4 ms·

Yes, the medical situation in the US is badly broken, and everyone knows it. However, it is unlikely to get fixed within the next several decades. It took decad

by mcherm 14y ago

Yes, the medical situation in the US is badly broken, and everyone knows it. However, it is unlikely to get fixed within the next several decades. It took decades and an extreme swing in political power (one party fully controlling both houses of Congress and the presidency at once) to get a change to the law that said essentially "Keep doing it the same way you're doing it except that a little over 3/4 of the people with absolutely no insurance will now get insurance." Such a tiny step forward, still unclear whether it will actually hold, and this was the crowning achievement after decades of work. The way we pay for health care in the US may not improve in a substantial way for a LONG, LONG, time.

mjn 14y ago
It feels like one of those oddly contingent things that wasn't inevitable. Some decades ago, Richard Nixon and the Democratic-controlled Congress each had health-care-reform proposals, but weren't able to reach an agreement. So, nothing passed. But viewed from today's perspective they weren't really that far apart.
VLM 14y ago
"the medical situation in the US is badly broken" Those in power would disagree. If the purpose is to achieve a local maxima of profit they're doing pretty well. Privatize the gains, socialize the losses. If the purpose is to provide medical care, well, yeah, its a pretty epic fail. But that's not the purpose of the system. The system has to be bled completely dry before it can be redesigned and rebooted. Too many people are still paying in. That has to stop, before things can be improved.
- twoodfin 14y ago
  Just how profitable do you think health insurers are, relative to, say, McDonald's?
  - muhfuhkuh 14y ago
    Just to compare apples to insurance here, the largest pure auto insurer (progressive) maintains ~5-6% profit margins according to filings, whereas Wellpoint one of the largest insurers in healthcare maintains a 7% margin.
  - VLM 14y ago
    There's more to "the system" than just insurers. The large number of middlemen all extracting a profit is one of the many problems. Don't forget overhead and their middlemen, all the way back to med school tuition...
talmand 14y ago
From my reading a great deal of the problems we have now is after decades of government intervention in an attempt to "fix" the system and only making it worse. The legislation you speak was not a tiny step at all, it was a huge leap into making things even worse. The legislation does little to fix the existing problems, in some cases makes them worse, and at the same time forcibly inserts millions of people into the system that most seem to agree does not work. I fail to see how such a thing can possibly help. If this was a crowning achievement of decades of work then politicians have extremely low standards.
- mjn 14y ago
  Most of the problems I see with the system are inherent in the idea of attempting to socialize costs using the model of "insurance". For example, a friend of mine was born with a heart defect. No rational free-market insurance would sell him coverage at any price he could possibly pay, because the expected lifetime cost is quite high. The only real way to deal with such cases is to spread them across a large population, so people not born with heart defects subsidize those who were (and likewise for other major issues). But of course the population has to be selected in a way that is reasonably representative, rather than only the least healthy people opting in. The three traditional non-adverse-selected populations are: 1) the entire population of a country (the socialized-medicine solution); 2) the members of a large union; or 3) the employees of large corporations (the U.S. solution of employer-tied group plans). But #3 is showing cracks as corporate-jobs-for-life get less common. In a world where you change jobs more frequently, now there are messes of coverage gaps, COBRA, etc. Not to mention that this arrangement discourages freelancing and entrepreneurship, since you must work for a large corporation with a group plan to be part of a health-care pool, a connection that otherwise seems rather arbitrary (why should where you get risk-pooled for health-care purposes depend on who you work for? only because corporation-tied pools are a way of minimizing adverse selection in the pool).
  - VLM 14y ago
    Has anyone in the world ever tried a variation of selection criteria #1 where the property tax of the residents in the coverage footprint of a hospital pay for the hospital? It seems logical and cheap to administer, which is why it would be opposed in the US, not much room to profit. However it does seem "fair".
Vivtek 14y ago
"everyone knows it" No, see - that's the problem. The vast majority of the electorate has no idea either that our system is broken or that other countries actually do things better - indeed, that it is even possible, in principle, to do anything better than current practice in the United States.
- muhfuhkuh 14y ago
  One sticking point in my mind is that people always seem to conflate our pharmaceutical and medical technology industry with our healthcare and health insurance system, which are different areas completely. They think that if we don't have the expensive, privately-held bureaucratic system we do, then GE can't charge what it does for its MRI and CT scanner machines and exit the market, and then Grandma will die a horrible, painful death in a ditch outside Waukegan. Or, if pharmaceuticals don't charge insured patients $10000 a dose of some new drug, that our system will collapse because no one will make medicine in America ever again (never mind that 5 of the top 10 largest drug makers are outside of the US in countries that have abundantly socialist healthcare systems).
  - maxerickson 14y ago
    A little bit of devil's advocate versus your last point, how many of those makers refuse to do business in the U.S.? That is, if there is some structural pricing advantage in the U.S., what is stopping those companies from benefiting from it?
    - Vivtek 14y ago
      I'm not sure I even understand your point. Bayer and Pfizer, for instance, do lots and lots of business in the US. His point is that Switzerland - like every industrialized nation in the world, with one exception - has a socialized health care system, and still somehow manages to have an economy that includes health care providers.
      - maxerickson 14y ago

by mcherm 14y ago

mjn 14y ago

It feels like one of those oddly contingent things that wasn't inevitable. Some decades ago, Richard Nixon and the Democratic-controlled Congress each had health-care-reform proposals, but weren't able to reach an agreement. So, nothing passed. But viewed from today's perspective they weren't really that far apart.

VLM 14y ago

"the medical situation in the US is badly broken" Those in power would disagree. If the purpose is to achieve a local maxima of profit they're doing pretty well. Privatize the gains, socialize the losses. If the purpose is to provide medical care, well, yeah, its a pretty epic fail. But that's not the purpose of the system. The system has to be bled completely dry before it can be redesigned and rebooted. Too many people are still paying in. That has to stop, before things can be improved.

twoodfin 14y ago
Just how profitable do you think health insurers are, relative to, say, McDonald's?
- muhfuhkuh 14y ago
  Just to compare apples to insurance here, the largest pure auto insurer (progressive) maintains ~5-6% profit margins according to filings, whereas Wellpoint one of the largest insurers in healthcare maintains a 7% margin.
- VLM 14y ago
  There's more to "the system" than just insurers. The large number of middlemen all extracting a profit is one of the many problems. Don't forget overhead and their middlemen, all the way back to med school tuition...

talmand 14y ago

From my reading a great deal of the problems we have now is after decades of government intervention in an attempt to "fix" the system and only making it worse. The legislation you speak was not a tiny step at all, it was a huge leap into making things even worse. The legislation does little to fix the existing problems, in some cases makes them worse, and at the same time forcibly inserts millions of people into the system that most seem to agree does not work. I fail to see how such a thing can possibly help. If this was a crowning achievement of decades of work then politicians have extremely low standards.

mjn 14y ago
Most of the problems I see with the system are inherent in the idea of attempting to socialize costs using the model of "insurance". For example, a friend of mine was born with a heart defect. No rational free-market insurance would sell him coverage at any price he could possibly pay, because the expected lifetime cost is quite high. The only real way to deal with such cases is to spread them across a large population, so people not born with heart defects subsidize those who were (and likewise for other major issues). But of course the population has to be selected in a way that is reasonably representative, rather than only the least healthy people opting in. The three traditional non-adverse-selected populations are: 1) the entire population of a country (the socialized-medicine solution); 2) the members of a large union; or 3) the employees of large corporations (the U.S. solution of employer-tied group plans). But #3 is showing cracks as corporate-jobs-for-life get less common. In a world where you change jobs more frequently, now there are messes of coverage gaps, COBRA, etc. Not to mention that this arrangement discourages freelancing and entrepreneurship, since you must work for a large corporation with a group plan to be part of a health-care pool, a connection that otherwise seems rather arbitrary (why should where you get risk-pooled for health-care purposes depend on who you work for? only because corporation-tied pools are a way of minimizing adverse selection in the pool).
- VLM 14y ago
  Has anyone in the world ever tried a variation of selection criteria #1 where the property tax of the residents in the coverage footprint of a hospital pay for the hospital? It seems logical and cheap to administer, which is why it would be opposed in the US, not much room to profit. However it does seem "fair".

Vivtek 14y ago

"everyone knows it" No, see - that's the problem. The vast majority of the electorate has no idea either that our system is broken or that other countries actually do things better - indeed, that it is even possible, in principle, to do anything better than current practice in the United States.

muhfuhkuh 14y ago
One sticking point in my mind is that people always seem to conflate our pharmaceutical and medical technology industry with our healthcare and health insurance system, which are different areas completely. They think that if we don't have the expensive, privately-held bureaucratic system we do, then GE can't charge what it does for its MRI and CT scanner machines and exit the market, and then Grandma will die a horrible, painful death in a ditch outside Waukegan. Or, if pharmaceuticals don't charge insured patients $10000 a dose of some new drug, that our system will collapse because no one will make medicine in America ever again (never mind that 5 of the top 10 largest drug makers are outside of the US in countries that have abundantly socialist healthcare systems).
- maxerickson 14y ago
  A little bit of devil's advocate versus your last point, how many of those makers refuse to do business in the U.S.? That is, if there is some structural pricing advantage in the U.S., what is stopping those companies from benefiting from it?
  - Vivtek 14y ago
    I'm not sure I even understand your point. Bayer and Pfizer, for instance, do lots and lots of business in the US. His point is that Switzerland - like every industrialized nation in the world, with one exception - has a socialized health care system, and still somehow manages to have an economy that includes health care providers.
    - maxerickson 14y ago