

To the young brilliant minds - galactus
http://scripting.com/stories/2011/04/11/toTheYoungBrilliantMinds.html

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yummyfajitas
Health care is expensive, limited, and must be rationed. Not everyone can have
as much as they want. There simply is not enough to go around. In the US, this
rationing process is done by price, and by insurance companies. In other
countries, this is done by govt bureaucrats.

No rationing system can change this fundamental fact: some people will die
because we don't have the resources to save them.

I don't know why the author can't believe it has come to this in the US. Does
he feel that the laws of scarcity should not apply, simply by virtue of
American Exceptionalism?

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rdtsc
> No rationing system can change this fundamental fact: some people will die
> because we don't have the resources to save them.

Don't agree. If access is free then a lot of preventative care can be done in
order to not have to conduct expensive critical and emergency procedures.

People in this country don't go to the doctor because they may or may not end
up owing sums of money ranging from $0 to many hundreds of thousands,
depending on the combination of provider, doctor, insurance policy, state and
federal laws. So people just stay away. Until they have a heart attack, or
cancer is in the terminal stages then they are rushed to emergency and then
guess what happens -- a very expensive procedure probably needs to be
perfomed. So not very surprising that health care is expensive.

But let's take from another point of view. You say it is expensive. But how
come Scandinavian and many European countries manage do provide it? Could it
be that we just spend everything on defense (well...I personally called it
offense but let's keep it official here) -- more than all the countries in the
world combined? Do our doctors and medical supplies companies charge insane
prices? I don't know the answer, but I know it has been done in other
countries, and it is currently better than here. So it seems like it is
possible.

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yummyfajitas
_Don't agree. If access is free then a lot of preventative care can be done in
order to not have to conduct expensive critical and emergency procedures._

Preventative care also consumes resources. A doctor can only perform 8-10
hours worked / (duration of preventative procedure) preventative procedures
per day. The number of doctors is limited. Thus, the number of preventative
procedures is limited.

You might be right that the US is currently not at the optimum. Insurance
companies try very hard to find a better optimum - they stand to gain millions
if they can find it. But that doesn't change the fact that doctor hours are
limited.

The OP didn't say that the US had a suboptimal system relative to some other.
He merely criticized the fact that medical care is a scarce resource and we
can't all have as much as we want.

 _But how come Scandinavian and many European countries manage do provide it?_

Scandinavian and European countries provide unlimited medicine to whoever
wants it? That's news to me. Do you have evidence for this?

Also, if Scandinavia and Europe have reached the singularity, and now live in
a post-scarcity world, how come they are still poorer than the US? How is it
possible that their singularity only works for medicine?

 _...it has been done in other countries, and it is currently better than
here._

Do you have evidence for this? So far, in spite of asking this many times, I
see very little that is convincing. All I see are life expectancy gaps
comparable to the life expectancy gap between people who eat leafy green
vegetables and those who don't, and studies from the WHO that give more weight
to inequality of marginal costs than to actual medical care provided.

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loire280
_Preventative care also consumes resources. A doctor can only perform 8-10
hours worked / (duration of preventative procedure) preventative procedures
per day. The number of doctors is limited. Thus, the number of preventative
procedures is limited._

Maybe doctors shouldn't be doing preventative care. Surely you don't need a
Ph.D in medicine to perform and interpret blood tests, monitor blood pressure,
take some measurements, and conduct an interview. If there are serious
symptoms or something that doesn't respond properly to changes in diet,
exercise, or simple medication, escalate to a doctor.

Specially trained nurses could be filling these roles much more cheaply,
freeing up doctors' time for activities that require their training and
experience.

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warrenwilkinson
I agree. The only thing standing in the way is state licensing. The AMA
lobbied for medical practitioner licensing in the earlier 1900s on the grounds
that they would set high standards for future doctors. The end result was
different:

"The licensing boards in each state soon began refusing licenses to health
professionals who had not been trained at one of the 'approved' medical
schools. Only half of the existing medical schools were approved, so most of
the others had to close their doors by 1920. By 1932, almost half the medical
school applicants had to be turned away. Those who apprenticed, went to
unapproved schools, or developed their own therapies were stopped- at
gunpoint, if necessary- from healing. As a result, the number of medical
doctors per 100,000 people dropped from 157 in 1900 to 125 by 1929.
Specialists, such as midwives, were usually forbidden to practice unless they
had a full-fledged medical degree."

Source: <http://www.ruwart.com/Healing/chap5.html>

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RyanMcGreal
It doesn't matter how often I come across it or from which direction: I'm just
flabbergasted that the USA doesn't have universal health care.

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rick888
I'm flabbergasted that Europeans won't admit that it's a failing system. Both
France and Sweden need to scale back their systems because it's just not
efficient or cost effective.

I know it's just anecdotal evidence, but everyone I know from Canada that has
had to get any major surgery has come over to the US. The reason? the waiting
list is too long (in the years). Most universal health care advocates will
deny this, but I just can't ignore it when I've seen it happen so many times.

I would rather have a system with no insurance companies that we paid for
ourselves. This way, Doctors would be forced to charge affordable rates.

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grhino
Great point. Right now, doctor's have to charge twice what they expect to be
reimbursed by insurance companies. So, an individual who chooses to buy health
care without a health insurance provider has to pay twice what doctor's even
expect to get. I don't even think doctors get any reduction in transaction
costs when dealing with large insurance companies over individual patients. In
a lot of ways, it seems like doctors have to deal with the large insurance
company and the individual patient.

Health insurance in the US is more like a payment plan to join a health-care
purchasing group than health insurance. What's worse is that your purchasing
group choice is chosen by your employer.

I think there's a serious reduction in job mobility because the US has chosen
to provide tax incentives when health insurance is provided by the employer,
but not when an individual purchases those.

~~~
yummyfajitas
_Right now, doctor's have to charge twice what they expect to be reimbursed by
insurance companies. So, an individual who chooses to buy health care without
a health insurance provider has to pay twice what doctor's even expect to
get._

The second does not follow from the first. What usually happens is doctors try
to rip off the insurance companies as best they can (and the insurance company
does the same to them), but prices magically become reasonable when you
mention you don't have insurance.

Doctor bill: $100 splint (her finger taped to a piece of wood), total bill
$350.

My uninsured mom: "This is ridiculous. You can keep it, I'll just have my son
duct tape me to a dowel."

Billing girl: "Oh, you don't have insurance? I'm so sorry, my mistake. It'll
be $75, let me print you a correct bill."

(I don't recall exact numbers, but that was the rough flavor of the
interaction.)

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Retric
Talk with some private practice doctors some time. They often spend about as
much time dealing with patents as they do with the insurance company. As to
the initial bill, they need to inflate it because the insurance company will
always try and drop the price on something. It's the same game purchasing
departments at large company's play where it's easier to buy something for 75$
after the 25% discount than 500$ without a discount.

~~~
Retric
Ops, 750$

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johngalt
Taking everything this article says at 100% face value:

1\. You will get expensively sick when you get old

2\. Insurance carrier will try to kick you out and not pay for hospital stays.

If getting old and having $500k operations are certain for everyone, then
wouldn't a better bet be for everyone to save their money? If all of this is a
certainty why have the insurance as the middle man? Save your own money, and
then don't deny yourself coverage.

More realistically, what alternatives exist? There is nothing that changes the
cost of the expensive operation. A single payer NHS doesn't change the amount
of money operations cost.

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dbfclark
A single payer NHS actually does change the overall cost of healthcare: the UK
pays about half as much per person as the US does for its healthcare system as
a whole with no noticeable difference in measured effects.

The reason is simply market forces: people import drugs to the US from Canada
because the power of single payer there changes what pharmaceutical companies
can charge Canadians for drugs. The UK pays less for drugs, doctors, the whole
shebang. Operations are cheaper in the UK and Canada (not to mention the rest
of the world, which is more extreme in general), period.

The takehome point is simple: pretending that consumers must be price-takers
for any good as vital as healthcare entitles producers to arbitrary profit. I
hope not to spend all my savings on healthcare and my best hope is to get some
kind of market power, be that from an insurance company or the government.

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johngalt
I don't believe adding more layers of bureaucracy between me and the
person/company providing my care will ever result in better treatment net.

Countries that do use the Walmart approach to healthcare are piggybacking on
innovations that wouldn't happen otherwise. Pfizer may not fund a new drug if
every government in the world thinks it should sell at 10% above costs.

Additionaly there are other regional differences in pricing between the US/UK.
A better comparsion would be the performance of the federal health programs we
have now. What kind of treatment are patients at the VA hospitals getting?

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wyclif
Anyone who bills himself as "the father of blogging" really ought to figure
out how to make their blog available under high load.

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sudont
I _think_ this might be a
mirror:[http://scriptingecho.wordpress.com/2011/04/11/to-the-
young-b...](http://scriptingecho.wordpress.com/2011/04/11/to-the-young-
brilliant-minds/)

~~~
galactus
There is also:
[http://s3.scripting.com/stories/2011/04/11/toTheYoungBrillia...](http://s3.scripting.com/stories/2011/04/11/toTheYoungBrilliantMinds.html)

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scotth
To the brilliant young Americans.

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j_baker
Thank God. I thought this would be another condescending post about how kids
these days think they know everything and just need to learn how to listen to
their elders because they know everything.

