[bko]

That's my big problem with the healthcare debate. People think that its because of "profit", but if you look at the profit margins of all participants, they're all reasonable. Even if you could shift that profit over to consumer surplus, you're still looking at crazy high health care spending.

Something deeper is wrong with America's healthcare system. I think the third-party payer system and onerous regulations distort the market in costly ways. Just as the simplest example, if you want to open up a health care provider you need a "certificate of need" in most states. This means a board of current health care providers in the are determine whether there is a real "need" in the neighborhood for a competitor.

> Certificate of Need (CON) laws are state regulatory mechanisms for establishing or expanding health care facilities and services in a given area. In a state with a CON program, a state health planning agency must approve major capital expenditures for certain health care facilities. CON programs aim to control health care costs by restricting duplicative services and determining whether new capital expenditures meet a community need.

Ah yeah, lets reduce costs by restricting "duplicative services"

https://www.ncsl.org/research/health/con-certificate-of-need...

[542354234235]

The US wastes $150,000,000,000 a year (the most per capita in the world) in pushing paperwork directly because of our “competing” individual insurance provider model [1]. The US spends the most overall per capita by far on healthcare, while also not even covering all residents. Despite having poor health outcomes and lower life expectancy, the US is the leader in expensive diagnostic imaging and prescription drugs [2]. Its almost like the “competing” private insurance model creates large amounts of wasted effort in trying to extract profit, as well as perverse incentives to push high profit interventions while ignoring actual health outcomes.

> In countries where hospitals receive global, lump-sum budgets, garnering operating funds requires little administrative work. Per-patient billing, on the other hand, requires additional clerical and management staff and special information technology systems. In countries where there are multiple payers, as in the United States, billing is even more complex, since each hospital must negotiate payment rates separately with each payer and conform with a variety of requirements and billing procedures.

> Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions…Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions… Even though the U.S. is the only country without a publicly financed universal health system, it still spends more public dollars on health care than all but two of the other countries…

[1] https://www.commonwealthfund.org/publications/journal-articl...

[2] https://www.commonwealthfund.org/publications/issue-briefs/2...

[bko]

Ah yes, competition is what causes higher prices. We just need one organization creating the products and services for a given industry and setting prices.

I wonder why no one else thought of this and why we don't apply it to everything we produce

[542354234235]

>Ah yes, competition is what causes higher prices.

Since no one said that, I don't know what you are talking about. This has nothing to do with competition being bad or good. The US isn’t the only country with private insurance. The US model competes in a fee-for-service model, instead of based on things like positive health outcomes through global budgeting, like Germany or Canada. The US model has providers negotiate prices which each individual insurer, with the actual costs being hidden and complex, instead of a transparent “all-payer reimbursement rate” for each provider[1]. Maryland, the only state to use global budgeting and all-payer reimbursement, is saving over $100,000,000 per year on healthcare spending compared to the national average[2].

I really do not understand how people can act like quality healthcare at lower prices is some utopian dream, and not the reality in every single high-income country except the US. That people can look at the US spending 3 times more money on paper pushing as the next highest country, while not even cracking the top 10 in spending on preventive or long-term healthcare, and throw their hands up and say “its unsolvable!” [3] How people can look at the American’s barely middle of the road health outcomes and think the out of control spending is somehow actually leading to quality care. The condescending dismissive attitude in the face of mountains of data from working healthcare systems around the world is truly stunning.

[1] https://www.americanprogress.org/issues/healthcare/reports/2...

[2]https://www.healthaffairs.org/do/10.1377/hblog20170131.05855...

[3] https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare...

[bko]

>> Since no one said that, I don't know what you are talking about.

> The US wastes $150,000,000,000 a year (the most per capita in the world) in pushing paperwork directly because of our “competing” individual insurance provider model

When you have real competition and the final user pays, as opposed to a third party, you'll naturally have a model in which people pay for outcome as opposed to fee for service. If I take my car to be repaired, I just want the mechanic to fix it at the lowest cost possible. I don't care how many services they have to run. It works in every other aspect of our economy, including safety critical sectors. For instance, I may pay for a safer car as opposed to a cheaper less safe car.

I just want a system in which I can make my own decisions regarding my health.

I don't know why people argue that the US has a free market in health care. It does not, as you have plainly stated. There's a lot of intermediaries and parties involved that are highly regulated and influenced by the state. US spends as much in public spending in health care as other countries. I would prefer to remove the complexity, allow actual competition and remove third party payer as much as possible. Your solution sounds like more of the same but better, which doesn't make sense

[542354234235]

My solution: use any tried and tested model from other countries that have better, cheaper healthcare.

Your solution: a free market where you as the consumer can make your own health choices, of which you are not qualified to understand unless you went to medical school, and expect to pay the lowest cost for things you may need to prevent your own death (we all know price gouging in life or death situations is never a thing). Good luck with that.

Just so you know, unlike your car, you can’t just go buy a new life when you can’t afford to put in a new transmission.

[bko]

> Just so you know, unlike your car, you can’t just go buy a new life when you can’t afford to put in a new transmission.

Exactly why I want to make my own healthcare decisions rather than some faceless appointed regulatory body

Maybe you have more faith in politicians to do the right thing on your behalf. I'm sure these systems will still exist and you could follow their guidance (e.g. the food pyramid). I just want more choice

[boruto]

From personal experience between USA and Germany, I can say quality of health care in US is many many times better than in DE.

[retrac]

A great deal of service provision in many countries' systems is private. Even here in Canada, "socialist" medicine often boils down to a private clinic billing the public insurer. Though the major hospitals are usually owned and operated by non-profit corporations, or the local government.