I think the writer is unaware of her privilege, because this is already happening to many of us in the US.
Tell everyone else that they can’t have the fancy new drug they just read about, or that they have to wait half a year to see a specialist, and they will freak out, too.
I think the writer is unaware of her privilege, because this is already happening to many of us in the US.
I literally had to wait six months to see a psychiatrist. She referred me for a psych evaluation which took another six months. And it turned out that was just an intake meeting with a different...
I literally had to wait six months to see a psychiatrist. She referred me for a psych evaluation which took another six months. And it turned out that was just an intake meeting with a different doctor and the actual testing took another six months to schedule. After all that, it took me two more months to get an appointment to go over the results with the intake doctor and luckily only a week after that to meet back with the psychiatrist to discuss medication options based on the results.
Twenty months all told! And I have a better employer-provided private health insurance plan than almost all my friends.
As far as I know it was primarily a supply/demand issue with there not being enough doctors available. I've heard it's not so unusual in the mental health care sector right now, at least in my...
As far as I know it was primarily a supply/demand issue with there not being enough doctors available. I've heard it's not so unusual in the mental health care sector right now, at least in my area apparently. But the place I went was one of the bigger names nationwide for psychological care and in a major metropolitan area, it's not like I was in the middle of nowhere where a single doctor rolls up in a horse-drawn buggy once a year after the harvest.
I don't blame any of the doctors or other individuals I spoke to, they were all sympathetic and I appreciate the work they did. But I take umbrage with anyone who implies that private healthcare is some unassailable juggernaut of efficiency.
I think it's more charitable to assume it's poor phrasing. We all know these things like this happen. Tighter cost controls will result in more of that sort of thing.
I think it's more charitable to assume it's poor phrasing. We all know these things like this happen. Tighter cost controls will result in more of that sort of thing.
Of note, nowhere did the author mention that one of the largest costs savings would have come from the Public Option that was unceremoniously killed. Or how we now have Medicare with the option to...
Of note, nowhere did the author mention that one of the largest costs savings would have come from the Public Option that was unceremoniously killed.
Or how we now have Medicare with the option to negotiate drug prices.
Or how we ask for the newest drug because it’s one of the only countries that allows advertising of prescription drugs.
Well, hope springs eternal and maybe something else will work? We can only see what happened for things that have been tried. I'm sure advertising increases sales somewhat, but doubt that demand...
Well, hope springs eternal and maybe something else will work? We can only see what happened for things that have been tried.
I'm sure advertising increases sales somewhat, but doubt that demand for new drugs is primarily advertising-driven. There are worldwide shortages of the latest weight-loss drugs. Somehow people found out about them without the advertising?
Point of order - this is one of the lowest quality articles I've seen on Tildes to date. I don't mind opinion pieces that source their statistics and offer some nuance or effort in positing a...
Point of order - this is one of the lowest quality articles I've seen on Tildes to date.
I don't mind opinion pieces that source their statistics and offer some nuance or effort in positing a particular viewpoint. In this case, however, the author is somewhatnotorious for getting factual matters wrong, general bad faith, and incoherence.
The topic post is a prime example. McArdle fails to engage with a huge body of evidence on the fundamental issues with U.S. healthcare and the factors known to distinguish it from functioning systems that cost less. I'm not going to write a full rebuttal here. The data is widely available for anyone who cares to look, compiled by people who are far less well paid and conspicuously placed than a Koch-funded shill.
I do, personally. If only because it has muddied the water of what is news to such a degree, that for at least a decade now it is impossible to get news devoid of opinion. The muddying of the...
I don't mind opinion pieces that source their statistics and offer some nuance or effort in positing a particular viewpoint.
I do, personally. If only because it has muddied the water of what is news to such a degree, that for at least a decade now it is impossible to get news devoid of opinion. The muddying of the waters has enabled people with a distinct political agenda to label publications like NPR as liberal or left wing. Honestly, the majority of articles now are opinion pieces masquerading as news. To be frank, I would love to see strict rules against opinion pieces on a site like Tildes. That's what comment sections are for, not articles and publications themselves.
I would personally love to see a societal change taking a stance against opinion pieces, at least as top level content.
I'll start by pointing out that this article's author, Megan McArdle, describes herself as a right leaning libertarian. She's been railing against ObamaCare for as long as it's been discussed, so...
I'll start by pointing out that this article's author, Megan McArdle, describes herself as a right leaning libertarian. She's been railing against ObamaCare for as long as it's been discussed, so there's some history here.
It's not entirely clear why Ms. McArdle decided to write and post this missive, nor is it clear that anything she's asserting is true. For instance, in this NY Times article, they note that MediCare costs have somewhat flattened from their projected trajectory starting around 2010(around when Obamacare was passed). This more than makes up for the money spent funding the CMMI that she sees as wasted money. Which is weird since that agency appears to have the same goals as she does- reducing costs and improving care.
She speaks without any nuance, like when she says the government can just cut doctors' salaries in half(!) with the stroke of a pen. It's scary language, meant to seem drastic. Is this seriously how she sees it going down? No reasonable person thinks that way. If any such program were to go into effect, it would be gradual. Or when she says that no company will produce a given drug for whatever imaginary price the government sets for it. Plenty of companies can and do produce drugs at government set rates. Does she think that companies will turn down profit just be cause it's only a little and not a lot? Don't be ridiculous.
She ends by saying this is just the way things are, nothing to be done so just accept that this is the way it is. She never offers anything positive. What's her angle?
Finally, her biggest omission, the ignoring the 800lb gorilla that is the health insurance cabal. She must like them or something. Kind of telling that she couldn't find one positive thing to wedge into the article somehow. Insurance is the biggest driver of health care costs in this country.
Cutting salaries that much would be a drastic change for the US, but it would be needed to get costs down to what they are in Germany (say). This isn't an argument for doing it, it's explaining...
Cutting salaries that much would be a drastic change for the US, but it would be needed to get costs down to what they are in Germany (say). This isn't an argument for doing it, it's explaining why it's hard to match other countries on costs.
Note that overhead for health insurance itself is capped. However, these companies are often conglomerates.
Yes, I'm aware that overhead is capped for insurance companies. Whatever the cap is, doesn't change the fact that they are poor stewards of the public health, and put their own interests far ahead...
Yes, I'm aware that overhead is capped for insurance companies. Whatever the cap is, doesn't change the fact that they are poor stewards of the public health, and put their own interests far ahead of any person in need of health care.
Ultimately insurance companies are useless leeches that make everything they touch worse. The only good purpose they would serve (mitigating costs in disaster like cancer) are better served by...
Ultimately insurance companies are useless leeches that make everything they touch worse. The only good purpose they would serve (mitigating costs in disaster like cancer) are better served by taxpayer funding, or at most, like a non-profit NGO that isn't directly tied to tax dollars but is still publicly accountable.
I agree wholeheartedly. Health insurance companies, as they exist today, are actively harming American society and making a majority of peoples' lives worse. This sector needs extreme oversight,...
I agree wholeheartedly. Health insurance companies, as they exist today, are actively harming American society and making a majority of peoples' lives worse. This sector needs extreme oversight, tight regulation, and a drastic reduction in size and scope.
This article is a bit short and there’s not enough detail to be fully convincing. Here’s the core of the argument, though. How do we know whether it’s true? … …
This article is a bit short and there’s not enough detail to be fully convincing. Here’s the core of the argument, though. How do we know whether it’s true?
Obamacare contained a lot of elements that were expected to realize significant cost savings while actually improving the quality of care.
Preventive care, it was hoped, could catch conditions early and forestall expensive emergency room visits. (It’s a lot cheaper to treat high blood pressure than a stroke.) Doctors and hospitals could be paid to keep patients healthy, rather than to perform expensive procedures. A government board somewhat akin to Britain’s National Institute for Health and Care Excellence could rigorously assess treatments for cost-effectiveness. An innovation center would experiment with new models of care to drive further reforms.
…
Unfortunately, though, in its first decade, the CMMI ended up costing the government about $5.4 billion, and it is expected to cost another $1.3 billion by 2030. Nor is the CMMI the only initiative that failed in this way. In a June letter to Sen. Sheldon Whitehouse (D-R.I.), the CBO reported that “overall, the evidence about the effects of ACOs on Medicare spending is mixed.” Translated from Wonkese, this means it was hard to tell whether ACOs produced significant savings.
Preventive care turned out to cost more than it saved, in part because doctors may need to treat a lot of minor conditions to prevent one serious health crisis. Expanding the number of insured turns out to make emergency room visits rise, not fall, because newly insured people worry less about the cost. A program to reduce hospital readmissions among Medicare patients may have killed thousands, as hospitals tried to avoid admitting patients who might trigger a readmission penalty. A plan to promote new insurance co-ops, a kind of voluntary public option, saw almost all of them fail within six years.
This is not to say that all the Obamacare programs were worthless. (Okay, the one that may have killed people was bad.) But part of innovating is risking failure. What this demonstrates is how hard it is to actually change the system in ways that generate major savings.
It’s not that we don’t know ways to save money. The system could be run more efficiently by reducing slack, but this would make people wait longer for many tests and treatments, as Canadians and Brits do. Doctor salaries, which averaged $316,000 in 2021, could be trimmed to the levels of German doctors ($183,000) or those in Britain ($138,000). The government could mandate lower drug prices, which would result in Americans losing access to medicines that aren’t worth making at the mandated price, as well as many that aren’t yet developed.
The problem is that these savings aren’t free.
…
The savings come attached to significant other costs, making them too politically expensive to contemplate. Try to cut doctors’ salaries almost in half, and they will freak out. Tell everyone else that they can’t have the fancy new drug they just read about, or that they have to wait half a year to see a specialist, and they will freak out, too. Politicians know this and won’t take the risk.
Your loss. Yes, Republicans have used "Obamacare" derisively, but nowadays it's a widely used colloquial term. Taken literally, it's giving Obama credit for his signature achievement, which isn't...
Your loss. Yes, Republicans have used "Obamacare" derisively, but nowadays it's a widely used colloquial term. Taken literally, it's giving Obama credit for his signature achievement, which isn't a bad thing.
I pondered this a bit. Just because it's widely used doesn't mean its shed its negative connotations of its origins. I've not done more than an anecdotal check, but I certainly noticed that left...
nowadays it's a widely used colloquial term
I pondered this a bit. Just because it's widely used doesn't mean its shed its negative connotations of its origins. I've not done more than an anecdotal check, but I certainly noticed that left or center sources I read from might use the term once or twice, usually phrased as popularly known as Obamacare or "Obamacare", where the farther the source is to the right the less they'll mention ACA.
Yeah, sometimes it works as a “tell” in poker terms. But I think it’s a noisy enough signal that we shouldn’t assume too much about the author; they might not have meant anything in particular by it.
Yeah, sometimes it works as a “tell” in poker terms. But I think it’s a noisy enough signal that we shouldn’t assume too much about the author; they might not have meant anything in particular by it.
I think the writer is unaware of her privilege, because this is already happening to many of us in the US.
I literally had to wait six months to see a psychiatrist. She referred me for a psych evaluation which took another six months. And it turned out that was just an intake meeting with a different doctor and the actual testing took another six months to schedule. After all that, it took me two more months to get an appointment to go over the results with the intake doctor and luckily only a week after that to meet back with the psychiatrist to discuss medication options based on the results.
Twenty months all told! And I have a better employer-provided private health insurance plan than almost all my friends.
That's insane, but this isn't anywhere near typical. I don't know where the failure point was in your process.
As far as I know it was primarily a supply/demand issue with there not being enough doctors available. I've heard it's not so unusual in the mental health care sector right now, at least in my area apparently. But the place I went was one of the bigger names nationwide for psychological care and in a major metropolitan area, it's not like I was in the middle of nowhere where a single doctor rolls up in a horse-drawn buggy once a year after the harvest.
I don't blame any of the doctors or other individuals I spoke to, they were all sympathetic and I appreciate the work they did. But I take umbrage with anyone who implies that private healthcare is some unassailable juggernaut of efficiency.
I think it's more charitable to assume it's poor phrasing. We all know these things like this happen. Tighter cost controls will result in more of that sort of thing.
Of note, nowhere did the author mention that one of the largest costs savings would have come from the Public Option that was unceremoniously killed.
Or how we now have Medicare with the option to negotiate drug prices.
Or how we ask for the newest drug because it’s one of the only countries that allows advertising of prescription drugs.
Well, hope springs eternal and maybe something else will work? We can only see what happened for things that have been tried.
I'm sure advertising increases sales somewhat, but doubt that demand for new drugs is primarily advertising-driven. There are worldwide shortages of the latest weight-loss drugs. Somehow people found out about them without the advertising?
Point of order - this is one of the lowest quality articles I've seen on Tildes to date.
I don't mind opinion pieces that source their statistics and offer some nuance or effort in positing a particular viewpoint. In this case, however, the author is somewhat notorious for getting factual matters wrong, general bad faith, and incoherence.
The topic post is a prime example. McArdle fails to engage with a huge body of evidence on the fundamental issues with U.S. healthcare and the factors known to distinguish it from functioning systems that cost less. I'm not going to write a full rebuttal here. The data is widely available for anyone who cares to look, compiled by people who are far less well paid and conspicuously placed than a Koch-funded shill.
I do, personally. If only because it has muddied the water of what is news to such a degree, that for at least a decade now it is impossible to get news devoid of opinion. The muddying of the waters has enabled people with a distinct political agenda to label publications like NPR as liberal or left wing. Honestly, the majority of articles now are opinion pieces masquerading as news. To be frank, I would love to see strict rules against opinion pieces on a site like Tildes. That's what comment sections are for, not articles and publications themselves.
I would personally love to see a societal change taking a stance against opinion pieces, at least as top level content.
Reuters and the Associated Press provide just-the-facts news for free. Lots of the opinion-based stuff out there is just repackaging those two.
I'll start by pointing out that this article's author, Megan McArdle, describes herself as a right leaning libertarian. She's been railing against ObamaCare for as long as it's been discussed, so there's some history here.
It's not entirely clear why Ms. McArdle decided to write and post this missive, nor is it clear that anything she's asserting is true. For instance, in this NY Times article, they note that MediCare costs have somewhat flattened from their projected trajectory starting around 2010(around when Obamacare was passed). This more than makes up for the money spent funding the CMMI that she sees as wasted money. Which is weird since that agency appears to have the same goals as she does- reducing costs and improving care.
She speaks without any nuance, like when she says the government can just cut doctors' salaries in half(!) with the stroke of a pen. It's scary language, meant to seem drastic. Is this seriously how she sees it going down? No reasonable person thinks that way. If any such program were to go into effect, it would be gradual. Or when she says that no company will produce a given drug for whatever imaginary price the government sets for it. Plenty of companies can and do produce drugs at government set rates. Does she think that companies will turn down profit just be cause it's only a little and not a lot? Don't be ridiculous.
She ends by saying this is just the way things are, nothing to be done so just accept that this is the way it is. She never offers anything positive. What's her angle?
Finally, her biggest omission, the ignoring the 800lb gorilla that is the health insurance cabal. She must like them or something. Kind of telling that she couldn't find one positive thing to wedge into the article somehow. Insurance is the biggest driver of health care costs in this country.
I've never heard a more succinct summary of conservative mentality.
Yep, and you were right. This article was just a lot of hot air.
Cutting salaries that much would be a drastic change for the US, but it would be needed to get costs down to what they are in Germany (say). This isn't an argument for doing it, it's explaining why it's hard to match other countries on costs.
Note that overhead for health insurance itself is capped. However, these companies are often conglomerates.
Yes, I'm aware that overhead is capped for insurance companies. Whatever the cap is, doesn't change the fact that they are poor stewards of the public health, and put their own interests far ahead of any person in need of health care.
Ultimately insurance companies are useless leeches that make everything they touch worse. The only good purpose they would serve (mitigating costs in disaster like cancer) are better served by taxpayer funding, or at most, like a non-profit NGO that isn't directly tied to tax dollars but is still publicly accountable.
I agree wholeheartedly. Health insurance companies, as they exist today, are actively harming American society and making a majority of peoples' lives worse. This sector needs extreme oversight, tight regulation, and a drastic reduction in size and scope.
This article is a bit short and there’s not enough detail to be fully convincing. Here’s the core of the argument, though. How do we know whether it’s true?
…
…
Because they're using the derisive right-wing dogwhistle term to refer to the ACA, I know that I don't need to waste my time.
Your loss. Yes, Republicans have used "Obamacare" derisively, but nowadays it's a widely used colloquial term. Taken literally, it's giving Obama credit for his signature achievement, which isn't a bad thing.
I pondered this a bit. Just because it's widely used doesn't mean its shed its negative connotations of its origins. I've not done more than an anecdotal check, but I certainly noticed that left or center sources I read from might use the term once or twice, usually phrased as
popularly known as Obamacareor"Obamacare", where the farther the source is to the right the less they'll mention ACA.Yeah, sometimes it works as a “tell” in poker terms. But I think it’s a noisy enough signal that we shouldn’t assume too much about the author; they might not have meant anything in particular by it.