3 ms·

We don’t have to imagine how Medicare works because it exists, so I don’t see the use of such analogies. I suspect that it’s mainly doctors who need to be more

by foldr 1y ago

We don’t have to imagine how Medicare works because it exists, so I don’t see the use of such analogies. I suspect that it’s mainly doctors who need to be more responsive to cost incentives as they’re often the ones recommending unnecessary tests or treatments.

whimsicalism 1y ago
My analogy is not with socialized healthcare but with the medicare scheme. Socialized healthcare works in lots of other countries due to a combination of rationing and (in the case of drug prices) prioritizing accessibility over R&D. > I suspect that it’s mainly doctors who need to be more responsive to cost incentives as they’re often the ones recommending unnecessary tests or treatments. Doctors would recommend fewer tests if their patients were more price sensitive, I think. I'm not sure a more direct route to making doctors price sensitive when they are on the provider-side, why would they want you to utilize less? There probably also needs to be malpractice/tort reform in the US.
- foldr 1y ago
  I edited my post to say Medicare shortly after your reply (sorry). But if there’s evidence that Medicare is especially profligate with unnecessary tests and treatments then you should give that evidence, rather than arguing by strained analogies.
  - whimsicalism 1y ago
    I think that analogies are helpful for elucidating the point but in terms of concrete evidence, there are two gold standard studies that really reveal this issue. These studies are very hard to come by because it is typically difficult (for good reason) politically to experiment with people's healthcare, but we are lucky to have two: the RAND healthcare study and the Oregon medicaid lottery. My understanding of both of those studies is that (particularly for pre-registered analyses), we saw that adding some sort of cost-sharing substantially reduced utilization of healthcare services (~30%) without any impact on health indicators even multiple decades down the line, with the possible exception of mental health indicators. Nowadays people try to p-hack their way out of these conclusions, but it is pretty strong high-N experimental evidence.

by foldr 1y ago

whimsicalism 1y ago

My analogy is not with socialized healthcare but with the medicare scheme. Socialized healthcare works in lots of other countries due to a combination of rationing and (in the case of drug prices) prioritizing accessibility over R&D. > I suspect that it’s mainly doctors who need to be more responsive to cost incentives as they’re often the ones recommending unnecessary tests or treatments. Doctors would recommend fewer tests if their patients were more price sensitive, I think. I'm not sure a more direct route to making doctors price sensitive when they are on the provider-side, why would they want you to utilize less? There probably also needs to be malpractice/tort reform in the US.

foldr 1y ago
I edited my post to say Medicare shortly after your reply (sorry). But if there’s evidence that Medicare is especially profligate with unnecessary tests and treatments then you should give that evidence, rather than arguing by strained analogies.
- whimsicalism 1y ago
  I think that analogies are helpful for elucidating the point but in terms of concrete evidence, there are two gold standard studies that really reveal this issue. These studies are very hard to come by because it is typically difficult (for good reason) politically to experiment with people's healthcare, but we are lucky to have two: the RAND healthcare study and the Oregon medicaid lottery. My understanding of both of those studies is that (particularly for pre-registered analyses), we saw that adding some sort of cost-sharing substantially reduced utilization of healthcare services (~30%) without any impact on health indicators even multiple decades down the line, with the possible exception of mental health indicators. Nowadays people try to p-hack their way out of these conclusions, but it is pretty strong high-N experimental evidence.