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Comment by observationist | Hacker News Reader

Imagine if we let doctors do medicine instead of letting profiteering beancounters optimize for number go up.

I can see why some things landed here. Medicine is expensive. Desperate people are more susceptible to fraud. Yet things are improving: someone like me would be long dead a generation ago.

We should look at these challenges holistically and think about better fiscal/social engineering of our marketplaces. Alvin Roth's book, "Who Gets What and Why", is a good introduction to identifying market failures and thinking about how to address them.

> Medicine is expensive.

The whole point is that, past a certain point, it really isn't.

Step therapy is required in countries with universal healthcare, too.

It can actually be harder to get access to new therapies in countries with universal healthcare because they’re more uniform and strict in what they allow.

For a relatable example: The UK just raised the age of eligibility for COVID vaccines all the way up to 75 years old: https://www.mirror.co.uk/news/health/covid-russian-roulette-... Contrast this with the US where COVID vaccine coverage is a basic expectation of health insurance for all ages. And that’s for a simple, cheap medicine without step therapy! It doesn’t matter if your doctor thinks you need it, the rules are set from the top.

> Step therapy is required in countries with universal healthcare, too.

This is something Americans with strong opinions about healthcare but little time spent researching it never seem to know.

It can be harder, but it's specific to the country/system. Here it Taiwan you can walk into any clinic with stock and get a (NHI covered) vaccine any time.

There are other things to complain about of course, but the rules for what's covered ate generally logical. Non-covered medication is affordable to, which helps.

To be honest, given the issues with the NHS, the UK isn't the best example to use for a "universal healthcare" system these days.

Worth noting that "eligibility for COVID vaccines" is for "free at the point of delivery" NHS treatment - you can still get it elsewhere at any age. Boots (a major chain of pharmacies) do it for £98:

https://www.boots.com/online/pharmacy-services/covid-19-vacc...

Sorry but this not actually true.

THe most appropriate treatment is required, not "step therapy". For antibiotics this makes sense, as last mile, powerful antibiotics need to be used sparingly.

The same with cancer, it'll be treated according to the requirements of the cancer, with guidance from nice about the most effective therapy.

Is it perfect? no.

Does it lead to mistakes? yes.

It is better than american style insurance denying care based entirely on price? 100%

> the US where COVID vaccine coverage is a basic expectation of health insurance for all ages

That wasn't a sure thing this past year and there's always a risk it won't be next year. (https://www.pbs.org/newshour/health/fact-checking-rfk-jr-s-c...)

We do. They just can’t charge it to a third party to the relationship. As a doctor you are welcome to provide services at cost.

We do let them do that if you are willing to pay them for it. The fact is that if you "let doctors do medicine" without any cost benefit analysis, then you really aren't going to like the cost.

You mean we do let them do that unless you aren't able to pay them for it. If you're the minority that has very large sums of money your doctors can decide what treatment works best, but for everyone else their healthcare is dictated by some company whose only concern is increasing the amount of profit they rake in and they'd happily see you dead if it would improve their bottom line.

Your comment contains nothing of value. If you have a better way to allocate scarce resources please state it.

In the US the allocation process itself is very expensive. Something like a third of the cost goes towards paying the administrative costs of navigating the byzantine insurance rules.

These resources are only scarce because of artificial scarcity.

This is especially true of patent medicines, where it's government enforced artificial scarcity.

If not for the government enforced artificial scarcity then many of those medicines wouldn't exist in the first place. Bringing a new drug to market costs >$1B now, largely due to clinical trials. No one is going to do that without patent protection.

Medical patents should come with compulsory licensing requirements. Nobody's saying that research houses shouldn't get paid, just that the monopoly needs to end.

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