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Comment by markvdb | Hacker News Reader

Healthcare and profit don't go together. This is just exhibit n° 31415926535897932384626433.

What happens in the software world when you see twentyseven useless levels of abstraction? Exactly the same. You smell a rat.

In my ideal world:

* Healthcare research funding to come from the public sector and donations only.[0]

* Healthcare products can only be sold once the production process is verifiably fully publicly documented. This means independent reproduction by multiple reputable non-profits.

* Market based generics manufacturers handle production. Competitors (for profit or non-profit) jump in if pricing gets out of hand.

* Healthcare education free to students.

* Only non-profit healthcare services allowed.

* Compensation for people providing healthcare services is linked to median income.

[0] This is not such a big difference as one would think, as more than half of the basic research in the field is actually publicly funded already.

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>Healthcare research funding to come from the public sector and donations only.

And I suppose the public will indirectly vote on where research goes and where it does not? I don't trust any party in power to have a monopoly on healthcare research without a private sector counterbalance. But I'm open to reconsidering the current allocation.

I was watching some NASA scientists ask the federal government for money on C-SPAN and the NASA people said that they decide what research to fund by surveying the scientific community. I forget what they call the system exactly.

EDIT: I found it. They use something called a "decadal survey"

https://science.nasa.gov/earth-science/decadal-surveys

I would trust the group of folks NASA is surveying MUCH more than the general public, even when it came to healthcare.

The freedom to research would stay! If anything, researchers should have more freedom to research. An example.

Imagine a researcher invents cheap medication that obviates the need for some kind of eye surgery.

What would happen now? Surgeons don't like it, insurance companies don't like it. It might never catch on. The silly researcher certainly wouldn't get rewarded for his idiotic idea.

What would happen in an ideal scenario? Better health with less side effects for the patients. Cheaper for the community.

Exactly. Institute proper nutrition at school lunch programs and easy access to clean water throughout the day, and watch what happens to healthcare costs, dental costs, test scores, etc. It costs more, but society currently pays the cost later times ten.

Same with sunlight to prevent the onset of myopia, etc. These are things we already know about and can have huge impact, but it's politically infeasible to solve these problems correctly.

> Only non-profit healthcare services allowed

Honestly, this isn't necessary, as long as you have single payer (or close to it). When the government is the one paying for 99% of healthcare, they have huge clout enforcing razor-thin margins and high efficiency on the provider side. Just look at how the massive supermarket chains are able to keep the margins of the upstream supply chain at a minimum.

> Honestly, this isn't necessary, as long as you have single payer (or close to it). When the government is the one paying for 99% of healthcare, they have huge clout enforcing razor-thin margins and high efficiency on the provider side. Just look at how the massive supermarket chains are able to keep the margins of the upstream supply chain at a minimum.

The problem is that governments don't work that way. When a purchasing officer at a business negotiates a lower price he gets a large bonus. What does a Congressman get when he negotiates a lower price, compared to what he gets (from the people he's negotiating with) if he "negotiates" a higher price? What about the government bureaucrat who will be working in that industry soon? That is the problem.

Meanwhile who is more knowledgeable about produce if you have a question, the staff at Walmart or the farmers at the local farmer's market? It's easy to order cost cutting from the top of the tower, but if you don't know what's happening on the ground, you don't know what you're actually cutting.

What you need is for people -- the people who are actually consuming services and can choose to go somewhere else if the price is wrong -- to be able to choose based on published price information. The argument people sometimes make about this is that you don't get to choose which hospital an ambulance takes you to when you're unconscious, but the majority of healthcare spending isn't that, and that doesn't explain why we have no price transparency for non-emergency surgical procedures or diabetes or cancer treatment.

> The problem is that governments don't work that way

Well, they can... Just look at France. Amazing healthcare, a lot of it private, relatively cheap

> What does a Congressman get

Nothing, they don't negotiate

> What about the government bureaucrat

A performance bonus, a raise, a promotion? Just like any other organisation?

> What you need is for people to be able to choose based on published price information

OK, go and buy a pound of ground meat. Or an LCD screen. Are you seriously telling me you can get a better deal than McDonalds or Apple?

> What you need is for people to be able to choose based on published price information

What they're saying is that a large amount of healthcare spending is driven by patients and providers, but paid for by insurance companies. Neither patients nor doctors have an immediate, short-term incentive to make sure they utilize insurance company resources judiciously. On the contrary, the both have an incentive to consume as many insurance company resources as possible (the patient wants to make sure they get every possible treatment, even if that means consuming 10x resources to prevent a 1/10th as likely outcome, and the provider wants to bill as much as possible to increase revenue).

I can tell you, as somebody whose family has catastrophic coverage only, that we think long and hard before we blow $200 so that a doctor can tell us to take some ibuprofen and drink plenty of fluids. And we also ask lots of questions about how much various recommended treatments will cost vs. what they will do for us.

> Well, they can... Just look at France. Amazing healthcare, a lot of it private, relatively cheap

In a place with a different political system, population, demographics, culture, economy, etc... and France has a price transparency law.

> Nothing, they don't negotiate

They pass laws dictating how others can negotiate (or not).

> A performance bonus, a raise, a promotion? Just like any other organisation?

But not like any other organization, because if you gave a government employee a million dollar bonus for doing their job there would be a riot. Meanwhile they can get million dollar private sector employment for not doing their job.

> OK, go and buy a pound of ground meat. Or an LCD screen. Are you seriously telling me you can get a better deal than McDonalds or Apple?

I'm telling you I can get a better deal than the Department of Defense.

Doesn’t the French government have some leverage via pharmaceutical intellectual property rights? I’m no expert, but I don’t think it’s as simple as “everyone should just buy in bulk like we do.”

> What does a Congressman get when he negotiates a lower price, compared to what he gets (from the people he's negotiating with) if he "negotiates" a higher price? What about the government bureaucrat who will be working in that industry soon?

Ideally there would be some sort of accountability for elected officials, where they would have to answer to their electorate, and where conflicts of interest would be against the law (and prosecuted), but who am I kidding?

> Ideally there would be some sort of accountability for elected officials, where they would have to answer to their electorate, and where conflicts of interest would be against the law (and prosecuted), but who am I kidding?

Right, exactly. It's like the claim that Communism would work great once automation eliminates the need for all human labor. It's a nice theory, might even be true, but until we can satisfy the precondition what practical relevance does it have? Go work on the precondition and come back after you accomplish that. In the meantime we need something else.

If the us tried to become your ideal world, you would lose a huge chunk of the doctors you have, and the amount of medical services you would provide will be lower than it is today.

"Only non-profit healthcare services allowed."

Not sure if this is required - the UK manages to have a socialist health care system (the NHS) for the vast majority and a relatively small private healthcare system for those who want treatments not covered by the NHS, or a nicer room etc.

I'm not sure I'd be happy with completely banning access to private healthcare - although I'd prefer it if the NHS was resourced to a level where there really wasn't much need to to go private (which certainly used to be the case).

I wouldn't hold the NHS up as a paragon of virtue. I got sick on a recent trip to London and tried to get in to see a GP under the NHS and it was impossible.

The clinics near my hotel only accepted same day bookings. I tried calling just after opening hours and the phone was engaged. I managed to get through 15 minutes after the clinic opened and the clinic was booked out for the day and I would have to call back the next day. I tried a number of clinics and they were all booked out. I was lucky that I wasn't that sick and got better. Otherwise, I was looking at an exorbitant fee to see a private doctor.

I was shocked, as I always assumed that the NHS was better than the system we have in Australia. I think that there are lots of perverse incentives involved in Medicine and Healthcare. Government intervention is required to balance out these incentives from profit takers and consumers (i.e. smokers, obesity, etc). I'm not sure that any model in the world right now gets the balance right.

Note my comment about "I'd prefer it if the NHS was resourced to a level"....

The issue with not getting GP appointments quickly seems to have been a relatively recent thing - due to lack of resources and mismanagement rather than fundamental problems with the approach.

That's not entirely true. If you're actually emergent and require a same day apptmnt then they've got held appointments for you. However this has led to an extremely strange system where often GP receptionists are essentially gatekeeping services (as a pre requisite to accessing the GPs who gatekeep the other services...)

> I'd prefer it if the NHS was resourced to a level

You know what a great system for allocating resources in an incredibly complex system is?

Prices.

> a relatively small private healthcare system for those who want treatments not covered by the NHS, or a nicer room etc.

From what I've heard about the Charlie Gard [0] and Alfie Evans [1] cases, that isn't always allowed, and even being an Italian citizen or an offer from the Pope can't sway the decision [3].

[0] https://en.wikipedia.org/wiki/Charlie_Gard_case

[1] https://en.wikipedia.org/wiki/Alfie_Evans_case

[3] https://www.telegraph.co.uk/news/2018/04/23/protesters-storm...

??? Alfie Evans had nothing to do with the NHS not wanting to cover the treatment. From the first paragraph of the wikipedia article you linked to:

> Alder Hey Children's NHS Foundation Trust sought a declaration that continued ventilatory support was "unkind and inhumane", and not in Evans' best interests

Some people liken that to a "death panel", in that it was not unanimously agreed with by other medical professionals, including those that thought there may be other forms of treatment for the same affliction that were not being covered by the NHS.

Yes, doctors here (as, indeed, in most countries) can take cases to court when they believe the best interests of their patients are not being looked after by the legal guardians. And these are not mediocre doctors, nor was this being done lightly.

The treatments not covered were not even approved for use in the UK privately afaik - it was entirely unrelated to the NHS budgets.

The NHS is a partnership with the private sector any way, because GPs are greedy.

All GP practices in the UK are privately run.

>31415926535897932384626433

This should be 31415926535897932384626434.

This all assumes that healthcare is a human right, which I am not so sure about. Why should health education be free but not engineering education? I'd hazard an argument that not everyone deserves healthcare, so it would be difficult to make it a Right.

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