morphism
live long and prosper
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User ID: 2721
No. Look, if you sit down and actually do the calculation, the combination of GDP, prices, salaries doesn't add up as you claim — and that's before asking the question of which quality of service you're getting.
EDIT: And the statement "salaries are higher, therefore prices must be higher" cannot even be a causation — if anything, it's the other way round: higher prices cause higher salaries (assuming that the workload stays the same). But why should prices for each specific medical procedure or diagnostic in the US be higher? Do they add magic sprinkles to it, so that the health outcome is phenomenally better than in Germany? Price and value are two fundamentally different things, and the question is whether the US offers a good price for the medicine stuff.
morphism
live long and prosper
8d ago
Well, you know what they say about anecdotes and data. Germany spends about 12% of its GDP on healthcare, and that percent has steadily gone up over time. The US spends 17%, which is certainly higher but not massively so
But comparing GPD is not the same as comparing prices.
Prices for medical procedures in Germany are regulated by the Gebührenordnung für Ärzte (GoÄ), which is publicly visible. For example, the typical cost of a duodenoscopy (optical inspection of the gastrointestinal tract just after the stomach) is ~ 200 EUR. This is the price that a person would pay if they decide to get this procedure out of their own pocket (I have friends who have done this).
I don't know a good source for prices in the US, but let me take this New York based thing as an example. They list an upper endoscopy at $975. That's a 4-5x price difference compared to the price in Germany!
In addition, in Germany, this price is almost always covered by insurance, which is mandatory for everybody. In Germany, it is unheard of for people to go bankrupt due to a health expense. In the US, that's very different — people regularly go broke due to medical costs and ask for monetary support online.
If your figures about GDP are correct, this implies that the US performs dramatically less procedures than Germany. This can be due to efficiency, which I doubt, or due to 4-5x reduced level of care.
morphism
live long and prosper
9d ago
OK, but you can't just run a large organization with no administration. Some of those administrators do useful work!
Sure. But administrative costs can easily blow 10x for checking rule B that would be unnecessary if rule A did not exist.
Total unemployment spending is like $10 billion a year, and that's mostly just benefits.
Care to cite a reference for this? What percentage is spent on the administration of those $10 billion?
Likewise, you can't just approve any grant that a scientist asks for. It actually seems reasonable that scientists would spend a lot of time proposing different ideas, and then have a separate agency deciding which ones are worth doing.
If you look at the source that I indicated, you will find ample evidence that the current system is dysfunctional, despite it "seeming reasonable". The gist is this: a) You need scientist time to check grants, which could be spent on doing science instead, and b) as science is inherently unpredictable, finding out which ones are doing is actually hard and the separate agency currently mostly fails at that task.
most of the countries that do comparable service at lower cost are also countries with much lower salaries overall, so that goes back to the point about "just lower salaries." Generally the countries with more money, like Switzerland, also spend more on healthcare.
I once took a breadth test in Germany, and a breadth test in the US, close in time. The Germany one is 50 EUR, the US one was $1020. That's a 20x difference, and I don't think that this can be explained by salaries alone.
morphism
live long and prosper
10d ago
Oh, and here are more big issues for private health care, second-order effects:
- Timely treatment is cheaper than delayed treatment — due to increasing complications as the medical problem festers
- Effective treatment keeps people in the workforce
The issue with health problems is that it is usually cheaper to fix them early and thoroughly, rather than spend money peacemeal and end up with a complex operation to save the patient's life at the end. It's more efficient to do a the stitches today, than to deny care only to amputate the entire arm in two weeks.
On the second point, when a medical insurer is forced to keep paying for a patient that was taken out of the workforce by their illness, the insurer has an incentive to pay for early interventions, because the patient can still contribute to the insurance while they are working. If the patient can't work, they don't generate income for the insurer.
morphism
live long and prosper
10d ago
I think we're all hoping that there's some big pot of money being totally wasted. […] But I'm not sure that's the case.
It's never as simple as an obviously frivolous budget. However, here are at least two systemic issue that are large sources of inefficiency:
- Information asymmetry. Doctors can and will prescribe treatments that are medically not quite necessary, but where the patient is fundamentally unable to tell the difference. This is actually a problem in Germany.
- Administrative costs. A system with complex rules for who gets denied care and who does not will need accountants who check these rules. This is busywork that could be spent on simply actual care. I have no estimates how this affects that health care sector, but I bet that it's substantial. But I know of at least two other sectors where this problem occurs:
- Checking unemployment benefits vs universal basic income
- Science funding. I can't find the estimate, but for some grants, at least 50% of the work goes into writing the grant, not doing the actual research.
In the end, money is just "liquefied" work that people do for other people. Not all of that work is useful towards the goal of meaningful health care, and not all of these people are paid the same amount of dollars per hour of useful work, rightfully or wrongly.
We could perhaps make an argument for cheaper, but worse, health care.
Well, the fact that countries other than the US have health care systems which deliver comparable service, but at significantly lower cost indicates that a large chunk of money is spent ineffectively.
morphism
live long and prosper
11d ago
I agree that more transparent price information would improve the market, but that does not yet imply that the market is fit for purpose.
It's a question of market design. Markets have a specific purpose — optimize the allocation and procurement of scarce goods using decentralized decision making, but depending on circumstances, not all of them are effective at this purpose. This topic is closely related to auction theory, where e.g. a second-bid auction is better than pay-as-bid auctions.
The main troubles with market design in health care are:
- Inflexible demand. A person who is sick generally cannot abstain from buying the good "healthcare".
- Information asymmetry. Doctors can generate demand by recommending procedures that are not quite necessary or more expensive than necessary, but the patient does not have a chance of being informed enough to know the difference.
Due to these issues, a "free market" will lead to perverse incentives; other market designs are better at solving the optimization problem. And yes, market design = regulation.
morphism
live long and prosper
1yr ago
people are still having to pay more for goods and services than they did previously; their money is worth less and they are poorer now than they were previously.
This is actually intended by the Federal Reserve — the typical inflation target is 2%. The reasoning behind this is that money is only useful if it is spent for goods and services — people who make the goods and perform the services will only do so if there is demand for it, and the inflation gives a little nudge to spend money rather than hoard it. Put differently, spending money is equivalent to soliciting work from other people. No spending, no working.
As a counterpoint, the creators of cryptocurrencies typically think that this is a terrible line of reasoning, and therefore created their own money.
it becomes more plausible to me that there is an underlying emotional component that is either modulating the symptoms, or leading to some of them.
I'm afraid, but this is a logical non-sequitur.
- The "weirdness" of a physical symptom does not logically imply that it has an emotional cause. Counterexample: People with rabies panic when presented with liquids to drink. I would say that this symptom qualifies as "weird" — unfortunately, the disease is still deadly virtually all of the time.
- Even if the symptom is an emotion, such as irrational fear, this does not imply that the cause is emotional. Counterexample: 1) Rabies as above, 2) Depression can be caused by continued ingestion of fructose during fructose malabsorption.
Even more afraidly, I have to point out that current notions of an "emotional cause" have no basis in science — even though there are codified in popular diagnoses, such as F45 ("somatform disorder") in ICD-10.
Specifically, the problem with F45 is the following:
F45 postulates that the inability to detect a physical cause implies the presence of an emotional cause.
But "absence of evidence is not evidence of absence". As Ioper already points out, the physical cause may be unknown and a) there exists no current test for it. In practice, b) the doctor is "too lazy" to test for it.
In fact, the postulated criterion for presence of "emotional cause" is unscientific — by definition, a criterion which is scientific must be falsifiable. Here, this means that there must exist an experiment which is able to reject the hypothesis that XY is the "emotional cause". No such experiment has ever been put forward for F45. (If you know of any such experiment, please do write a reply to this post.)
As for your "weird" symptoms: Mast cell diseases, such as mastocytosis, MCAD or hereditary alpha tryptasemia are known to cause "weird" symptoms.
(This fact is useful, but strictly speaking unnecessary for rejecting F45.)
You are the one who does not seem interested in such a calculation. You cite some GDP figures and rest on your preconception that you're right. I'm not gonna bother discussing data against such attitude towards truth. (EDIT) For example, you make an assumption about me making a trip to Germany, which is factually wrong.
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