Meta Econ Takeover Day 40 \ stacker news ~meta

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1924 sats \ 20 comments \ @Undisciplined 25 Nov 2023 meta

A couple of articles on health care today:

By Ulyana Kubini Private Medical Care STILL Is a Better Deal Than Government Care "Americans are constantly told that Europeans have wonderful medical care provided by their governments. In reality, private care is gaining ground because it provides better care and a better deal."

By Łukasz Jasiński Seven Reasons to Abandon the Public Health System "Government-run medical systems are always touted by political elites, who usually take advantage of private care themselves. It is time for everyone else to have access to the same system."

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682 sats \ 10 replies \ @grayruby 25 Nov 2023

The medicare for all folks don't have any clue how bad public healthcare is. Firstly, you pay an insane amount of taxes to fund it, regardless if you ever use it and then you get pretty inadequate care for the excessive taxes you pay. Yes, if you have a medical emergency you won't be turned away or saddled with a 100k bill if you have to spend a week in hospital but it's very hard to find even a good family doctor that isn't so overworked and overwhelmed that they can give you the care you need. Then god forbid you need to see a specialist or need some specialized test. My dad's doctor wanted to him to have an MRI and referred him for the test back in August, he finally got an appointment and it's next April. 8 months is a long time to wait for people with potentially serious diseases or who are in chronic pain. I was planning on looking into just driving to Buffalo and paying cash for him to get the MRI.

Many years ago when I used to manage a retail drugstore there was a small doctor's office attached to our store. It was always overflowing with people and they would loiter and sit in our pharmacy area. I recall talking to the doctor and he said 2/3 of these people don't need to be here. They think their healthcare is "free" so they come to the doctor for almost everything and that all the pointless visits prevented people who needed to be under doctors care from getting the care they need.

Things have only gotten worse in Canadian healthcare since then.

Around 5 years ago the Trudeau gov changed the taxation rules for Doctors. They could no longer work as professional corporations (their offices can but not them personally) which essentially turned them into government employees taxed at the highest income tax bracket (53%). Many doctors left Canada for the US, others retired, and others just reduced their practicing hours.

Follow the incentives. Punish me for being productive and I will only be as productive as I need to make ends meet.

567 sats \ 2 replies \ @grayruby 25 Nov 2023

I just came to grips with the fact that I am old enough to use terms like "many years ago". This was probably 15 or so years ago. Is that many years ago or some years ago?

100 sats \ 1 reply \ @Undisciplined OP 25 Nov 2023

When I was little 15 years ago was the 70's, which certainly felt like many years ago.

I remember getting old enough that movies that were like 10 years old were still "the new movie" in my mind.

0 sats \ 0 replies \ @grayruby 25 Nov 2023

I have noticed the past few years that whenever I reference something that happened "a few years ago" that thing almost always happened 10 or more years ago. Haha.

50 sats \ 6 replies \ @Undisciplined OP 25 Nov 2023

The fact that they call for "Medicare for all" rather than "Medicaid for all" proves they aren't acting in good faith.

At least in the US we have a growing system of truly private medical care, where practices don't even accept insurance.

It's very interesting how much trust was lost with the medical system because of doctors and nurses promoting and complying with obvious nonsense.

614 sats \ 5 replies \ @elvismercury 25 Nov 2023

Not sure which obvious nonsense you're referring to, but complying with nonsense is required to work in this industry at all. It's required for the industry to exist at all. Or, flipping it over: given the regulatory structures, the only legal operation in the healthcare industry is laden with nonsense.

No better example of Public Choice Theory in action than healthcare. There would be a lot more Libtertarians if people only knew how the sausage was made.

478 sats \ 4 replies \ @Undisciplined OP 25 Nov 2023

You're right, but it wasn't until Covid that a lot of people became aware of that fact.

I'm thinking about how many people had conversations with their doctors about masks or vaccines or a bunch of other Covid practices that revealed to them that their medical care providers were either hopelessly uninformed or too cowardly to oppose the official position. Whichever one it is, it's a huge breach of trust.

1350 sats \ 3 replies \ @elvismercury 25 Nov 2023 freebie

I'm deeply exhausted by all the culture-warring on the topic, so I stopped following the back and forth, but the most comprehensive research I know about is that masks were a good idea, and they remain a good idea. The amount of nonsense that unfolded on that topic defies description. You can't even have a discussion about it anymore. But as always, I welcome credible evidence to the contrary.

Similarly, working near ground zero of how COVID played out in American healthcare, from both the payer and provider sides, I can say I don't fault physicians, as a group, for anything that happened. They were, on net, doing the best they could with the information that they had in the conditions they were in. A lot of criticism looks very different when there are literally people in front of you whose lives you're responsible for, morally and legally. It renders most armchair quarterbacking absurd. Real life tends to do that.

Where I will enthusiastically get on the train is that the whole system is layer upon layer of captured incentives and rot. A bunch of people have gotten very rich rent-seeking. The whole thing needs to burn down. Of course, there will be casualties, literal and metaphorical, when it does.

478 sats \ 2 replies \ @Undisciplined OP 25 Nov 2023

We probably aren't very far apart here. Although, I don't see much of a case for masking in the way it was done; i.e. extremely prolonged usage. As best as I could follow the research that had been done and that came out during the pandemic, masking is almost completely ineffective against respiratory viruses.

However, that's besides the point I'm making. The issue is that people who tried to do their own research and communicate their concerns to their doctors often discovered that their doctors' knowledge was shockingly lacking. That shattered the widely held illusion that doctors are damn near omniscient.

As a member of the "expert class", it doesn't surprise me at all that an inquisitive lay person could pretty quickly surpass an expert's knowledge on a narrow area that the expert isn't actively looking into. I encounter that pretty much every day just on Stacker News.

I agree with you that the failure is more systemic. Doctors trusted the advice of other medical experts, who trusted the advice of still other experts. In a system like that, it doesn't take too many errors or bad faith actors to cause enormous damage, especially if political pressures are stifling corrective mechanisms.

614 sats \ 1 reply \ @elvismercury 25 Nov 2023

The issue is that people who tried to do their own research and communicate their concerns to their doctors often discovered that their doctors' knowledge was shockingly lacking. [...] As a member of the "expert class", it doesn't surprise me at all that an inquisitive lay person could pretty quickly surpass an expert's knowledge on a narrow area that the expert isn't actively looking into.

I've had the same experience. But I will tell you that, unless you've worked in the industry, you can't fathom the amount of lunacy and horseshit that doctors must contend with under the guise of patients DYOR, and the dynamics in play don't allow them to just scroll past the idiot take. The priors you develop for the insightfulness of patient intel asymptotes to zero at great velocity.

Combine that with a time pressure to churn through patients so great that many of them can barely eat lunch, and perpetual fear of malpractice and lawsuits, and you get the current thing. It sucks for everyone.

413 sats \ 0 replies \ @Undisciplined OP 25 Nov 2023

I would submit that, as someone who started out in climate science before moving into economics, that I can at least fathom the amount of lunacy and horseshit doctors encounter. The time constraint is a completely different dynamic, though.

To some degree, this is just a general feature of specialization. You're almost always going to know way more about what you do than whoever you're doing it for does.

When I'm teaching and a student brings something up that I don't know how to answer, I look into it and come back to them with an explanation. It's a disservice to treat people as dismissively as doctors (and professors) often do.

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730 sats \ 1 reply \ @gnilma 25 Nov 2023

Agree to what @grayruby said. Public healthcare is just inefficient, promotes capital misallocation, and disincentivises competition.

Here in the north, family doctor wait time is usually 1 hour or more (past your appointment time) even if you have an appointment. Hospitals' emergency department usually have 2 to 10 hours of wait time, but I would say mostly at least 4 hours. Specialists take about 6 to 12 months wait. Public healthcare just cost too much and is dysfunctional; but I guess cost too much and dysfunctional is the case for anything run by the government.

I once took my son to the local children's hospital because he got pushed off the top bunk of a bunk bed and hit his head on the ground. We had to wait 8 hours before a doctor came to check on him.

672 sats \ 0 replies \ @grayruby 25 Nov 2023

When I still lived in Toronto I had to take my daughter to Sick kids for a test her pediatrician wanted. We had an appointment and still waited 2 hours and I was shocked at how run down and dirty Sick Kids was. I had never been there before, and maybe it was just the wing I was in, but I was shocked considering it is supposed to be a world class children's hospital.

567 sats \ 4 replies \ @gabybaby 25 Nov 2023

Public healthcare can never work at scale because of adverse selection. You see this already with the ACA exchanges here in the US; people who opt for ACA plans are on average less able to pay full-price (require public subsidies) and need more care. You will never be able to find enough healthy people willing to pay into the system while taking up minimal to none of the pooled resources.

Anyone can see this is true by looking at the plans that are available. Even the cheapest options have massive deductibles and still decently large monthly premiums.

It's one of the reasons I never even considered becoming a health actuary (I'm in property & casualty), the business is fundamentally economically imbalanced and the only way to make profit is to lobby government and find ways to get reimbursed from the feds/states. Just not a real business fundamentally if it's driven mainly by political jockeying and not superior positioning in the marketplace.

0 sats \ 3 replies \ @Undisciplined OP 25 Nov 2023

The complete perversion of insurance must drive actuaries nuts. It's such a powerful market institution, but it has to be allowed to actually function as insurance.

567 sats \ 2 replies \ @gabybaby 25 Nov 2023

It's not really insurance if it inevitably gets stopgapped by taxpayers against their will. It absolutely grinds my fucking gears and when I talk to health actuaries I'm blown away by how much less sophisticated their pricing techniques are relative to my industry's.

We actually rely pretty heavily on data and statistical techniques, significantly less on trying to get our way through political avenues.

One thing too to note about insurance markets, don't be surprised if places like CA or FL see private personal lines insurers (homeowners, auto, etc.) leave because of terrible economics and get replaced by fully public options.

0 sats \ 1 reply \ @Undisciplined OP 25 Nov 2023

I've only heard mention of Florida screwing up their homeowners insurance, but I don't know the details of what happened. Obviously, I'm not surprised California screwed theirs up.

567 sats \ 0 replies \ @gabybaby 25 Nov 2023

Depending on how the heads of Departments of Insurance (DOIs) are selected (elected or appointed), there can be varying levels of political pressure to keep insurance rates down even in the face of grim economic realities.

A popular maneuver is capping the rate increases that can be filed on a yearly basis; this looks like a win for the consumers in the short term (and great for political bonafides), but creates a massive loss in the medium to long term as insurers leave markets entirely and remaining insurers have little to no incentive to provide good service.

Sadly, both states have geographical drawbacks (CA, wildfires; FL, hurricanes) and aggressive DOIs that make it hard to charge the appropriate rates given the risks involved. Surprisingly, FL is a bit more reasonable than CA or even NY are; I have personal experience filing in FL and while they're tough and demanding they understand that insurers raise rates for a reason. Other states are much less flexible and forgiving.

567 sats \ 1 reply \ @shado_op 25 Nov 2023

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50 sats \ 0 replies \ @Undisciplined OP 25 Nov 2023

This doubles as an argument about why democracy is stupid.