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Comment by carsongross | Hacker News Reader

Few know this:

The United States currently spends more money per capita on socialized medicine than any other country except Norway:

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

In fact, the US spends more on socialized medicine than Japan, the UK and Finland spend in total, private and public spending.

The US healthcare system is totally out of control. Nothing will fix it until there is a collapse.

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My friend has dual U.S.-Swedish citizenship. It's crazy to think, but a few times now he's actually flown out to Sweden to have a medical procedure performed, because it's _cheaper_ to get an international round-trip ticket to Sweden then it would be to just have the procedure done in the U.S. (where he lives). And it's never been anything big; just outpatient type stuff.

The U.S. healthcare system _is_ totally out of control.

He should have just flown to Oklahoma instead: http://reason.com/blog/2017/01/27/what-happens-when-doctors-...

Wow, I'm surprised. So doctors/hospitals are extremely expensive in USA? What is spend monthly very roughly on health care in USA (if you're have one)? I'm originally from Germany and I always assumed we pay more for health care generally.

One aspect that makes care in the US cost more is our culture of being highly litigious. We seem to believe that if doctors make honest mistakes, it entitles the patient or their heirs to a large settlement. So doctors/hospitals need expensive malpractice insurance and that cost gets bundled in with the cost of care. To add to that, settlements encompass both medical costs and compensation for pain and suffering, which is usually a multiple of the medical costs. So the cost of lawsuits increases the cost of care which, in turn, increases the size of settlements which, in turn, increases the cost of malpractice insurance which increases the cost of care. It's a feedback loop.

It's not the only reason why our health care costs are spiraling out of control, but it is a reason that will naturally continue to increase over time unless we cap malpractice claims.

Allow me to play devil's advocate...

Medical negligence is the third leading cause of death in the United States. We have an epidemic of "honest mistakes" like scalpels left in patients after surgeries,[0] often leading to deaths, or amputations of the wrong limb[1] leading to enormous harms to the patient. Something as innocent as 'forgetting to wash your hands' has outsized consequences in this industry, forgiving 'honest mistakes' is not a safe standard.

It's also not generally true that plaintiffs in tort cases receive exorbitant damages, this is a popular myth because there are a few outlandish examples. The most popular examples, such as the "Stella awards," are completely made up.[1][2]

States that have capped medical malpractice have seen no difference in medical costs, and it has not been found to be a significant contribution to costs in the industry.[3] Meanwhile, capping costs hurts patients - some mistakes end up costing millions in additional medical costs throughout an injured patient's life, and most importantly for getting improved care over time, it lightens incentives for billion dollar hospitals to actually correct underlying procedures that make harms more likely.

[0] https://en.wikipedia.org/wiki/Retained_surgical_instruments

[1] http://www.hotcoffeethemovie.com/default.asp?pg=mcdonalds_ca...

[2] http://www.snopes.com/legal/lawsuits.asp

[3] http://www.decof.com/decof/wp-content/uploads/2015/12/five-m...

[4] More on handwashing as a challenge to health in hospitals: http://annals.org/aim/article/712481/compliance-handwashing-...

> We have an epidemic of "honest mistakes" like scalpels left in patients after surgeries,[0] often leading to deaths, or amputations of the wrong limb[1] leading to enormous harms to the patient.

I thought "wrong site surgery" was rare.

https://www.ecri.org/components/HRCAlerts/Pages/HRCAlerts111...

> Wrong-site, wrong-patient, and wrong-procedure surgery continues to be the sentinel event most frequently reported to the Joint Commission, with 1,196 such events reported through September 30, 2015, according to recently updated statistics provided by the accreditor. The next most frequently reported events include unintended retention of a foreign object (1,072), delays in treatment (1,035), suicide (932), and operative or postoperative complications (904).

That's way too many, but in 2009 there were 48 million inpatient surgical procedures carried out in the US.

https://stanfordhealthcare.org/medical-clinics/surgery-clini...

I don't think you can call 0.007% an "epidemic".

> I thought "wrong site surgery" was rare.

It is, but that wasn't the entire sentence, nor really representative of the total harm from medical errors.

These sorts of incidents are terrible and we should do everything to avoid them going forward. But, given their prevalence, it would seem that the medical industry hasn't done a particularly good job of dealing with them. The current system, which is more interested in assigning blame and providing restitution, is the free market approach that believes that capital incentives are the only ones needed and seem, to me, to be a failure. If you contrast the way that the medical industry handles incidents with the way that the aviation industry handles incidents, you'll see that pilot incidents are handled through a process that is much more interested in preventing future problems than it is in assigning blame. This leads to less defensiveness and more cooperation in finding processes and equipment that prevent future problems.

Also, if you want to make the case that malpractice settlements don't significantly contribute to the cost of health care, it's probably good to cite a source that isn't an association of trial lawyers. Among their failures in logic...arguing that insurance premiums are more tied to market performance than payouts completely disregards the fact that premiums wouldn't be necessary at all without the kind of payouts we currently have. There's an entire insurance industry making billions of dollars per year that is essentially unnecessary overhead that could be eliminated. And the trial lawyers themselves are making significant amounts of money off our broken health care system too.

These types of overhead can be eliminated in a single-payer system. Malpractice can be handled by panels of doctors who's sole goals are to push out habitually negligent doctors and reduce the incidence of mistakes for the vast majority who are quality doctors. And, since single-payer covers all future medical costs, there's no need to compensate patients for future costs that result from malpractice. Such a system completely eliminates all the inefficiency of dealing with medical incidents using the judicial system.

A young single person can get insurance for about $300 a month but it won't cover much until they have spent about $8000. This varies by state of course.

(the first couple simple doctor appointments would be $20 or something, there is some basic care built into the monthly payments)

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