4 ms·

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

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