The Real Problems with American Healthcare

[suchmoon]

For some reason what Bitcointalk users "think" is more important that observable facts....

It might have something to do with many users here being young and healthy. When you're using healthcare 15 minutes a year (if that) it might seem better to fork out $200 for that doctor's visit out of pocket instead of paying $1000s in taxes or health insurance premiums.

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1714913548

[TheHas]

...
IMO this very US idea that 'Government should stay out of my life' just doesn't work when we are talking about healthcare. You want the Government accountable to meeting the health needs of the population, just like you want them accountable for national security, education and public infrastructure.

That's your opinion, but you are wrong. The reason is that in the USA the health care and Pharma companies are a powerful enough force to subvert legislation to their wishes. Thus your (or any) proposed "solution" simply becomes a tool for these forces to use to legislate themselves large chunks of our money.

You can't get around that.

So let me get this right. You're saying that because the US Government is in the pocket of private interest groups, that the answer is to do what they want by the Government doing even less, as because if they did more they would be so meek and powerless against these groups that their legislation would end up helping them?

That makes no sense. There is a difference between implementation issues and policy issues. What you are describing is an implementation issue whereby Government efforts get railroaded by private interest groups who hold too much influence in the US political system. An implementation issue doesn't mean that a policy idea or funding model is conceptually bad. It doesn't mean the idea of Government having a greater role in how healthcare is provided and funded in the US is a poor model. It is a good model as that is what happens in pretty much every other developed country, which again, have better, more efficient and less costly health systems.

If the US Government is so weak that they can't legislate to put the health needs for their citizens ahead of the profits of private companies, then that says a lot about the country.

[TheHas]

~To put in perspective - none, and I mean none, of the OECD countries have a model anywhere close to the current US model...

For some reason what Bitcointalk users "think" is more important that observable facts....

The US literally has the worst and most inefficient healthcare system in the developed world and for some reason the answer found in this board is MOAR PROFIT will fix it, even as every other developed country proves them 100% wrong!

Totally. Any OECD health data shows the same trends and health spending issues with the US, but apparently to many the answer for the US is to do more of the things (ie. privatizing healthcare) that make them an outlier in health spending, instead of doing more of the things that would make them more like the rest of the world!

I used to do policy development work in this space (not in the US though) and was always bemused by the US system, and the language and apparent unwillingness of many in the US to let the Government get more involved in healthcare. From an outsider looking in it always ended up a name calling match with shouts of 'socialist healthcare!' that don't actually mean anything in practice. It's a real shame and people's health outcomes and money keep going to waste.

[Flying Hellfish]

~To put in perspective - none, and I mean none, of the OECD countries have a model anywhere close to the current US model...

For some reason what Bitcointalk users "think" is more important that observable facts....

The US literally has the worst and most inefficient healthcare system in the developed world and for some reason the answer found in this board is MOAR PROFIT will fix it, even as every other developed country proves them 100% wrong!

Totally. Any OECD health data shows the same trends and health spending issues with the US, but apparently to many the answer for the US is to do more of the things (ie. privatizing healthcare) that make them an outlier in health spending, instead of doing more of the things that would make them more like the rest of the world!

I used to do policy development work in this space (not in the US though) and was always bemused by the US system, and the language and apparent unwillingness of many in the US to let the Government get more involved in healthcare. From an outsider looking in it always ended up a name calling match with shouts of 'socialist healthcare!' that don't actually mean anything in practice. It's a real shame and people's health outcomes and money keep going to waste.

As a non American as well, I'm constantly amused at the mental gymnastics involved with UNIVERSAL HEALTHCARE = MAKE AMERICA COMMUNIST. 

The USA is the only country where people are one medical emergency away from declaring bankruptcy.
"Pre-existing condition" means something TOTALLY different in the US than the rest of the world!

[Jet Cash]

It might have something to do with many users here being young and healthy. When you're using healthcare 15 minutes a year (if that) it might seem better to fork out $200 for that doctor's visit out of pocket instead of paying $1000s in taxes or health insurance premiums.

I'm 77. and I am entitled to free "health care", this includes free drugs. They only times I've visited doctors are to give blood, or for repair jobs due to fighting or motor cycle accidents. I'm never ill, and I don't have colds or any of those other fiddly problems. So what do I attribute this to? I haven't been vaccinated since my pre-teen years, and I don't take any medication whatsoever. This includes pain killers, antacids, anti-biotics or any of the other products that weaken immune system. America would be much healthier if they stopped injecting poisons and disease into babies and adults, produced healthy food without perticides, growth hormones and preservatives, and stopped eating unhealthy food manufactured from diseased animals.

[Spendulus]

...
IMO this very US idea that 'Government should stay out of my life' just doesn't work when we are talking about healthcare. You want the Government accountable to meeting the health needs of the population, just like you want them accountable for national security, education and public infrastructure.

That's your opinion, but you are wrong. The reason is that in the USA the health care and Pharma companies are a powerful enough force to subvert legislation to their wishes. Thus your (or any) proposed "solution" simply becomes a tool for these forces to use to legislate themselves large chunks of our money.

You can't get around that.

So let me get this right. You're saying that because the US Government is in the pocket of private interest groups.....

If the US Government is so weak that they can't legislate to put the health needs for their citizens ahead of the profits of private companies, then that says a lot about the country.

Probably does say a lot. But that's pretty much the way it is. That's how strong the lobbies are in DC.

You take your "good idea" (we could debate that but leaving that for the moment...) put it in Washington and it becomes .... "bad."

[o_e_l_e_o]

TheHas has already laid out some great data in this thread, but I'll add a little more below.

As a percentage of GDP, the US pays absurdly more on healthcare than any other developed nation. As TheHas has pointed out, US citizens actually pay a similar amount of tax towards healthcare as most other developed nations, it's just that US citizens also pay absurd private premiums on top of these taxes. Most of this extra money is simply eaten up by middle men and insurance companies.


The next thing to look at it health outcomes. You would expect the US, since it spends so much more than other countries, would have far better outcomes. The complete opposite is true, with the US having the worst outcomes of any developed nation.
   

The best healthcare system in the developed world - the UK's - spends 2.5x less per person than the worst - the US. Not to mention that no one in the UK has ever gone bankrupt from a disease or accident. Medical fees account for around 2/3rds of all bankruptcies in the US.

[Spendulus]

...Medical fees account for around 2/3rds of all bankruptcies in the US.

All of your "data" and reasoning is suspect, but let's focus on just one item: Bankrupcies.

What you've ponderously quoted is a complete lie.

Really, just another in a long series of lies by our favorite Poncahantas, Elizabeth Warren.

The real number is not 65%, but 4%.

https://www.washingtonpost.com/blogs/post-partisan/wp/2018/03/26/the-truth-about-medical-bankruptcies/

[o_e_l_e_o]

The real number is not 65%, but 4%.

https://www.washingtonpost.com/blogs/post-partisan/wp/2018/03/26/the-truth-about-medical-bankruptcies/

I am familiar with the paper from which that article pulls its 4% figure, and it is flawed for a number of reasons.

It only considers adults below the age of 65. The elderly population are more likely to suffer from pretty much any major disease process, including the ones which cause the highest amount of debt; cancers, heart attacks and heart failure, strokes and rehabilitation, dementia, falls and fractures, etc.
It only considers adults who visited the hospital for the first time in 3 years. These are largely people who are relatively fit and healthy, and who present for either a purely elective procedure (tonsillectomy, varicose veins, etc.) or with a condition which requires one course of treatment to be fully resolved; appendicitis, chest infection, etc. It excludes anyone with chronic or serious diseases who will require multiple visits, which also happen to be the most expensive.

Given the above caveats that they looked almost exclusively at fit and well non-elderly adults without chronic or serious health problems, and a single visit to the hospital contributed to 4% of bankruptcies in this cohort, it is still a damning indictment of US healthcare.

[Spendulus]

The real number is not 65%, but 4%.

https://www.washingtonpost.com/blogs/post-partisan/wp/2018/03/26/the-truth-about-medical-bankruptcies/

I am familiar with the paper from which that article pulls its 4% figure, and it is flawed ...

I'll listen you your argument on that AFTER you enumerate the flaws in the 65% number.

Fair's fair.

[TECSHARE]

 You will often find doctors who run a cash only practice will charge considerably less because of the removal of all of these compliance and documentation issues for example. Doctors spend more time doing paperwork than anything else, and that is retarded. Giving the government more power is not a solution because it is what got us here today.

I'm enjoying this discussion and I get where your head is at, but in this case more Government power and regulation is the answer.

I know this is bitcointalk and there is a tendency to lean towards being anti-centralization, and to have concerns about Government overreach. But there is virtually no evidence that the health system in the US would be better if there was less Government involvement. I can say that, because every other OECD country doing better than the US on healthcare has much more Government involvement.

If you're suggesting less Government involvement, then by default there would be more private company sway and freedom for doctors to treat and prescribe medicines as they wish, with essentially no Government body of oversight that can represent the consumer/citizen who needs healthcare. This is an issue. The power imbalance and information asymmetry between doctor and patient is massive, and there needs to be protections in place for a consumer to not get ripped off, receive poor treatment, or get given drugs they don't need.

As an example, those big pharma ads in the US about 'ask your doctor about how xyz drug can help you today' are criminal in other countries, because Government made the call that profits do not determine health treatment. Doctors are also not allowed to get kick backs from pharma companies for over prescribing their drugs. If you want health needs to come first, the answer is not less regulation and Government involvement, but more.

To put in perspective - none, and I mean none, of the OECD countries have a model anywhere close to the current US model which clearly suffers from private company profits prioritising consumer needs. The US should look to other OECD countries who are absolutely dominating the US system on providing a more affordable, efficient and a better health system. Many (not all) OECD countries do not even have a private insurance or private treatment component - it is all publicly and centrally funded, so Government can achieve economies of scale, set fair subsidy rates for drugs and work with the medical profession to subsidy treatments based on evidence (not on where doctors get kick backs from big pharma).

IMO this very US idea that 'Government should stay out of my life' just doesn't work when we are talking about healthcare. You want the Government accountable to meeting the health needs of the population, just like you want them accountable for national security, education and public infrastructure.

Every other OECD country is different than ours for one. None of them take in as many immigrants, none of them are as large by population, none of them have as much diversity as the USA does. You make a claim "there is virtually no evidence that the health system in the US would be better if there was less Government involvement." which is a quite ironic statement considering you are making a claim of no evidence while providing no evidence to support this position. The fact is there is plenty of evidence, just look at every government program ever. They always expand beyond their mandate, inflate prices because the customer doesn't care and its just "free money" to them that the public foots the bill for, then the prices get more and more bloated as the middle men like insurance agencies, banks, and lawyers start working their way in.

The marketplace is cutthroat. That means if one organization is full of worms, people can go to the more efficient worm free version because it provides better service at a lower cost. Unfortunately with government regulations a system of protectionism and rent seeking is set up for these companies which literally prevents competition and protects their monopolistic profiteering stranglehold. Don't make the mistake of thinking governments and corporations are different entities. While technically they are, largely they exist to serve each other in practice. This is why they need to be kept separate at all cost. I am not against regulation necessarily depending on how it is constructed, but this whole concept of government subsidy is a failure from the word go.

Finally, most important of all, all of these other dithering excuses aside, IT IS NOT THE US GOVERNMENTS MANDATE to provide you with anything other than what is explicitly mandated in the constitution. Again this goes back to the rights versus commodity arguments. You have a right to life, you do not have a right to mandate others spend years getting very expensive training to treat you for free just like you don't have a right to food unless you work for it. You have a right to liberty, but if your liberty infringes on the liberty of another, your right ends there. You have the 2nd amendment right to protect yourself with a firearm, you do not have a right to a free firearm. You have a right to have access to healthcare, you do not have a right to receive free healthcare.

Any time governments are allowed into these systems they inevitably destroy them. They add more and more bureaucracy that serves only to prevent actual competition and create systems of rent-seeking and protectionism for the huge mega-corporations. I argue that the current failures of our medical system are a DIRECT RESULT of GIVING government control over these issues, and attempting to subsidize them in the past that have failed, not the market economy itself. Much like people try to say "oh look the economy is failing we need more socialism!" when we have been introducing Socialist/Communist policy for many years which I argue is the actual cause of the failure these people championing more of the same claim to be able to save us from. Any time you create a system of dependence on what are supposed to be public servants, they now have leverage and therefore control over the population, transforming you into the servant of it and not vice versa.




We are somewhere on the second half of this chart.

[SaltySpitoon]

A friend of mine that is a veterinarian ended up in the emergency room for three days, one day in intensive care, and then two in observation. She ended up leaving with a $200k bill, of which $60k was out of pocket. The absolute exact same treatment, medication, staff time, MRI, for a horse would have cost around $15k total, and that carries the risk of getting kicked in the head. Long story short, don't go to the doctor, go to the vet.

I can't say I'm completely on board with a government run system, but one of the things that I believe the government could do is be solely in charge of procuring medications, which would then be distributed to all of the usual pharmacies. Even those that scream communism can probably agree that if you consolidate buying power, there would be more negotiating power. Whether health is a right or a commodity is something American society decided a long time ago when people decided that it wasn't conducive to tourism and a happy population to let people die on street corners, even if they couldn't pay for the treatment. I'm a little hesitant to value statistics about the amount of care provided that goes unpaid, because its hard to gauge how much of it wouldn't go unpaid if the cost of care was reasonable in the first place. That said, rest assured the hospitals are writing off that bad debt for a tax break.

I'm sympathetic to a few socialist ideals but very against others. If I had to say what I'd think is the biggest (non ethical) problem surrounding healthcare, its the mix and matching of policies. In some cases, socialist policies are just the most efficient. In some cases, they overstep their bounds and result in government over involvement in areas they shouldn't be. A lot of American policies are a compromise between socialist and capitalist ideas, and the result is a inefficient mess. We really need to commit to one, because the middle ground results in paying for things that you don't get. Either drop the taxes significantly and cut social policies so that everyone can personally put their own saved tax money towards their own matters, or completely socialize policies to make sure everyone is adequately covered as cheaply as possible.

Though I suppose there isn't much to complain about, we just get taxed nearly as high as countries that provide guaranteed living conditions to everyone, and we don't get shit.

[BADecker]

^^^ The neat thing about this is, the vet can form a Private Membership Association, and get away with this. The PMA is simply a detailed, written and signed agreement that the patient is accepting something from the vet in private. If it is in private - provided nothing dangerous is done - the medical and law enforcement have nothing to do with it.

The only reason why law enforcement goes into private homes at times when they are not invited is, the people don't know how to use the 70+ court cases, the Amendments, the Constitution, and the literal laws to keep LE out.

Google PMA and find out how to set up your own Private Membership Club, and how to make it outside the law.

[Spendulus]

...
I can't say I'm completely on board with a government run system, but one of the things that I believe the government could do is be solely in charge of procuring medications, which would then be distributed to all of the usual pharmacies. ....

Let's say that's a Great Idea.

Get the people to agree, and have it put into committees in the House or Senate. Get it to a floor vote and then meld it with the other body's version.

By that time, you've got a sell-out to the very companies that were overcharging. That's the power of the lobbies and the way things work in DC.

It winds up a Bad Idea.

[SaltySpitoon]

...
I can't say I'm completely on board with a government run system, but one of the things that I believe the government could do is be solely in charge of procuring medications, which would then be distributed to all of the usual pharmacies. ....

Let's say that's a Great Idea.

Get the people to agree, and have it put into committees in the House or Senate. Get it to a floor vote and then meld it with the other body's version.

By that time, you've got a sell-out to the very companies that were overcharging. That's the power of the lobbies and the way things work in DC.

It winds up a Bad Idea.

Right, if it was as simple as that, it wouldn't be that hard to get people on board. Everyone understands warehouse store's business model, the idea isn't really that special. The negotiation between individual insurance companies and pharmaceutical companies/hospitals/pharmacies is a massive inflationary mess. That was just an example of saying the buyers need more leverage than individual insurance companies can offer. Be it a government in charge of purchasing, or a small handful of private insurance companies (though then we get into monopoly laws), my main point however poorly communicated was that increasing some central power could be of help in cutting costs. The reason I said government, is because they are the only ones that can legally hold a monopoly.

As I'm sure you are aware, insurance company A agrees to pay X towards a medication. Paying more towards that medication allows them to keep more customers, but the drug companies know that. In exchange, they jack up their drug prices to get the insurance companies to pay more and more for them. That in turn raises premiums, but if they refuse to pay more towards them, they'll lose clients. Thats (partially) how you end up with $700 Epipens. No insurance company is going to stop covering an immediately life saving medication, so the price can be jacked up. That type of thing could be eliminated by someone with enough buying power to say that either the drug companies play ball or they won't be selling any products in the US.

As a side note, I'm aware of the plethora of other issues. Just saying play hardball with the drug companies isn't a complete solution to health care reform, its a very small step.

[Spendulus]

.... No insurance company is going to stop covering an immediately life saving medication, so the price can be jacked up. That type of thing could be eliminated by someone with enough buying power to say that either the drug companies play ball or they won't be selling any products in the US.

As a side note, I'm aware of the plethora of other issues. Just saying play hardball with the drug companies isn't a complete solution to health care reform, its a very small step.

Obviously you really know this subject, so we're in agreement.

Something just occurred to me.

There's only one person who could actually play hardball with the drug companies all the way down the line to a solution, and it's a guy who stood against both the Republican and Democrat parties, through truly difficult years, and that's Trump.

[TECSHARE]

Too bad the pharmaceutical industry are the largest advertisers for mainstream media and the largest political donors...

[Spendulus]

Too bad the pharmaceutical industry are the largest advertisers for mainstream media and the largest political donors...

hahaha....

I know where that's headed...

[SaltySpitoon]

Too bad the pharmaceutical industry are the largest advertisers for mainstream media and the largest political donors...

Yup, in short, we are screwed.

It'll take national uproar over an otherwise healthy child dying because their parents couldn't get a pill that costs $0.15 to create, but retails for $1k+. The only thing that'll make politicians oppose their backing is if they are at a greater risk of losing a more important backing. They'd probably tell 25% of their voters to get bent for pharmaceutical companies, but maybe not 75%.

And as great as our outlook is at that changing, we've just been talking about pharmaceutical companies that a lot of people already agree are "bad guys". Now lets see what we need to do to change the rest of it... Ecuador anyone? https://internationalliving.com/countries/ecuador/health/

[Spendulus]

...Even those that scream communism can probably agree that if you consolidate buying power, there would be more negotiating power. ...

In the real world of price, distribution and production this may not be what it seems at first glance.

I'm reminded of when - this is from memory, could be wrong - Hillary was responsible for consolidating one vaccine production issue into one order, where previously there had been six suppliers there was just one. Ramp up capability in case of a sudden demand was limited.

That was the bird flu issue.

Oftentimes, "consolidating buying power" leads to price changes exponentially less as the order size increases. Past a certain point the benefits are negligible.

On another, weakly related comparison, any of us would, in a crisis, take Walmart's distribution over FEMA's.