

How American Health Care Killed My Father - mhb
http://www.theatlantic.com/doc/print/200909/health-care

======
tptacek
This isn't a political article. Its author has contributed tens of thousands
of dollars to Democratic political causes, but the article itself is almost
completely opposed to the Democratic Party's thoughts on health care.

Instead, this is an article about business, efficiency, the impact of IT and
modern business process on health care, and the impact our current system has
on consumers and businesses.

~~~
pg
I agree. This kind of article is a de facto test of flagging judgement. For a
while now I've been considering having HN learn whose flags to pay attention
to. (I already have code to collect stats about rates of crying wolf, but I
don't do anything with these numbers yet.)

~~~
davidw
As someone who certainly "cries wolf", I'll go ahead and ask: how are we to
judge "good" politics articles from bad ones?

I read The Economist, and think they occasionally do some pretty good politics
articles, and having an on-line version, it would be easy to post them here.

~~~
pg
Actually you're not that bad. You only misflag articles 17% of the time.

As for political articles, the test is whether the article is an instance of
the ordinary back and forth of debate on some political question, or whether
it's about some deeper underlying phenomenon that only happens to be related
to politics. E.g. "Politician A accuses Politician B of X" or "Why policy Y is
good/bad" are probably both offtopic, whereas "How political campaigns use
statistics" is probably ok.

~~~
Radix
How do you judge misflags? Do you compare against yourself and the other
editors kills? Or, do you compare to popular opinion? Which might could be
wrong if the community grew too fast. ...Does it help to flag dead articles?

~~~
pg
A 17% misflag rate simply means that 17% of the articles you flag don't end up
getting killed. Which is pretty good: it means your flags are an 83% accurate
predictor of whether an article will be killed.

~~~
abalashov
That has the unfortunate effect of silencing minority constituencies that may
have a substantive and HN spirit-compatible reason for thinking that an
article is important to get out there and discuss, but whose thoughts do not
mirror the prevailing trend of the groupthink.

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bwd2
The title is misleading, this article is actually an examination of economic
distortions in the US healthcare industry, and a quite good one at that.

~~~
joe_the_user
I don't see a contradiction between the article's title and the subject you
mention. Various economic factors distort the provision of healthcare to the
point that it kills people. The title naturally highlights this crucial point,
understandably so given the author's personal experience with this.

------
electromagnetic
It's quite disturbing that Pronovost had to beg hospitals to adopt a _free_
technique that could cut the average 100,000 deaths from hospital acquired
infections down to ~30,000 overnight with nothing but telling your doctors to
wash their hands.

This was adopted a long time ago in the UK and became cemented in place with
the MRSA outbreaks. Visitors can actually be removed from the hospital if
they're seen not using the alcohol based sanitizer.

~~~
mrkurt
The last paragraph of the article addresses this specifically:

"Imagine my father’s hospital had to present the bill for his “care” not to a
government bureaucracy, but to my grieving mother. Do you really believe that
the hospital—forced to face the victim of its poor-quality service, forced to
collect the bill from the real customer—wouldn’t have figured out how to make
its doctors wash their hands?"

~~~
DannoHung
Nope. Because collections are outsourced.

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mustpax
For the whole article on a single page:
<http://www.theatlantic.com/doc/print/200909/health-care>

------
Xichekolas
Some of my favorite parts:

 _"But health insurance is different from every other type of insurance.
Health insurance is the primary payment mechanism not just for expenses that
are unexpected and large, but for nearly all health-care expenses. We’ve
become so used to health insurance that we don’t realize how absurd that is.
We can’t imagine paying for gas with our auto-insurance policy, or for our
electric bills with our homeowners insurance, but we all assume that our
regular checkups and dental cleanings will be covered at least partially by
insurance."

"For that matter, try discussing prices with hospitals and other providers.
Eight years ago, my wife needed an MRI, but we did not have health insurance.
I called up several area hospitals, clinics, and doctors’ offices—all within
about a one-mile radius—to find the best price. I was surprised to discover
that prices quoted, for an identical service, varied widely, and that the
lowest price was $1,200. But what was truly astonishing was that several
providers refused to quote any price. Only if I came in and actually ordered
the MRI could we discuss price."

"By contrast, consider LASIK surgery. I still lack the (small amount of)
courage required to get LASIK. But I’ve been considering it since it was
introduced commercially in the 1990s. The surgery is seldom covered by
insurance, and exists in the competitive economy typical of most other
industries. So people who get LASIK surgery—or for that matter most cosmetic
surgeries, dental procedures, or other mostly uninsured treatments—act like
consumers. If you do an Internet search today, you can find LASIK procedures
quoted as low as $499 per eye—a decline of roughly 80 percent since the
procedure was introduced. You’ll also find sites where doctors advertise their
own higher-priced surgeries (which more typically cost about $2,000 per eye)
and warn against the dangers of discount LASIK. Many ads specify the quality
of equipment being used and the performance record of the doctor, in addition
to price. In other words, there’s been an active, competitive market for LASIK
surgery of the same sort we’re used to seeing for most goods and services."_

~~~
ahoyhere
That's because the notion of insurance is wrong. People need healthcare
coverage, not insurance.

We are all connected in this stupid country - if the family down the street
can't afford preventative care, and the wife gets sick, and can't take care of
the kids, and the husband misses work and gets fired from his job, and then
they can't afford good nutritious food for their kids, so the kids go to
school hungry and don't learn as well and don't test as well, the ripples can
last for generations.

Here's the thing. People act as if healthcare is something that has to be
earned, and deserved, and not only is this viewpoint inhumane (in the Greatest
Nation in the World!), but it's _economically indefensible._

If people don't get early medical care, their lifetime economic output can be
greatly reduced. And their children are affected. If children aren't taken
care of with nutrition and care, their mental abilities, abilities to stay in
school, are affected -- and _their_ lifetime economic output is reduced. And
targeted poverty (as opposed to where everyone's poor) breeds crime. Which
creates greater loss of human economic potential AND greater costs for the
government.

The country benefits from more, healthier workers, who can think straight, and
don't spend significant portions of their time figuring out how to scrape by.
These people can then spend money. Middle- and lower-middle-class people spend
far more of their income than higher income brackets, if only they have the
money to spend.

Net effect: The benefits to the entire country outweigh the costs, in a system
where costs aren't an arms race between health insurance providers,
malpractice insurers, and other for-profit companies.

A stitch in time saves nine.

------
jpwagner
theatlantic: "wow this story is amazing, thoughtful, and powerful, but the
title has got to go. How about something catchy like: How American Health Care
Killed My Father"

author: "umm..."

------
nazgulnarsil
medical reform isn't political in the sense that what we currently have is
obviously bullshit and what the politicians propose is obviously bullshit. if
we're talking about a non-bullshit solution we're in the realm of fantasy, not
politics.

------
davars
Appealing when presented in the abstract, but I have nightmarish visions of
such a system.

On the one hand, you'd further motivate those consumers who were already
likely to avoid preventive care and ignore symptoms until they require costly
(to me as contributor to the catastrophic plan) emergency and intensive care.
And the author's position that folks would be able to withdraw funds that
exceed a certain ceiling adds the perverse incentive to risk not spending this
money, with the downside being absorbed by the catastrophic plan.

On the other hand, you'd do nothing to discourage consumers with irrational
fears about their health from distorting prices upwards, or to discourage
unscrupulous providers from fomenting those fears. The plan he describes takes
fee-for-service and all its problems to a whole new level. I think of things
like the celebrity anti-vaccine mess and the healthcare debate with its
distorted media coverage and disingenuous advertising, and I have hard time
accepting a consumer-driven market succeeding, even with all the government-
collected and -analyzed data in the world.

Even worse, I fear that such a system would result in a tiered system, where
the best and brightest providers provide excessive care to those with means
while the rest of us continue to struggle with barely adequate, barely
affordable care.

I don't think that any system that relies on healthcare consumers making the
choice between limiting their usage of healthcare services and spending money
is destined for success. Providers need to be rewarded for providing the best
outcomes for the lowest cost with the fewest mistakes, not the most and most
expensive services. Significant efforts must be made to improve the public
health of Americans. The conversation should be about how to make those things
happen. All this debate about who pays when is just a side show that is
obstructing real reform.

~~~
donaldc
Your fears are ones that one could have about any market. But in general, free
markets seem to work better than any of the alternatives across a wide range
of markets, and I really doubt that health care would prove an exception to
this.

It won't be perfect, of course, but a perfect system doesn't exist. I'm
absolutely appalled that I'm paying (on average, as an American) over $1.5
million over my life for the present system, and can't imagine this would
remain the case if pricing and outcome transparency were drastically
increased. I think that quality and service would improve, while cost would
decrease.

------
protomyth
I kinda wish Hacker News would skip the political articles. There are plenty
of technical things about health care to cover (e.g. databases for health,
clinical trials, input cost reduction).

That being said, I lived under US government health care for a goodly chunk of
my life (IHS), and until they fix that, they really have no biz working on
anything else.

~~~
kragen
IHS is the Indian Health Service? They don't care about that because Indians
have no political power. It's unbelievable the kind of corruption and
incompetence that exists inside that agency.

FWIW, Medicare, Medicaid, the VA, and medical care for soldiers are all pretty
good on the US scale.

~~~
ahoyhere
Really? The VA? Did you miss all the scandals about the Walter Reed medical
base in DC, where soldiers were mistreated, ignored and neglected, and even
one killed himself in his room and no one noticed for 2 days? The hospital had
no idea until his parents called and forced them to look for their missing
son. This was a guy who was evacuated due to a semi-suicide attempt, and they
didn't even bother to monitor him. Shameful.

Not to mention the _older_ vets, especially from Vietnam. They are screwed at
every turn and the previous administration cut their benefits even more.

~~~
yardie
The Walter Reed scandal would really reinforce what people have been saying
about for profit healthcare.

Walter Reed is a huge military complex with Army and contractor buildings on
the base. Most vets that go to Walter Reed end up under the military care.
This is the old colonial style buildings that most people see. They are in
pretty good shape and most vets don't have a complaint about Army care. The
real fiasco is the private contractors. This is the part of Walter Reed people
read about in the paper. They work under VA but since they are for-profit
companies, you know the rest.

People like to use Walter Reed of why the gov't shouldn't get into healthcare
at all. Walter Reed is an example of why private, healthcare companies have no
business being in healthcare.

~~~
mrkurt
Government contractors are vastly, vastly different from most private
enterprises.

------
Fannie
I can believe American Health care killed your father. The people who have
insurance, are afraid to go to the emergency room with chest pain, afraid the
pain is gas and they can't afford the high out of pocket costs they have to
pay.

------
towski
I'm tired of health care articles based on anecdote. His entire article is
seems biased by the fact that his dad died.

------
kingkongrevenge
He says he is a democrat, but a reasonable interpretation of the article
points towards the republican solution of taxing health care benefits. The
problem is that both the industry and consumers are very insulated from price
sensitivity, so costs shoot out of control and providers have little incentive
to improve quality. People need to be paying for far more of their care out of
pocket with cash. We need price wars between hospitals.

~~~
run4yourlives
Why is it that you Americans are so two dimensional? Every possible idea for
social reform must either be the republican or democrat position. If it can't
be pigeon-holed into one of those viewpoints, it's not worth discussion. If it
can, it quickly devolves into some form of partisan debate.

Your two party system is killing you in every area, and you don't even know
it.

~~~
pixcavator
Do you mean "one dimensional"?

~~~
run4yourlives
hehe, yes I suppose. I was thinking two dimensional with the understanding
that the number of dimensions to an argument (dimension == viewpoint) was
infinite.

The argument itself though is very one dimensional. :)

------
pragmatic
Et tu, Hacker News?

The political pieces on HN are starting to overwhelm the technical articles.
Isn't there enough of this on Reddit?

~~~
jgrahamc
Yes, there's plenty of this on Reddit. That's why I used my 'flag' power to
flag this article. This article bugs me for two reasons:

1\. It's about a non-technical political topic

2\. I am British and care very little about the internal political arguments
in the US concerning their health care system.

~~~
plinkplonk
"I am British and care very little about the internal political arguments in
the US concerning their health care system."

Amen Brother!

Political articles should be (imho) shut down very fast. The "flag and wait
for a moderator" tactic doesn't seem to be working as well as it used to.

~~~
callahad
_"The 'flag' and wait for a moderator doesn't seem to be working as well as it
used to."_

How can we judge how well the system is working when we have no direct insight
into it? Perhaps a moderator reviewed the post and found it to be of merit?

~~~
plinkplonk
"Asserting that the system is not "working as well as it used to ..."

I said

"The "flag and wait for a moderator" tactic doesn't _seem_ to be working as
well as it used to."

there is a subtle difference between what I said and what you claimed I said.

~~~
callahad
My response came off snarkier than I intended. I've edited it to hopefully de-
snark the point I was trying to make.

~~~
plinkplonk
No harm done!

My response doesn't make sense anymore now that you edited yours! :-) I am
leaving it unedited however.

