Comment by jmward01

American healthcare spending 80% more than Canada on a per-capita basis for worse or equal outcomes.[1]

Our system has major problems, but we spend less money and have a healthier population. That definitionally means we're more efficient.

> The same motivations and outcomes occur.

Our hospitals don't have shareholders that capture excess revenue as profit. Efficiency gains in a non-profit hospital typically get reinvested into the mission of providing healthcare. Efficiency gains in a for-profit hospital often go to the owners.

"Efficiency" is also measured differently in a non-profit context. A business measures monetary return on investment. A non-profit organization measures the monetary cost of achieving its mission.

Many for-profit hospitals in the United States offer free mental health clinics. These clinics have been accused of baiting patients into saying something suicidal as a tactic to involuntarily commit said patients.[2] Because appeals of an emergency mental health order are difficult, this is an extremely efficient way of making money (the hospital gets to bill the patient for their stay).

I don't believe this could happen in Canada. The goal is to get people out of the hospital because there aren't enough beds.

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

[2] https://www.buzzfeednews.com/article/rosalindadams/intake

But I think that's a wrong way to look at it. Or rather, it posits that we're at a point we truly consider good enough independent of cost.

It's entirely possible that we want better healthcare outcomes - all the historical trends point to that - but that we're more or less out of ideas how to get there on the cheap. This might be a new possibility.

In your model, why do we get improved, costlier insulin if the old thing was good enough? Because we actually want to pay more if it works better, and it doesn't mean we cut something else to make up for it. You just pay more in taxes in a subsidized model, or pay more at the pharmacy with private healthcare. There's a drug manufacturer profit motive in there, but it holds true in the added-cost ML scenario too.

While I agree that you shouldn't, and that the end goal (privatized health care) is at the same time more costly and less efficient, that doesn't mean people can't or don't.

The Baumol effect you link to only shows that wage demands from health care workers go up in proportion to the wages of other workers. This means (roughly speaking), that reducing the health care budget will reduce the effectiveness of your health care system, because you're able to afford fewer people (I think this is the point you're making, please correct me if I'm wrong).

But that's entirely the point of starving the beast! By cutting funding to some federal department, that department becomes less effective, which makes people think that the government is incapable of running said department, and makes them open to the idea of privatizing the department. Et voila, you've opened up a whole new market that can be exploited for profits! The holy grail is opening up a market with inelastic demand such as health care, where people, no matter what you charge, will be forced to buy your product. This program has been incredibly successful in the US, which can be seen by comparing their health care system to that of other wealthy nations.

You can reduce the spend per person by replacing more qualified workers with less qualified (cheaper) workers, and adding friction to the process of obtaining healthcare.

Increasing prior authorizations, increasing paperwork complexity, increasing hold times on the phone, obfuscation for who is responsible for what, constantly changing coverage so people have to change providers, and otherwise discourage them from seeking care.

What do you recommend? Just letting people die of cancer and ignore teenage pregnancies?

I don't think data supports your claim that tobacco use was merely redirected to other forms of nicotine. But even if it did, that's a success since they're less harmful.

> Reducing tobacco usage makes more room for nicotine OTC and vaping to replace it. Among other stimulants.

And? Nicotine itself is not particularly dangerous and might be even neuroprotective if consumed in moderation. Vaping as a consumption method might be problematic of course, but I don’t think there is any research showing it to be even as remotely as harmful?

It does, there is even a study on it. https://pubmed.ncbi.nlm.nih.gov/9321534/

Smokers also help keep pension/social security costs down since they pay into it but don't collect out of it or do for much shorter period.

Huh? How does this relate to value judgements made by individuals?

> relies on a true free market, which healthcare definitely isn't.

I think this is the part that people miss the most. When a purchasing decision is made based on something like "who has the best quality shoes in price range X", competition can occur.

When the buying decision is "will I live or die", there's not really any choice made there. Couple that with the complete lack of transparency for how much a give procedure will cost, and you've strayed so far away from a free market that it's not even recognizable.

I mean, even the hospital can't even remotely accurately tell you how much something will cost before you actually get a bill...

>Any better than 'good enough' isn't rational and the people running that company should be fired.

This is kind of the reason the Japanese economy is stagnant and continues to fail in winning global marketshare. Businesses that are too good will fail or at least not compete with businesses that settle for being good enough.

> If a company has an opportunity to make money, they will. Any better than 'good enough' isn't rational and the people running that company should be fired.

...where "good enough" is relative to a particular level of quality and price point, of course. Otherwise there wouldn't be different markets for rich and poor people. And this mechanic helps avoid a "collapse into mediocrity" that you'd otherwise get if all goods and services were offered at a single price point.

The real problem is what you identified at the end, that healthcare isn't anything like a free market. There's no buyer mobility, no transparency as to the level of the service you're getting - heck, you don't even know how much you're going to pay in advance, unlike almost every other industry.