beyond Europe as well. Singapore which has exceptionally low healthcare spending (5.9% of GDP) heavily controls prices and purchases down to individual equipment in hospitals.
It is more similar to the US system than a system like the UK or Canada.
Singapore controls prices through collective bargaining at the national level and unlike the US practically every purchase in its hospitals has to go through registration with the HSA (the country's relevant regulatory agency). You essentially cannot purchase any major equipment without running it by the national government. That's one of the reasons why the country has a very transparent pricing system.
It's not only savings accounts but also a very tight control over costs and acquisitions that keeps the price low, that's completely missing in the American system which just keeps growing.
And getting HSA approval doesn’t have anything to do with price - that regulatory. Even the FDA has to approve anything used in the US.
It is true you can’t purchase at the hospital level without some agreement on price, but the hospitals often do their own tenders, which are confidential prices. It’s not done at the national level for everything.
And yes, prices are tightening but companies are already deciding to just not market in Singapore if prices get too low.
Check out Germany, I think it was AZ that decided to just not launch a drug there at all because the price was too low.
yea because they have healthy population, its not because of some smart govt policy( if only it was that easy).
singapore obesity rate = 10%
usa obesity rate = 42 %
usa obesity healthcare spend = 90%
The costs for obese folk are on average 90%-100% higher than for non-obese folk, but that's not 90% of total spending. (See e.g. https://pubmed.ncbi.nlm.nih.gov/33470881/)
Total cost approaches 20% of spending: https://www.hsph.harvard.edu/obesity-prevention-source/obesi...
https://www.nhlbi.nih.gov/health/metabolic-syndrome
metabolic disease = all things that can be fixed by lifestyle modifications ( unless you are too far gone, ie).
see my reply here: https://news.ycombinator.com/item?id=32744868
For example, there are a lot of people on psychiatric medications that can cause metabolic syndrome as a primary side effect.
Would be interesting to know how often.
Because obesity also drives down lifespan, and age has a huge impact on healthcare expenditures.
I can’t imagine any downside of trying to prioritize lowering obesity.
Obesity is a serious public health problem but we won't fix it by calling people stupid or charging them extra.
There are too many stakeholders with too many backgrounds and conditions for anything like your proposed system to work. Everyone would be angry.
And this genetic mutation somehow happened in the last 50-100 years or so? Obese people have always existed. Obese poor people are fairly new. The root cause is diet, not genetics.
Read "a contamination theory of the obesity epidemic" to see how incorrect your assumptions are.
Gut flora, in turn, play a significant role in hormone and appetite.
The interactions are complex, but genetics contributes to obesity.
Yes, precisely. Keep chopping down at these factors until all that's practically left is private healthcare -- that's a feature not a bug. It's enough that I have to pay the bill to scrape the blood off the street when a motorcycle is crashed, not interested in paying someone elses motorcycle related health premiums on top of that (I've gotten enough motorcycle injuries while carrying my own private healthcare :) )
>This is one of the moral hazards of a socialized medical system.
As you say with public healthcare the effect (you say temptation) is to socialize your health related losses while privatizing the gains you reap.
> socialize your health related losses while privatizing the gains you reap.
Those famous health care gains.
Driving cars would be minor and apply to almost everyone, so it would mostly cancel out and be negligible. Really it would be a slight discount for taking transit, and that seems... fine to me.
And those other ones aren't even notable risk factors.
Yeah, so almost everyone.
> Driving is one of the most dangerous things humans do. The argument that all health care should be private– the perspective this comment addressed– would not make such a consolation simply because it's common.
Car deaths are about 1% of deaths. Heart disease and cancer are each around 15x as likely.
Even if it's high on the danger scale, I don't think it would be a very big factor in health care costs.
CDC: Motor vehicle crashes are a leading cause of death in the U.S.1, with over 100 people dying every day. 2 More than 2.5 million drivers and passengers were treated in emergency departments as the result of being injured in motor vehicle traffic crashes in 2015.1 The economic impact is also notable: for crashes that occurred in 2017, the cost of medical care and productivity losses associated with occupant injuries and deaths from motor vehicle traffic crashes exceeded $75 Billion."
American Society of Civil Engineers infrastructure report card says only 45% of the US population has no access to public transit.
Motor vehicle crashes are slightly outside the top ten causes of death. Those 100+ deaths are coming out of about 9300 total deaths.
> The economic impact is also notable: for crashes that occurred in 2017, the cost of medical care and productivity losses associated with occupant injuries and deaths from motor vehicle traffic crashes exceeded $75 Billion.
Productivity losses are outside the scope of medical costs, but even if we include those dollars that's $75B out of $4100B in health care spending.
So I stand by my statement that it's a pretty small impact.
> American Society of Civil Engineers infrastructure report card says only 45% of the US population has no access to public transit.
And most of the other 55% still need cars.
You said "good subway systems and a walkable infrastructure" and that's what I responded to. We can go ahead and remove the word "subway", but the fraction of people with access to good public transit systems is pretty small.
You use a lot of energy? You pay for the damage to the world.
That might be a good idea after we make sure that every single person has equal access to healthy foods and equal ability to afford healthier options. Maybe we could also ban companies from adding HFCS to everything, ban advertising of any unhealthy foods, fine people for not wearing masks or vaccinating their babies, and police what people are allowed to have in their refrigerators so we can punish anyone who has too many unhealthy foods in their home!
Or... maybe we can let doctors and scientists figure out what the best ways to combat the obesity problem are and try to find ways to help people instead of punishing them while in the meantime making sure everyone has access to the care that they need. If we had universal healthcare the costs for your family would the same as everyone else no matter if you or the next person drinks, or smokes, or likes rock climbing, or plays sports, or drives more than x number of miles in a year, or has more than x number of sexual partners, or doesn't exercise at least x number of hours a day and nobody would have to go around spying on everybody to make sure they aren't doing anything that might raise someone else's costs "or else".
yes it is, because the health population itself is supported by strong intervention. Singapore banned the advertisements of sugary drinks years ago, Singapore strictly regulates the number of vehicle licenses in the country encouraging public transport and walking, it forces citizens to allocate money for healthcare to private savings funds which incentives reducing your own healthcare costs, and so on.
The reason American's are obese isn't a miracle or because Americans are stupider, it's because Americans refuse to take collective action when it comes to the health of the nation.
You need this with lots of stuff. “Vice” states are adjacent to more prudish states. Think New Hampshire, Delaware, Pennsylvania, South Carolina.
In the case of healthcare, states tend to push costs to somewhere else. As in send the sick person to NYC.
Granted, not the total amount spent, but city states do have some advantages on things like this.