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Comment by imbokodo | Hacker News Reader

Congress repealed the creation of the Independent Payment Advisory Board, that would cut the cost of Medicare without cutting service much. Thus Medicare costs are higher, thus spending exceeds income. Reinstate this board, as well as some other measures, and it will be back on target.

It is a manufactured problem. Anything benefiting the taxpayer like Social Security or schools is always being cut, while the funds to move the US embassy to Jerusalem or send the Navy to the South China Sea seems to be bottomless.

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>Congress repealed the creation of the Independent Payment Advisory Board, that would cut the cost of Medicare without cutting service much.

Medicare services are already being rationed covertly via wait lists and via the increasing numbers of physicians who refuse to take Medicare or Medicaid.

The IPAB would most likely decrease access to services by cutting payments even further below market rates which would decrease supply of those services.

Market rates are inflated due to lack of price controls in programs like Medicare and Medicaid, plus employer-sponsored insurance plans are not as incentivized to negotiate for lower prices as individual consumers are.

Couple that with the supply side problems where doctors need 7+ years of training before they can perform simple procedures like testing for strep throat or prescribing antibiotics, and the fact that a large fraction of medical spending does very little to prolong life or improve quality of life and you can see that the current health care system is incredibly wasteful.

Medicare and Medicaid are the definition of price controls for paying physicians: they pay below market rate such that private insurance is billed higher to offset. There are week price controls for medical equipment and pharmaceuticals and the failure to address overuse of unnecessary equipment costs way more than the savings from price controls.

Testing for strep and prescribing antibiotics represent the smallest fraction of healthcare resources. Why didn't you include brain or spine surgery on your list of things that shouldn't require 7 years of training? Expensive end of life care isn't the fault of hospitals or clinicians: it's the fault of families who can't say no to excessive and futile end of life care.

If you want to get into getting rid of "wasteful" spending, why aren't you recommending everyone should smoke a pack of cigarettes per day? Most people would work and live a productive life until they die of lung cancer at age 65? Saves 15-25 years of unnecessary "end of life" care.

Sorry, you are right about price controls. I think it's still a problem that they incentivize unnecessary care.

I don't think we're actually that far apart on what we think the problems are. I wasn't trying to say that requiring large amounts of school in order to test for strep and antibiotics are the only cause of our high costs of healthcare, but they obviously contribute.

I agree (and I think any thinking person would agree) that you should have training to perform more specialized procedures.

Expensive end of life care is partly the fault of clinicians who get paid to authorize expensive procedures and who don't want to tell their patients and their families that there is very little they can do to prolong their life, so they should just surround themselves with loved ones and prepare to die.

And we can both agree that there is wasteful spending without arguing that people should kill themselves sooner. Just looking at our healthcare expenses relative to other countries shows we pay somewhere between 1.5-2x more for roughly the same level of care. That's obviously a market failure.

>and via the decreasing numbers of physicians who refuse to take Medicare or Medicaid.

do you mean "increasing number of physicians"?

Yes, you're right, I wrote it incorrectly.

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