Get Sick and Die; The State of U.S. Healthcare

The Something Awful Forums > Discussion > Debate & Discussion > Get Sick and Die; The State of U.S. Healthcare

KingNastidon: Jun 25, 2004

Apologize if I skip things.

BiggerBoat posted:

Wouldn't ALL this stuff be less complicated and make more sense without marketing and advertising? Or worrying about which hospital or doctor is "in network" in the event I'm barely out of a coma?

Marketing and advertising by insurance companies, hospitals, drug companies, med device companies, patient advocacy groups is its own thing. There are certain aspects where the US is a clear outlier and should be addressed (e.g., direct to consumer advertising on TV). Devil's advocate in me would say there are benefits to DTC advertising for things like viagra because it makes topics like erectile dysfunction less taboo. Men are notorious about not procrastinating on healthcare issues or being shy about bringing ailments up with their doctor.

The in and out of network thing is a pain of the rear end for patients and why I pay more for a plan that won't potentially leave me in a bad spot even if I'll never use it. The rationale behind it is that insurance companies make deals with providers. Easiest example is with dentists. Dental insurance companies will say: "Hey, there are X number of people in your area with our dental insurance. Our insurance will cover you and send you business from these patients, but you have to agree to a 20% discount off your normal rates."

This allows the dentist to determine whether access to those incremental patients, albeit at a reduced cost, makes sense to them. This is all fine and good with something like a dentist where people can typically investigate benefits in advance, but less so when your accidentally chopped your finger off cooking dinner and need treatment ASAP.

BiggerBoat posted:

Also, you said, "given my insurance is paying for it". That's the point. They're NOT. I'm being denied tests and medicine at every turn and I'm "one of the good ones" who WORKS for my super duper private insurance.

This is a crass way to look things given healthcare, but think about it like a car insurance assessor/adjuster. They're doing additional work to make sure they aren't paying for repairs that aren't needed or overpaying for services that are rendered. From the perspective of the patient or car owner this looks like they're just loving you and only you. The alternative is they're more permissive of outright fraud and those costs are passed onto you via higher premiums.

Tomberforce posted:

Have you ever considered that forcing someone to provide you a service is called slavery so publically funded medical care mesns making doctors into slaves. But this doesn't apply to any other public sector job for reasons.

I see this fuckin insanity trotted out all the time and I cannot wrap my head around the stupidity of this mindset.

I see where you're coming from and this underpins the debate around healthcare being a "right" vs. a service that a humane society provides to its people. Likening it to slavery is unhelpful because anyone involved in providing healthcare can simply opt out of doing so. If some future single payer legislation caps reimbursement such that healthcare provider pay goes down significantly or biopharma/med devices can't breakeven then so be it. People will just leave to more interesting/lucrative careers, but this isn't chattel slavery.

DC Murderverse posted:

when is this an issue for things that aren't painkillers/abusable drugs?

Many hospitals, clinics, etc use buy and bill. This gets very into the weeds in an area I don't focus on, but tl;dr is healthcare practices make money for each drug prescribed/infused. Doctor isn't going to care if they make 10% mark-up on giving Chantix, but they might if that 10% is applied against a $200k/year cancer treatment.

Griefor posted:

This is just plain false. Huge pharma coorporations have been buying up smaller companies that just developed an effective new treatment, jacking up the prices and slashing the R&D department because there is no short term profit in R&D. Even though that R&D department researched the treatment they are now making bank on. Dozens of smaller companies that still did research have been gobbled up by big pharma for the patents and had their R&D shut down.

This is just one way the industry works. Big pharma does their own R&D, but much of the work is done at smaller biotechs. This is because outside investors will have significantly more influence on how the company is run (e.g., seats on the board) and greater upside if their bet is successful. Any biopharma R&D is highly speculative in terms of discovered drugs -> Phase 1 success -> Phase 2 success -> Phase 3 success -> FDA approval. What typically happens is that big pharma will jump in at Phase 3/FDA approval stage to buy out the company because it's less risky. Big pharma gets cash flow, employees and investors at small biotech get payout. Each side is happy otherwise shareholders on both sides wouldn't have done the deal. The value of that ongoing R&D (e.g., Phase 1/2 trials) is priced into the deal. When or if R&D associated with the small biotech is eliminated it's because the new big pharma co has decided it's not worth pursuing relative to other options.

Kreeblah posted:

It also incentivizes finding ongoing treatments rather than cures. Why let somebody pay $200,000 for a cure when they could be paying you $10,000/month for years?

How much that actually happens is something that will probably never be publicly known, but I have no doubt it's more than never.

Conspiracy theory bullshit. Trust me, enough doctors and VCs and biotech founders/CEOs are megalomaniacs in that they'd rather be on Time Magazine for curing X than increase their already high net worth. People aren't letting The Miracle Cancer/Alzheimer's Cure die on the vine in the clinic because treating the disease is more profitable than curing it, maaaann. You can't simultaneously believe that corporations only care about maximizing next quarter's revenue and that they're walking away from 100% market share at essentially any price for a cure. Also while clinical trials are sponsored and paid for by pharma, major academic hospitals/doctors are the principal investigators. They diagnose the patient, administer the therapy, and see the results. They want to present the data at the plenary session at ASCO and have their name on the NEJM publication. The conspiracy doesn't run so deep that everyone is hiding The Cure.

KingNastidon fucked around with this message at 02:04 on Aug 8, 2020

# ? Aug 8, 2020 01:31

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# ? Apr 28, 2024 05:46

Highbrow Slick: Jul 1, 2007; it is a fool who stays alive - but such fools are we.

All right so the executive order stating all insurance plans must cover pre-existing conditions was clearly performative, as the ACA already mandates this, but -

There are a TON of insurance plans sold off-exchange that are junk or just plain scams. They explicitly do not cover pre-existing conditions and charge a pittance compared to comprehensive plans, like $20-40/month. I would love love love to see this EO turn into yet another inexplicable own-goal by those who wish to dismantle what little options Americans currently have by effectively legislating junk plans into bankruptcy.

# ? Aug 8, 2020 02:00

Kreeblah: May 17, 2004; INSERT QUACK TO CONTINUE; Taco Defender

KingNastidon posted:

Conspiracy theory bullshit. Trust me, enough doctors and VCs and biotech founders/CEOs are megalomaniacs in that they'd rather be on Time Magazine for curing X than increase their already high net worth. People aren't letting The Miracle Cancer/Alzheimer's Cure die on the vine in the clinic because treating the disease is more profitable than curing it, maaaann. You can't simultaneously believe that corporations only care about maximizing next quarter's revenue and that they're walking away from 100% market share at essentially any price for a cure. Also while clinical trials are sponsored and paid for by pharma, major academic hospitals/doctors are the primary investigators. The conspiracy doesn't run so deep that everyone is hiding The Cure.

Giant pharma companies don't have to hide cures. They just have to be aware of things like Sovaldi and decide where their money is best spent to generate maximal returns and, therefore, the most investor attention.

I have little doubt that if a cure for something is developed, that it'd be made available, but it's also a fact of capitalism that rent-seeking behavior is not only encouraged but demanded, and while investors love to hear about record profits, that can turn around real quick if suddenly the product that was responsible for those isn't any longer.

# ? Aug 8, 2020 02:13

wins32767: Mar 16, 2007

Kreeblah posted:

Giant pharma companies don't have to hide cures. They just have to be aware of things like Sovaldi and decide where their money is best spent to generate maximal returns and, therefore, the most investor attention.

I have little doubt that if a cure for something is developed, that it'd be made available, but it's also a fact of capitalism that rent-seeking behavior is not only encouraged but demanded, and while investors love to hear about record profits, that can turn around real quick if suddenly the product that was responsible for those isn't any longer.

You realize that there are multiple Hep C cures on the market and that's what another big factor driving the cratering value for Gilead, right?

# ? Aug 8, 2020 02:48

wins32767: Mar 16, 2007

I've found this thought experiment to be a good illustration of many of the dysfunctions in the US healthcare system: Let's say a there is a magic box where if you feed in all of a patient's health records in and a proposed treatment (be it a prescription, surgery, whatever), it will tell you with perfect accuracy what the outcome for that patient would be (e.g. cancer in remission for 5 years, continues to smoke, dies on the operating table). Who would be interested in the magic box? Why would they want it? How much would they be willing to pay for it? And who has the information to feed into that magic box so it can operate?

# ? Aug 8, 2020 02:56

KingNastidon: Jun 25, 2004

wins32767 posted:

You realize that there are multiple Hep C cures on the market and that's what another big factor driving the cratering value for Gilead, right?

Right. Gilead didn't just have Sovaldi magically fall into their lap from the NSF. They spent $11B to acquire it from smaller biotech Pharmasset almost 10 years ago. Since then other companies like Abbvie and Merck have gotten similar therapies approved albeit with slightly different indications. Additional competitors allows payors to apply more pricing pressure, thus diminished revenue for all players involved.

# ? Aug 8, 2020 02:57

A GIANT PARSNIP: Apr 13, 2010; Too much fuckin' eggnog

RIP Fall Sick and Die, wherever you are.

# ? Aug 8, 2020 03:42

wins32767: Mar 16, 2007

wins32767 posted:

I've found this thought experiment to be a good illustration of many of the dysfunctions in the US healthcare system: Let's say a there is a magic box where if you feed in all of a patient's health records in and a proposed treatment (be it a prescription, surgery, whatever), it will tell you with perfect accuracy what the outcome for that patient would be (e.g. cancer in remission for 5 years, continues to smoke, dies on the operating table). Who would be interested in the magic box? Why would they want it? How much would they be willing to pay for it? And who has the information to feed into that magic box so it can operate?

Since I work in adjacent to the healthcare space, the standard disclaimer applies: I'm not speaking for my company, these views are my own, etc. My answer spoilered in case people want to play along at home.

The main interested parties are patients, private insurers (e.g. Aetna), public insurers (e.g. Medicare), providers (e.g. Brain Surgeons), treatment creators (pharma or medical device companies).

Patients are really interested in knowing their own outcomes, but don't care about anyone else's. In the US they are also unable to pay much since the median American family can't handle a surprise $400 bill. They have access to some of the important data (like how often do they take their medications and what they eat) but not all of it.
Private insurers are only interested in paying at maximum their allowed administrative overhead minus the cost of avoiding fraud, minus some amount of profit. In reality, they're only interested in whatever profits they can extract in the delta between their administrative costs and the costs of the box. Patient outcomes are uninteresting other than they impact profitability (there is a second order effect here of needing to not have too divergent patient outcomes from their competitors). There are some/many folks within the companies that also care about patients, but structurally that's not how the companies are designed to operate. The insurers have limited access to the data required for the box other than what they can get doctors and patients to provide.
Public insurers are similar to private insurers other than they also in theory have an incentive to optimize for the best care for the lowest price, depending on who is in office. They'd be willing to pay for access to the box to reduce the prevalence of ineffective procedures (which is pure waste from the government perspective) and they'd be fine using it to determine which treatments are just not cost effective (optimizing for quality adjusted year of life per dollar turns into death panels politically though).
Providers have an ethical duty to provide the best care, but they have limited incentive to pay for the output of the magic box. For one, it increases their risk of malpractice suits due to various human failures on either the patient's or provider's part (the box said I'd be ok, but I had a heart attack!). Additionally, for most illnesses they are overtreating, so they'll be taking money out of their own pocket by paying for the box. They have a large chunk of the information required for the box to work.
Treatment creators are willing to pay if it increases their sales and would treat it like any other marketing expense. This means they'd be only willing to pay for it if their treatment was more effective than their competitors in at least some subpopulation and they'd only be willing to pay up to whatever their budget for customer acquisition cost is. They don't have any of the information used to run the box.

So the net is that the party most interested is too poor to pay much for the box, and the party with most of the information required to use the box loses money from its use. Switching to government run healthcare changes some of the incentives in a better way, but it isn't optimized for the optimal outcome for each patient, just the best bang for whatever bucks are allocated (until such a point as the providers get to regulatory capture).

# ? Aug 8, 2020 04:16

Ardlen: Sep 30, 2005; WoT

KingNastidon posted:

People aren't letting The Miracle Cancer/Alzheimer's Cure die on the vine in the clinic because treating the disease is more profitable than curing it, maaaann.

Glybera was a cure for a rare form of pancreatitis. The company charged $1 million for the cure, sold it once, and now it is off the market entirely. Their reasoning for pricing it that high was because treatments for similar rare diseases normally cost $300,000 / year for the rest of the patient's life.

The research was publicly funded by the University of British Columbia.

# ? Aug 8, 2020 07:13

knox_harrington: Feb 18, 2011; Running no point.

Ardlen posted:

Glybera was a cure for a rare form of pancreatitis. The company charged $1 million for the cure, sold it once, and now it is off the market entirely. Their reasoning for pricing it that high was because treatments for similar rare diseases normally cost $300,000 / year for the rest of the patient's life.

The research was publicly funded by the University of British Columbia.

quote:

Alipogene tiparvovec was a gene therapy for LPL deficiency available in Europe until 2017 when the sponsor declined to renew market authorization. While TG levels normalized in 12 weeks, levels then returned to prior baseline by 6 months after therapy.

https://www.acc.org/latest-in-cardiology/articles/2020/03/03/15/08/clinical-review-on-triglycerides

6 months is not a cure by any stretch.

While US corporate culture is a major problem, the issues with healthcare in the US are not going away without proper regulation, and that seems unlikely without somehow solving the issue of lobbying. I don't think that expecting corporations to suddenly ignore the pressure to make number go up is going to be successful.

I grew up in the UK and worked in research in the NHS for a long time and think a properly funded national system is the best healthcare setup. Having said that I now live in an extremely capitalist country with a privatised system (Switzerland), and while it's expensive it's properly regulated so everyone has health cover and pre existing conditions are always included. The system seems to work pretty well.

The US could very easily implement the same system, but doesn't because of politicians' vested interests. A country that specifically outlaws its state healthcare scheme from negotiating drug prices is just mad.

# ? Aug 8, 2020 09:12

GABA ghoul: Oct 29, 2011

Ardlen posted:

Glybera was a cure for a rare form of pancreatitis. The company charged $1 million for the cure, sold it once, and now it is off the market entirely. Their reasoning for pricing it that high was because treatments for similar rare diseases normally cost $300,000 / year for the rest of the patient's life.

The research was publicly funded by the University of British Columbia.

Dude, even the wikipedia article contradicts this. It was a novel gene therapy treatment for a very rare genetic disease and it was on the market for two years. I have no way to check out the companies claim that it was commercially unsuccessful, but it's certainly plausible. If they sold only 31 treatments in two years it might not have been enough revenue to cover all the running costs of manufacturing, training, legal costs, insurance, etc.

I'm not a big fan of how most of the pharma industry is run, but this is not a problem specific to the private sector. A public pharma industry would have to answer about spending limited resources just the same. Like, you can use available resources to bring drugs to market that could help millions or you can spend them to set up a production line for Glybera and help 31, but you can't do both at the same time. A public company might have faced a similar outrage, but for choosing to produce an obscure seizure medicine that helps 32 people a year over Glybera that would have helped only 31 people.

# ? Aug 8, 2020 09:17

silence_kit: Jul 14, 2011; by the sex ghost

Still Dismal posted:

Hospitals themselves don't get nearly enough flack honestly. Insurance companies are the main villains in most healthcare reform arguments (not at all saying they don't deserve this), but hospitals are a huge part of the problem as well. Hospitals have much better PR but are every bit as culpable for the insane runaway cost inflation that you see in American healthcare. I think the problem is that people generally like doctors, nurses, etc., and hospitals like to conflate attacking their predatory pricing and practices with attacking the workers providing healthcare themselves.

Yeah, everyone in the system deserves some portion of the blame. Another reason for the fixation on the health insurance companies is because that is who people deal with when it comes time to pay for the healthcare. So problems created by other parts of the system get attributed to the health insurance companies.

GABA ghoul posted:

I'm not a big fan of how most of the pharma industry is run, but this is not a problem specific to the private sector. A public pharma industry would have to answer about spending limited resources just the same. Like, you can use available resources to bring drugs to market that could help millions or you can spend them to set up a production line for Glybera and help 31, but you can't do both at the same time. A public company might have faced a similar outrage, but for choosing to produce an obscure seizure medicine that helps 32 people a year over Glybera that would have helped only 31 people.

Yeah, I don't get how a totally government-run health care system would create better outcomes for people with orphan diseases. I'd think that the government would just not make the investment to develop treatments for rare diseases, and instead would spend the government money on developing treatments which would benefit more people.

edit:

wins32767 posted:

I've found this thought experiment to be a good illustration of many of the dysfunctions in the US healthcare system: Let's say a there is a magic box where if you feed in all of a patient's health records in and a proposed treatment (be it a prescription, surgery, whatever), it will tell you with perfect accuracy what the outcome for that patient would be (e.g. cancer in remission for 5 years, continues to smoke, dies on the operating table). Who would be interested in the magic box? Why would they want it? How much would they be willing to pay for it? And who has the information to feed into that magic box so it can operate?

Thanks for sharing this thought experiment and your answers to it in a later post.

silence_kit fucked around with this message at 21:14 on Aug 8, 2020

# ? Aug 8, 2020 21:04

Craptacular!: Jul 9, 2001; Fuck the DH

knox_harrington posted:

I grew up in the UK and worked in research in the NHS for a long time and think a properly funded national system is the best healthcare setup. Having said that I now live in an extremely capitalist country with a privatised system (Switzerland), and while it's expensive it's properly regulated so everyone has health cover and pre existing conditions are always included. The system seems to work pretty well.

If I remember from that older �healthcare abroad� PBS special, Swiss healthcare is a market of private players, but they�re all required to be not for profit.

# ? Aug 12, 2020 09:27

KOTEX GOD OF BLOOD: Jul 7, 2012

A GIANT PARSNIP posted:

RIP Fall Sick and Die, wherever you are.

i was just thinking about this today. what happened to this guy.

# ? Aug 13, 2020 03:26

F_Shit_Fitzgerald: Feb 2, 2017

Question for those in this thread: how in the world do you respond to morons who tell you that universal health care is "slavery" because it's "forcing people to give charity"? I've run into this on another forum and its baffling, though I know it's a dumb way to reframe the issue.

I've tried pointing out that people have a right not to be forced into medical bankruptcy, and that M4A doesn't mean that doctors and nurses don't get paid, but it's like talking to a wall.

# ? Aug 14, 2020 15:40

Griefor: Jun 11, 2009

F_Shit_Fitzgerald posted:

Question for those in this thread: how in the world do you respond to morons who tell you that universal health care is "slavery" because it's "forcing people to give charity"? I've run into this on another forum and its baffling, though I know it's a dumb way to reframe the issue.

I've tried pointing out that people have a right not to be forced into medical bankruptcy, and that M4A doesn't mean that doctors and nurses don't get paid, but it's like talking to a wall.

If your definition of slavery is being forced to do anything at all you could argue that being forced to free your slaves is slavery.

# ? Aug 14, 2020 15:48

F_Shit_Fitzgerald: Feb 2, 2017

Griefor posted:

If your definition of slavery is being forced to do anything at all you could argue that being forced to free your slaves is slavery.

Or going into medical bankruptcy because you get sick and can't afford your medical bills.

# ? Aug 14, 2020 15:57

Mechafunkzilla: Sep 11, 2006; If you want a vision of the future...

F_Shit_Fitzgerald posted:

Question for those in this thread: how in the world do you respond to morons who tell you that universal health care is "slavery" because it's "forcing people to give charity"? I've run into this on another forum and its baffling, though I know it's a dumb way to reframe the issue.

I've tried pointing out that people have a right not to be forced into medical bankruptcy, and that M4A doesn't mean that doctors and nurses don't get paid, but it's like talking to a wall.

Why are you wasting your breath?

# ? Aug 14, 2020 15:58

GABA ghoul: Oct 29, 2011

F_Shit_Fitzgerald posted:

Question for those in this thread: how in the world do you respond to morons who tell you that universal health care is "slavery" because it's "forcing people to give charity"? I've run into this on another forum and its baffling, though I know it's a dumb way to reframe the issue.

I've tried pointing out that people have a right not to be forced into medical bankruptcy, and that M4A doesn't mean that doctors and nurses don't get paid, but it's like talking to a wall.

Quick answer that they will understand: they are already paying for other people's healthcare because our moral consensus does not allow us to refuse non-elective medical care to people. Universal healthcare will actually safe them money and make them pay less for other people

Real answer: Nobody "earns" anything. A developed economy is a highly complicated machine that produced a shitload of goods and services that are then distributed using a very complicated, arbitrary and byzantine distribution key. Improving the distribution of healthcare service and goods to the most impoverished workers will actually improve the overall output and efficiency of the economy and therefore improve the economic wellbeing of almost all people.

# ? Aug 14, 2020 16:01

silence_kit: Jul 14, 2011; by the sex ghost

F_Shit_Fitzgerald posted:

Question for those in this thread: how in the world do you respond to morons who tell you that universal health care is "slavery" because it's "forcing people to give charity"? I've run into this on another forum and its baffling, though I know it's a dumb way to reframe the issue.

I've tried pointing out that people have a right not to be forced into medical bankruptcy, and that M4A doesn't mean that doctors and nurses don't get paid, but it's like talking to a wall.

This person might be a lost cause, but I think that it might be a good idea to actually address what they are saying and get them to talk and explain their ideas, instead of just changing the subject on them. Let them do most of the talking, and ask questions and then you can use their own reasoning to reach conclusions that you hope they disagree with, and point out paradoxes in their thinking.

I don't know how they will be able to expound a lot on the idea that UHC is the same thing as 'giving to charity' without saying a bunch of stuff that most people find morally monstrous. Their idea that UHC is slavery is predicated on the idea that taxation is slavery, but surely they don't actually believe that taxation is slavery because you can probably point to government programs that they like that wouldn't get funded if the government made taxes optional . . . etc . . . etc . . .

edit: It is hilarious to me that this process of getting people to explain and reason about their beliefs and pointing out paradoxes in their thinking is considered to be bad on some online communities, and 'just asking questions' is a pejorative, but here we are.

silence_kit fucked around with this message at 12:21 on Aug 15, 2020

# ? Aug 14, 2020 16:08

F_Shit_Fitzgerald: Feb 2, 2017

Good suggestions. Thanks, all. Probably is a lost cause, but I get a perverse pleasure out of forcing people to confront the contradictions of their philosophy.

# ? Aug 14, 2020 16:42

BiggerBoat: Sep 26, 2007; Don't you tell me my business again.

https://twitter.com/latrey69/status/1294019780744056833?s=09

# ? Aug 15, 2020 11:13

Inferior Third Season: Jan 15, 2005

F_Shit_Fitzgerald posted:

Question for those in this thread: how in the world do you respond to morons who tell you that universal health care is "slavery" because it's "forcing people to give charity"? I've run into this on another forum and its baffling, though I know it's a dumb way to reframe the issue.

I've tried pointing out that people have a right not to be forced into medical bankruptcy, and that M4A doesn't mean that doctors and nurses don't get paid, but it's like talking to a wall.

Doctors and nurses who don't like the working conditions and remuneration in a universal health care system can quit and pursue other career paths. Slaves, on the other hand, could not. Very subtle difference there, I know.

# ? Aug 15, 2020 12:35

knox_harrington: Feb 18, 2011; Running no point.

F_Shit_Fitzgerald posted:

I've tried pointing out that people have a right not to be forced into medical bankruptcy, and that M4A doesn't mean that doctors and nurses don't get paid, but it's like talking to a wall.

Adjacent to this, I occasionally read the medicine subreddit and it's surprising and disappointing how many doctors are libertarians. There's quite a lot of opposition to universal coverage in there, on the basis that they will earn less.

Doctors' salaries in the US are pretty insane, and the justification for the high pay is that medical school is expensive and residency is poorly paid. I'm not against doctors being well paid but it highlights to me that solving the problem of high healthcare cost in the US also includes solving the high university cost.

Medicine should really also be an undergraduate degree, it involves no research and is a driver behind the doctorification of all professions in the US.

# ? Aug 15, 2020 13:26

Mulva: Sep 13, 2011; It's about time for my once per decade ban for being a consistently terrible poster.

F_Shit_Fitzgerald posted:

Question for those in this thread: how in the world do you respond to morons who tell you that universal health care is "slavery" because it's "forcing people to give charity"? I've run into this on another forum and its baffling, though I know it's a dumb way to reframe the issue.

I think it's against the rules to promote felonies, so I'mma just say that there's no convincing people with no to low empathy to have it. Best you can do is the utilitarian "Every single major look at what it would cost to implement says it saves the country money overall, and I like saving money". You pay now, or you pay later. You always pay for sick people. There is no FYGM there, no matter how badly someone's tiny narcissistic heart hopes it would be so. You always pay. You can have a good universal health care system and pay up front, or you can have a terrible one and society collapses in the face of a global pandemic and pay later. You always pay.

# ? Aug 15, 2020 15:33

silence_kit: Jul 14, 2011; by the sex ghost

knox_harrington posted:

Adjacent to this, I occasionally read the medicine subreddit and it's surprising and disappointing how many doctors are libertarians.

This is a little rich because doctors in the US might be the biggest beneficiaries of protectionist labor laws. Don't get me wrong--doctors make an incredibly valuable contribution to society, obviously, and should be able to live comfortably so they can focus on their jobs.

knox_harrington posted:

There's quite a lot of opposition to universal coverage in there, on the basis that they will earn less.

I suspect that in order for a US UHC policy to actually deliver on its promises to greatly lower the cost of healthcare, it would have to force everybody in the healthcare industry to take a haircut, since everybody is partially responsible for driving up the cost of healthcare in the US. The high cost problem is not just localized to the health insurance companies.

This would include doctors, who could easily make less money, and still be able to live comfortably and focus on their work. Doctors in the US make more money than doctors in other rich countries.

knox_harrington posted:

Doctors' salaries in the US are pretty insane, and the justification for the high pay is that medical school is expensive and residency is poorly paid. I'm not against doctors being well paid but it highlights to me that solving the problem of high healthcare cost in the US also includes solving the high university cost.

The current system is not ideal, but doctors in the US tend to exaggerate the problem and the burden. Paying for an MD is still an incredible investment. You are guaranteed a stable, well-paying job for life when you get accepted into any US medical school. This is pretty unique for academic degrees. My cousin paid back his medical school loans in like 3 years after getting his first job.

edit: I just Googled 'average residency salary' and it is $60k. Getting paid $60k per year for job training is pretty good, IMO. It is extremely low though, when compared to real doctor salaries.

knox_harrington posted:

Medicine should really also be an undergraduate degree

Yeah, this is a no-brainer. This is how almost every other rich country does it. I suspect that the guild would not be a big fan of this though.

silence_kit fucked around with this message at 18:00 on Aug 15, 2020

# ? Aug 15, 2020 17:47

wins32767: Mar 16, 2007

One of my big issues with medical school and the training system is that the culture they instill in doctors is fundamentally broken. Medical errors are a huge cause of death and poor outcomes. Medical culture has far too much top down, "the expert is right" mindset to ever drive those errors close to zero and as the folks atop the pile, doctors are the most resistant to changing that culture. One of the good thing about consolidation on the provider side is that it will empower administrators to force a change of that culture. They'll probably just replace it with a cost optimizing one, but that'd be more amenable to change through incentives than the status quo.

# ? Aug 15, 2020 18:07

raifield: Feb 21, 2005

wins32767 posted:

One of my big issues with medical school and the training system is that the culture they instill in doctors is fundamentally broken. Medical errors are a huge cause of death and poor outcomes. Medical culture has far too much top down, "the expert is right" mindset to ever drive those errors close to zero and as the folks atop the pile, doctors are the most resistant to changing that culture. One of the good thing about consolidation on the provider side is that it will empower administrators to force a change of that culture. They'll probably just replace it with a cost optimizing one, but that'd be more amenable to change through incentives than the status quo.

Hell, I have a friend who was hit by a car when she was a teenager and now, in her mid-30s, has an extremely messed up back. Herniations, bone spurs, and moderate to severe canal stenosis all over the place. Her most recent neurosurgeon lost his license and moved out of state, but only after repairing two of her herniations by installing the screws backwards. Apparently no one else in the operating room thought this was an issue or didn't want to speak up. Since each screw is now loose she simply waits for the day they work into the canal and she wakes up a paraplegic.

And that surgery cost her over $10,000, to which she has no recourse to sue for. Boggles my mind to this day.

# ? Aug 15, 2020 18:30

BiggerBoat: Sep 26, 2007; Don't you tell me my business again.

F_Shit_Fitzgerald posted:

Question for those in this thread: how in the world do you respond to morons who tell you that universal health care is "slavery" because it's "forcing people to give charity"? I've run into this on another forum and its baffling, though I know it's a dumb way to reframe the issue.

I've tried pointing out that people have a right not to be forced into medical bankruptcy, and that M4A doesn't mean that doctors and nurses don't get paid, but it's like talking to a wall.

Maybe ask why so many of my tax dollars go towards the military and how that "forces me to pay for wars I oppose"? Paying taxes for cops or firefighters I've never personally needed isn't slavery. Paying into social security so that my street isn't lined with the corpses of widowed 70 year olds isn't slavery. Paying for basic sanitation and trash collection I think we can all agree is good. Even before I had a kid, paying into a public education system I didn't use wasn't slavery because I want my neighbors to have an education.

Whatever forum you're on sounds like it's filled with idiots but I usually just tell these types that "we live in a society", see if there's any traction and then go from there.

I mean, the simplest answer is that something like healthcare is a thing all of us are going to need at some point so sharing the costs and eliminating the profit incentive is just simply more cost effective. I mean, should I be forced to go bankrupt because my son has epilepsy and has had 2 seizures by age 7? I think socializing the costs of common needs is wise even if it creates other problems but for some reason the types of people you're talking to tend to think that "free market competition" solves everything. You wouldn't want to privatize water, electricity, food, education, prisons and...

oh wait.

I personally think we need to socialize the commons and let capitalism do the consumer products end of things but I dunno and am lacking the energy to really get into it.

My hip/back/leg arthritis driven pain has spiked up to about level 9 over the last 3 weeks or so. Level 10 is when I can't walk or sleep hardly at all. Right now I can walk SOME and sleep SOME. My insurance company won't cover cortisone injections and my options for physical therapy are limited so I'm reduced to doing that last part myself by watching you tube videos.

I'm cranky, beaten and mad about it. Everyone tells you "your health is the most important thing!" but god for loving bid you get sick or throw out your back and can't do your job anymore. Or, maybe worse, have to miss work hours to visit doctors.

# ? Aug 15, 2020 18:42

doverhog: May 31, 2013; Defender of democracy and human rights 🇺🇦

silence_kit posted:

This person might be a lost cause, but I think that it might be a good idea to actually address what they are saying and get them to talk and explain their ideas, instead of just changing the subject on them. Let them do most of the talking, and ask questions and then you can use their own reasoning to reach conclusions that you hope they disagree with, and point out paradoxes in their thinking.

I don't know how they will be able to expound a lot on the idea that UHC is the same thing as 'giving to charity' without saying a bunch of stuff that most people find morally monstrous. Their idea that UHC is slavery is predicated on the idea that taxation is slavery, but surely they don't actually believe that taxation is slavery because you can probably point to government programs that they like that wouldn't get funded if the government made taxes optional . . . etc . . . etc . . .

edit: It is hilarious to me that this process of getting people to explain and reason about their beliefs and pointing out paradoxes in their thinking is considered to be bad on some online communities, and 'just asking questions' is a pejorative, but here we are.

These people are probably Trump voters and their entire identity is built around all that emcompasses. Arguing is completely useless, because their position is not based on facts to begin with.

# ? Aug 15, 2020 19:12

KingNastidon: Jun 25, 2004

BiggerBoat posted:

https://twitter.com/latrey69/status/1294019780744056833?s=09

Seems like extreme focus on the $3k/patient cost of remdesivir is misplaced when it's potentially 0.3% of the costs in this example.

# ? Aug 15, 2020 19:23

F_Shit_Fitzgerald: Feb 2, 2017

BiggerBoat posted:

Maybe ask why so many of my tax dollars go towards the military and how that "forces me to pay for wars I oppose"? Paying taxes for cops or firefighters I've never personally needed isn't slavery. Paying into social security so that my street isn't lined with the corpses of widowed 70 year olds isn't slavery. Paying for basic sanitation and trash collection I think we can all agree is good. Even before I had a kid, paying into a public education system I didn't use wasn't slavery because I want my neighbors to have an education.

Whatever forum you're on sounds like it's filled with idiots but I usually just tell these types that "we live in a society", see if there's any traction and then go from there.

I mean, the simplest answer is that something like healthcare is a thing all of us are going to need at some point so sharing the costs and eliminating the profit incentive is just simply more cost effective. I mean, should I be forced to go bankrupt because my son has epilepsy and has had 2 seizures by age 7? I think socializing the costs of common needs is wise even if it creates other problems but for some reason the types of people you're talking to tend to think that "free market competition" solves everything. You wouldn't want to privatize water, electricity, food, education, prisons and...

oh wait.

I personally think we need to socialize the commons and let capitalism do the consumer products end of things but I dunno and am lacking the energy to really get into it.

My hip/back/leg arthritis driven pain has spiked up to about level 9 over the last 3 weeks or so. Level 10 is when I can't walk or sleep hardly at all. Right now I can walk SOME and sleep SOME. My insurance company won't cover cortisone injections and my options for physical therapy are limited so I'm reduced to doing that last part myself by watching you tube videos.

I'm cranky, beaten and mad about it. Everyone tells you "your health is the most important thing!" but god for loving bid you get sick or throw out your back and can't do your job anymore. Or, maybe worse, have to miss work hours to visit doctors.

It definitely is filled with idiots. This particular idiot didn't respond after they proposed making medicines and treatments cheaper (which is a start) and I answered that everyone needs health care regardless of their ability to pay, their health condition, or their job (or lack of one).

Just as well. I and my family have dealt with the wrong end of for-profit health insurance and it doesn't take much for me to get really heated about it. As someone else said, people like this are generally a waste of breath to argue with.

F_Shit_Fitzgerald fucked around with this message at 21:20 on Aug 15, 2020

# ? Aug 15, 2020 20:11

Coolness Averted: Feb 20, 2007; oh don't worry, I can't smell asparagus piss, it's in my DNA

GO HOGG WILD!
🐗🐗🐗🐗🐗

Another barrier to change I've been thinking of something like a third of all gofundme campaigns are for medical expenses. Even zuck is getting in on the 'pay me 3% to donate' scam. So forces that technically shouldn't be involved in the discussion have a vested interest in keeping the healthcare system incredibly broken in the US. Meanwhile sources of information about politics don't really disclose things like the pod bless america assholes were invested in gofundme, so gosh of course they'd say m4a isn't a good option for another 10-40 years.

# ? Aug 15, 2020 21:18

BiggerBoat: Sep 26, 2007; Don't you tell me my business again.

F_Shit_Fitzgerald posted:

It definitely is filled with idiots. This particular idiot didn't respond after they proposed making medicines and treatments cheaper (which is a start) and I answered that everyone needs health care regardless of their ability to pay, their health condition, or their job (or lack of one).

Just as well. I and my family has dealt with the wrong end of for-profit health insurance and it doesn't take much for me to get really heated about it. As someone else said, people like this are generally a waste of breath to argue with.

Since I smoke, have abused drugs in the past and drink, I hear the argument a lot that "why should I pay for your poor life choices when you get sick?" And most of these people are fat and eat McDonalds and Taco Bell and poo poo, wondering why they can't lose weight. But OK. Fair enough.

My ex wife (and my son) both have epilepsy. My mother had bipolar disorder and mental illness brought on in large part by rape and molestation as a child committed by her father and half brother. My ex was also molested by a family neighbor at the age of 11 that contributes to her acute anxiety. My son also has ADHD and caught a nasty gash above his eye at gymnastics class that put him the ER. They all need(ed) care. The gently caress did THEY do to deserve what's coming to them? And why should they have to go broke for the crime of being sick?

We've barely even touched on the mental health part of this health care thread.

That whole "forcing people to pay charity" quote you cited burns my rear end the more I think about it. It's so selfish, backwards and mean spirited and the point is that we shouldn't NEED charity to cover medical expenses. Those assholes would be the first ones whining about their taxes going to support someone on disability and I automatically have to assume they routinely poo poo on homeless people, many of whom are there due to medical issues.

Also, since we're talking about being "forced to pay for charity" and since these dickheads are usually heavily involved in some sort of church that they'll generally cite for all their glorious charity work, maybe ask them why churches are tax exempt but still allowed to own entire city blocks, huge TV networks and politically stump from the pulpit as they rake in cash? One could argue that I have to pay taxes to support an ideology I strongly disagree with while a lot of these fuckers revel in opulence and, in many cases, make or break my elected representative candidates in elections.

BiggerBoat fucked around with this message at 21:26 on Aug 15, 2020

# ? Aug 15, 2020 21:23

KingNastidon: Jun 25, 2004

You're always going to have some segment of the population that genuinely believes each individual should be fully responsible for their own healthcare. Even if some are born with a condition that requires out-sized health expenditures, are eventually diagnosed with a disease that is not really linked to any personal behavior (e.g., hematologic cancers), or suffer a random tragic accident. These are people that you will never reach and shouldn't worry about.

My minimum acceptable situation is UHC with personal mandate. In any given year top 1% of the population contributes to 22% of health expenditures (avg per capita: >$110k), top 5% of the population contributes 50% (avg: $50k), and the bottom 50% of the population contributes 3% (avg: $276). There is massive financial incentive for people to not want to pay for sick people -- premiums certainly higher than $276/year for those that fall into the bottom 50% of healthcare use! But who falls into the high spend groups changes constantly and often randomly. I find opposition to UHC and a personal mandate unquestionably immoral because it's just a roll of the dice, especially with moral hazard where HCPs will not refuse care even if you willingly choose to not be insured. I also don't really understand opposition to making insurers non-profits along the lines of Switzerland since they aren't driving much innovation.

The good faith arguments against full single payer generally fall along the lines of "better the devil you know..." Everyone is aware the various for-profit market incentives that lead to higher costs and bad care in some circumstances. The three major questions that single payer advocates need to address and have good answers for are 1) what do you pay for 2) how much do you pay for those services and 3) how do you pay for cost of total program.

#1 introduces questions around abortion, trans healthcare, homeopathic/herbal medicine, chiropractics/sports medicine, therapy and mental health, on and on. One may assume that any country that is able to pass single payer will make the right policy choices, but the political winds change (see: Trump and USPS). Also introduces the dreaded death panels because the easiest way to constrain costs is not pay for old, sick people. #2 determines how much providers (HCPs, hospitals, pharma/med device, etc) get paid. To the discussion earlier, no one is forced to work in the healthcare industry but financial incentives + influence over one's day-to-day work will drive who stays/leaves. This also applies to any private, for-profit entity interacting with the public healthcare system. There will be no private funds invested if it's a guaranteed loss. #3 is probably the easiest question since it's just a mathematical exercise, but tax incidence will have influence on where you draw support.

None of these questions are unsolvable otherwise you wouldn't have NHS/NICE in UK. But now every single minute aspect of healthcare for consumers and providers becomes an issue of federal politics. I can understand why those that are risk averse or have sincere local government or anti-authoritarian beliefs would want no part of single payer even if they support UHC or medicare/medicaid in their current form.

# ? Aug 15, 2020 23:21

Fill Baptismal: Dec 15, 2008

F_Shit_Fitzgerald posted:

Question for those in this thread: how in the world do you respond to morons who tell you that universal health care is "slavery" because it's "forcing people to give charity"? I've run into this on another forum and its baffling, though I know it's a dumb way to reframe the issue.

I've tried pointing out that people have a right not to be forced into medical bankruptcy, and that M4A doesn't mean that doctors and nurses don't get paid, but it's like talking to a wall.

If you really must engage with these people, ask them this:

A)Do you believe in the right to fair trial?
and
B)Do you think judges, prosecutors, and public defenders work for free?

There are plenty of rights that we pay money to people to provide, that indeed can be only guarantee by people being employed to provide them.

# ? Aug 15, 2020 23:47

F_Shit_Fitzgerald: Feb 2, 2017

BiggerBoat posted:

Since I smoke, have abused drugs in the past and drink, I hear the argument a lot that "why should I pay for your poor life choices when you get sick?" And most of these people are fat and eat McDonalds and Taco Bell and poo poo, wondering why they can't lose weight. But OK. Fair enough.

My ex wife (and my son) both have epilepsy. My mother had bipolar disorder and mental illness brought on in large part by rape and molestation as a child committed by her father and half brother. My ex was also molested by a family neighbor at the age of 11 that contributes to her acute anxiety. My son also has ADHD and caught a nasty gash above his eye at gymnastics class that put him the ER. They all need(ed) care. The gently caress did THEY do to deserve what's coming to them? And why should they have to go broke for the crime of being sick?

Holy poo poo.

Since you told your story (and your family's), I'll tell mine. I was born with my hips dislocated, a condition that was handed down from one of my distant uncles. Before I was eighteen, I had about ten surgeries: seven on both hips, one for a hernia (caused by being in a body cast), one knee surgery (to correct uneven growth of my legs), and a spinal fusion for scoliosis. Until the ACA, I spent years as an adult without health insurance.

My sister was as bad or worse. She had Down syndrome and some congenital heart defects and as a result, was considered uninsurable. My parents did OK; we weren't rich but had pretty good group insurance through my parents' job. Then my Dad lost his job in the mid '90s and we lost that insurance. It took my dad getting a job with a school picture company taking money to insure my sister, and luckily for us that insurance lasted until her death in late 2002.

Neither of us was responsible for the health conditions we had/have, but we were both considered too "risky" to insure because :capitalism:

: when insurance is for-profit, it sets shareholders trying to make a profit against sick people and their needs. Guess who wins in that scenario?

quote:

That whole "forcing people to pay charity" quote you cited burns my rear end the more I think about it. It's so selfish, backwards and mean spirited and the point is that we shouldn't NEED charity to cover medical expenses. Those assholes would be the first ones whining about their taxes going to support someone on disability and I automatically have to assume they routinely poo poo on homeless people, many of whom are there due to medical issues.

Also, since we're talking about being "forced to pay for charity" and since these dickheads are usually heavily involved in some sort of church that they'll generally cite for all their glorious charity work, maybe ask them why churches are tax exempt but still allowed to own entire city blocks, huge TV networks and politically stump from the pulpit as they rake in cash? One could argue that I have to pay taxes to support an ideology I strongly disagree with while a lot of these fuckers revel in opulence and, in many cases, make or break my elected representative candidates in elections.

Me too. My family would have been up poo poo creek if it hadn't been for Shriner's Hospital, which did surgery on me - and even transported us to the hospital a time or two - for free. I was lucky. But if we lived in a country that cared about people over profit, there would be no need for a Shriner's; kids like me, or your son, would get the help they need for free.

# ? Aug 16, 2020 00:53

side_burned: Nov 3, 2004; My mother is a fish.

So anyone no a good source of data on American dentistry? Things like the percentage of the population that actually goes and what percentage of cost actually get covered by insurance. It seems like every 18 months I read an article about those charities that set up in warehouse with 30 dentist offering free dental care for a day and you anecdotes from some hillbillies that drove five states to get a tooth pulled. The Nation ran a good example of the genre in 2017 and I am certain things have not gotten better.

side_burned fucked around with this message at 05:21 on Aug 16, 2020

# ? Aug 16, 2020 05:18

Communist Thoughts: Jan 7, 2008; Our war against free speech cannot end until we silence this bronze beast!

As a brit its so depressing to have read this thread in 2007 and still be reading it, I'm an atheist and I knelt and prayed for Obama to win to give you universal healthcare (lmao young me).
To an outsider the american system is repulsive, farcical and nightmarish. Its a genuine moral outrage.

Now in 2020 its still the same "debate" and my own country has savaged and asset stripped the NHS, in another 13 years maybe you guys might have UHC, I hope so so much but outlook isn't great, the NHS will probably be a flock of angry vultured confusedly pecking at a dried carcass.

# ? Aug 17, 2020 17:43

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# ? Apr 28, 2024 05:46

Classon Ave. Robot: Oct 7, 2019; by Athanatos

If Trump wins it'll probably be another 10 years before Americans have any kind of reasonable healthcare system, if Biden wins they very well may never.

# ? Aug 17, 2020 18:01

The Something Awful Forums > Discussion > Debate & Discussion > Get Sick and Die; The State of U.S. Healthcare

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