Comment by rdtsc | Hacker News Reader

Comment by rdtsc | Hacker News Reader

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> No rationing system can change this fundamental fact: some people will die because we don't have the resources to save them.

Don't agree. If access is free then a lot of preventative care can be done in order to not have to conduct expensive critical and emergency procedures.

People in this country don't go to the doctor because they may or may not end up owing sums of money ranging from $0 to many hundreds of thousands, depending on the combination of provider, doctor, insurance policy, state and federal laws. So people just stay away. Until they have a heart attack, or cancer is in the terminal stages then they are rushed to emergency and then guess what happens -- a very expensive procedure probably needs to be perfomed. So not very surprising that health care is expensive.

But let's take from another point of view. You say it is expensive. But how come Scandinavian and many European countries manage do provide it? Could it be that we just spend everything on defense (well...I personally called it offense but let's keep it official here) -- more than all the countries in the world combined? Do our doctors and medical supplies companies charge insane prices? I don't know the answer, but I know it has been done in other countries, and it is currently better than here. So it seems like it is possible.

But how come Scandinavian and many European countries manage do provide it?

The simple answer is we don't.

England has a body called NICE (National Institute for Health and Clinical Evidence) who assess each and every treatment. They're a body of experts who look at all the evidence on a particular treatment and work out how much it will cost and how much of an improvement it will bring to a persons life. It it doesn't reach a certain threshold - measured in cost per QUALYs (quality adjusted life years) - the government won't pay.

It comes in for criticism every so often (usually when it won't fund a new, very expensive cancer drug) but in the physicians (and government's) eyes it does a very good job for something so hard.

This. I was born in the UK, and I still have family there. They all have private insurance for this very reason.

Don't agree. If access is free then a lot of preventative care can be done in order to not have to conduct expensive critical and emergency procedures.

Preventative care also consumes resources. A doctor can only perform 8-10 hours worked / (duration of preventative procedure) preventative procedures per day. The number of doctors is limited. Thus, the number of preventative procedures is limited.

You might be right that the US is currently not at the optimum. Insurance companies try very hard to find a better optimum - they stand to gain millions if they can find it. But that doesn't change the fact that doctor hours are limited.

The OP didn't say that the US had a suboptimal system relative to some other. He merely criticized the fact that medical care is a scarce resource and we can't all have as much as we want.

But how come Scandinavian and many European countries manage do provide it?

Scandinavian and European countries provide unlimited medicine to whoever wants it? That's news to me. Do you have evidence for this?

Also, if Scandinavia and Europe have reached the singularity, and now live in a post-scarcity world, how come they are still poorer than the US? How is it possible that their singularity only works for medicine?

...it has been done in other countries, and it is currently better than here.

Do you have evidence for this? So far, in spite of asking this many times, I see very little that is convincing. All I see are life expectancy gaps comparable to the life expectancy gap between people who eat leafy green vegetables and those who don't, and studies from the WHO that give more weight to inequality of marginal costs than to actual medical care provided.

Preventative care also consumes resources. A doctor can only perform 8-10 hours worked / (duration of preventative procedure) preventative procedures per day. The number of doctors is limited. Thus, the number of preventative procedures is limited.

Maybe doctors shouldn't be doing preventative care. Surely you don't need a Ph.D in medicine to perform and interpret blood tests, monitor blood pressure, take some measurements, and conduct an interview. If there are serious symptoms or something that doesn't respond properly to changes in diet, exercise, or simple medication, escalate to a doctor.

Specially trained nurses could be filling these roles much more cheaply, freeing up doctors' time for activities that require their training and experience.

I agree. The only thing standing in the way is state licensing. The AMA lobbied for medical practitioner licensing in the earlier 1900s on the grounds that they would set high standards for future doctors. The end result was different:

"The licensing boards in each state soon began refusing licenses to health professionals who had not been trained at one of the 'approved' medical schools. Only half of the existing medical schools were approved, so most of the others had to close their doors by 1920. By 1932, almost half the medical school applicants had to be turned away. Those who apprenticed, went to unapproved schools, or developed their own therapies were stopped- at gunpoint, if necessary- from healing. As a result, the number of medical doctors per 100,000 people dropped from 157 in 1900 to 125 by 1929. Specialists, such as midwives, were usually forbidden to practice unless they had a full-fledged medical degree."

Source: http://www.ruwart.com/Healing/chap5.html

Scandinavian and European countries provide unlimited medicine to whoever wants it? That's news to me. Do you have evidence for this?

This is a straw man. Nobody is claiming that Scandinavian (or any countries) provide "unlimited" heathcare. Only that they distribute it more effectively to a larger proportion of the population.

From the post I was responding to:

> No rationing system can change this fundamental fact: some people will die because we don't have the resources to save them.

Don't agree. If access is free then a lot of preventative care...

If you want to argue that Scandinavia distributes health care more effectively, make that argument. The OP doesn't. It merely complains about scarcity.

Norway, Denmark and Sweden are all richer (per capita) than the U.S. (http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nomin...).

I should have been more careful with the term "rich". Most of those countries are a lot more expensive than the US, so the higher nominal GDP doesn't buy you anywhere near as much as it does in the US.

http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(PPP)_...

You are right about Norway, however. (Luxembourg is also substantially richer.)

> Scandinavian and European countries provide unlimited medicine to whoever wants it?

I didn't say that. I just pointed out that they have free public health care and to me it seems they are spending less and are a healthier country. Now yes, I don't have hard evidence for you but is just my general impression. The point was that it is possible in theory and in practice to provide it.

> how come they are still poorer than the US?

Disagree with that. Look at the income distribution across the population. Look at other social indicators not just GDP. What is the life expectancy, crime, general health, and happiness of the population.

> I see very little that is convincing.

Sorry. It is just my personal oponion and impressions. Take it for what it's worth (probably nothing for you). Maybe someone else has a pointer to some hard data...

The preventitive care thing, sounds a little soundbite-ish to me. Most people have health insurance that covers preventitive care. There may be some people that just prefer not to go to the doctor, but that's more of a cultural thing than a purely rational economic decision. People do preventitive maintenance on their cars, even though insurance doesn't cover it.

Bottom line, if we provided preventative care only up to a certain low ceiling. You'd call it good? Everyone else can die? Or does everyone need all encompassing care?

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