Is it “broken” if it was intentionally made to be that way? The American Heart Association reported that heart disease and stroke alone cost the U.S. healthcare system over $200 billion each year. Studies have shown that dietary improvements could save the U.S. billions in healthcare costs.
I’m pretty sure the guys who were gonna pocket all that cash prefer to have paying customers.
Irrational yes. Broken, no just optimized differently than other systems. The system is optimized to serve those who can afford it and those who are very poor and get it for free, but not those in between. It is optimized to generate profit, but also new treatments. Rich people from all over the world come here for surgery and treatment.
The pricing system is intentionally designed to be opaque so that everyone except the consumer benefits. It is not uncommon for a top surgeon to make 500-750K per year, nurses are paid well above the median and can make over 100K with overtime, hospital administrators, insurance companies... the way pricing and billing is handled protects all those interests.
Sounds like something you would want to fix, right? Well that too is complicated. Healthcare is one of the only sectors that is growing middle class jobs. A hospital is one of the only places someone with an associates degree and a certification can make 60K per year.
Furthermore, it is one of the only growing industries that provides many opportunities for women. Not many women want to move to Montana to frack shale oil.
Start socializing medicine and all that job growth and opportunity disappears.
It is a tough problem to solve. The utter irrationality of it used to drive me nuts and still does sometimes, but I prefer it to the alternatives.
I always wondered: ok, the US medical system is atrociously expensive and inaccessible, but where does all that money go? Surely a surgery cannot really cost half a million dollars, can it?
Well, when a large number of patients are effectively outbidding each other over an insufficient pool of medical professionals, then yes, it really can cost that much, not necessarily by making doctors absurdly rich (probably some of that too), but in the sense that price gouging structures will surely emerge to capture that surplus.
You are 100% right. You can't identify a single factor that's causing high cost because all players are rotten. Insurances, doctors, hospitals, pharmaceuticals are all bad players in a system that benefits them at the expense of patients.
Like so many things that are broken in America, it's not one thing that's to blame - it's multiple:
People lives longer; more illness we can treat; growing administration; new expensive technology; few doctors; price gouging; anti-competitive behavior; malpractice lawsuits; lack of preventative care; uninsured bumping in and out of emergency rooms; and so on...
Some of these are successfully solved by most western countries. Some of them are quite plausibly not solvable.
As we have more technology and treatments to keep people alive, cost will necessarily go up.
You addressing the wrong side of the problem. The issue isn't WHO's paying, the issue is why so much? Have you seen some of the bills that folks without insurance are getting? Nearly every sort of surgery, no matter how trivial, wipes out most people's savings plus some.
Isn't it obvious? All of the fields experiencing the cost disease are dominated by government. Either through massive funding, or vast numbers of regulations.
Even within sectors, we see the pattern. For example, the two fields of medicine which have seen the least cost growth are cosmetic [1] and laser eye surgery. Not only have costs risen the least, but the quality of some procedures in these fields has improved tremendously over the last two decades. Both are electives, so there are fewer mandates requiring that they be covered by insurance and fewer redistributive programs to subsidise them.
The source of the complex system dysfunction is the political and social system, which enables special interests to mislead the public in order to implement policies that benefit themselves but have a negative-sum impact on the economy as a whole. One of the 'big lies' that these special interests have succeeded in convincing the public of is that the free market is a misguided ideology that is promulgated by the rich in order to exploit the poor, when in reality it is a basic rule-set necessary for economic development in complex systems (due to properties like the rule-set enabling effective large-scale coordination of economic resources through price signalling, aligning private incentives with the public interest through laws granting and protecting the right to property produced through one's own efforts, or acquired through trade (and inversely, prohibiting acquisition of property through theft, armed robbery and other non-voluntary and predatory means), etc).
It's actually the middle class that pays the price, through insurance premiums, out-of-pocket co-pays, and high deductibles. Poor people have Medicaid.
Medicaid, which even happens to pay reasonable amounts for procedures performed. The entire system would re-adjust into a sustainable steady-state, if all prices were equivalent to Medicaid reimbursements. But I suppose that under such a model, the average middle-aged surgeon wouldn't be able to afford their third summer home...
Too expensive to fix an auto issue. Oh well, let’s just dump the car and get another one.
Too expensive to fix healthcare issue. You’ll probably die or make it worse if you don’t fix it. “How much is your life worth to you?”
You can get a ton more random money by holding people’s lives over them. That is in summary the US healthcare system. Full of middlemen squeezing every penny they can out of you because they can.
Whoever campaigns for a transparent healthcare system, I’m voting for them.
Our broken healthcare system kills more people than all terrorist attacks and natural disasters combined because people can’t afford to pay the bill mafia.
A problem I have with systems of such complexity is that it feels basically unknowable whether or not this is true. It totally may be. On the otherhand, it might just be that we're basically subsidizing an incredibly expansive practice by creating enormous and complex upstream costs that we ignore in our current accounting.
I think the point is that healthcare costs can't be the cause, because they are just a symptom of a broken healthcare market. The actual cost of medical supplies and doctor salaries isn't astronomical, but the price that employers and patients pay is. That disconnect, due to a lack of a sufficient combination of market forces and regulation, is what's bankrupting the country. Saying that healthcare costs are the problem is stopping short, and puts the attention where it can't actually fix things.
The cost is so high precisely because our healthcare toolkit is so poor.
If we could restore our systems to full functionality, our healthcare cost will drop like a rock.
Though we will be faced with new questions. If everyone are fully healthy, then our mortality rate will also drop like a rock, destroying social security as it currently exists.
Is it? It feels like something is broken. The government spends nearly a trillion dollars a year on health related expenses. They should be investing aggressively so that a trillion dollars in health related expense aren't needed forever. It seems totally unsustainable. The US is going to need cheaper, more effective health care to keep Medicare/Medicaid/VA Hospital programs solvent.
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