How American Health Care Killed My Father

http://www.theatlantic.com/doc/print/200909/health-care

by mhb • 17 years ago

166 105 17 years ago

bwd2• 17 years ago

The title is misleading, this article is actually an examination of economic distortions in the US healthcare industry, and a quite good one at that.

joe_the_user2• 17 years ago

I don't see a contradiction between the article's title and the subject you mention. Various economic factors distort the provision of healthcare to the point that it kills people. The title naturally highlights this crucial point, understandably so given the author's personal experience with this.

electromagnetic• 17 years ago

It's quite disturbing that Pronovost had to beg hospitals to adopt a free technique that could cut the average 100,000 deaths from hospital acquired infections down to ~30,000 overnight with nothing but telling your doctors to wash their hands.

This was adopted a long time ago in the UK and became cemented in place with the MRSA outbreaks. Visitors can actually be removed from the hospital if they're seen not using the alcohol based sanitizer.

jacquesm• 17 years ago

If there is one place to avoid if you want to stay healthy it's the hospital.

mrkurt4• 17 years ago

The last paragraph of the article addresses this specifically:

"Imagine my father’s hospital had to present the bill for his “care” not to a government bureaucracy, but to my grieving mother. Do you really believe that the hospital—forced to face the victim of its poor-quality service, forced to collect the bill from the real customer—wouldn’t have figured out how to make its doctors wash their hands?"

DannoHung• 17 years ago

Nope. Because collections are outsourced.

kingkongrevenge3• 17 years ago

He says he is a democrat, but a reasonable interpretation of the article points towards the republican solution of taxing health care benefits. The problem is that both the industry and consumers are very insulated from price sensitivity, so costs shoot out of control and providers have little incentive to improve quality. People need to be paying for far more of their care out of pocket with cash. We need price wars between hospitals.

mrkurt4• 17 years ago

A market based fix for health care isn't really a "Republican solution". If, for instance, we had an "everyone pays for their own care out of pocket" system, and we had state or federal subsidies for those that couldn't afford their care, we'd have a market backed by government aid.

Like food stamps.

philwelch2• 17 years ago

Or school vouchers (wait--that's another "Republican solution").

hnal9433• 17 years ago

All you've done is taken a "Republican solution" and injected government control into it. The part of it that remained Market-based (i.e. the part that would work) would be the sole domain of conservatives.

nradov• 17 years ago

People need to be paying far less for preventative care out of pocket. When they have to pay for preventative care, a lot of them (especially low income) just skip it. And then small problems turn into big, expensive problems. We want diabetics to come in for periodic foot exams so they don't have to get their feet amputated later.

hnal9433• 17 years ago

...and under what circumstances do people pay increasingly less for an increasingly improved product?

The free market!

I agree that there needs to be more direct competition for health care dollars.

anamax3• 17 years ago

> People need to be paying far less for preventative care out of pocket. When they have to pay for preventative care, a lot of them (especially low income) just skip it.

We've posted the links repeatedly - preventative care improves quality of life but doesn't reduce cost.

And, pre-natal care is FREE in the US, yet many poor folks don't bother.

In other words, both assumptions for your argument are false.

lutorm• 17 years ago

The article addresses this by saying there could be vouchers or some way for the government to encourage people to go to them. And don't forget that in his system, the low income people would be subsidized anyway, so they might be in a better position to get preventative care than they are now.

run4yourlives2• 17 years ago

Why is it that you Americans are so two dimensional? Every possible idea for social reform must either be the republican or democrat position. If it can't be pigeon-holed into one of those viewpoints, it's not worth discussion. If it can, it quickly devolves into some form of partisan debate.

Your two party system is killing you in every area, and you don't even know it.

pixcavator• 17 years ago

Do you mean "one dimensional"?

kingkongrevenge3• 17 years ago

> social reform must either be the republican or democrat position

Uhh, no. It just so happens that in this case some Republicans are the only people putting forward the idea of taxing medical benefits as ordinary income, to reduce the role of insurance in the system. I don't even vote, let alone think in terms of democrat vs republican.

grandalf• 17 years ago

I'm an American and I think the one dimensional political spectrum idea is nonsense. I have also never voted for a mainstream party.

Xichekolas3• 17 years ago

Yeah, I don't understand why people accept/reject an argument based on which political party supports it, and why one party has to define itself in opposition to the other on every topic. Shouldn't we be looking for good solutions? Not just good solutions endorsed by our party of choice, but overall good solutions...

anigbrowl2• 17 years ago

Oh yeah, when I'm sick I really want my care to wait on the outcome of a bidding war between hospitals. How about a reverse eBay, where I post my life-threatening condition and hospitals bid on it in a dutch auction until the price gets low enough for my insurance company to click 'buy it now'. And if nobody bids, I just pay the auction listing fee, and die relatively economically. I mean, what could go wrong!

OK, I am not being entirely serious here. but I think market solutions don't work that well when it comes to healthcare because patients can neither be fully informed consumers (without a medical degree) nor can they exercise a free choice about when they plan to fall ill. Consider: having your house burn down is also a bit unpredictable, so you buy insurance for that. And indeed, the costs of a home fire can run into the hundreds of thousands, not incomparable to the cost of health problems. And yet, fire insurance is way, way cheaper than health insurance. Why?

Hint: it's not due to competing fire departments. We used to have those, but we got rid of them for a reason.

aardvarkious• 17 years ago

EVERYBODY will have health problems and use their health insurance. Very few people will have their house burn down and use their fire insurance. Therefore, there is a massive difference in price.

Dove5• 17 years ago

The analogy to fire departments doesn't work. Your fire insurance doesn't pay the fire department to save your house, it pays you to repair/replace it. That one's free market all the way.

Furthermore, there are many free markets in which consumers cannot be fully informed which work just fine. I know very little about the design of video cards, the maintainence of automobiles, how to remodel a house, what makes a good lawyer, whether my glasses are good for my vision, or myriad other things I pay others for on a regular basis. Nonetheless, I am able to navigate these markets just fine and make tradeoffs according to my personal values. The combined effect of consumer reports, public opinion, and paid personal advocates seems to get me there okay.

I submit that in a free market, most would have no more difficulty shopping for a docter than they do for a mechanic.

And while patients cannot choose when or how to fall ill, they can choose what to treat, what to treat well, what to invest in preventing, and what to simply tough out. The dire necessity of my owning a car does not prevent competition between car dealerships.

pragmatic• 17 years ago

Et tu, Hacker News?

The political pieces on HN are starting to overwhelm the technical articles. Isn't there enough of this on Reddit?

jgrahamc2• 17 years ago

Yes, there's plenty of this on Reddit. That's why I used my 'flag' power to flag this article. This article bugs me for two reasons:

1. It's about a non-technical political topic

2. I am British and care very little about the internal political arguments in the US concerning their health care system.

plinkplonk5• 17 years ago

"I am British and care very little about the internal political arguments in the US concerning their health care system."

Amen Brother!

Political articles should be (imho) shut down very fast. The "flag and wait for a moderator" tactic doesn't seem to be working as well as it used to.

mhb4• 17 years ago

The article has little to do with politics and the subject which is the economics of health care is well thought out and presented.

Although it refers to the US health care system, the narrative applies to health care delivery in general and is applicable to other countries.

You are right that it is non-technical, but it is of a higher quality and more intellectually satisfying than countless other submissions here. Presumably you also have flagged Signaling and Indian Higher Education though I'm not sure whether your nationality would make that more appealing to you.

kingkawn• 17 years ago

Flag power, go!

hooande• 17 years ago

There are no set topics on hacker news for a reason. As I understood it, the main criteria was for submissions to be intelligent and informative. This article is one of the most rational discussions of the US health care system I have seen, and it's worth reading if you want to find out how it works.

I think the key is that every story on the home page helps you to better understand how something works or why something happened. You know, the hacker part of "hackernews".

We should probably save the flags for stories that are being manipulated by spammers or small groups. Anything else will rotate off the home page in a few hours anyway.

davidw10• 17 years ago

The thing I worry about is that these stories attract people interested in discussing politics, who in turn post more stories, which may not be quite as good, which in turn attract more people, and so on and so forth.

Politics/economics are low hanging fruit that anyone can dig up a story on and comment on. Erlang vs Scala in terms of creating distributed systems... not so much. The first will always crowd out the second, given enough time.

noonespecial• 17 years ago

This one's more hacker than you think. The medical machine is running poorly. We're poking at the source code to figure out what might be wrong.

protomyth2• 17 years ago

I kinda wish Hacker News would skip the political articles. There are plenty of technical things about health care to cover (e.g. databases for health, clinical trials, input cost reduction).

That being said, I lived under US government health care for a goodly chunk of my life (IHS), and until they fix that, they really have no biz working on anything else.

kragen• 17 years ago

IHS is the Indian Health Service? They don't care about that because Indians have no political power. It's unbelievable the kind of corruption and incompetence that exists inside that agency.

FWIW, Medicare, Medicaid, the VA, and medical care for soldiers are all pretty good on the US scale.

ahoyhere3• 17 years ago

Really? The VA? Did you miss all the scandals about the Walter Reed medical base in DC, where soldiers were mistreated, ignored and neglected, and even one killed himself in his room and no one noticed for 2 days? The hospital had no idea until his parents called and forced them to look for their missing son. This was a guy who was evacuated due to a semi-suicide attempt, and they didn't even bother to monitor him. Shameful.

Not to mention the older vets, especially from Vietnam. They are screwed at every turn and the previous administration cut their benefits even more.

miked• 17 years ago

FWIW, Medicare, Medicaid, the VA, and medical care for soldiers are all pretty good on the US scale.

Ahoyhere's comment isn't the half of it. The incident happened at Walter Reed Army Hospital, which is the same place that US president's usually go for care. If stuff like that could happen there (it may have been a different branch in DC), what's the rest of the system going to be like?

I worked for a medical software company for seven years, converting Medicare specs for outpatient code editing into working programs. We would get regulatory updates once a quarter, make changes to the code and the data, test and ship. The fun part was that we would usually receive the reg changes 3 weeks before the hospitals had to have the updated application. Also, their reference application didn't match what was written in the specs. Worst of all, the spec changes were often unreadable and we would have to call DC to figure out what they meant. It will not surprise many of you to learn that they wouldn't know either and would "have to get back to us". I could go on and on...

protomyth2• 17 years ago

Yep, that is the IHS I meant. I wouldn't be so quick to complement the VA, they too have a lot of problems.

mustpax• 17 years ago

For the whole article on a single page: http://www.theatlantic.com/doc/print/200909/health-care

tptacek2• 17 years ago

This isn't a political article. Its author has contributed tens of thousands of dollars to Democratic political causes, but the article itself is almost completely opposed to the Democratic Party's thoughts on health care.

Instead, this is an article about business, efficiency, the impact of IT and modern business process on health care, and the impact our current system has on consumers and businesses.

pg3• 17 years ago

I agree. This kind of article is a de facto test of flagging judgement. For a while now I've been considering having HN learn whose flags to pay attention to. (I already have code to collect stats about rates of crying wolf, but I don't do anything with these numbers yet.)

davidw10• 17 years ago

As someone who certainly "cries wolf", I'll go ahead and ask: how are we to judge "good" politics articles from bad ones?

I read The Economist, and think they occasionally do some pretty good politics articles, and having an on-line version, it would be easy to post them here.

joe_the_user2• 17 years ago

"Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results."

The author supports this point in rich and irrefutable detail. Read it and weep.

This article is indeed "not political" but ONLY in the sense that none of the efforts at a solution being debated even slightly address the crucial considerations that he makes. Shame on the solvers...

jpwagner2• 17 years ago

theatlantic: "wow this story is amazing, thoughtful, and powerful, but the title has got to go. How about something catchy like: How American Health Care Killed My Father"

author: "umm..."

towski• 17 years ago

I'm tired of health care articles based on anecdote. His entire article is seems biased by the fact that his dad died.

davars• 17 years ago

Appealing when presented in the abstract, but I have nightmarish visions of such a system.

On the one hand, you'd further motivate those consumers who were already likely to avoid preventive care and ignore symptoms until they require costly (to me as contributor to the catastrophic plan) emergency and intensive care. And the author's position that folks would be able to withdraw funds that exceed a certain ceiling adds the perverse incentive to risk not spending this money, with the downside being absorbed by the catastrophic plan.

On the other hand, you'd do nothing to discourage consumers with irrational fears about their health from distorting prices upwards, or to discourage unscrupulous providers from fomenting those fears. The plan he describes takes fee-for-service and all its problems to a whole new level. I think of things like the celebrity anti-vaccine mess and the healthcare debate with its distorted media coverage and disingenuous advertising, and I have hard time accepting a consumer-driven market succeeding, even with all the government-collected and -analyzed data in the world.

Even worse, I fear that such a system would result in a tiered system, where the best and brightest providers provide excessive care to those with means while the rest of us continue to struggle with barely adequate, barely affordable care.

I don't think that any system that relies on healthcare consumers making the choice between limiting their usage of healthcare services and spending money is destined for success. Providers need to be rewarded for providing the best outcomes for the lowest cost with the fewest mistakes, not the most and most expensive services. Significant efforts must be made to improve the public health of Americans. The conversation should be about how to make those things happen. All this debate about who pays when is just a side show that is obstructing real reform.

donaldc• 17 years ago

Your fears are ones that one could have about any market. But in general, free markets seem to work better than any of the alternatives across a wide range of markets, and I really doubt that health care would prove an exception to this.

It won't be perfect, of course, but a perfect system doesn't exist. I'm absolutely appalled that I'm paying (on average, as an American) over $1.5 million over my life for the present system, and can't imagine this would remain the case if pricing and outcome transparency were drastically increased. I think that quality and service would improve, while cost would decrease.

abalashov2• 17 years ago

You're making the somewhat curious assumption that systematic neglect of "preventive" care (i.e. routine checkups) results directly in the "downside": large-scale, high-cost catastrophic events.

It certainly can, but from the point of view of statistics in human pathology, a complete non sequitur. For every person that neglects a checkup and misses early detection of a highly surreptitious, life-threatening disease, there will be ten for whom it either has no impact or results in low-grade, unremarkable chronic conditions that require occasional office visits and prescriptions.

Having to directly bear the cost of going to the doctor also provides a considerable incentive for leading a healthier life and staying away from bad habits with adverse medical consequences, in the same way that people are disincentivised to do avoidable things that hurt their financial standing in other areas.

Dove5• 17 years ago

Yeah. It's the same way with auto insurance and warranties. The dealer covers the costs of any catastrophic maintainence for the first few years, so the consumer tends to skip out on routine maintainence like oil changes. And at those regular tune-ups, when the mechanics appraise someone of a developing problem, they tend to avoid preventative maintainence, saying, "Nah, I'll just let it fail so the warranty handles it."

. . . ;)

My theory is that the inconvenience of a major failure and the risk to life and limb are much more important to most folks than the tiny costs associated with regular and preventative maintainence. I know they're more important to me!

It's actually been rigorously shown to work the same way with medicine. There was a study on HSA / High Deductable plans already in use, and it found that use of preventative care actually increased compared to the baseline.

http://www.marginalrevolution.com/marginalrevolution/2009/08...

nazgulnarsil• 17 years ago

medical reform isn't political in the sense that what we currently have is obviously bullshit and what the politicians propose is obviously bullshit. if we're talking about a non-bullshit solution we're in the realm of fantasy, not politics.

Xichekolas3• 17 years ago

Some of my favorite parts:

"But health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance."

"For that matter, try discussing prices with hospitals and other providers. Eight years ago, my wife needed an MRI, but we did not have health insurance. I called up several area hospitals, clinics, and doctors’ offices—all within about a one-mile radius—to find the best price. I was surprised to discover that prices quoted, for an identical service, varied widely, and that the lowest price was $1,200. But what was truly astonishing was that several providers refused to quote any price. Only if I came in and actually ordered the MRI could we discuss price."

"By contrast, consider LASIK surgery. I still lack the (small amount of) courage required to get LASIK. But I’ve been considering it since it was introduced commercially in the 1990s. The surgery is seldom covered by insurance, and exists in the competitive economy typical of most other industries. So people who get LASIK surgery—or for that matter most cosmetic surgeries, dental procedures, or other mostly uninsured treatments—act like consumers. If you do an Internet search today, you can find LASIK procedures quoted as low as $499 per eye—a decline of roughly 80 percent since the procedure was introduced. You’ll also find sites where doctors advertise their own higher-priced surgeries (which more typically cost about $2,000 per eye) and warn against the dangers of discount LASIK. Many ads specify the quality of equipment being used and the performance record of the doctor, in addition to price. In other words, there’s been an active, competitive market for LASIK surgery of the same sort we’re used to seeing for most goods and services."

ahoyhere3• 17 years ago

That's because the notion of insurance is wrong. People need healthcare coverage, not insurance.

We are all connected in this stupid country - if the family down the street can't afford preventative care, and the wife gets sick, and can't take care of the kids, and the husband misses work and gets fired from his job, and then they can't afford good nutritious food for their kids, so the kids go to school hungry and don't learn as well and don't test as well, the ripples can last for generations.

Here's the thing. People act as if healthcare is something that has to be earned, and deserved, and not only is this viewpoint inhumane (in the Greatest Nation in the World!), but it's economically indefensible.

If people don't get early medical care, their lifetime economic output can be greatly reduced. And their children are affected. If children aren't taken care of with nutrition and care, their mental abilities, abilities to stay in school, are affected -- and their lifetime economic output is reduced. And targeted poverty (as opposed to where everyone's poor) breeds crime. Which creates greater loss of human economic potential AND greater costs for the government.

The country benefits from more, healthier workers, who can think straight, and don't spend significant portions of their time figuring out how to scrape by. These people can then spend money. Middle- and lower-middle-class people spend far more of their income than higher income brackets, if only they have the money to spend.

Net effect: The benefits to the entire country outweigh the costs, in a system where costs aren't an arms race between health insurance providers, malpractice insurers, and other for-profit companies.

A stitch in time saves nine.

Fannie• 17 years ago

I can believe American Health care killed your father. The people who have insurance, are afraid to go to the emergency room with chest pain, afraid the pain is gas and they can't afford the high out of pocket costs they have to pay.

How American Health Care Killed My Father

Related Stories