6 ms·

And interestingly both have predominantly grown in "administrative" costs

by bmau5 3y ago

NoMoreNicksLeft 3y ago
If we get the government more involved in funding these things directly, it can only improve the outcome.
- vkou 3y ago
  Funding directly by issuing a blank check to the vendors? No, it won't. Funding directly by setting a price cap, and paying vendors that amount for services rendered? Seems to work for almost every other developed country in the world. With the monetary savings of #2, it could even give every medical student a fully free ride.
  - NoMoreNicksLeft 3y ago
    > Seems to work for I love when someone says "seems to work". In the strict sense, that only ever means "does something". Not necessarily "does what someone wants"... and never "does what I want". When it works for those other countries, does it "do what you want"? Because it doesn't "do what I want" at all. > With the monetary savings of #2, it could even give every medical student a fully free ride. Won't someone think of the millionaire heart surgeons in the 1%? They obviously needed free rides back when they started, it's why they're only single digit millionaires! > Funding directly by setting a price cap, Starving the people you want to provide your medical treatment isn't the brightest strategy. Increases to price caps are always reactive, after they've been complaining for years. The bureaucracy demands that it take years more to raise the price caps. And by the time that happens, they've been bleeding money the whole time. It's a strong incentive for them to do all sorts of things that you don't want... and if you do it for any length of time at all, it trains them to do these bad things so even if you realize the error of your ways and withdrawn the bad policy, they keep on doing the bad things. Quite clearly, the problem with health insurance is that we need a gigantic insurance company larger than any other in history, and that it needs to be managed by the paragons of competency, the federal government. Of course, they'll need to staff up... and with all the layoffs in the private insurance industry, we'll hire all those empathetic, kind-hearted subject matter experts. Should be the best thing ever. I can't possibly see anything that might go wrong.
    - verteu 3y ago
      I suspect GP is referring to the fact that the US has the one of the worst health outcomes per dollar spent vs peer countries [1] [2]. If "better health outcomes per dollar" is not "what you want" -- how come? [1] https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare-system-compare-to-other-countries https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare... [2] https://www.piie.com/blogs/realtime-economic-issues-watch/what-comparing-healthcare-costs-really-reveals https://www.piie.com/blogs/realtime-economic-issues-watch/wh...
      - vkou 3y ago
        People making this argument tend to want 'better health outcomes for millionaires/healthy white collar people', either because they are one, or they think they will be one.
        nathan_compton 3y ago
        What I always point out is that markets are a form of rationing too. They are just form where people with money are allocated more goods than people without it, sometimes to the total exclusion of large parts of the population. Given that we set up polities for the common good, I'd argue that any necessity which markets fail to deliver to everyone should use some other kind of rationing strategy.
      - zer8k 3y ago
        The US's healthcare system is so bleak because we quite literally fund healthcare for the rest of the planet. Taxpayers in the US get access to the best treatment decades earlier if they're rich enough. Prices are increased on US citizens to account for the strong arming other governments do to get prices lower for their citizens. If the pharma companies couldn't do this, for example, they'd refuse to negotiate with other countries. A microcosm of this behavior is medicare here is the US. Yes, the US taxpayers even have to be charitable to them. IMO, if the US decided to actually help its citizens every country the average progressive considers "great at healthcare" would likely implode under the sudden increase in cost. The cost of medication alone would likely nearly bankrupt several governments. Imagine if the price of insulin, almost completely funded by US citizens paying absurd prices, went up to its US price. Much like with defense, the US taxpayer is the hero of the rest of the world's healthcare. Without US tax cattle the rest of the world would not be as nice as it is. It's just like when prices go up at your favorite store due to theft. The US is punished by insurance companies because other countries refuse to pay more.
toomuchtodo 3y ago
Who knew providers would raise prices with wild abandon when demand is firmly inelastic and debt without default risk is liberally provided? /s Hopefully states experimenting with universal higher education legislation makes some improvement possible: https://apnews.com/article/minnesota-legislature-college-tuition-free-7a229e7fa33fdf8d302f1d3e716b7ad6 https://apnews.com/article/minnesota-legislature-college-tui... ("Minnesota lawmakers reach deal for free college tuition") Note for this article that private colleges have the highest drop out rate, and Minnesota's plan excludes such institutions: > Qualifying students would have to attend a two- or four-year school in either the University of Minnesota or Minnesota State systems, or a tribal college. Private college tuition would not be covered. > From 2008 through 2009, enrollment in private for-profit colleges rose disproportionately compared to private non-profit and public colleges. Private for-profit colleges have extraordinarily high rates of default, near 16% of borrowers default within 3 years. https://educationdata.org/student-loan-default-rate https://educationdata.org/student-loan-default-rate
- solarmist 3y ago
  Demand isn’t fully inelastic. Many people are forgoing college that would’ve gone 20 years ago. It’s not huge yet, but it is happening. The rest of your point stands though.
  - toomuchtodo 3y ago
    Agreed, but they're forgoing college because they better opportunities without acquiring the traditional credential(s) due to a tight labor market, demographics and older folks retiring making trades and non college paths more lucrative, etc. The debt load is not worth the potential opportunity benefit. The whole "get a college degree if you want to be middle class" scam is evaporating, which results in your observation. https://reason.com/2023/03/31/poll-most-americans-dont-think-a-college-degree-is-worth-the-cost/ https://reason.com/2023/03/31/poll-most-americans-dont-think... https://apnews.com/article/skipping-college-student-loans-trade-jobs-efc1f6d6067ab770f6e512b3f7719cc0 https://apnews.com/article/skipping-college-student-loans-tr...
hospitalJail 3y ago
No no don't let the Physician cartel get out of this. Year over year they get at least 5% pay increases with US tax dollars. Not to mention, they get private pay increases by weaponizing the ACGME to keep residency slots low. Residency does not need to be paid. Outside of the Medical industry, people pay for their college. For some reason Physicians make tax payers pay for their education and a decent salary.
- ralmidani 3y ago
  Medical school is education, and in the US it’s astronomically expensive (some people graduate with half a million dollars of debt). Residency is more like on-the-job training (a hospital still makes money when a resident sees and treats you). It just takes longer to train a physician because there are human lives at stake. Yes, teaching fellows and others in academia are often taken advantage of and work for free, but that doesn’t mean physicians are evil for getting paid during residency.
  - hospitalJail 3y ago
    >It just takes longer to train a physician because there are human lives at stake. Airbags? Our electrical infrastructure? Our plumbing? Please, there are plenty of of industries that have lives at stake and we don't have a cartel controlling the supply of people. The issue is that we don't have enough Physician(By design), so they need to operate independently. Any other industry has multiple layers of qualified people checking to make sure things are safe. I kind of dream of a world where you'd have 1 physician and a physician manager and a physician director all looking at your paperwork. Instead you get 1 total.
    - ralmidani 3y ago
      I don’t want to trivialize the amount of work that goes into airbags, electrical infrastructure, or plumbing. However, the human body is much more complicated. Would you trust the life of a loved one who, God forbid, has cancer or needs surgery to a person with a fraction of the education and training physicians receive? By the way, I’m reminded of a joke: a doctor called a plumber for a faucet leak. The plumber fixed it in 5 minutes and charged $175. The doctor said “how can you charge that much for 5 minutes of work? I spend a whole hour with a patient and charge less!” The plumber said “that’s exactly what I used to say when I was a doctor.”
RoyGBivCap 3y ago
[dead]

And interestingly both have predominantly grown in "administrative" costs

by bmau5 3y ago

And interestingly both have predominantly grown in "administrative" costs

NoMoreNicksLeft 3y ago

If we get the government more involved in funding these things directly, it can only improve the outcome.

vkou 3y ago
Funding directly by issuing a blank check to the vendors? No, it won't. Funding directly by setting a price cap, and paying vendors that amount for services rendered? Seems to work for almost every other developed country in the world. With the monetary savings of #2, it could even give every medical student a fully free ride.
- NoMoreNicksLeft 3y ago
  > Seems to work for I love when someone says "seems to work". In the strict sense, that only ever means "does something". Not necessarily "does what someone wants"... and never "does what I want". When it works for those other countries, does it "do what you want"? Because it doesn't "do what I want" at all. > With the monetary savings of #2, it could even give every medical student a fully free ride. Won't someone think of the millionaire heart surgeons in the 1%? They obviously needed free rides back when they started, it's why they're only single digit millionaires! > Funding directly by setting a price cap, Starving the people you want to provide your medical treatment isn't the brightest strategy. Increases to price caps are always reactive, after they've been complaining for years. The bureaucracy demands that it take years more to raise the price caps. And by the time that happens, they've been bleeding money the whole time. It's a strong incentive for them to do all sorts of things that you don't want... and if you do it for any length of time at all, it trains them to do these bad things so even if you realize the error of your ways and withdrawn the bad policy, they keep on doing the bad things. Quite clearly, the problem with health insurance is that we need a gigantic insurance company larger than any other in history, and that it needs to be managed by the paragons of competency, the federal government. Of course, they'll need to staff up... and with all the layoffs in the private insurance industry, we'll hire all those empathetic, kind-hearted subject matter experts. Should be the best thing ever. I can't possibly see anything that might go wrong.
  - verteu 3y ago
    I suspect GP is referring to the fact that the US has the one of the worst health outcomes per dollar spent vs peer countries [1] [2]. If "better health outcomes per dollar" is not "what you want" -- how come? [1] https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare-system-compare-to-other-countries https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare... [2] https://www.piie.com/blogs/realtime-economic-issues-watch/what-comparing-healthcare-costs-really-reveals https://www.piie.com/blogs/realtime-economic-issues-watch/wh...
    - vkou 3y ago
      People making this argument tend to want 'better health outcomes for millionaires/healthy white collar people', either because they are one, or they think they will be one.
      - nathan_compton 3y ago
        What I always point out is that markets are a form of rationing too. They are just form where people with money are allocated more goods than people without it, sometimes to the total exclusion of large parts of the population. Given that we set up polities for the common good, I'd argue that any necessity which markets fail to deliver to everyone should use some other kind of rationing strategy.
    - zer8k 3y ago
      The US's healthcare system is so bleak because we quite literally fund healthcare for the rest of the planet. Taxpayers in the US get access to the best treatment decades earlier if they're rich enough. Prices are increased on US citizens to account for the strong arming other governments do to get prices lower for their citizens. If the pharma companies couldn't do this, for example, they'd refuse to negotiate with other countries. A microcosm of this behavior is medicare here is the US. Yes, the US taxpayers even have to be charitable to them. IMO, if the US decided to actually help its citizens every country the average progressive considers "great at healthcare" would likely implode under the sudden increase in cost. The cost of medication alone would likely nearly bankrupt several governments. Imagine if the price of insulin, almost completely funded by US citizens paying absurd prices, went up to its US price. Much like with defense, the US taxpayer is the hero of the rest of the world's healthcare. Without US tax cattle the rest of the world would not be as nice as it is. It's just like when prices go up at your favorite store due to theft. The US is punished by insurance companies because other countries refuse to pay more.

toomuchtodo 3y ago

Who knew providers would raise prices with wild abandon when demand is firmly inelastic and debt without default risk is liberally provided? /s Hopefully states experimenting with universal higher education legislation makes some improvement possible: https://apnews.com/article/minnesota-legislature-college-tuition-free-7a229e7fa33fdf8d302f1d3e716b7ad6 https://apnews.com/article/minnesota-legislature-college-tui... ("Minnesota lawmakers reach deal for free college tuition") Note for this article that private colleges have the highest drop out rate, and Minnesota's plan excludes such institutions: > Qualifying students would have to attend a two- or four-year school in either the University of Minnesota or Minnesota State systems, or a tribal college. Private college tuition would not be covered. > From 2008 through 2009, enrollment in private for-profit colleges rose disproportionately compared to private non-profit and public colleges. Private for-profit colleges have extraordinarily high rates of default, near 16% of borrowers default within 3 years. https://educationdata.org/student-loan-default-rate https://educationdata.org/student-loan-default-rate

solarmist 3y ago
Demand isn’t fully inelastic. Many people are forgoing college that would’ve gone 20 years ago. It’s not huge yet, but it is happening. The rest of your point stands though.
- toomuchtodo 3y ago
  Agreed, but they're forgoing college because they better opportunities without acquiring the traditional credential(s) due to a tight labor market, demographics and older folks retiring making trades and non college paths more lucrative, etc. The debt load is not worth the potential opportunity benefit. The whole "get a college degree if you want to be middle class" scam is evaporating, which results in your observation. https://reason.com/2023/03/31/poll-most-americans-dont-think-a-college-degree-is-worth-the-cost/ https://reason.com/2023/03/31/poll-most-americans-dont-think... https://apnews.com/article/skipping-college-student-loans-trade-jobs-efc1f6d6067ab770f6e512b3f7719cc0 https://apnews.com/article/skipping-college-student-loans-tr...

hospitalJail 3y ago

No no don't let the Physician cartel get out of this. Year over year they get at least 5% pay increases with US tax dollars. Not to mention, they get private pay increases by weaponizing the ACGME to keep residency slots low. Residency does not need to be paid. Outside of the Medical industry, people pay for their college. For some reason Physicians make tax payers pay for their education and a decent salary.

ralmidani 3y ago
Medical school is education, and in the US it’s astronomically expensive (some people graduate with half a million dollars of debt). Residency is more like on-the-job training (a hospital still makes money when a resident sees and treats you). It just takes longer to train a physician because there are human lives at stake. Yes, teaching fellows and others in academia are often taken advantage of and work for free, but that doesn’t mean physicians are evil for getting paid during residency.
- hospitalJail 3y ago
  >It just takes longer to train a physician because there are human lives at stake. Airbags? Our electrical infrastructure? Our plumbing? Please, there are plenty of of industries that have lives at stake and we don't have a cartel controlling the supply of people. The issue is that we don't have enough Physician(By design), so they need to operate independently. Any other industry has multiple layers of qualified people checking to make sure things are safe. I kind of dream of a world where you'd have 1 physician and a physician manager and a physician director all looking at your paperwork. Instead you get 1 total.
  - ralmidani 3y ago
    I don’t want to trivialize the amount of work that goes into airbags, electrical infrastructure, or plumbing. However, the human body is much more complicated. Would you trust the life of a loved one who, God forbid, has cancer or needs surgery to a person with a fraction of the education and training physicians receive? By the way, I’m reminded of a joke: a doctor called a plumber for a faucet leak. The plumber fixed it in 5 minutes and charged $175. The doctor said “how can you charge that much for 5 minutes of work? I spend a whole hour with a patient and charge less!” The plumber said “that’s exactly what I used to say when I was a doctor.”

RoyGBivCap 3y ago

[dead]