Hacker News Reader

Comment by rayiner | Hacker News Reader

I’m a supporter of universal healthcare but that trope about preventative care reducing cost isn’t true: https://www.nytimes.com/2018/01/29/upshot/preventive-health-...

View on HN

At a societal level, it isn't that ridiculous to look at worse outcomes as a cost.

Like only counting dollars is a bad way to run a society.

> Like only counting dollars is a bad way to run a society.

Absolutely. But one measure everyone understands is money, and you can convert a lot of situations into money. Poor health = missed work, missed rent payments, drugs needed etc. It’s not a nice measure, but it works.

I think one of the points of this entire thread has been to make it clear that "it works" only applies to people who have money, which means of course that it doesn't work.

I live in New Zealand, and we have a healthcare system that’s free to use (YMMV). It’s creaking, but the situation in the US really doesn’t seem to suit anyone, nor even the rich.

New Zealand is incredibly beautiful, I just wish I could go back. The US healthcare system suits the rich quite well. The companies that the rich people work for tend to offer significantly better plans that cover a lot of what you hear a bunch of people complain about. High earners and C-suite execs typically get offered a different plan then the rest of the proletariat do. They can cover the out of pocket costs just fine, and cover the elective procedures themselves. They generally have access to better doctors as well just based on location, flexibility with working hours, plans that will pay for them, and/or it being easier to handle the out of pocket costs.

Universal healthcare actually means a downgrade in the experience for these people, which is one of the reasons why they don't want it. Yea, they might want to make sure that people don't get sent to the poor house just because they came down with some random disease, but god forbid they have to wait their turn behind some plebe in the doctors office.

> Universal healthcare actually means a downgrade in the experience for these people

But it also means a much higher cost. I know these people are wealthy, but they are getting fleeced. Many (all?) socialised systems also have a private system along side, so the wealthy can avoid the great unwashed.

It is because it’s not a cost of the policy, it’s a benefit. You can reframe any benefit of a policy as the “cost” of not doing the policy. In practice it’s just a right-brain advocacy-speak way to double count the benefit in the equation: “people will be healthier, and it will reduce costs.” That’s not a good way for intelligent people to communicate.

I dunno, it sounds to me a little bit like the concept of "opportunity costs"?

It is like saying you will have the savings of being healthy plus avoid the costs of being sick.

How would you show that on your balance sheet?

That's a real thing, but counting the benefits and the opportunity cost of not doing it is still double counting

That's as may be, but you can't just change the common definitions of terms to win the argument.

I suppose if I had written a longer comment I might have gone on about how lots of times advocates choose bad positions (so like here, the trope is trying to argue that preventative care reduces medical costs when there's a better position arguing that the benefits of preventative care outweigh the costs).

It's not really very interesting to discuss the bad position at any length, except maybe as a launching point into some more interesting adjacent discussion.

so like here, the trope is trying to argue that preventative care reduces medical costs

That wasn't the point I was trying to make. Everyone arguing against me is trying to claim that and then say it's a dumb position.

Try arguing with my actual point in the future.

I'll grant you I could have stated it more clearly. My bad. I also clarified, yet this assertion lives on.

Whatever.

If you watch what you eat, avoid obesity and some of the practices that lead to heart disease, and if you can moderately exercise you can avoid expensive health procedures. I don't even think that's debatable...

None of what you just described is preventative care from a doctor. Everyone knows about exercise and junk food that doesn’t mean someone will chose to do or not to do those things.

This is simply not true, to a significant degree, as people age into and past middle age. (And even that is ignoring that accidents happen to healthy people of all ages. Eating well and exercising don't eliminate the need for expensive medical care after being in a serious car accident.)

I don't think the point is that eliminates every single cost, but offset some very major costs. Hope you see and obesity derived illness are real.

Insurance companies sure do seem to push preventive care a lot these days, which would be bizarre if they didn't think it would reduce their costs.

Insurance companies (in the US) prefer rising costs, because they get a flat 8% (or whatever) of what costs are. If they reduce consumer costs, they also have to reduce their revenue and profit.

I'm not convinced that the way insurance works in the US explains rising costs here, because costs in most of the rest of the first world such as the EU and Japan have been rising about as fast as costs in the US for at least at least the last 50ish years.

We pay a lot more per capita than any of those other places, but the ratio of what we pay per capita to what a given other first world country pays per capita has been pretty steady long term.

The article ends with ‘good things cost money’, which is a pretty good summary.

See: Canada

I have no idea what's happening in Canada. What do you mean?

Reply on news.ycombinator.com