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> Why does each of these cost tens or hundreds of thousands of dollars? Because money is just a tool for allocating resources. And having well trained people w

> Why does each of these cost tens or hundreds of thousands of dollars? Because money is just a tool for allocating resources. And having well trained people with equipment ready to attend to every person in that situation requires a lot of resources. I’m not justifying our systems inefficiency - let’s just be clear that medical care costs a lot of money. So the challenging political question is how to manage access and costs (often devolves into rationing) and who should pay for it.

liontwist 2y ago
Note that what constitutes healthcare is culturally defined. Different groups have varying expectations of procedures which is then conflated with other services. When my baby was born my wife and I stayed in the hospital for two nights during which we received constant checks and meals. I was ready to go because my baby was healthy and I knew it was expensive. Is this level of service required medical care? I don’t think so. Many choose to have a medical professional at home to help with a delivery for a day or so. If it is deemed required, how many nights should be offered? I’m sure people with a bad home environment would stay as long as they could. If we set a hard cap of a few days, that’s also bad because some babies need to be at the hospital and it’s very helpful to have that. Alternatively imagine if the beds are occupied who don’t really need to be there and then a new baby needs to be born?
jack_h 2y ago
> Because money is just a tool for allocating resources. > often devolves into rationing Just to expand upon what you're saying a bit; most people don't view things in such terms which I think is unfortunate. You often see discussions about waiting times in single payer healthcare systems and cost in more free-market systems. The fact of the matter is that if demand is greater than supply you must ration the supply somehow. Prices are one way but not the only way. Waiting lines, by need, randomly, etc... are all valid rationing mechanisms as well. What I've noticed is that when people don't view this is a resource allocation problem they are able to always see the greener grass somewhere else. They see the lack of treatment of a person or group of persons as a failing of their system where those people would have received treatment in a different system that uses a different rationing mechanism. The issue is that in a different system there would still be people who don't receive treatment, they would just be different people. By not viewing it as a resource allocation problem I think it gives the appearance that there is a perfect solution and that its just political will halting its implementation.
- ClumsyPilot 2y ago
  > if demand is greater than supply you must ration the supply somehow. This is logic of post-2008 fail-capitalism instead of 1970’s and China’s aspirational, problem solving capitalism. You don’t address shortages of healthcare, housing or food with an elegant and fair system to decide who starves and dies. You expand supply to make sure no one has to. You examine supply chain and figure out the bottlenecks. For example China has started mass producing MRI machines, that’s one way you adress a problem.
  - liontwist 2y ago
    > who starves and dies. It’s not a binary decision. Healthcare is a gradient of treatment options and outcomes. The concept you are missing is called economizing which includes substituting services, adjusting time preferences, sharing, expanding network of providers, etc. > post-2008 fail-capitalism You mean the one where government agencies were taking the risk of bad mortgages from sellers? We don’t have anything close to a capitalist market in healthcare or finance.
    - ClumsyPilot 2y ago
      Well we did have TrueCapitalism in the FreeBanking era where all banks could issue their own currency and they would go bust every Tuesday. https://en.wikipedia.org/wiki/Free_banking https://en.wikipedia.org/wiki/Free_banking
      - liontwist 2y ago
        From your own article: > Although the period from 1837 to 1864 in the US is often referred to as the Free Banking Era, the term is a misnomer in terms of the definition of "free banking" above. Free Banking in the United States before the Civil War refers to various state banking systems based on what were called "free banking" laws at the time. These laws made it necessary for new entrants to secure charters, each of which was subject to a vote by the state legislature with obvious opportunities for corruption. These general banking laws also restricted banks' activities in important ways.
DangitBobby 2y ago
We already are doing rationing, it's just the rations are distributed according to our class system instead of any reasonable metric. Everyone already pays for heavily for it, much more than necessary due to the grift. These things are conceptually simple and much easier for a bureaucracy to handle than the current dumpster fire. It's actually only impossibly hard for us to solve because entrenched power and corruption mean few politicians are actually particularly interested in making the changes necessary to fix it, and those who are are excluded from the democratic process by gatekeepers.
- liontwist 2y ago
  We are rationing. But not in the binary yes/no sense you will get from a bureaucracy designed flow chart. It’s economizing which allows substitution and sharing across supply and demand. At least you agree it’s a resource problem and we don’t have infinite healthcare. The point about rich folks being price insensitive is demonstrably false. One key here is that rich and reckless exists, but is a much rarer breed than rich and careful. > much easier for a bureaucracy to handle Navigating bureaucracy favors elite groups even more strongly as it requires education in law, politics, and communication skills most lacked by disadvantaged groups. The biggest problem is if your voice isn’t loud enough you literally have no alternative. The insurance pleading nightmare is exactly this system. They are a rationing bureaucrat. The US has unique demographic problems where the bottom quartile of health and well being demand most healthcare resources. So the sales pitch for European style healthcare sounds like “we are going to make everything slightly worse for responsible people and remove higher end options, so we can better cover super users”.
  - DangitBobby 2y ago
    > The US has unique demographic problems where the bottom quartile of health and well being demand most healthcare resources. This is not a unique problem. The sickly and elderly always consume much more medical resources than the healthy. > slightly worse for responsible people You mean people with money. And for all the problems the EU countries medical systems have, I've never heard a European say they'd prefer the American system.

liontwist 2y ago

Note that what constitutes healthcare is culturally defined. Different groups have varying expectations of procedures which is then conflated with other services. When my baby was born my wife and I stayed in the hospital for two nights during which we received constant checks and meals. I was ready to go because my baby was healthy and I knew it was expensive. Is this level of service required medical care? I don’t think so. Many choose to have a medical professional at home to help with a delivery for a day or so. If it is deemed required, how many nights should be offered? I’m sure people with a bad home environment would stay as long as they could. If we set a hard cap of a few days, that’s also bad because some babies need to be at the hospital and it’s very helpful to have that. Alternatively imagine if the beds are occupied who don’t really need to be there and then a new baby needs to be born?

jack_h 2y ago

> Because money is just a tool for allocating resources. > often devolves into rationing Just to expand upon what you're saying a bit; most people don't view things in such terms which I think is unfortunate. You often see discussions about waiting times in single payer healthcare systems and cost in more free-market systems. The fact of the matter is that if demand is greater than supply you must ration the supply somehow. Prices are one way but not the only way. Waiting lines, by need, randomly, etc... are all valid rationing mechanisms as well. What I've noticed is that when people don't view this is a resource allocation problem they are able to always see the greener grass somewhere else. They see the lack of treatment of a person or group of persons as a failing of their system where those people would have received treatment in a different system that uses a different rationing mechanism. The issue is that in a different system there would still be people who don't receive treatment, they would just be different people. By not viewing it as a resource allocation problem I think it gives the appearance that there is a perfect solution and that its just political will halting its implementation.

ClumsyPilot 2y ago
> if demand is greater than supply you must ration the supply somehow. This is logic of post-2008 fail-capitalism instead of 1970’s and China’s aspirational, problem solving capitalism. You don’t address shortages of healthcare, housing or food with an elegant and fair system to decide who starves and dies. You expand supply to make sure no one has to. You examine supply chain and figure out the bottlenecks. For example China has started mass producing MRI machines, that’s one way you adress a problem.
- liontwist 2y ago
  > who starves and dies. It’s not a binary decision. Healthcare is a gradient of treatment options and outcomes. The concept you are missing is called economizing which includes substituting services, adjusting time preferences, sharing, expanding network of providers, etc. > post-2008 fail-capitalism You mean the one where government agencies were taking the risk of bad mortgages from sellers? We don’t have anything close to a capitalist market in healthcare or finance.
  - ClumsyPilot 2y ago
    Well we did have TrueCapitalism in the FreeBanking era where all banks could issue their own currency and they would go bust every Tuesday. https://en.wikipedia.org/wiki/Free_banking https://en.wikipedia.org/wiki/Free_banking
    - liontwist 2y ago
      From your own article: > Although the period from 1837 to 1864 in the US is often referred to as the Free Banking Era, the term is a misnomer in terms of the definition of "free banking" above. Free Banking in the United States before the Civil War refers to various state banking systems based on what were called "free banking" laws at the time. These laws made it necessary for new entrants to secure charters, each of which was subject to a vote by the state legislature with obvious opportunities for corruption. These general banking laws also restricted banks' activities in important ways.

DangitBobby 2y ago

We already are doing rationing, it's just the rations are distributed according to our class system instead of any reasonable metric. Everyone already pays for heavily for it, much more than necessary due to the grift. These things are conceptually simple and much easier for a bureaucracy to handle than the current dumpster fire. It's actually only impossibly hard for us to solve because entrenched power and corruption mean few politicians are actually particularly interested in making the changes necessary to fix it, and those who are are excluded from the democratic process by gatekeepers.

liontwist 2y ago
We are rationing. But not in the binary yes/no sense you will get from a bureaucracy designed flow chart. It’s economizing which allows substitution and sharing across supply and demand. At least you agree it’s a resource problem and we don’t have infinite healthcare. The point about rich folks being price insensitive is demonstrably false. One key here is that rich and reckless exists, but is a much rarer breed than rich and careful. > much easier for a bureaucracy to handle Navigating bureaucracy favors elite groups even more strongly as it requires education in law, politics, and communication skills most lacked by disadvantaged groups. The biggest problem is if your voice isn’t loud enough you literally have no alternative. The insurance pleading nightmare is exactly this system. They are a rationing bureaucrat. The US has unique demographic problems where the bottom quartile of health and well being demand most healthcare resources. So the sales pitch for European style healthcare sounds like “we are going to make everything slightly worse for responsible people and remove higher end options, so we can better cover super users”.
- DangitBobby 2y ago
  > The US has unique demographic problems where the bottom quartile of health and well being demand most healthcare resources. This is not a unique problem. The sickly and elderly always consume much more medical resources than the healthy. > slightly worse for responsible people You mean people with money. And for all the problems the EU countries medical systems have, I've never heard a European say they'd prefer the American system.