Thread by @adamscrabble

🔥Thread. I'm gonna make you a "Health Care" berserker.
Pharma, hospital & insurance cartels appropriated the language of their adversaries. They have sent out an army of Terminators, programmed for reconnaissance, infiltration & a team of robot killer dogs. You can be our hero

A survey was done by Commonwealth Fund, it compared health-care systems of 14 advanced countries. On the 20 measures of comparison, Britain’s National Health Service (NHS) performed well in 13, meh in two, and very poorly in five..

If popular satisfaction is the aim of a health-care system NHS did great.
Brits were the most satisfied with their health care of all the populations surveyed.
But, on many vital measures of ***actual achievement*** rather than ***subjective assessment*** the NHS came out worst

1. Worst for 5 year survival rates in cervical, breast, colon cancer
2. Worst for 30-day mortality rates after admission to a hospital for either hemorrhagic or ischemic stroke

How is it that the population most confident that it'll receive treatment of the highest standard and w/latest medical advances, actually has worst survival rates in those diseases that require the most modern treatments?
Survival rates are not imm. visible for inspection

In a quick and incomplete comp between ‘theirs’ and ‘ours’,
1. American rate of Rx consumption is 2x British rate.
2. NHS has been inexpensive because it rationed care by means of long waiting lists and neglecting to spend money on new hospitals and equipment

Canada is vaunted as an ideal. Its not:
A survey by Fraser Institute found a median wait of 20 weeks for “medically necessary” treatments and procedures in 2016 = more than double the wait times reported in 1993.

The survey looked at total wait times starting from:
Time they received a referral to
Consultation with a specialist to
When patient ultimately receives treatment.
By any actual measure, Canada fails.
(brief intermission. Petunia getting her nails clipped. Shes a fighter)

So, lets reverse engineer how we got here to find solutions...
In 1995, there were about 50+ independent drug companies in U.S. pharma markets.
Locally owned pharmacies had not yet been displaced in most communities by giant chains like CVS and Walgreens.

Doctors still worked as indies or in small groups. Most hospitals were locally owned and community focused, yet they faced real competition from other local hospitals over insured patients...

Regulatory barriers to entry bottled supply of health care professionals and limited the building of new hospitals.
Informal cartels and kickbacks between hospitals existed but it was rare for providers to exercise their absolute monopoly power

In the 1980s/’90s, doctors and hospitals were put on the defensive = insurers merged with one another and forced doctors and providers to make price concessions if they wanted to keep their insured patients

Insurers used their increasing MONOPSONY power (like amazon has) to tighten drug companies and everyone else in the medical supply chain. This MONSOPSONY effect explains why in the 1990s, the nation’s overall health care bill declined. Monopsonies always become monopolies.

Those 50+ drug companies melded into 10, hospitals, outpatient facilities, physician practices, labs, health care providers began merging vertically/horizontally into integrated, corporate health care platforms that increasingly dominated the supply side of medicine

These are ‘life’ platforms that have extended their power by controlling the marketplace in which customers and suppliers have to do business.
Identical to what Amazon is doing today...

What if a government program like Medicare were given responsibility for purchasing all health care in the U.S?

What happens when a single payer finds itself negotiating with a single provider?

The profit motive is supposed to lower costs, not increase them. In the idealized model of a completely free market, the profit motive is supposed to lower costs as customers are free to choose the best product/service for the lowest price.

In the real-world, open competition drives profits to zero. Every attempt to gain advantage in price, increases supply and further commoditizes the product/service.

This dynamic pushes prices down to the point that nobody can make a profit until competitors are driven out of business and a cartel or monopoly secures the market and controls supply, price and profit.

In the real world of state-cartel-capitalism, competition is eliminated so cartels can maximize profits.

Cartels instruct the state to protect their cartels. State reformers can try all sorts of complex reform schemes but they fail to lower costs because they all leave the cartel structure and cartel ownership of governance intact.
Why is Gov giving cartels exactly what they want?

In the 1950s/1960s/70s the, U.S. healthcare was more localized, and the central state (federal government) wasn’t the Sugar Daddy for the cartels.

This is why the cartels love "Medicare For All" proposals: the federal government–protector and funder of the cartels–will give the cartels a blank check not just for the 120 million people currently drawing benefits from Medicare/Medicaid but for all 325 million Americans.

Medicare Beneficiaries: 57.7 million
Medicaid Beneficiaries: 72.3 million
Medicare/Medicaid budget, 2015: $1.2 trillion
Total U.S. healthcare costs: $3.2 trillion, 18% of GDP
Department of Defense budget (not iclding added bills), 2015: $575 billion

Prevention is intrinsically low-profit. Illness, especially chronic illness, is highly profitable because the profits flow continuously from treatments, medications, procedures, tests, visits, hospitalization, home care, a constant churn of billing, etc.

You can reconfigure the system any way you want, but you have to eliminate cartels, cartel ownership of governance, opaque pricing, government blank checks and incentives for profiteering from chronic illness. If you don’t eliminate all these, you’ve fixed nothing.

Healthcare as human right spreads a notion of entitlement, a powerful solvent of human solidarity

And great rhetor to get elected regardless that it leaves in its wake a substantial number of disgruntled ingrates

And once something is a right, someone has to pay for it

Regulations are mechanisms to preserve cartels. Lets look at a problem but not its solution. HIPPA.

Commercial off the shelf technology, is cheap/effective. Specialized technology written to constantly evolving regulation is expensive, and favors cronyism and monopoly.

HIPPA is a thicket of regulations that has as its vague purpose “security” to protect privacy. Those few companies who become specialists at meeting regulations become advocates for regulations, which aligns with the army of bureaucrats who promulgate and enforce regulations.

Finding vendors who meet 1 hurdle is hard, finding ones that meet 30 is impossible unless the vendor is engineering the firm to market solely to this niche and charging monopoly rates as their reward

In HIPPA, a tech system is deliberately inflexible, even if attaining that inflexibility while maintaining its intended function requires time be spent precisely determining the intended function and deliberately removing everything outside of that intended function.

Security is not the goal. A well established audit trail is the goal. Being secure is not enough, you have to be able to demonstrate that everyone using the app is secure. The app my doctor uses only value is as a risk repository.

So, one last thing. Carcinogens...

The FDA is one of the top research shops, but they have little/no teeth/enforcement authority. The have done exhaustive work to evaluate carcinogenic chemical, compounds, etc - and those things are allowed to be used in American products like toys, toiletries, cosmetics...

Much of this is shipped to us from China.
Yet, China does not even allow these items to be sold in their country, nor has the EU permitted it. The same shampoo in US and Europe is actually not the same. Ours have the bad chemical, theirs don't
amazon.com/Exposed-Chemis…

Look. At. Chart. Of. United Health
You're. Socialism. Is. Their. Capitalism.

Look. At. Chart. Of. Aetna.
You're. Socialism. Is. Their. Capitalism.