4 ms·

What's the path forward? Where do we go from here?

toomuchtodo 2y ago
Congress fixes this or we continue to drag ourselves towards worse failure modes.
AtlasBarfed 2y ago
So my four pigs analogy, where insurance companies, drug/device companies, doctors/hospitals, and lawyers all feed at the trough, increase costs and point to someone else (although I will admit lawyers are probably the smallest cost component and the most blamed by the other three). There is a fifth one that imposes costs: our comprehensively unhealthy food, health, and lifestyle in America that capitalism feeds upon with addictive high-margin food and drink, with overworked workers that can barely have time to raise kids (our healthy demographics are due to immigration) much less a healthy lifestyle. The entertainment complex certainly doesn't help either. Providers: you need comprehensive family care to avoid specialist care being needed, an increase in supply of doctors, decreasing their educational loan burden (which strongly incentivizes specializataion, and a system that involves specialists). I think advanced AI systems can do much more day-to-day tracking and diagnosis/information, but of course that is a personal information nightmare. Actually I don't mean advanced. I think current AI is plenty good enough. Unfortunately only insurance companies will employ these systems or pay for them. Insurance: Probably need a medicare-for-all option. We were close to this with Obamacare but FUCKING JOE LIEBERMAN killed it. Exhibit A in why the Democrats with full control of government will never get anything done. Drug/Device companies: reduce patents, I don't know, maybe allow price negotiation (which is just mind blowing in a "free market" economy), reform the FDA to make bringing drugs to market cheaper. Lawyers: caps caps caps so there isn't costly malpractice insurance. Maybe would also necessitate a federal review board to weed out "bad doctors". But the biggest is probably governmental direction to actually get people to be able to eat and live active lives. Maybe GLP-1 will help, but the quiet time bomb of increasing obesity in Americans each decade is probably a sneaky large amount of our costs. Otherwise, on the nihilistic side, keep doing whatever our society is doing which is causing men to kill themselves in huge rates (soma ... uh... I mean opioids were also doing this as well) before they reach their ultra-expensive late stage of life. Anyway, none of that is happening (except, sadly, the nihilistic solution is the most realistically happening). Maybe setup huge provider networks across the border in Mexico and Canada served by high speed transit, so large portions of the world get health maintenance in functioning health care systems, and only do hospitalization and emergency care here?
- basementcat 2y ago
  > reform the FDA to make bringing drugs to market cheaper. We recently tried this with some vaccines and now a large segment of the population is now vaccine-hesitant. https://pmc.ncbi.nlm.nih.gov/articles/PMC10257562/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10257562/ > Lawyers: caps caps caps so there isn’t costly malpractice insurance. Caps don’t always result in improved health outcomes. https://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?params=/context/facpub/article/2140/&path_info=121120_zeiler_hardcastle_caps_chapter_SSRN.pdf https://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?p... > Maybe would also necessitate a federal review board to weed out "bad doctors". This exists; each state medical board has a procedure for reviewing medical licenses. https://www.mbc.ca.gov/ https://www.mbc.ca.gov/
  - sverhagen 2y ago
    Didn't Jon Oliver do a bit on those review boards, pointing out how friendly to fellow doctors they generally are? I think when someone says that we need "a (federal) review board", I think they mean one that works, one with teeth.
  - franktankbank 2y ago
    > We recently tried this with some vaccines and now a large segment of the population is now vaccine-hesitant. Forced vaccination was the problem here.
- forgetfreeman 2y ago
  > reform the FDA to make bringing drugs to market cheaper. Uh, definitely not. The drug discovery and trial process is every bit as complex and expensive as it is for a reason. If you're serious about lowering the cost of getting compounds through the pipeline the first thing that should go is private equity's growing chokehold on the provider practices that perform clinical studies.
blindriver 2y ago
Dump $1 trillion into Kaiser and push it out to all 50 states. I have it in Bay Area and it’s mostly been great for me. It’s not the best but it also gets 90% of things right.
- toast0 2y ago
  Kaiser is the one thing I miss the most having left the Bay Area. It has sort of moved in here, but it took over an existing group and afaik, it's not really integrated like it was down there; there's no Kaiser hospitals here, so hospital care is going to be a mess, and I'm not sure if they have pharmacies either. But, a lot of people don't like Kaiser. You have to be ok with getting good enough care, and not really be trying to seek 'the best' care. Integration is so nice though. I'm sure Kaiser never puts you in the situation where the Dr says I'm not sure which drug will be covered, let's try A, the pharmacist says A isn't covered, ask your Dr to write a script for B, and your Dr doesn't answer the phone so you have to decide to either pay $250 for A or wait over the weekend to start your kid's treatment.
- deleted 2y ago
  [deleted]
- asadotzler 2y ago
  There was a study comparing Kaiser Permanente with the UK's National Health Service (NHS) that found Kaiser achieved better performance at roughly the same cost. If we could use tax dollars to make Kaiser national, and scale that large without losing the efficiency and results, we'd be in darned good shape. Eliminate other private health insurance and if people want above and beyond service they can negotiate directly with providers and pay out of pocket for that.
  - Angostura 2y ago
    > There was a study comparing Kaiser Permanente with the UK's National Health Service (NHS) that found Kaiser achieved better performance at roughly the same cost. Linky?
  - tonyedgecombe 2y ago
whoitwas 2y ago
Educate humans (not possible because they have to want to learn). Abolish Citizens United. Stop funding insurance. Put the insurance money to healthcare for all.
jmye 2y ago
Vote and legislate. Doesn’t even have to be federal, since the exchanges are state run. But it’s a highly regulated industry (for good reason, this isn’t a place where deleting laws helps normal people), so you have to fix the regulation. The ACA killing pre-existing coverage denials was a great start, but you have to fix risk adjustment before anything else can happen, as it’s literally just a wealth transfer from new entrants to existing behemoths (I think it was well intentioned, and works well in MA, but is completely broken in the commercial market). Reinsurance fixes to address the fund lockup would also probably help, but they’d be tax-expensive and probably untenable. But it all starts with voting for people who want to fix it, and not for people who just want to burn it down or maintain the status quo.
dennis_jeeves2 2y ago
Will be consider mostly irrational, but I'll mention it: Learn medicine, and practice outside of of the mainstream clandestinely (a past real world example would be abortion clinics on ships). It needs a group of committed/smart people to pull it off, so not easy. Also it cannot be offered to the public at large for several obvious reasons. As a general rule one cannot involve 'average' people in such an endeavor. All organization settle down to the lowest common denominator. When it come to large organizations in govt/health/etc. they are prone to increasing corruption and bureaucracy if average people are involved.

Congress fixes this or we continue to drag ourselves towards worse failure modes.

So my four pigs analogy, where insurance companies, drug/device companies, doctors/hospitals, and lawyers all feed at the trough, increase costs and point to someone else (although I will admit lawyers are probably the smallest cost component and the most blamed by the other three). There is a fifth one that imposes costs: our comprehensively unhealthy food, health, and lifestyle in America that capitalism feeds upon with addictive high-margin food and drink, with overworked workers that can barely have time to raise kids (our healthy demographics are due to immigration) much less a healthy lifestyle. The entertainment complex certainly doesn't help either. Providers: you need comprehensive family care to avoid specialist care being needed, an increase in supply of doctors, decreasing their educational loan burden (which strongly incentivizes specializataion, and a system that involves specialists). I think advanced AI systems can do much more day-to-day tracking and diagnosis/information, but of course that is a personal information nightmare. Actually I don't mean advanced. I think current AI is plenty good enough. Unfortunately only insurance companies will employ these systems or pay for them. Insurance: Probably need a medicare-for-all option. We were close to this with Obamacare but FUCKING JOE LIEBERMAN killed it. Exhibit A in why the Democrats with full control of government will never get anything done. Drug/Device companies: reduce patents, I don't know, maybe allow price negotiation (which is just mind blowing in a "free market" economy), reform the FDA to make bringing drugs to market cheaper. Lawyers: caps caps caps so there isn't costly malpractice insurance. Maybe would also necessitate a federal review board to weed out "bad doctors". But the biggest is probably governmental direction to actually get people to be able to eat and live active lives. Maybe GLP-1 will help, but the quiet time bomb of increasing obesity in Americans each decade is probably a sneaky large amount of our costs. Otherwise, on the nihilistic side, keep doing whatever our society is doing which is causing men to kill themselves in huge rates (soma ... uh... I mean opioids were also doing this as well) before they reach their ultra-expensive late stage of life. Anyway, none of that is happening (except, sadly, the nihilistic solution is the most realistically happening). Maybe setup huge provider networks across the border in Mexico and Canada served by high speed transit, so large portions of the world get health maintenance in functioning health care systems, and only do hospitalization and emergency care here?

basementcat 2y ago
> reform the FDA to make bringing drugs to market cheaper. We recently tried this with some vaccines and now a large segment of the population is now vaccine-hesitant. https://pmc.ncbi.nlm.nih.gov/articles/PMC10257562/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10257562/ > Lawyers: caps caps caps so there isn’t costly malpractice insurance. Caps don’t always result in improved health outcomes. https://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?params=/context/facpub/article/2140/&path_info=121120_zeiler_hardcastle_caps_chapter_SSRN.pdf https://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?p... > Maybe would also necessitate a federal review board to weed out "bad doctors". This exists; each state medical board has a procedure for reviewing medical licenses. https://www.mbc.ca.gov/ https://www.mbc.ca.gov/
- sverhagen 2y ago
  Didn't Jon Oliver do a bit on those review boards, pointing out how friendly to fellow doctors they generally are? I think when someone says that we need "a (federal) review board", I think they mean one that works, one with teeth.
- franktankbank 2y ago
  > We recently tried this with some vaccines and now a large segment of the population is now vaccine-hesitant. Forced vaccination was the problem here.
forgetfreeman 2y ago
> reform the FDA to make bringing drugs to market cheaper. Uh, definitely not. The drug discovery and trial process is every bit as complex and expensive as it is for a reason. If you're serious about lowering the cost of getting compounds through the pipeline the first thing that should go is private equity's growing chokehold on the provider practices that perform clinical studies.

blindriver 2y ago

Dump $1 trillion into Kaiser and push it out to all 50 states. I have it in Bay Area and it’s mostly been great for me. It’s not the best but it also gets 90% of things right.

toast0 2y ago
Kaiser is the one thing I miss the most having left the Bay Area. It has sort of moved in here, but it took over an existing group and afaik, it's not really integrated like it was down there; there's no Kaiser hospitals here, so hospital care is going to be a mess, and I'm not sure if they have pharmacies either. But, a lot of people don't like Kaiser. You have to be ok with getting good enough care, and not really be trying to seek 'the best' care. Integration is so nice though. I'm sure Kaiser never puts you in the situation where the Dr says I'm not sure which drug will be covered, let's try A, the pharmacist says A isn't covered, ask your Dr to write a script for B, and your Dr doesn't answer the phone so you have to decide to either pay $250 for A or wait over the weekend to start your kid's treatment.
deleted 2y ago
[deleted]
asadotzler 2y ago
There was a study comparing Kaiser Permanente with the UK's National Health Service (NHS) that found Kaiser achieved better performance at roughly the same cost. If we could use tax dollars to make Kaiser national, and scale that large without losing the efficiency and results, we'd be in darned good shape. Eliminate other private health insurance and if people want above and beyond service they can negotiate directly with providers and pay out of pocket for that.
- Angostura 2y ago
  > There was a study comparing Kaiser Permanente with the UK's National Health Service (NHS) that found Kaiser achieved better performance at roughly the same cost. Linky?
- tonyedgecombe 2y ago

whoitwas 2y ago

Educate humans (not possible because they have to want to learn). Abolish Citizens United. Stop funding insurance. Put the insurance money to healthcare for all.

jmye 2y ago

Vote and legislate. Doesn’t even have to be federal, since the exchanges are state run. But it’s a highly regulated industry (for good reason, this isn’t a place where deleting laws helps normal people), so you have to fix the regulation. The ACA killing pre-existing coverage denials was a great start, but you have to fix risk adjustment before anything else can happen, as it’s literally just a wealth transfer from new entrants to existing behemoths (I think it was well intentioned, and works well in MA, but is completely broken in the commercial market). Reinsurance fixes to address the fund lockup would also probably help, but they’d be tax-expensive and probably untenable. But it all starts with voting for people who want to fix it, and not for people who just want to burn it down or maintain the status quo.

dennis_jeeves2 2y ago

Will be consider mostly irrational, but I'll mention it: Learn medicine, and practice outside of of the mainstream clandestinely (a past real world example would be abortion clinics on ships). It needs a group of committed/smart people to pull it off, so not easy. Also it cannot be offered to the public at large for several obvious reasons. As a general rule one cannot involve 'average' people in such an endeavor. All organization settle down to the lowest common denominator. When it come to large organizations in govt/health/etc. they are prone to increasing corruption and bureaucracy if average people are involved.