Why medicine is so damn expensive

[Neil]

And certain types of care are going to rise even more sharply as more folks get old.  In countries with non-barbaric health care, you won't see the costs rise.  What you will see (and are already seeing) is longer wait times.  Sugeries for joint repair or replacement, for example, has started to have some long wait times.  Everyone is starting to get them, and with the times being what they are the government can't just outlay millions of dollars in capital the way the private sector can for more operating theatres.  Private clinics could open offering those sorts of treatments, but for what the government would pay them, would it be economical?  We've established that market forces simply cannot work with health care.  Sure, the socialized system is objectively better than the US disaster, but it's also inflexible and unresponsive.  Perhaps a blended system would work even better.  The only question is how would you put the system together so that it would blend the affordability and morality of the social system with the flexibility and availibility of the private one?

[Zanza]

Why isn't more being done to expand the supply at least so that it matches population growth? Note that with the growth in specialization and demand for specialists since 1970, we actually need more doctors overall since 1970 because of a larger population, but we also need more per capita, and the production of new doctors has not kept up at all.

That's interesting, because it's a different situation here. The media here always complains about a lack of physicians, but when you actually look at the numbers, the amount of physicians has grown a lot here. Back in the 1960s, we had just 70.000 doctors, 1990, we had 230.000 and now we have 340.000. That's with very limited population growth. However, the number of general practitioners has actually shrunk in the last 20 years, specialists have almost doubled. And doctors in general have concentrated in the cities. So we don't really have a lack of doctors, it's just that the incentives for them to work where they are needed the most are lacking.

[Sheilbh]

Actually a few EU countries have medical costs that are rising but in-line or lower than inflation. In the Netherland were they've a private system (though heavily regulated) costs have started falling recently.

Also the US health system pays way over the odds for most medical procedures compared to any other system.

[Neil]

Since Germany is so small, couldn't people just commute for their medical needs?

[Zanza]

Since Germany is so small, couldn't people just commute for their medical needs?

Based on anecdotal evidence, the average age of patients at general practitioners is about 75, so they are probably not particularly mobile anymore. But yes, of course they commute. I think the health insurance pays for taxi rides etc. when necessary.

[Tonitrus]

I tend to think the best, workable system would be similar to the Canadian one...state-funded basic care (delivered mostly by private providers), but also unrestricted private care (for those willing to pay and avoid "waiting lists".

Bureaucracy is unavoidable, of course, but handing it all over to the state (as I understand the UK does it), won't work here.  And people who complain about socialized medecine in the U.S., we already have it.  Medicare/medicaid is just a poorly-functioning, half-assed version of it.  And giant medical insurance conglomerates aren't really all that useful either.

From reading the Wiki article on Canada's system (not the best source, I know), it seems that the government has price restrictions on private health providers?  That seems unnecessary to me...if a wealthy person wants to get quick access to services, and there are providers willing to provide it, why not?  Fairness?  So what?  Wealthy people already get unfair advantages, so trying to lock down health care in that way seems pointless.

And the idea that the U.S. military health system might be any kind of model for socialized healthcare?  It is...and an atrociously poor one.  If I were the DoD, I'd suggest scrapping the entire apparatus, excluding training hospitals and overseas bases, and let service members in the CONUS get their healthcare from private physicians like everyone else.

[Sheilbh]

I believe most countries restrict the prices of private companies too, I think that's the point the Washington Post blog made yesterday:
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/02/23/steven-brills-26000-word-health-care-story-in-one-sentence/

[OttoVonBismarck]

Actually a few EU countries have medical costs that are rising but in-line or lower than inflation. In the Netherland were they've a private system (though heavily regulated) costs have started falling recently.

Also the US health system pays way over the odds for most medical procedures compared to any other system.

Well to be candid I'm talking a bit bigger picture, I didn't focus in on Rhode Island for example because I don't know or care what a small subset is doing. In 2012 it was the first year spending as a portion of GDP on health care decreased in Europe since 1975. Prior to that it had risen by an average 4.6% average annual Europe-wide for the decade ending 2009; a rate significantly higher than inflation in recent years which has been at times under 2%.

[OttoVonBismarck]

Since Germany is so small, couldn't people just commute for their medical needs?

Based on anecdotal evidence, the average age of patients at general practitioners is about 75, so they are probably not particularly mobile anymore. But yes, of course they commute. I think the health insurance pays for taxi rides etc. when necessary.

Here is an interesting article that highlights some of the craziness. Note that early in the article it is mentioned that between the 1980s and 1990s, only a single new medical school opened in the United States.

It's created a situation where yes, we do get the strongest students from bachelor programs. Medical school admissions basically became so competitive that people generally needed to be in the top 1-2% of their undergraduate college class to have the requisite grades to get in. For many other programs, like Master's of Business Admin, Law and etc, the admissions bodies tend to take into account if you had a harder major. So an electrical engineer would be looked on more favorably than a english literature student with slightly better grades. With medical school, spots had become so competitive that basically only the people with nearly perfect grades in the hardest subjects had much hope of getting in.

The only way to fix an undergraduate fuckup would be to go to graduate school for something else and get perfect grades, and then you might get into one of four Caribbean medical schools that have lower admission standards than the U.S. but meet criteria such that their graduates are allowed to go back to the U.S. and take the MCATs and get licensure. These Caribbean schools are mostly made up of Americans who just barely couldn't get into medical school.

It's a crazy system--yes medicine is hard and smart people should be selected to follow that path, but it's not so hard that we can only safely allow the top 1% of students into medical school. It's also not the case any student who got a few low grades in four years of college is too stupid to be a doctor.

[Zanza]

Here is a comparison of growth of healthcare costs:

[Razgovory]

Frank has his own empire now?  Wow, I didn't think that guy would amount to anything!

[Zanza]

He had his own empire since 843.

[Sheilbh]

Well to be candid I'm talking a bit bigger picture, I didn't focus in on Rhode Island for example because I don't know or care what a small subset is doing. In 2012 it was the first year spending as a portion of GDP on health care decreased in Europe since 1975. Prior to that it had risen by an average 4.6% average annual Europe-wide for the decade ending 2009; a rate significantly higher than inflation in recent years which has been at times under 2%.

Which is fine, but the policies that are put in place in Rhode Island or the Netherlands provide useful lessons for anyone else. Maryland's an interesting example in that article I posted. But I think from an EU perspective the Dutch, heavily regulated, privatisation model is interesting.