[CryptoPunk]

From what I've seen, subsidies and regulations are the primary cause of inefficiency in healthcare:

https://www.athenahealth.com/knowledge-hub/practice-manageme...

>>Here's some food for thought: The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200 percent for the same time period.

*

>>Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. (To cite just a few industry-disrupting regulations, consider the Prospective Payment System of 1983 [1]; the Health Insurance Portability & Accountability Act of 1996 [2]; and the Health Information Technology for Economic and Clinical Act of 2009. [3])

In contrast, areas of medicine which are subject to much fewer subsidies and regulations, as a consequence of being electives, have seen prices actually decline in inflation adjusted terms. [4]

[1] https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen...

[2] https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg...

[3] https://www.hhs.gov/hipaa/for-professionals/special-topics/h...

[4] http://healthblog.ncpathinktank.org/why-cant-the-market-for-...

[Broken_Hippo]

Regulations and subsidies do not seem to make other countries' systems inefficient. They make it so that folks are safe and that they can actually get health care.

I really want regulation in health care. I do not want medication to be a free-for-all like supplements are in the US. I'm not a doctor, after all, and they are slow to take supplements off the market even if they are harming or killing folks (take a look at diet pills to see this effect). I do not want average folks to be able to get antibiotics willy-nilly because I want to be able to take them when I'm old. And so on.

[rscho]

The big difference up to now has been that US hospitals have been run by a huge layer cake of administrators for a long time, while in other western countries healthcare workers have had much more direct control over how things are run.

This is changing fast though, and Europe is migrating to the US model at a rapid pace, with growing administrative layer and loss of control over prices. Interestingly, european politicians are also telling everyone that the problem is that docs earn too much and people tend to believe them.

[Broken_Hippo]

I have so many issues with this: Europe is a big place and the countries do not exactly work in unison on these things. I only have experience in Norway - and that's only for the last 8 or 9 years. The prices have always been pretty standard - the doctors office doesn't set the rates, at least not in the public system (there is a private system, but the majority of doctors are in the public system). There hasn't been huge layers of administration, at least not in the way of the US - and this is, in part, because the insurances in the US create the layers of administrators. (Doctors offices do not need nearly as much staff for paperwork duties). For the end user, they've actually removed a layer - there were two types of deductibles that were merged into one (and is less than half the cost of the two combined)

And honestly, I find it very difficult to think that this is the administrative cake you were thinking. I also find it really difficult to think that Norway, Poland, Greece, Italy, Germany, and Britain are all taking the same steps and adding complexity.

Where do you get information? Do you have links?

[rscho]

Nope, that's just experience from daily life. I'm a doc in a public hospital in Switzerland, and also worked in the US.

Europe is still a bit behind in terms of admin, but getting there. And yes, american influence is felt all over Europe, with varying degrees of implementation among countries, as you noted.

I can understand that outsiders don't believe what we have to say when political propanganda is so strong. But for us insiders, it's really crystal clear what is happening. It used to be that problems arising in clinical management was solved by asking frontline workers what they needed. Healthcare workers had a lot of control over their working environment. Nowadays, admins are taking all decisions from above. European hospitals are now in competition with the private sector due to changes in the billing and insurance system coming from the US. As a result, european hospitals are now managed much more like your usual run-of-the-mill company than they used to. This is a terrible result for anyone but upper management.

[CryptoPunk]

>>Regulations and subsidies do not seem to make other countries' systems inefficient.

Other countries' healthcare systems are growing increasingly more inefficient as well, with the proportion of GDP expended on healthcare rapidly rising, with many seeing it double over the last 40 years. [1]

And they face critical shortages, like this case of a woman in Canada who had to wait two years to get a test that diagnosed her with cancer, because of a shortage of state-licensed doctors:

https://www.cbc.ca/news/health/doctor-shortage-cancer-video-...

>>I really want regulation in health care. I do not want medication to be a free-for-all like supplements are in the US.

I think the best of both worlds would be most regulations being opt-in, while disclosure regulations are mandatory.

More specifically, I think healthcare would benefit from legalizing the provision of medical service by un-certified individuals, as well as providing more than one tier of certification, where people who can't afford fully certified practitioners, but would like the assurance of some certification, have that option.

Instead of making it illegal for individuals who don't possess full certification to practice medicine, the law could instead require medical practitioners to disclose their level of certification, and any warnings the state provides in relation to that.

So for example, an uncertified doctor/nurse may be required to disclose not only that they are uncertified, but also the warning that the state strongly advises against using uncertified medical practitioners.

Why providing these options is critically important is that sometimes the prescribed institutions fail, and an escape hatch is a life saver, as in the case of a woman in Canada mentioned above.

>>I do not want average folks to be able to get antibiotics willy-nilly because I want to be able to take them when I'm old.

If the negative externalities of irresponsible antibiotic use is your concern, maybe you could advocate specifically regulations on antibiotic use.

When you advocate wholesale centralized gatekeeping of all manner of healthcare interaction, you deny people a way to escape failures of over-regulation, like regulations that prevent people from accessing life-saving medical products/services in a timely manner [2][3] or deny people access to a vaccine due to a risk from side effects that is orders of magnitude lower than the risk the vaccine mitigates. [4]

[1] https://www.researchgate.net/figure/Healthcare-spending-as-a...

[2] https://www.propublica.org/article/this-scientist-created-a-...

[3] https://www.nytimes.com/2020/03/10/us/coronavirus-testing-de...

[4] https://www.nytimes.com/2021/04/13/us/politics/johnson-johns...

[jltsiren]

> Other countries healthcare systems are growing increasingly more inefficient as well, with the proportion of GDP expended on healthcare rapidly rising, with many seeing it double over the last 40 years.

There are two (mostly) unrelated issues: the efficiency of the healthcare system and increasing availability of effective but expensive treatments.

I believe we have already reached the point where even 100% of GDP is insufficient for healthcare. There is always something more you can do, something better you can try. No matter how much money you choose to spend, somebody must eventually make the decision to withhold better care because the economy is not big enough.

[CryptoPunk]

There is in fact a correlation between per capita GDP, and the proportion of GDP expended on healthcare, so you may be correct. It's worth noting that the US has much higher per capita GDP than most OECD countries.

In any case, the price inflation seen in highly regulated vs lightly unregulated markets is, to me, telling:

https://www.aei.org/carpe-diem/chart-of-the-day-or-century-3...