3 ms·

In many countries, treatments are less expensive than the US (by orders of magnitude). The US somehow has health care costs that seem to be divorced from the un

In many countries, treatments are less expensive than the US (by orders of magnitude). The US somehow has health care costs that seem to be divorced from the underlying costs for time and/or raw materials. I still don't understand how this came to be, but that's the situation. Random youtube and web searches can quickly find situations of Americans buying medicines in eg. northernish Europe. "I'm terribly sorry sir, but you don't have health insurance here, so you'll have to pay that in cash, out of pocket" , and they end up paying next-to-nothing anyway. If the costs are a few zeros lower, the decision becomes a lot easier a lot of the time. Afaict "death panels" don't exist outside the US political discourse. Everything else is Overton window (If someone lies hard enough: "Surely there must be a grain of truth!" But no.) If the UK NHS managed to keep Steven Hawking alive, you'd think they'd manage the same for practically anyone.

alistairSH 3y ago
The cost part is complicated. Despite claims from the right, we don't have a free market for healthcare (in no particular order)... - The number of new doctors is tightly controlled via the residency program. In the past, the American Medical Assoc has lobbied to have those positions capped (though now there's enough of a shortage that the AMA is lobbying for more positions). The residency slots are funded by the federal government, not the medical schools/hospitals that run them. - Every new healthcare facility goes through a local need analysis. There is always pressure from existing facilities to deny expanded need (this impacts things like MRIs - they're expensive because there are fewer than the market optimum number). - Insurance divorces the consumer from the real cost. Further exacerbated because insurance is usually funded pre-tax by a person's employer (vs post tax from the employee's income). - Insurance is coupled to employment - consumers can't pick and choose policies on the open market - the corporate HR benefits department does it. - Various other regulatory systems create massive profits (insurance margins are capped, but in gross their profits are huge; Pharma is hugely profitable, even after accounting for R&D/approval costs) - Medical doctors are paid extremely well. Average salary for a GP is over $250k US. Across all specialities, it's over $350k. Even accounting for the cost of medical school and low income during residency, they do very well. Most of the surgical specialists are $500k or more annually. We seem to get the worst of all systems here. The downsides of strictly capitalist/free-market system plus the downsides of a strictly nationalized system. It works really well for the upper-middle-class (as long as you stay employed) and wealthy, but barely works at all for everybody else.

alistairSH 3y ago

The cost part is complicated. Despite claims from the right, we don't have a free market for healthcare (in no particular order)... - The number of new doctors is tightly controlled via the residency program. In the past, the American Medical Assoc has lobbied to have those positions capped (though now there's enough of a shortage that the AMA is lobbying for more positions). The residency slots are funded by the federal government, not the medical schools/hospitals that run them. - Every new healthcare facility goes through a local need analysis. There is always pressure from existing facilities to deny expanded need (this impacts things like MRIs - they're expensive because there are fewer than the market optimum number). - Insurance divorces the consumer from the real cost. Further exacerbated because insurance is usually funded pre-tax by a person's employer (vs post tax from the employee's income). - Insurance is coupled to employment - consumers can't pick and choose policies on the open market - the corporate HR benefits department does it. - Various other regulatory systems create massive profits (insurance margins are capped, but in gross their profits are huge; Pharma is hugely profitable, even after accounting for R&D/approval costs) - Medical doctors are paid extremely well. Average salary for a GP is over $250k US. Across all specialities, it's over $350k. Even accounting for the cost of medical school and low income during residency, they do very well. Most of the surgical specialists are $500k or more annually. We seem to get the worst of all systems here. The downsides of strictly capitalist/free-market system plus the downsides of a strictly nationalized system. It works really well for the upper-middle-class (as long as you stay employed) and wealthy, but barely works at all for everybody else.