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On December 02 2020 17:56 Salazarz wrote:
But again, if you want to believe the US is just a very special place that plays by very special rules and what goes literally everywhere else in the world doesn't apply to the US, that's up to you I suppose.
To be fair, in the last 4 years they showed us they are "specials" (at least for 40% of them).
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Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs.
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United States10238 Posts
On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs.
Have the countries with universal health care shown that this is the case though? Obviously a lot of this stems from culture but I'm willing to bet that asian countries with universal healthcare like Korea and Japan already practice quite a bit of preventative care, as with the Scandinavian countries. I could totally be wrong about this, just stereotypical view of those countries.
Or maybe your point isn't referring to UHC but just how to improve healthcare in general could lead to less preventative care measures. Forgive me if I got the point wrong.
Even if it weren't the case, it certainly is difficult to change how America is already. We're so dependent on fast food and american food in general is incredibly oily, greasy, buttery. Very high in fats, less emphasis on vegetables.
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On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs.
I think the main problem, which has been mentioned many times, is that the market can not regulate healthcare in a fair and efficient way. What is the value to the patient of a life saving treatment? If you are the seller in a situation like that, you can charge almost whatever you want. Even if there is competition in such a market, the sellers (hospitals, insurance companies and pharma) will still as a group charge much more than they need to. This does also happen in other areas where what people are willing to pay is much higher than the cost of service and production, like phone services (remember what an SMS cost when they were new?), glasses and contact lenses.
Preventative care is discouraged in other healthcare systems to too. The results of actual treatment is much easier to show and get paid for, even if the goverment takes the whole bill. Both governments and insurance companies have strong incentives to try to keep the number of treatments as low as possible while doctors and hospitals have incentives to do "profitable" treatments. It is usually impossible to stop them at it, even if they might not be necessary. This problem is much bigger with for-profit healctcare all over the world.
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On December 02 2020 18:51 Slydie wrote:Show nested quote +On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs. I think the main problem, which has been mentioned many times, is that the market can not regulate healthcare in a fair and efficient way. What is the value to the patient of a life saving treatment? If you are the seller in a situation like that, you can charge almost whatever you want. Even if there is competition in such a market, the sellers (hospitals, insurance companies and pharma) will still as a group charge much more than they need to. This does also happen in other areas where what people are willing to pay is much higher than the cost of service and production, like phone services (remember what an SMS cost when they were new?), glasses and contact lenses. Preventative care is discouraged in other healthcare systems to too. The results of actual treatment is much easier to show and get paid for, even if the goverment takes the whole bill. Both governments and insurance companies have strong incentives to try to keep the number of treatments as low as possible while doctors and hospitals have incentives to do "profitable" treatments. It is usually impossible to stop them at it, even if they might not be necessary. This problem is much bigger with for-profit healctcare all over the world.
When the same entity is on the hook for the long-term effects of not doing preventative care, you will find that they are very inclined to encourage preventative care, and helping people generally be healthy.
For example, here in Germany your health insurance company usually covers some of the costs if you regularly do sports, if you go to a dentist at least once a year for checkup your copay for teeth replacements is reduced, and there are recommendations as to which checkups (breast cancer etc...) you are supposed to do regularly and you often get rewarded for doing those, too. And of course all of these things don't cost out of pocket money to the patient. All of this is because they know that this is cheaper for them rather than having to cover the eventual treatment of people who get very sick.
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Norway28712 Posts
I think the argument (it's the one I'm making, anyway) is that government-funded health care with 0 profit incentive, only a cost-reduction incentive, will be more likely to focus on preventive care, because that is less expensive.
And I think the US tends to have more of a band-aid approach to making policy (let society develop, then try to come up with some law or policy to prevent some observably bad outcome) than what the case is for Scandinavian countries, where we've taken more of a 'let's use politics to guide the development of society'-approach.
This further reflects itself in how 'holistic' an approach ends up being. I admittedly don't know enough about the American school system to say whether this is something they also have, but in Norway, 'food and health' is a subject that kids have from the age 13-15, to ensure that young adults know a) basic cooking and b) basic nutrition. Add to it that all our sports are very non-competitive at young ages to encourage as wide spread participation as possible. (I just googled it and saw that 36.9% of American children aged 6-12 are in some type of organized sport, the same number for Norway is in the 80-90% range. And to be clear - this is a conscious political decision aimed at improving public health.)
So yes, there might very well be truth to the argument American treatment is top notch, and that the problems with American health (not with American health care) are caused by a wide array of underlying conditions. The main two issues I have is that the same people who present that argument tend to be negative towards what I perceive as the solution (government taking a more active role in shaping society), and that child mortality is another metric where the US falls short of comparably wealthy countries, and this to me at least implies that a significant % of the least privileged Americans get worse health care than what the case is for a similar % of the least privileged citizens from EU country X.
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On December 02 2020 18:51 Slydie wrote:Show nested quote +On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs. I think the main problem, which has been mentioned many times, is that the market can not regulate healthcare in a fair and efficient way. What is the value to the patient of a life saving treatment? If you are the seller in a situation like that, you can charge almost whatever you want. Even if there is competition in such a market, the sellers (hospitals, insurance companies and pharma) will still as a group charge much more than they need to. This does also happen in other areas where what people are willing to pay is much higher than the cost of service and production, like phone services (remember what an SMS cost when they were new?), glasses and contact lenses. Preventative care is discouraged in other healthcare systems to too. The results of actual treatment is much easier to show and get paid for, even if the goverment takes the whole bill. Both governments and insurance companies have strong incentives to try to keep the number of treatments as low as possible while doctors and hospitals have incentives to do "profitable" treatments. It is usually impossible to stop them at it, even if they might not be necessary. This problem is much bigger with for-profit healctcare all over the world. If I pay my insurance 100 bucks a month regardless of my health status, and they cannot throw me out if I am to expensive it is in the insurances interest to keep me as healthy as possible. Preventive care is generally cheaper then fixing the problems when they actually show up.
It is cheaper for an insurance company to pay for regular checkups then the massive bill of a later stage cancer diagnosis for example.
Or help pay for someone trying to quit smoking, compared to pay for the likely health complications that come later in life as a smoker.
And while hospitals might be incentivised to do unnecessary treatments, its the insurance company that gets stuck with the bill, not the patient. And the insurance companies are big enough that, if needed, they can refuse to pay for needless or extra expensive treatments and take a hospital to court over the bill. Something an individual can often not afford.
Or the Insurance company stops working with the hospital, as a result non-critical patients are directed towards other hospitals and lose money that way.
I don't really know of unnecessary treatments being an actual problem in UHC systems outside of an occasional isolated incident.
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On December 02 2020 18:47 FlaShFTW wrote:Show nested quote +On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs. Have the countries with universal health care shown that this is the case though? Obviously a lot of this stems from culture but I'm willing to bet that asian countries with universal healthcare like Korea and Japan already practice quite a bit of preventative care, as with the Scandinavian countries. I could totally be wrong about this, just stereotypical view of those countries. Or maybe your point isn't referring to UHC but just how to improve healthcare in general could lead to less preventative care measures. Forgive me if I got the point wrong. Even if it weren't the case, it certainly is difficult to change how America is already. We're so dependent on fast food and american food in general is incredibly oily, greasy, buttery. Very high in fats, less emphasis on vegetables.
Cultural factors go both ways, for example the US has significantly lower cigarette consumption per capita than your average European country. The difference in outcomes shouldn't be waved away based on obesity rate alone.
You know how instead of giving plastic bags for free, supermarkets charging an insignificant token fee for them drastically reduces their use? Even in the wildest libertarian utopia with fair competition and pricing practices, simply having an extra hurdle such as a direct cost associated with checking whether something's wrong will invariably negatively affect outcomes.
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On December 02 2020 08:37 Wegandi wrote:Show nested quote +On December 02 2020 08:26 Artisreal wrote:On December 02 2020 06:53 Wegandi wrote:On December 02 2020 01:01 Yurie wrote:Anybody that knows US history well that can explain what happened around 1980-85? It broke the trend of the US life expectancy keeping up with many other western nations. While increasing spending. ![[image loading]](https://i.imgur.com/gLeHaCb.png) None of this takes into account lifestyle choices - namely, obesity and all the co-morbidities that come with it. It's why analysis using life expectancy vice health expenditure is misleading at best. Track co-morbid trend lines with that graph. It's not a surpise that Japan is #1. They're very active people who have a good diet. Numerous studies have shown life expectancy increases with caloric deficits. It's always been so odd for me to see people do studies on this issue that completely dismiss lifestyle and diet factors. What a quick way to blame the individual. I would be interested in reading a PubMed study on your argument that lots of additional healthcare spending in the US is caused by individual gluttony. Can you link me one or two that was paramount in forming this opinion? What a quick way to deflect and dismiss the point without engagement. Kudos. Is this even a question? It's pretty common sense that those who are obese cost more in healthcare terms. Here, I'll do the work for you though. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074251/Show nested quote +Obesity is a growing global health concern, accounting for substantial national healthcare expenditures, with healthcare costs predicted to be higher by around a third in obese people compared to those of normal weight 1. The association between obesity and healthcare costs is well‐documented in international literature. Investigators have largely used attributable fraction methodology 2, 3 and, more recently, instrumental variable approaches.4, 5. These studies have estimated the proportion of healthcare spending on obesity to be around 5%, with results of up to 20% identified in the United States 4, 6. Despite recent efforts to quantify direct costs associated with obesity, the mediators underlying this relationship are poorly understood. Given the continued rise in obesity prevalence and persistence of the condition in individuals 7, the drivers of obesity‐related costs need to be analysed. https://pubmed.ncbi.nlm.nih.gov/26134917/Show nested quote +ORCs (Obesity-related comorbidities) are associated with substantial economic burden, especially for those requiring continuous treatments. https://www.tandfonline.com/doi/full/10.1080/03007995.2018.1464435?src=recsysShow nested quote +The cohort included 9651 individuals with BMI V85 codes. After weighting, the BMI distribution was: normal (31.1%), overweight (33.4%), obese class I (22.0%), obese class II (8.1%) and obese class III (5.4%). Increasing BMI was associated with greater prevalence of cardiometabolic conditions, including hypertension, type 2 diabetes and metabolic syndrome. The use of antihypertensives, antihyperlipidemics, antidiabetics, analgesics and antidepressants rose with increasing BMI. Greater BMI level was associated with increased inpatient, emergency department and outpatient utilization, and higher total healthcare, medical and pharmacy costs. I could go on, but I think you get the point. By the way compare obesity rates. The US dwarfs all other developed countries: https://en.wikipedia.org/wiki/List_of_countries_by_obesity_rate
First Study --> UK. What's that got to do with the US?
Conclusion of that study
High healthcare costs in obesity may be driven by the presence of comorbidity and depression. Prioritizing primary prevention of cardiovascular disease and diabetes in the obese population may contribute to reducing obesity‐related healthcare costs.
Second Study --> Goes into detail about obesity related comorbidities.
Says they are more expensive when people are obese than when they arent. Wow, well done Sherlock.
What I want to point out here is that obese people may cost more when they are alive, but they die earlier.
Hence you might even "save" money. Hence your argument that the increase in healthcare spending is caused by people's gluttony is discputed at best - according to my recent readings.
Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.
Source
Our results show that obese people who survive to age sixty-five have much larger annual Medicare expenditures than those of normal weight, and June Stevens and colleagues show that the elderly obese have only a marginally shorter life expectancy. 19 Therefore, unlike for smokers, there are few “benefits” to Medicare and Social Security associated with obesity among the elderly.
Source
And the annotation 19 from above says the following:
Excess body weight increases the risk of death from any cause and from cardiovascular disease in adults between 30 and 74 years of age. The relative risk associated with greater body weight is higher among younger subjects.
Source
So unless you actually provide a meta study that clearly shows the link between the increase in healthcare spending in the US with and obesity as well as the causation with lower life expectancy, this cannot be regarded as anything but hearsay.
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On December 02 2020 13:47 Zambrah wrote:
Look at that administrative gap, thats almost as telling as any of the other figures.
the bureaucracy was one of the main reasons i quit medicine
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On December 02 2020 18:47 FlaShFTW wrote:Show nested quote +On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs. Have the countries with universal health care shown that this is the case though? Obviously a lot of this stems from culture but I'm willing to bet that asian countries with universal healthcare like Korea and Japan already practice quite a bit of preventative care, as with the Scandinavian countries. I could totally be wrong about this, just stereotypical view of those countries. Or maybe your point isn't referring to UHC but just how to improve healthcare in general could lead to less preventative care measures. Forgive me if I got the point wrong. Even if it weren't the case, it certainly is difficult to change how America is already. We're so dependent on fast food and american food in general is incredibly oily, greasy, buttery. Very high in fats, less emphasis on vegetables.
There are many socio-economic factors that go into life expectancy. For instance, if you can't afford to eat healthy food, you will generally be less healthy and more prone to develop medical conditions. Stress tends to exarcebate or cause medical conditions, and if you're living paycheck to paycheck, it's hard not to feel stressed. To give an extreme example, if we were living in a post-nuclear apocalypes situation, and we had futuristic healthcare robots and meds taking care of the few of us that are left, but all we're eating is poisoned, the life expectancy would still be very low even if our healthcare is top-notch and everyone's getting it.
I do think that UHC skews towards more preventative care rather than less and would be my preferred option to fix the healthcare issues in America, but hey, I am European and American's attitude of 'the market will sort itself out' baffles me generally.
I think, however, that there is value in arguing the case with the conservative posters in this thread. I would be interested to get Wegandi/Danglars' perspective:
(a) do you agree that 'more preventative care' is better because that would lower costs for all in the long run?
(b) if you agree, what would you do within the current system to increase the level of preventative care across the whole population of the US?
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On December 02 2020 19:23 Gorsameth wrote:Show nested quote +On December 02 2020 18:51 Slydie wrote:On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs. I think the main problem, which has been mentioned many times, is that the market can not regulate healthcare in a fair and efficient way. What is the value to the patient of a life saving treatment? If you are the seller in a situation like that, you can charge almost whatever you want. Even if there is competition in such a market, the sellers (hospitals, insurance companies and pharma) will still as a group charge much more than they need to. This does also happen in other areas where what people are willing to pay is much higher than the cost of service and production, like phone services (remember what an SMS cost when they were new?), glasses and contact lenses. Preventative care is discouraged in other healthcare systems to too. The results of actual treatment is much easier to show and get paid for, even if the goverment takes the whole bill. Both governments and insurance companies have strong incentives to try to keep the number of treatments as low as possible while doctors and hospitals have incentives to do "profitable" treatments. It is usually impossible to stop them at it, even if they might not be necessary. This problem is much bigger with for-profit healctcare all over the world. If I pay my insurance 100 bucks a month regardless of my health status, and they cannot throw me out if I am to expensive it is in the insurances interest to keep me as healthy as possible. Preventive care is generally cheaper then fixing the problems when they actually show up. It is cheaper for an insurance company to pay for regular checkups then the massive bill of a later stage cancer diagnosis for example. Or help pay for someone trying to quit smoking, compared to pay for the likely health complications that come later in life as a smoker. And while hospitals might be incentivised to do unnecessary treatments, its the insurance company that gets stuck with the bill, not the patient. And the insurance companies are big enough that, if needed, they can refuse to pay for needless or extra expensive treatments and take a hospital to court over the bill. Something an individual can often not afford. Or the Insurance company stops working with the hospital, as a result non-critical patients are directed towards other hospitals and lose money that way. I don't really know of unnecessary treatments being an actual problem in UHC systems outside of an occasional isolated incident.
You should never underestimate the massive money sink of "regular checkups". There is virtually no limit to how many checkups and tests you can make, for diminishing returns, and I am pretty certain that the amount of tests done to the most privileged of US insurance customers is a major contribute to the inflated cost.
Even the private healthcare insurance of my work here in Europe offers to do yearly checks on me for no reason other than "being safe." I always decline, both as I think it is a waste, and that if they DO find something, they can use their findings against me.
As for treatment, I believe completely unnecessary operations etc. are rare, but I heard this story from my brother in law, who is a doctor: Private hospital X has to pay for a slot time for an operation. The room, doctors and nurses are all on stand by, and will be paid for no matter if they work or not. A patient comes in, and there is doubt if the operation will do you any good, but what do you do? Operate and earn money or don't operate and lose money for nothing?
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On December 02 2020 17:41 Wegandi wrote:Show nested quote +On December 02 2020 17:36 Salazarz wrote:
So basically, no available data is good enough because it runs contrary to your beliefs, and the data that would support your beliefs would definitely be there if someone collected it but nobody did. Nothing to do with my beliefs. It has to do with methodology and epistemology. You can't determine the quality of a healthcare system on raw per capita #'s that are heavily influenced by factors outside of the healthcare domain. If anything, you're the one who is manipulating the data to serve your beliefs. My other point is it is very hard to find and collate this data whereas raw per capita # is easy and thus it is everywhere and basically useless as a method of understanding what I said - how is your data going to inform a person on the quality of care they'll receive status post 30 min CVA in the US compared to Canada compared to Switzerland compared to Japan. You think that is irrelevant?
This is an extremely malicious obfuscation of the issue at hand.
You are trying to use the U.S.'s higher prevalence of obesity to somehow nullify any and all arguments condemning the healthcare system by saying that you can't make meaningful conclusions due to this difference. This is simply absurd. The healthcare system is more than just the care given out within the physician's office or operating room. It includes access, preventative medicine, community health, etc. The U.S. consistently fails on all of these metrics. Infant mortality rates, minority mortality rates, mortality rates from various diseases when standardized for population, public health outcomes, access to healthcare for the population, affordability of healthcare, basically all of these metrics are a failure. Even if you dig into the CV disease data, other countries with high rates of obesity (e.g. Australia, NZ, UK) still have better outcomes than the U.S. Every country has unique cultural issues concerning healthcare (e.g. Europeans smoke more than Americans and yet you don't seem to acknowledge that), but it is the country's responsibility to deal with those issues to improve healthcare for its citizens. Obesity is a public health issue (i.e. yet another healthcare system issue), and the U.S. has failed to deal with it.
Also, you can look up CVA outcome states pretty easily. Even a cursory Google search shows that the U.S.'s CVA outcome stats have been improving more slowly than that of peer countries.
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs.
Life expectancy is absolutely an incomplete metric, but it definitely has a degree of meaning when talking about quality of healthcare.
Wegandi and Danglars's attempt to paint it as a useless measure is very disingenuous.
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On December 02 2020 22:34 Slydie wrote:Show nested quote +On December 02 2020 19:23 Gorsameth wrote:On December 02 2020 18:51 Slydie wrote:On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs. I think the main problem, which has been mentioned many times, is that the market can not regulate healthcare in a fair and efficient way. What is the value to the patient of a life saving treatment? If you are the seller in a situation like that, you can charge almost whatever you want. Even if there is competition in such a market, the sellers (hospitals, insurance companies and pharma) will still as a group charge much more than they need to. This does also happen in other areas where what people are willing to pay is much higher than the cost of service and production, like phone services (remember what an SMS cost when they were new?), glasses and contact lenses. Preventative care is discouraged in other healthcare systems to too. The results of actual treatment is much easier to show and get paid for, even if the goverment takes the whole bill. Both governments and insurance companies have strong incentives to try to keep the number of treatments as low as possible while doctors and hospitals have incentives to do "profitable" treatments. It is usually impossible to stop them at it, even if they might not be necessary. This problem is much bigger with for-profit healctcare all over the world. If I pay my insurance 100 bucks a month regardless of my health status, and they cannot throw me out if I am to expensive it is in the insurances interest to keep me as healthy as possible. Preventive care is generally cheaper then fixing the problems when they actually show up. It is cheaper for an insurance company to pay for regular checkups then the massive bill of a later stage cancer diagnosis for example. Or help pay for someone trying to quit smoking, compared to pay for the likely health complications that come later in life as a smoker. And while hospitals might be incentivised to do unnecessary treatments, its the insurance company that gets stuck with the bill, not the patient. And the insurance companies are big enough that, if needed, they can refuse to pay for needless or extra expensive treatments and take a hospital to court over the bill. Something an individual can often not afford. Or the Insurance company stops working with the hospital, as a result non-critical patients are directed towards other hospitals and lose money that way. I don't really know of unnecessary treatments being an actual problem in UHC systems outside of an occasional isolated incident. You should never underestimate the massive money sink of "regular checkups". There is virtually no limit to how many checkups and tests you can make, for diminishing returns, and I am pretty certain that the amount of tests done to the most privileged of US insurance customers is a major contribute to the inflated cost. Even the private healthcare insurance of my work here in Europe offers to do yearly checks on me for no reason other than "being safe." I always decline, both as I think it is a waste, and that if they DO find something, they can use their findings against me. As for treatment, I believe completely unnecessary operations etc. are rare, but I heard this story from my brother in law, who is a doctor: Private hospital X has to pay for a slot time for an operation. The room, doctors and nurses are all on stand by, and will be paid for no matter if they work or not. A patient comes in, and there is doubt if the operation will do you any good, but what do you do? Operate and earn money or don't operate and lose money for nothing?
any citation to that claim? you think there is a massive over testing of our wealthy, they go to doctors more than they need to?
this is contrary to everything i’ve ever read on the subject. yearly checkups are a cost saving measure and are not ‘too much.’
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On December 02 2020 22:34 Slydie wrote:Show nested quote +On December 02 2020 19:23 Gorsameth wrote:On December 02 2020 18:51 Slydie wrote:On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs. I think the main problem, which has been mentioned many times, is that the market can not regulate healthcare in a fair and efficient way. What is the value to the patient of a life saving treatment? If you are the seller in a situation like that, you can charge almost whatever you want. Even if there is competition in such a market, the sellers (hospitals, insurance companies and pharma) will still as a group charge much more than they need to. This does also happen in other areas where what people are willing to pay is much higher than the cost of service and production, like phone services (remember what an SMS cost when they were new?), glasses and contact lenses. Preventative care is discouraged in other healthcare systems to too. The results of actual treatment is much easier to show and get paid for, even if the goverment takes the whole bill. Both governments and insurance companies have strong incentives to try to keep the number of treatments as low as possible while doctors and hospitals have incentives to do "profitable" treatments. It is usually impossible to stop them at it, even if they might not be necessary. This problem is much bigger with for-profit healctcare all over the world. If I pay my insurance 100 bucks a month regardless of my health status, and they cannot throw me out if I am to expensive it is in the insurances interest to keep me as healthy as possible. Preventive care is generally cheaper then fixing the problems when they actually show up. It is cheaper for an insurance company to pay for regular checkups then the massive bill of a later stage cancer diagnosis for example. Or help pay for someone trying to quit smoking, compared to pay for the likely health complications that come later in life as a smoker. And while hospitals might be incentivised to do unnecessary treatments, its the insurance company that gets stuck with the bill, not the patient. And the insurance companies are big enough that, if needed, they can refuse to pay for needless or extra expensive treatments and take a hospital to court over the bill. Something an individual can often not afford. Or the Insurance company stops working with the hospital, as a result non-critical patients are directed towards other hospitals and lose money that way. I don't really know of unnecessary treatments being an actual problem in UHC systems outside of an occasional isolated incident. You should never underestimate the massive money sink of "regular checkups". There is virtually no limit to how many checkups and tests you can make, for diminishing returns, and I am pretty certain that the amount of tests done to the most privileged of US insurance customers is a major contribute to the inflated cost. Even the private healthcare insurance of my work here in Europe offers to do yearly checks on me for no reason other than "being safe." I always decline, both as I think it is a waste, and that if they DO find something, they can use their findings against me. As for treatment, I believe completely unnecessary operations etc. are rare, but I heard this story from my brother in law, who is a doctor: Private hospital X has to pay for a slot time for an operation. The room, doctors and nurses are all on stand by, and will be paid for no matter if they work or not. A patient comes in, and there is doubt if the operation will do you any good, but what do you do? Operate and earn money or don't operate and lose money for nothing? 5 seconds on google gave me 129 euro's per employee for a company paying for yearly healthchecks for them.
You can take one every year for your entire working life and it will likely cost less then a single hospital visit.
As for using it against you, for starters if the doctor shared anything about it with your company he stands to lose his medical license because of doctor-patient confidentiality. And I don't know your countries situation but where I'm from an employer can not fire you on medical grounds and if they try to cover it up with some crap reason there are plenty of lawfirms who would love to take the case.
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On December 02 2020 23:02 brian wrote:Show nested quote +On December 02 2020 22:34 Slydie wrote:On December 02 2020 19:23 Gorsameth wrote:On December 02 2020 18:51 Slydie wrote:On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs. I think the main problem, which has been mentioned many times, is that the market can not regulate healthcare in a fair and efficient way. What is the value to the patient of a life saving treatment? If you are the seller in a situation like that, you can charge almost whatever you want. Even if there is competition in such a market, the sellers (hospitals, insurance companies and pharma) will still as a group charge much more than they need to. This does also happen in other areas where what people are willing to pay is much higher than the cost of service and production, like phone services (remember what an SMS cost when they were new?), glasses and contact lenses. Preventative care is discouraged in other healthcare systems to too. The results of actual treatment is much easier to show and get paid for, even if the goverment takes the whole bill. Both governments and insurance companies have strong incentives to try to keep the number of treatments as low as possible while doctors and hospitals have incentives to do "profitable" treatments. It is usually impossible to stop them at it, even if they might not be necessary. This problem is much bigger with for-profit healctcare all over the world. If I pay my insurance 100 bucks a month regardless of my health status, and they cannot throw me out if I am to expensive it is in the insurances interest to keep me as healthy as possible. Preventive care is generally cheaper then fixing the problems when they actually show up. It is cheaper for an insurance company to pay for regular checkups then the massive bill of a later stage cancer diagnosis for example. Or help pay for someone trying to quit smoking, compared to pay for the likely health complications that come later in life as a smoker. And while hospitals might be incentivised to do unnecessary treatments, its the insurance company that gets stuck with the bill, not the patient. And the insurance companies are big enough that, if needed, they can refuse to pay for needless or extra expensive treatments and take a hospital to court over the bill. Something an individual can often not afford. Or the Insurance company stops working with the hospital, as a result non-critical patients are directed towards other hospitals and lose money that way. I don't really know of unnecessary treatments being an actual problem in UHC systems outside of an occasional isolated incident. You should never underestimate the massive money sink of "regular checkups". There is virtually no limit to how many checkups and tests you can make, for diminishing returns, and I am pretty certain that the amount of tests done to the most privileged of US insurance customers is a major contribute to the inflated cost. Even the private healthcare insurance of my work here in Europe offers to do yearly checks on me for no reason other than "being safe." I always decline, both as I think it is a waste, and that if they DO find something, they can use their findings against me. As for treatment, I believe completely unnecessary operations etc. are rare, but I heard this story from my brother in law, who is a doctor: Private hospital X has to pay for a slot time for an operation. The room, doctors and nurses are all on stand by, and will be paid for no matter if they work or not. A patient comes in, and there is doubt if the operation will do you any good, but what do you do? Operate and earn money or don't operate and lose money for nothing? any citation to that claim? you think there is a massive over testing of our wealthy, they go to doctors more than they need to? this is contrary to everything i’ve ever read on the subject. yearly checkups are a cost saving measure and are not ‘too much.’
What I found of the bat:
https://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
The most obvious example I have been in contact with is ultrasound checks for pregnant women. There is no limit to how many of these checks some women would like to have made to "feel sure", even though the medical reason to do can be very weak, and results can not change much.
Tests with doubt can then again generate even more tests, and a monster which usually does nothing in terms of public health except create worries for the results is born.
My whole family are doctors, you should trust me on this. There is a gigantic market for unnecessary tests, and physicians willing to do them for the right price.
Any western country does a lot of tests with a very low chance of finding anything "just in case," but in leaving it to private businesses, the already low returns are becoming even lower.
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On December 02 2020 23:46 Slydie wrote:Show nested quote +On December 02 2020 23:02 brian wrote:On December 02 2020 22:34 Slydie wrote:On December 02 2020 19:23 Gorsameth wrote:On December 02 2020 18:51 Slydie wrote:On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs. I think the main problem, which has been mentioned many times, is that the market can not regulate healthcare in a fair and efficient way. What is the value to the patient of a life saving treatment? If you are the seller in a situation like that, you can charge almost whatever you want. Even if there is competition in such a market, the sellers (hospitals, insurance companies and pharma) will still as a group charge much more than they need to. This does also happen in other areas where what people are willing to pay is much higher than the cost of service and production, like phone services (remember what an SMS cost when they were new?), glasses and contact lenses. Preventative care is discouraged in other healthcare systems to too. The results of actual treatment is much easier to show and get paid for, even if the goverment takes the whole bill. Both governments and insurance companies have strong incentives to try to keep the number of treatments as low as possible while doctors and hospitals have incentives to do "profitable" treatments. It is usually impossible to stop them at it, even if they might not be necessary. This problem is much bigger with for-profit healctcare all over the world. If I pay my insurance 100 bucks a month regardless of my health status, and they cannot throw me out if I am to expensive it is in the insurances interest to keep me as healthy as possible. Preventive care is generally cheaper then fixing the problems when they actually show up. It is cheaper for an insurance company to pay for regular checkups then the massive bill of a later stage cancer diagnosis for example. Or help pay for someone trying to quit smoking, compared to pay for the likely health complications that come later in life as a smoker. And while hospitals might be incentivised to do unnecessary treatments, its the insurance company that gets stuck with the bill, not the patient. And the insurance companies are big enough that, if needed, they can refuse to pay for needless or extra expensive treatments and take a hospital to court over the bill. Something an individual can often not afford. Or the Insurance company stops working with the hospital, as a result non-critical patients are directed towards other hospitals and lose money that way. I don't really know of unnecessary treatments being an actual problem in UHC systems outside of an occasional isolated incident. You should never underestimate the massive money sink of "regular checkups". There is virtually no limit to how many checkups and tests you can make, for diminishing returns, and I am pretty certain that the amount of tests done to the most privileged of US insurance customers is a major contribute to the inflated cost. Even the private healthcare insurance of my work here in Europe offers to do yearly checks on me for no reason other than "being safe." I always decline, both as I think it is a waste, and that if they DO find something, they can use their findings against me. As for treatment, I believe completely unnecessary operations etc. are rare, but I heard this story from my brother in law, who is a doctor: Private hospital X has to pay for a slot time for an operation. The room, doctors and nurses are all on stand by, and will be paid for no matter if they work or not. A patient comes in, and there is doubt if the operation will do you any good, but what do you do? Operate and earn money or don't operate and lose money for nothing? any citation to that claim? you think there is a massive over testing of our wealthy, they go to doctors more than they need to? this is contrary to everything i’ve ever read on the subject. yearly checkups are a cost saving measure and are not ‘too much.’ What I found of the bat: https://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawandeThe most obvious example I have been in contact with is ultrasound checks for pregnant women. There is no limit to how many of these checks some women would like to have made to "feel sure", even though the medical reason to do can be very weak, and results can not change much. My whole family are doctors, you should trust me on this. There is a gigantic market for unnecessary tests, and physicians willing to do them for the right price.
this is an extremely long anecdote that as far as i can tell tries to say doctors are over selling their product, not that patients are trying to waste money.
are you reading this differently? this supports Drones point completely, that in a profit driven industry doctors are incentivized to waste money, not that patients are over using the system.
it even draws a parallel to car services and states its goal explicitly “
“There’s no question we have considerable up-selling in the industry,” Ray told me when I reached him by phone.”
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On December 02 2020 23:46 Gorsameth wrote:Show nested quote +On December 02 2020 22:34 Slydie wrote:On December 02 2020 19:23 Gorsameth wrote:On December 02 2020 18:51 Slydie wrote:On December 02 2020 18:30 EnDeR_ wrote:
Salazarz, Wegandi's and Danglars' point that life expectancy vs money spent is a poor metric for healthcare outcomes is valid. You framed your initial argument against something that is very easy to argue against, i.e. there are many things that go into life expectancy like Wegandi pointed out.
I think you'll find that both of them agree to some degree with the statement 'the healthcare system in the US could be improved'. The tricky part is figuring out how to go about that. To me, one of its biggest flaws is that it discourages preventative care for a significant fraction of the population, and this inevitably leads to poorer outcomes and much higher healthcare costs. I think the main problem, which has been mentioned many times, is that the market can not regulate healthcare in a fair and efficient way. What is the value to the patient of a life saving treatment? If you are the seller in a situation like that, you can charge almost whatever you want. Even if there is competition in such a market, the sellers (hospitals, insurance companies and pharma) will still as a group charge much more than they need to. This does also happen in other areas where what people are willing to pay is much higher than the cost of service and production, like phone services (remember what an SMS cost when they were new?), glasses and contact lenses. Preventative care is discouraged in other healthcare systems to too. The results of actual treatment is much easier to show and get paid for, even if the goverment takes the whole bill. Both governments and insurance companies have strong incentives to try to keep the number of treatments as low as possible while doctors and hospitals have incentives to do "profitable" treatments. It is usually impossible to stop them at it, even if they might not be necessary. This problem is much bigger with for-profit healctcare all over the world. If I pay my insurance 100 bucks a month regardless of my health status, and they cannot throw me out if I am to expensive it is in the insurances interest to keep me as healthy as possible. Preventive care is generally cheaper then fixing the problems when they actually show up. It is cheaper for an insurance company to pay for regular checkups then the massive bill of a later stage cancer diagnosis for example. Or help pay for someone trying to quit smoking, compared to pay for the likely health complications that come later in life as a smoker. And while hospitals might be incentivised to do unnecessary treatments, its the insurance company that gets stuck with the bill, not the patient. And the insurance companies are big enough that, if needed, they can refuse to pay for needless or extra expensive treatments and take a hospital to court over the bill. Something an individual can often not afford. Or the Insurance company stops working with the hospital, as a result non-critical patients are directed towards other hospitals and lose money that way. I don't really know of unnecessary treatments being an actual problem in UHC systems outside of an occasional isolated incident. You should never underestimate the massive money sink of "regular checkups". There is virtually no limit to how many checkups and tests you can make, for diminishing returns, and I am pretty certain that the amount of tests done to the most privileged of US insurance customers is a major contribute to the inflated cost. Even the private healthcare insurance of my work here in Europe offers to do yearly checks on me for no reason other than "being safe." I always decline, both as I think it is a waste, and that if they DO find something, they can use their findings against me. As for treatment, I believe completely unnecessary operations etc. are rare, but I heard this story from my brother in law, who is a doctor: Private hospital X has to pay for a slot time for an operation. The room, doctors and nurses are all on stand by, and will be paid for no matter if they work or not. A patient comes in, and there is doubt if the operation will do you any good, but what do you do? Operate and earn money or don't operate and lose money for nothing? 5 seconds on google gave me 129 euro's per employee for a company paying for yearly healthchecks for them. You can take one every year for your entire working life and it will likely cost less then a single hospital visit. As for using it against you, for starters if the doctor shared anything about it with your company he stands to lose his medical license because of doctor-patient confidentiality. And I don't know your countries situation but where I'm from an employer can not fire you on medical grounds and if they try to cover it up with some crap reason there are plenty of lawfirms who would love to take the case.
This is where things look very different from each side. If you are the doctor who has to do 1000 of these checks to find anything, and even that case would be found anyway, it is clear that it is a colossal waste.
My employer is covered, if we are unable to do our jobs for medical reasons, we can be fired, and people have been. In those cases of severe illness, they are taken care of economically, though.
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Yea, I'm not really sure what comparative point Slydie is trying to make.
Over-treating and running unnecessary tests is a massive issue in the U.S., and is tied to 1) CYA medicine being the dominant form of practice due to malpractice vulnerabilities, and 2) a profit motive to run more tests or procedures.
These have both been criticized heavily in the American Healthcare industry and there have been many moves to address them (e.g. recommendations on when to start doing mammograms changing frequently).
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On December 03 2020 00:16 Slydie wrote:
This is where things look very different from each side. If you are the doctor who has to do 1000 of these checks to find anything, and even that case would be found anyway, it is clear that it is a colossal waste.
Speaking as a doctor who is doing "1000 of these checks", no, it is not a colossal waste. Regular preventive care visits are a dream compared to the patient who hasn't seen a doctor in 20 years, has fucked up everything about their body, and now needs a bunch of expensive referrals and interventions. People who only see their doctor when something is "wrong" are the ones most at risk for too much testing for too little mortality benefit.
When the doctor has seen you every year for the last 10 years, they have a lot more data to work with when making medical decisions for you to begin with, which means that they're less likely to need expensive tests or imaging to make those decisions. A lot of the expensive testing and imaging is necessitated in the context of someone who does not have 10 years of inexpensive lab data to show trends, or 10 years of primary care visits to know what their lifestyle and medical history is. Regular primary care follow-up leads to less waste, not more.
On December 03 2020 00:58 Stratos_speAr wrote:
Yea, I'm not really sure what comparative point Slydie is trying to make.
Over-treating and running unnecessary tests is a massive issue in the U.S., and is tied to 1) CYA medicine being the dominant form of practice due to malpractice vulnerabilities, and 2) a profit motive to run more tests or procedures.
These have both been criticized heavily in the American Healthcare industry and there have been many moves to address them (e.g. recommendations on when to start doing mammograms changing frequently).
If I were to guess, I would say that Slydie is probably a young, healthy person with few medical comorbidities who is mistakenly projecting his belief that his own recommended yearly medical follow-ups are a waste of time onto the issue of wasteful medical practice as a whole--without seeing the bigger picture of how having a large pool of inexpensive medical data from when he's young and healthy helps to aid medical decisions when he's older and no longer as healthy and subsequently save on much more expensive tests in the long run.
The primary care setting isn't where a lot of that over-testing occurs. Primary care visits and basic labs every year are not where all the massive money drain is in medicine. It's in expensive imaging, interventions, and specialty consultations. Getting yearly labs drawn for your entire lifetime still costs less than a single coronary angiogram.
Where over-testing happens is when someone who doesn't see their doctor shows up in the ED with a headache and gets a billion labs, head imaging, and specialty consultations because they have no medical history on file and no historical data, so you have to start from square 1 to rule out everything. The best way to avoid over-testing is to follow with your primary care doctor regularly, practice good preventive care, and not end up in the hospital.
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EPT
