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Oddly enough the big rhetorical push against a universal system from prior decades was about "death panels" deciding what care somebody would get. And guess wha

Oddly enough the big rhetorical push against a universal system from prior decades was about "death panels" deciding what care somebody would get. And guess what's happened with insurance? Death panels! The propaganda spin on the health care system in the US has been on overdrive ever since Hillary Clinton wanted to implement some reforms in the 1990s, leading to absolutely massive resistance to any change whatsoever. Even the changes implemented by Obama, which were a HUGE improvement in access, barely made it across the legislative line, and dismantling that access to the health care system has been a huge rallying cry for one of the major political parties. I won't say which one because mentioning that fact results in people turning off their brains and downvoting. The US healthcare has optimized for availability and higher access to the most treatment options. This does not mean evenly distributed treatment options, but that people have the chance to get access to things more quickly. And for most people, the healthcare system works fairly great. There are exceptions, like the denial described in this thread, and they usually get lots of attention because holy hell is that a messed up situation. But the everyday care that most people get is better than adequate.

xnx 1y ago
Like Ticketmaster, health insurance companies get paid to be the "bad guys". This is a reasonable function since Americans can't seem to understand that someone must decide where limited resources go. However, there's no reason their cut should be so large.
- epistasis 1y ago
  Health insurance companies have had their profits capped at a percentage of revenues. That means that to grow profits, they must increase revenue. Which means incentives to increase care and increase costs. Oddly enough, all the plots I have seen of cost increases don't show a massive skyrocketing of costs since the profit caps were introduced. If anything, they have been somewhat reduced. However a reckoning must happen at some point, health care can not consume the entire economy's efforts.
- tptacek 1y ago
  Their cut is in fact very small; it's around 6.5% of total US health care spending. https://nationalhealthspending.org/ https://nationalhealthspending.org/
  - xnx 1y ago
    But for what? Why not something closer to credit cards, like 1%?
    - tptacek 1y ago
      I don't know how to answer that. I think the system is pretty inefficient in a variety of ways. If you universalized Medicare, eliminating insurance entirely, you'd get costs somewhere in between Medicare's current admin overhead and the overhead of private insurance (you mechanically would not get Medicare's current overhead, because the majority of your customers would have much lower claims than Medicare's all-seniors patients do, and overhead is a ratio). But the largest inefficiencies are all on the providers side. We simply pay practitioners too much, enforce artificial scarcity of practitioners, and prescribe too many services. So if we're talking about "The American System" as a whole --- which is what the thread is about --- it behooves us first to consider the question "how much better would things be if we simply zeroed this category of expense out". The answer is, to a first approximation, we would get a 6.5% price break. I would not drive even a couple blocks out of my way to get a 6.5% price break on a pack of chicken breasts.
      - xnx 1y ago
        > But the largest inefficiencies are all on the providers side. We simply pay practitioners too much I agree. The complex insurance billing system enables his by obfuscating prices and limiting ability to comparison shop.
        tptacek 1y ago
        That's true, but it's a problem single-payer doesn't fix; that's my big issue with it (it locks in rapacious rates and preferences for the health provider industry, making them palatable to consumers by hiding the payer).
rkomorn 1y ago
> And guess what's happened with insurance? Death panels! The insurance death panels already existed at the time. It didn't even happen after. That's what made the whole thing so ridiculous in the first place.
nonfamous 1y ago
>>> And for most people, the healthcare system works fairly great. There are exceptions, like the denial described in this thread, and they usually get lots of attention because holy hell is that a messed up situation. But the everyday care that most people get is better than adequate. As an individual who has lived in multiple countries in three continents, I dispute that “the care most people get is better than adequate”. Perhaps better than the world average, but certainly not better than in most first-world countries. And that’s not even counting the impact of delayed decisions and denied care, and the stress of dealing with the system overall. And if you’re looking for more than anecdotes, there are plenty of studies that show that Americans have lower expected lifetimes than citizens of peer countries, despite much higher per-capita health care costs.
- tptacek 1y ago
  Life expectancy tells you basically nothing about the quality of health care in the US. It's dominated by car accidents, homicide, and then CVD --- but CVD varies dramatically across the United States (from states in the south with drastically worse CVD outcomes to states in the north with outcomes on par with the Nordics) despite the same health care structure across all those states.
  - nonfamous 1y ago
    There are plenty of other countries with car accidents, homicide and cardiovascular disease. They also do worse than the US in life expectancy.
    - tptacek 1y ago
      Do you need a cite to back up the analysis I just gave you? Because it will be easy to provide.
- epistasis 1y ago
  While I don't doubt that there are endless stories of bad care, especially among the non-unionized working class, the bulk of voters with middle class lifestyles do have good care. Which is why it's so hard to make it into an issue that drives political change. > there are plenty of studies that show that Americans have lower expected lifetimes than citizens of peer countries, despite much higher per-capita health care costs. Americans aren't dying earlier of diseases that are solvable with a doctor visit, surgeries, pills, or other easy medical interventions. The medically related early deaths are primarily because of overnutrition and lack of exercise leading to pre-diabetes, diabetes, high blood pressure, and heart disease. That comes from public policy mandating car dependence throughout society and huge subsidization of empty calories in the food system. Overeating and lack of exercise are problems that have been stubbornly resistant to the medical system's efforts to change behavior. There's also other heightened early death risks like car crashes, drug overdoses, and suicide, but few of these deaths could be prevented by increased access to the medical system.

xnx 1y ago

Like Ticketmaster, health insurance companies get paid to be the "bad guys". This is a reasonable function since Americans can't seem to understand that someone must decide where limited resources go. However, there's no reason their cut should be so large.

epistasis 1y ago
Health insurance companies have had their profits capped at a percentage of revenues. That means that to grow profits, they must increase revenue. Which means incentives to increase care and increase costs. Oddly enough, all the plots I have seen of cost increases don't show a massive skyrocketing of costs since the profit caps were introduced. If anything, they have been somewhat reduced. However a reckoning must happen at some point, health care can not consume the entire economy's efforts.
tptacek 1y ago
Their cut is in fact very small; it's around 6.5% of total US health care spending. https://nationalhealthspending.org/ https://nationalhealthspending.org/
- xnx 1y ago
  But for what? Why not something closer to credit cards, like 1%?
  - tptacek 1y ago
    I don't know how to answer that. I think the system is pretty inefficient in a variety of ways. If you universalized Medicare, eliminating insurance entirely, you'd get costs somewhere in between Medicare's current admin overhead and the overhead of private insurance (you mechanically would not get Medicare's current overhead, because the majority of your customers would have much lower claims than Medicare's all-seniors patients do, and overhead is a ratio). But the largest inefficiencies are all on the providers side. We simply pay practitioners too much, enforce artificial scarcity of practitioners, and prescribe too many services. So if we're talking about "The American System" as a whole --- which is what the thread is about --- it behooves us first to consider the question "how much better would things be if we simply zeroed this category of expense out". The answer is, to a first approximation, we would get a 6.5% price break. I would not drive even a couple blocks out of my way to get a 6.5% price break on a pack of chicken breasts.
    - xnx 1y ago
      > But the largest inefficiencies are all on the providers side. We simply pay practitioners too much I agree. The complex insurance billing system enables his by obfuscating prices and limiting ability to comparison shop.
      - tptacek 1y ago
        That's true, but it's a problem single-payer doesn't fix; that's my big issue with it (it locks in rapacious rates and preferences for the health provider industry, making them palatable to consumers by hiding the payer).

rkomorn 1y ago

> And guess what's happened with insurance? Death panels! The insurance death panels already existed at the time. It didn't even happen after. That's what made the whole thing so ridiculous in the first place.

nonfamous 1y ago

>>> And for most people, the healthcare system works fairly great. There are exceptions, like the denial described in this thread, and they usually get lots of attention because holy hell is that a messed up situation. But the everyday care that most people get is better than adequate. As an individual who has lived in multiple countries in three continents, I dispute that “the care most people get is better than adequate”. Perhaps better than the world average, but certainly not better than in most first-world countries. And that’s not even counting the impact of delayed decisions and denied care, and the stress of dealing with the system overall. And if you’re looking for more than anecdotes, there are plenty of studies that show that Americans have lower expected lifetimes than citizens of peer countries, despite much higher per-capita health care costs.

tptacek 1y ago
Life expectancy tells you basically nothing about the quality of health care in the US. It's dominated by car accidents, homicide, and then CVD --- but CVD varies dramatically across the United States (from states in the south with drastically worse CVD outcomes to states in the north with outcomes on par with the Nordics) despite the same health care structure across all those states.
- nonfamous 1y ago
  There are plenty of other countries with car accidents, homicide and cardiovascular disease. They also do worse than the US in life expectancy.
  - tptacek 1y ago
    Do you need a cite to back up the analysis I just gave you? Because it will be easy to provide.
epistasis 1y ago
While I don't doubt that there are endless stories of bad care, especially among the non-unionized working class, the bulk of voters with middle class lifestyles do have good care. Which is why it's so hard to make it into an issue that drives political change. > there are plenty of studies that show that Americans have lower expected lifetimes than citizens of peer countries, despite much higher per-capita health care costs. Americans aren't dying earlier of diseases that are solvable with a doctor visit, surgeries, pills, or other easy medical interventions. The medically related early deaths are primarily because of overnutrition and lack of exercise leading to pre-diabetes, diabetes, high blood pressure, and heart disease. That comes from public policy mandating car dependence throughout society and huge subsidization of empty calories in the food system. Overeating and lack of exercise are problems that have been stubbornly resistant to the medical system's efforts to change behavior. There's also other heightened early death risks like car crashes, drug overdoses, and suicide, but few of these deaths could be prevented by increased access to the medical system.