I see the same issues here in the states. I think no matter what the economic model, we need to take a long hard look at the overhead and complexity of healthcare. And by and large, I suspect the insurance companies will be found to be at the root of it.
I can't believe I of all people am calling for less regulation, but the amount of bullshit it seems like doctors have to go through to provide basic service seems counterproductive.
I think people will hit a breaking point and it will be undeniable that heavy regulation and subsidization is the root of dysfunction and deterioration of most important aspects of life.
It's hard not to see the parallel between healthcare and education where the parasitic overhead has been completely unchecked and enabled by federal subsidies. There's a similar deal with food, housing and other areas. It's absurd the amount of money that has been spent by the federal government in these areas with so little to show, the average person feels not only a lack of progress but decline.
People say this a lot but it feels unlikely to me. I think the biggest causes of the problem love the idea that insurance is to blame.
Hospital admin, doctors orgs, pharmacy benefit managers are all much more interested in things being overly complex, under-staffed, etc. Insurance companies just want to sell insurance with the % profit that is typical of insurance (eg Cigna's profit margin is the same as Allstate).
Besides, if insurance was to blame, it would work better in Canada and other countries that rely on private insurance less. But Canadians don't seem very pleased with their longer waits.
I'm fairly certain a large chunk of the problem is demographic shift. healthcare is one of those industries most used by the elderly, and the proportion of the population in that demographic has skyrocketed
> And by and large, I suspect the insurance companies will be found to be at the root of it.
At least in the US, this is true. The pervasiveness of interaction with insurance and the power they wield turns them into a rent-seeking layer with the massively negative economic effects of socialism.
Insurance is meant to insure you against massive economic damage caused by unlikely events, like breaking your spine. It is not meant to be used for routine care appointments. It's meant to be risk-pooling, not cost-sharing. The very fact that you have to pull out your insurance card at a yearly doctor checkup should tell us that something is very wrong.
We need more doctors and nurses [1], full stop. Anything that prevents an aggressive increase in supply of these workers is something that needs to be actioned against.
Healthcare is a utility masquerading as a profit based industry. Squeeze the profit and inefficiency out, any comp should be going directly to systems and people providing care. Insurance companies? Gone [2]. Pharmacy benefit managers? Gone [3]. Lock private equity out of owning anything healthcare related [4] [5] [6]. I don’t want to knee jerk “union” for individual contributors, but you need some sort of governance mechanism so the CEO of a non profit hospital isn’t taking home $1M/year [7] [8] [9] while doctors and nursing are fighting for proper compensation and work life balance (including patient ratios, which are used to increase labor load without increasing labor costs or hiring more practitioners [10]).
I had a prescription for 1 20mg pill a day. Pharmacy didn't have 20mg but they had 10mg. They couldn't give me 2 10s instead of 1 20 because regulations didn't allow that. Yeah, we need less regulations.
I think there are things that could do with less regulation in Canada that would be easy wins.
Like for people with recurring prescription meds, maybe don't require them to make an appointment every month to get their meds? Even if we consider extreme examples like opiates, it's not like cutting off drug abusers or people selling their meds does anything to curb the opiate crisis. Opiates are already available everywhere and the supply is much more dubious and dangerous.
My best friend since high school is a doctor. Hearing all the bullshit that she had to go through, the different selection processes, abuse (scheduling), etc; it's crazy.
It doesn't weed out people who will be bad doctors, it weeds out people that can't handle the abuse.
The American system is too expensive and leaves too many people without coverage. Not very many people would argue that.
The Canadian system is suffering from doctor shortages and other problems and the article lists a lot of reasons why (at least for Alberta).
What countries are the shining examples of how to do it? How is access to excellent, modern healthcare in Japan? Sweden? Spain? Ireland? Australia? It's all about tradeoffs, what countries do you think make the best tradeoffs?
As with many things the best model to look at is Singapore, which spends far less than most of the OECD with outsized results. They spend half as much on healthcare than the UK and far, far less than the US with results that often put them in the top 5 for healthcare outcomes.
I have a co-worker that moved to the US from the DR last year. She's shocked at how involved and expensive the system is for the most routine visits. It's interesting to hear someone speak with first hand experience in multiple systems.
Canada has a worst of both worlds system. Most wealthy Canadians come to the US for procedures because they can afford it and there is no waitlist, and so they don't care how bad the Canadian healthcare system gets.
The article is about Alberta, the least socialist of the Canadian provinces. Other provinces have similar problems but Alberta seems to have it the worst. The article talks about doctors moving from Alberta to BC, and I indirectly know a couple who moved from Ontario to BC for similar reasons.
I'm not sure why you're bringing up the Canadian and UK systems after launching an opening salvo at socialism. Surely it makes more sense to take a look at access to healthcare in socialist countries like China or Vietnam?
The UK's problem is that it wants universal healthcare paid for by general taxation, and free at the point of use. However, the previous government wanted that whilst also reducing public expenditure. You can't have both.
It totally can be done, but it's expensive. I, personally, hope to see taxes rise to pay for this system to work as it should.
Private healthcare is already digging in its claws in the UK due to the fall in availability of state-provided care and (from my experience) it's not a good experience; and it's still expensive!
The UK's state provided system is pretty good, but it runs too much on good will right now.
This right here. The system needs funding to work. The problem is conservative politicians repeatedly trying to make the system worse so they can privatize it.
Yep, discussions of capitalism as contrasted with socialism are largely pointless as all western countries operate different flavors of mixed economies. Keynes won. You have to have both— if you stray too far in either direction your economy topples.
But accepting "Have government involved in the economy, not too much. Mostly markets" means you have to actually know about the specific industry and surrounding economic factors and that makes discussions boring. It's way more fun to have Cage Match: Capitalism vs Socialism, this Saturday on pay-per-view.
In my experience it works pretty well under progressive governments that are willing to do the necessary tax-and-spend approach to make it work. Alberta's government is radically conservative, far beyond moderate pro-business conservatism.
As much as the media fixates on Prime Minister Justin Trudeau, it's important to remember that Canada's healthcare is administered provincially, and most provinces have Conservative governance.
Publicly-funded healthcare is much less-expensive with respect to public health outcomes compared to the American system, but it's not so cheap that you can cut it to the bone without creating awful negative consequences.
This article doesn’t really implicate socialism, it’s more about staffing rural towns with doctors (the first anecdote is about Elnora, which is a town of 288 people), and about doctors en masse not wanting to be family general practitioners for their careers. The US and other countries all have a hard time keeping doctors in rural places.
You are implicating private for-profit insurance, however. And maybe forgetting about all the top-ranked government socialized medical systems in The Netherlands, Norway, Sweden, Japan, and others - all ranked higher than the US in quality and efficiency of care. There’s contrary evidence refuting the claim that when government sets prices quality will decline.
The problem is deeper. The entire structure of the industry makes no sense. Doctors need 12 years of training after high school (the first 4 years of which is useless). Then they end up doing a job where 95% of the work is trivial and could be done by almost anyone with a bit of training.
I know a guy training to do lasik surgery. Turns out it's easy. You could easily train a lasik tech to do it, but that's not allowed. We require it to be done by a doctor making $500k a year who has 12 years of higher education, only 1 year of which is focused on lasik surgery. But we insist on continuing this overly broad training when most modern doctors only practice in a single specialized area. It's like if we required the guy at the oil change place to have a PhD in mechanical engineering. Of course it's going to cost a fortune.
95% can absolutely be done by someone with far less training than a medical doctor, but the real job of being a doctor is having the expertise and experience to spot the other 5% and sometimes to respond quickly enough with extreme skill to prevent medical catastrophe.
I want to see far more involvement in direct patient interaction happen with nurse practitioners and physician assistants, with doctors supervising cases to ensure no one falls through the cracks. I'd love to see more specialization of NPs and PAs to handle cases that are complex but routine within a speciality.
The problem is a lack of respect for NPs and PAs, with many patients only wanting to see a doctor. We need to promote these occupations as the highly trained and licensed professionals that they are and make sure they get the respect they deserve.
Dont forget Canada speaks the same language as USA so in order to keep skilled medical staff Canada, rather than going to USA for better salary, has pay competitively. USA skilled medical salaries are quite attractive. Therefore Canada has to spend a lot on wages. More than European countries. This makes "socialized" medicine that much more Expensive than the same In Europe
Every healthcare system rations care. In the U.S. that rationing is largely based on quality of employment or how much wealth you have. To some this is a largely immoral way to ration care.
As with all healthcare systems if there is a shortage of workers or it is not properly funded it will deteriorate. The U.S. healthcare system sucks for people who have no real access to it. The wait time of someone with no access to the system is effectively infinity.
Socialism, capitalism, communism, fascism, etc. are merely economic systems and all of them suck if not properly administered.
The Social healthcare still have a budget and the govt structure wants resources.
So are we "investing" resources in young and people who will still work and pay taxes?
Or do we invest in people who are already retiring or "incurable".
The older you get the less resources you will be available for you on the social healthcare.
Not saying the US system is sane or one option is better than other.
But the best system is the one that gives you option (and govt hates giving option to you).
1. Want social care? Ok. xx% will be deducted from your paycheck.
2. Want private care? No deductions, you are on your own. And If you don't have money and is charged we will generate a federal debp + 10% for processing fees.
But no... That can't happen. because it would expose the govt or private sector failures.
1. the “socialist” system AKA healthcare for everyone has insane waiting times because everyone needs healthcare & there aren’t enough doctors.
2. the “capitalist” system seems better for the people that can afford it because the people that can’t afford it don’t go so they have no waiting time because a part of the people that need healthcare aren’t getting it due to the price.
It’s silly to say / imply that system 2 is the better way of doing it
USA here, I think we need to pay them less. It's basically become a game of how little can they do and how much can they charge. Many already don't care about your symptoms, or bother to do any research. They just prescribe stuff as it's pushed. If they aren't already, I'm sure your doctor will soon just be entering your symptoms into ChatGPT.
One reason doctors have so little time for each patient is because 1) demand is through the roof due to artificial constraints on doctor supply, 2) they spend tons of their time dealing with insurance paperwork, and 3) they don't actually get paid that much which means they need tons of volume to stay in business.
(2) and (3) are related since "dealing with insurance companies" == arguing for reimbursement from those companies, which means they're losing time arguing and losing money when they lose those arguments.
You know it's okay simply not to have an opinion on something if you can't spend more than 5 minutes or so thinking about it.
This is already happening, with more and more primary care responsibilities being pushed to physician assistants and nurse practitioners. At your modern urgent care or "doc in a box" primary care clinic, you may never see the doctor, who mostly exists to lend legitimacy to the practice. Not to say that I don't appreciate the hard work that PAs and NPs do, and I think they are certainly qualified to handle most medical issues in their fields, just that the medical industry is trending towards a less personal experience run by lower paid workers and I can't imagine that leading to better health outcomes for the average person.
I don't disagree per se, but it seems from reading the article that they're bemoaning the shortage of qualified doctors and how they're all spent cause they have to work within the confines of centrally planned subsidy prices.
Really they should be charging as high as possible directly to consumers until doctors are attracted into the profession. Cut out the middleman, there is no reason that routine expenses like a sick visit that gets routine labwork or medication need to be insured.
It'd be better to reroute the software developers that construct complex systems to SERVE ADS and addict people to scrolling.
I wish doctors would enter my symptoms in ChatGPT. In my experience they have the opposite problem. They think they know everything and when they hear something they don't understand they just brush it off as nothing. Twice in my life doctors have completely screwed up a diagnosis and later upon doing research it turns out my symptoms were basically a dead ringer for the condition it turned out to be. If the doc had just taken a few minutes to Google it, he would have found it. I don't walk into a doctors office today without doing research first.
deepthaw|1 year ago
I can't believe I of all people am calling for less regulation, but the amount of bullshit it seems like doctors have to go through to provide basic service seems counterproductive.
lurking15|1 year ago
It's hard not to see the parallel between healthcare and education where the parasitic overhead has been completely unchecked and enabled by federal subsidies. There's a similar deal with food, housing and other areas. It's absurd the amount of money that has been spent by the federal government in these areas with so little to show, the average person feels not only a lack of progress but decline.
simonsarris|1 year ago
Hospital admin, doctors orgs, pharmacy benefit managers are all much more interested in things being overly complex, under-staffed, etc. Insurance companies just want to sell insurance with the % profit that is typical of insurance (eg Cigna's profit margin is the same as Allstate).
Besides, if insurance was to blame, it would work better in Canada and other countries that rely on private insurance less. But Canadians don't seem very pleased with their longer waits.
waveBidder|1 year ago
throw10920|1 year ago
At least in the US, this is true. The pervasiveness of interaction with insurance and the power they wield turns them into a rent-seeking layer with the massively negative economic effects of socialism.
Insurance is meant to insure you against massive economic damage caused by unlikely events, like breaking your spine. It is not meant to be used for routine care appointments. It's meant to be risk-pooling, not cost-sharing. The very fact that you have to pull out your insurance card at a yearly doctor checkup should tell us that something is very wrong.
toomuchtodo|1 year ago
Healthcare is a utility masquerading as a profit based industry. Squeeze the profit and inefficiency out, any comp should be going directly to systems and people providing care. Insurance companies? Gone [2]. Pharmacy benefit managers? Gone [3]. Lock private equity out of owning anything healthcare related [4] [5] [6]. I don’t want to knee jerk “union” for individual contributors, but you need some sort of governance mechanism so the CEO of a non profit hospital isn’t taking home $1M/year [7] [8] [9] while doctors and nursing are fighting for proper compensation and work life balance (including patient ratios, which are used to increase labor load without increasing labor costs or hiring more practitioners [10]).
[1] https://thehill.com/changing-america/well-being/prevention-c...
[2] https://penncapital-star.com/uncategorized/americans-suffer-...
[3] https://www.ftc.gov/news-events/news/press-releases/2024/07/...
[4] https://www.amjmed.com/article/S0002-9343(23)00589-2/fulltex...
[5] https://www.washingtonpost.com/business/2024/10/17/private-e...
[6] https://www.theguardian.com/business/2024/oct/10/slash-and-b...
[7] https://www.npr.org/sections/shots-health-news/2024/08/19/nx...
[8] https://www.audacy.com/wwjnewsradio/news/national/revealed-c...
[9] https://arstechnica.com/health/2023/10/nonprofit-hospitals-s...
[10] https://healthjournalism.org/blog/2023/09/a-primer-for-cover...
fallingknife|1 year ago
pcthrowaway|1 year ago
Like for people with recurring prescription meds, maybe don't require them to make an appointment every month to get their meds? Even if we consider extreme examples like opiates, it's not like cutting off drug abusers or people selling their meds does anything to curb the opiate crisis. Opiates are already available everywhere and the supply is much more dubious and dangerous.
meowster|1 year ago
It doesn't weed out people who will be bad doctors, it weeds out people that can't handle the abuse.
criddell|1 year ago
The Canadian system is suffering from doctor shortages and other problems and the article lists a lot of reasons why (at least for Alberta).
What countries are the shining examples of how to do it? How is access to excellent, modern healthcare in Japan? Sweden? Spain? Ireland? Australia? It's all about tradeoffs, what countries do you think make the best tradeoffs?
sickofparadox|1 year ago
DrillShopper|1 year ago
In the western hemisphere? Cuba.
vlan0|1 year ago
debacle|1 year ago
bryanlarsen|1 year ago
bsnnkv|1 year ago
maxehmookau|1 year ago
It totally can be done, but it's expensive. I, personally, hope to see taxes rise to pay for this system to work as it should.
Private healthcare is already digging in its claws in the UK due to the fall in availability of state-provided care and (from my experience) it's not a good experience; and it's still expensive!
The UK's state provided system is pretty good, but it runs too much on good will right now.
CooCooCaCha|1 year ago
ksynwa|1 year ago
truculent|1 year ago
I would hardly describe any of the governments of Canada or the UK in the past, what, 50(?) or so years as being socialist...
Teever|1 year ago
Spivak|1 year ago
But accepting "Have government involved in the economy, not too much. Mostly markets" means you have to actually know about the specific industry and surrounding economic factors and that makes discussions boring. It's way more fun to have Cage Match: Capitalism vs Socialism, this Saturday on pay-per-view.
Pxtl|1 year ago
As much as the media fixates on Prime Minister Justin Trudeau, it's important to remember that Canada's healthcare is administered provincially, and most provinces have Conservative governance.
Publicly-funded healthcare is much less-expensive with respect to public health outcomes compared to the American system, but it's not so cheap that you can cut it to the bone without creating awful negative consequences.
dahart|1 year ago
You are implicating private for-profit insurance, however. And maybe forgetting about all the top-ranked government socialized medical systems in The Netherlands, Norway, Sweden, Japan, and others - all ranked higher than the US in quality and efficiency of care. There’s contrary evidence refuting the claim that when government sets prices quality will decline.
FredPret|1 year ago
This is what happens every time a Canadian doctor moves to the US for the money.
fallingknife|1 year ago
I know a guy training to do lasik surgery. Turns out it's easy. You could easily train a lasik tech to do it, but that's not allowed. We require it to be done by a doctor making $500k a year who has 12 years of higher education, only 1 year of which is focused on lasik surgery. But we insist on continuing this overly broad training when most modern doctors only practice in a single specialized area. It's like if we required the guy at the oil change place to have a PhD in mechanical engineering. Of course it's going to cost a fortune.
theluketaylor|1 year ago
I want to see far more involvement in direct patient interaction happen with nurse practitioners and physician assistants, with doctors supervising cases to ensure no one falls through the cracks. I'd love to see more specialization of NPs and PAs to handle cases that are complex but routine within a speciality.
The problem is a lack of respect for NPs and PAs, with many patients only wanting to see a doctor. We need to promote these occupations as the highly trained and licensed professionals that they are and make sure they get the respect they deserve.
tharmas|1 year ago
skhunted|1 year ago
As with all healthcare systems if there is a shortage of workers or it is not properly funded it will deteriorate. The U.S. healthcare system sucks for people who have no real access to it. The wait time of someone with no access to the system is effectively infinity.
Socialism, capitalism, communism, fascism, etc. are merely economic systems and all of them suck if not properly administered.
nsxwolf|1 year ago
hash07e|1 year ago
So are we "investing" resources in young and people who will still work and pay taxes?
Or do we invest in people who are already retiring or "incurable".
The older you get the less resources you will be available for you on the social healthcare.
Not saying the US system is sane or one option is better than other.
But the best system is the one that gives you option (and govt hates giving option to you).
1. Want social care? Ok. xx% will be deducted from your paycheck.
2. Want private care? No deductions, you are on your own. And If you don't have money and is charged we will generate a federal debp + 10% for processing fees.
But no... That can't happen. because it would expose the govt or private sector failures.
yapyap|1 year ago
1. the “socialist” system AKA healthcare for everyone has insane waiting times because everyone needs healthcare & there aren’t enough doctors.
2. the “capitalist” system seems better for the people that can afford it because the people that can’t afford it don’t go so they have no waiting time because a part of the people that need healthcare aren’t getting it due to the price.
It’s silly to say / imply that system 2 is the better way of doing it
bluedino|1 year ago
USA here, I think we need to pay them less. It's basically become a game of how little can they do and how much can they charge. Many already don't care about your symptoms, or bother to do any research. They just prescribe stuff as it's pushed. If they aren't already, I'm sure your doctor will soon just be entering your symptoms into ChatGPT.
llamaimperative|1 year ago
(2) and (3) are related since "dealing with insurance companies" == arguing for reimbursement from those companies, which means they're losing time arguing and losing money when they lose those arguments.
You know it's okay simply not to have an opinion on something if you can't spend more than 5 minutes or so thinking about it.
brendoelfrendo|1 year ago
lurking15|1 year ago
Really they should be charging as high as possible directly to consumers until doctors are attracted into the profession. Cut out the middleman, there is no reason that routine expenses like a sick visit that gets routine labwork or medication need to be insured.
It'd be better to reroute the software developers that construct complex systems to SERVE ADS and addict people to scrolling.
fallingknife|1 year ago
consteval|1 year ago