cscurmudgeon 4y ago
    That is plainly disgusting.
- speakfreely 4y ago
  Doctors are typically very status-hungry creatures, thus when someone quantitatively more influential than them comes along, they are extra impressed and pay more attention to them. But simply having an 8 digit net worth won't do much for you, except to allow you to buy expensive concierge medicine services that can use their medical community connections to pull strings for you.
phkahler 4y ago
>> there are countries doing socialized medicine spend less public funds. And then of course we additionally spend our private funds on insurance premiums and out-of-pocket costs. To tie some things together, don't forget the doctors have to earn very high pay to cover the (insane) cost of medical school and insurance.
- lotsofpulp 4y ago
  >have to earn very high pay to cover the (insane) cost of medical school and insurance. Also opportunity cost for people capable to become physicians in the US have other options with competitive pay to quality of life at work ratio. Lots of ways to not spend one’s 20s memorizing stuff for step exams and then spend 26 to 30 being a slave during residency, and then maybe a fellowship or getting board certified, and at the end, you still have to deal with patients. Alternatively, they could go for a job where they sit behind a computer and not deal with the general public and get to work from home when shit hits the fan.
rcme 4y ago
The medical systems of other countries definitely deliver better results on average. It's plainly obvious if you look at a top-level metric like life expectancy. However, from personal experience in the U.K., Germany, and the U.S., the U.S. system unquestionably delivers better outcomes to wealthy people with health insurance. It's not surprising that the U.S. policy remains in place: it benefits the elites. Also, healthcare makes up something insane like 20% of GDP. The amount of people employed by the healthcare sector is staggering. Spending less means putting people out of work. It's going to be hard to sell that idea.
Eddy_Viscosity2 4y ago
One is there is a supply problem. There are lots of people who would like to be doctors, that are capable of being doctors, that won't become doctors because there are only so many seats available at medical schools. So fixed supply of new grads every year. Next is there is no market pressure on prices, even though theoretically that's what should happen. People NEED medical care so there isn't much to haggle about. Insurance companies don't care about prices so much, they just raise their rates if prices go up and take a bigger cut. In countries with socialized medicine, the government is THE buyer and can negotiate prices for things. But here, a drug company just raises the prices by 10^3 percent and everyone just pays it.
deleted 4y ago
[deleted]

lokar 4y ago

But at least we don’t have death panels!

johnea 4y ago
Instead we have the idiot herd... Did you not read the part about 10,000+ unnecessary deaths per year due to financial inaccessability?
- lokar 4y ago
  You won’t get very far in the Ayn Rand club with that redistributive attitude.
- kevviiinn 4y ago
  People in the US tend to ignore systemic issues while hyper focusing on individual cases. Talk about missing the forest for the trees
- lostlogin 4y ago
  I read the comment you’re replying to as intensely sarcastic.
- amluto 4y ago
  And there are even what are, effectively, “death panels”! Doctor prescribes potentially lifesaving (or life extending, or quality of life improving) medicine. Drug maker sets outrageous price. Patient and doctor argue with the insurer (the death panel!) over whether the patient actually gets to buy the medicine. Meanwhile, the drug seller engages in the utterly corrupt practice of offering a kickback (sorry, I mean coupon) to help give the patient an incentive to win the argument with the insurer.

s1artibartfast 4y ago

The problem is that there are no incentives to optimize benefit versus price. Socialized systems, the state looks at each new drug and decides if the benefit is worth the additional cost. They will either agree to Buy it, not buy it, or negotiate the price. When private individuals purchase Healthcare out of pocket, they do the same. It is only in an insurance Market with mandatory treatment coverage where drugs and Medicine get purchased no matter what the cost is. If you asked a private individual or socialized system to pay 500K to extend someone's life 2 months, both would refuse. Someone with insurance that they've been paying for has no reason to put the brakes on

rayiner 4y ago
> Someone with insurance that they've been paying for has no reason to put the brakes on Especially when the insurance company itself can just pass the costs along in the form of higher premiums because people are legally required to buy insurance.
- lotsofpulp 4y ago
  The 2017 TCJA repealed all federal penalties for not having health insurance, making the individual mandate to have health insurance moot since 2019. https://www.commonwealthfund.org/publications/fund-reports/2018/jul/eliminating-individual-mandate-penalty-behavioral-factors https://www.commonwealthfund.org/publications/fund-reports/2...
  - toomuchtodo 4y ago
    These people still get indirectly subsidized when they receive healthcare they can’t pay for and providers have to collectively eat the cost. Removing the penalty simply enables inefficient freeloading on the system (as these folks are likely to be stuck with medical debt or have to declare bankruptcy from medical bills they will never be able to repay).
    - sanp 4y ago

rayiner 4y ago

Most countries with universal healthcare don't have "socialized medicine." The UK has a socialized system, with public insurance and public healthcare providers. But only a third of hospitals are publicly owned/managed, and even there most doctors are private practitioners. And in the Netherlands and Switzerland, both the insurance and hospitals are private. Changing "who pays" won't solve anything in the U.S. system, which is obvious because if that mattered Medicare and Medicaid would be a dramatically better system than private insurance. What's different in all those countries is higher supply of medical providers, lower compensation for medical providers,[1] and aggressive price controls not just for drugs, but for all procedures. [1] It's notable that in the U.S., being a nurse or even a nursing assistant is a great middle class job for non-college educated people. In the U.K., where nurses are public employees, nurses are literally on strike right now because of their extremely low wages.

dumpsterlid 4y ago
[dead]
tptacek 4y ago
The US is moving towards requiring a bachelors degree to maintain an RN license, and the majority of US nurses have one already.
- rayiner 4y ago
  More of elite America’s war on the working class.
  - tptacek 4y ago
    In the main I agree with this sentiment, but you're being reflexive here, which gets you into trouble. The movement towards BSN degrees follows a significant amount of research showing that BSN degrees correlate with superior patient outcomes. You wouldn't call a degree credentialing requirement for an MD "an elite war on the working class", nor would you visit a doctor without a degree. You're happy to throw a little culture war barb at nursing credentials because: you don't respect the profession. It is much, much harder than it looks. Its biggest problem is that it has a stupid name; they should be called "associate physicians". You can reasonably disagree with state statutes requiring BSNs for RN licensure! But you can't pretend that the notion is risible, the way you have here. It is not.

savanaly 4y ago

>And we don't have better outcomes. It's apples and oranges though, yeah? Do we have worse health outcomes after controlling for the health-related demographics of our population? That's like saying I live a ten minute walk from my job in Manhattan's financial district and you live a ten minute walk from your job in New Jersey; I pay more in rent but have the same commuting outcome! Therefore it's the fault of the overpriced sidewalks in Manhattan??

dumpsterlid 4y ago
[dead]
lostlogin 4y ago
If you ignore those pesky poor people and those that died, the stats look amazing. You realise that comparing countries and the amount they paid is as good as it gets? It’s a direct comparison.
kashunstva 4y ago
> Do we have worse health outcomes after controlling for the health-related demographics of our population? Health outcomes in the U.S. do track socioeconomic and regional factors. But should the system not meet the needs of whomever walks through the clinic door? I mean, some of the difference is not just the direct effects of poverty or social disadvantage on physiologic parameters but also on access to healthcare itself. We can control for socioeconomic factors and make the data look better but it doesn’t entirely exculpate the system which makes it incredibly difficult to get state-of-the-art care if you haven’t got ample resources to gain access.
wwweston 4y ago
We're talking about other industrialized mixed market democratic nation states. At that level, demographics fade into the background, to the point where it's not even clear that we're talking Granny Smith vs Red Delicious, it's more like Fuji vs Pink Lady. If there's citrus in the basket of fruit under examination, it's policy.

refuse 4y ago

Also of interest is that R&D costs are often used to justify exorbitant drug costs, but it's been pretty widely reported that pharma spends much more on marketing drugs than developing them. Don't forget that these drugs are funded in large part by tax dollars. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/ https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...

cscurmudgeon 4y ago

US does have an exceptional health care system if you are moderately rich or moderately powerful. There is a reason an Indian communist leader that hates the US came to the US flying halfway around the world on tax payer money for medical treatment. https://swarajyamag.com/amp/story/insta%2Fkerala-chief-minister-pinarayi-vijayan-to-visit-us-again-this-time-for-health-check-up https://swarajyamag.com/amp/story/insta%2Fkerala-chief-minis...

gorbachev 4y ago
I just read this article earlier today about NYU Langone ER prioritizing treatment of VIP patients (politicians, celebrities, donors, trustees of the hospital): https://www.nytimes.com/2022/12/22/health/nyu-langone-emergency-room-vip.html https://www.nytimes.com/2022/12/22/health/nyu-langone-emerge...
- metadat 4y ago
  JS-free archive link: https://archive.today/eds69 https://archive.today/eds69
- cscurmudgeon 4y ago
  That is plainly disgusting.
speakfreely 4y ago
Doctors are typically very status-hungry creatures, thus when someone quantitatively more influential than them comes along, they are extra impressed and pay more attention to them. But simply having an 8 digit net worth won't do much for you, except to allow you to buy expensive concierge medicine services that can use their medical community connections to pull strings for you.

phkahler 4y ago

>> there are countries doing socialized medicine spend less public funds. And then of course we additionally spend our private funds on insurance premiums and out-of-pocket costs. To tie some things together, don't forget the doctors have to earn very high pay to cover the (insane) cost of medical school and insurance.

lotsofpulp 4y ago
>have to earn very high pay to cover the (insane) cost of medical school and insurance. Also opportunity cost for people capable to become physicians in the US have other options with competitive pay to quality of life at work ratio. Lots of ways to not spend one’s 20s memorizing stuff for step exams and then spend 26 to 30 being a slave during residency, and then maybe a fellowship or getting board certified, and at the end, you still have to deal with patients. Alternatively, they could go for a job where they sit behind a computer and not deal with the general public and get to work from home when shit hits the fan.

rcme 4y ago

The medical systems of other countries definitely deliver better results on average. It's plainly obvious if you look at a top-level metric like life expectancy. However, from personal experience in the U.K., Germany, and the U.S., the U.S. system unquestionably delivers better outcomes to wealthy people with health insurance. It's not surprising that the U.S. policy remains in place: it benefits the elites. Also, healthcare makes up something insane like 20% of GDP. The amount of people employed by the healthcare sector is staggering. Spending less means putting people out of work. It's going to be hard to sell that idea.

Eddy_Viscosity2 4y ago

One is there is a supply problem. There are lots of people who would like to be doctors, that are capable of being doctors, that won't become doctors because there are only so many seats available at medical schools. So fixed supply of new grads every year. Next is there is no market pressure on prices, even though theoretically that's what should happen. People NEED medical care so there isn't much to haggle about. Insurance companies don't care about prices so much, they just raise their rates if prices go up and take a bigger cut. In countries with socialized medicine, the government is THE buyer and can negotiate prices for things. But here, a drug company just raises the prices by 10^3 percent and everyone just pays it.

deleted 4y ago

[deleted]