How to reduce healthcare costs and improve quality (opens in new tab)

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.

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?

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

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.

I think he's saying the same thing, but his proposed program is a high-deductable+HSA plan.

This will help how? There are few economies of scale to be gained by going national [1], and single-payer gives consumers no incentive to consume less.

[1] You save a bit of money by having the IRS collect payments, but the billing department is not a major component of healthcare costs.

One second-order benefit of universal healthcare is that countries with such plans view health problems as a social cost, so there's more regulation of food production, industrial practices, et cetera. Consequently, Western Europe is a safer and environmentally cleaner place, in many ways, to live.

If you make it legal to optionally sign away your right to sue, then everyone will lose their right to sue, except for the few adverse venues of last resort (public-funded hospital emergency rooms, perhaps) that won't be able to decline services.

The same thing happens with the "let people shop interstate for insurance" idea. If you look just a couple moves ahead into that game, you see that that proposal is just cover for "adopt the lowest common denominator of insurance regulation nationwide", because every rational insurance company will simply move to Alaska or Wyoming or wherever regulations are least onerous.

The exact same thing happens in banking, which is why Charlotte is a US banking hub.

> Tort reform. Cap every state as has been done in California and Texas.

Most studies show this claim to be specious at best. Tort reform has almost no impact on quality of care or cost of that care. The only real impact of tort reform in the realm of medical malpractice is to transfer money from the pockets of wealthy litigators to the pockets of wealthy insurance executives.

Yeah, the bit about name-brand drugs being only for those who an afford them out of pocket is especially bad. Drug patents are 20 years, so the peasants would be getting 20-year-old cancer treatments, while the select few would be getting actual modern medicine. Besides the ethics, though, what would the cost of modern medicines be for those few thousand who can actually afford them? Today, plenty of middle-class people get modern drugs because their insurance pays for it, so the cost of research, clinical trials, manufacturing, etc is distributed among a large population. What would the price of a pill be if only the richest of the rich could afford treatment?