

Ask HN: How would you fix healthcare? - rokhayakebe

1- My 1st simple solution would be to go out on a worldwide hunt and hire doctors in third world countries. Some would move and work in the US for less than 40K. Cost goes down.<p>2- Another option would be to simply send medical school students abroad to study in countries where they will be spending only a fraction of tuition cost in the US.<p>3- Hire a bunch statisticians and mathematicians to come up with the ultimate tailored-contribution-model, based on income/living costs.<p>4- "Government ran gyms".<p>How would you fix the growing healthcare problem?
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ckopec
I clicked in thinking this was going to be an interesting topic but your four
bullets are idiotic. Why does everything have to be about sending things
overseas or make the government deal with it?

Why not start simple, teach better preventative care. What I mean is that the
US as a whole is very unhealthy. Rather than having people wait till they get
sick, get people to take better care of themselves through eating, fitness,
etc. Even have means to reward these people. It's proven people that eat
healthy and workout visit doctors/hospitals much less. An article I recently
read stated that an obese person visits a doctor 10 times more in a year than
a healthy person.

Beyond this I think health plans should be revisited and restructured to make
people more aware of their spending. Force people to watch their health care
spending and limit it only to procedures that are necessary. It will make you
reconsider visiting the ER with a cold rather than calling around, finding a
family doctor and seeing him the following day.

~~~
anamax
> Why not start simple, teach better preventative care.

Better preventative care doesn't reduce costs, it increases them.

[http://www.nytimes.com/2007/08/08/business/08leonhardt.html?...](http://www.nytimes.com/2007/08/08/business/08leonhardt.html?_r=1)

Note that smoking is actually a net benefit. Smokers tend to die about the
time that they start collecting retirement benefits. So, they pay in their
entire working lives and get almost no return. (Black men are particularly
hosed by this while non-smoking white women make out like crazy.)

~~~
ckopec
The article you reference doesn't reinforce your point. It basically states
that preventative care is not a proven solution.

If you take the safeway example mentioned in that article. They have
successfully reduced health care costs internally:
<http://online.wsj.com/article/SB124476804026308603.html>

One point made in this article is that most health care costs are in fact
preventative.

"Safeway's plan capitalizes on two key insights gained in 2005. The first is
that 70% of all health-care costs are the direct result of behavior. The
second insight, which is well understood by the providers of health care, is
that 74% of all costs are confined to four chronic conditions (cardiovascular
disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular
disease and diabetes is preventable, 60% of cancers are preventable, and more
than 90% of obesity is preventable."

Given this statement, the money spent preventing these issues will be far less
than the amount required to correct these issues in people once they get to
the point of needing some type of hospital procedure or operation.

~~~
anamax
You're assuming that you spend prevention costs perfectly when you can't.

The money that you spend on someone to prevent/reduce a problem is completely
wasted if that is not suseptable or is struck by something else. (Also, the
cost to deal with obesity and diabetes together is less than the sum of
dealing with obesity and diabetes separately.) It's also wasted if the person
gets the problem anyway.

And, you're still ignoring the benefits of early death.

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russell
I have had to deal with third world programmers. I am not particularly
interested in entrusting my life to the medical equivalent. US students are
free to go to their med schools but prefer US schools because the quality of
the education is so much higher.

The US has excellent health care, but there are two problems: availability and
price. If you dont have employer paid insurance, medicare, or excellent
health, you are pretty much shut out. The pricing structure is out of whack.
My SO takes a drug that costs $700 per month. It went generic in February and
in October full competition will kick in and it will probably cost $20-30 per
month. Meanwhile we are paying for excessive profits, television ads, and
salesmen. I dont know what the price is in Canada or Mexico, but probably much
less.

Another example of a completely whacked out pricing system is hospitalization.
Several years back I had a pretty routine routine heart procedure. The bill
from the hospital was $80,000. The insurance company allowed $20,000 and I
only had to pay $2000. Someone without insurance would have been hit with the
whole $80,000. And then there was the anesthesiologist who didnt participate
in the insurance plan and billed me $4,000. Nobody told me about him
beforehand, and you don't do much comparison shopping in those circumstances.

~~~
rokhayakebe
Maybe we could make it illegal for drug companies to advertise directly to
consumers.

~~~
russell
I think consumers need the materials to make an informed decision. Television
ads don't accomplish that. A beautiful woman dancing through a field of
flowers doesn't tell me the benefits or side effects, so I agree with you
there. Drug ads on TV are about as socially acceptable as cigarette ads. The
same picture in print with the full PDR dump on the back may be a different
case. The information is there to read, although I have seen a distinct
difference in quality between the information for physician and the advice for
patients.

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rdouble
Your point 1, foreign doctors, already happens. It is called the J-1 visa.
Doctors on this visa are required to serve time in an under-served area.. My
father is a GP in a rural area, his colleagues are from Pakistan, Nigeria,
Uruguay, Argentina and the Caribbean.

Point 3, this is what insurance companies have done since the dawn of the
"actuarial sciences."

Point 4, if 24 hour fitness is too expensive, there are YMCA, YWCAs and nice
parks in every US city I've ever been in.

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noss
Build cities so that they encourage walking and biking, and close out cars
with the exception for lorries and other service traffic.

Stop this century-long obsession with working industry hours. Make people stop
slaving to the wakeup-work-lunch-work-tv-dinner-tv-sleep cycle that doesnt
leave room for physical activities.

A tiny thing I am trying to introduce at work is to have walking-meetings, to
leave the office for a little walk instead of sitting in a room free of
oxygen. It's the small things.

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apsurd
Let's be clear on what problem it is you are talking about. Healthcare being
not-affordable, or in other words too-much for most citizens or in other words
insurance being too much? Or maybe healthcare in the sense that we aren't
healthy; needing less healthcare?

The question is too vague for me. If we are talking in terms of "sicko" (the
documentary) then one solution I have to say is socialized healthcare. I don't
feel that social healthcare is necessarily the same as just any other social
industry. Therefore people should not react in the same way. Socializing the
auto industry is terribly anti-capitalism but its not the same as health-care
because there is (or should) be a moral obligation to help people in need
regardless of their financial state. You can't morally need a new car. It
might still be possible to have private hospitals, for "premium" treatment.
That already sounds rather _dirty_ , but it reminds me of the postal service.
Having government-run postal service actually made the industry better as a
whole. Everyone can send a letter for 42 cents is it? but if they want it
there overnight, there's fedex.

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noblethrasher
Use the existing K-12 system to teach people the basics of medicine and
nutrition. The only thing that a person owns is this world is his or her body
so we should do this even if we have to get rid of some other subject (though
I don’t see why we’d have to).

Not sure how feasible this is but my idea is that everyone would graduate high
school with the equivalent of two years of medical school. In addition to the
current post secondary education options afforded to high school graduates
(college, vo-tech, military, work force, etc.) offer a government-run quasi
vocational program that completes medical training. Graduates of this program
would have 14 – 16 years of training in medicine and would then be licensed to
practice.

This scheme would increase the number of doctors, decrease the need for them,
and decrease the extreme asymmetry in medical knowledge between doctors and
patients. Furthermore, with nearly ubiquitous medical knowledge we would
undoubtedly see more entrepreneurial activity in that space and give
innovation a chance to drive down cost and improve care.

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seanx
Look at what every other western country does. They pretty much all have some
form of "socialised" medicine aka universal healthcare. In New Zealand, we
spend about 1/4 as much per capita on healthcare, yet we live longer and have
better stats re child mortality and the like. We are not particularly good
either, there are a lot of countries doing better than us.

The role of insurance is then to cover the difference between basic health
care and premium.

The main objections I have seen from yanks is: 1 It's socialism! Maybe,
depending on your definition, but it works. The word "socialism" should not be
an off switch for your brain. 2 I don't want to pay for someone else's health
care. If you have insurance, you already are paying for someone else's
healthcare. Sometimes they are paying for you, that's how insurance works.

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mblakele
Tax employer-provided health benefits. This would increase my health care
costs, and probably yours too. But it would eliminate the existing disconnect
between costs and payers, which would reign in costs.

See chart 1 at
[http://www.economist.com/displayStory.cfm?story_id=13899647&...](http://www.economist.com/displayStory.cfm?story_id=13899647&source=hptextfeature)
(<http://media.economist.com/images/20090627/CBB677.gif>). Look at the private
vs out-of-pocket gap between the US and Switzerland (or anywhere else, but
Switzerland is #2). How do you think taxing employer-provided health benefits
would affect that gap?

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anamax
> How would you fix the growing healthcare problem?

Which healthcare problem?

A huge fraction of the folks in the US without healthcare aren't supposed to
be in the US anyway. How much are you willing to pay (or give up) to give them
healthcare? And, if you're willing to pay for their health care, why not
simply send the money to their home countries to provide healthcare there?
(That will help more people.)

Another large fraction make enough to pay for it but have decided that they'd
rather not. In many cases, this is a rational decision for them because
they're being asked to subsidize others and have decided to opt out.

An interesting fraction are "between" providers for some reason. They'll have
healthcare next month, but their place in the no healthcare line will be taken
by another temporary. (This is related to the reason why unemployment never
goes to 0.)

Take away those three groups, and the problem isn't that big and it isn't
growing.

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yummyfajitas
4 is a great idea. It would probably make us healthier.

Apart from that, we simply do not have enough data. What I'd like to do is
repeat the RAND experiment. Take a large group of people at random, and give
them different amounts/types of health care. Measure their health outcomes.

This will at least give us some data to make a more informed choice.

------
MaysonL
Expand Qliance: see <http://www.qliance.com>

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DanielBMarkham
You need to define the problem more if you want to talk about a possible
answer. Just what about it is "broken"? Is it the fact that people invent
treatments that are too expensive for other people to buy? I'm not sure how
you would stop that. Is it the fact that large numbers of people have no
insurance? Is it the fact that people, with or without insurance, have to make
difficult choices in regards to treatment? Would you like to have your
politician be involved with things like how many MRIs are in your town? Is
there something "dishonest" about insurance companies (as some have suggested)
that they need fixing? Would you like not to worry about anything health-
related? (highly unlikely to happen, but it's your problem definition)

"How would you fix healthcare" sounds like a simple question, but it's not at
all. It's very odd (to me, at least) that we're having a national discussion
and planning major changes for something so ill-defined.

I think there's a real problem. If I had to define it, I'd say we have too
many people that are uninsured and insurance products are purposely confusing
and non-standardized to consumers.

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sarvesh
Option 1 although good it probably won't fly well. The first step to cleaning
up the existing mess it to stop rewarding doctors based on the number
procedure they apply on a patient to cure them in medicare. That is probably
the most insane healthcare practice and I don't think it is done anywhere else
in the world.

Once the doctors realize that these current practices are not sustainable they
probably will come out with some novel ideas like this one
<http://hbswk.hbs.edu/item/4585.html>.

It doesn't really make sense to have only for profit health insurance
companies, look the executive salaries
(<http://www.prwatch.org/node/8425#comment-4517>). With the amount of money
the US government is spending on healthcare it would make a lot of sense for
us to have a single-payer system.

~~~
russell
Yesterday, I had a discussion with my doctor on this very topic. Her office
visits take an hour not fifteen minutes. If you need more time than that, she
takes it. She does not participate in any insurance plans because they pay $75
or less for a visit.

I think sarvesh has the wrong cause for assembly line medicine. It's not that
doctors are doing it to enrich themselves, but that insurance companies are
forcing them to do it with unreasonably low payments.

In another reply I objected to recruiting third world doctors because their
training was not up to US standards, but I also object because I don't think
we should deprive those countries of their services so we could pay them like
janitors here.

------
csomar
\- Stop the INDUSTRY (or not stop it, turn it Green)

\- Good and healthy food

\- Practice sport?

This should be enough

