4 ms·

I like almost all of those, but it fails to address issue #1 which is the employer-funded health care system (which itself is an artifact of salary restrictions

I like almost all of those, but it fails to address issue #1 which is the employer-funded health care system (which itself is an artifact of salary restrictions that were part of WWII rationing). Right now most people get what appears to them to be unlimited health care at a fixed price and thus have no incentive to strive for cost-effectiveness. Imagine your employer said "We made a deal with Safeway. We'll take $30/mo out of your paycheck, and you can go to Safeway and all of your groceries are free." You'd be eating Filet Mignon washed down with a bottle of '82 Margaux every night. That's effectively the way our health care system works. It won't become truly efficient until the people consuming the service are paying for it too.

Retric 17y ago
Single payer systems don't just write blank checks. The real issue with US healthcare is it's become a game where the players spend money to lower their percentage of the healthcare burden without lowering the total costs. The net effect of which is the average person pays a lot more for zero average gain. With a small number of people get a free ride and everyone doing a lot of extra paperwork.
pwnstigator 17y ago
Somehow, I think there's a difference between eating filet mignon and being treated for cancer. I could eat a good steak every day, but I wouldn't want chemotherapy unless I was pretty sure I had cancer in the first place. Most people are just trying to get the treatment necessary to keep them at a high level of function. Why should anyone be denied that? Almost no one goes into a hospital and demands thousands of dollars worth of unnecessary tests for diseases they couldn't possibly have-- and those who do are often mentally ill hypochondriacs, given inappropriate treatment because (surprise!) health insurers are generally shitty about MH issues.
- mattmaroon 17y ago
  You completely and totally missed the point.
  - pwnstigator 17y ago
    You made an inappropriate analogy. There are no inherent costs to the consumer in eating fine foods. There are enormous inherent costs to medical care. Most patients want to be treated with minimal pain, risk, and time lost, so they can get back to their regular lives. Their incentive is already, in virtually all cases, in the cost-minimizing direction.
    - yummyfajitas 17y ago
      This has been shown empirically to be false. Patients will consume medicine with no health benefits if it is free, but not if they must pay for it. http://www.rand.org/health/projects/hie/ http://www.rand.org/health/projects/hie/
      - mattmaroon 17y ago
        You did not miss the point.
    - mattmaroon 17y ago
      It's not inappropriate. The point is that when people perceive something as free, they intrinsically opt for the most expensive option. They also will get costly tests and procedures that have at best an extremely remote chance of being useful. The whole reason tort reform, which the original author did mention, is needed is because doctors know this and then prescribe expensive, unneeded tests simply to cover their asses. Between that perverse incentive (which he did address) and the patient's lack of fiscal accountability, enough people have an MRI done every time they sneeze to have a huge impact on health care prices. When insurance companies instituted even very small patient copays on non-generics, usage rates of generics skyrocketed. Just having to pay $5 more (for a product that actually costs hundreds more, but is chemically identical) aligned people with their economic incentives and caused a massive shift in consumer behavior. Brand name pharma companies fought back by giving vouchers to doctors to pass out to patients that covered their co-pays. Brand name medicine market share went right back up. Insurance companies have no effective way to combat vouchers and are forced instead to raise health care rates. Also you're just plain wrong because you're applying rational thought to people who are in a panicked state. When someone has a health problem, they'll do anything and everything to fix it. We all value our own lives as effectively worth infinite dollars, which makes any treatment rational from our perspective. Society, on the other hand, cannot afford to be so generous.
- rick888 17y ago
  "Somehow, I think there's a difference between eating filet mignon and being treated for cancer. I could eat a good steak every day, but I wouldn't want chemotherapy unless I was pretty sure I had cancer in the first place." The point isn't cancer surgery. The point is that right now, if you have a small cough or are feeling bad, but don't really need to go to the doctor, you won't. When the government takes over health care, you will start to have a perceived value that there is an unlimited supply of health care and will go to the hospital more than you should. This, in turn, will flood our hospitals and make it difficult for everyone to get the care that they need. This is why there either needs to be a limit per person per year or a fee per visit. If not, I don't see how the system can possibly be any more efficient than what we have now. "Most people are just trying to get the treatment necessary to keep them at a high level of function. Why should anyone be denied that? Almost no one goes into a hospital and demands thousands of dollars worth of unnecessary tests for diseases they couldn't possibly have-- and those who do are often mentally ill hypochondriacs, given inappropriate treatment because (surprise!) health insurers are generally shitty about MH issues." The US has tons of programs for people that are poor. Also, you will never be turned away for care..you just need to pay for it. A government run program for children was tested in Hawaii and it failed, how will a much larger version of the exact same thing be any different? We need to bring some logic and thinking into the conversation rather than just pure emotion. Otherwise, we will end up a bankrupted country.
- yummyfajitas 17y ago
  There is actually not much of a difference. Filet Mignon makes you marginally happier, and cancer care (mostly) makes you live only marginally longer. http://www.washingtonpost.com/wp-dyn/content/article/2009/11/25/AR2009112503408.html http://www.washingtonpost.com/wp-dyn/content/article/2009/11... Incidentally, last time we did a study to measure it, we found that at least 30% of health care consumed by patients is unnecessary. http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experimen... The conclusion of the study is that health care you are unwilling to pay for out of pocket doesn't help more than it harms (on average). A specific example of care people don't need but will get: mammograms. They are pointless (benefits don't outweigh harms) for people under 50. I mentioned this to a few women I know, but all said they intend to continue getting them. [wow, down to -1 in 20 minutes from citing an expert opinion and an experiment. I should go back to reddit.]
  - pwnstigator 17y ago
    Any time you want to talk about cancer, you have to acknowledge the fact that it's actually over a hundred diseases. Cancer treatment is phenomenally effective for some cancers, for some classes of patients, and ineffective for others. I can name eight people, off the top of my head, I've known who've had cancer. (I'm sure I could list more.) Three died, four are alive and well, and one was diagnosed last month. We're talking about a disease that would have killed all 8 a few decades ago. Also, even if the improvements in cancer treatment are only interative (8 months instead of 3) that's still a major gain, from a research perspective. Look at HIV/AIDS; in 1985, it was an incurable and fatal disease. Due to a series iterative improvements, someone who contracts HIV today in the developed world will very likely be alive in 15 years, and by then, there may be a cure.
    - tptacek 17y ago
      You guys can have a big long emotional conversation about cancer care, but cancer isn't where all the cost is in the system, and cancer treatment may not even be where all the cost is in cancer care (tests, many of which have been demonstrated to be ineffective, may be the major component instead).
- teej 17y ago
  People absolutely go to the hospital to seek treatment thy don't need. We see it in the US already - people flooding emergency rooms with the sniffles looking for antibiotics. That's entirely the reason triage exists, to seperate out the people looking for clinic care and the people with real emergencies. You are correct about cancer and major surgeries - almost no one is going to elect to have these if they can avoid it. The only exception is obeseity cases where people would rather have a gastric bypass then have to suffer through diet and exercise.
  - pwnstigator 17y ago
    Much of the ER flooding comes from two sources: 1. Uninsured people who go to the ER because they legally can't be turned away there. 2. Panic attacks. Untreated anxiety/panic disorders are a huge burden on the hospitals. Most repeat panic visitors have never had a specialist (a) tell them what they're experiencing, and that it's non-fatal (and that there's absolutely no benefit in going to the ER for a panic attack) and (b) prescribe them medicines that can actually help them. Any guess as to why this is the case? Because those people are uninsured.
- tptacek 17y ago
  The nationwide direct costs of arthritis are within 90% of the direct costs of cancer. Matt wasn't saying "withhold chemo".
pragmatic 17y ago
A deductible (present in most systems I've used) minimizes this buffet style spending.
tptacek 17y ago
I don't think this is the #1 issue with health care, Matt. I think the #1 issue with health care is that virtually all market health care in the US is provided through insurance companies who collude with providers to set prices. It's hard to convince me that our big problem is that people are paying for unnecessary care when we have no idea what care costs. Per-service cost numbers are arrived at via allocation schemes based on bulk purchase agreements between hospital chains and giant insurers. Unnecessary care certainly is an issue, but how do you rank it when you don't know what an MRI, a hospital bed, an ambulance ride, or an appendectomy should actually cost?

Retric 17y ago

Single payer systems don't just write blank checks. The real issue with US healthcare is it's become a game where the players spend money to lower their percentage of the healthcare burden without lowering the total costs. The net effect of which is the average person pays a lot more for zero average gain. With a small number of people get a free ride and everyone doing a lot of extra paperwork.

pwnstigator 17y ago

Somehow, I think there's a difference between eating filet mignon and being treated for cancer. I could eat a good steak every day, but I wouldn't want chemotherapy unless I was pretty sure I had cancer in the first place. Most people are just trying to get the treatment necessary to keep them at a high level of function. Why should anyone be denied that? Almost no one goes into a hospital and demands thousands of dollars worth of unnecessary tests for diseases they couldn't possibly have-- and those who do are often mentally ill hypochondriacs, given inappropriate treatment because (surprise!) health insurers are generally shitty about MH issues.

mattmaroon 17y ago
You completely and totally missed the point.
- pwnstigator 17y ago
  You made an inappropriate analogy. There are no inherent costs to the consumer in eating fine foods. There are enormous inherent costs to medical care. Most patients want to be treated with minimal pain, risk, and time lost, so they can get back to their regular lives. Their incentive is already, in virtually all cases, in the cost-minimizing direction.
  - yummyfajitas 17y ago
    This has been shown empirically to be false. Patients will consume medicine with no health benefits if it is free, but not if they must pay for it. http://www.rand.org/health/projects/hie/ http://www.rand.org/health/projects/hie/
    - mattmaroon 17y ago
      You did not miss the point.
  - mattmaroon 17y ago
    It's not inappropriate. The point is that when people perceive something as free, they intrinsically opt for the most expensive option. They also will get costly tests and procedures that have at best an extremely remote chance of being useful. The whole reason tort reform, which the original author did mention, is needed is because doctors know this and then prescribe expensive, unneeded tests simply to cover their asses. Between that perverse incentive (which he did address) and the patient's lack of fiscal accountability, enough people have an MRI done every time they sneeze to have a huge impact on health care prices. When insurance companies instituted even very small patient copays on non-generics, usage rates of generics skyrocketed. Just having to pay $5 more (for a product that actually costs hundreds more, but is chemically identical) aligned people with their economic incentives and caused a massive shift in consumer behavior. Brand name pharma companies fought back by giving vouchers to doctors to pass out to patients that covered their co-pays. Brand name medicine market share went right back up. Insurance companies have no effective way to combat vouchers and are forced instead to raise health care rates. Also you're just plain wrong because you're applying rational thought to people who are in a panicked state. When someone has a health problem, they'll do anything and everything to fix it. We all value our own lives as effectively worth infinite dollars, which makes any treatment rational from our perspective. Society, on the other hand, cannot afford to be so generous.
rick888 17y ago
"Somehow, I think there's a difference between eating filet mignon and being treated for cancer. I could eat a good steak every day, but I wouldn't want chemotherapy unless I was pretty sure I had cancer in the first place." The point isn't cancer surgery. The point is that right now, if you have a small cough or are feeling bad, but don't really need to go to the doctor, you won't. When the government takes over health care, you will start to have a perceived value that there is an unlimited supply of health care and will go to the hospital more than you should. This, in turn, will flood our hospitals and make it difficult for everyone to get the care that they need. This is why there either needs to be a limit per person per year or a fee per visit. If not, I don't see how the system can possibly be any more efficient than what we have now. "Most people are just trying to get the treatment necessary to keep them at a high level of function. Why should anyone be denied that? Almost no one goes into a hospital and demands thousands of dollars worth of unnecessary tests for diseases they couldn't possibly have-- and those who do are often mentally ill hypochondriacs, given inappropriate treatment because (surprise!) health insurers are generally shitty about MH issues." The US has tons of programs for people that are poor. Also, you will never be turned away for care..you just need to pay for it. A government run program for children was tested in Hawaii and it failed, how will a much larger version of the exact same thing be any different? We need to bring some logic and thinking into the conversation rather than just pure emotion. Otherwise, we will end up a bankrupted country.
yummyfajitas 17y ago
There is actually not much of a difference. Filet Mignon makes you marginally happier, and cancer care (mostly) makes you live only marginally longer. http://www.washingtonpost.com/wp-dyn/content/article/2009/11/25/AR2009112503408.html http://www.washingtonpost.com/wp-dyn/content/article/2009/11... Incidentally, last time we did a study to measure it, we found that at least 30% of health care consumed by patients is unnecessary. http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experimen... The conclusion of the study is that health care you are unwilling to pay for out of pocket doesn't help more than it harms (on average). A specific example of care people don't need but will get: mammograms. They are pointless (benefits don't outweigh harms) for people under 50. I mentioned this to a few women I know, but all said they intend to continue getting them. [wow, down to -1 in 20 minutes from citing an expert opinion and an experiment. I should go back to reddit.]
- pwnstigator 17y ago
  Any time you want to talk about cancer, you have to acknowledge the fact that it's actually over a hundred diseases. Cancer treatment is phenomenally effective for some cancers, for some classes of patients, and ineffective for others. I can name eight people, off the top of my head, I've known who've had cancer. (I'm sure I could list more.) Three died, four are alive and well, and one was diagnosed last month. We're talking about a disease that would have killed all 8 a few decades ago. Also, even if the improvements in cancer treatment are only interative (8 months instead of 3) that's still a major gain, from a research perspective. Look at HIV/AIDS; in 1985, it was an incurable and fatal disease. Due to a series iterative improvements, someone who contracts HIV today in the developed world will very likely be alive in 15 years, and by then, there may be a cure.
  - tptacek 17y ago
    You guys can have a big long emotional conversation about cancer care, but cancer isn't where all the cost is in the system, and cancer treatment may not even be where all the cost is in cancer care (tests, many of which have been demonstrated to be ineffective, may be the major component instead).
teej 17y ago
People absolutely go to the hospital to seek treatment thy don't need. We see it in the US already - people flooding emergency rooms with the sniffles looking for antibiotics. That's entirely the reason triage exists, to seperate out the people looking for clinic care and the people with real emergencies. You are correct about cancer and major surgeries - almost no one is going to elect to have these if they can avoid it. The only exception is obeseity cases where people would rather have a gastric bypass then have to suffer through diet and exercise.
- pwnstigator 17y ago
  Much of the ER flooding comes from two sources: 1. Uninsured people who go to the ER because they legally can't be turned away there. 2. Panic attacks. Untreated anxiety/panic disorders are a huge burden on the hospitals. Most repeat panic visitors have never had a specialist (a) tell them what they're experiencing, and that it's non-fatal (and that there's absolutely no benefit in going to the ER for a panic attack) and (b) prescribe them medicines that can actually help them. Any guess as to why this is the case? Because those people are uninsured.
tptacek 17y ago
The nationwide direct costs of arthritis are within 90% of the direct costs of cancer. Matt wasn't saying "withhold chemo".

pragmatic 17y ago

A deductible (present in most systems I've used) minimizes this buffet style spending.

tptacek 17y ago

I don't think this is the #1 issue with health care, Matt. I think the #1 issue with health care is that virtually all market health care in the US is provided through insurance companies who collude with providers to set prices. It's hard to convince me that our big problem is that people are paying for unnecessary care when we have no idea what care costs. Per-service cost numbers are arrived at via allocation schemes based on bulk purchase agreements between hospital chains and giant insurers. Unnecessary care certainly is an issue, but how do you rank it when you don't know what an MRI, a hospital bed, an ambulance ride, or an appendectomy should actually cost?