This should be step one, always.
While those perverse incentives exist everything else is an uphill battle.
Imagine the OTA weighing in on the recent net neutrality shitshow. Wouldn't have made the FCC look to smart would it have? That same threat existed for every agency and congress and the executive. Literally everyone wanted them gone.
If anything, a fact checking organisation has incentives to align with or even become a lobby group. We've seen what happens to "fact checking" in the political sphere.
Some would say, if a senator doesn't believe in climate change that's a question of fact, and if they merely received better advice they'd change their opinion.
A cynical person, on the other hand, would say they know full well that climate change is real but they've accepted money to pretend they believe otherwise. In that case, no amount of independent advice will change their minds, as it is not a question of facts but of money.
No, no it shouldn't
There's a really, really, really fine line to walk between preventing the AMA from lobbying congress to screw us and preventing actual grass roots people from paying someone to argue on their behalf.
Besides, without lobbying groups working against you, the feedback loop of voting them out actually starts working. (no it's not a complete solution so please don't argue against that straw man, it's just the most important first step to unblock others)
Edit: clarity
I feel like the choice has to be removed from families as our current system has proven that life will be extended regardless of quality simply due to the fact nobody wants to make a difficult choice. As the only quantitative item on the list and a very substantial one this should be ranked much higher in terms of priority (not sure if list was unordered or not).
I'd be happy if the app could show medical expenses before the treatment.
Right now millions of Americans are basically committing fraud: they go to a doctor who has taken an oath to help you. The bill is not getting paid so the government has to step in anyway. May as well make it official.
At least under the current model, many people don't hit their deductible or max out of pocket. I know some older retired couples who are buying insurance on the market with 10k+ deductibles because they're generally in really good health, and the cost of insurance isn't absolutely insane with that level of deductible.
They would absolutely drive an hour rather than 5 minutes for non-emergency situations!
And they are all invested in each others bags. For instance I've read that doctors are major investors in health providers, are often the owners of the expensive equipment, and also heavily invested in the malpractice insurance industry.
Half of billing is multiple businesses billing one another.
It seems quite possible that what makes government health care more efficient is simply knowing where the money is going, if it's all coming out of one checkbook.
It's certainly not the majority of healthcare workers.
Physicians are often scapegoated as responsible for healthcare costs when in reality physicians in Canada, New Zealand and Australia earn similar salaries without the massive cost blowout.
https://www.physiciansweekly.com/how-do-us-physician-salarie...
Also if you factor in earnings and expenses over a lifetime (including cost of studying and the fact that many of the countries mentioned have free healthcare and education and far lower insurance requirements) it evens out substantially.
More importantly, even the highest physician salaries are orders of magnitude less than insurance company CEO salaries.
Disclosure: I'm a physician, currently practicing in the US, previously in New Zealand and the UK.
And sure insurance CEOs are paid more, but there are also a several magnitude more doctors than insurance CEOs. You could pay all the CEOs $1 and the cost of healthcare isn’t going to budget much.
https://www.beckershospitalreview.com/payer-issues/what-5-he...
And its not just the CEOs - its all the parasites in the c-suite.
And these people contribute less than nothing to the health of patients, quite the opposite.
Seems likely enough that adding another 100 CEOs wouldn't make the total much more.
https://www.latimes.com/opinion/story/2021-09-14/dont-blame-...
An interesting side effect might be to change the demographics of who can become a doctor, maybe attracting more people from middle class or blue collar backgrounds.
Doctors already come from a variety of different backgrounds.
Incentivizing the best and brightest in the software industry has gotten us to where we have to give new computer science graduates a coding exam, to find out if they can program.
Many people that browse this forum will likely have lifetime income similar to that of a physician.
And sure, comparing it to Silicon Valley looks bad, but so does every other job. “Amazing how bad other jobs look when you compare them to the top 1%”
It's much higher than other countries. There's also a 7 to 10 year period of medical school and residency where you're making no wage or a poor wage. People tend to get fixated on the attending-level annual salary while ignoring that piece. That's 7 to 10 years where you're not really building any savings, retirement, or wealth.
My wife (a doctor) and I (a non-SV software engineering who's career has taken a backseat to hers) ran the math. On an hourly basis, she will likely never come out ahead of me. She just has too many unpaid and low-paid hours in med school and residency to overcome. In aggregate, she will likely out-earn me - but that break-even point will be in our 50's with her having worked many more hours than me. That's 30 years into our careers.
Is there a particular reason for this?
In a world where people are making billions for photo-sharing apps and financial rent seeking, is it really that egregious for people that treat disease to do well financially?
It was essentially a calorie and exercise tracker that also displayed your health insurance info, absolutely nothing special compared to fitness apps already out there, but millions of dollars down the drain.
Follow that by banning burning of coal and oil, we also remove a significant amount of noise and air pollution.
Next we can ban any hormone-disrupting chemicals (including as plastic additives) from being used in anything that will ever touch human food or drink, or ground water.
Finally we can legaize euthanasia for anyone aged 70 or older and with a terminal health condition.
With these changes you have a human population much healthier and less reliant on expensive healthcare.
https://www.youtube.com/channel/UC0intLFzLaudFG-xAvUEO-A
Clearly, they mainly focus on cycling being the solution, but still, the overall analysis seems quite good.
And it shouldn't be for financial reasons. I fully support someone's right to death, but I do not support creating systems that might encourage it. I also don't realistically care if the health condition is terminal: I care more that folks are suffering and want death to escape it.
We definitely need do do a better job with end of life care/terminal diseases - in practice this would look like earlier/more hospice/compassionate care, less needless end of life treatments and interventions).
Most things have added sugar in them.
Things you wouldn't think have sugar, and are not sweet, have sugar!
Sauces, pickles, plain yogurt, it's ridiculous
It will still not be enough to win over China, but at least enough to keep the free world in existence. Otherwise democracy will be just simply gone from the world altogether in one generation.
https://worldbeyondwar.org/ - is an organization dedicated to the abolition of war. I encourage you and anyone reading this to take a look.
Also take a look at possible alternatives. (A global security system that doesn't require violence) - there's an ebook discussing this system in full.
https://worldbeyondwar.org/alternative/
Continuing to head in the direction of militarism, will continue the disaster of a world that we live in, and almost certainly guarantee the end of mankind.
Stick to watching fox news.
https://www.athenahealth.com/knowledge-hub/practice-manageme...
>>Here's some food for thought: The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200 percent for the same time period.
*
>>Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. (To cite just a few industry-disrupting regulations, consider the Prospective Payment System of 1983 [1]; the Health Insurance Portability & Accountability Act of 1996 [2]; and the Health Information Technology for Economic and Clinical Act of 2009. [3])
In contrast, areas of medicine which are subject to much fewer subsidies and regulations, as a consequence of being electives, have seen prices actually decline in inflation adjusted terms. [4]
[1] https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen...
[2] https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg...
[3] https://www.hhs.gov/hipaa/for-professionals/special-topics/h...
[4] http://healthblog.ncpathinktank.org/why-cant-the-market-for-...
I really want regulation in health care. I do not want medication to be a free-for-all like supplements are in the US. I'm not a doctor, after all, and they are slow to take supplements off the market even if they are harming or killing folks (take a look at diet pills to see this effect). I do not want average folks to be able to get antibiotics willy-nilly because I want to be able to take them when I'm old. And so on.
This is changing fast though, and Europe is migrating to the US model at a rapid pace, with growing administrative layer and loss of control over prices. Interestingly, european politicians are also telling everyone that the problem is that docs earn too much and people tend to believe them.
And honestly, I find it very difficult to think that this is the administrative cake you were thinking. I also find it really difficult to think that Norway, Poland, Greece, Italy, Germany, and Britain are all taking the same steps and adding complexity.
Where do you get information? Do you have links?
Europe is still a bit behind in terms of admin, but getting there. And yes, american influence is felt all over Europe, with varying degrees of implementation among countries, as you noted.
I can understand that outsiders don't believe what we have to say when political propanganda is so strong. But for us insiders, it's really crystal clear what is happening. It used to be that problems arising in clinical management was solved by asking frontline workers what they needed. Healthcare workers had a lot of control over their working environment. Nowadays, admins are taking all decisions from above. European hospitals are now in competition with the private sector due to changes in the billing and insurance system coming from the US. As a result, european hospitals are now managed much more like your usual run-of-the-mill company than they used to. This is a terrible result for anyone but upper management.
Other countries' healthcare systems are growing increasingly more inefficient as well, with the proportion of GDP expended on healthcare rapidly rising, with many seeing it double over the last 40 years. [1]
And they face critical shortages, like this case of a woman in Canada who had to wait two years to get a test that diagnosed her with cancer, because of a shortage of state-licensed doctors:
https://www.cbc.ca/news/health/doctor-shortage-cancer-video-...
>>I really want regulation in health care. I do not want medication to be a free-for-all like supplements are in the US.
I think the best of both worlds would be most regulations being opt-in, while disclosure regulations are mandatory.
More specifically, I think healthcare would benefit from legalizing the provision of medical service by un-certified individuals, as well as providing more than one tier of certification, where people who can't afford fully certified practitioners, but would like the assurance of some certification, have that option.
Instead of making it illegal for individuals who don't possess full certification to practice medicine, the law could instead require medical practitioners to disclose their level of certification, and any warnings the state provides in relation to that.
So for example, an uncertified doctor/nurse may be required to disclose not only that they are uncertified, but also the warning that the state strongly advises against using uncertified medical practitioners.
Why providing these options is critically important is that sometimes the prescribed institutions fail, and an escape hatch is a life saver, as in the case of a woman in Canada mentioned above.
>>I do not want average folks to be able to get antibiotics willy-nilly because I want to be able to take them when I'm old.
If the negative externalities of irresponsible antibiotic use is your concern, maybe you could advocate specifically regulations on antibiotic use.
When you advocate wholesale centralized gatekeeping of all manner of healthcare interaction, you deny people a way to escape failures of over-regulation, like regulations that prevent people from accessing life-saving medical products/services in a timely manner [2][3] or deny people access to a vaccine due to a risk from side effects that is orders of magnitude lower than the risk the vaccine mitigates. [4]
[1] https://www.researchgate.net/figure/Healthcare-spending-as-a...
[2] https://www.propublica.org/article/this-scientist-created-a-...
[3] https://www.nytimes.com/2020/03/10/us/coronavirus-testing-de...
[4] https://www.nytimes.com/2021/04/13/us/politics/johnson-johns...
There are two (mostly) unrelated issues: the efficiency of the healthcare system and increasing availability of effective but expensive treatments.
I believe we have already reached the point where even 100% of GDP is insufficient for healthcare. There is always something more you can do, something better you can try. No matter how much money you choose to spend, somebody must eventually make the decision to withhold better care because the economy is not big enough.
In any case, the price inflation seen in highly regulated vs lightly unregulated markets is, to me, telling:
https://www.aei.org/carpe-diem/chart-of-the-day-or-century-3...
- Dismantling the insurance/big hospital complex that milks the US population for the enrichment of c-suite executives.
- Removing the capacity for lobbying by insurance companies, large hospital groups, device and pharma companies (so they're less able to price gouge consumers).
- Price transparency on all links of the chain of healthcare delivery.
- Changing the incentives for physicians and other providers towards expensive, often harmful and unnecessary interventions.
- Facilitating improved therapeutic relationships between providers and patients (More time spent, more communication, more incentives for harm reduction).
- Social changes including less stigma for things like drug use, greater emphasis on community cohesion and care.
- Demilitarization (Not only are absurd amounts of money spent on the military that could be redirected to better community health services; but innumerable veterans (not to mention foreign and local civilians) are injured psychologically and physically annually in the absurd pursuit of 'global security'.
- Better end of life care. I think something around 40% of healthcare expenditure is on patients in the last 2 years of life. Patients and families would benefit from earlier access to hospice care and less aggressive therapies that only prolong suffering.
- A greater emphasis on preventative health and lifestyle choices (better diet, exercise and sleep regimes - ideally within the context of a long term health care provider relationship).
Its very typical of modernism (especially in the US) to think that the way to address everything is a nice app with a better UI. This also facilitates the corporate narrative of marketing the shiny new thing to throw money at (make money for the company) to solve everything whilst digging the hole even deeper (and letting society absorb the collateral damage).
EDIT* Thanks for the feedback, I have added some of the points made by others to the list above.