4 ms·

Had a similar case with someone in Nicaragua. The procedure (including diagnosis, medication etc) was $3,000 there whereas it would have been at least $30,000

Had a similar case with someone in Nicaragua. The procedure (including diagnosis, medication etc) was $3,000 there whereas it would have been at least $30,000 in the US. I think it goes well beyond cost of living comparisons, because most things there cost perhaps 2-4 times less than here. Even if we factor in that per-capita medical costs in the US are roughly double the rest of the developed world ($6,000 vs $3,000) there is still another multiplier of perhaps 2-3x for procedures. I’m becoming more convinced every day that the US has become a two-tier society. I (and many of my friends) have had some very lean years, earning perhaps $7-15,000 and surviving. During those times, saving even $3,000 was next to impossible, because we were already $5, $10, $20,000 in debt or more. Multiply that by 10 and it’s effectively out of reach for, I don’t know, 90% of the country. The standard deductible (which is looking like it’s going to be about $6,000 under Obamacare) will often mean the loss of a home, vehicle, or college savings, especially for chronic conditions. Meanwhile the people who determine these rates (doctors, hospitals, medical supply companies, insurance agencies) enjoy comfortable incomes of $50, $100, $250,000 or more. I don’t think they are capable of setting rates ethically. Throw in the fact that aging people are desperate and will basically pay anything to live longer, and it’s an unavoidable conflict of interest. I think the simplest solution to all of this (and probably the most controversial) is to decouple medical research from practice. Ban all medicine-related patents. Create low interest government matching funds for the loans provided by supply companies to dentists and other independent practitioners. Remove the regulations that prop up monopolists and rent seekers. Start reducing the administrative layer that adds so much cost but so little quality of care. Then protect doctors from frivolous lawsuits with a bond system like plumbers and electricians use for catastrophic accidents so they can perform the procedures they feel are needed instead of the ones deemed “safest” or most profitable. Go after the true medical costs, the Erin Brockovich type of coverups that cost the economy billions. And especially go after the sources of illness - radiation from burning coal, carcinogens released by fracking, a hamstrung FDA that doesn’t have the resources to test interactions between thousands of household chemicals, carcinogenic herbicides and pesticides used on genetically modified food, and so on. I’ve heard the standard arguments about how all of this might disincentivize medical research but I don’t buy them. The system we have now rewards treatments more than cures, as evidenced by big pharma ads on TV for irritable-whatever. If we really want to start over, we need to go back to pre-Nixon, before HMOs and profit-driven care. We need to spend substantially more on medical research than we do now (rather than practice), through universities and big-data approaches where biologists and chemists can run simulations and avoid human trials. Dump the current grant system and make funding far more accessible so researching don’t spend all of their time fundraising. If we do all of this, we may just have a shot at cracking the underlying mechanisms that cause illness, basically map every virus and bacteria, the mechanisms through which genes control proteins, how we age and repair damage, etc etc. We should be growing replacement organs by now. We should have cured chronic conditions like diabetes and arthritis years ago and gotten cures for allergies, asthma and autism for free since similar pathways are at work. Right now we are doing little to no prevention, charging just enough to keep people from going to the doctor at early stages of illness, and then charging an arm and a leg for the medical equivalent of disaster cleanup. It’s really quite remarkable, and sad.

ceejayoz 12y ago
Generally agree, but a couple quibbles: > protect doctors from frivolous lawsuits with a bond system Malpractice suits only make something like 1% of healthcare costs, and malpractice insurance is already everywhere. > big-data approaches where biologists and chemists can run simulations and avoid human trials We don't know enough about the human body to be able to accurately do this. Might help for initial tests (and already does, I'd imagine), but you still always need clinical trials.
- dllthomas 12y ago
  I don't know the degree of it, but malpractice suits and insurance are only going to be a portion of the costs that frivolous lawsuits incur. Costs would also arise from running tests to strengthen a legal defense rather than for medical reasons, and those numbers are going to be harder to pull out.
- dllthomas 12y ago
  "We don't know enough about the human body to be able to accurately do this. Might help for initial tests (and already does, I'd imagine), but you still always need clinical trials." Trials are expensive per successful drug less because individual trials cost a lot, and more because you're dividing a non-insignificant cost by a low rate of success. If simulations let you avoid 10% of unnecessary trials, that's a substantial savings. (Which means that the pharmaceutical companies are probably already working very hard at this...)
- danielweber 12y ago
  Malpractice suits only make something like 1% of healthcare costs, and malpractice insurance is already everywhere. This isn't measuring the right thing. Pretend that some lawyers managed to win a case locally that the "standard of care" for a shoulder injury was an MRI, even through there is no medical reason, because a bunch of doctors in one hospital did it for whatever reason. Now all the doctors in town rapidly move to MRI'ing every shoulder injury so they don't get sued. This doesn't show up in the malpractice premium numbers. "Standard of care" is strictly a one-way ratchet. If enough doctors in your town/county/field do something, you have to do it, too. You can have comparative results research as long as your arm showing it has no benefit (and even creates slight radiation risks) and it won't do you any good. "Standard of care" is the legal term of art, and it always increases, never decreases. Two more pieces of evidence that lawsuits matter [1] 1. Vaccine manufacturers were going to stop making vaccines because the lawsuit risk was getting too high. (Vaccines do have risks, although minor.) The vaccine courts were set up and everyone seems pretty happy with it. 2. Hillary Clinton's health care plan from 1993 had a whole bunch of tort reform. This is not because the Clintons hated trial lawyers! But they didn't want the courts to be the ultimate arbiters of how much medical care someone should get. You would not be allowed to sue for malpractice without first going through an arbitration process. [1] I'm not blaming everything on lawsuits. But you couldn't run an NHS-like system privately in the US.

ceejayoz 12y ago

Generally agree, but a couple quibbles: > protect doctors from frivolous lawsuits with a bond system Malpractice suits only make something like 1% of healthcare costs, and malpractice insurance is already everywhere. > big-data approaches where biologists and chemists can run simulations and avoid human trials We don't know enough about the human body to be able to accurately do this. Might help for initial tests (and already does, I'd imagine), but you still always need clinical trials.

dllthomas 12y ago
I don't know the degree of it, but malpractice suits and insurance are only going to be a portion of the costs that frivolous lawsuits incur. Costs would also arise from running tests to strengthen a legal defense rather than for medical reasons, and those numbers are going to be harder to pull out.
dllthomas 12y ago
"We don't know enough about the human body to be able to accurately do this. Might help for initial tests (and already does, I'd imagine), but you still always need clinical trials." Trials are expensive per successful drug less because individual trials cost a lot, and more because you're dividing a non-insignificant cost by a low rate of success. If simulations let you avoid 10% of unnecessary trials, that's a substantial savings. (Which means that the pharmaceutical companies are probably already working very hard at this...)
danielweber 12y ago
Malpractice suits only make something like 1% of healthcare costs, and malpractice insurance is already everywhere. This isn't measuring the right thing. Pretend that some lawyers managed to win a case locally that the "standard of care" for a shoulder injury was an MRI, even through there is no medical reason, because a bunch of doctors in one hospital did it for whatever reason. Now all the doctors in town rapidly move to MRI'ing every shoulder injury so they don't get sued. This doesn't show up in the malpractice premium numbers. "Standard of care" is strictly a one-way ratchet. If enough doctors in your town/county/field do something, you have to do it, too. You can have comparative results research as long as your arm showing it has no benefit (and even creates slight radiation risks) and it won't do you any good. "Standard of care" is the legal term of art, and it always increases, never decreases. Two more pieces of evidence that lawsuits matter [1] 1. Vaccine manufacturers were going to stop making vaccines because the lawsuit risk was getting too high. (Vaccines do have risks, although minor.) The vaccine courts were set up and everyone seems pretty happy with it. 2. Hillary Clinton's health care plan from 1993 had a whole bunch of tort reform. This is not because the Clintons hated trial lawyers! But they didn't want the courts to be the ultimate arbiters of how much medical care someone should get. You would not be allowed to sue for malpractice without first going through an arbitration process. [1] I'm not blaming everything on lawsuits. But you couldn't run an NHS-like system privately in the US.