5 ms·

It should be no surprise that the more government "regulates" and subsidizes health care, the more expensive it gets. And the answer to high costs is always mor

by jstalin 13y ago

It should be no surprise that the more government "regulates" and subsidizes health care, the more expensive it gets. And the answer to high costs is always more regulation! I keep reading more about doctors who are opting out of the medicare system and switching to cash-only services. In the name of providing care to all, the system is breaking down and stratifying. Obamacare is an abomination of payoffs to special interest that will do nothing to reduce health care costs. Health care must be rationed. It is a finite good. The question is how it gets rationed. Market forces? Private insurance? He who can pay? Whoever the government decides gets it? The bottom line is that the more government decides who gets it, the more expensive it becomes. There's gotta be a happy medium, and my intuition informs me that the happy medium is closer to the free-market side than the mega-regulation side.

clicks 13y ago
> Health care must be rationed. It is a finite good. Instead of FWD.us initiative of bringing over competent technology people from abroad, maybe we should instead try to attract more doctors/medical professionals from India/China into coming here.
- jdminhbg 13y ago
  I dunno about "instead of," but not granting citizenship to any qualified doctor who wants it is pretty stupid on our part. Easy for me to say, though, since the AMA won't run ads about me killing babies for voting for such a thing.
- steve19 13y ago
  I don't think that is the answer. Can every student in the USA who is willing and capable of being a doctor get into med school? I would guess that this is probably not the case. Increasing the number of doctors produced locally would seem to me to be a much easier way of increasing supply.
  - fancyketchup 13y ago
    > Can every student in the USA who is willing and capable of being a doctor get into med school? No, but it's not because they aren't good enough. In grad school, I TA'd a physics class for pre-med students, which were widely considered to be one of the most miserable and obnoxious groups to teach. Each student felt entitled to an A, even though the department mandated that only 25% of students could receive an A. In reality, probably more than 80% of the class earned an A, and I would have felt comfortable that most of the rest were smart enough to one day give me medical advice. Yet, less than 45% of people who applied to one or more medical schools [1] are admitted (and this is a self-selected group: those without 4.0 GPAs, three extra-curriculars, and a side-business of helping old ladies across the street generally don't apply). I would estimate that only about the top 15% to 25% of the class actually applied. So, from undergrad pre-med to MD, there is about a (hand-wavy) 90% attrition rate of people who are probably smart enough and probably willing to work hard enough, and who have the desire to become doctors. > Increasing the number of doctors produced locally would seem to me to be a much easier way of increasing supply. I agree, but the medical profession is not willing to allow this to happen. Each medical school has a quota, and nobody wants to rock the boat. The trouble is, there isn't really any way to force medical schools to admit more students. [1]http://en.wikipedia.org/wiki/Medical_school_in_the_United_States http://en.wikipedia.org/wiki/Medical_school_in_the_United_St...
- gruseom 13y ago
  In fact, the economist Dean Baker has been arguing for just that as a free-market reform that would actually bring health care costs down. And the converse, too: that Medicare/Medicaid patients should be allowed to get cheaper health care abroad. http://www.cepr.net/index.php/op-eds-&-columns/op-eds-&-columns/the-health-care-industry-protectionism-the-free-traders-love http://www.cepr.net/index.php/op-eds-&-columns/op-eds-&#... http://www.guardian.co.uk/commentisfree/2012/dec/21/free-trade-medicare-benefits-washington http://www.guardian.co.uk/commentisfree/2012/dec/21/free-tra...
- fnordfnordfnord 13y ago
  Or we could open more medical schools? https://en.wikipedia.org/wiki/List_of_medical_schools_in_the_United_States https://en.wikipedia.org/wiki/List_of_medical_schools_in_the...
old-gregg 13y ago
Regulations and the free market are not the only options. There's a 3rd one which I personally want: completely socialized healthcare, where doctors are paid a fixed salary and all drugs and medical equipment are purchased at negotiated and aggressively low prices. I suspect the quality of care will not blow anyone's mind, and we'll have to work on that. But at least we'll finally graduate from a medieval society we are today. Private healthcare is no different from private armies: too few can afford it, that's why we need the state. If you are a free market believer, my position is not easy to agree with. But at least I hope it is understandable because at this very moment I am sitting on $41K in medical bills which I got for a 4 hours at the hospital (surgery+time in a recovery room). Yes, that is $2.8 per second and it wasn't a brain surgery, it was a skiing accident - broken arm.
- mseebach 13y ago
  So, socialized healthcare, despite its flaws, despite that its quality indeed does "not blow anyone's mind", at least has simplicity going for it. But what you're asking to be "understandable", is that someone else should pick up the tab because you like to play wild in the snow and couldn't be bothered to get properly insured first. Now that is a poor argument for socialized anything.
  - old-gregg 13y ago
    You're making a few incorrect assumptions here. First of all, I am insured and most of the bill will be paid by Humana (after hours and hours of painful phone calls which nobody is paying me to waste my time on). Secondly, I find it very typical that you've ignored the insane and mind blowing amount. Too many healthcare discussions are focused on "who" should be paying, instead of asking "why so much"? There is no way in hell they should be charging $250 for a "recovery kit" containing a can of apple juice, 5 crackers and 4 pills of ibuprofen. My Humana policy is STAGGERINGLY expensive. And finally, I paid more taxes (state+fed) here in California this year than most EU residents did. In my view, I already paid for my healthcare, they're just not delivering it to me, spending my money somewhere else.
    - 13y ago
steve19 13y ago
Having experienced medical care in a number of different countries, I am convinced that rationing is the heart of the problem. For example, as more treatments for symptoms of old age are invented, more is demanded and spent per elderly person (who can blame them). The problem is that in the West the elderly are increasing relative to the working population (medicare enrollment in the US is expected to double in the next 15-20 years). Governments in socialized healthcare countries have to decide how to allocate services between the young and the old. Free market advocates would argue that a true free market system would allocate resources appropriately (richer older folks would sacrifice medical care for themselves in order to pay for their younger relatives). I don't know what is the right solution. The idea of a lightly-regulated free market where innovation happens appeals to me, but I can't see it happening in this political climate.
aneth4 13y ago
What we need is mandatory health insurance. It works with auto insurance, it will work with health insurance. If Obamacare was as simple as that - that every resident must have a minimum level of health insurance, and banning pre-existing conditions as factors - it would be perfect. It's so simple, and many conservatives and liberals come to the same conclusion, with the main disagreement being whether there should be private insurers or a single public one. (I believe in private insurance.) Various other regulations, like transparent pricing, also need to be enacted. This distributes risk across the whole population and gets everyone health care. People who do not purchase health care of course need to be taxed and given a default plan, which should always be less attractive than private plans.
artsrc 13y ago
> It should be no surprise that the more government "regulates" and subsidizes health care, the more expensive it gets. And the answer to high costs is always more regulation! I am guessing that you might be American. Do you think you have adequately considered health care else where in the world? Looking at health care around the western world, the country where the government regulates and subsidises health care the least is the US. And in that country health care costs twice what it does anywhere else in the world. On another topic effective markets require good regulation. For example in Australia phones work on all networks (government mandated GSM), and you can take your phone number between carriers (required by regulation) etc. This created a more effective market. One barrier to an effective market is complex pricing (deliberately introduced to avoid market forces). Regulations to limit pricing complexity would improve the workings of the market. Similarly in health care, requiring publicly available prices and quality reporting is what enables comparisons made, and make competition possible. Economic entities don't want competitive markets, they want excess profits. In summary markets are not an alternative to regulation. Regulation and markets work together to form a system of management.

by jstalin 13y ago

clicks 13y ago

> Health care must be rationed. It is a finite good. Instead of FWD.us initiative of bringing over competent technology people from abroad, maybe we should instead try to attract more doctors/medical professionals from India/China into coming here.

jdminhbg 13y ago
I dunno about "instead of," but not granting citizenship to any qualified doctor who wants it is pretty stupid on our part. Easy for me to say, though, since the AMA won't run ads about me killing babies for voting for such a thing.
steve19 13y ago
I don't think that is the answer. Can every student in the USA who is willing and capable of being a doctor get into med school? I would guess that this is probably not the case. Increasing the number of doctors produced locally would seem to me to be a much easier way of increasing supply.
- fancyketchup 13y ago
  > Can every student in the USA who is willing and capable of being a doctor get into med school? No, but it's not because they aren't good enough. In grad school, I TA'd a physics class for pre-med students, which were widely considered to be one of the most miserable and obnoxious groups to teach. Each student felt entitled to an A, even though the department mandated that only 25% of students could receive an A. In reality, probably more than 80% of the class earned an A, and I would have felt comfortable that most of the rest were smart enough to one day give me medical advice. Yet, less than 45% of people who applied to one or more medical schools [1] are admitted (and this is a self-selected group: those without 4.0 GPAs, three extra-curriculars, and a side-business of helping old ladies across the street generally don't apply). I would estimate that only about the top 15% to 25% of the class actually applied. So, from undergrad pre-med to MD, there is about a (hand-wavy) 90% attrition rate of people who are probably smart enough and probably willing to work hard enough, and who have the desire to become doctors. > Increasing the number of doctors produced locally would seem to me to be a much easier way of increasing supply. I agree, but the medical profession is not willing to allow this to happen. Each medical school has a quota, and nobody wants to rock the boat. The trouble is, there isn't really any way to force medical schools to admit more students. [1]http://en.wikipedia.org/wiki/Medical_school_in_the_United_States http://en.wikipedia.org/wiki/Medical_school_in_the_United_St...
gruseom 13y ago
In fact, the economist Dean Baker has been arguing for just that as a free-market reform that would actually bring health care costs down. And the converse, too: that Medicare/Medicaid patients should be allowed to get cheaper health care abroad. http://www.cepr.net/index.php/op-eds-&-columns/op-eds-&-columns/the-health-care-industry-protectionism-the-free-traders-love http://www.cepr.net/index.php/op-eds-&-columns/op-eds-&#... http://www.guardian.co.uk/commentisfree/2012/dec/21/free-trade-medicare-benefits-washington http://www.guardian.co.uk/commentisfree/2012/dec/21/free-tra...
fnordfnordfnord 13y ago
Or we could open more medical schools? https://en.wikipedia.org/wiki/List_of_medical_schools_in_the_United_States https://en.wikipedia.org/wiki/List_of_medical_schools_in_the...

old-gregg 13y ago

Regulations and the free market are not the only options. There's a 3rd one which I personally want: completely socialized healthcare, where doctors are paid a fixed salary and all drugs and medical equipment are purchased at negotiated and aggressively low prices. I suspect the quality of care will not blow anyone's mind, and we'll have to work on that. But at least we'll finally graduate from a medieval society we are today. Private healthcare is no different from private armies: too few can afford it, that's why we need the state. If you are a free market believer, my position is not easy to agree with. But at least I hope it is understandable because at this very moment I am sitting on $41K in medical bills which I got for a 4 hours at the hospital (surgery+time in a recovery room). Yes, that is $2.8 per second and it wasn't a brain surgery, it was a skiing accident - broken arm.

mseebach 13y ago
So, socialized healthcare, despite its flaws, despite that its quality indeed does "not blow anyone's mind", at least has simplicity going for it. But what you're asking to be "understandable", is that someone else should pick up the tab because you like to play wild in the snow and couldn't be bothered to get properly insured first. Now that is a poor argument for socialized anything.
- old-gregg 13y ago
  You're making a few incorrect assumptions here. First of all, I am insured and most of the bill will be paid by Humana (after hours and hours of painful phone calls which nobody is paying me to waste my time on). Secondly, I find it very typical that you've ignored the insane and mind blowing amount. Too many healthcare discussions are focused on "who" should be paying, instead of asking "why so much"? There is no way in hell they should be charging $250 for a "recovery kit" containing a can of apple juice, 5 crackers and 4 pills of ibuprofen. My Humana policy is STAGGERINGLY expensive. And finally, I paid more taxes (state+fed) here in California this year than most EU residents did. In my view, I already paid for my healthcare, they're just not delivering it to me, spending my money somewhere else.
  - 13y ago

steve19 13y ago

Having experienced medical care in a number of different countries, I am convinced that rationing is the heart of the problem. For example, as more treatments for symptoms of old age are invented, more is demanded and spent per elderly person (who can blame them). The problem is that in the West the elderly are increasing relative to the working population (medicare enrollment in the US is expected to double in the next 15-20 years). Governments in socialized healthcare countries have to decide how to allocate services between the young and the old. Free market advocates would argue that a true free market system would allocate resources appropriately (richer older folks would sacrifice medical care for themselves in order to pay for their younger relatives). I don't know what is the right solution. The idea of a lightly-regulated free market where innovation happens appeals to me, but I can't see it happening in this political climate.

aneth4 13y ago

What we need is mandatory health insurance. It works with auto insurance, it will work with health insurance. If Obamacare was as simple as that - that every resident must have a minimum level of health insurance, and banning pre-existing conditions as factors - it would be perfect. It's so simple, and many conservatives and liberals come to the same conclusion, with the main disagreement being whether there should be private insurers or a single public one. (I believe in private insurance.) Various other regulations, like transparent pricing, also need to be enacted. This distributes risk across the whole population and gets everyone health care. People who do not purchase health care of course need to be taxed and given a default plan, which should always be less attractive than private plans.

artsrc 13y ago

> It should be no surprise that the more government "regulates" and subsidizes health care, the more expensive it gets. And the answer to high costs is always more regulation! I am guessing that you might be American. Do you think you have adequately considered health care else where in the world? Looking at health care around the western world, the country where the government regulates and subsidises health care the least is the US. And in that country health care costs twice what it does anywhere else in the world. On another topic effective markets require good regulation. For example in Australia phones work on all networks (government mandated GSM), and you can take your phone number between carriers (required by regulation) etc. This created a more effective market. One barrier to an effective market is complex pricing (deliberately introduced to avoid market forces). Regulations to limit pricing complexity would improve the workings of the market. Similarly in health care, requiring publicly available prices and quality reporting is what enables comparisons made, and make competition possible. Economic entities don't want competitive markets, they want excess profits. In summary markets are not an alternative to regulation. Regulation and markets work together to form a system of management.