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I think it’s amazing that a solid system can be defunded like that until it just sorta crumbles under it’s own weight. There’s no immediate solution either. If

by Aeolun 3y ago

I think it’s amazing that a solid system can be defunded like that until it just sorta crumbles under it’s own weight. There’s no immediate solution either. If you build more hospitals, you need more staff, if you need more staff, you need to make it more attractive, but even if you do you need several years before the first doctors/nurses from the wave with renewed interest in the position finishes university. And that’s only if there is any political will to do so.

bpodgursky 3y ago
Healthcare across the entire west is crumbling, and not through defunding. It's driven by demographic shifts that nobody has a real plan to fix.
- nradov 3y ago
  Ultimately the only viable plan is going to be severe care rationing. In most developed countries we have an aging population with an increasing incidence of chronic diseases and a shortage of physicians. Regardless of whether payments come from governments, employers, or individuals the reality is that we simply won't have the resources to care for everyone.
  - HarryHirsch 3y ago
    In Britain, citizens have a hard time getting basic dental care that they can afford: https://www.bloomberg.com/news/articles/2023-07-13/uk-dentistry-in-crisis-as-people-pull-out-own-teeth-with-pliers#xj4y7vzkg https://www.bloomberg.com/news/articles/2023-07-13/uk-dentis... The demographic explanation simply does not hold water when routine healthcare is not available.
    - themitigating 3y ago
      But that's routine healthcare for one particular part of the body. Meaning it could be true for general health. In the US dental is considered a seperate insurance for most. So there's a separation for whatever reason meaning using it to disprove the demographic theory for "regular" healthcare might be valid
    - DanBC 3y ago
      Important to point out that dentistry in England does not follow the NHS model of "free at the point of delivery, available to all regardless of ability to pay" but follows an insurance model, with a bit of state provision for those who can't afford insurance. And dentistry is why people in England are scared of changing the model for NHS healthcare, because we see that dentistry is fucking awful for huge numbers of people. The problem with the NHS is not the model, it's the funding.
  - confidantlake 3y ago
    At least in the US they could stop restricting the number of residency slots.
    - alostpuppy 3y ago
      This
    - nradov 3y ago
      The number of residency slots isn't restricted. The problem is that almost all residency program funding comes from Medicare and hasn't increased much for many years. https://savegme.org/ https://savegme.org/
- dangus 3y ago
  Explain how Japan has the #2 best healthcare system in the world then. (It’s universal with 70% of costs paid by the government)
  - Danieru 3y ago
    Strong planning and hard decisions. Japan over produces doctors. Japan forces a strict 30minute cap on doctor visits when billed by that insurance. Japan limits hospitals to be only owned by doctors, not corporations. Japan has no medical malpractice lawsuits. Japan makes everyone pay 30% of medical costs, UpTo a cap of about 1k dollars per month. There is no such thing as the "nice" health care insurance nearly every American programmer working at a FAANG gets. Japan makes seniors also pay a large deductable. Japan put in place many strategic constraints on their system to achieve this result. Hard decisions most countries would revolt at, doctors unions would strict at, and westerns would call broken. But at least the system does it's job and is not projected to collapse. You can win votes, or you can design a functional system. You cannot do both.
    - dangus 3y ago
      Almost everything you mentioned is basically a legislative signature away from being a reality in Western countries. That’s why I questioned the idea that demographic issues are going to prevent the West from solving this problem. A little bit of political will and some signatures is all it takes.
  - opportune 3y ago
    I don’t like “exceptionalism” arguments in general, and I think “muh homogeneity” is bunk as well, but Japan has a very strong and unique culture that results in outcomes that the rest of the world would not see in the same conditions. See for example Japan having very few public trash cans but also very low amounts of litter, or even very low wage workers taking pride in their jobs, or Japan having both extremely low unemployment and also low/no wage inflation for very long periods of time. Japanese business culture is one of seeing a duty to the public/consumer in a way that most other capitalist countries do not. They have a cultural aversion to screwing people over and ripping them off, and in working very many extra unbilled hours because it’s expected of them - they’d never have the same healthcare failure modes as in other countries
gruez 3y ago
>I think it’s amazing that a solid system can be defunded like that until it just sorta crumbles under it’s own weight "defunded"? Maybe if you're comparing post pandemic budgets to pandemic budgets, but spending is still way up compared to pre-pandemic levels. [1] https://flo.uri.sh/visualisation/12020081/embed?auto=1 https://flo.uri.sh/visualisation/12020081/embed?auto=1
- sefrost 3y ago
  I want to add some extra data for other people. The UK has an aging population. Old people need more healthcare spending. If we adjust the data for age and demographic changes, then we can see spending was reduced between 2010 and 2021. https://www.nuffieldtrust.org.uk/news-item/the-past-present-and-future-of-government-spending-on-the-nhs https://www.nuffieldtrust.org.uk/news-item/the-past-present-...
  - throwawaylinux 3y ago
    It is pretty blatant dishonesty to call it defunded or reduced spending though, as much as some ideologues like to claim it is.
    - DanBC 3y ago
      The people doing the defunding say that it's defunding. They're proud of it. They wrote a manifesto saying they were going to do it, and then they did it. It's pretty blatant dishonesty to say that healthcare hasn't been defunded, and then only focus on NHS provision of healthcare while ignoring public health, social care, nursing care, etc.
      - throwawaylinux 3y ago
        > The people doing the defunding say that it's defunding. They're proud of it. They wrote a manifesto saying they were going to do it, and then they did it. Oh? Do what, fund the health system at almost record levels? > It's pretty blatant dishonesty to say that healthcare hasn't been defunded, and then only focus on NHS provision of healthcare while ignoring public health, social care, nursing care, etc. It would be if someone had done that. Incidentally, are you saying that NHS has not been defunded? You wouldn't be very popular with said ideologues either then.
chaostheory 3y ago
The main problem is that senior retirees are beginning to out number working adults who fund the system. Only skilled legal immigration can stem the tide, but that is not politically popular even amongst liberals. The end result is an entitlement system that is no longer sustainable. https://www.imf.org/en/Publications/fandd/issues/Series/Analytical-Series/aging-is-the-real-population-bomb-bloom-zucker https://www.imf.org/en/Publications/fandd/issues/Series/Anal... > And that’s only if there is any political will to do so. More taxes can only do so much if that was what you were implying. Middle class families can barely support themselves now let alone subsidize the little income they have left. Case in point, in the US for a family to have the same economic power as families in the past; they must make $240,000 - $300,000 depending on the metro

by Aeolun 3y ago

bpodgursky 3y ago

Healthcare across the entire west is crumbling, and not through defunding. It's driven by demographic shifts that nobody has a real plan to fix.

nradov 3y ago
Ultimately the only viable plan is going to be severe care rationing. In most developed countries we have an aging population with an increasing incidence of chronic diseases and a shortage of physicians. Regardless of whether payments come from governments, employers, or individuals the reality is that we simply won't have the resources to care for everyone.
- HarryHirsch 3y ago
  In Britain, citizens have a hard time getting basic dental care that they can afford: https://www.bloomberg.com/news/articles/2023-07-13/uk-dentistry-in-crisis-as-people-pull-out-own-teeth-with-pliers#xj4y7vzkg https://www.bloomberg.com/news/articles/2023-07-13/uk-dentis... The demographic explanation simply does not hold water when routine healthcare is not available.
  - themitigating 3y ago
    But that's routine healthcare for one particular part of the body. Meaning it could be true for general health. In the US dental is considered a seperate insurance for most. So there's a separation for whatever reason meaning using it to disprove the demographic theory for "regular" healthcare might be valid
  - DanBC 3y ago
    Important to point out that dentistry in England does not follow the NHS model of "free at the point of delivery, available to all regardless of ability to pay" but follows an insurance model, with a bit of state provision for those who can't afford insurance. And dentistry is why people in England are scared of changing the model for NHS healthcare, because we see that dentistry is fucking awful for huge numbers of people. The problem with the NHS is not the model, it's the funding.
- confidantlake 3y ago
  At least in the US they could stop restricting the number of residency slots.
  - alostpuppy 3y ago
    This
  - nradov 3y ago
    The number of residency slots isn't restricted. The problem is that almost all residency program funding comes from Medicare and hasn't increased much for many years. https://savegme.org/ https://savegme.org/
dangus 3y ago
Explain how Japan has the #2 best healthcare system in the world then. (It’s universal with 70% of costs paid by the government)
- Danieru 3y ago
  Strong planning and hard decisions. Japan over produces doctors. Japan forces a strict 30minute cap on doctor visits when billed by that insurance. Japan limits hospitals to be only owned by doctors, not corporations. Japan has no medical malpractice lawsuits. Japan makes everyone pay 30% of medical costs, UpTo a cap of about 1k dollars per month. There is no such thing as the "nice" health care insurance nearly every American programmer working at a FAANG gets. Japan makes seniors also pay a large deductable. Japan put in place many strategic constraints on their system to achieve this result. Hard decisions most countries would revolt at, doctors unions would strict at, and westerns would call broken. But at least the system does it's job and is not projected to collapse. You can win votes, or you can design a functional system. You cannot do both.
  - dangus 3y ago
    Almost everything you mentioned is basically a legislative signature away from being a reality in Western countries. That’s why I questioned the idea that demographic issues are going to prevent the West from solving this problem. A little bit of political will and some signatures is all it takes.
- opportune 3y ago
  I don’t like “exceptionalism” arguments in general, and I think “muh homogeneity” is bunk as well, but Japan has a very strong and unique culture that results in outcomes that the rest of the world would not see in the same conditions. See for example Japan having very few public trash cans but also very low amounts of litter, or even very low wage workers taking pride in their jobs, or Japan having both extremely low unemployment and also low/no wage inflation for very long periods of time. Japanese business culture is one of seeing a duty to the public/consumer in a way that most other capitalist countries do not. They have a cultural aversion to screwing people over and ripping them off, and in working very many extra unbilled hours because it’s expected of them - they’d never have the same healthcare failure modes as in other countries

gruez 3y ago

>I think it’s amazing that a solid system can be defunded like that until it just sorta crumbles under it’s own weight "defunded"? Maybe if you're comparing post pandemic budgets to pandemic budgets, but spending is still way up compared to pre-pandemic levels. [1] https://flo.uri.sh/visualisation/12020081/embed?auto=1 https://flo.uri.sh/visualisation/12020081/embed?auto=1

sefrost 3y ago
I want to add some extra data for other people. The UK has an aging population. Old people need more healthcare spending. If we adjust the data for age and demographic changes, then we can see spending was reduced between 2010 and 2021. https://www.nuffieldtrust.org.uk/news-item/the-past-present-and-future-of-government-spending-on-the-nhs https://www.nuffieldtrust.org.uk/news-item/the-past-present-...
- throwawaylinux 3y ago
  It is pretty blatant dishonesty to call it defunded or reduced spending though, as much as some ideologues like to claim it is.
  - DanBC 3y ago
    The people doing the defunding say that it's defunding. They're proud of it. They wrote a manifesto saying they were going to do it, and then they did it. It's pretty blatant dishonesty to say that healthcare hasn't been defunded, and then only focus on NHS provision of healthcare while ignoring public health, social care, nursing care, etc.
    - throwawaylinux 3y ago
      > The people doing the defunding say that it's defunding. They're proud of it. They wrote a manifesto saying they were going to do it, and then they did it. Oh? Do what, fund the health system at almost record levels? > It's pretty blatant dishonesty to say that healthcare hasn't been defunded, and then only focus on NHS provision of healthcare while ignoring public health, social care, nursing care, etc. It would be if someone had done that. Incidentally, are you saying that NHS has not been defunded? You wouldn't be very popular with said ideologues either then.

chaostheory 3y ago

The main problem is that senior retirees are beginning to out number working adults who fund the system. Only skilled legal immigration can stem the tide, but that is not politically popular even amongst liberals. The end result is an entitlement system that is no longer sustainable. https://www.imf.org/en/Publications/fandd/issues/Series/Analytical-Series/aging-is-the-real-population-bomb-bloom-zucker https://www.imf.org/en/Publications/fandd/issues/Series/Anal... > And that’s only if there is any political will to do so. More taxes can only do so much if that was what you were implying. Middle class families can barely support themselves now let alone subsidize the little income they have left. Case in point, in the US for a family to have the same economic power as families in the past; they must make $240,000 - $300,000 depending on the metro