4 ms·

Can the issue of who pays for healthcare be adequately separated from the issue of its cost? I think so -- given how wide the disparity in health COSTS (put asi

by rexreed 13y ago

Can the issue of who pays for healthcare be adequately separated from the issue of its cost? I think so -- given how wide the disparity in health COSTS (put aside the payer) are between not only countries, but even counties in the US [1]. It would be great if we can talk about the origin of these health costs without getting entangled into who should be paying them. But maybe that's an impossible task. The Libertarian-in-Chief Ron Paul himself a Physician who claims that the exhorbitant costs in health care are a more recent phenomenon. He quotes how much his costs were to do house-visits (remarkably small), and compares that with the ballooning in costs more recently. While one can argue that Libertarianism is a Utopic view, the rapidly escalating prices of healthcare are not something that is espoused by Libertarian philosophy. I.e. Low health costs and individual responsibility for health paying are not incompatible. Then again, neither are low health costs and universal health coverage. Right now, we have the worst of both worlds: high health costs and individual responsibility for payment. [1] http://big.assets.huffingtonpost.com/hospital-procedure-costs-map-2.png http://big.assets.huffingtonpost.com/hospital-procedure-cost...

pyre 13y ago
Can (some of) the ballooning costs be attributed to the costs / time investment in medical school? When Ron Paul went to medical school how much did it cost (adjusted for inflation)? How much more knowledge are doctors expected to have now than then?
- rexreed 13y ago
  Maybe, but not any significant part. As evidenced by this post, only a small portion of the costs are attributable to the work performed by the surgeon. The majority of costs are allocated to facility costs (whose increases in price are not related to tuition costs) and equipment. Indeed, if there was such a direct correlation between the two, the easiest way to control healthcare costs would be to reduce doctoral school tuition rates. Clearly, this is not a viable solution here because the two are not directly correlated. Now, it is true that Tuition Costs have risen at a much higher rate since 1960 than Health Care costs on a percentage basis compared to inflation [1] [2] [3], but in aggregate the actual health care costs on a per-individual basis dwarf total tuition costs as part of household income [4]. [1] https://lh3.ggpht.com/-dqm5PIPoC58/Ti8HKy2jjrI/AAAAAAAAPgU/Wm3iJROU5KQ/s1600/college.jpg https://lh3.ggpht.com/-dqm5PIPoC58/Ti8HKy2jjrI/AAAAAAAAPgU/W... [2] http://chartingtheeconomy.com/wp-content/uploads/2009/04/healthcare309_28214_image012.gif http://chartingtheeconomy.com/wp-content/uploads/2009/04/hea... [3] http://cdn.theatlanticwire.com/img/upload/2011/08/aw-chart-college-tuition-vs-other-price-indices-2/large.png http://cdn.theatlanticwire.com/img/upload/2011/08/aw-chart-c... [4] http://static2.businessinsider.com/image/4d775519ccd1d57115010000/chart.gif http://static2.businessinsider.com/image/4d775519ccd1d571150...
  - pyre 13y ago
    To be fair, comparing the costs of ACL surgery to Ron Paul's costs for 'making house calls' isn't exactly an apples-to-apples comparison either. I'm merely pointing out that this is a complex beast with many contributing factors: - The money/time investment to become a medical professional. - The increase in the number / complexity of procedures over the years. Our medical knowledge keeps increasing we keep getting more and more ways to fix things. - Comparisons without details. For example, people like to compare how cheap MRIs are in Japan, but the MRIs that people get in Japan aren't as powerful/accurate as the ones that are charged for in the US. Does this justify the cost difference? Maybe, but maybe not.
    - rexreed 13y ago
      When an ACL costs $68k in California and $20k in Illinois and $32K in Delaware, you know that it's not an issue with simply the cost of getting medical training. Something else (I agree, something a lot more complicated than simply the cost of education or differencies in country-specific medical practices) is at work. I think we actually agree here - the dramatic rise in health care costs doesn't have a single root cause, or even perhaps a readily identifiable root cause. It's systemic, rather than simplistic. Education is a factor, but a small one. Insurance and health liabilities are probably an equal factor. But neither explain disparities in cost within the US (no need to look at comparisons between Japan for that). See my [1] reference two comment posts up for the chart on cost disparities intra-US. It's quite possible that medical suppliers are using information asymmetry to overcharge in some instances and properly charge in others. Could it be as simple as that? Why is it that the same procedure with the same equipment using similarly trained staff in similar hospitals with similar liability exposures would have such different costs? The only thing I can think of is that medical purchasing is sufficiently complex and with such little visibility and transparency between different establishments that medical suppliers and providers can get away with pricing them "as much as the market can support". But that's just an unsubstantiated theory and maybe there is a reason why the same procedure is cheaper in another state, county, or city.
      - pyre 13y ago

by rexreed 13y ago

pyre 13y ago

Can (some of) the ballooning costs be attributed to the costs / time investment in medical school? When Ron Paul went to medical school how much did it cost (adjusted for inflation)? How much more knowledge are doctors expected to have now than then?

rexreed 13y ago
Maybe, but not any significant part. As evidenced by this post, only a small portion of the costs are attributable to the work performed by the surgeon. The majority of costs are allocated to facility costs (whose increases in price are not related to tuition costs) and equipment. Indeed, if there was such a direct correlation between the two, the easiest way to control healthcare costs would be to reduce doctoral school tuition rates. Clearly, this is not a viable solution here because the two are not directly correlated. Now, it is true that Tuition Costs have risen at a much higher rate since 1960 than Health Care costs on a percentage basis compared to inflation [1] [2] [3], but in aggregate the actual health care costs on a per-individual basis dwarf total tuition costs as part of household income [4]. [1] https://lh3.ggpht.com/-dqm5PIPoC58/Ti8HKy2jjrI/AAAAAAAAPgU/Wm3iJROU5KQ/s1600/college.jpg https://lh3.ggpht.com/-dqm5PIPoC58/Ti8HKy2jjrI/AAAAAAAAPgU/W... [2] http://chartingtheeconomy.com/wp-content/uploads/2009/04/healthcare309_28214_image012.gif http://chartingtheeconomy.com/wp-content/uploads/2009/04/hea... [3] http://cdn.theatlanticwire.com/img/upload/2011/08/aw-chart-college-tuition-vs-other-price-indices-2/large.png http://cdn.theatlanticwire.com/img/upload/2011/08/aw-chart-c... [4] http://static2.businessinsider.com/image/4d775519ccd1d57115010000/chart.gif http://static2.businessinsider.com/image/4d775519ccd1d571150...
- pyre 13y ago
  To be fair, comparing the costs of ACL surgery to Ron Paul's costs for 'making house calls' isn't exactly an apples-to-apples comparison either. I'm merely pointing out that this is a complex beast with many contributing factors: - The money/time investment to become a medical professional. - The increase in the number / complexity of procedures over the years. Our medical knowledge keeps increasing we keep getting more and more ways to fix things. - Comparisons without details. For example, people like to compare how cheap MRIs are in Japan, but the MRIs that people get in Japan aren't as powerful/accurate as the ones that are charged for in the US. Does this justify the cost difference? Maybe, but maybe not.
  - rexreed 13y ago
    When an ACL costs $68k in California and $20k in Illinois and $32K in Delaware, you know that it's not an issue with simply the cost of getting medical training. Something else (I agree, something a lot more complicated than simply the cost of education or differencies in country-specific medical practices) is at work. I think we actually agree here - the dramatic rise in health care costs doesn't have a single root cause, or even perhaps a readily identifiable root cause. It's systemic, rather than simplistic. Education is a factor, but a small one. Insurance and health liabilities are probably an equal factor. But neither explain disparities in cost within the US (no need to look at comparisons between Japan for that). See my [1] reference two comment posts up for the chart on cost disparities intra-US. It's quite possible that medical suppliers are using information asymmetry to overcharge in some instances and properly charge in others. Could it be as simple as that? Why is it that the same procedure with the same equipment using similarly trained staff in similar hospitals with similar liability exposures would have such different costs? The only thing I can think of is that medical purchasing is sufficiently complex and with such little visibility and transparency between different establishments that medical suppliers and providers can get away with pricing them "as much as the market can support". But that's just an unsubstantiated theory and maybe there is a reason why the same procedure is cheaper in another state, county, or city.
    - pyre 13y ago