8 ms·

I kind of want these issues to continue and get worse. Because then we will have a healthcare revolution, rather than more bandaid policy fixes. It seems like

I kind of want these issues to continue and get worse. Because then we will have a healthcare revolution, rather than more bandaid policy fixes. It seems like the US healthcare system is too far gone, and we need to hard reset it. Anyone who lives in another developed nation would be absolutely outraged if they had to deal with half the things Americans do when it comes to healthcare and the respective insurance.

tashi 7y ago
I know that doesn't feel like optimism to you, but in my experience whenever people decide to let things get so bad that there has to be a revolution, bad just becomes the new normal. The only advancements I've seen in politics, in my few decades of paying attention, have come from people working incredibly hard to make tiny improvements.
gizmo686 7y ago
How many people are you willing to let die to get to that revolution. Then, once the revolution comes, how many people are you willing to let die while you iron out the operational bugs in your new system. Fixing the US healthcare system is going to be like changing an engine mid flight. It will require long term planning and consist of a lot of bandaids and ducktape while we work on it. Unfortunately, our political system is by-polar, so plans need to be designed not by what will work best, but by what cannot be dismantled when leadership changes.
- notjesse 7y ago
  I'm not sure it needs to be like that. Most developed nations have a public health system. Akin to how the US has public schools and emergency services. The revolution could be the government bitting the bullet, and spending a fortune on bootstrapping a public health system that undermines insurance and private health. Yes, it will hurt that sector a lot, it won't happen overnight, it will cause huge deficits, and it will inevitably cause higher taxation. But it's ultimately what needs to be done. We just need to give up on the sunk cost fallacy and go with proven models.
  - saagarjha 7y ago
    Any plan like that is going to have a portion where you convince the part of the country openly hostile to it that you're not bringing in socialism.
    - jakeogh 7y ago
      Having the gov decide who gets what care is incompatible with a free society. Alfie Evans is a striking example.
      - lazyasciiart 7y ago
        A "free society" doesn't require that parents be given free reign to torture their children. You may wish to argue whether that's what was happening, but that's the reasoning the state gave for their actions. If you'd like to argue that a free society does require this, go ahead, but I don't think most people agree.
        jakeogh 7y ago
        The "state says" excuse? That's free to you? There was absolutely nothing wrong with his parents. The state in that case forbid them from accepting help and decided to (frankly) murder the person.
        onion2k 7y ago
        Alfie's doctors made the decision that taking him from hospital for an experimental treatment in a different country had a strong chance of killing him, and that he was better off dying peacefully and not in pain in the UK. Alfie's parents fought to try and save his life at any cost even if it meant he went through tortuous pain first. Frankly both sides of the argument are understandable. No one wants a child to suffer but no parent wants to give up on their baby. It's a tragic case. It's also an exception. Using it as the basis of how you decide 99.999% of other medical cases is idiotic, and using Alfie's memory as a tool to promote a particular system of healthcare payment is obscene and shameful. Just remember this - for every case like Alfie's where there genuinely are two sides to consider there are millions more where the doctors are simply right. Setting a precedent that parents wishes automatically overrule the doctors would cause so many children to suffer. This is why we let doctors and courts make decisions - to save children from stupid parents.
- deleted 7y ago
  [deleted]
- maxerickson 7y ago
  If you want to frame it like that, you also have to ask how many people you are willing to let die in the meantime.
- iamnothere 7y ago
  One could argue that we are currently stuck on a local maxima, and that the broader political system is designed such that any significant improvement will first require massively disruptive changes that will indeed lead to deaths. In this sort of situation, the end result of a change will save many more lives over the long term, but it will require short term sacrifices. Not just sacrifices of money; unfortunately, some people won't make it through the process. Opposition from incumbents ensures that any change will be a difficult process, and a "new normal" will not come easily. Any long-term planning efforts will be sabotaged and subverted toward capture of profits. The best we can hope for is a series of smaller disruptive shifts (each followed by a resettling) that eventually improves the situation. Something needs to happen. Increasingly it looks like dissatisfaction with the current system will boil over and force a major shift, but other events (wars, for instance) could pop up and distract the public for a time.
  - notjesse 7y ago
    That's a great way of looking at it! I've never thought of it like that.
  - Gibbon1 7y ago
    Before the ACA San Francisco implemented Healthy SF which eventually came to cover every family making up to 500% of poverty levels. It was just slowly phased in over about 5 years. Key thing I've noted about was it was designed to get people covered and to stay that way. That's the opposite of neoliberal ACA which is designed to be annoying and has traps designed to rat fuck people.
    - iamnothere 7y ago
      The media likes to associate the ACA with Obama, who was at least nominally on the left. This conveniently covered up the fact that the ACA was based on Romneycare, a vehicle from the neoliberal "center" designed to prevent truly disruptive reform. The ACA was a stalling tactic, and it has been rather successful in that role. People are starting to see through the ruse though.
- schrodinger 7y ago
  The problem is that those who need healthcare most (i.e. those that would be let to die) are those that are most opposed to universal healthcare!
  - flowersjeff 7y ago
    Very true. The level of disconnect that we have in this nation around this is just unreal.
- krferriter 7y ago
  It would take a number beyond reckoning, thousands to change our minds. Tens of thousands. But my lord there is no such force. > looks at US uninsured death rate and medical bankruptcy rate. > horn blows. A new power is rising. Its victory is at hand.
  - fragmede 7y ago
    > Tens of thousands. Not to be callous but if they're poor, is that enough? Because 64,000 Americans died of drug overdose in 2016, and 72,000 in 2017 (200/day). (2018 stats not yet out.) 2/3rds of those are linked to the opioid epidemic, but those numbers haven't been enough to engage with the same sort of cultural change in other areas of the American psyche, as socialized healthcare would be. (NOT proffering an opinion on that here, just pointing out the body count may not be enough. Sadly.
    - erentz 7y ago
      Well also putting aside the terrible opioid problem which is partly economic in cause, purely on a healthcare issue we already do have thousands dying from lack of access! Its been estimated that approximately 40,000 people die due to lack of access to healthcare each year. But these are poor people so we don’t see them or hear about them and thus no revolution yet. (Although a majority of Americans want Medicare for all so somehow we just need to get representatives that represent voters not donors.)
- YinLuck- 7y ago
  As many as it takes. Why should anyone care about unrelated statistics like human deaths?
- ozzyman700 7y ago
  A few million
pishpash 7y ago
It's finally starting to squeeze the bourgeoisie, so maybe they'll side with the working class this time instead of eating crumbs from the oligarchs.
nostromo 7y ago
Except most Americans are pleased with the healthcare they receive. https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx https://news.gallup.com/poll/245195/americans-rate-healthcar... You’ll never hear this in the media, but the reason there isn’t sweeping change on the horizon is because a large majority of Americans are satisfied with their healthcare. A majority even report being satisfied with their personal healthcare costs.
- untog 7y ago
  Except that.. > Seniors, Medicaid/Medicare Recipients Rate Coverage, Quality Most Positively So, the people most satisfied are the ones with healthcare provided by the government, which is what many are proposing. "Pleased" with your healthcare is a relative term. It doesn't mean you couldn't get better. I am pleased with my healthcare compared to the healthcare I used to have. But I'd go back to the public healthcare I had in the UK in a heartbeat.
  - flowersjeff 7y ago
    And... How many times do we need to hear from these Medi* Recipients to keep the guvernment outta their medical plan. I really think that we need to stop listening to attitude and perceptions' based studies, and focus on cold hard numbers ($). People don't understand the system - not by a long mile and will swear up/down/sideways that they do...We need to take a more analytical approach and look at the numbers.
- mgkimsal 7y ago
  > "Majority satisfied with cost of their personal healthcare" BECAUSE THEY'RE NOT PAYING IT The major tie-in with employers footing a large portion of an insurance premium means most people have absolutely no idea what things actually cost. Why this is a 'deductible' expense for businesses but not for average working people is insane, and it distorts whatever pretense of a 'free market' there ever might have been.
- rockinghigh 7y ago
  You can't use this poll to support the private system. Only 51% of the respondents who have a private insurance are satisfied with the personal healthcare costs. Versus 70% for people who are under Medicare or Medicaid. If anything, this is an argument for Medicare for all.
flowersjeff 7y ago
I can understand the sentiment...i.e.: It seems like we in the USA only are willing to fix that which is beyond broken, and I think it has gotten beyond the point of fixing honestly. Honestly- don't even know how we could 'fix' this. The fact that we need study after study after study to tell us what we already know, it's gross. Coupled with the fact that it seems impossible to communicate to people just how bad it is (only when they have to personally experience the horror of our medical system to become believers) - I'm personally terrified.
cortesoft 7y ago
The problem is that MOST people never need that much health care; they will never have to live through one of the destructive trauma of one of these health disasters. Since it never effects them personally, they won't vote to change it.
- flowersjeff 7y ago
  Totally agree - and it is truly a sad reflection on us as a species. What's the real kick in the pants, we all will need medical care at some point in our lives...
henvic 7y ago
Socialists... Always willing to sacrifice people for the "greater good". Yes, the US healthcare system is horrible. Courtesy of state regulations, barriers to affordable medical care, big pharma influence on state actors (like, patents on medicine), etc. Instead, what we need is more transparency and respect on this field.
lsc 7y ago
>I kind of want these issues to continue and get worse. Because then we will have a healthcare revolution, rather than more bandaid policy fixes. This is the justification I hear for a lot of my "bernie or bust" friends. I always just assumed they were trying to justify voting themselves tax cuts. I mean, in a revolution, those of us in the tech sector... I don't see it going well for us. Normal people hated us before we became the new "upper class" - if it ever becomes acceptable to go around killing "rich" people - I bet we'll be among the first. the problem is that this means we end up with trump, who teams up with a lot of people who think that it's good that people without good jobs don't have access to healthcare.
- yonaguska 7y ago
  See this comment. https://news.ycombinator.com/item?id=19793335 https://news.ycombinator.com/item?id=19793335 I work in the healthcare insurance industry, lots of market swings due in part to talk about medicare for all, but also drops in expected profits because Trump is pushing for transparency in Rx costs.
BurningFrog 7y ago
Name three systems that have had successful revolutions of that type. I certainly can't think of one.
GavinMcG 7y ago
Growing up in Idaho I kept waiting for self-sabotaging policies to get so overwhelmingly bad for things to change. The market can remain irrational longer than you can remain solvent.
- dsfyu404ed 7y ago
  Don't worry. Idaho, like every other western state, will eventually be colonized by migrants from California who will bring their politics and culture with them. Things will change. You just might not like all the changes.

tashi 7y ago

I know that doesn't feel like optimism to you, but in my experience whenever people decide to let things get so bad that there has to be a revolution, bad just becomes the new normal. The only advancements I've seen in politics, in my few decades of paying attention, have come from people working incredibly hard to make tiny improvements.

gizmo686 7y ago

How many people are you willing to let die to get to that revolution. Then, once the revolution comes, how many people are you willing to let die while you iron out the operational bugs in your new system. Fixing the US healthcare system is going to be like changing an engine mid flight. It will require long term planning and consist of a lot of bandaids and ducktape while we work on it. Unfortunately, our political system is by-polar, so plans need to be designed not by what will work best, but by what cannot be dismantled when leadership changes.

notjesse 7y ago
I'm not sure it needs to be like that. Most developed nations have a public health system. Akin to how the US has public schools and emergency services. The revolution could be the government bitting the bullet, and spending a fortune on bootstrapping a public health system that undermines insurance and private health. Yes, it will hurt that sector a lot, it won't happen overnight, it will cause huge deficits, and it will inevitably cause higher taxation. But it's ultimately what needs to be done. We just need to give up on the sunk cost fallacy and go with proven models.
- saagarjha 7y ago
  Any plan like that is going to have a portion where you convince the part of the country openly hostile to it that you're not bringing in socialism.
  - jakeogh 7y ago
    Having the gov decide who gets what care is incompatible with a free society. Alfie Evans is a striking example.
    - lazyasciiart 7y ago
      A "free society" doesn't require that parents be given free reign to torture their children. You may wish to argue whether that's what was happening, but that's the reasoning the state gave for their actions. If you'd like to argue that a free society does require this, go ahead, but I don't think most people agree.
      - jakeogh 7y ago
        The "state says" excuse? That's free to you? There was absolutely nothing wrong with his parents. The state in that case forbid them from accepting help and decided to (frankly) murder the person.
        onion2k 7y ago
        Alfie's doctors made the decision that taking him from hospital for an experimental treatment in a different country had a strong chance of killing him, and that he was better off dying peacefully and not in pain in the UK. Alfie's parents fought to try and save his life at any cost even if it meant he went through tortuous pain first. Frankly both sides of the argument are understandable. No one wants a child to suffer but no parent wants to give up on their baby. It's a tragic case. It's also an exception. Using it as the basis of how you decide 99.999% of other medical cases is idiotic, and using Alfie's memory as a tool to promote a particular system of healthcare payment is obscene and shameful. Just remember this - for every case like Alfie's where there genuinely are two sides to consider there are millions more where the doctors are simply right. Setting a precedent that parents wishes automatically overrule the doctors would cause so many children to suffer. This is why we let doctors and courts make decisions - to save children from stupid parents.
deleted 7y ago
[deleted]
maxerickson 7y ago
If you want to frame it like that, you also have to ask how many people you are willing to let die in the meantime.
iamnothere 7y ago
One could argue that we are currently stuck on a local maxima, and that the broader political system is designed such that any significant improvement will first require massively disruptive changes that will indeed lead to deaths. In this sort of situation, the end result of a change will save many more lives over the long term, but it will require short term sacrifices. Not just sacrifices of money; unfortunately, some people won't make it through the process. Opposition from incumbents ensures that any change will be a difficult process, and a "new normal" will not come easily. Any long-term planning efforts will be sabotaged and subverted toward capture of profits. The best we can hope for is a series of smaller disruptive shifts (each followed by a resettling) that eventually improves the situation. Something needs to happen. Increasingly it looks like dissatisfaction with the current system will boil over and force a major shift, but other events (wars, for instance) could pop up and distract the public for a time.
- notjesse 7y ago
  That's a great way of looking at it! I've never thought of it like that.
- Gibbon1 7y ago
  Before the ACA San Francisco implemented Healthy SF which eventually came to cover every family making up to 500% of poverty levels. It was just slowly phased in over about 5 years. Key thing I've noted about was it was designed to get people covered and to stay that way. That's the opposite of neoliberal ACA which is designed to be annoying and has traps designed to rat fuck people.
  - iamnothere 7y ago
    The media likes to associate the ACA with Obama, who was at least nominally on the left. This conveniently covered up the fact that the ACA was based on Romneycare, a vehicle from the neoliberal "center" designed to prevent truly disruptive reform. The ACA was a stalling tactic, and it has been rather successful in that role. People are starting to see through the ruse though.
schrodinger 7y ago
The problem is that those who need healthcare most (i.e. those that would be let to die) are those that are most opposed to universal healthcare!
- flowersjeff 7y ago
  Very true. The level of disconnect that we have in this nation around this is just unreal.
krferriter 7y ago
It would take a number beyond reckoning, thousands to change our minds. Tens of thousands. But my lord there is no such force. > looks at US uninsured death rate and medical bankruptcy rate. > horn blows. A new power is rising. Its victory is at hand.
- fragmede 7y ago
  > Tens of thousands. Not to be callous but if they're poor, is that enough? Because 64,000 Americans died of drug overdose in 2016, and 72,000 in 2017 (200/day). (2018 stats not yet out.) 2/3rds of those are linked to the opioid epidemic, but those numbers haven't been enough to engage with the same sort of cultural change in other areas of the American psyche, as socialized healthcare would be. (NOT proffering an opinion on that here, just pointing out the body count may not be enough. Sadly.
  - erentz 7y ago
    Well also putting aside the terrible opioid problem which is partly economic in cause, purely on a healthcare issue we already do have thousands dying from lack of access! Its been estimated that approximately 40,000 people die due to lack of access to healthcare each year. But these are poor people so we don’t see them or hear about them and thus no revolution yet. (Although a majority of Americans want Medicare for all so somehow we just need to get representatives that represent voters not donors.)
YinLuck- 7y ago
As many as it takes. Why should anyone care about unrelated statistics like human deaths?
ozzyman700 7y ago
A few million

pishpash 7y ago

It's finally starting to squeeze the bourgeoisie, so maybe they'll side with the working class this time instead of eating crumbs from the oligarchs.

nostromo 7y ago

Except most Americans are pleased with the healthcare they receive. https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx https://news.gallup.com/poll/245195/americans-rate-healthcar... You’ll never hear this in the media, but the reason there isn’t sweeping change on the horizon is because a large majority of Americans are satisfied with their healthcare. A majority even report being satisfied with their personal healthcare costs.

untog 7y ago
Except that.. > Seniors, Medicaid/Medicare Recipients Rate Coverage, Quality Most Positively So, the people most satisfied are the ones with healthcare provided by the government, which is what many are proposing. "Pleased" with your healthcare is a relative term. It doesn't mean you couldn't get better. I am pleased with my healthcare compared to the healthcare I used to have. But I'd go back to the public healthcare I had in the UK in a heartbeat.
- flowersjeff 7y ago
  And... How many times do we need to hear from these Medi* Recipients to keep the guvernment outta their medical plan. I really think that we need to stop listening to attitude and perceptions' based studies, and focus on cold hard numbers ($). People don't understand the system - not by a long mile and will swear up/down/sideways that they do...We need to take a more analytical approach and look at the numbers.
mgkimsal 7y ago
> "Majority satisfied with cost of their personal healthcare" BECAUSE THEY'RE NOT PAYING IT The major tie-in with employers footing a large portion of an insurance premium means most people have absolutely no idea what things actually cost. Why this is a 'deductible' expense for businesses but not for average working people is insane, and it distorts whatever pretense of a 'free market' there ever might have been.
rockinghigh 7y ago
You can't use this poll to support the private system. Only 51% of the respondents who have a private insurance are satisfied with the personal healthcare costs. Versus 70% for people who are under Medicare or Medicaid. If anything, this is an argument for Medicare for all.

flowersjeff 7y ago

I can understand the sentiment...i.e.: It seems like we in the USA only are willing to fix that which is beyond broken, and I think it has gotten beyond the point of fixing honestly. Honestly- don't even know how we could 'fix' this. The fact that we need study after study after study to tell us what we already know, it's gross. Coupled with the fact that it seems impossible to communicate to people just how bad it is (only when they have to personally experience the horror of our medical system to become believers) - I'm personally terrified.

cortesoft 7y ago

The problem is that MOST people never need that much health care; they will never have to live through one of the destructive trauma of one of these health disasters. Since it never effects them personally, they won't vote to change it.

flowersjeff 7y ago
Totally agree - and it is truly a sad reflection on us as a species. What's the real kick in the pants, we all will need medical care at some point in our lives...

henvic 7y ago

Socialists... Always willing to sacrifice people for the "greater good". Yes, the US healthcare system is horrible. Courtesy of state regulations, barriers to affordable medical care, big pharma influence on state actors (like, patents on medicine), etc. Instead, what we need is more transparency and respect on this field.

lsc 7y ago

>I kind of want these issues to continue and get worse. Because then we will have a healthcare revolution, rather than more bandaid policy fixes. This is the justification I hear for a lot of my "bernie or bust" friends. I always just assumed they were trying to justify voting themselves tax cuts. I mean, in a revolution, those of us in the tech sector... I don't see it going well for us. Normal people hated us before we became the new "upper class" - if it ever becomes acceptable to go around killing "rich" people - I bet we'll be among the first. the problem is that this means we end up with trump, who teams up with a lot of people who think that it's good that people without good jobs don't have access to healthcare.

yonaguska 7y ago
See this comment. https://news.ycombinator.com/item?id=19793335 https://news.ycombinator.com/item?id=19793335 I work in the healthcare insurance industry, lots of market swings due in part to talk about medicare for all, but also drops in expected profits because Trump is pushing for transparency in Rx costs.

BurningFrog 7y ago

Name three systems that have had successful revolutions of that type. I certainly can't think of one.

GavinMcG 7y ago

Growing up in Idaho I kept waiting for self-sabotaging policies to get so overwhelmingly bad for things to change. The market can remain irrational longer than you can remain solvent.

dsfyu404ed 7y ago
Don't worry. Idaho, like every other western state, will eventually be colonized by migrants from California who will bring their politics and culture with them. Things will change. You just might not like all the changes.