7 ms·
The problem is I don't see any "easy" solution to this issue, simply because there will always be an institution in place to decide about someone else's life ou
by blantonl 2y ago
The problem is I don't see any "easy" solution to this issue, simply because there will always be an institution in place to decide about someone else's life our death.
Be it a privately run for profit insurance system that runs on perverse incentives, or a government agency that runs on power and influence and corruption.
- bendauphinee 2y agoThe “easy” solution is to try and remove profit as much as possible from the equation. Pretty much every other high GDP country in the world has single payer healthcare. Guess how many people get told their anaesthesia won’t be covered for their full surgery. That shouldn’t even be a question, and yet the US system makes it one.
- deleted 2y ago[deleted]
- Thorrez 2y agoTwo people I know who moved to the US from countries with single payer healthcare said that in their previous countries they would have to wait a long time for certain operations, but in the US can get them almost immediately.
- harimau777 2y agoFrom what I understand, wait time can certainly be an issue with single payer healthcare. However, there's people in the US who have effectively infinite wait time because they can't afford treatment at all.
- ceejayoz 2y agoI have an excellent insurance plan and ready access to a large US hospital system. The wait to see a dermatologist as a new patient is ~6 months. Definitely not unique to single-payer systems.
- alostpuppy 2y agoAlso, this wait times in many part of the US are in line with the single payer countries. The quality of care in the US is heavily dependent on location.
- bendauphinee 2y agoDepends on criticality. Yes, the US beats Canada for example on wait time in a lot of cases, however, as a Canadian I can walk into a ER and not have a co-pay. I had my appendix out a few years ago, I walked into the ER at 2PM, had the surgery done by midnight, and was able to be discharged by 9AM the next day. The only cost was my parking, because I drove myself over. Meanwhile, I've also had friends in the US who were clearly quite ill, and made the conscious decision to not go to the ER because it would have cost them hundreds of dollars. It's all a balance, but I'm happier with my single pay system, because for the most part, health decisions aren't at the whim of my bank balance being too low. I personally wouldn't be as disappointed in the US system, if the reason someone can get a surgery immediately didn't balance out with something like UnitedHealthcare's 32% rejection rate, because someone wanted a $10MM / yr salary or a $40MM yacht.
- deleted 2y ago[deleted]
- Thorrez 2y agoThe US has a law that 80% or 85% of premiums needs to go to healthcare. So if an insurance company is already up against the limit, increasing the rejection rate will actually decrease salaries and yachts (because less money will be spent on healthcare, thus premiums need to be reduced, and the 20% available for employee salary becomes smaller). https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio https://www.cms.gov/marketplace/private-health-insurance/med... Although, if increasing the rejection rate allows the insurance company to decrease individual premiums, which causes a lot more people to sign up for coverage due to low cost, that could increase total premium income, total spent on healthcare, and salaries.
- contagiousflow 2y agoSome problems in those countries are also caused by for profit healthcare existing in America. The shortage of doctors in Canada is not helped by the appeal of making much more money down south. Not to mention Canadian expats are generally the ones who would be able to afford the American healthcare costs.
- goatlover 2y agoAlso sounds like Canada isn't paying their doctors enough, which isn't to say America's healthcare is better, but it is something to take into account.
- sudosysgen 2y agoCanadian doctors are extremely well paid by Canadian and international standards, just not by the standards of American doctors (who have to repay massive medical debt). Increasing their wages is not really feasible, outside of a few underpaid specialties.
- bgnn 2y agoWaiting time increases with accessibility and aging population. Most developed countries with universal healthcare amd the hospitals are full with elderly. The developing countries are often much better due to younger population. Places like Turkey are incredibly accessible and cheap compared to the develped countries.
- wqaatwt 2y agoDutch and Swiss healthcare systems are entirely private (more so than in the US since there are no Medicare or Medicaid equivalents) yet they are highly regulated and profits are limited. Why can’t the US just copy paste them? It’s not like single payer is the only option..
- Thorrez 2y agoUS health insurance is profit limited too: https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio https://www.cms.gov/marketplace/private-health-insurance/med...
- lr1970 2y ago> Dutch and Swiss healthcare systems are entirely private (more so than in the US since there are no Medicare or Medicaid equivalents) and Swiss doctors are paid very well compared to let say German ones. There is long waiting list of German doctors that would like to practice in Switzerland.
- ChadNauseam 2y ago> Pretty much every other high GDP country in the world has single payer healthcare. This is just completely not true. Take France and Germany for example. > Guess how many people get told their anaesthesia won’t be covered for their full surgery. That shouldn’t even be a question, and yet the US system makes it one. So anesthesiologists should be able to ask for any amount their heart desires and the insurance is the bad guy if they don’t want to pay it? Anesthesiologists have a profit motive too, you know.
- bendauphinee 2y ago> All French citizens are required to have health insurance, and there are three main health insurance funds. The funds are non-profit and negotiate with the state on healthcare funding. > Does Germany have free public healthcare? Yes, all Germans and legal residents of Germany are entitled to free “medically necessary” public healthcare, which is funded by social security contributions. However, citizens must still have either state or private health insurance, covering at least hospital and outpatient medical treatment and pregnancy.
- ChadNauseam 2y agoNeither of those are single-payer systems, which you can see by the fact that both of your quotations involve multiple payers. Google "does france have single payer healthcare" or "does germany have single payer healthcare" for more info
- ceejayoz 2y ago> So anesthesiologists should be able to ask for any amount their heart desires and the insurance is the bad guy if they don’t want to pay it? Obviously not; if they're billing 72 hours a day, that's fraud. If my procedure goes long because of a complication, I'd still prefer they not wake me up mid-procedure for a credit card and signature.
- ChadNauseam 2y agoNaturally they would not wake you up mid-procedure for payment, nor ask you for payment later. What anthem wanted to do was put a cap on the number of billable hours per procedure, and have anesthesiologists accept payment based on that cap as "payment in full", meaning they would not expect additional payment for the extra time they spent after a procedure went long, either from the patient or the insurerer. This would have resulted in anesthesiologists making less money (as well as having less opportunity for fraud), which is why they didn't like it. But it was presented in popular media as if the insurance company was trying to shift the cost of overlong procedures onto the patient, rather than onto the anesthesiologists. Thankfully there was a public outcry and the anesthesiologists won, well-deservedly so considering they must be barely scraping by on a median income of $470,000/year.
- Ajedi32 2y agoWhen you remove profit from the equation, you also remove the incentive to increase supply. That's fundamentally what profit is: a reward for fulfilling the needs of consumers. If you can fulfill those needs better or more efficiently or at a larger scale than your competitors, you get more profit.
- titusjohnson 2y agoWhen you remove profit from the equation, you also remove the incentive to increase supply. Uhhh, what? What kind of wongo bongo thinking is this?
- Ajedi32 2y agoWhat other incentive is there? There might be some willing to go deep into debt in medical school so they can work for free out of the goodness of their hearts, but that's a vanishingly small number of people.
- Daishiman 2y agoAnd yet apparently countries all over the world have to artificially raise the bar for med school because so many people want to be doctors for incentives aside from just the money.
- s1artibartfast 2y agoWhat are you talking about? Almost every country has a doctor shortage and Doctors are still well paid professionals there.
- Daishiman 2y agoPeople don't go bankrupt at anywhere near the rate Americans do for medical reasons. People don't constantly bring up dealing with insurance as the #1 burden during medical procedures.
- SideQuark 2y agoAnd pretty much every one of those countries also has widely used private insurance because the public one most definitely has price caps, longer waits, and lesser service. No system could afford to spend unlimited amounts for anyone wanting it. You get triaged since resources are not infinite. Pick your favorite system, say the UK, and google UK healthcare rationing to find state policy on what limits people face.
- dgroshev 2y agoAny medical system inevitably has limits of what they can spend per patient. Do you prefer the limit to be set and enforced by the government that is amenable to political process, or anonymous profit-seeking insurance company board members, like in the sibling comment case https://news.ycombinator.com/item?id=42375998 https://news.ycombinator.com/item?id=42375998 ?
- SideQuark 2y agoThat comment was about a person on Medicare Advantage, which is extremely heavily regulated by Medicare, the epitome a of govt medically regulated cost per procedure system. Here is the govt Medicare page about Medicare Advantage Plans, with references to all the pages of legislation and Medicare rules such plans must comply with. https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options https://www.medicare.gov/health-drug-plans/health-plans/your... For example, select “What should I know about Medicare Advantage Plans?” It states, among other things, “ Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits (also called “Original Medicare”), including new benefits that come from laws or Medicare policy decisions”. Op claims Medicare “always” provides PT, which is not true. Here’s some rules about it: https://www.healthline.com/health/medicare/does-medicare-cover-physical-therapy#parts-of-medicare https://www.healthline.com/health/medicare/does-medicare-cov... Note in particular Medicare advantage will provide any PT where Medicare would. If you look at peer reviewed research, MA outperforms M in outcomes and satisfaction by a slight amount. These are reasons why forming or reinforcing beliefs on anecdotes and not understanding the truth is a bad way to make claims. So now that you see this outcome was medical care “set and enforced by the government” and not the outcome from “anonymous profit-seeking insurance company board members,” will you redirect your outrage?
- barbazoo 2y agoA first step could be to look at health care outcomes across the globe and see if the ones at the top have anything in common: https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.wikipedia.org/wiki/List_of_countries_by_quality_o...
- bgnn 2y agoThere is a huge difference between US and pretty much the rest of the world. The most corrupt healthcare system is US, hands down.