Comment by Consultant32452 | Hacker News Reader

Comment by Consultant32452 | Hacker News Reader

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Consultant32452

Causes of price inflation and the looming demographic crisis are not "abstract ideas."

For literally decades the US did not open a single medical school due to lobbying from the medical industry. Even though we've tried to reverse the trend since the 90s, there are still fewer medical schools today than there were 100 years ago. When the government decides how many doctors there will be, it may get the number right or it may get the number wrong. But that's nothing akin to "free market-like." And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.

During the New Deal era regulations wage caps were put on workers in the hopes of staving off inflation. Employers, wanting to entice good employees to work for them sought to get around these wage caps by offering health insurance. This then spread like wildfire, coincides with the time healthcare inflation separated from general inflation, and began the trend towards a lack of price transparency.

Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability. Americans are very obese. Not having to pay a copay to visit the doctor is not going to change that. But obesity means we'll have more problems with newborns, lower life expectancy, etc.

Start with the data!

> there are still fewer medical schools today than there were 100 years ago... it may get the number right or it may get the number wrong... And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.

http://www.nationmaster.com/country-info/stats/Health/Physic...

> Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability. Americans are very obese. Not having to pay a copay to visit the doctor is not going to change that. But obesity means we'll have more problems with newborns, lower life expectancy, etc.

https://obesity.procon.org/view.resource.php?resourceID=0043...

> During the New Deal era regulations wage caps were put on workers in the hopes of staving off inflation. Employers, wanting to entice good employees to work for them sought to get around these wage caps by offering health insurance. This then spread like wildfire, coincides with the time healthcare inflation separated from general inflation, and began the trend towards a lack of price transparency.

Except, of course, in the countries where it didn't spread like wildfire. Why all this crazy post-hoc history-building when you can just... empirically observe how the natural experiment played out?

Your modus operandi in this thread is the start with an ideology and then derive conclusions that are often wholly inconsistent with observed reality. There's nothing wrong with premises or theory-building, but when the data flatly contradict your conclusions... well, that's the difference between reality and fantasy.

>http://www.nationmaster.com/country-info/stats/Health/Physic....

By your link we're 52nd in doctors per capita. That's not great. Plus I'd already noted that we've made a concerted effort to undo the damage since the 90s. Are you suggesting that supply and demand has no impact whatsoever on the wages doctors are capable of demanding? Do you believe that artificially restricting the supply for decades has had no impact on wages whatsoever?

>https://obesity.procon.org/view.resource.php?resourceID=0043....

https://medicalxpress.com/news/2018-01-mortality-obesity-sta...

But obesity is not the only issue, general issues related to poverty are:

https://www.newyorker.com/tech/elements/why-america-is-losin...

Higher adolescent pregnancy rates, higher rates of HIV, etc.

=== Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.===

So best case scenario access and affordability to healthcare accounts for about 25% of improvements in life expectancy. Except the majority of people already have access to healthcare in the US. It's not as available and affordable as we'd like, and we're talking about how best to improve availability and affordability, but it's a tiny fraction of the problem of why US health outcomes are so bad.

It's clear you still don't understand my critique.

> By your link we're 52nd in doctors per capita. That's not great.

I think this sort of argument is innumerate. Statistical sciences provide us with many ways of testing the correlation between "value of care per dollar spent" and "average doctor salary".

None-the-less, I am tempted to point out that Cuba is #2 on this metric ;-)

Regarding the rest of your post, consider actually reading that New Yorker piece. The things you think it says, it DEFINITELY does actually not say.

== And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.==

That is a nice thought, fortunately NPR has done the actual reporting on this. It seems like the answer is government interference [1]:

"But the biggest reason German health costs are so much lower, experts say, is that doctors are paid less. This largely reflects Germany's concerted efforts to keep costs down over the past two decades."

On administrative costs it seems like government mandates on benefits and payment rates keep those costs 50% lower. Also, they have an employer-based system:

"On top of that, administrative costs are almost 50 percent lower. That's not because the German health system is simple and streamlined. With its employer-based system, multiple insurers and ever-changing rules, German health care is as complicated in many ways as the U.S. system. But administration is much simpler because nearly everybody gets the same benefits, payment rates are uniform and virtually everybody is covered."

==Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability.==

You have provided no evidence to back up this claim. What makes you so certain that it's true?

==Not having to pay a copay to visit the doctor is not going to change that.==

Might this encourage more people to visit health providers more frequently? This might lead to earlier detection/treatment and lower long-term costs. Why have you dismissed this potential outcome?

[1] https://www.npr.org/templates/story/story.php?storyId=919310...

>"But the biggest reason German health costs are so much lower, experts say, is that doctors are paid less. This largely reflects Germany's concerted efforts to keep costs down over the past two decades."

Yes, this supports my statement. I said the medical lobby has artificially constricted the supply of doctors. Limited supply means higher wages. I'm not familiar with the German system, they may have done other things such as price fixing to keep wages lower. Personally, I'd prefer having "too many" doctors. This would give me more personal choice to choose the one I like the most while simultaneously keeping prices reasonable.

>You have provided no evidence to back up this claim. What makes you so certain that it's true?

Here's the first article that came up when I googled the subject. https://www.newyorker.com/tech/elements/why-america-is-losin.... It talks about issues of poverty, adolescent pregnancy, etc.

===Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.====

>Why have you dismissed this potential outcome?

As noted above the majority of improved health outcomes are not the result of access to healthcare at all. Let's be generous and use the highest percentage in the stat provided above: 25%. So now we're only at 25% of healthcare gains at all, and the fraction of that that isn't actually affordable either by the individual themselves, through their insurance coverage, or provided by charity. We're talking a really tiny fraction of gains here.

> Here's the first article that came up when I googled the subject... [cites article laying down the case for increased social welfare funding, which doesn't even justify the stated claim]

Oy... talk about (not quite) winning a battle but losing the war.

Also, this whole methodology toward argumentation just reinforces the top-level critique. The important word in "start with the data" is not "data", it's "START". I.e., begin by understanding the problem. Then solve the problem. Don't walk around with a hammer trying to bash things.

== I said the medical lobby has artificially constricted the supply of doctors.==

In the free market, money equals influence. As long as AMA determines who is/isn't a doctor, they have an incentive to make it as hard as possible to become a doctor.

==The rest has come from changes in the social determinants of health, particularly in early childhood.==

Now you have to prove that free and easily accessible access to health care won't have a positive impact on the social determinants of health. It stands to reason that part of America's reluctance to visit doctors is rooted in the historical costs associated with visiting doctors. If we can remove that stigma through cheaper and more accessible care, it stands to reason that we can improve the social determinants of health over the long term.

Here's an example: In Canada, one can visit a dietician as part of their health insurance, this could have a positive impact on obesity, which would lead to healthier population.

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