Comment by brittohalloran | Hacker News Reader

Comment by brittohalloran | Hacker News Reader

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As a 10 year engineer in the medical device industry I've slowly come to believe the root cause is not greed for more profit, but actually runaway altruism.

All across healthcare, providers, scientists, administrators are faced with millions of tiny choices every day: should we spend more money to improve outcomes. Should we add that extra feature to this device - costs more but improves care a little. Should we use this more expensive material - costs more but is probably safer. Should we do additional testing - costs more but we'll be more sure it's safe. The calculus of incremental value vs. cost is subconsciously seen as inhumane across the industry -- it's seen as starting down that slippery slope that ends with a "dollars per life" number which feels wrong to everyone. Nobody wants to be the person who traded someone's health for a buck.

I'm not necessarily condemning it, I want the best possible care for my children, but I do think that (like a lot of big socioeconomic problems) this comes back to incentives.

> The calculus of incremental value vs. cost is subconsciously seen as inhumane across the industry -- it's seen as starting down that slippery slope that ends with a "dollars per life" number which feels wrong to everyone. Nobody wants to be the person who traded someone's health for a buck.

That's not what's going on though, is it?

All across healthcare you have groups trying to provide an evidence base, and other groups trying to decide whether that evidence base means something is value for money or not. In England that's going to be NICE, in the US it's insurance companies.

The US has a serious problem of over-testing. The reason isn't because they think it improves outomes. They know it doesn't, they know it makes things worse. They over-test because it means they're less likely to get sued. The cost of the test is lower than the cost of getting sued, even though too much testing is causing harm.

Good outcomes don't have to be expensive. Europe spends half what we do per-capita on healthcare, with similar (and often better) overall outcomes.

Well that's kind of truism. Good food, good education, good car, good house and so on, none of them have to be expensive, but more often than not they are.

Where healthcare's concerned, that's simply not the case.

The US spends 2-3 times what the rest of the OECD countries spend on a per-capita basis. https://data.oecd.org/healthres/health-spending.htm

For all that spending, we have lower life expectancy and worse stats in a variety of outcomes. http://www.commonwealthfund.org/publications/press-releases/... http://www.latimes.com/nation/la-na-healthcare-comparison-20...

Not only does healthcare not have to be expensive, it isn't (comparatively speaking) in the rest of the developed world.

So by this reasoning, you're saying virtually every other country on Earth that spends less than half as much per capita as the U.S., has no such concept as medical bankruptcies, and covers a greater percentage of citizens must be LESS altruistic than America?

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