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> 2 - the disparity in prices shows that the free market just doesn't work for American Health Care (basic microeconomics) she just starts talking over me. Jing
by lionhearted 17y ago
> 2 - the disparity in prices shows that the free market just doesn't work for American Health Care (basic microeconomics) she just starts talking over me. Jingoism has replaced discourse.
Some reasons American medicine is very expensive:
1. Health insurance, but not treatment, is fully tax deductible. So if you buy your own penicillin, it's with after tax money, but if your insurance company buys it, it's pre-tax money. That's one of the reasons that health insurance is so widespred in America even for routine medicine like antibiotics and checkups. That's a major contributing factor in why the administrative costs are so high.
2. There's a shortage of doctors in America, and qualified doctors from other countries are not allowed to practice medicine in the United States. So there's good doctors from Canada, England, Japan, wherever that'd love to practice in the USA, but can't. This artificially inflates doctor's wages by restricting supply.
3. American doctors are typically required to get an undergraduate degree, medical degree, and do a below market, crazy hours residency in order to be able to practice medicine. That's 8-10 years of study and below market working to practice medicine. Now, medicine is very important and needs to be done right, but I don't believe for a second that a focused apprenceship couldn't teach a very specific kind of medicine - say arithscopic surgery - in just 2-4 years under a highly trained doctor, but this isn't an option.
4. The Food and Drug Administration requires new drugs to be proven not only for safety, but also efficacy. That's an incredibly high and expensive burden to meet - that means that drugs need to be proven to work to a certain standard, instead of just not harm. This adds years of development time and millions of dollars in cost to the new drug development cycle.
Those are all legislated reasons that increase the cost of medical insurance, doctors, and drugs. They'd be fairly easy to remove -
1. All medical and health expenses can be written off taxes regardless of insurance. Employees can choose to convert som of their wages to a medical or health plan tax free to both the employer and employee. (Currently, under most circumstances, only employer-provided health insurance can is tax free)
2. Allow any doctor in a country with reasonably competent medical standards to practice in the United States.
3. Require that doctors be able to demonstrate that they can practice their area of medicine capably. Be flexible in how they demonstrate that. Note: This will incur high opposition from medical schools and current doctors who are currently enjoying the wage premium and had to go through the very long, difficult, and expensive system.
4. Change the drug standard from "safety and efficacy" to only safety. Drugs will come to market much faster and cheaper. There's plenty of people and organizations that will test proven safe drugs for efficacy for free or nominal cost once drugs hit market, and efficacy will get understood with time. Put this way - a proven safe but questionably effective treatment against heart disease being held off the market for five years and costing much more to get to market is not a good thing. If it's certainly safe, then let people make the decisions with their physicians, instead of having the FDA take such a strong gatekeeping stance.
Technology has progressed such that we don't need government protection from ourselves as much any more. The current set of legislation has greatly increased the costs of doctors and medicine. Regardless of political position, and regardless of stance on other health issues, addressing these four points will make the medical system fairer, more effective, and and less expensive with relative ease.
Admittedly, there's some powerful entrenched interests that are winning in the current arrangement, and will oppose these simple improvements.
- DanielBMarkham 17y agoPerhaps I got to the party late, but I've read some dynamite analysis of the problems of healthcare by commenters and articles on HN. Most all of these are able to lay out the drivers of the problems and suggest concrete, simple ways to fix things. However when I look at the current proposed solutions, they are neither simple or concrete. Instead (to me) they look byzantine, obtuse, and obfuscated. This leads me to believe that either lots of really smart people have vastly underestimated the complexity of the problem, or that the people currently charged with fixing it are unable or unwilling to work in a direct manner. All three of these are interesting conclusions.
- camccann 17y agoMaking things happen in politics typically requires convincing at least some threshold number of largely disparate groups that they each stand to benefit (in some tangible, direct way) from your proposal, or at least won't be harmed by it. This tends to constrain the space of possible solutions in awkward ways, as an initially simple proposal may accrete peculiar exceptions, irrelevant attachments, and other cruft until enough people are happy. If you're lucky, the final result of the process will still fulfill the purpose of the original proposal. If you're unlucky, the crufting process will have completely undermined the original intent and you'll have to either vote against your own proposal (which is embarrassing) or pass it anyway (wasting taxpayer money on all the useless cruft). That said: smart people are often prone to underestimating the complexity of problems outside of their domain of expertise, and it's easy to propose solutions when you're not the person implementing them. So it's probably a bit of both.
- DanielBMarkham 17y agoIt seems based on your reply that we will never know, then, whether initial assessments of complexity were correct. If the description of a problem never matches the solution, it becomes very difficult to have a conversation about whether a solution actually addressed a problem, no? The problem mutates from it's original nature and becomes assembling and coordinating disparate groups. I note that there are many examples of solutions to problems in legislative circles done in a direct fashion -- I'm not certain this is as much a requirement of legislative solution-creation as much as a certain style of decision-making. I don't have any conclusions, just the observation that if the goal is to gain support of various groups, then it's not really about solving the initial problem any more, because with just a small number of groups it's very easy to over-constrain a solution. Very interesting. Is it a bug? Or feature?