5126

We can’t pay less and expect to get the same level of service. The capacity offered by a medical center is explicitly tied to the expected return.

MRI machines and orthopedic clinics are only built if the expenses are justified by the expected revenue. So if you decrease revenues, fewer will be built and you will either have to decrease demand or put up with longer wait times.

And you seem to suggest that reducing what a doctor gets paid will reduce her salary. Actually, it will cause her to try to maintain her salary by booking more patients and spending even less time with each patient.

5127

I’ll agree 100% we do need pushback across the system, It is not something that Bernie or Elizabeth mention. It is all about the profit of the evil corporations. One of the ironies American life is the places we’ve seen the highest inflation, college education and health care also have the greatest number of not-for-profit corporations. Education is almost entirely non-profit, the Universities of Phoenix and such are represent a very small percentage of college spending. Healthcare does have a lot for profit players, but with 70% of hospitals as non-profit and insurance/MMO like Kaiser, Cleveland, Mayo, and the majority of Blue Cross/Blue Shield are also non-profit. The result is a hodge-podge of organizations. What is clear is that with no organized pushback from consumers, no transparency in pricing, without any demands from shareholders, market signals aren’t working. We end up with a system, with extremely highly paid doctors, even higher paid hospital administrators and very well paid nurse. We have perverse incentives, that lead to competing for doctors by duplicative expensive medical equipment, and patients with fancy reception areas and conceirge services.

.I agree with this also. You know a lot more than I about medical instruments. But even simple things like the majority of US hospitals beds are private or semi-private rooms, while that is rare in the rest of the world. This requires more equipment for treatment and monitoring as well as more nursing, driving up costs.

In general American have less deference to authority, and the rise of Dr. Google is going to only increase American’s misplaced self-confidence to demand second-opinions and more tests. Bernie rallies against evil Insurance companies for refusing treatment, but the fact of the matter somebody needs to say no, the cost of this treatment, this test far exceed its benefits. I sincerely doubt that Americans are going to happier to hear NO from a Medicare bureaucrat than an insurance company clerk.

Finally, as Bill Maher pointed out last week if you want to know a big factor in US healthcare costs we need to look in the mirror. American’s eat too much (like myself) and exercise too little. Funny, I don’t hear that from Elizabeth or Bernie. (Or any other politician to be fair.)

5128

Isn’t one of the factors just medical equipment? Every hospital tries to get all the newest shiniest equipment, and they have to justify it. In Europe, there is more specialization, so fewer hospitals have or need to have the same equipment. So, it’s one less cost that individual hospitals in Europe have to contend with.

5129

I understand that “public debt doesn’t matter”, is the hot new monetary theory of the year. Color me and plenty of economist skeptical that is true. I think both public and private debt levels are scary.

5130

Yes, technology in general is a significant driver of costs.

Suppose your doctor gives you the option between treatment X or treatment Y. Treatment X is newer, and equally good as and perhaps slightly better than Y. It is also more expensive, but your insurance will pay for either. Which do you choose? Of course you choose X. The problem is that you were given a choice.

5131

Of course you can, if the problem is with the rates for services. They are unregulated. They could be regulated, or effectively regulated by bargaining power. Nothing in medical science says doctors must be millionaires in order to produce decent care.

I get health care in Ecuador, and they have the exact same equipment. Somehow, that doesn’t translate into US service rates.

5132

It seems to be. Why can’t US service providers be paid what e.g. EU service providers are paid? The answer seems to be that we think they won’t do the work. They will .

5133

Please show proof that medical equipment & service is same across Ecuador and US.

FWIW, Having experienced both the US and Japanese medical system I can believe that the EU is more like Japan than the US.

5134

Well, we’re partially subsidizing the rest of the world, not just with pharmaceutical companies but also equipment and devices.

There is no possible scenario where some giant body, government or otherwise, is going to be able to say nurses, technicians, providers and all their supporting staff, eat your loans, you’re all getting pay-cuts and there… we’ve solved it. No. It’s not that simple. Any approach to try and treat it like it is is a mistake.

We have to change our behavior, like magnet said. Consumers need to stop demanding the new and fancy but barely better than the older cheap options we have. They need to stop demanding brand name drugs. We need to stop running more tests and more images than the rest of the world, just in case, because everyone is afraid of being sued for millions, tens of millions, which you also don’t see in the rest of the world. We need to stop footing the bulk of the bills for devices and drugs so the other nations can get theirs on the cheap. We need to address education… a lot of the employees in healthcare, not just the providers themselves, but throughout the system are trained, skilled labor. We need to stop building multi million dollar fountains to make patients feel like they’ve approached a spa instead of a place of health. Why does every patient need a private room? How much are we willing to spend to give someone who is say 90 years old a few more years of life. Their families will always say, whatever it takes, no matter the expense, of course they will. No one even likes asking these questions. Why do the screws for some of the implants cost so much? Does anyone else think it’s a little odd, maybe a conflict of interest that physicians can get so close to a device manufacturer that a rep might be in the room while they perform surgery? How come so many surgeons choose devices simply based on what they used during their education, forcing so many systems to buy the devices from all over the place instead of focusing on strong and efficient relationships with one or two suppliers? Why do a number of insurers in an electronic medical world still require, require, paper charts? How often do new regulations that cost millions to implement for the government and for the providers, get forced and the repelled again? That’ wasted money right there often trying to address what, fraud that cost a lot les than that? How much is too much imaging just to make sure someone doesn’t sue the shit out some provider decades later?

Consumer side, there is no limit… no one wants to take the test that gives them 1% less accurate result but is fine 99% of the time and cost half as much.

It’s sexy and easy for a politician to stand up there and say, hey I am going to take their profits and make everything cheaper. Meanwhile another hospital closes down leaving the population without because of all those profits… just wasn’t true.

This is complicated. And anyone who sells easy and fast and some soundbite is selling snake oil.

5135

I’ve had several CT and MRI scans in my life. I never asked them to make sure I got the newest machine.

5136

LOL. Odd how my personal experience of a thing counts but your’s doesn’t is a thing, huh?

If doctors get paid less in the EU, why can’t they be paid less in the US?

5137

Well, part of the reason is the cost of medical school. Free medical school makes it easier to get cheaper GPs.

As for medical equipment, I can only talk about my own experience. My father has a heart condition. He has to usually travel Maastricht for special consultations, instead of the nearby hospital, because there are experts there and some of the more specialized equipment.

Again, it’s not about not having the machines available, its about not needing them to be available in every single hospital in the area. Competition can sometimes drive up costs.

5138

I’m making comparisons on personal patient experiences vs. you comparing equipment at a country level. One seems more valid than the other but maybe that’s just me.

5139

Medicare and Medicaid between them already pay more health care costs in the US than all private insurers combined. They use their market power to negotiate better rates and as a result are more efficient. There’s no reason at all to believe that they can’t take on a larger share with the same cost-reducing result. What would prevent that?

5140

I’m doing the same. The doctors I see in Ecuador have the same training, same equipment, same drugs available. Other people I know in Ecuador have the same experience, and their experience is broader than mine. It’s a poor country, so of course medical care is a luxury for many people, but it is not the cost of equipment that makes it so, because if that were the case the treatment would be even more expensive as there are very many fewer potential customers to offset that cost.

5141

The average doctor in the US earns $300k. It won’t take many years at that rate to pay for medical school. That’s not why doctor’s wages are so high in the US.

Edit: Every other civilized country has some variation of Medicare for all of MFA plus private insurers. The idea that we can’t ‘afford’ it is insane.

5142

It’s a real big part of it. How much do you think medical school costs?

5143

Who actually made that claim? Put that in quotes down below.

5144

The EU has many different countries with many different systems, but many have been hit by a wave of cost cutting that often fail by trying to measure every little expense, failing to account for economies of scale, or, my favorite, outsourcing and public private partnerships.
I’m not a social person, but even I know cases of medical misconduct influenced by lack of resources, so be wary of broad generalizations.

I think I have heard one or two American politicians, but let’s be real, campaigning on controlling what people eat would make anyone look like a commie for a lot of voters. It would be even harder than here, where there was a lot of gnashing of teeth (and the war on salt (here) is many years out of date, but whatever).

It’s not, because no one says something that dumb. It says that public debt, by itself, doesn’t tell you anything useful, and cutting it blindly is a disaster. You still can’t spend whatever number you want, but for different reasons. MMT has a theory on why that might very well be wrong, but monetarists keep coming up with post-facto models that don’t generalize. That’s not good enough when shit’s failing and people think Trump is an economic genius.

5145

You tell me, then tell me how quickly you could pay that amount off with an income of $300k per year.