Efficiency of Our Healthcare Systems | Hacker News Reader

Efficiency of Our Healthcare Systems

kyso.io

39 pointsKyleOS25 comments

I think the opioid crisis is more the problem than "inefficient healthcare"[1]

Inefficient healthcare sounds like it's just that ambulance transit times are too long or that there's too much paperwork. It doesn't bring to mind "pharma companies getting consumers addicted to opioids later triggering a massive addiction crisis that nobody is equipped or prepared to tackle"

[1] http://thenationshealth.aphapublications.org/content/49/1/1....

I think the opioid crisis and the structural inefficiencies of the healthcare system are 2 separate (but related) problems that both need solving.

They definitely are, but I'm replying to the idea that the drop in life expectancy is because of inefficiencies - the us system has always been pretty inefficient and nothing there has changed in a way that would trigger a decrease in expectancy as far as I know. This current decrease in life expectancy seems to be linked to the ongoing opiod crisis, not a sudden decrease in health delivery efficiency

The number of uninsured people has been climbing the past few years and the expense of healthcare has continued to grow in relation to inflation.

Those are two factors that drive down life expectancy

Life expectancy started to drop in 2015, right as the uninsured rate reached its all-time low. They numbers don’t correlate. It might track to the increased cost of coverage and care, but not the uninsured rate.

They're both symptoms of the true underlying problem, which is that the system is more about corporate profits than about making people healthy.

It is probably some mix of opioids, long term impacts of continual growth in the obesity rate, and the fact that a lot of people now have health insurance with $8,000+ deductibles. These are all fixable problems.

There are fundamental problems with the most popular and attempted solutions. Opioid deaths ballooned when high-dosage users had the prescriptions/sources pulled abruptly, overweight Americans have been deluged by misleading and conflicting advice for decades, and every political party's proposal for healthcare is to just spend more money on it (differing on where exactly the funds will come from.) We need new ideas, not re-attempts of the old and failed ones.

Honestly, I'm happier to see an article talking about efficiency problems rather than just how to pay for it. I'd much rather our efforts on healthcare reform revolve around fixing the problems than paying for them.

They're related. The way healthcare is paid causes inefficiencies. If you first need to check whether a patient is insured, and how they're insured, before you can start saving their life, that can cost valuable time and reduce life expectancy.

But there's no single problem hampering US healthcare, and therefore there's no single silver bullet that will fix it. Many healthcare systems have some problems, but US health care has a lot, and many of them need to be fixed in order to improve the situation.

But if I could point to a single underlying problem that causes many of the other problems, it's that the system is primarily designed to make profit, rather than to heal people.

“But there's no single problem hampering US healthcare, and therefore there's no single silver bullet that will fix it”

Exactly. In a lot of discussions someone will point out a problem and the response is “that’s not the real problem. The real problem is XYZ”. And the result is that nothing gets done. There are many problems in US healthcare that all need to be tackled independently. And most of them are around some people making a lot of money off these inefficiencies.

I think that depends on which "healthcare" you're discussing. If you're talking about emergency services, they administer services first and then talk about billing second. The doctors are removed from the billing process, for the most post (other than keeping a scan of what they use). They aren't thinking, "I'm going to use this more expensive surgical thread to get this poor drunk fool who crashed his car into a playground to pay more, because then the thread industry will pay me more!" While twirling his mustaches. Now when it comes to pharmaceuticals, there are the distributors who make the pricing out of control. Agreed. But the whole system isn't designed to make a profit, rather the supply chain is, and the equation of the two has been spread and the blame has been laid (often) as mistrust at the feet of doctors and nurses who are the face of the healthcare system to most people.

> They aren't thinking, "I'm going to use this more expensive surgical thread to get this poor drunk fool who crashed his car into a playground to pay more, because then the thread industry will pay me more!"

Actually, kickbacks are not exactly unheard of. Maybe not for thread, but certainly for some kinds of medication.

And yes, in some ways the system is most definitely designed to generate profit. Medicare, for example, is by law not allowed to negotiate for lower prices. Insurers have a reputation for trying not to pay out. Some hospitals don't want to tell you the price of treatment you need before you choose whether you want it. It's an extremely opaque and dysfunctional market, which makes it a great place to charge extortionate prices for treatments that are far cheaper in other countries.

Are you saying the people who manufacture/engineer drugs should work for free?

Looks like someone's allergic to commie talk, eh? Don't worry, that's not what they're saying. All of the countries in that article do pay for healthcare. It's just that the US pays an imperial shit-ton, and doesn't get all that much for it. So no, not for for free. And the people working in the sector should probably make more if anything. Just investors and CEOs might have to make less to make this system resemble anything like the meritocracy that people like to pretend it is.

How does Canada get it's insulin so cheap?

There's a lot of room between extortion and free. In other countries, drug manufacturers still make money without charging the extortionate prices you often see in the US.

> Many healthcare systems have some problems, but US health care has a lot, and many of them need to be fixed in order to improve the situation.

The US system has lots of problems, but reducing them by even 1 improves the situation. It may take fixing many to make the situation “good” by some standard, but not to merely improve it.

I think that's likely true. But interestingly it doesn't, theoretically, have to be. In principle the combination of a multiple factors, each of which would move us significantly away from the global maximum (therefore constituting "problems"), might put us at a local maximum where removing any small number of them might leave us worse off.

You're absolutely right. Even the Affordable Care Act, for all its faults, is saving real lives. It is a very real improvement over the situation before, but it's not the end point yet. More steps need to be taken. All at once or one at a time, whichever works.

In other words: you don’t solve big problems. You only replace them with smaller problems.

No matter what you do, you will make some group worse off. If you can ignore that, you can succeed. If you can’t, your change will fail.

https://www.medicalnewstoday.com/articles/282929.php

Our number one reason for dying is heart disease. This tracks pretty well with the obesity epidemic. Likely is one of the primary factors.

Drug epidemics, medical efficiency and others are much smaller factors.

We really need to sin tax food that hits our pleasure receptors. But mess with a persons favorite food and watch what happens. Doubt there is the will to move the needle in the right direction.

Americans on average engage in riskier and unhealthier behaviors than people in similarly developed countries. It is unfair to place the full blame on the medical system for lower life spans when they are not causing them.

The people with the highest life expectancy in the world are Asian-Americans living in NJ.

> Americans on average engage in riskier and unhealthier behaviors than people in similarly developed countries. It is unfair to place the full blame on the medical system for lower life spans when they are not causing them.

Do you have numbers for these claims? What risk taking behaviour is the entire US doing that other countries are not?

>The people with the highest life expectancy in the world are Asian-Americans living in NJ.

And does that group represent the socio-economic gamut? While you're correlating race, I wonder if it ends up being reducible to something like "upper-middle class individuals who don't smoke or drink".

Americans are far more obese than people in comparable countries. We also drive a lot more than our counterparts. (Driving is likely the riskiest activity you do every day)

That group represents about a million people but I don't have detailed enough information to claim that it is not skewed.

https://bigthink.com/strange-maps/two-maps-and-one-graph-com...

This is an interesting point. Do you have a source for the life expectancy numbers? I'm genuinely curious.

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