Hacker News Reader

Comment by loeg | Hacker News Reader

Americans just consume a lot of healthcare services. Any substantial cost savings requires providing less healthcare service.

View on HN

That's not necessarily true; fewer limitations on who is allowed to provide health service and manufacture medicine and health technologies would also drop prices. Competition in healthcare is very, very difficult because it's often illegal to compete.

You're actually talking about the same problem. Competition in healthcare is heavily restricted by stuff like certificates of need because there is little cost-sharing with utilizers so you get overutilization & induced demand. This is Roemer's law [0]. A large part of the reason for competition restrictions is because of a hacky attempt to control overutilization without direct cost-sharing.

0: https://en.wikipedia.org/wiki/Roemer%27s_law

In some cases they are provided healthcare services without a choice, so they're not really "consuming" those services. E.g. tests that don't change outcome but do cover a provider from a legal risk.

Something like 20% of healthcare services are "low value care" which aren't justified by evidence-based medicine criteria and may even harm the patient. Regardless of the financing system we could free up a lot of capacity and slash costs by eliminating that low value care. Of course in practice it's difficult to do that at scale.

https://www.bloomsbury.com/us/price-we-pay-9781635575910/

Citation needed (per capita please).

Given that people constantly, literally AVOID care because they can’t pay for it until it’s such an absurd problem that it’s very, very expensive, I struggle to believe this, at all.

And money amount doesn’t matter in this evidence because, again, Americans regularly avoid care until it’s catastrophic because they literally can’t afford it and/or have to wait for insurance to meet a certain harm level threshold where it literally can no longer be argued (emergency care)

I think a citation is needed for "Americans regularly avoid care ... because they can’t afford it."

I think there are other reasons, e.g. they don't like doctors, or it's too inconvenient, or waiting times are too long. I have good insurance and haven't seen a doctor in probably 20 years.

I know people who are visiting the doctor for every sore throat, ache and pain or sneeze and sniffle, and that's not me at all.

Here you go, a recent survey: https://www.jgwentworth.com/resources/medical-emergency

> The survey showed that over nine in ten (92%) of insured respondents had delayed or avoided medical care because of concern about cost.

> In fact, 95% of those surveyed said a medical emergency would likely put them into serious debt even with insurance.

An unexpected car replacement would put most people into serious debt. And there's no insurance for that.

People get so hung up on the idea that they should have to pay for health care, when you have to pay for every other necessity in life.

So you didn’t want a citation after all. Alas.

Why are you moving the goal posts? You asked for a citation and were given one and now you just change to a different argument.

We want consumers to consider cost when evaluating what services to buy, though. That's a feature.

The medical emergency debt statistic is just the usual thing of people not really understanding how medical insurance works.

When I’m having a heart attack, or when I’m in anaphylactic shock - you know, some of the most expensive procedures that happen - I’ll make sure to confirm the ambulance is in network, the hospital, the specific first ER doctor, the specialist, the surgeon, the lab, the lab techs, the anesthesiologists and so on, while I’m either unconscious or actively dying.

Every insurance plan I've ever had makes exceptions to the in-network requiremnts for emergencies like that.

I’m glad that’s worked out for you. Not everyone has good plans.

> We want consumers to consider cost when evaluating what services to buy, though.

A lot of medical care involves inelastic demand because your options are 1) pay this or 2) suffer and/or die.

"The market" does not function correctly with inelastic demand curves.

Yet another reason to socialize healthcare.

This is the crux. Capitalism doesn't work here and a fair bit of people like to pretend it does.

Then there's the people who bemoan "paying for someone else's healthcare" while completely ignoring that's what they're doing in the current system anyway.

The people who avoid care they need because they can't afford it are a very small portion of the population that gets an outsized share of attention on the issue.

Until public healthcare advocates understand this and make actual attempts to convince the majority of people who are satisfied with the current system that there are benefits, the status quo will remain.

Half the population does not vote. This is the problem socialists have- how do you get the underclass to exercise their power against the bourgeois?

No, the problem socialists have is that most people are smart enough to realize they won't be better off under a socialist regime, to the chagrin of the self-selected vanguard.

I'm not sure most people can actually define socialism, let alone recognize it.

Exactly. Although even if you can avoid the words they don't understand or were told to be frightened of you'd still have the problem of getting them to vote, even for policies they think would be good for them.

I'm not convinced that your assumption that they are a very small portion of the population holds up, but I only have the same anecdotal evidence you likely have.

Yes it's anecdotal for specific statements, but I'm roughly basing my statement on surveys like this one: https://www.nbcnews.com/politics/politics-news/poll-are-sati...

I find it hard to believe that people who would like to seek care but are unable to do so because of limits on their existing coverage would say that they are satisfied with their medical insurance.

The wonders of American healthcare really mean that it's all more expensive, and at the same time, more is consumed, because so much of what is paid is done past deductible. If you look at so many standard of care situations vs, say, Spain, the American system will do a whole lot more. Even for preventive care: For instance America wants colonoscopies every 10 years from 45. Spain will give you a non invasive fecal test every 2 years, and only consider colonoscopies after the test is positive. Every time I send my american prescribed intervention list, given my symptoms, to my family members working in the Spanish public caresystem, they look at it with their hair on fire. Very different standards. You might think US insurance is restrictive regarding what needs to be done, but most public care system are significantly more restrictive than that. It'll be for better reasons, instead of defaulting to no on everything, but ultimately still far more cautious regarding their spending.

So we fail both ways at the same time: We avoid interacting with the medical system, but when we do, far more is done, at far higher price per intervention, so we end up with more interventions for the same outcome, even though we avoid doctors more!

Reply on news.ycombinator.com