5 ms·

Healthcare costs are spiralling because: - ageing population, ironically because of the success of healthcare - (US specific) avoidance of preventative/precau

Healthcare costs are spiralling because: - ageing population, ironically because of the success of healthcare - (US specific) avoidance of preventative/precautionary treatment for fear of outsized bills - (US specific) wildly inefficient and predatory 'insurance' system

amanaplanacanal 3y ago
One more thing, which might even be the most important, third party payments, which means the patient has almost no incentive to find cheaper options. This is exacerbated by the inability to compare prices built into the system.
- somewhereoutth 3y ago
  I don't think a market for health is appropriate or could function correctly at the consumer level. If I'm ill, I want to get fixed with the currently understood medical best practice and in a timely manner - not look for 'cheaper options'. That is what universal/non-marketplace healthcare is intended to deliver - and to a first approximation does just that in many places, and any rationing necessary is done according to need, not ability to pay.
  - ttt3ts 3y ago
    Even in those systems if you have more money you can get better and faster care. Something like 60% of Canadians have private insurance. I live near the border and several of my friends have visited the US for to bypass lines.
- Explore3003 3y ago
  [dead]
- angmarsbane 3y ago
  How possible is it to find cheaper options even if someone wanted to do so? It's nearly impossible to get healthcare providers to commit to a price.
  - ttt3ts 3y ago
    This is getting better. Most providers provide price transparency. The data is dirty and not consistent between providers but definitely a start. Check out https://turquoise.health/patients https://turquoise.health/patients a startup scraping and standardizing the data.
TexanFeller 3y ago
It's not just features of the "health care" system, there are many features of American life and culture that put us in a uniquely bad position: - Higher rates of overweight and obesity than almost any other country. Obesity is a top correlate of most of the most expensive chronic conditions. - Healthy food is less available and more expensive than unhealthy, ultra processed food engineered to be hyper palatable and not very filling. Govt policy that reinforces and subsidizes this. - Infrastructure design that discourages walking. Culture that encourages sedentary activities and lifestyle in general. - Being overweight and out of shape has been culturally normalized. Propaganda telling us that weight is genetic, out of our control, and we can be "healthy at any size" anyway. - Work culture that leads to chronic stress and time deprivation worsening all the other problems and leaving people unable to expend the time and energy to avoid chronic problems proactively by losing weight and being active.
- Auracle 3y ago
  I’ll fight you on your second point, though I feel the rest are valid. Healthy food is not more expensive than ultra processed food. Easy healthy food is. You can go get quite a bit of basic meat and veggies for very little money compared to some Hot Pockets or McDonalds or whatever. I can make a stew for $15 that’s at least two meals for my family. Chuck roast, carrots, potatoes, onion, etc. Chicken is even cheaper. Availability is only poor in areas where people won’t willingly buy raw ingredients. Food deserts are (largely) lazy oases.
  - somewhereoutth 3y ago
    Time - Cost - Quality Pick two. So you can have fast, cheap, but low quality food ('fast food'), or slow, cheap, good quality food (cooking at home), or fast, expensive, high quality food (decent restaurant). By time I would also include mental overhead required, i.e. thinking about cooking. Unfortunately poor people often have neither the money or the time to choose quality. The daft thing is that cooking individually, or indeed to order in a restaurant, is very inefficient. In fact it is possible to win on all 3, but this requires a communal style cafeteria as would be found in offices, schools, the military etc. Wouldn't it be great if such cafeterias were available to the general public, with a limited but rotating good quality menu, using actual plates instead of single use plastic, bench seating such that singles would feel comfortable dining there, tap water on tap, self serve with trays. You can find something like this in shopping malls, but often a wide menu instead of a rotating menu, so failing to scale and thus falling behind with quality
JohnClark1337 3y ago
[dead]
lxm 3y ago
In absence of insurers, who can play the role of customer advocate when negotiating prices? How do you create a modicum of cost control and push back on providers introducing arbitrary markups?
- malermeister 3y ago
  The state.
- swagasaurus-rex 3y ago
  Thinking the insurers provide this service is laughable. They want high hospital costs because then they can charge more for their coverage.
  - ryan_lane 3y ago
    And they do this because they're only allowed to take a certain percentage of their revenue as profit. The more healthcare costs, the more they can charge and the more they can make. The obvious answer here is that health insurance should not be privatized. Health insurance should be negotiating to keep costs low so that they can cover more, not letting costs skyrocket to make more profit.
- deleted 3y ago
  [deleted]

amanaplanacanal 3y ago

One more thing, which might even be the most important, third party payments, which means the patient has almost no incentive to find cheaper options. This is exacerbated by the inability to compare prices built into the system.

somewhereoutth 3y ago
I don't think a market for health is appropriate or could function correctly at the consumer level. If I'm ill, I want to get fixed with the currently understood medical best practice and in a timely manner - not look for 'cheaper options'. That is what universal/non-marketplace healthcare is intended to deliver - and to a first approximation does just that in many places, and any rationing necessary is done according to need, not ability to pay.
- ttt3ts 3y ago
  Even in those systems if you have more money you can get better and faster care. Something like 60% of Canadians have private insurance. I live near the border and several of my friends have visited the US for to bypass lines.
Explore3003 3y ago
[dead]
angmarsbane 3y ago
How possible is it to find cheaper options even if someone wanted to do so? It's nearly impossible to get healthcare providers to commit to a price.
- ttt3ts 3y ago
  This is getting better. Most providers provide price transparency. The data is dirty and not consistent between providers but definitely a start. Check out https://turquoise.health/patients https://turquoise.health/patients a startup scraping and standardizing the data.

TexanFeller 3y ago

It's not just features of the "health care" system, there are many features of American life and culture that put us in a uniquely bad position: - Higher rates of overweight and obesity than almost any other country. Obesity is a top correlate of most of the most expensive chronic conditions. - Healthy food is less available and more expensive than unhealthy, ultra processed food engineered to be hyper palatable and not very filling. Govt policy that reinforces and subsidizes this. - Infrastructure design that discourages walking. Culture that encourages sedentary activities and lifestyle in general. - Being overweight and out of shape has been culturally normalized. Propaganda telling us that weight is genetic, out of our control, and we can be "healthy at any size" anyway. - Work culture that leads to chronic stress and time deprivation worsening all the other problems and leaving people unable to expend the time and energy to avoid chronic problems proactively by losing weight and being active.

Auracle 3y ago
I’ll fight you on your second point, though I feel the rest are valid. Healthy food is not more expensive than ultra processed food. Easy healthy food is. You can go get quite a bit of basic meat and veggies for very little money compared to some Hot Pockets or McDonalds or whatever. I can make a stew for $15 that’s at least two meals for my family. Chuck roast, carrots, potatoes, onion, etc. Chicken is even cheaper. Availability is only poor in areas where people won’t willingly buy raw ingredients. Food deserts are (largely) lazy oases.
- somewhereoutth 3y ago
  Time - Cost - Quality Pick two. So you can have fast, cheap, but low quality food ('fast food'), or slow, cheap, good quality food (cooking at home), or fast, expensive, high quality food (decent restaurant). By time I would also include mental overhead required, i.e. thinking about cooking. Unfortunately poor people often have neither the money or the time to choose quality. The daft thing is that cooking individually, or indeed to order in a restaurant, is very inefficient. In fact it is possible to win on all 3, but this requires a communal style cafeteria as would be found in offices, schools, the military etc. Wouldn't it be great if such cafeterias were available to the general public, with a limited but rotating good quality menu, using actual plates instead of single use plastic, bench seating such that singles would feel comfortable dining there, tap water on tap, self serve with trays. You can find something like this in shopping malls, but often a wide menu instead of a rotating menu, so failing to scale and thus falling behind with quality

JohnClark1337 3y ago

[dead]

lxm 3y ago

In absence of insurers, who can play the role of customer advocate when negotiating prices? How do you create a modicum of cost control and push back on providers introducing arbitrary markups?

malermeister 3y ago
The state.
swagasaurus-rex 3y ago
Thinking the insurers provide this service is laughable. They want high hospital costs because then they can charge more for their coverage.
- ryan_lane 3y ago
  And they do this because they're only allowed to take a certain percentage of their revenue as profit. The more healthcare costs, the more they can charge and the more they can make. The obvious answer here is that health insurance should not be privatized. Health insurance should be negotiating to keep costs low so that they can cover more, not letting costs skyrocket to make more profit.
deleted 3y ago
[deleted]