The US has the rich world's most expensive health care system, and that system delivers the worst health outcomes of any country in the rich world. Also, the US is unique in relying on market forces as the primary regulator of its health care system. All of these facts are related!
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If you'd like an essay-formatted version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/2
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/3
There's some truth to this: when demand for something exceeds the supply, prices tend to go up.
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/4
But this elegant, self-regulating system rarely survives contact with reality.
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/5
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/6
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/7
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/8
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/9
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195137/
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Medicare's prospective payment system: A critical appraisal
PubMed Central (PMC)Cory Doctorow
•Ostrzeżenie o treści: Long thread/10
https://prospect.org/economy/2024-06-13-fantasyland-general/
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Fantasyland General
Robert Kuttner (The American Prospect)Cory Doctorow
•Ostrzeżenie o treści: Long thread/11
https://pluralistic.net/2021/10/27/crossing-a-line/#zero-fucks-given
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/12
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/13
https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/hospitals
The theory here was that publishing prices would create "market discipline." Again, this isn't wholly nonsensical. To the extent that patients have nonurgent conditions and the free time to shop around, being able to access prices will help them.
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/14
But there's another wrinkle here. The same people who claim that prices can solve all of our problems also insist that monopolies are *impossible*.
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/15
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/16
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/17
> ADJUSTABLE C TAPER NECK PLUS|1|UNITED HEALTHCARE [1016]|HB CH UNITED HMO / PPO / INDEMNITY [34]|UNITED HEALTHCARE HMO [101604]|75|Inv Loc: 1004203; from OR location 1004203|52.02|Inpatient PAF; 69.36% Billed|75|Inv Loc: 1004203; from OR location 1004203|56.87|Outpatient PAF; 75.83% Billed
https://www.massgeneralbrigham.org/en/patient-care/patient-visitor-information/billing/cms-required-hospital-charge-data
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CMS Required Hospital Charge Data | Mass General Brigham
www.massgeneralbrigham.orgCory Doctorow
•Ostrzeżenie o treści: Long thread/18
Kuttner describes the surreal lengths he had to go through to prevent his mother from getting ripped off by Mass Gen through an upcoding hustle.
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/19
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/20
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/21
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/22
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/23
https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/24
https://armandalegshow.com/episode/multiplan/
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Meet the Middleman’s Middleman - An Arm And a Leg
An Arm And a LegCory Doctorow
•Ostrzeżenie o treści: Long thread/25
https://pluralistic.net/2022/05/04/house-always-wins/#are-you-on-drugs
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/26
No matter what the problem is with America's health industry, the answer is always the same: more markets!
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/27
The US health industry is a perfect parable about the dangers of trusting shareholder accountable markets to do the work of democratically accountable governments.
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/28
https://pluralistic.net/2021/01/29/fractal-bullshit/#dayenu
Hospitals formed regional monopolies to counter the seller power of consolidated Big Pharma.
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/29
Monopoly at any point in a supply chain leads to monopoly throughout the supply chain. But patients can't consolidate (that's what governments are for - representing the diffuse interests of people).
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/30
Kuttner describes how his eye doctor races from patient to patient "as if he was on roller skates."
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/31
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/32
But for market cultists, all of that *can't* work. Instead, we have to create more esoteric middlemen like "pharmacy benefit managers" and Multiplan. We need more prices to shovel into the market computer's data-hopper. If we just capitalism hard enough, surely the system will finally work...someday.
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Cory Doctorow
•Ostrzeżenie o treści: Long thread/eof
On June 22, I'll be in Oakland, CA for a panel and a keynote at the Locus Awards:
https://locusmag.com/2024-locus-awards-weekend/
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2024 Locus Awards Weekend, June 19-22
Locus OnlineThree plus or minus five
•Ostrzeżenie o treści: Long thread/32
They know it’s wasteful. They don’t want markets because they are better. I think want markets because they can abuse them.
Cory Doctorowudostępnił to.
enoch_exe_inc
•Ostrzeżenie o treści: Long thread/21
All is not entirely well here, with waiting times between annoyingly long to borderline lethal, but at least we don’t spend it arguing on the phone about how much it’ll cost.
Cory Doctorowudostępnił to.
Zhi Zhu 🕸️
•Ostrzeżenie o treści: Long thread/21
Stephan Schulz
•Ostrzeżenie o treści: Long thread/5
Cory Doctorowudostępnił to.
gavinisdie :troll:
•Ruth O’Day
•Rather than the US relies on “… market forces as the primary regulator of its health care system”, how about: the US relies on “the profit motive as the primary regulator of its health care system”.
Big difference.
Cory Doctorow
•Ruth O’Day
•Cory Doctorow
•The prior view - articulated, for example, in the legislative debates of the 1880s leading to the Sherman Act - was that the profit motive, absent regulation, inevitably produced monopoly.
Ruth O’Day
•Competitors with “unconventional” approaches (naturopaths, chiropractors, etc.) are not covered or are only partially covered by health insurance plans.
In his youth, a work colleague had a job with Big Pharma. In his naïveté at a meeting, he suggested a tweak to a treatment that would improve health outcomes. He was told, “our job is to treat, not to cure.”
Then Big Pharma tries to put obstacles in front of unconventional treatments coming to market.
Clutha🏴🇸🇩🇺🇦
•USA has a serious mental health problem.
Aho
•Virginicus
•