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Comment by DonnyV | Hacker News Reader

Worthless paper, administrative costs is only a piece of the many issues with US "Healthcare". Medicare For All is the better and cheaper way forward. No one ever talks about what is the value all these Health Insurance companies bring? The whole point of their existence when they were created was to control costs. Obviously they have failed miserably. Medicare For All handles lowering or eliminating student loans for Doctors and Nurses. It regulates costs for pharmaceuticals and medical equipment. By having the government be the insure. It relieves business on having to provide insurance and creates a much healthier workforce. It would also create an explosion of entrepreneurship. Now that insurance isn't tied to a job.

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> ...Medicare For All is the better and cheaper way forward.

I'm puzzled why the article prefaces one of its rationales with this:

'...“With Medicare for All seemingly off the table, our paper suggests we can still tackle administrative costs through structural changes to the payment process,” said Kevin Schulman, MD, MBA, ...'

Why is that Medicare for All is off the table?

Thats by design. Every major player is trying to make Medicare For All go away. They don't want to lose there golden egg. Insurance companies, Pharmaceutical companies, Pro Capitalists organizations, Medical device vendors, etc

> Why is that Medicare for All is off the table?

Perhaps because of this:

https://www.politifact.com/factchecks/2020/mar/10/facebook-p...

Or we could make it legal to open hospitals, or charge differential pricing based on the time of day... you know, basic stuff?

Most people have no idea how captured healthcare is. There's no competition, indeed most healthcare is government granted monopolies already.

Having lived in countries with "free" healthcare, that isn't all it's cracked up to be either. A good example of cost cutting: just make the disease illegal, like ADHD in the UK. If it doesn't exist, nobody can claim medication for it. Problem solved.

The rest of your post I agree with but

> just make the disease illegal, like ADHD in the UK

What in the world are you talking about?[1]

1. https://www.nhs.uk/conditions/attention-deficit-hyperactivit...

You need a psychiatric evaluation for diagnosis, which is exceptionally hard to get. So there's a nice shiny website and then there's the reality. Getting the diagnosis and then medication can literally take years, and it looks like this is on purpose.

The alternative take is that ADHD is over diagnosed in the United States.

So not actually "illegal", just a different bar for diagnosis. Also, do you not need a psychiatric evaluation in other countries?

You make some good points otherwise, I don't understand why you're resorting to hyperbole or distortion like this.

No, you don't. For adults it should be either a psychiatrist or a doctor with training and expertise; for children it should be a paediatrician.

https://www.nice.org.uk/guidance/ng87/chapter/Recommendation...

> 1.3.1 A diagnosis of ADHD should only be made by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in the diagnosis of ADHD, on the basis of:

Prescribing data is open. We can easily see plenty of ADHD meds being prescribed.

Lisdexamfetamine Dimesylate https://openprescribing.net/chemical/0404000U0/

Methylphenidate Hydrochloride https://openprescribing.net/chemical/0404000M0/

Atomoxetine Hydrochloride https://openprescribing.net/chemical/0404000S0/

There are problems with lots of NHS treatment. You don't need to spread misinformation.

Have you ever actually had someone on medicare navigate healthcare?

Its only partial coverage and the supplemental plans also are partial. Retirees regularly rake up thousands a year in medical expenses on medicare.

If anything we need medicaid for all. Its a total mess with the piecemeal systems that exist, but in PA at least (where I live) medicaid recipients pay like a dollar for basically any service. None of the copay nickle and diming (to the tune of $30 a pop) my grandmother is hounded with constantly.

And even that is a bitter pill. Its giving private insurance companies all the money and power still. The single payer has strong negotiating power but they still have to get someone to insure the citizenry and the cartel of insurers that exist can predate off that and do so eagerly.

Medicare For All is not just an extension of the existing Medicare. It expands it to everyone and fixes some of those holes. Medicaid would still be there for services outside MFA like senior long term care.

So it’s like “defund the police” where they don’t actually mean defund the police?

>It regulates costs for pharmaceuticals and medical equipment.

This is an underappreciated requirement if we want to significantly lower costs. Drug patents, medical device patents and illogical government regulations imposed by corrupt and incompetent regulators lead to massive costs for patients. Allowing drug to charge hundreds or thousands of dollars for a dose of a drug that costs .50 cents to manufacture is an atrocity. This is doubly true since a large portion of medical research that these patents rely on is done by publicly funded research at universities and research clinics. Patent laws need to be completely rewritten to allow for a decent return on investment while disallowing price gouging.

Free goods have infinite demand. Medicare for All will simply degrade outcomes a lower common denominator. Interestingly, will the government allow private medical practices to exist in a Medicare for All regime? If so, it seems we would simply end up where we are now.

With Medicare For All the government would act as an insurer, that is all. All hospital services stay private.

But it would be paid for by taxes spread across the tax-paying citizens. It would appear to all people in the US that their healthcare is free as they are not directly paying for it. Hence infinite demand.

That’s the worst argument I’ve ever heard against Medicare for All.

Rephrased in another way, you’re saying “the plebs are going to get medical treatment and overwhelm the system by doing so if we let them!”

I don’t think there is infinite demand for healthcare as people are not infinitely sick.

But they may be excessively worried that they are sick and demand excess testing and excessive stays in hospitals.

This isn't a free sandwich promotion that ends with irrational people waiting hours in line! People are not going to go hangout in doctors offices, hospitals, clinics, etc... for fun. Most people that have good insurance, like myself, almost never go to the doctor because it's a pain, not because of a co-pay.

And if by some chance there is a big increase the use of medical care / services ... maybe that's a good thing, that people are going and finding issues before they become severe life threatening issues and everyone saves more overall in the long run. And they have better quality of life and less suffering from going untreated... Did you consider that?

The introduction of high-deductible health care plans has accelerated consumerism (shopping for best deal) in health care delivery driving down costs.

Deloitte study: https://www2.deloitte.com/content/dam/Deloitte/tr/Documents/...

> Free goods have infinite demand.

I, too make unnecessary doctor appointments and hospital trips because my insurance covers them. I've developed a paraphilia for having blood drawn, and I'm considering having some perfectly functional limbs amputated.

Silly response.

One study found 20.6% of overall medical care was unnecessary. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587107/

Simple example is testing. If free to consumer, they will get too many cat scans and other expensive tests, "just in case."

Testing is “free” to the provider, so they suggest it just in case.

The much maligned HMO was an early attempt at applying market discipline to medical care. Guess what? People hated it.

> The much maligned HMO was an early attempt at applying market discipline to medical care. Guess what? People hated it.

HMOs remain common, and none of the satsifaction data I can find shows satisfaction with them significantly lower than PPOs or traditional insurance. Not sure why you act like they are something that exist only in the past or universally hated.

>The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%).

so not relevant to this coversation.

LOL...love it

There are two issues in healthcare. Efficiency and and access.

Medicare for all solves the access problem, but it doesn't do anything for the efficiency problem.

Do you know why efficiency is such a problem? Its because people put off going to the doctor because THEY CAN'T AFFORD IT!. Thats why vists sky rocket when people become eligible for Medicare. https://www.uclahealth.org/u-magazine/u-s-ranks-near-bottom-...

Your link doesn't have any analysis on how preventive care is the cause of increased costs.

But there are lots of ways that are obviously not related to preventative care that drive up costs.

Our doctors and nurses make way more money than doctors and nurses in other countries.

We spend more money on questionable, or low yield procedures that have low returns that other countries don't.

Not to mention medicine just isn't that good at preventative care. The only real preventative medicine are diabetes medications and cardiovascular medications.

> Worthless paper, administrative costs is only a piece of the many issues with US "Healthcare". Medicare For All is the better and cheaper way forward.

As frustrating and arcane as the current system may be, the government fully in charge for the provisioning (rationing) and financing will only increase 'worthless paper, administrative costs'.

This is clearly not the case with Medicare. The only guaranteed savings with M4A is in administrative costs.

edit: even the researchers in the linked article doesn't claim to reduce administrative overhead as much as M4A, they claim to be able to get most of the way there.

It's really simple to lower administrative costs, just spend more money and don't look for fraud.

Citation needed

The government would act as an insurer, that is all. All hospital services stay private. And having all medical services have to go through one system to get paid would streamline it SIGNIFICATLY.

If they are the only payer, they control the prices. And when prices are controlled, shortages are the result.

Right now the buy controls the prices. There is no real negotiation. Think that's better?

Doesn't hold water, USA actually has less doctors per capita than most of the developed world.

Like the IRS has streamlined taxes and the US postal service has streamlined mail delivery?

That’s interesting, because your latter example is pretty excellent. USPS can deliver to anyone in the country (unlike the private companies) and I’d say it’s pretty streamlined. The IRS is definitely in a bad position, but there are two problems: firstly, they’re only enforcing the tax code written by Congress. They can’t just streamline the tax code. Secondly, there are private companies lobbying to prevent the IRS from being as good as it could be. And that will obviously be the same with health care.

As a country, we’ve decided it’s in everyone’s best interest to be able to get mail. Private enterprises cannot solve global access problems because they have no incentive to go the extra mile for the last few people the system can’t reach. (Which is why internet is so shitty in rural parts of the country.)

So why not health care as well? To me, it seems like the problem are solvable.

We clearly differ on the USPS. FedEx, UPS, DHL, etc clearly provide superior service for overnight and courier service. Rural service could be solved - it simply has a cost. To your point, "as a country we've decided that it's in everyone's best interest to be able to go get mail." We have also decided to subsidize the cost of the service with metropolitan customers subsidizing the rural (similar to phone service). If the US used taxes to pay a FedEx, there would be better quality service at a lower cost.

Having the government provide the service introduces politics to the operation of running a business. Where should post offices be located, how often should mail be delivered, what products should we offer, should prices vary according to cost to delivery, etc. These issues make the USPS what it is today - a bureaucratic behemoth that is still delivering Christmas cards from 2020.

Of course the problems are solvable if you have desirable incentives. But as Pournelles Iron Law of Bureaucracy points out that the incentives to solve the problem are ALWAYS eventually replaced to preserve and grow the bureaucracy. And that’s why a universal, government solution is doomed to fail.

Funny you mention bad rural Internet considering that’s a problem technology and competition is about to solve.

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