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The bizarre thing is that the problems are fixable. The federal government already spends more per capita on healthcare than other developed countries, just tha

The bizarre thing is that the problems are fixable. The federal government already spends more per capita on healthcare than other developed countries, just that our healthcare is so much more expensive and for no good reason.

nradov 2y ago
Our healthcare system, to the extent that it was intentionally designed at all, implicitly prioritizes consumer choice and immediate access over cost efficiency. While there are certainly gaps in access and affordability, the typical middle-class voter can still get elective care quickly from a variety of local providers. Most other developed countries have longer queues or certain services are less available. We also subsidize drug development costs for the rest of the world. Whether those are good reasons for paying more is a matter of opinion. Of course there's also a certain amount of waste, fraud, and abuse that inflate our costs. https://peterattiamd.com/saumsutaria/ https://peterattiamd.com/saumsutaria/
- amrocha 2y ago
  The US certainly does not subsidize drugs for the rest of the world. It literally would rather enforce patents than save lives. And there are no long queues for healthcare where I live. Service is cheap and insurance is nationalized.
  - sib 2y ago
    > The US certainly does not subsidize drugs for the rest of the world. It literally does. The costs of producing drugs are mostly borne by the US market, allowing drug manufacturers to charge less elsewhere while still investing the billions of dollars necessary to develop the drugs.
    - amrocha 2y ago
      If you think that’s for the benefit of the rest of the world then I’ve got a bridge to sell you.
      - nradov 2y ago
        No one claimed that it's for the benefit of the rest of the world. But the reality is that if US drug prices were fixed by the government at lower levels then there would be less new drug development. The US develops around 75% of world's new drugs. Would you prefer to have fewer new drugs going forward?
        amrocha 2y ago
        [flagged]
        sib 2y ago
        Nope. Nobody changed the argument. No one said "USA subsidizes drug development out of a societal sense of charitable obligation to the rest of the world." It just so happens that - due to the unfortunate design of our system - the rest of the world is receiving a subsidy. In fact, there are European-HQ'd pharma companies that also make the lion's share of their profits in the US - so that's certainly not benefiting the US.
        amrocha 2y ago
        It’s not the rest of the world getting subsidized, it’s pharmaceutical companies. The rest of the world is getting fleeced trying to buy vaccines. If your government wants to give even more profits to big pharma then go ahead, just don’t claim everyone else should be thankful.
        buttercraft 2y ago
        > just don’t claim everyone else should be thankful. They did not claim that. >> it’s good to let people die because they’re poor They didn't say that either. What dishonest responses...
    - paulsutter 2y ago
      Interesting - Why doesn’t this happen in other fields? Why don’t we pay 10x more for iPhones? - When did the american public chose to engage in this magnanimous largesse? More likely it’s a scam and regulatory capture
      - 0xDEAFBEAD 2y ago
        Economists, and pharma lobbyists, argue against US drug price regulation because new drugs produce large positive externalities. I think it's a mix of pharma lobbying and also altruism. Pharma lobbies Congress to do the altruistic thing, and many Congresspeople agree, because they believe in markets and understand incentives.
        paulsutter 2y ago
        I’m arguing AGAINST the drug price regulation that allows pricing to be much higher in the US For example the prohibition on importing drugs from other countries, or the rules that prevent medicare from negotiating price for drugs
- techdmn 2y ago
  You left out one of the most important products of our system, profits!
Maarten88 2y ago
> much more expensive and for no good reason There is a good reason: profits and management pay. And greed is good, right? > the problems are fixable Fixable in theory. The US would first have to fix the underlying issue, which i.m.o. is government, media and even judicial capture by financial interests. Billionaires are now openly buying "shares" in those. I don't see any sign of it changing anytime soon. It only seems to get worse.
- sgerenser 2y ago
  It's not just profits and management. Administrators, nurses, and yes, definitely doctors, get paid far higher in the U.S. than in other countries. Who wants to be the one to say we need to cut staff, and cut wages for nurses and doctors, in order to bring down costs? Just cutting fat from insurance companies, or having the government step in as insurer with no other changes, wouldn't move the needle much.
  - Maarten88 2y ago
    I'm pretty sure healthcare costs in the US are also higher as a percentage of GDP compared to EU, so higher wages would not explain the difference. Also productivity should be higher? I think pharmaceutical, hospital, insurance and legal companies take all the money.
  - paulsutter 2y ago
    Doctor and nurse pay is like 13% of costs. Massive savings are elsewhere
    - sgerenser 2y ago
      Yes there’s tons of overhead and extra costs, but it isn’t mostly at the insurance company level. It’s spread all around the system, that was my point. There’s no one “quick fix” that leaves everyone with the same job and fat salary as they had before.
      - 2y ago

nradov 2y ago

Our healthcare system, to the extent that it was intentionally designed at all, implicitly prioritizes consumer choice and immediate access over cost efficiency. While there are certainly gaps in access and affordability, the typical middle-class voter can still get elective care quickly from a variety of local providers. Most other developed countries have longer queues or certain services are less available. We also subsidize drug development costs for the rest of the world. Whether those are good reasons for paying more is a matter of opinion. Of course there's also a certain amount of waste, fraud, and abuse that inflate our costs. https://peterattiamd.com/saumsutaria/ https://peterattiamd.com/saumsutaria/

amrocha 2y ago
The US certainly does not subsidize drugs for the rest of the world. It literally would rather enforce patents than save lives. And there are no long queues for healthcare where I live. Service is cheap and insurance is nationalized.
- sib 2y ago
  > The US certainly does not subsidize drugs for the rest of the world. It literally does. The costs of producing drugs are mostly borne by the US market, allowing drug manufacturers to charge less elsewhere while still investing the billions of dollars necessary to develop the drugs.
  - amrocha 2y ago
    If you think that’s for the benefit of the rest of the world then I’ve got a bridge to sell you.
    - nradov 2y ago
      No one claimed that it's for the benefit of the rest of the world. But the reality is that if US drug prices were fixed by the government at lower levels then there would be less new drug development. The US develops around 75% of world's new drugs. Would you prefer to have fewer new drugs going forward?
      - amrocha 2y ago
        [flagged]
        sib 2y ago
        Nope. Nobody changed the argument. No one said "USA subsidizes drug development out of a societal sense of charitable obligation to the rest of the world." It just so happens that - due to the unfortunate design of our system - the rest of the world is receiving a subsidy. In fact, there are European-HQ'd pharma companies that also make the lion's share of their profits in the US - so that's certainly not benefiting the US.
        amrocha 2y ago
        It’s not the rest of the world getting subsidized, it’s pharmaceutical companies. The rest of the world is getting fleeced trying to buy vaccines. If your government wants to give even more profits to big pharma then go ahead, just don’t claim everyone else should be thankful.
        buttercraft 2y ago
        > just don’t claim everyone else should be thankful. They did not claim that. >> it’s good to let people die because they’re poor They didn't say that either. What dishonest responses...
  - paulsutter 2y ago
    Interesting - Why doesn’t this happen in other fields? Why don’t we pay 10x more for iPhones? - When did the american public chose to engage in this magnanimous largesse? More likely it’s a scam and regulatory capture
    - 0xDEAFBEAD 2y ago
      Economists, and pharma lobbyists, argue against US drug price regulation because new drugs produce large positive externalities. I think it's a mix of pharma lobbying and also altruism. Pharma lobbies Congress to do the altruistic thing, and many Congresspeople agree, because they believe in markets and understand incentives.
      - paulsutter 2y ago
        I’m arguing AGAINST the drug price regulation that allows pricing to be much higher in the US For example the prohibition on importing drugs from other countries, or the rules that prevent medicare from negotiating price for drugs
techdmn 2y ago
You left out one of the most important products of our system, profits!

Maarten88 2y ago

> much more expensive and for no good reason There is a good reason: profits and management pay. And greed is good, right? > the problems are fixable Fixable in theory. The US would first have to fix the underlying issue, which i.m.o. is government, media and even judicial capture by financial interests. Billionaires are now openly buying "shares" in those. I don't see any sign of it changing anytime soon. It only seems to get worse.

sgerenser 2y ago
It's not just profits and management. Administrators, nurses, and yes, definitely doctors, get paid far higher in the U.S. than in other countries. Who wants to be the one to say we need to cut staff, and cut wages for nurses and doctors, in order to bring down costs? Just cutting fat from insurance companies, or having the government step in as insurer with no other changes, wouldn't move the needle much.
- Maarten88 2y ago
  I'm pretty sure healthcare costs in the US are also higher as a percentage of GDP compared to EU, so higher wages would not explain the difference. Also productivity should be higher? I think pharmaceutical, hospital, insurance and legal companies take all the money.
- paulsutter 2y ago
  Doctor and nurse pay is like 13% of costs. Massive savings are elsewhere
  - sgerenser 2y ago
    Yes there’s tons of overhead and extra costs, but it isn’t mostly at the insurance company level. It’s spread all around the system, that was my point. There’s no one “quick fix” that leaves everyone with the same job and fat salary as they had before.
    - 2y ago