Friday, June 10, 2016

Round-up on US healthcare costs

Today I was contemplating the ever-present problem of healthcare costs in the US. Why does it cost so much here? This article answered that question pretty well. However, it did sugarcoat a big problem:
"... the rest of the system consists, in essence, of a vast number of independent, entrepreneurial providers of health care services and marketers of pharmaceuticals and medical supplies who are free to set their fees and prices as they see fit."
What wasn't said here is that those 'entrepreneurial providers' have a big incentive to gouge as much as they can get away with. That would have been a clearer way to say it.

The next article is much plainer in its explanation, which is great. The comments are also helpful. The highlight here is on how the "I want it now" mentality escalates costs. This is also true.

Neither article dealt much with alternatives, or what a different but still workable system would look like. I would really like a national conference on this. We should look at all the systems in other countries, and pick one out and adopt it. That would mean junking our current system, and I guess I'm ready to do that.

The last article suggests that we adopt the system from Singapore. After reading about it, I have strong doubts that it would work here. Let me know if you share my doubts and why.



Dangerous said...

The primary complexity is the sheer volume of money involved in healthcare and the stakeholders with competing interests over both the services and the money to pay for those services.

The simple fact is that left to their own devices, few people in this country can afford the cost of highly-trained and specialized professional in an area of life so critical to people. The same is true around the world and various societies solve the problem any number of ways from pure democracy to pure libertarianism. In the USA, we spend more and get more care than in other countries. We also have the issues of cost/benefit and outcomes-driven allocation of limited resources, which produce competition among people for the available care. And most healthcare spending occurs in the last few years of peoples' lives.

The cost of care for injuring and illness are insurable financial risks to a point, except for the extremely wealthy. Except that the insurers are incentivized NOT TO PAY claims or to minimize the cost of care any way possible, including limiting care to the bear minimum proven to produce positive outcomes.

My particular healthcare policy is: Everyone gets basic care and nobody goes broke. Those terms need to be clearly defined and continual analyzed. As for the in-between, parties will have to get private insurance or manage the financial risk of any care outside the "everyone gets" scope. I don't know of a country that does it that way, but with the pushback insurance companies would pose to any change at all, demanding existential threats to those companies would spell the end of any such effort a la single-payer.

Our current system isn't bad (it would be a lot better with Medicaid expansion into 50 states), and could be better along the lines I describe above. Some parts of it are just stupid, owing to political limits and posturing. But the notion of "repeal and replace" is so stupid that anyone suggesting it really has no intention of doing anything after repeal. But just think how much more money we'd have if we just outlawed medicine and people were just allowed to die?

ModeratePoli said...

@dangerous, one thing I focus on that you didn't mention is the ineffeciencies built into the US system due to concerns about malpractice. The duplication of diagnostic methods is now enshrined as the 'standard of care' in many cases. That's an area that can be reformed when the will is available. Also, the amount of care given in the last two years of life.

Anson Burlingame said...

I wonder what the cost of medical care has become to treat illnesses, injuries and other trauma caused by bad life style choices (tobacco, alcohol, drugs, guns, etc). The other category of extraordinary medical expenses falls under the broad term of End of Life care (EOL), which is also a "life style" choice to a degree, speaking as a 74 year old in good health for the moment.

At my age I muse from time to time what exactly I might do if/when I receive a "terminal" diagnosis of say cancer. Obviously the medical profession will offer options that will, to some degree, preserve my life, but at huge cost (to others but not to me or my immediate family) and great demands to endure various treatments. The "other choice" rarely mentioned is to simply let the disease take its course but provide effective relief from "pain and suffering" for both me as the patient and my immediate family (EOL counseling, etc.) It is my understanding that about 60% of all Medicare costs are associated with "treating" EOL disease (cancer, heart, Parkinson, etc., etc.) Most people will opt for the very expensive treatment (paid by government)in order to "extend life" not matter at what cost. Yet even with the best possible treatment such patients become a real burden to themselves, their family and society in general. Just tour a nursing home to observe what it is like to live on the fringes of life. Why do people choose to do so?


ModeratePoli said...

@anson, When it comes to EOL care, as with care issues at other times, a lot of the decision about care is based on the 'standard of care,' which is often a lot of intervention. If we could find where and under what conditions we should slim down the care, that would help the overall cost without denying good care to people.