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Posted this in the comments last week, but was curious to get some more thoughts on a potential path forward on the healthcare front that isn't just single-payer across the board:
I do occasionally wonder if you could get to a decent place via:
That's going to create some winners and losers, hospitals will be upset that more high cost people are on Medicare, but shifting people from Medicaid to commercial reimbursement rates should help out with that. The amount of bureaucratic nonsense saved by getting rid of Medicaid should be huge.
All a bit of pie in the sky dreaming anyways...
The whole situation is a mess, I like to think of healthcare economics like communism - yes you can absolutely up end the system and make it way better than what we have now, but when has that ever happened successfully?
The thing that probably gets the most complaints over in doctor land is that changes to the current medicaid structure is likely going to result in a further decline in safety net and rural hospitals. This trend has been ongoing for some time but loss of medicaid dollars will probably accelerate it greatly and people are expecting to see that with the current wave of budget cuts.
Two specific things off the top of my head that you'd have to watch for:
-It is very easy for the hospital to help you by signing you up for medicaid. Private insurance would likely find ways to block this. Hospitals rely heavily on this.
-Medicare and Medicaid are much lower overhead on the clinical side of things and less paperwork. Private insurance is a lot more work (although Medicare is trying to change that! Yay). Don't expect a reduction in medicaid to reduce bureaucratic costs and middleman costs.
Basically every other western nation manages to spend equivalent or less amounts of healthcare than the USA, and has equivalent or better outcomes. So yes, basically everyone else's system is better than the USA status quo.
Their are two problems with this line of thinking:
The U.S. is fundamentally a different place than Western Europe - we spend a lot of money on illegal immigrants, have a maximal amount of cost disease, we are more unhealthy (and importantly as other countries catch up they look more like us), we subsidize the rest of the world's medical research (maybe not fair, but we are the wealthiest country and nobody else will pick up the slack if we go away), we are more independently minded (people don't want to be forced onto insurance or into making certain decisions), medical malpractice is a huge drain, we don't have death panels and rationing, you can get care fast if you can afford it, etc. etc.
Fundamentally our healthcare system doesn't resemble anyone else's in both bad and good ways (don't believe the reddit left - the best care is in the USA).
Even putting aside those things good luck changing our system to resemble other's once reality comes into play (for instance forcing people onto plans).
They are better than the USA, which is the key benchmark. Canada is much more similar than Western Europe and also has historically out-performed the USA, although our healthcare system is getting fucked on pretty hard right now so idk how the stats match up post-COVID.
Unlikely currently, although given the USA is finally starting to (slowly) go pretty YIMBY on building a state-by-state basis, the USA does have a pretty blessed capacity to drive change in a way other countries do not.
This is one of the factors tanking Canada's healthcare system, although they're not illegal, just extremely net negative on "tax contributions - cost to society"
Strike me as a good argument to cut out the middlemen, as they need more expensive salaries
This is hard, no easy solutions here (Ozempic as a condition of Medicaid if you're obese?)
I'm torn on this, if the USA also captures most of the world's pharma profits than this is a net gain no? No idea how the math works out there though.
This is true but hilarious. Americans are violently against "taxes to pay for healthcare" but are completely fine with "employer subsidized insurance premiums that mean they get less cash in hand in exchange for access to healthcare" which is functionally just taxes but with more middlemen??!!?! And poor people I guess get less services versus single-payer, but then everyone subsidizes them anyway via higher medical bills to offset all the non-payments from the aforementioned poor people.
This is by far the easiest problem here to solve. Just legislate limits in damages or applicable suits. Although you will say "but will anyone actually do that" and the answer is "probably not" given it hasn't happened.
Are death panels real anywhere? I also feel like prices/medical bankruptcy (66% of all USA bankruptcy filings) are kind of analogous? If you can't afford chemo you sell everything you have until you run out of money to pay for it and die. Also you absolutely do have rationing, it's just in the form of prices versus bureaucratic limits. It can be debated which type of rationing is better, but the human demand for healthcare is infinite, supply never will be.
Profoundly true
Unfortunately profoundly true, I'm pretty black-pilled on western nations being able to pro-actively change anything until it explodes in their faces and they are forced too, at great cost.
In some ways I guess the USA's system is more survivable in that way. I can't really see it ever imploding, it'll just get shittier and shittier to get care from as all the costs/frictions drag on it. Unfortunately, I can see Canada's healthcare system imploding if it continues to be as mis-managed as it seems to be.
Don't fall for the propaganda here, the U.S. has worse outcomes on many metrics but a population that is more unhealthy and those worse metrics are driven by a social goal (you have the freedom to accept lifestyle diseases). When you get sick you are better off here than everywhere else in every way except the pay check. You'll get faster care if it's outpatient, and better across the board. You might have worse outcomes because you eat too many Big Macs but that is a public health and cultural problem instead of a medical care one. The expense is higher is really the only problem.
(And note well: those lifestyle disease worsen outcomes on everything, example diabetes fucks with wound healing and metabolic process of all kinds, obesity makes surgery impossible, etc.)
I don't know either but good thinking.
This manifests in all kinds of ways. Don't want to take vaccines and want to accept the bad outcomes? American individualism. Clearly dying grandma with 95% 30 day mortality rate? Spend EVERYTHING. Etc.
The usual way this shows up in real life is in other countries under spending on end of life care (which is super expensive and with where I am in my life now.....yes I'd want that for me) and delay of care. Canada is notorious for this. I need major hip or knee surgery in the US and I can get it within the week, but Canada though? Months. People also die from cancer and other diseases or have worse morbidity because it takes awhile to be seen and treated.
U.S. has a lot of profit motive and well payed people so they get to both care about patients and actually hustle when it's necessary and the system allows it because $$$.
Also, since I don't really get to talk about my favorite medical topic here but now is a perfect time - Trauma!
No better place in the world to get fucking shot (at least in a civilian context)!
Super fair point.
This is kind of a large "but" given how much of a nightmare healthcare costs are to those who can't afford/have shitty insurance, but I do happily agree that the upper bound of USA healthcare quality is incredible, it's just a matter of having extended access to it...
Brother tell me about it. So far all my experiences (I do a lot of dangerous sports, so I've been to the ER far more than I would like) have been speedy and great, but I live in downtown Toronto and have a great family doctor, so I am pretty lucky in that way. My friends/their parents all have overall good experiences/timelines as well, but again, we're all educated white collar workers who live nearby to the largest agglomeration of healthcare resources in the nation.
The news stories and stats I see though.... Jesus Christ it's grim.
As my parents (and me! yikes!) get older I do find myself wondering if I should familiarize myself with USA v Canada "healthcare arbitrage". If I can get one of my parents an MRI in 1 week for $5,000 vs in 9 months for free when time is directly proportional to better outcomes, that's $5,000 I'd spend in a heartbeat.
Funnily enough, as MRI is the only example I actually know of for "things its worth going to the USA for". The one time I got an MRI, for in retrospect was a slightly frivolous diagnostic rule-out, I was scheduled for one a week after my ENT appointment. Although I am assuming that is Toronto-privilege, I bet if I was in Halifax that would not have been as fast.
Yeah you can absolutely get some things done faster by heading over to the U.S. but keep in mind that the times where it's really useful (ex: cancer workup, need a new knee) it will become cost prohibitive and unreliable very quickly.
I assume the reality of the situation is Canada is not as bad as some of the stories would make it seem but those stories are still quite alarming.
It's also worth noting that while US care is expensive EMTALA and others things ensure you will get care for most types of maladies even if you become bankrupt afterwards. Many countries don't ensure this this outside the affluent west.
Mexico has western-standards dental work and elective surgeries for cheap. Cash only.
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