Thank you for highlighting perhaps the central question of healthcare that needs an answer before proceeding with any additional steps. As you note, each stakeholder has a different answer to that question which understandably can be self-serving. I can't speak about everyone else but as a doctor, I want patients to be happy, their referring MDs to be happy and to avoid a malpractice lawsuit. So, to keep patients happy, I yield to their desires such as a desire to increase lifespan even with no healthspan (from the point of view of the patient when they are actually 80 and diseased rather than for a 50 year old policy wonk deciding for an 80 year old.) Referring MDs want you to solve the problem, not to punt the problem back to them. For some, it means MRIs and invasive treatments or at least an attempt to fix a problem even if the odds look statistically poor. Finally, to avoid lawsuits, it behooves me to overkill every chance at a diagnostic test because no one will fault you for being excessively careful. Payors will view these actions as "poor value." But if patients and caregivers view them as valuable, then what mechanism exists to resolve these points of view?
Also, it is worthwhile to note that in 1980, those over 65 constituted about 11% of the population, whereas it is now closer to 18%, a greater than 60% increase so there would be an expectation to take a greater proportion of the GDP if everything else remained the same. But everything else probably doesn't remain the same, i.e. new technologies, meds costs more out of proportion to inflation. United Healthcare, the largest private insurer, IPO'ed at $0.06 a share in 1984, and now trades at $615/share based presumably on anticipated net income.
This is clearly discussion based on a lot of experience and a lot of thoughtful observation of the system around you. Thank you for sharing from your view inside. I really love your phrase of "what mechanism exists to resolve these points of view?" It really boils down the problem to the essentials; I'm going to pull up this phrasing of yours in other settings in the future.
The first idea that strikes me about your discussion is none of the three stakeholders (except for maybe your malpractice concern) have any clear prices on them, and thus it elevates the relative importance of non-price aspects that are very "local" to the decision maker- The patients want to be happy- but don't bear/ don't know the full cost of the care, and the referring MD's earnings (or happiness) probably isn't explicitly connected to how you solve the problem. The "local"ness of the problem really stands out in your discussion, no one is on the same page (or accounting sheet) for benefit or for costs.
Thanks for your reply. From the vantage point of a foot solider, like me, decisions based on expected value seem to be part of the problem because they hide the fact that at the decision making steps, the equilibrium state (as in game theory), point to outcomes that harm any economic goals of the system as a whole.
Thank you for highlighting perhaps the central question of healthcare that needs an answer before proceeding with any additional steps. As you note, each stakeholder has a different answer to that question which understandably can be self-serving. I can't speak about everyone else but as a doctor, I want patients to be happy, their referring MDs to be happy and to avoid a malpractice lawsuit. So, to keep patients happy, I yield to their desires such as a desire to increase lifespan even with no healthspan (from the point of view of the patient when they are actually 80 and diseased rather than for a 50 year old policy wonk deciding for an 80 year old.) Referring MDs want you to solve the problem, not to punt the problem back to them. For some, it means MRIs and invasive treatments or at least an attempt to fix a problem even if the odds look statistically poor. Finally, to avoid lawsuits, it behooves me to overkill every chance at a diagnostic test because no one will fault you for being excessively careful. Payors will view these actions as "poor value." But if patients and caregivers view them as valuable, then what mechanism exists to resolve these points of view?
Also, it is worthwhile to note that in 1980, those over 65 constituted about 11% of the population, whereas it is now closer to 18%, a greater than 60% increase so there would be an expectation to take a greater proportion of the GDP if everything else remained the same. But everything else probably doesn't remain the same, i.e. new technologies, meds costs more out of proportion to inflation. United Healthcare, the largest private insurer, IPO'ed at $0.06 a share in 1984, and now trades at $615/share based presumably on anticipated net income.
This is clearly discussion based on a lot of experience and a lot of thoughtful observation of the system around you. Thank you for sharing from your view inside. I really love your phrase of "what mechanism exists to resolve these points of view?" It really boils down the problem to the essentials; I'm going to pull up this phrasing of yours in other settings in the future.
The first idea that strikes me about your discussion is none of the three stakeholders (except for maybe your malpractice concern) have any clear prices on them, and thus it elevates the relative importance of non-price aspects that are very "local" to the decision maker- The patients want to be happy- but don't bear/ don't know the full cost of the care, and the referring MD's earnings (or happiness) probably isn't explicitly connected to how you solve the problem. The "local"ness of the problem really stands out in your discussion, no one is on the same page (or accounting sheet) for benefit or for costs.
Thanks for your reply. From the vantage point of a foot solider, like me, decisions based on expected value seem to be part of the problem because they hide the fact that at the decision making steps, the equilibrium state (as in game theory), point to outcomes that harm any economic goals of the system as a whole.