5 ms·

I think the point is that one of the big hype phrases is that it will decrease costs of healthcare and lower people's bills, but even if you lower the cost, the

I think the point is that one of the big hype phrases is that it will decrease costs of healthcare and lower people's bills, but even if you lower the cost, there is no actual incentive to lower patient bills, so the extra value simply goes to owners and investors rather than the end consumer.

staunton 3y ago
Would you rather be treated in a modern hospital or one from 50 years ago? Would you choose the historical hospital if it charged you the same fraction of median income as it did back then?
- LegibleCrimson 3y ago
  It's not that black and white. There's more at play than just charges. Things can be better and still shockingly corrupt, with extreme amounts of unjustified overhead. Things are minimally better for any individual patient, while being extremely more expensive, and the insurance overhead has skyrocketed. The question is a little bit like responding to a complaint about industrialized agriculture's effects on the environment by saying "Would you rather eat sausage from 100 years ago or now?" It's not actually that relevant to the initial complaint, and it reads like it's trying to just terminate the conversation on a loophole. Things can be better and still also be filled with many problems, particularly modern problems that weren't relevant in the time period you're comparing to. To actually answer the question honestly, it depends on my condition. For the kind of thing I would typically see my GP for, including run-of-the-mill checkups, definitely one from 50 years ago. For any serious medical issues, modern (as long as I can convince the doctors that it's actually serious so they spend more than 30 seconds on investigation). As far as charges go, per-capita healthcare expenditure is now over 5 times as high as it was in 1980. Are we getting a 5-fold improvement in medical care? When I go to the doctor for anything more than a checkup, 90% of my time is spent waiting, and I spend twice as much time with RNs who repeatedly ask me the same questions, before a frazzled doctor comes in, asks a couple questions, then rushes out, maybe handing me a prescription for antibiotics regardless of what my concern is.
  - staunton 3y ago
    > It's not that black and white The reason I wrote anything was that your original comment sounded very black and white to me. I think we tend to overlook how much things improve in the long term. Knowing that they do hints at potential to do better still and should encourage us to take action and improve the situation. Pointing out the current problems is necessary for that to happen. However, your comment came across as denying that healthcare can be improved, or at least that improvements can benefit patients. This is obviously false and I'm sure you didn't mean to claim it, so it's great we're able to add a bit more nuance.
    - LegibleCrimson 3y ago
      Fair enough, and I appreciate the extra perspective. I wouldn't deny that many of these things have improved. Very little actually gets worse in a literal sense (environmental issues and other negative externalities aside, though they are very relevant as well). The concern is that they tend to get marginally better when they should by all means be getting significantly better, because the lion's share of the benefits feed the ever-widening wealth gap.
- rchaud 3y ago
  Ceteris paribus is doing a lot of heavy lifting here. If the 50 year old hospital has an available operating room and the modern hospital does not, I'm going there. I won't have a choice if the treatment needed is urgent.
sofixa 3y ago
That's assuming the extremely broken and frankly incomprehensible American model. Over in the EU, where most of the healthcare is single-payer (sometimes with optional add-ons/extra payers/private care), cost of care has been growing too. There are simply many more treatments which are available now than before, more tests possible to discover issues, etc. as well as of course the higher life expectancy and higher average age across the board. That doesn't mean improvements shouldn't be undertaken. Such as electronic medical files (which are the norm in multiple EU countries but sadly not everywhere, and not on an EU scale - as born in one EU country and now living in another, it would have been extremely useful to be able to automatically share my childhood records), or maybe ML to do predictions and stuff.
- LegibleCrimson 3y ago
  I agree 100%. In America the capitalist dream of competition and technological innovation actually driving costs lower for the consumer has mostly just died in almost every category. Any savings are now passed onto a cabal of private equity firms and legislatively-entrenched insurance corporations. Goodhart's Law is in full force, and the measure of business health, profit, has become the target, rather than consumer welfare and rights. Boy have we optimized for profit at the expense of anything else.
  - snowpid 3y ago
    Even that is very American specific. In Germany there is a certain limited competition between health insurances.

staunton 3y ago

Would you rather be treated in a modern hospital or one from 50 years ago? Would you choose the historical hospital if it charged you the same fraction of median income as it did back then?

LegibleCrimson 3y ago
It's not that black and white. There's more at play than just charges. Things can be better and still shockingly corrupt, with extreme amounts of unjustified overhead. Things are minimally better for any individual patient, while being extremely more expensive, and the insurance overhead has skyrocketed. The question is a little bit like responding to a complaint about industrialized agriculture's effects on the environment by saying "Would you rather eat sausage from 100 years ago or now?" It's not actually that relevant to the initial complaint, and it reads like it's trying to just terminate the conversation on a loophole. Things can be better and still also be filled with many problems, particularly modern problems that weren't relevant in the time period you're comparing to. To actually answer the question honestly, it depends on my condition. For the kind of thing I would typically see my GP for, including run-of-the-mill checkups, definitely one from 50 years ago. For any serious medical issues, modern (as long as I can convince the doctors that it's actually serious so they spend more than 30 seconds on investigation). As far as charges go, per-capita healthcare expenditure is now over 5 times as high as it was in 1980. Are we getting a 5-fold improvement in medical care? When I go to the doctor for anything more than a checkup, 90% of my time is spent waiting, and I spend twice as much time with RNs who repeatedly ask me the same questions, before a frazzled doctor comes in, asks a couple questions, then rushes out, maybe handing me a prescription for antibiotics regardless of what my concern is.
- staunton 3y ago
  > It's not that black and white The reason I wrote anything was that your original comment sounded very black and white to me. I think we tend to overlook how much things improve in the long term. Knowing that they do hints at potential to do better still and should encourage us to take action and improve the situation. Pointing out the current problems is necessary for that to happen. However, your comment came across as denying that healthcare can be improved, or at least that improvements can benefit patients. This is obviously false and I'm sure you didn't mean to claim it, so it's great we're able to add a bit more nuance.
  - LegibleCrimson 3y ago
    Fair enough, and I appreciate the extra perspective. I wouldn't deny that many of these things have improved. Very little actually gets worse in a literal sense (environmental issues and other negative externalities aside, though they are very relevant as well). The concern is that they tend to get marginally better when they should by all means be getting significantly better, because the lion's share of the benefits feed the ever-widening wealth gap.
rchaud 3y ago
Ceteris paribus is doing a lot of heavy lifting here. If the 50 year old hospital has an available operating room and the modern hospital does not, I'm going there. I won't have a choice if the treatment needed is urgent.

sofixa 3y ago

That's assuming the extremely broken and frankly incomprehensible American model. Over in the EU, where most of the healthcare is single-payer (sometimes with optional add-ons/extra payers/private care), cost of care has been growing too. There are simply many more treatments which are available now than before, more tests possible to discover issues, etc. as well as of course the higher life expectancy and higher average age across the board. That doesn't mean improvements shouldn't be undertaken. Such as electronic medical files (which are the norm in multiple EU countries but sadly not everywhere, and not on an EU scale - as born in one EU country and now living in another, it would have been extremely useful to be able to automatically share my childhood records), or maybe ML to do predictions and stuff.

LegibleCrimson 3y ago
I agree 100%. In America the capitalist dream of competition and technological innovation actually driving costs lower for the consumer has mostly just died in almost every category. Any savings are now passed onto a cabal of private equity firms and legislatively-entrenched insurance corporations. Goodhart's Law is in full force, and the measure of business health, profit, has become the target, rather than consumer welfare and rights. Boy have we optimized for profit at the expense of anything else.
- snowpid 3y ago
  Even that is very American specific. In Germany there is a certain limited competition between health insurances.