dagblog - Comments for "The Actual Reason Markets Do Not Work In Healthcare is... Pain!"

https://www.nytimes.com/2016

Peter Schwartz — Sun, 15 Jan 2017 18:32:31 +0000

In reply to The Actual Reason Markets Do Not Work In Healthcare is... Pain!

https://www.nytimes.com/2016/12/19/upshot/price-transparency-is-nice-just-dont-expect-it-to-cut-health-costs.html

And that doesn't even include

Peter Schwartz — Sun, 15 Jan 2017 17:01:46 +0000

In reply to Even with something as simple

And that doesn't even include the time it would take you to be in a position to evaluate what each doctor tells you. "Yes, you need this." "No, you don't need that." "Well, why is that?" "I'm sorry, I have someone waiting for me (with real work for me to do). Hope to see you when you've made your decision."

Not impossible, but so many obstacles are in the way, especially if you're not well educated, or even if you are.

Even with something as simple

ocean-kat — Sun, 15 Jan 2017 04:13:35 +0000

In reply to You make the perfect case for

Even with something as simple as a damaged arm it's nearly impossible to shop around. First you need to go to a doctor (for free?) to get authorization for an X-ray. Is it a bad sprain, a torn ligament, a simple fracture, compound fracture? Do you just need to set and cast it or will it require surgery? Then you'd need to take the x-ray to a few doctors to get a price quote. Are they really going to examine that arm and x-ray for free to give you a quote? How long would it take to get a few doctor appointments to have them give you a price quote. You might be walking around with a broken arm for a few days just to see the doctors to give you the quote.It's not like calling a few garages and asking how much they charge to replace an alternator. Like Mike said, shopping around for some elective procedure might be possible but not when a person is in distress.

Very funny. Also cheap. But

Flavius — Sun, 15 Jan 2017 03:38:26 +0000

In reply to Brooks? Oh boy Oh boy...

Very funny. Also cheap. But that's OK. It's hard to resist the temptation to make fun of Brooks. He's such a maddening combination of clear gentility and cluelessness. Or as a friend says in terms dripping with sarcasm "A sociologist" !. Anyway , he's the only person I know besides me who's actually read tKenneth Arrow on why the invisible hand metaphor is completely inapplicable to health care . Which is all demand, no supply.

Like the guy who slips and falls off a cliff. Grabs a root and dangles over a thousand feet of space.

Is anybody out there? He shouts

A deep voice:

I'm here my son

Oh ,thank God .

You're welcome.

And who are you?

I am the only person on whom you can rely now.

Thank you thank you. And what are we going to do ?

Let go of the root.

Let go of the root?

Let go of the root.

And drop a thousand feet?

Trust me, my son.

And let go of the root?

Yes.

Is anybody else out there?

Well stated. Repeal and

NCD — Sun, 15 Jan 2017 03:05:29 +0000

In reply to You make the perfect case for

Well stated. Repeal and replace is a Republican con job.

ACA is a law, you can amend it or strike sections of it. You don't repeal the entire tax code or traffic laws to change them.

The replace is the con. Snake oil.

It is eventually going to fail 56 million Americans with preexisting conditions as underfunded 'risk pools' don't work.

The only goal of the GOP is eliminating taxes, especially the 3.8% unearned income tax on 250k incomes and up. The Center on Budget and Priorities says that tax break alone will, just for the richest 400 households, eliminate the entire ACA subsidies for just.under one million families in 20 states.

You make the perfect case for

CVille Dem — Sun, 15 Jan 2017 01:22:57 +0000

In reply to Perhaps I wasn't clear. I was

You make the perfect case for universal health care. Only if there is a pool of the young and the old; the healthy and the ill; can health care dollars be spent effectively to cover everyone.

The problem is that republicans don't WANT to cover everyone. They simply don't care about those who are in need because they see those who are in need as less than deserving. They believe that because they have landed on 3rd base, they made it happen and everyone else is a loser.

The whole concept of health-care consumers going on-line for pricing is ridiculous and ignorant. A good health-care consumer might go to the Cleveland Clinic, UVA, Johns Hopkins, etc to find out what the latest thoughts are about their rare illness; they might check to see who has done the most of these procedures with the best outcomes, but NO ONE is going to find the cheapest alternative to the surgery that they need!

These ridiculous GOP talking points make me want to confront them face-to-face. They are just liars and scare-mongers. I am so sick of it!

Perhaps I wasn't clear. I was

Peter Schwartz — Sat, 14 Jan 2017 23:45:54 +0000

In reply to If you think about national

Perhaps I wasn't clear. I was trying to explain why a market-based approach to providing health care is inappropriate. HC is a different kind of product from, say, a car. With cars, we don't worry that working class people can't afford a car with all the bells and whistles, i.e., a Cadillac. Cadillacs are built for wealthy people in general, and there are new and used cars for people who can't afford a Cadillac. So the various levels of car are aligned with people's needs and ability to pay for them.

With HC, this is not so. People who genuinely need the equivalent of Cadillac HC--very expensive, high tech-- are often the people who are least able to pay for it. It would be as if--somehow--car manufacturers built Cadillacs to sell to poor people. Put more simply, poorer people often have poorer health and need very expensive treatments and drugs to live. There is no health care in their "price range" as there is with other kinds of products or services, e.g., starter homes and apartments instead of mansions, row boats instead of yachts, the Gap and Goodwill instead of Armani, and so on.

My thesis is that with these other kinds of products, there is generally a price point for every pocketbook. And you can often make do with less or spend time shopping for a bargain. This isn't true with HC where those who can least afford HC are the ones who need the most expensive HC. And when you need an operation, you're in no position, really, to spend time shopping for the "best deal," and it's somewhat hard to imagine an open-heart surgery that would be the equivalent of a Pinto.

Maybe you forgo a private room with T.V., but you're not going to forgo anesthesia or fewer operating nurses in the OR than are needed or are wise for a successful outcome or sterilized instruments or anything else that might compromise the procedure and your health. No doubt there are ways to save money on certain aspects of a heart surgery. Eliminate certain "nice to haves" that aren't necessary strictly speaking. Or maybe you endure a little bit more pain to save on X. I don't know.

All the examples I've read about where surgeons are making do with less are horrific, e.g., they run out of anesthetics, so the patient, literally, bites the bullet.

It's Paretto's curve, by the

PeraclesPlease — Sat, 14 Jan 2017 08:02:33 +0000

In reply to "Five percent of the

It's Paretto's curve, by the way. And yeah, it's 5% to cover half the population (that doesnt need it) and 20% to cover 80% of the population) and 100% to cover everyon, including those who really really need it.

We can base our system on missing the seriously sick and risky, and save a ton of money for more wars and tax breaks for vot suppressors and other whoop-de-do. I think Jesus said the poor and sick will be with us always, so we have an out clause. Wheeee! I like this curve, like a carnival slide.

Brooks? Oh boy Oh boy...

oldenGoldenDecoy — Sat, 14 Jan 2017 06:48:45 +0000

In reply to I know there are people who

Brooks? Oh boy Oh boy...

Dr. Brooks... Dr. David Brooks. Please report to the Vivarium. The orangutan cage is in need of cleaning.

From: A Nose Embedded in the Noise

~OGD~

I know there are people who

Michael Maiello — Sat, 14 Jan 2017 02:34:22 +0000

In reply to I've thought this for some

I know there are people who are neurotic doctor see-ers, who go because they're lonely or need someone to "take care of them." But for the most part--especially men--don't relish the idea of going to the doctor.

Yeah, we have this whole debate as if doctor visits are some sort of desirable leisure activity. When I go to the doctor, it's serious enough that I needed to go to the doctor. My doctor's opening line is always, "Why didn't you call in days ago? Why did you suffer like this?" Because I was hoping it'd go away so I wouldn't have to be here is why!

The only circumstances I can think of where a carte blanche approach would be a problem is 1) if my insurance covered elective procedures and the technology existed for me to painlessly optimize myself or 2) if I contracted some unknown or incurable condition and, to treat it, demanded limitless tests and experimental treatments. Well, issue 1 is not even in the cards. As for issue 2 -- I'm all for it. In the event that only unlimited and unhindered treatment has any chance of saving me or alleviating me from pain, that is what I want. Otherwise, I want the bare minimum to fix the problem and I mostly want the problem to fix itself.