Totally wrong. The reason the US healthcare system sucks is that it's an oligopoly. Medical schools limit enrollment to limit the supply of doctors thus keeping salaries higher than they otherwise would be. Nurses unionize to drive up their own wages. Insurance companies pile on the paperwork because they can charge you for it. Doctors are incentivized to push more expensive drugs and procedures because they make more money. Drug companies develop drugs that will make them the most money and wine and dine pharmacists and doctors to ply their drugs. Thus those that can pay end up paying more and more. Those that cannot get no coverage at all. Oligopolistic capitalism at its finest. Everyone in the system gets paid off a bit to not rock the boat.
Ah that old canard. Fewer than 20% of RNs are in unions. Those in unions do make more than their non-union counterparts (~$200 more per week [1]), but if you think that's why nurses tend to unionize, you're fairly far from the mark. Especially since real nurses wages haven't increased in the past 10 years.[2]
Imagine that being a programmer required a license from the state in order to practice. Now imagine that if you make a significant error, you lose that license, pretty much ensuring you could never make another dollar in salary as a programmer. Say your work consists of doing week-long projects, with a team of 4 other programmers. Your code must be released weekly and must be bug-free. Now what happens when your boss realizes he could save 40% on costs if he cuts your team from 5 to 3? Or to 2? How likely are you to release bug-free code? That's the situation for nurses.
Adding to that, nursing is one of the most dangerous jobs in the country based on the number of on-the-job injuries and missed-work.[3] Most of these injuries are caused since hospital staffs are being cut, which leads to nurses having to lift, turn, and dress patients without additional help.
Furthermore, nursing care levels are directly correlated with improved patient outcomes, shorter hospital stays, lower mortality, and a number of other positive indicators. [4]
So you have hospital management on one side, who's incentives are to cut pay, cut hours, and cut staff (and frankly, to keep patients longer). And then you have nurses / techs / etc. on the other side, who are more likely to injure themselves, more likely to lose their licenses, and more likely to provide substandard care with those cuts. Do you honestly think unionizing is a bad idea?
IMHO, unions are obviously a counterbalance against management but the truer axiom would be that power corrupts. So just as unfettered power on 'management's side can corrupt so it can on the unions side.
You're the one showing bias here. I never said unions were bad, just that there is collusion across the system because there is so much money to be had. And I include the nurses unions in the lot just as I included every other party in the system. If you haven't noticed, nurses are doing better than most of the rest of the workers whose real wages are actually falling.
I agree. So how do you break such an oligopolistic system? Maybe by introducing the one thing it tries to hide in order to stay alive: radical price transparency. At the very bottom are the patients who search for care and primary care givers, let's include surgery centers for large but rare tickets. If you connect both fundamental entities directly, you create a brutally and publicly transparent market place where competition, innovation and price pressure could force the market to first just slightly shift but eventually see falling costs because some will offer better prices at higher quality. Without such an open platform though, I don't see how any regulation or for that matter functional changes in the technological landscape will make any big impact.
I can't agree more. Coming from socialized medicine countries like New Zealand and Australia this is a no-brainer for me. Medicare (which EVERY Australian gets) sets reasonable rates for almost any procedure. They also give Doctors incentive's to charge these set rates. A doctor can charge what they want, but if they do their patients have to pay out of pocket and go to medicare to get compensated. That means less patients choose those doctors. A doctor that charges the scheduled fees is able to "Bulk Bill" that means that the government will transfer payment directly to the doctor (I am not sure how regularly), which means they are likely to have far more patients and really it keeps everything more convenient (No cash on premises, etc.)
On another point, I think that a serious problem is Tort Law. Unfortunately it's such a complicated debate I don't think it could ever be resolved in the US. I personally believe the New Zealand government has this perfect with the ACA (http://en.wikipedia.org/wiki/Accident_Compensation_Corporati...). While it is still possible to pursue a civil suit against someone, in the case of a car accident for example. No lawyer is going to do this pro-bono. You have the right to claim medical and loss of work directly from the ACA, therefore the likelihood of a New Zealand judge awarding a large claim would require some serious negligence by the other driver and even then the cost of pursuing that would not be worth the risk. After all, a "normal" person would be satisfied with being medically taken care of and having any loss of income recovered. This will not sit well with those that feel "SOMEONE SHOULD PAY FOR THIS! AND THIS IS THE PAY DAY I'VE BEEN WAITING FOR"
I think if you really boil it down the most fundamental problem with medicine in the USA is there are no prices. There is no functioning market for products and services because everything is structured to insulate customers up-front from prices.
Everybody gets charged differently. Everybody ends up paying different amounts for the same thing. The numbers on bills seem to come out of an after the fact lottery ball mixer.
Probably the best reform would have been to eliminate the tax deductibility of insurance benefits. A much larger fraction of people would choose high deductible plans and be price sensitive shoppers, imposing some market discipline on the system. But of course obamacare is a move in exactly the opposite direction.
Couldn't agree more. Dr. Keith Smith describes your suggestion actually as the "Obamacare Paradox". He thinks that the ACA unintentionally created a situation where premiums and deductibles sky-rocket. It's unlikely that they designed it that way, probably hoping the subsidies would sugercoat the insurance prices or in the worst event increase pressure towards a single payer system. However, as it stands, it seems that quite a lot of people esp. in the middle class won't be able to afford the kind of insurance offered on the insurance exchange. They will HAVE to find local doctors that offer concierge memberships (very affordable) and cover themselves with a catastrophic insurance or none - because, in effect, the monthly premiums are too high, so that they take away the money people actually NEED to pay for medical situations for their kids/families.
Comments
Totally wrong. The reason the US healthcare system sucks is that it's an oligopoly. Medical schools limit enrollment to limit the supply of doctors thus keeping salaries higher than they otherwise would be. Nurses unionize to drive up their own wages. Insurance companies pile on the paperwork because they can charge you for it. Doctors are incentivized to push more expensive drugs and procedures because they make more money. Drug companies develop drugs that will make them the most money and wine and dine pharmacists and doctors to ply their drugs. Thus those that can pay end up paying more and more. Those that cannot get no coverage at all. Oligopolistic capitalism at its finest. Everyone in the system gets paid off a bit to not rock the boat.
Imagine that being a programmer required a license from the state in order to practice. Now imagine that if you make a significant error, you lose that license, pretty much ensuring you could never make another dollar in salary as a programmer. Say your work consists of doing week-long projects, with a team of 4 other programmers. Your code must be released weekly and must be bug-free. Now what happens when your boss realizes he could save 40% on costs if he cuts your team from 5 to 3? Or to 2? How likely are you to release bug-free code? That's the situation for nurses.
Adding to that, nursing is one of the most dangerous jobs in the country based on the number of on-the-job injuries and missed-work.[3] Most of these injuries are caused since hospital staffs are being cut, which leads to nurses having to lift, turn, and dress patients without additional help.
Furthermore, nursing care levels are directly correlated with improved patient outcomes, shorter hospital stays, lower mortality, and a number of other positive indicators. [4]
So you have hospital management on one side, who's incentives are to cut pay, cut hours, and cut staff (and frankly, to keep patients longer). And then you have nurses / techs / etc. on the other side, who are more likely to injure themselves, more likely to lose their licenses, and more likely to provide substandard care with those cuts. Do you honestly think unionizing is a bad idea?
[1] Barry Hirsch and David Macpherson, “Union Membership and Earnings Data Book,” The Bureau of National Affairs. Bloomberg. 2012. [2] http://www.ananursespace.org/BlogsMain/BlogViewer/?BlogKey=c... [3] http://www.bls.gov/news.release/osh2.nr0.htm [4] http://www.nejm.org/doi/full/10.1056/NEJMsa012247
IMHO, unions are obviously a counterbalance against management but the truer axiom would be that power corrupts. So just as unfettered power on 'management's side can corrupt so it can on the unions side.
You're the one showing bias here. I never said unions were bad, just that there is collusion across the system because there is so much money to be had. And I include the nurses unions in the lot just as I included every other party in the system. If you haven't noticed, nurses are doing better than most of the rest of the workers whose real wages are actually falling.
I agree. So how do you break such an oligopolistic system? Maybe by introducing the one thing it tries to hide in order to stay alive: radical price transparency. At the very bottom are the patients who search for care and primary care givers, let's include surgery centers for large but rare tickets. If you connect both fundamental entities directly, you create a brutally and publicly transparent market place where competition, innovation and price pressure could force the market to first just slightly shift but eventually see falling costs because some will offer better prices at higher quality. Without such an open platform though, I don't see how any regulation or for that matter functional changes in the technological landscape will make any big impact.
I can't agree more. Coming from socialized medicine countries like New Zealand and Australia this is a no-brainer for me. Medicare (which EVERY Australian gets) sets reasonable rates for almost any procedure. They also give Doctors incentive's to charge these set rates. A doctor can charge what they want, but if they do their patients have to pay out of pocket and go to medicare to get compensated. That means less patients choose those doctors. A doctor that charges the scheduled fees is able to "Bulk Bill" that means that the government will transfer payment directly to the doctor (I am not sure how regularly), which means they are likely to have far more patients and really it keeps everything more convenient (No cash on premises, etc.)
On another point, I think that a serious problem is Tort Law. Unfortunately it's such a complicated debate I don't think it could ever be resolved in the US. I personally believe the New Zealand government has this perfect with the ACA (http://en.wikipedia.org/wiki/Accident_Compensation_Corporati...). While it is still possible to pursue a civil suit against someone, in the case of a car accident for example. No lawyer is going to do this pro-bono. You have the right to claim medical and loss of work directly from the ACA, therefore the likelihood of a New Zealand judge awarding a large claim would require some serious negligence by the other driver and even then the cost of pursuing that would not be worth the risk. After all, a "normal" person would be satisfied with being medically taken care of and having any loss of income recovered. This will not sit well with those that feel "SOMEONE SHOULD PAY FOR THIS! AND THIS IS THE PAY DAY I'VE BEEN WAITING FOR"
I think if you really boil it down the most fundamental problem with medicine in the USA is there are no prices. There is no functioning market for products and services because everything is structured to insulate customers up-front from prices.
Everybody gets charged differently. Everybody ends up paying different amounts for the same thing. The numbers on bills seem to come out of an after the fact lottery ball mixer.
Probably the best reform would have been to eliminate the tax deductibility of insurance benefits. A much larger fraction of people would choose high deductible plans and be price sensitive shoppers, imposing some market discipline on the system. But of course obamacare is a move in exactly the opposite direction.
Couldn't agree more. Dr. Keith Smith describes your suggestion actually as the "Obamacare Paradox". He thinks that the ACA unintentionally created a situation where premiums and deductibles sky-rocket. It's unlikely that they designed it that way, probably hoping the subsidies would sugercoat the insurance prices or in the worst event increase pressure towards a single payer system. However, as it stands, it seems that quite a lot of people esp. in the middle class won't be able to afford the kind of insurance offered on the insurance exchange. They will HAVE to find local doctors that offer concierge memberships (very affordable) and cover themselves with a catastrophic insurance or none - because, in effect, the monthly premiums are too high, so that they take away the money people actually NEED to pay for medical situations for their kids/families.