
The Cost of My Mother’s Cardiac Care in the United States and India - denzil_correa
http://www.annfammed.org/content/12/5/470.long
======
zaptheimpaler
Coming from India, I have really come to hate the medical system here in the
US. There are countless times I have been screwed over by the lack of
transparency in cost and the layer of bureaucracy and BS imposed by having to
deal with an insurance company rather than __the doctor/hospital who treated
me__!!

It has been a few months since I have seen a doctor, but I still receive some
new goddamn bill every other day. They are usually cryptic and leave me
wondering what the hell they are for, and why they were not just presented to
me on the day of the test. Don't even bother asking anyone what a procedure
costs. Hospital staff will redirect you to someone who deals exclusively with
insurance (completely unnecessary if we just had simple bills like any other
transaction FFS), and the insurance people don't have enough specifics to ever
really give you an answer, not to mention the time it will take waiting on
hold etc. When you are getting multiple procedures, its just not worth the
time. So you are practically forced to go in completely blind about potential
costs.

To top it all off, my insurance coverage has expired as I recently graduated.
So my options are to either pay $600 for 30 days of medicine that I need, or
get the exact same medicine shipped to me from India, for $10-$20. They
produce it by the millions in blister packs. This should not be so difficult!
If we just had realistic prices in the first place instead of inflating them
and bringing them down with insurance, this crap would not happen.

And don't even get me started on "pre-existing conditions". What that means
for me is constantly lying to doctors and being unable to give them a complete
medical history - otherwise I'll have f __* "pre-existing condition" stamped
on my head and never get sane rates again.

I fail to see why health care is not treated more like a series of simple
business transactions in an economic system instead of this colossal mess.

/rant

~~~
chimeracoder
> And don't even get me started on "pre-existing conditions".

First, I would delete the sentence after this if I were you, since it could
come back to haunt you legally[0].

Second, unless things are different for foreigners in the US (which AFAIK is
not the case), this is not how pre-existing conditions actually work
(anymore), post-ACA.

[0] (I am not a lawyer, I am not your lawyer, and this is not legal advice.)

> So you are practically forced to go in completely blind about potential
> costs.

This (price transparency) is actually the real problem more than the sticker
prices themselves.

If patients had the ability to know expected prices beforehand, market forces
would work to bring prices down. As it stands, we have a very awkward
situation in which _insurers_ compete to keep premiums down to attract
customers, and therefore negotiate lower prices with providers, but patients
are completely blind to this entire process and are unable to "vote with their
wallets", because the prices that patients pay and the prices that insurers
pay are not always directly linked in practice.

~~~
crag
"If patients had the ability to know expected prices beforehand, market forces
would work to bring prices down."

If patients knew to ask. Really. If you are covered by insurance (including
medicare/tri-care/etc) you won't get an answer. But if you are paying out of
pocket (and most hospitals require credit if you are doing something serious -
like open heart)you can negotiate the price.

Let me say again, the hospital will negotiate. The doctors and labs (not done
in the hospital) are another matter.

Also, if you see an aspirin on your bill costing $75 you need to call. You'd
be surprised how effective this is. Most Americans never question the price of
anything. Even cars these days people take at face value.

Of course, if you in the ER with chest pain, I'll admit, the last thing on
your mind is the bill. And the hospitals know that.

So what's the lesson here? In America have insurance. Even if you are 20 years
old. A simple care wreck can destroy you financially. You think student loans
are bad? Try a drug overdose. Or a heart attack. Or a fractured back ( a car
wreck). If you young, insurance is cheap. Dirt cheap.

~~~
maxxxxx
I haven't had much success getting prices when I had a high deductible
insurance. Most doctors won't tell you anything or they will quote you one
price today and 5 times as much tomorrow. You certainly won't get a binding
quote you can plan with.

------
acabal
I recently wrote on my blog about the cost of having a benign mole removed. I
got so angry when I heard the cost of that simple procedure that I went online
and calculated the cost to do it in Colombia, where I have some family. Long
story short, I estimated that it would be 34% cheaper to fly to Colombia, have
the same procedure done, _and_ have a full week's vacation (at hostel rates,
which is how I travel). _Everything, including airfare and a full week of food
and lodging, for 34% less than just the procedure in America!_

The best part is that I guesstimated the cost of the procedure in Colombia.
But _even if I tripled my guesstimate_ , it would still be cheaper to fly!

For time-insensitive or elective procedures, you can and should go abroad. The
real cruelty is people who don't have a choice--emergency situations, cancers,
etc. They're trapped in our hideous system and often have to choose between
their life savings and a lifetime of debt, and dying.

Our American approach to healthcare disgusts me. Every time I think about it I
get filled with rage.

~~~
cpwright
If you can shop around in the US for something like that it can matter too. To
correct my son's tongue tie the first ENT would have been over $1500 out of
pocket, including anesthesia. The second one did it in his office as part of
another appointment we had related to his hearing, total out of pocket $50.

IMO, The biggest problem is really lack of transparency for this stuff. If a
hospital takes government money (and pretty much every one of them does), it
should be required to publish its rates like a utility does.

~~~
danielweber
The more they deal with insured patients, the less ready they will be to give
you quotes. I was trying to find a news story of someone calling around to get
price quotes on procedures and many places just immediately hung up at the
question.

------
primitivesuave
I was traveling through India with my sister, and she got terrible food
poisoning. I put her in a private hospital, where she was given incredible
service and recovered within a four days. The hospital bill was only 8000
rupees, or ~$150. My sister told me of one nurse who gave her exceptional
care, so I tried to give that nurse a 5000 rupee ($100) tip. Without a moment
of hesitation, she flat-out refused. Her response brought tears to my eyes -

"Sir, this is my duty. There are poor people right outside, your money would
really help them."

As I talked to my relatives about what I experienced, I learned that Indian
medical staff see their job as their _dharma_ (duty), a belief that stems from
their medical training and originally from the _Bhagavad Gita_ , a religious
text that is central to Hinduism. If I had to state a particular reason for
the quality of Indian medical treatment, that's what it would be - that they
consider their jobs a sacred duty. When someone truly believes that their job
is a sacred duty, they will do it with a passion that cannot be artificially
reproduced by a huge salary or per-patient compensation.

~~~
pkaye
It is also because being a doctor is considered high status in India. Higher
than lawyers, businessmen, engineers. Also they also command a high income. So
what you did of offering a tip is more of an insult.

~~~
kamaal
>>Higher than lawyers, businessmen, engineers.

This was true at one point in time. May be around 2 decades back. But
engineering has gotten very lucrative due to the IT boom, overall growth in
economy and general demand for engineers in a high growth environment.

Also engineering has a lower barrier to entry and pays better than what many
physicians make these days. To make anything decent as a doctor you have to do
your MD, which is expensive both in terms of investment of time and money. And
even after that, the job at the hospital won't pay you anything close to what
your average engineer at a MNC would get paid.

And then don't forget the fact that many engineers can make money through side
projects, freelancing and take adhoc risks like doing start ups which isn't
even an option to most doctors.

------
jostmey
Awhile back I was struck by the sprawling medical campus at my University (in
the US). First I passed by the original hospital, a large six story structure.
Then I passed the new Children's hospital, an even larger building. Finally I
walked by the latest building under construction - a twelve story behemoth
spread over several city blocks.

It seems that every few years a new building is added, and each one is bigger
than the last. Something about the pattern felt vaguely familiar. What I asked
myself also exhibits unrestrained exponential growth like the pattern of
construction that I saw - then I realized the answer. A tumor!

~~~
forca
I voted you up. What you say is disturbing and true. American medicine treats
the symptoms and intentionally strings people along rather than cure the
underlying cause. There is no profit in curing cancer -- only in the
treatments. I'm convinced of this after having a few people I dearly loved die
in the American medical system. We need more of a system whereby our taxes are
used solely for the good of the people -- to improve our lives. It's sad,
really. As much money as the US has, we could have the highest standard of
living on the planet, but we're nowhere near that because of greed on the
parts of tax-dodging corporations, greedy capitalists, and a whole host of
other reasons.

------
yummyfajitas
Her experience is the same as mine.

I've had most of my medical care over the last few years done in India. This
includes LASIK (34k per eye), a selective nerve root blocker injection (8k)
and a micro lumbar discectomy (85k). I expect to have a second discectomy done
in the next month (being really tall sucks), provided my condition doesn't
worsen and I'm able to fly.

Overall, my experience with India's medical system has been fantastic. I've
found clean hospitals (not all of them!), total price was all completely
transparent (+/\- 10% of quoted price), and the doctors have generally been as
good as in the US.

Overall, for anyone needing significant medical work done, I strongly
recommend medical tourism.

Also, while you are there, have a custom suit made (particularly if you are
really tall, and ordinary clothes don't fit). But be warned - I spent more on
my suit than on the root blocker injection.

[edit: numbers in INR. Quick reference: 1 lac INR = 1600 USD. In spite of a
few years worth of inflation, I don't expect to spend more than 2k USD on back
surgery.]

[edit 2: 1 lac = 100,000.]

~~~
dpeck
Are these in USD or INR?

~~~
voxic11
I love how they work out to be about what it would cost in both countries
using their own currency.

------
jeromeparadis
When he was born, my son had cardiac surgery. Had another one 4 months later
and a catheter later on. The two surgeries were done by one of the top 10
surgeons in the world. All in all, he was 6 weeks in the hospital. He's now in
very good health. Since we live in Canada, it costs us nothing except the
parking at the hospital (about $120 total with a pass) and the lost work time.

~~~
forca
Free as it ought to be -- payed for out of yours and everyone's taxes. Parking
should have been free, to be honest. Nothing I hate more than seeing basic
services turned into money-making opportunities for the shady.

~~~
RealGeek
Since Canada doesn't spend trillions in wars and bailing out banks, they can
afford to provide healthcare to it's citizens.

~~~
mahyarm
Actually, Canada pays less on a per citizen basis than the US does on it's
health care. America can still have it's wars, bank bailouts and health care,
if they weren't politically gridlocked with the issue.

------
tn13
When two parties mutually agree on some deal they both feel satisfied and have
incentives to make each other happy. When the government decides what is the
"interest" of one party and steps in to "protect that interest", very likely
it will end up pissing off one party which eventually loses interest in any
kind of innovation.

US has achieved the rare distinction of screwing up both the parties in case
of healthcare.

Indian government in reality has even more laws and nonsense but it is too
incompetent to implement any of those laws. This mostly leaves the things in a
Laissez-faire situation. Like it happens in any Laissez-faire situation the
third parties see too many problems but the people who are actually affected
are more than happy because they are a better judge of their situation.

In my village in India, we have only 1 doctor. This doctor is a homeopathic
doctor who even today charges Rs 10 ( $0.16) per visit. He spends less than 5
minutes per patient and his treatment is allopathic. He moved from a distant
city to this village purely because homeopathic doctor giving allopathic
medicine is illegal.

Over last 30 odd years not only he has got rich but he is the most powerful
person in the village. He is very good at his job, has saved countless lives,
delivered babies, removed aching teeth and written countless death
certificates. Yes, there have been cases of wrong diagnosis and side-effects
too but overall he has lead to net positive benefit to the society in my
village and hence is revered.

Many proper doctors tried to setup their shop in my village and have failed
purely because this doctor turned out to be better than them.

In India, Indian Medical Council controls the total number of doctors in the
country but for a bribe of around $2M you can easily get a license to start a
medical school. Medical Schools make insane amount of money and thousands of
poor people enter the hospital everyday where you can get away making mistakes
because the choice before these poor people is "either get this treatment or
die in your home".

------
tn13
Another Note: Unlike best engineers in India, best doctors in India can not
migrate to US. Because of the sheer population, Indian doctors see 4x more
daily patients than their American counterparts perform far too many surgeries
very likely to have seen more corner cases than American doctors.

Indian doctors in average private hospitals are far more competent than
average American doctors.

It is good that American government is protecting jobs of American Doctors at
the expense of public health by barring entry to Indian doctors. We Indians
get cheaper and better healthcare. :P

Disclaimer: I worked for a large Cancer hospital in India.

------
RealGeek
I moved to US last year, and figured the healthcare system in US is the
biggest train wreck. It is not only super expensive, but also super
complicated. You have to jump through many hoops likes insurance, appointment
waiting list, mail order pharmacies (who always mess up your order), pre-
existing conditions etc.

We were denied treatment by our insurance because of pre-existing conditions.
Thankfully, Obamacare fixed it and we began to receive healthcare in 2014.

The prices of healthcare are artificially inflated so high so that it is not
affordable for most Americans, so they can be forced into the bizarre health
insurance system. This system only makes healthcare even more expensive due to
administrative costs and make it complicated for everyone. There should be no
place for a middleman in healthcare.

I recently went to see a doctor for a non-serious problem, and here is how it
worked out.

Steps to get medical care in US:

1) Call a specialist's office for appointment, and you will usually get a wait
list of 3 to 6 months.

2) After months of wait, you get to see the doctor who will diagnose you.

3) Doctor sends in your prescription to your mail order pharmacy.

4) Pharmacy messes up your order; it could be incorrect dosage, pre-
authorization, incorrect billing etc.

5) Your medication is delivered to you after few days, sometimes it can even
take weeks.

6) You get bills, which could be 10x higher than what you were expecting. Your
insurance company provides no explanation of the mysterious charges.

Costs: $50 co-pay, $450 for prescription.

Insurance claims: $700 specialist, $2750 prescription.

Here's how it works in India:

1) Call into doctor's office, you will usually get appointment for same day or
next day. You can even walk in without appointment.

2) The doctor diagnoses you, and write a prescription.

3) You take that prescription to any pharmacy, and buy the medications.

Costs: $10 to $20 fee for specialist, and $20 for prescription.

No Insurance required

Edit: I've compared prices of various medications in US and India. Most of the
medications in US cost 10x to 20x more than India.

~~~
vonmoltke
> 1) Call a specialist's office for appointment, and you will usually get a
> wait list of 3 to 6 months.

In the past year I have seen both a dermatologist and an orthopedist for the
first time. I never had to wait more than a week.

> 3) Doctor sends in your prescription to your mail order pharmacy.

Mine have always gone to the local pharmacy of my choice. Same for my wife.

> 5) You get bills, which could be 10x higher than what you were expecting.
> Your insurance company provides no explanation of the mysterious charges.

I rarely get bills after the fact, but they always itemize and explain the
charges. I also get statements showing what my insurance company paid.

~~~
RealGeek
> In the past year I have seen both a dermatologist and an orthopedist for the
> first time. I never had to wait more than a week.

Appointment times vary by type of specialist, location and luck. I've never
got any specialist's appointment before a month here in New York.

> Mine have always gone to the local pharmacy of my choice. Same for my wife.

I tried sending the prescription to local CVS pharmacy. CVS said that my
insurance only approved medication for 1 month, while my prescription was for
3 months. Moreover, they were charging me 4x copay than the mail-order
pharmacy that works with my insurance company. I guess this is another tactic
of my insurance company to maximize their profit by forcing us to buy
medication from their partner pharmacy.

> I rarely get bills after the fact, but they always itemize and explain the
> charges. I also get statements showing what my insurance company paid.

My Insurance company's partner pharmacy keeps charging me random amounts for
same mediation. I've been getting few medications for $37 each since past 6
months, but now they suddenly starting charging me $185 each for the same
medications without any explanation. I could buy the same medications in India
for less than $10 each.

------
AndrewKemendo
I feel like there is a lot of beating the dead horse with this issue.

Is there (holding the jingoistic flag wavers aside) any real disagreement on
the conclusion that the US healthcare system is terrible for the average user
- such that we need continual reminder?

Didn't the whole ACA debate prove that yes, we get it it's broken and there is
major popular support for changes, even if the actual changes made were not
themselves popular by a plurality?

~~~
danielweber
Everyone agrees that it needs to change.

There is little agreement on _how_ to change it. Most proposed changes are
"let's gore the other side's ox."

~~~
rodgerd
> There is little agreement on how to change it.

That's because, generally speaking, the more collectivist proposals rely on
evidence from the many, many countries that pay less for healthcare per-capita
and get better outcomes, while the side that feels a more lassaiz-faire
approach are relying on an essentialy religious position.

~~~
danielweber
The former group also ignores countries like India and Singapore, and pretend
that there is just one kind of health-care system everyone else uses,
sometimes calling vaguely calling it "single-payer." People like Ezra Klein
desperately try to correct these people, to no avail.

And after all, why should they care to learn the facts? All they need is
enough buzzwords to call the other side stupid on message boards, and they are
perfectly happy.

------
forca
Great read. This just show how evil for-profit medicine really is. The fact
that the pay is so high in the west is disturbing. I really pray we see a
single-payer socialised system in our lifetime in the US. Growing up with
socialised medicine has shown me the truth. No doctor, no matter how talented,
needs to make what they do. All of this should be government run as a non-
profit. Government should mandate and force all pharmaceutical companies into
non-profit status as well for the good of mankind.

I'm sick to death of not being able to go to hospital here in the US, even
with insurance, because what with the co-pays and deductibles, it costs a
fortune. I just don't go, and I am in need of surgery that I cannot afford.

QUESTION:

Would an Indian facility in India treat me for a relatively small amount of
money? Even after the flights, it would still be cheaper than the $22k I've
been quoted here by multiple sources.

~~~
yummyfajitas
_Great read. This just show how evil for-profit medicine really is._

I think you mean how evil semi-socialized, heavily regulated medicine really
is. India's medical system is as close to free market health care as I've ever
encountered.

You walk into a hospital, ask the price, pay it. If you don't like the price,
you can go to a different hospital and ask them. If you have insurance, you
send them the bill afterwards. That's basically it, and most hospitals are
for-profit. In my experience, the government hospitals are significantly
dirtier than the private ones. Employer sponsored health insurance isn't a big
thing. Doctors who won't talk to you without insurance [1] are more or less
nonexistent.

Most likely an Indian facility can treat you. The cost is unlikely to be more
than 1 or 2 lac (e.g. $3k tops), depending on your condition. Throw in another
$1k for the flight + $1k for a decent hotel. If you want to learn more, send
me an email.

[1] In the US I'm willing to pay cash for care before treatment, but most
doctors won't talk to me. I'm told it attracts undesired regulatory attention.

~~~
snlacks
The U.S. insurance system is not semi-socialized on that part, it is a result
of collusion between hospital administration and insurance companies to
maximize profits instead of health of the nation. Corporatism keeps laws on
the books that reduce competition and take the decisions out of the hands of
patients and doctors and puts it into bureaucrats.

Medicaid and Obamacare are the socialization aspects, which try to work within
the Corporatist solution... we should have and should just tear the whole
system apart.

Too many good minds work in billing and adminstrative research and
development, not in medical development.

Disclaimer: I make medical billing and administrative software. I have a job
because of a broken system... I'd sacrifice my comfort for a better system.

~~~
yummyfajitas
The US insurance system is heavily tuned to make some people pay for others.
Employer sponsored insurance, together with accompanying regulations about
individual costs, is tuned to make sure the smoker and the healthy person pay
the same price. See also community rating in the private market. On top of
that, the US government pays more for it's own socialized medical programs
than most other nations do.

And this isn't even getting into all the ways regulations micromanage doctors
and other parts of the system. Not to mention micromanage financial services -
India actually has innovation in that space.

Any theories which claim that for-profit systems are horrible need to be
tested against the Indian system. It's mostly for-profit, free market, etc -
all the incorrect claims people make about the US are pretty much true there.

~~~
chrisbennet
_Employer sponsored insurance, together with accompanying regulations about
individual costs, is tuned to make sure the smoker and the healthy person pay
the same price._

That is kind of what insurance is for though - to level out the cost for
everyone.

It's a common misconception that smokers cost society. The truth is, smokers
die earlier and cost tax payers less in insurance benefits and health care
than non-smokers. [1] We should be encouraging people to smoke if we want to
save money. (I'm joking!)

[1]
[http://www.plosmedicine.org/article/info:doi/10.1371/journal...](http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050029)

~~~
yummyfajitas
_That is kind of what insurance is for though - to level out the cost for
everyone._

No, the point of insurance is to reduce the variance of an individual's future
cost. Due to the law of large numbers, averaging across independent
identically distributed people is equivalent to averaging over the future, but
that's a side effect.

Averaging over independent non-identically distributed people is NOT part of
insurance at all - that's what I'm describing as "the socialist part".

An example illustrating the difference - say you have 10 dice, and if a die
rolls a 6 it costs $1,000. You also have 10 coins, and if the coin comes up
heads, it costs $1,000. Insurance is when you charge the dice $166 and the
coins $500. Socialism is when you charge everyone $333 - that's redistribution
from the dice to the coins.

The link about smoking costs is interesting, however that applies at the level
of government paying for lifetime costs. Annual costs are higher. So insurance
_for this year_ should cost the smoker more than the healthy person.

------
discardorama
This reminds me of the case of a friend (who is from India) who went on
vacation to India. There, something went wrong and he suffered a herniated
disk in his back. He immediately went to the hospital. They took an MRI, and
advised surgery. He underwent the surgery, and then had a 1 month stay at home
with a nurse in attendance. Total cost came to about 200,000 rupees (about
$4000).

He came back to the US and then told the insurance company what had happened.
(He didn't know he had to inform the company when it happened). They balked at
paying his expenses, and came up with all sorts of excuses. Then he told them
the cost: $4000. The person he was talking to told him was shocked, saying
just an MRI here would have cost them more. They asked him to get an post-
surgery evaluation done by his primary physician, and paid the bill no
questions asked.

------
induscreep
But India is 24 hrs away by flight. If there was a list of countries with the
flight duration and cost of medical care, what countries would lie on the
Pareto front? What if you sorted by a "$-hr" metric?

~~~
mahyarm
You hear good things about Thailand and some South American countries.

------
it_learnses
We should still consider the fact that the author has a husband who's a
doctor, and has family from India and is herself from India. Not sure if the
costs would be the same if someone who hadn't been to India in a while or had
no family were to go to seek treatment. Someone could easily take advantage of
you and you'd hardly have any recourse.

~~~
yummyfajitas
I have no relatives in medicine (my sister trained as an EMT, but doesn't work
as such), I'm not from India and have no family there. They've been pretty
straightforward with me. The price they give me comes out of the same price
list as the price they give to everyone else.

Also, if they rob you it's still a great deal. Do you really care a lot
whether you spend $1k or $2k on surgery?

I haggle with autowallahs on principle, not because I care about paying 30rs
extra.

------
cdnsteve
Thank you for sharing. Not only cost is important but people seem to forget
about waiting times, the silent killer.

------
kr_60642
i am an indian living in the US for more than 10 years. Costs are cheaper in
India and the big hospitals usually have good quality care. The problem is
what happens when you have complications or side effects. In the US, you can
sue the hospital/doctor and expect to get paid. You can't do that in India
(cases drag on for decades).

------
zackmorris
Had a similar case with someone in Nicaragua. The procedure (including
diagnosis, medication etc) was $3,000 there whereas it would have been at
least $30,000 in the US. I think it goes well beyond cost of living
comparisons, because most things there cost perhaps 2-4 times less than here.
Even if we factor in that per-capita medical costs in the US are roughly
double the rest of the developed world ($6,000 vs $3,000) there is still
another multiplier of perhaps 2-3x for procedures.

I’m becoming more convinced every day that the US has become a two-tier
society. I (and many of my friends) have had some very lean years, earning
perhaps $7-15,000 and surviving. During those times, saving even $3,000 was
next to impossible, because we were already $5, $10, $20,000 in debt or more.
Multiply that by 10 and it’s effectively out of reach for, I don’t know, 90%
of the country. The standard deductible (which is looking like it’s going to
be about $6,000 under Obamacare) will often mean the loss of a home, vehicle,
or college savings, especially for chronic conditions.

Meanwhile the people who determine these rates (doctors, hospitals, medical
supply companies, insurance agencies) enjoy comfortable incomes of $50, $100,
$250,000 or more. I don’t think they are capable of setting rates ethically.
Throw in the fact that aging people are desperate and will basically pay
anything to live longer, and it’s an unavoidable conflict of interest.

I think the simplest solution to all of this (and probably the most
controversial) is to decouple medical research from practice. Ban all
medicine-related patents. Create low interest government matching funds for
the loans provided by supply companies to dentists and other independent
practitioners. Remove the regulations that prop up monopolists and rent
seekers. Start reducing the administrative layer that adds so much cost but so
little quality of care. Then protect doctors from frivolous lawsuits with a
bond system like plumbers and electricians use for catastrophic accidents so
they can perform the procedures they feel are needed instead of the ones
deemed “safest” or most profitable. Go after the true medical costs, the Erin
Brockovich type of coverups that cost the economy billions. And especially go
after the sources of illness - radiation from burning coal, carcinogens
released by fracking, a hamstrung FDA that doesn’t have the resources to test
interactions between thousands of household chemicals, carcinogenic herbicides
and pesticides used on genetically modified food, and so on.

I’ve heard the standard arguments about how all of this might disincentivize
medical research but I don’t buy them. The system we have now rewards
treatments more than cures, as evidenced by big pharma ads on TV for
irritable-whatever. If we really want to start over, we need to go back to
pre-Nixon, before HMOs and profit-driven care. We need to spend substantially
more on medical research than we do now (rather than practice), through
universities and big-data approaches where biologists and chemists can run
simulations and avoid human trials. Dump the current grant system and make
funding far more accessible so researching don’t spend all of their time
fundraising.

If we do all of this, we may just have a shot at cracking the underlying
mechanisms that cause illness, basically map every virus and bacteria, the
mechanisms through which genes control proteins, how we age and repair damage,
etc etc. We should be growing replacement organs by now. We should have cured
chronic conditions like diabetes and arthritis years ago and gotten cures for
allergies, asthma and autism for free since similar pathways are at work.
Right now we are doing little to no prevention, charging just enough to keep
people from going to the doctor at early stages of illness, and then charging
an arm and a leg for the medical equivalent of disaster cleanup. It’s really
quite remarkable, and sad.

~~~
ceejayoz
Generally agree, but a couple quibbles:

> protect doctors from frivolous lawsuits with a bond system

Malpractice suits only make something like 1% of healthcare costs, and
malpractice insurance is already everywhere.

> big-data approaches where biologists and chemists can run simulations and
> avoid human trials

We don't know enough about the human body to be able to accurately do this.
Might help for initial tests (and already does, I'd imagine), but you still
always need clinical trials.

~~~
danielweber
_Malpractice suits only make something like 1% of healthcare costs, and
malpractice insurance is already everywhere._

This isn't measuring the right thing. Pretend that some lawyers managed to win
a case locally that the "standard of care" for a shoulder injury was an MRI,
even through there is no medical reason, because a bunch of doctors in one
hospital did it for whatever reason.

Now all the doctors in town rapidly move to MRI'ing every shoulder injury so
they don't get sued. This doesn't show up in the malpractice premium numbers.

"Standard of care" is strictly a one-way ratchet. If enough doctors in your
town/county/field do something, you have to do it, too. You can have
comparative results research as long as your arm showing it has no benefit
(and even creates slight radiation risks) and it won't do you any good.
"Standard of care" is the legal term of art, and it always increases, never
decreases.

Two more pieces of evidence that lawsuits matter [1]

1\. Vaccine manufacturers were going to stop making vaccines because the
lawsuit risk was getting too high. (Vaccines do have risks, although minor.)
The vaccine courts were set up and everyone seems pretty happy with it.

2\. Hillary Clinton's health care plan from 1993 had a whole bunch of tort
reform. This is _not_ because the Clintons hated trial lawyers! But they
didn't want the courts to be the ultimate arbiters of how much medical care
someone should get. You would not be allowed to sue for malpractice without
first going through an arbitration process.

[1] I'm not blaming everything on lawsuits. But you couldn't run an NHS-like
system privately in the US.

------
lizzard
I hope she knows all the lyrics to The Ramones' "Teenage Lobotomy".

"Then I guess I'll have to tell 'em / That I've got no cerebellum."

[https://www.youtube.com/watch?v=6ssoBUb2cJk](https://www.youtube.com/watch?v=6ssoBUb2cJk)

~~~
danielweber
You can delete your own posts.

