3924

That’s the goal.

3925

But it doesn’t work for inelastic things. Like healthcare.

3926

I’m unable to tell whether you believe that the market is the best solution for health care or that the market can’t really work in the case of health care.

3927

I don’t think that more free market would work. But I can certainly acknowledge what its goals are, because if it could actually meet those goals then I would change my mind.

The theory is that health care is not totally inelastic. You could choose between expensive care and inexpensive care.

How would you actually make that choice? That’s why I don’t think it would work.

3928

So, now that it has failed, can we try the stuff that other countries are doing that is actually working?

I mean, other countries seem to a better solutions then we currently have.

3929

We already have!

Medicare is a single-payer third-party health care system, similar to that in Canada. It covers more patients than the Canadian healthcare system. Nearly every health care provider in the US accepts Medicare patients. Yet it has not succeeded in controlling costs in the US.

The Veterans Health Administration is a national health care system similar to the NHS. It has complete control over its providers, clinics, and hospitals. I personally think it works pretty well. Would Americans accept VA-style care for everyone? Maybe! But maybe not.

I see arguments that Medicare and/or the VA would work better if they had even more patients. But I don’t see why. If other countries can control costs with fewer patients, then why do we need so many more?

3930

Probably because unlike every other system there are no price controls.

We decided letting hospitals overcharge Medicare was fine.

3931

That’s not how it works. Medicare decides what it will pay for a given procedure, and that’s all that providers can get.

If Medicare decided to pay everyone 5% less next year, then everyone would get paid 5% less. Which has happened for certain procedures. And when that happens, hospitals may reduce their capacity or even stop doing those procedures.

3932

And there are entire departments devoted to making sure a patient’s chart ticks as many boxes as possible to maximize reimbursement.

3933

https://www.npr.org/sections/health-shots/2019/11/19/780642946/want-new-taxes-to-pay-for-health-care-lessons-from-the-affordable-care-act

Yep.

3934

This doesn’t exactly go here, but not sure where else. Illuminating thread. Fact bombs.

3935

I’m not sure if the guy is stupid or just being deliberately obtuse. For most people, being able to select your own doctors is very small factor when people talk about choice in insurance: deductible, copays, drug coverage, all this matter a helluva a lot more than doctors.

For a while, I was covered by my ex-girlfriends Kaiser insurance, which was the same insurance that Kaiser doctors got (she wasn’t a doctor). It was fantastic no deductible, $5 copays on visits, drugs etc and even big discounts on things like Lasik, or cosmetic surgery. Compared to Medicare with it is 20% copays, and limited coverage of newer procedure this insurance was vastly better.

Now my current Kaiser coverage, has a $5K deductible and no drug coverages (it’s grandfathered plan not ACA). Compared to this Medicare is much better coverage and depending on the price of Medicare for us under 65 folks there is a good chance I’ll go with it. But I’ll still use Kaiser, with our rather limited choice of doctors.

3936

Yeah, I agree with this. I’ve had to change doctors a couple of times. One moved and retired. One went into research and gave up his practice. I’m on my third GP. I don’t really care who I see. They do blood and urine testing and look in my throat and ears, and poke me a bit. I feel like a nurse could do all that and they could feed my symptons and results into a computer and get a healthcare recommendation.

Cost and coverage is the most important factor. Choice is down the list.

3937

Sounds like your health care needs are pretty simple. That’s me in a nutshell too - I don’t care a whole lot who I see the two or three times a year I see a doctor.

However, if you have special medical needs, it’s a whole different ballgame. My wife sees a number of specialists - a neurologist, a rheumatologist, an endocrinologist, not to mention a GP, an urologist, and an allergist. Finding good doctors that she believe in was not trivial, and because she likes the doctors she uses, she’s reluctant to move to a different area. When you have a serious and difficult to manage medical problem, being able to choose the right doctors is much more important.

3938

Edit: This is a reply to Strollen and Mark. Thanks for the nuanced post @Charlatan

I think we need to be careful of extrapoluating our own personal experiences to “what people want.” What percentage of people have health care insurance with no or little deductibles and co-pays? Further, polls suggest that people actually do care about their doctor


(subtitle: Reduced support for single-payer overcome by assurance that Americans would not lose their doctor and hospital)

From 2016/17:
Only Nine Percent of U.S. Consumers Believe Pharma and Biotechnology Put Patients over Profits; Only 16 Percent Believe Health Insurers Do

And from 2007 and the MI attorney general:

Profits over People The Drive to Privatize and Destroy the Social Mission of Blue Cross
and Blue Shield

3939

I do think men are much more forgiving regarding who their doctor is. I think pretty much every woman I have talked to has either looked for or is still looking for a doctor she would be comfortable with.

Now if it comes down to no doctor or some doctor you are assigned, then that doctor is by default better. Usually.

3940

Slightly tangential but I have to think that from a cost effectiveness perspective that some level of standardization and removal of choice is probably better for the system as a whole. The level to which the US system forces everyone to choose and schedule their own care piece meal has always felt a bit crazy to me.

Not only is it a huge burden to take on myself, the entire process strikes me as super time consuming and inefficient. I wish I can just sign up for the US equivalent of the Japanese “Human Dock” exams once every few years and call it good

3941

This is a terrible idea. Many of those tests should not be used on patients without very specific reasons.

3942

The way it usually works is that there’s a doctor who does a preliminary check and based on your age/health they decide the actual set of tests. They have the gear and experts on hand to do it over the course of a day or so. It’s standard operating procedure in Japan for folks over 40.

As for if this works - I mean, have you checked the avg. life expectancy there?

3943

Ok, and Americans also have primary care physicians who decide which screening exams are needed. So I’m not sure what makes Japan special, unless you mean scheduling all of them at once. Which as a patient I would hate, by the way.

Also, life expectancy is not the best way to judge national outcomes, given the differences in Japanese lifestyle, diet, etc.