Hacker News Reader

Comment by thmsths | Hacker News Reader

I am not surprised. Healthcare costs have been rising faster than inflation for several years. It's a difficult sell to increase budgets, so we have to resort to these "invisible" cost cutting measures to try and stay afloat.

View on HN

> rising faster than inflation for several years

Over here in Canada healthcare spending has been rising faster than general inflation more or less continuously since the 1960s. Seems to be generally true of many wealthy countries. More tech and therapies. And an ageing population. And probably other factors.

https://commons.m.wikimedia.org/wiki/File:Health_care_cost_r...

Salaries probably pay factor as well? Check the sunshine list, plenty of radiologists making 600k/year. That's literally 10x of the median salary.

That does not explain everything. While you could make a reasonable case that doctors are overpaid in the US, the same budgetary crisis is happening all over Europe where salaries are much lower.

The crisis in France is clearly not on the same level that is in Quebec. It's not the only factor, but a serious one. As a continuation of it we have a heavily caped number of doctors what can be 'minted' every year. Same caps exist in the USA states.

This also happens in Italy, there's a maximum number of people who can get into med school. However, even though some complain of being overworked, some others complain that increasing that maximum number will lead to unemployment. So apparently medical professionals can either be overworked or unemployed, there is no in between..

Perhaps in the US, but nobody is getting paid that in most public European systems. A quick google suggests that the absolute highest pay band for a doctor in the UK is ~£142k (~$190k USD). And there won't be many making that.

See: https://www.worktheworld.co.uk/blog/highest-paying-medical-j...

Sure but at least radiologists do something. What do hospital administrators do? Like a university a hospital has bureaucracy that grows.

This cherrypicks a high billing specialty, doesn't appreciate an overhead of 25-40% for most physicians, and also overestimates the proportion of physician salaries in healthcare budgets (~15%). You could literally pay physicians half and not save that much.

Also is that too high? I know a guy in his early 40s still finishing his 2nd radiology fellowship (4 years undergrad, 4 years med school, 5 years radiology, 1-2 years each fellowship = cost of his 20s/30s) to get a job...

I find HN comments on healthcare compensation when it comes up funny because on the other hand compensation expectations in the tech gold mine here are justified. E.g. I take home less in CDN dollars than an L3 SE at google without benefits. I'm happy with what I do/get but there is a mismatch in rationalizing high compensation, markedly more years of university and training, and from my point providing a societal benefit.

Another factor is Baumol's cost disease. While some aspects of healthcare have been automated, much of it still comes down to individual clinicians performing procedures on patients.

https://a16z.com/solving-baumols-cost-disease-in-healthcare/

Yeah hospital accounting is weird. I had family in the ER and one of their crappy meals was like $60, for basically just rice and canned vegetables on a tray. A single bandaid cost like $25 or something outrageous like that. This was pre-covid too. I'm sure that same meal is getting close to $100 by now.

It's not just costs.

It is patient (and relatives) expectations.

It is knowing that any perceived issue could result in litigation.

It is that management may well have never 'worked the floor' so have no insight in to what happens.

There may well just not be the time to do all the tasks that someone else had decided needed to be done.

> It's not just costs.

It is profits. When someone is sick, or dying, we really need to make a huge profit, before it is too late. Porsches, Lamborghinis, Malibu houses cost money. You can't just sit there and let others do it, instead of you.

This will continue to happen as long as automation in health care is slower than in other sectors. It's due to Baumol's Cost Disease: https://en.m.wikipedia.org/wiki/Baumol_effect

The same is true for other sectors that struggle with automation like education.

So after every industry is fully automated and everyone has lost all their jobs, do we all just hold hands and walk into the sea together or...?

The way I see it, you have three choices, the government, corporations, or billionaires. It's an oversimplification of power in this world today, but those are your choices. Which one of those do you pick to clothe and feed and house you, after the singularity happens?

Another potential alternative is healthy capitalism, where a large number healthcare providers are in competition with each other to provide the best service at the lowest cost. In this model a hospital, for example, would be forbidden to buy another hospital down the road, in the same way a doctor’s office would be forbidden to buy a second doctor’s office, because both cases reduce competition.

That would be government. Markets don't regulate themselves and monopoly is the natural equilibrium state of capitalism.

No, it would be a mixed economy, where private individuals and businesses provide most of the goods and services, and the government plays a significant role in regulating the market.

Monopolized markets are almost always evidence of regulatory failure.

"Healthy capitalism" isn’t an option distinct from government intervention. Healthy capitalism it is government-regulated capitalism. Any system where competition is protected depends on active, ongoing government enforcement of the rules. Without that, markets naturally tend toward monopoly or oligopoly.

Advocating for "healthy capitalism," is advocating for a system where government sets boundaries and steps in to preserve competition. That places it firmly within the spectrum of government-regulated options, not outside or apart from them.

It's tempting to imagine ideal or the worst versions of each option and then claim, "what I want is none of these." Instead, we should look at whether our preferred scenario is actually possible within the real-world range of choices. In this case, "healthy capitalism" is only possible when government is both the referee and the enforcer, so it's a version of the government option, not a separate path.

Government. 100%. It has issues certainly as every organization created by humans does, but corporations already run almost everything and that's why most everything is on fire. And billionaires are just the dumbasses in charge of the aforementioned corporations.

Those are all the same choice

Not sure why we would walk into the sea because work doesn't need doing anymore. If you are worried about needing work to put food on the table, I think our best solution is to start with a small UBI that we try to increase as automation increases.

We ? No. I walk in the sea, you go back to work. /s

Which part of a nurses shifts would you automate?

I don't know, I'm merely stating what comes down to an economic law. I'm not an expert on healthcare.

However, as it happens I just spent the last weekend accompanying my wife as she was in a hospital. There was actually quite a bit that happened, especially once or l out of the ER and admitted, that I would have felt totally fine if a robot had done it. Half of what the nurses did were things like bringing puke bags, picking up a full puke bags, bringing water, paging the doctor again who wouldn't show up for another 4 hours, explaining how to order food.

It's the baby boom. If level of care stays the same then at some point one third of the labour force is projected to have to work in healthcare, it's not possible.

It IS possible,

just unlikely the industry will be able to command more interest than the sugar-mill → grave pathway that's been established.

Most prices increase faster than inflation, interestingly enough.

> so we have to resort to these "invisible" cost cutting measures to try and stay afloat.

Yeah, this is the narative. In reality we only need increased profits.

In CA, USA. We got a 20% hike in healthcare prices for the renewal we just got this month. 20% is insane.

To anyone here open minded enough to give it a shot, I encourage you to read The Real Anthony Fauci, or at least the first chapter. To people who feel resistance: what is the worst that can happen? If you after reading disagree then your brain will soon forget about it anyway so nothing is lost.

Healthcare costs have risen faster than inflation since the 1960s, when the government got involved with providing "free" healthcare.

Before then, costs tracked inflation.

Health care costs that are not provided "free" by the government have fallen, such as lasik eye surgery.

You seem to have the causality backwards. Prior to the 1960s, the healthcare system couldn't really do much. Most of the drugs, devices, and procedures were relatively cheap. After that the capabilities increased tremendously as did costs, and then government had to get involved to control costs and ensure patient access. (Although many of those government interventions ultimately had the opposite effect.)

Why did Lasik machines decrease in cost, while increasing in efficacy?

Drugs were far cheaper before the 1962 FDA Amendments, after that was a massive increase in costs. See "Regulation of Pharmaceutical Innovation" by Sam Peltzman.

https://www.amazon.com/Regulation-Pharmaceutical-Innovation-...