Several years ago, there seemed to be a lot of talk about how much The US spends (private & public) per capita on health. It’s a lot more than everywhere else. This was usually presented in the context of the health care “regime” A UK-esque system, a Swiss-like system, etc.
Lately, that comparison seems to come up less. Obama-care, Trump-care or Bernie-care would mostly deal with who pays & how, not how much.
The “who pays” question is a favourite ideological one so politicians and commentators are comfortable with it. But, I think the “how much” question is probably the more important one, and the harder one to solve. If the US could get costs down to average European rates, then I’m sure a workable system could be found within the confines of most ideological frameworks.
The problem is that getting costs down is almost impossible. Costs are salaries of doctors & nurses, a giant pharmaceutical industry, thousands of radiologists, ultrasound technicians, the machines they use (far more frequently than europeans)…
Getting costs down to EU levels would be mean the medical industry shrinks like manufacturing shrunk two generations ago.
I don’t have a solution to suggest, but I do suggest toning down the ideological discussion. The problem is more of a technical one.
I had a similar issue where I was billed for a physical that my insurance provider would not pay. My wife suggested I have the Dr. office re-code the bill. Not sure what that is but I contacted the Dr. office and explained that it was not a wellness check up but an annual physical that my insurance should cover. After arguing for about 10 minutes they finally agreed to re-submit to insurance under that code... and it ended up being covered by insurance after all.
http://www.chronicle.com/interactives/administrative_bloat https://hbr.org/2013/09/the-downside-of-health-care-job-grow...
The medical industry is the only industry with a broad anti-trust exemption. What this means is that they do not have to publish prices like all other industries.
How can one expect to control costs if you cannot even know how much things cost?
Removing this anti-trust exemption and allowing the public to see prices for the common procedures would be a good start.
In other words, demand is inelastic.
And, most people can't afford to pay 10k or 100k out-of-pocket. So, it's not like managing your household budget. The funds have to come from somewhere else (insurance).
Also, healthcare is not easy to evaluate for a layperson. If my doctor says that I need 'procedure X', I'm relying on their expertise. Healthcare recommendations are not fungible products. If I'm buying a car, I can read reviews about the different models, reliability, etc. But my doctor's recommendation for me is highly specific to my personal health history.
So, for a lot of healthcare spending, it's not me that's choosing a medical procedure. Instead, I'm choosing to trust a doctor's recommendation. The doctor is the one that's recommending the procedure.
I echoed this idea in a comment yesterday. The medical industry is the only industry with a broad anti-trust exemption. What this means is that they do not have to publish prices like all other industries.
Could you elaborate on this? I don't see what publishing prices has to do with anti-trust, and certainly I have encountered "call for prices" elsewhere.
At this point though, going with the known working solution sooner rather than later is the technically most plausible way to stop the cost expansion. It is exactly like people debating about national debt - you can't complain or argue about how to pay it off until you stop adding to it every year, often with an increasing deficit (which is how republican administrations for the last 30 years have governed).
It is crazy to argue that in the moment your house is on fire to try this untested strategy of using giant fans to blow the fire out that nobody else has done versus going with the tried and true use a fire truck to extinguish the blaze. Experiment after everything isn't on fire.
The only for most Americans to have a choice in their health insurance is when they get to pick between the plans from either husband's or the wife's employers.
The biggest disappointment of the Republican alternative to Obamacare was not coming up with a way to sever that tie.
Most medical markets (including the US') have large free market & "social" elements. I don't think moving one way or another along that axis would move the needle in a predictable way. That would be decided by the more detailed points. That's what I mean by technical
However, US private spending is much higher, so the total cost of healthcare is higher.
The OECD numbers for 2013 put US per capita spending at $9,086 compared with Swiss spending of $6,325. The OECD median is $3,661.
It would be better to compare the USA with Canada, which has a universal healthcare system at a lower cost to the state ($3,974 vs $4,197).
"Drugs must be effective, cost-effective and appropriate to be listed in the positive drug list (SL/Spezialitätenliste). The federal government sets the maximal allowable public price for drugs in the SL."
https://www.ispor.org/HTARoadMaps/SwitzerlandPH.asp
It is also the most expensive of the european OECD nations...
Which either demonstrates everything that is right or everything that is wrong with the world's leading free-market capitalist economy...
SSC in particular noted that it was not any individual salaries that were the problem -- everyone's pay seemed about reasonable. Rather, what made the US so different was how much they had to spend in near-paranoid countermeasures against the dreaded "lawsuits".
That, I think, provided the clearest clue: in Europe, it's near impossible to "sue the school", "sue for malpractice" if they adhered to the regulations, and if you can, the loser pays. On top of that, the state automatically covers the injuries, so it's much less likely for resources to get lost in the black hole of litigation and discovery.
[1] http://slatestarcodex.com/2017/02/09/considerations-on-cost-...
HN Discussion: https://news.ycombinator.com/item?id=13613687
Also, the lack of universal coverage here means that a lot of medical bills go unpaid, for many reasons including bankruptcy or even people giving the emergency room a fake name when they go in. The hospitals don't just eat that cost, they amortize it into the costs paid by patients who do pay their bills. Universal coverage would, therefore, lower the cost of care per individual by eliminating the costs of trying to collect from uninsured people who can't pay.
But the biggest ideological cost of health care in the US is our insistence on including the "free" market in paying for health care. Insurers have a ~25% profit margin. A single-payer system could be very inefficient and yet still come in far below that cost.
There's no such thing as a free lunch. If you don't pay for the damage caused by doctor's mistakes, you are just offloading part of the cost of your healthcare system onto a few unlucky people. If you do pay for it but it's not paid for by the doctors, you just re-invented malpractice insurance but with a different source of funding.
The left believes that healthcare should be a right - that everyone should get care regardless of whether you are homeless, or a billionaire.
The right believes that it is not a right. That you should only get healthcare if you earn it. If you are homeless, too bad. You die.
Now, conservatives know that they can't come right out and say it that way, but ultimately, that's what a lot of people believe. They don't want to pay for someone else's care.
So, the arguments aren't really about 'what is the most efficient way to pay for everyone to get healthcare'.
The arguments are about the fact that half the population doesn't want to pay for healthcare for someone else.
Those aren't the only costs though. A lot of the cost is on useless things like bureaucracy, middlemen and duplication.
For example, there are two very large hospitals within about a mile of my home solely because one of the insurance providers likes to build its own and providers don't like to share. You could cut costs significantly by simply demolishing one of the buildings and moving the staff to the other one.
Health insurance companies are able to negotiate lower prices for their subscribers due to leverage. Likewise, single payer would mean all subscribers would have their prices negotiated through a single entity.
Without consolidation of payment, the anti-trust exemptions for the healthcare industry means patients cannot effectively negotiate the cost for their care.
Single-payer would remedy that.
Capping or reducing healthcare cost as a % of GDP may help many other sectors to expand. On this basis politicians should first try to get the support of corporations to reduce their insurance costs, and try to change the argument - sustainable healthcare for all. This kind of corporate backing would counter the inevitable lobbying of pharma/medical corporations who will put their resources into countering any legislation that reduces their profit margins.
Pharmaceuticals are 5 large companies. The rest of the economy is 500. So let's imagine there is a bill that would reduce the cost of drugs by 50 billion dollars. Each non drug company would stand to save 100 million but each pharmaceutical company stands to lose 10 billion. This is a classic coordination problem, and free riding dictates the pharmaceuticals win everytime.
Wouldn't cutting down regulation, and reducing the AMAs monopoly on doctors help?
Less regulation = less costs.
More doctors drive costs down too.
http://www.nahu.org/legislative/policydocuments/NAHUWhitePap...
What would happen if US (a) lowered the bar for doctor certification or (b) automatically recognized foreign doctor and nursing diplomas from English-speaking (or Spanish-speaking, to accommodate some states) countries?
So HN, this field here is ripe for disruption. Like the kitchen remodeling stand at Lowe’s or Home Depot, why not a booth to connect people to competent doctors and medical specialists in Europe, Russia, or India with all medical records and diagnostics online, allowing people find the most competitive prices and options for their medical services.
Right now for a surgery if you need it, there are least three 14 hour non-stop direct flights daily to India or Dubai where well equipped hospitals and experienced surgeons will be available (added: at a fraction of the cost here)
meaning what? that a VC funded startup should come in and start offering health insurance? what are you suggesting? what does disruption even mean in this context?
let's get away from those corner cases where it's even thinkable to fly to Dubai for surgery. that's a high cost intervention for specific (wealthy) individuals. that isn't solving the problem of providing health care for 300 million people. how do you propose we do that?
In other words, a privatized system will always fail to adequately cover certain groups of people: the poor, those with unusually expensive conditions, the unemployed, the elderly, etc. Providing coverage for those groups, motivated by humanitarian concerns, is the reason there is so much ideological debate. The system as it is currently constructed uses a combination of limited-scope public services (medicare for the elderly, medicaid for the extremely poor) and heavy-handed regulations (various acts of Congress) to cover those groups.
That is why we have so much ideological debate and why it needs to continue. Cost reduction alone won't solve the totality of issues in the system.
Getting rid of them would be extremely hard, of course, given how well entrenched they are thanks to lobbying and regulatory capture.
Insurance companies are a massive-scale version of the car dealerships that have managed to keep Tesla out of many US states by taking advantage of local legislation -- nobody would want to deal with a car salesman or an insurance company given the choice.
Personally, I think health insurance should be, you know, insurance. For catastrophic things you wouldn't wish on yourself and cannot save for. And there's a definite role for government to make sure that market is solvent and available to everyone.
For day-to-day healthcare, that should just be included in "cost of living" calculations. General-purpose welfare programs (or ideally a minimum income) would guarantee that people could afford checkups, birth control, etc.
Getting employers out of the business of all of the above is paramount and what businesses should be lobbying for. I believe the slow recovery from the recession has been affected by unintended (though not unpredicted) consequences of the ACA's failure to address this issue. The Republicans likewise seem happy to punt on the issue. It's this sort of thinking that is making the American electorate disgruntled with politicians and each other.
That sounds reasonable, but is it efficient?
1. It discourages "routine maintenance" -- it's a lot cheaper to go to the dentist annually than to get a root canal every ten, yet there are many who if they only had catastrophic dental insurance would skip the annual.
2. This "cost of living" varies drastically based on age, sex, pre-existing conditions, et cetera. So it couldn't be covered fairly by a single fixed UBI. So you'd need bureaucracy to determine who is eligible for extra coverage
3. Every small doctor's office would need a billing department. In socialized healthcare countries, "billing" is not much more work than filling in a time sheet, and is often done by the doctor themselves.
It's cheaper, more efficient and more fair to cover day-to-day healthcare for everybody than to just cover only catastrophic care.
Amen. I never quite understood what benefit (pardon the pun) it served, although I've got some idea of the origins of employer-provided health insurance.
The cynical part of me believes it's definitely a way for larger companies to hold more control over their employees, and they may lobby for this because it provides an extra advantage over smaller competitors.
I've known plenty of really sharp/talented folks whose talents may better serve the economy by taking those skills to other companies (sometimes in other parts of the country). "But I'll lose my health insurance" is almost always a primary reason why people've stayed in their job (however crappy it might be otherwise re: pay, commute, colleagues, boss, industry, etc). This seems like it's been a real drag on labor mobility for some time now.
I would have thought 'conservatives' would be all over a 'free market' where people make their own choices with their own money. They'll happily deride a "nanny-state" as fostering people who just want the govt to provide them with everything, but ... expecting people to need employers to provide access to basic services? Apparently there's no problem there whatsoever, and it doesn't even seem contradictory to many I talk to.
It depends on where you are. There are areas of the country where insurance companies are fighting a cost war on behalf of patients against increasingly conglomerated and monopolistic hospitals.
This American Life had a great episode on this a while back. I went in thinking, "This problem's simple, it's all the fault of x." (For a few values of x.)
I left the episode thinking, "Wow, who knew health care could be so complicated?"
I have moved towards a Marxist philosophy on healthcare. Well, Groucho Marxist: I no longer trust any solutions to healthcare that non-experts like me could understand.
https://www.thisamericanlife.org/radio-archives/episode/391/...
This seems like an unnecessary war. Are patients really being helped by a structure where multiple corporate entities -- the hospital and the insurance companies -- are battling each other to extract the maximum value from both the patient and the government actor paying for some part of the care?
If the hospital were not a regular for-profit corporation, they wouldn't turn into a monopolistic conglomerate... But of course it's practically impossible to undo these corporate structures and replace them with something with a whiff of socialism. It might even mean a pay cut for doctors, and then you'd have to restructure their education costs too... It's a very deep problem.
I think you're being too generous here. Insurance providers are not only useless, but of negative value to patients and physicians alike. They add yet another bureaucratic layer atop the healthcare system as a whole, and inundate physicians with red tape that interferes with care.
In my experience, insurance companies will actively go out of their way to fuck over patients on technicalities—even in life threatening situations—just to try and save a dime. The sheer indifference to humanity can be breathtaking at times.
Of course you can argue that having just one system is far more efficient than having hundreds of different ones as exists in the US today.
However, someone still has to say "no" to certain care. I know when i was in Canada that role was taken by the gov't.
One of the biggest US health insurer is UnitedHealth Group. In their last financial quarter report they published:
Revenues $48.7 billion
Earnings From Operations $3.4 billion
Net Margin 4.5%
These type of good and enviable stable profits are not enough to explain the inefficiencies in the US. Insurance may be lobbying but that is dwarfed e.g. by the marketing expenditure of the pharmaceutical industry (same level as their R&D). Yes health insurance is living well on the inefficiencies and their (in part unnecessary) middle man role but there are way bigger money leaks.
I always go back to when the Affordable Care Act was passed. At the time the amount of money being spent and the future money promised was enough for the federal government to buy every public health insurance company on the open market. If that decision had been made the argument for going to single payer, universal healthcare would have been over.
Yes, it would have been a rough transition, but at the time elapsed between now and then would have moved the USA into the rest of the world when it comes to healthcare.
Still the real bogeyman is just like income taxes most people don't see the cost first hand or don't associate it with their income. They see the final check value and somehow disconnect the costs.
The step is getting name insurance off of products that are not insurance
Cheaper coverage can pretty much only be obtained by excluding people or limiting the benefit.
https://www.theatlantic.com/magazine/archive/2009/09/how-ame...
Some people (not me) would argue that their existence and competition create better choices for consumers.
For example, in theory, a single-payer system could have a single price (via taxes) and a single level of coverage. By contrast, private insurance companies are able to offer many different products depending on someone's tolerance for risk.
I don't think the private, market-driven system for health care is better in that regard, but some people do.
Imagine if people with Ether (or other blockchain currency) could "reserve" ethers to serve as insurance spending for other people that buys the insurance contracts... something like crowdsourcing of insurance.
That would be really cool.
That, ultimately is how the tobacco industry was (mostly) quashed.
* Endless number of middlemen and administrators. * Every player in the healthcare chain benefits from higher prices. * No price transparency. * Tacit collusion is rampant. * "Cost no object" mentality to treating the dying.
The last one, while insensitive, is true nonetheless, and it's alarming that over 50% of all healthcare spending takes place in the last two years of a person's life. We have basically decided that it's okay to spend literally any sum of money on a dying person in order to prolong life by an average of a few months. And the problematic word there is average, because some people do live a lot longer, and that's what we all look to. I realize this is grim and seemingly lacks humanity, but unfortunately that doesn't make it not true. Charlie Munger, who is on the board of Kaiser Permanente, said this same thing yesterday..."over-treatment of the dying" was the biggest problem they faced.
It's reminiscent of our approach to college education - justified at any cost. So we push millions of kids into a schooling system that's not right for them, and the result is a lot of crappy education, worthless degrees, student loans, etc. Once we flip the switch to "there is no price you can put on _____" things get sideways FAST.
Edit: ObXKCD: https://www.xkcd.com/931/ (Lanes) Every one of those lanes going off to the right is the end of healthcare spending for someone, but you can't know going in which ones are going to turn off. Focusing on the "50% in the last 2 years" number is a lot like the the naive visualization at the top.
excluding trauma care for accident victims (that end up dying anyway), and excluding cases of early-in-life cancer, and excluding every other case we can think of where a spike of medical spending shortly before the person dies anyway is understandable as part of a good faith effort that had a reasonable chance of prolonging their life for many years, after all those exclusions are made we will still find many instances of cases where the end-of-life medical spending seems excessive.
The canonical example I can think of would be organ transplants for very elderly people. A new kidney for a 75 year old person in advanced renal failure is unlikely to prolong their life by very much.
This kind of stuff gets very emotional and very political though. This is what provoked the demagoguery about "death panels" when Obamacare was being debated in congress in 2009. We are both very uncomfortable allowing the government to make those decisions and also very uncomfortable allowing private insurers to make those decisions. We want to empower families to make those decisions and so remove cost from their consideration (via regulation, requiring insurers to pay) and then we become surprised when people who haven't made their peace with death are willing to spend any amount of money (which is a hidden cost from their point of view) to prolong end-of-life. It shouldn't be surprising. We set up a perverse incentive structure and locked it in place with regulations.
1. Insurers are incentivized to seek out the minimum cost to achieve maintainable health.
2. Health care providers are incentived to reap as much as possible from insurers in return for acceptable (not always exemplary) health outcomes.
3. Patients, who on average are getting older and in need of more care, are pigeonholed (sometimes good, sometimes bad) into health care decisions by their providers and insurers.
4. Device/equipment manufacturers can charge ludicrous amounts because they capture very specific pieces of markets or gain preference from health care providers. However, the risk and cost involved in creating a new/competing product and entering a market can be staggering, and so high costs become inevitable (same argument drug developers can make).
As you said, 'justified at any cost' makes this whole shebang go, especially when no single party is capable of controlling the cost. We can't point to a boogeyman we all have a part in making.
But hospitals force patients to agree to be responsible for all bills their insurance doesn't cover.
So there are two large institutions, neither of which is entirely aligned with the interests of the individual dealing with them. Of course hospitals aren't trying to kill people, but good luck figuring out if the care they bill for is really necessary or not.
If an insurance company were to announce record profits because they were able to better control costs than their competitors, there would be immediate pressure to lower premiums and not take the additional profits.
When it comes to health care, the idea that we have anything resembling a free-market and private competition to lower prices is a farce on a grand scale.
http://freakonomics.com/podcast/are-you-ready-for-a-glorious...
http://www.npr.org/sections/money/2014/03/05/286126451/livin...
A lot of those countries have physician assisted suicide though, which greatly improves the humanity of late term care. That is an easy and obvious piece of the solution the US should have been able to get behind a long time ago.
Six US states have end of life care that can include doctors prescribing fatal doses of medication.
https://en.wikipedia.org/wiki/Assisted_suicide
> The United States has authorized medical aid in dying in six states, which refers to a terminally ill person with 6 months or less to live taking a medication prescribed by a doctor
Cutting the fat from that may mean a lot of folks lose livelihoods (and THEIR healthcare).
A ton of people in government related jobs only have equivalent roles in jobs at equally large and capital inefficient bureaucracies.
https://en.wikipedia.org/wiki/Parable_of_the_broken_window
Edit: Which is not to say those impacted won't need assistance moving on to other things. But, cutting the fat should be a net benefit to society.
Unfettered profit at all costs capitalism isn't a glowing unicorn.
By contrast, he said, while tax rates have fallen as a share of gross domestic product, health care costs have ballooned. About 50 years ago, he said, “health care was 5 percent of G.D.P., and now it’s about 17 percent.”
The same argument applies to bloated costs of equipment. If a surgical sponge is $500 vs. $10 elsewhere, i doubt the added benefit justifies the extra $490. That $490 is coming out of someones pocket and its a complete waste.
This graph [1] also shows the same story. The return on investment measured by life expectancy in the US is pathetic. The extra money is just not helping... so its either being misused or stolen, probably both.
https://ourworldindata.org/the-link-between-life-expectancy-...
Total Money spent on heath care has very poor correlation with outcomes. Largely because it includes things like medical billing and advertising which increases costs without providing any benefit. You also often do more dangerous and unnecessary procedures and give more drugs risking poorly understood interactions.
Something like 80% of the benefit of modern heathcare comes from the first 10% of spending. EX: Sanitation and quarantine are cheap and amazing tools to stop the spread of disease where hospitals are extremely expencive and gather sick people together to spread disease. A vaccine is vastly cheaper and more effective than dealing with outbreaks.
There are so many inefficiencies with monopolistic practices such as inability to import drugs from outside US, healthcare networks, and on and on.
* Inefficiencies in delivery mean that those for whom low-cost interventions are most beneficial, most especially pregnant women, and infants and children, don't receive preventive and supportive care which offsets future problems.
* High healthcare costs translate directly to high labour costs, exacerbating the competitve disadvantages American labour faces relative to the rest of the world, and obviating much or all of the advantage of the greater efficiencies of such labour.
* What health care services as are offered are, counter to my first point, late and heroic measures which do little to extend life or its quality, but keep sick patients alive longer. They are delivered largely based on capacity to pay, rather than social need.
* Programmes to increase overall community well-being, ranging from vaccinations, education, and other public-health measures, to treatment of drugs and drink addiction as medical rather than criminal problems, aren't provided. Entire towns and states fall victim to epidemics of entirely preventible conditions: measles, mumps, cervical cancer, HIV/AIDS, alcoholism, drink driving, heroin and opoids additions, cocaine and meth addiction.
* I won't even talk about mental health services. They are a national embarassment and shame to all Americans.
Instead, a handful of insurers, hospitals, drugs manufacturers, equipment manufacturers, and service providers (look up medical transport for an eye-opener) are skimming off fat profits whilst delivering little of actual value, and actively eroding the competitive and health viability of the country as a whole.
Other countries are getting better health results for way less money which all other things equal makes Americans comparatively less well off.
When I pay $1500 and dozens of hours of time for something that costs $2 and 15 minutes in another country, I am less well off.
I like being healthy, but I'd rather be more healthy for less money than less healthy for more money.
You are right, the money isn't transferred off into a void, it is a wealth transfer from consumers to the healthcare industry.
While I guess I have no problem with this statement specifically, it's a bit too close to "the top 1 percent of Americans will pay 45.7 percent of the individual income taxes" : http://www.cnbc.com/2015/04/13/top-1-pay-nearly-half-of-fede...
The problem with the latter statement is of course that it makes it sound like the top 1% is unfairly burdened by taxes, while hiding the fact that the richer they get compared to the rest, the larger a share of taxes they'll pay.
Taking it to the logical extreme, if all income went to the top 1%, they'd pay 100% of income taxes, while the lazy 99% contribute zero! Someone quickly give the rich a tax break!
If not, why should consuming those services cost significantly more money?
It might feel right that rich people should pay more, but that's not how any other market works - why should government services be different?
EDIT: To all of the people saying rich people consume more government services than poor people: you're forgetting about welfare payments. In the UK this is the largest government expenditure, and it is consumed almost entirely by people who are not paying for it.
Between myself and my employer, it costs about $20,000 to insure my family a year. My employer shares much of the cost breakdown and it's interesting how goes to prescriptions and how much of that goes to specialty drugs to keep a handful of people alive.
$500 million dollar spend on healthcare.
$120 million goes to prescriptions.
$40 million of that went to specialty drugs, representing 1.7% of the prescriptions.
"The average ingredient cost of a single-source brand prescription increased by 14.9% in 2016 to an average $745 per prescription, mainly driven by high-cost specialty drugs. The average ingredient cost of multiple-source brand prescription increased by 49.5% to an average $585 per prescription. The average ingredient cost for a generic prescription decreased by 10.9% to an average cost of $34.04 per prescription. "
In contrast a few weeks in the ICU can easily top 100k. A visit to the ER is usually 1500 just to walk in the door. Healthcare costs are largely a result too many middle men and overhead from extremely high healthcare provider salary.
may be there isn't any competition (which could be because it's quite hard to establish a new healthcare clinic/hospital)? Also, are there limited supplies of health care professionals that cause their salaries to grow to such a high number?
Wow, that's an awful lot. What's the level of service like? For comparison when I lived in Switzerland my family, ie my wife and 2 kids, were about 750 CHF a month. All paid from my pocket.
The level of care was stunning though. That 750 was for single room care, and we had two babies by caesarean. Also the times I was in the emergency room there were zero other people in line. Almost wondered whether it was actually an emergency room.
You can get less comfy care, I think at about 500 per month, sharing a bedroom with one other patient.
By contrast the NHS in the UK is pretty stretched when you go there, but paid via taxes.
Though with the cost of education and all the mess around malpractice, it seems very hard to _fix_ the US system.
Yes, right, problem is abnormal cost of healthcare in US, that should be fixed first. But when only thing you do about this is letting wild free market put price tags as they want and let poor people be hopeless under costs, that is 'unhealthy' for the society.
The free market is not the problem.
Then there are the medical device manufacturers, big Pharma and the hospitals. They all are getting rich off the current system. That's what needs to change.
The American Medical Association (AMA) does its duty to restrict the supply of doctors [1]. Countries like India, which produces plenty of high quality doctors, does not require aspiring doctors to go through an additional (unnecessary) 4 years of undergrad education. That would hugely cut the cost down in training the doctors.
Secondly, doctors on average makes $200K/year [2] or more. I have four housemates, who were trained in Myanmar (went through five years of medical school there right after high school) and scored above 95th percentile or more in all three steps of their USMLEs, to get into the residency programs in the US. One of them is going into general practice (family medicine) in Virginia and her starting salary is: $210K/year. I have no doubt that she (or anyone who has been trained 5 years in a decent med school--without the 4-year undergrad prior to that) is more than capable of treating generic diseases and illnesses. But this shows that we can train doctors cheaper and that we can reduce their pay by quite a bit (no hard-working person in other profession--except maybe Banking--could easily earn $210K/year to do such a relatively uneventful--in my opinion--job).
I regret quitting med school in Myanmar in the third year. Then, I thought med school training involves too much rote learning (a lot of memorization in organic chem for example) and that I'd rather do something more 'exciting' like tech or math. I was wrong.
[1] https://mises.org/library/how-government-helped-create-comin... [2] https://www.theatlantic.com/health/archive/2015/01/physician...
Sounds like a lot, right? Until you note its just $300 out of $10,000 spent per person each year.
And what's the trade-off? Despite your opinion that it's boring or potentially not very challenging... there are pretty logical reasons why people would still want a relatively disciplined, intelligent and careful person as their doctor. The lengthy and onerous requirements for schooling are filtering for more than just the ability to perform a series of carefully defined procedures.
Scarcity being a function of selective admissions is a tautology. To be useful, selectivity would need to be to some objective minimum standard, rather than enforcing an ever-changing standard that enforces the restriction of the profession to an arbitrary small number of entrants.
The bad news is that this is a choice Congress and Senate are taking on behalf of the American people. And with the partisan divide and lack of agreement on fundamental values, things won't really change.
Add in a rapidly aging population, and being cognizant of the per capita health care spending steeply increasing at later stages of life, kicking the can down the road won't make the later adjustment any easier...
Any of those is hard on its own. Combined - it is impossible.
The non tangible cost are also non negligible. There is friction in the job market as changing job risks incurring a potentially catastrophic coverage gap. There are bizarre industries focused on renegotiating issued medical bills, collecting those or managing the health related bankruptcies.
Pricing of pharmaceutical usually generally defies the laws of gravity as the incentives of regulators, suppliers, distributors, doctors and insurers have been distorted beyond anything resembling a fair playing field. In such an environment playing games is superior than providing value and adhering to generally accepted rules. When it comes to pricing the costs of providing the service is often the least important input.
Steve Balmer recently: “If you look at these tax deductions for employer-provided health [...], they’re really subsidies to the affluent, which I guess I hadn’t thought about them.”
The biggest problem society faces at the moment is the vanishing middle class and lower qualified jobs that are still providing enough to subside. For the latter the cost of food, shelter, fuel and health are key. Lower the cost of living and there will be more jobs that are worth taking.
http://slatestarcodex.com/2017/02/09/considerations-on-cost-...
Scott Alexander examines "cost disease" in the sectors of health care and education.
Approx. zero people reading this will believe the conclusion, but RCA argues that the US is not really an outlier on healthcare costs.
There's a dizzying amount of data and statistics levied for the argument. It's a fascinating read even if you don't agree just because of how much is put into the argument.
https://randomcriticalanalysis.wordpress.com/2014/11/24/nati...
https://randomcriticalanalysis.wordpress.com/2016/09/25/high...
This blogger indeed uses a dizzying amount of graphs, but doesn't mention until the end that he has built his entire argument on the assumption that Americans "choose" to spend their higher income on health care.
https://randomcriticalanalysis.wordpress.com/2016/09/25/high...
It argues that the high cost of health care in the United States is explained by its extreme wealth and that health care is a superior good (https://en.wikipedia.org/wiki/Superior_good).
This is a much different explanation than what is given by either political party.
Anyone have any points in support of or against this argument?
A study done at Harvard University indicates that this [medical costs] is the biggest cause of bankruptcy, representing 62% of all personal bankruptcies.
http://www.investopedia.com/slide-show/top-5-reasons-why-peo...
Surely spending dramatically higher amounts than other countries, with no better effects, is enough to drive us to consider how we can reduce the costs of education - and should make us think long and hard before considering proposals that we should throw even more money at this.
It's surely true that having a well-educated workforce improves productivity, but it's also true that having a healthy workforce does the same. I'm having trouble finding much difference between the two examples.
Traveling around a bit I've seen other cultures still require people to walk somewhat to get places and people will also just go on "walks" whereas Americans will go for a "drive"
Food culture is also responsible, just jamming food into your face as quickly as possible rather than enjoying a meal is for sure and American thing.
Add all this up and you get 60% obesity rates in adults and getting worse.
My grandfather used to get a shot that was $12,000 a pop, and didn't do anything.
The thing that is pretty remarkable is that you unfortunately realize just how far either political party is in addressing any of the issues brought in the piece.
