This is IMO the "simple solution" to healthcare -
nothing will bring down healthcare costs faster than the following
- be allowed to choose
- know how much something costs
- pay some of the cost themselves (co-pay, health savings account) etc.
- be allowed to choose
- know how much something costs
- pay some of the cost themselves (co-pay, health savings account) etc.
- Allow competition. Don't give hospitals the power to veto new hospitals in their area.
- Disallow regional consolidation of hospital systems and medical practices. Regional monopolies are bad.
- Increase resident slots and supply of doctors. Make foreign degrees easier to transfer to the US.
- Outright ban pharmaceutical advertising. Nothing whatsoever of importance would be lost and all the pharma companies would save millions every year.
Doctors have the knowledge and expertise to critically evaluate statements presented to them by marketing materials (whether they do so or not is a different story). The general public, modulo the odd autodidactic genius, largely does not. If someone from the general public wants this information, they are free to find it on the Internet. In fact maybe we could make it mandatory that any materials presented to doctors are also posted on the company's website for anyone to see.
https://apnews.com/82f638d6dfcf4193ad28ddf0e65897e1
https://www.washingtonpost.com/business/2019/01/30/stripper-...
Here, most hospitals are run either by cities or counties, or by the public insurance companies themselves.
This ensures that hospitals have an incentive to be efficient.
There are private hospitals, but only very few people go there, since they are very expensive, and you get good care in the public hospitals.
I agree the "general" care like broken bones etc its probably all the same, but healthcare innovation is done in the U.S. So it is kind of moot to say "its good here"... yes after the innovation trickles its way over to your country.
Lastly, one of my best friends is studying to become a doctor, in fact is a resident now. He is getting paid the princely salary of $55k after 15 years of studying and he has many years to go before he's able to really realize any gains.
To make the profession a civil servant's position is insanity.
> but healthcare innovation is done in the U.S
These are assertions without much evidence. Don't forget that the US does well on relatively meaningless measures (5 year survival rates for cancer) but poorly on all cause mortality. Why do US citizens die younger than people of other countries if the US healthcare system is so innovative?
Lifespan/mortality In the US includes things like drug overdoses and suicides, of which many countries don’t count towards or keep bad record of.
Also cancer survival rate for the US is mostly the best in the world [0].
I’m here for more easy volleys if you want to keep this going
https://www.cdc.gov/cancer/dcpc/research/articles/concord-2....
I've only heard of people travel to get dental work done cheaper (not to the US).
The only complaint I've heard is that some procedures (eg. joint replacements) have a waiting list, so if a doctor decides that you don't need it urgently, you may have to wait a few months. I don't know what the situation for these procedures is like in the US.
Just because it's publicly funded doesn't mean it's bad quality. It just means there's no incentive to charge ridiculous amounts for procedures.
Also, Doctors still earn a decent salary here. Maybe not comparable to US salaries in absolute numbers, but it's enough to live a very comfortable life, and they don't have any students loans to pay back...
Second, I believe Austria has great care and smart surgeons etc. But again there’s a vast difference between “good” and “outstanding/ first in class”. I’m not cheerleading the current US system, I think it’s terrible that it’s a monstrosity that leans more socialist than free market and everyone gets the worst of both worlds.
But seriously, let’s not argue where most medical innovation and drug breakthroughs come from. Before everyone goes into a rage, I’m not saying all innovation, but most. Kinda like there are tech hubs around the world but right now the center of gravitas is mostly SF.
What do you want to do? There are only so many operating theaters, and only so many surgical teams, and demand is greater. So you have two options:
- offer the procedure to whoever pays the most / has the best insurance / has good connections
- prioritise patients based on how urgently they need the procedure
I prefer the latter -- grandma had to wait a few months, but she got her new knee joint. She gets the same medical treatment as the president. You could pay extra to get a nicer room in the hospital, but you can't pay to get better medical care (At least in theory -- we have some amount of corruption just like everywhere else)
Of course, it would be even nicer if nobody had to wait! I don't know what the situation in the US is like. Do hospitals in the US not need to "ration" certain procedures? Do they have enough capacity to treat everyone who needs a joint replacement without any waiting time?
I've read that a lot of people in the US don't have good health insurance and can't afford the care they need. To me that sounds like rationing care based on who has the most money.
Your other point, that most medical innovation originates from the US, sounds implausible to me. People from the US only hear about US achievements, so they think nobody else achieves anything.
For example, take the wikipedia article on fetal surgery: It lists 3 hospitals in the US that perform fetal surgery, and 1 in Canada. So clearly the US is the world leader in fetal surgery!
But then you look at the German wikipedia page, we see a list of 5 hospitals in Germany and 2 in the US. Obviously Germany is the world leader in fetal surgery!
(Neither article bothers mentioning Austrian hospitals that perform fetal surgery)
But what if you don't want to be bankrupt afterwards?
Their savings would never be passed on to the customer. And it's hard to believe there would be any savings overall, because the advertising must be bringing in more money than it costs or they wouldn't be doing it.
1. Taking market share away from a competitors. Profitable for that product, zero-sum for the industry. Competitors respond by increasing their ad spend, equilibrium returns (unless one drug is genuinely superior to another)
2. Increasing demand for unnecessary medicines. Profitable for the market, bad for society.
Advertising is an arms race. Even if I don't want to advertise, I have to because my competitors do. If it's banned, everyone saves the expense of advertising.
Unless pharma companies are engaging in cartel-like price-fixing some of that money will definitely go to lower prices (some will also go to R&D, dividends/buybacks, and exec pay). It only takes one company to do it and the rest have to follow.
First, There are underdiagnosed diseases for which patients don't seek care, sometimes because they do not believe there to be a treatment. The lack of treatment means that it isn't as vital for physicians or patients to pursue diagnosis. Those patients might see an ad and return to a physician to ask if that treatment is a fit.
Second, not all physicians are as on top of new treatment options as we expect. It might have slipped their notice or be in a field with which they aren't the most familiar, and those patients might benefit from revisiting whether a new treatment is a good fit.
I don't really think these two cases make up for all of the advertising, but they might be missed if advertising is cut or abolished.
It might have some fairly large drawbacks, but I think it would be good for pharma and biotech companies to put some amount of money into a fund based on the disease and have awareness campaigns around the diseases. For example, companies with diabetes treatments could form a group that puts out diabetes ads urging patients to talk to their physicians. It gets dicey for first-in-market treatments, but I think it would be an overall improvement from the current system.
Disclaimer: I work in big pharma biology research; pricing and advertising are done in a fancier building with more marble floors, so I've thought about this a bit, but it isn't my department.
I thought this was called pharma marketing. I don't think this should be abolished - I only meant direct-to-consumer advertising. Although I've seen someone else argue that doctors should be required to undergo continuing education instead.
I'd like to see numbers on how often an ad is how the patient learns they have a disease. I imagine that anyone with really annoying or debilitating symptoms would research them online from time to time.
With regard to patients searching their symptoms regularly, it is my understanding from the physicians and clinical trial folks that you would be in the incredibly small minority, but it's a good idea.
Informing patients that an option is available to treat a particular condition, who might otherwise not go to a doctor.
This would also be a positive for both the market and for patients.
America has a problem with over-testing, over-diagnosis, and over-treatment. It seems that merely giving people a choice, telling them the cost, and getting them to pay a contribution isn't enough to prevent this.
Let's say it's 1990, and I'm in the market for a car. A Yugo costs a lot less than some other cars. But I'm getting a lot less for it, too - it's less reliable, won't last as long, and is less comfortable. But, as a car buyer, I can kind of tell that. It doesn't feel like it's as solid a car as some of the other options.
Now say I'm trying to have a hip replacement. Here's a place that costs 20% less than the other place. Sounds great, but... what are their rates of complications. How about if you go out 20 years? Without that kind of information, I can't compare on price, because I don't know whether I'm buying equivalent things.
- cost discovery will be inefficient and time-consuming, which is why single-payer with standard costs is so much more efficient
- who doesn't have copays and out of pocket in the US?