8 ms·

The US spends far more per-capita on healthcare than other OECD nations [1] and has objectively less coverage and worse outcomes [2]. Buying up property then l

by jmyeet 1y ago

The US spends far more per-capita on healthcare than other OECD nations [1] and has objectively less coverage and worse outcomes [2]. Buying up property then leasing it back is straight from the private equity playbook. It almost always ends badly. And it's driving up the cost of everything. Hospitals, vets, housing, etc. At some point you have to realize that the only innovation under capitalism is building enclosures and rent-seeking. Whereas in China, a command economy, they've built 20,000km+ of high speed rail in <20 years and just unveiled a 600kmh maglev train (note: that's faster than commercial aircraft) that will go from beijing to Shangai, over 1000km, in 2.5 hours. The US government, regardless of party, operates to transfer wealth from the young and poor to the old and wealthy, and the "old" part is on shaky ground. And it can't go on like this. I think by 2100 we'll see a collapse of this system, the kind that ends in land reform, guillotines, nationalization and sovereign debt default. [1]: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#Health%20expenditures%20per%20capita,%20U.S.%20dollars,%202023%20(current%20prices%20and%20PPP%20adjusted) https://www.healthsystemtracker.org/chart-collection/health-... [2]: https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 https://www.commonwealthfund.org/publications/issue-briefs/2...

jjice 1y ago
Why do we spend so much and still have such a busted system? Is it that the money goes towards price gouged services, or Americans have bad preventative health practices? Other things? Likely a combination of a lot?
- votepaunchy 1y ago
  Yes, from what I have read it is that Americans pay for more for doctors, drugs, and services. And when attempts are made to begin to curtail these costs, the lobbyists swoop in and buy off our politicians.
- victorbjorklund 1y ago
  Americans also consume a lot more healthcare than others. Yes, if you are poor and uninsured in US it sucks. But americans go way more to the doctor and wait less in time than in Europe.
  - masfuerte 1y ago
    Sure, you wait less time per visit but you spend far more time overall on medical nonsense for worse outcomes. What is the point?
    - victorbjorklund 1y ago
      In Sweden we can wait 6 months for a doctors visit. My impression is americans expect same day visit.
      - const_cast 1y ago
        Okay, but you understand this isn't actually beneficial, right? Because American spend more, but Sweden has significantly better healthcare outcomes. So the American system is just worse, period. Also: on the topic of same-day visits because I think there's some confusion here. American can, maybe, get same-day visits if and only if they have a PCP, which is increasingly rare. Your PCP cannot do jack fucking shit. At best, they can swab your throat. Every type of condition management outside of Strep MUST go to a specialist. Your tummy been hurting a lot? That's a job for a gastroenterologist, not your PCP. For specialists, it's not uncommon to wait many months or even a year. Especially because most insurance plans require a referral - so you have to see two doctors.
  - theragra 1y ago
    Weirdly, my sister in the US with good insurance waits more then I do in my post Soviet country. Although I have insurance and money to skip the lines. Still, I was surprised to hear how much she waits.
  - jmyeet 1y ago
    Yeah, um, citation needed. As one counterexample, there is a statistically significant spike in cancer diagnoses in the US at age 65 [1]. Why? Because people are on Medicare then so they finally go see a doctor. Another: the US is the worst for wait times [2]. The US has almost the lowest rate of annual doctor visits of any country, in large part due to lack of access and cost [3]. [1]: https://med.stanford.edu/news/all-news/2021/03/Cancer-diagnoses-implies-patients-wait-for-Medicare.html https://med.stanford.edu/news/all-news/2021/03/Cancer-diagno... [2]: https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country https://worldpopulationreview.com/country-rankings/health-ca... [3]: https://www.visualcapitalist.com/ranked-how-often-people-go-to-the-doctor-by-country/ https://www.visualcapitalist.com/ranked-how-often-people-go-...
- toast0 1y ago
  We spend so much because mostly we're spending other people's money, and no party is really in a position where cost control is possible and beneficial. The patient might prefer to pay less out of pocket, but they often aren't presented with cost information until a month after the service. Often nobody can tell you how much something costs before hand. Anyway, there is incentive to get more covered care, because insurance is paying for most of it. Insurance companies are generally limited on administrative costs and profit to a % of medical costs. More costs allowd them to pay higher executive salaries and profits. Insurance companies do have a cost control function, but the incentive isn't there to do it well. Individual practitioners and medicial facilities and facility groups have incentive to bill more things. People paying for the insurance, which is often employers, do have cost control incentives, but things are pretty murky at that level. Somewhere in all of those costs, we're paying for an army of billing specialists and an army of claims handlers. Throwing out insurance and moving to billing at time of service would be terrible for access but it would make cost control a lot more possible. Single payer systems can make cost control possible too, if the single payer system is able to do analysis and effectively set policies to avoid things that are not cost effective, and curtail billing abuses... Of course, nobody likes it when cost control says the thing they want to do isn't cost effective and they can't do it.
- QuadmasterXLII 1y ago
  We have a shitty universal healthcare system where the destitute get unlimited healthcare but only at emergency rooms, which is both extremely expensive and not that effective at making them healthy compared to e.g. regular primary care visits with free insulin and antipsychotics. The unpaid emergency rooms bills bring the hospital down and they have to take it out on the middle 50%
  - QuadmasterXLII 1y ago
    No money and diabetes? You can’t walk in to a Walgreens and get free no questions asked insulin, but you can absolutely pass out in a walgreens and get a ride to the hospital, diagnostics, and insulin (a $7000 value) and when a habit of this doesn’t keep your diabetes in check, they’ll do the amputation for you too ($50,000 a foot!)
- antisthenes 1y ago
  Extractive capitalism makes number go up. Bigger number better. Why don't you think of the poor anesthesiologists, hospital admins and insurance execs? Those yachts and 2nd vacation homes won't buy themselves.
gruez 1y ago
>Whereas in China, a command economy, they've built 20,000km+ of high speed rail in <20 years and just unveiled a 600kmh maglev train (note: that's faster than commercial aircraft) that will go from beijing to Shangai, over 1000km, in 2.5 hours. It's less because China is a command economy (ie. the government determines the allocation of capital), and more to do with the fact that it's an authoritarian state where the local population and interest groups basically has zero ability to object/block construction projects.
- jeroenhd 1y ago
  There are plenty of examples of invidiuals who do object. However, unlike in other countries, developers and the government are free to bully them and ruin their lives for daring not to sell their homes. Plenty of examples of houses in the middle of highways (one famously literally in the middle of the road), packed between huge flats, in the middle of active construction sites, placed on top of huge hills or pits when land height is altered, and other places where you'd never want to live. That said, the Chinese state is also doing this by spending a lot of money on infrastructure. This isn't unlike what the west did when everybody got electricity, phone lines, clean water, sewers, heating, and things like bridges and infrastructure. Of course the government helped rollout of rail infrastructure in populated areas by creating the necessary laws and ordinances (less populated land was still cheap enough that companies could just buy land). That approach worked fine, until populations grew so there was less cheap land and property became a method of investment that drove up prices to a ridiculous degree. My country's rail network has been reduced to the essentials, after several mergers and services that became unprofitable were shut down (despite them working fine as independent companies). Building new rail now takes decades of negotiations instead of a few years of laying tracks, if funding can even be secured, as politicians seem to hate the idea of investing in public transport when we could add Just One More Land. The entire system has been clogged. The authoritarian system is one way to work around the problems of modern high-density society, but it's not necessarily the only way. The trouble lies in convincing enough people to accept the downsides, and to stop the greedy fraudsters from bleeding any development plan dry in any way they can.
- ceejayoz 1y ago
  The line between "authoritarian state" and "entire region run by NIMBYs" can be… blurry.

by jmyeet 1y ago

jjice 1y ago

Why do we spend so much and still have such a busted system? Is it that the money goes towards price gouged services, or Americans have bad preventative health practices? Other things? Likely a combination of a lot?

votepaunchy 1y ago
Yes, from what I have read it is that Americans pay for more for doctors, drugs, and services. And when attempts are made to begin to curtail these costs, the lobbyists swoop in and buy off our politicians.
victorbjorklund 1y ago
Americans also consume a lot more healthcare than others. Yes, if you are poor and uninsured in US it sucks. But americans go way more to the doctor and wait less in time than in Europe.
- masfuerte 1y ago
  Sure, you wait less time per visit but you spend far more time overall on medical nonsense for worse outcomes. What is the point?
  - victorbjorklund 1y ago
    In Sweden we can wait 6 months for a doctors visit. My impression is americans expect same day visit.
    - const_cast 1y ago
      Okay, but you understand this isn't actually beneficial, right? Because American spend more, but Sweden has significantly better healthcare outcomes. So the American system is just worse, period. Also: on the topic of same-day visits because I think there's some confusion here. American can, maybe, get same-day visits if and only if they have a PCP, which is increasingly rare. Your PCP cannot do jack fucking shit. At best, they can swab your throat. Every type of condition management outside of Strep MUST go to a specialist. Your tummy been hurting a lot? That's a job for a gastroenterologist, not your PCP. For specialists, it's not uncommon to wait many months or even a year. Especially because most insurance plans require a referral - so you have to see two doctors.
- theragra 1y ago
  Weirdly, my sister in the US with good insurance waits more then I do in my post Soviet country. Although I have insurance and money to skip the lines. Still, I was surprised to hear how much she waits.
- jmyeet 1y ago
  Yeah, um, citation needed. As one counterexample, there is a statistically significant spike in cancer diagnoses in the US at age 65 [1]. Why? Because people are on Medicare then so they finally go see a doctor. Another: the US is the worst for wait times [2]. The US has almost the lowest rate of annual doctor visits of any country, in large part due to lack of access and cost [3]. [1]: https://med.stanford.edu/news/all-news/2021/03/Cancer-diagnoses-implies-patients-wait-for-Medicare.html https://med.stanford.edu/news/all-news/2021/03/Cancer-diagno... [2]: https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country https://worldpopulationreview.com/country-rankings/health-ca... [3]: https://www.visualcapitalist.com/ranked-how-often-people-go-to-the-doctor-by-country/ https://www.visualcapitalist.com/ranked-how-often-people-go-...
toast0 1y ago
We spend so much because mostly we're spending other people's money, and no party is really in a position where cost control is possible and beneficial. The patient might prefer to pay less out of pocket, but they often aren't presented with cost information until a month after the service. Often nobody can tell you how much something costs before hand. Anyway, there is incentive to get more covered care, because insurance is paying for most of it. Insurance companies are generally limited on administrative costs and profit to a % of medical costs. More costs allowd them to pay higher executive salaries and profits. Insurance companies do have a cost control function, but the incentive isn't there to do it well. Individual practitioners and medicial facilities and facility groups have incentive to bill more things. People paying for the insurance, which is often employers, do have cost control incentives, but things are pretty murky at that level. Somewhere in all of those costs, we're paying for an army of billing specialists and an army of claims handlers. Throwing out insurance and moving to billing at time of service would be terrible for access but it would make cost control a lot more possible. Single payer systems can make cost control possible too, if the single payer system is able to do analysis and effectively set policies to avoid things that are not cost effective, and curtail billing abuses... Of course, nobody likes it when cost control says the thing they want to do isn't cost effective and they can't do it.
QuadmasterXLII 1y ago
We have a shitty universal healthcare system where the destitute get unlimited healthcare but only at emergency rooms, which is both extremely expensive and not that effective at making them healthy compared to e.g. regular primary care visits with free insulin and antipsychotics. The unpaid emergency rooms bills bring the hospital down and they have to take it out on the middle 50%
- QuadmasterXLII 1y ago
  No money and diabetes? You can’t walk in to a Walgreens and get free no questions asked insulin, but you can absolutely pass out in a walgreens and get a ride to the hospital, diagnostics, and insulin (a $7000 value) and when a habit of this doesn’t keep your diabetes in check, they’ll do the amputation for you too ($50,000 a foot!)
antisthenes 1y ago
Extractive capitalism makes number go up. Bigger number better. Why don't you think of the poor anesthesiologists, hospital admins and insurance execs? Those yachts and 2nd vacation homes won't buy themselves.

gruez 1y ago

>Whereas in China, a command economy, they've built 20,000km+ of high speed rail in <20 years and just unveiled a 600kmh maglev train (note: that's faster than commercial aircraft) that will go from beijing to Shangai, over 1000km, in 2.5 hours. It's less because China is a command economy (ie. the government determines the allocation of capital), and more to do with the fact that it's an authoritarian state where the local population and interest groups basically has zero ability to object/block construction projects.

jeroenhd 1y ago
There are plenty of examples of invidiuals who do object. However, unlike in other countries, developers and the government are free to bully them and ruin their lives for daring not to sell their homes. Plenty of examples of houses in the middle of highways (one famously literally in the middle of the road), packed between huge flats, in the middle of active construction sites, placed on top of huge hills or pits when land height is altered, and other places where you'd never want to live. That said, the Chinese state is also doing this by spending a lot of money on infrastructure. This isn't unlike what the west did when everybody got electricity, phone lines, clean water, sewers, heating, and things like bridges and infrastructure. Of course the government helped rollout of rail infrastructure in populated areas by creating the necessary laws and ordinances (less populated land was still cheap enough that companies could just buy land). That approach worked fine, until populations grew so there was less cheap land and property became a method of investment that drove up prices to a ridiculous degree. My country's rail network has been reduced to the essentials, after several mergers and services that became unprofitable were shut down (despite them working fine as independent companies). Building new rail now takes decades of negotiations instead of a few years of laying tracks, if funding can even be secured, as politicians seem to hate the idea of investing in public transport when we could add Just One More Land. The entire system has been clogged. The authoritarian system is one way to work around the problems of modern high-density society, but it's not necessarily the only way. The trouble lies in convincing enough people to accept the downsides, and to stop the greedy fraudsters from bleeding any development plan dry in any way they can.
ceejayoz 1y ago
The line between "authoritarian state" and "entire region run by NIMBYs" can be… blurry.