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Private healthcare makes industries less innovative. It's time for change
- hmokiguess 2mo agoWanna see less innovation in healthcare under a single payer? Come to Canada, you will be on a queue for an MRI for at least 8 months (if you even get one).
- petesergeant 2mo agoPrivate healthcare isn't the problem, lack of free healthcare is the problem. I would much rather live in the UK where private healthcare is good and reasonably priced than Canada where in most places it's simply not available.
- AlexandrB 2mo agoYup. Recently drove 6 hours (each way, twice) to get to a Canadian private clinic to get treatment. This saved approximately a year (or more) of waiting in the public system for a routine outpatient procedure that takes 30 minutes to perform. I was lucky this option was even available within driving distance though. Canada's public healthcare system is massively overloaded and it seems to be getting worse. I really didn't appreciate how much of a problem this is in my 20s and 30s (while I didn't need much healthcare) and it was easy to assume the bellyaching from older folks was overblown. Time makes fools of us all.
- cwillu 2mo agoYou're describing a provincial issue, not a national one.
- AlexandrB 2mo agoThis is like the Canadian version of "no true Scotsman". When the province in question has 1/3 of the population of the country, what's the difference?
- jgon 2mo agoIts also described as a provincial problem but all of the provinces receive a substantial amount of funding, particularly for healthcare, via the federal government. People say "oh its the provinces fault, they just need to spend more", and then don't reflect on how much room there is for increased taxation, and particularly how much taxation the federal government currently applies. By far the most tax I pay as a Canadian is in the form of federal taxes. Of course, a bunch of this money does find its way back to the province, so the waters are a little muddy, but the federal government has been repeatedly downloading costs onto the provinces, while doing very little about its own spending. The Chretien government in particular did massive downloading of costs to the provincial governments, although their hand was forced by Canada's fiscal situation at the time. So simply saying, oh well the provinces need to step up, is an easy deflection from what is a pretty thorny problem. If the responsibility really is up to the provinces, then why does the federal government need all this money? If the feds are going to continue scooping up the lion's share of tax revenue then they need to continue helping to fund the various provincial responsibilities.
- wat10000 2mo agoAmericans have been propagandized like crazy and don't really understand what can actually be done. "Single-payer" is treated as a synonym for "universal health care." "Private" is seen as mutually exclusive. People will say we should/shouldn't have something like Europe, then describe a system that only a handful of countries have.
- Taikonerd 2mo agoYeah, I find it discouraging that "single-payer" and "fully socialized" are treated like synonyms. The "Bismarck model"[0] describes a family of healthcare models where people pay into a central healthcare fund, and that fund then pays medical providers -- which can be private businesses. [0]: https://en.wikipedia.org/wiki/Bismarck_model https://en.wikipedia.org/wiki/Bismarck_model
- cmrdporcupine 2mo agoAll doctor's offices in Canada are in fact private businesses. It's not actually a fully socialized system. It's just there's a single payer. Those businesses bill the provincial government instead of you. Most of the dysfunctions in the Canadian system come down to provinces screw around with billing and payment and funding. Take your dissatisfaction with the way the government manages payments to the voting booth instead of advocating dismantling what is on the whole a quite equitable system that has a history of actually producing very good health outcomes. I actually have on the whole extremely pleasant experiences here in my corner of Ontario. And then I hear horror stories. The system is underfunded and inconsistent. The province is to blame for that.
- petesergeant 2mo ago> a history of actually producing very good health outcomes It may outperform the US, but it doesn't outperform normal countries.
- AlexandrB 2mo ago> Take your dissatisfaction with the way the government manages payments to the voting booth And vote for who? I have yet to hear a compelling solution from any party. At most, politicians advocate for throwing more money at the problem. > The system is underfunded Hot take: the system will always be underfunded. The demand for healthcare is nearly infinite in practice. What stops people from going to the doctor for every sniffle is either cost (in a private system) or waiting times (in a public system). If you had infinite resources to offer services, there are some folks who would be going in for MRIs every year "just in case" and getting prescriptions for every flu they have.
- mchusma 2mo agoNothing is free. We want both low cost and high quality healthcare. This means we need to have ways in incentivize innovation (AI diagnostics, robotic procedures, drug discovery, deeper R&D). Free Markets (with government controls against monopoly) are generally better than governments at delivering cost and quality improvements, but healthcare in most countries is somewhere between “100% not a market” and “70% not a market” (the US). In many cases, governments also actively create and enforce monopolies (eg AMA or local hospitals in the US). There are a million other things but part of what is required for markets to work is skin in the game, which the UK, Canada, and the US all do bad jobs of in their own ways. Some say medicine has no elasticity. I don’t think that is true for 90% of spend (for gunshot wounds, maybe, but most spending is on chronic diseases where multiple providers and approaches are available and people could price shop). I would like to see more countries experiment with more free market healthcare. It’s remarkably effective for many pieces of healthcare.
- bensmoif 2mo ago1000%
- alightsoul 2mo agoIt also makes them more risk averse. Kind of the other side of the coin of not being innovative
- lotsofpulp 2mo agoWhy do governments steer clear from performing clinical trials for new medicines?
- ajmurmann 2mo agoGood article in general but such a misleading headline and framing. The problem, as described in the article's body, is employer-provided health insurance, not private healthcare.
- Taikonerd 2mo agoYeah, the article sort of conflates the two. It's funny that he (accurately) quotes the Cato Institute as being opposed to employer-provided health insurance... and then implies that the sole alternative is the NHS. Um, I'm pretty sure that's not what the libertarian Cato Institute was suggesting!
- ajross 2mo agoWith all respect: what exactly is the alternative you're imagining? The market emphatically did not provide accessible private health care to individuals, largely because of the wellness trap (no one buys insurance until they need it). It existed only as extremely expensive boutique products until the government put its regulatory thumb on the scale and passed the ACA. Employer health care may have bad externalities, but it has the extremely important (but... maybe invisible to the median libertarian) property that it constitutes collective bargaining. You can force insurers to cover folks they wouldn't want to otherwise by bringing more customers (employees) to the table. It's so weird that even now, with the ACA having been proved out over decades, that we have to have these weird free market arguments. It didn't work, guys. It's not a good that works well in an efficient market sense.
- irdc 2mo agoWhy is this news? As a European this seems totally obvious.
- Taikonerd 2mo agoI'm not sure which country you're from, but many EU countries do have private health insurance. The Netherlands, for example, has a system of subsidized private insurance, and a mandate that everyone buy a policy. (If Americans are thinking, "huh, that sounds like Obamacare / the ACA marketplace!" then you're right.)
- taejo 2mo agoPainting in such broad strokes, the German system also sounds like the ACA, but it's really not: the high level description really erases key differences. In Germany there is nothing like bronze/silver/gold plans. All statutory health insurance covers what is required to be covered by regulations, with just a few bonus services, at the regulated tariff plus just a few percentage points of variation. So the 90% of people in Germany who have statutory health insurance [1] have essentially the same coverage. The tariff is a percentage of income (up to a cap), not a flat fee. [1] not everyone is required to have statutory health insurance, for example employees above an income threshold and self-employed people
- reticulates 2mo agoThe Dutch system and the U.S. system are not comparable. Health insurance in the U.S. is a “free market” that the government dabbles in with a little policy here and there. Health insurance in The Netherlands is controlled by the government, it is heavily regulated.
- lII1lIlI11ll 2mo agoStill it is worth highlighting on this forum since many Americans believe that healthcare is "free" across Europe.
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- megaman821 2mo agoThis is less about private healthcare and more about how employer-provided healthcare is tax advantaged. Credits and tax breaks should go to the individual so they can choose and keep their insurance through different jobs.
- Ajedi32 2mo agoYes, the title gave me whiplash because I went in expecting an argument for socialized healthcare, then read a couple paragraphs and realized the article was actually presenting an argument against government meddling in the healthcare industry, then read further and realized it was actually using the problems created by government meddling in the healthcare industry to argue for more government meddling.
- natsucks 2mo ago"the thing I miss most is the NHS. It’s been treated like a political football since I left and is apparently a shell of its former self — not because the idea is bad and can’t work but because conservative politicians, some of whom have received funding from private healthcare companies, have deliberately sabotaged it." really it could not be because government is bad at managing massive programs and provides no incentive for high performance and efficiency....
- Ekaros 2mo agoReal truth is that health care just is massively expensive. Any efficiency gains that are also somewhat limited have been overshot by more "products". Nurses and doctors can only handle so many patients. This has not increased that much compared to say farming or most other areas. And while there has been some gains. There is also lot more produces and costs of those.
- ryandrake 2mo agoWhy is healthcare so uniquely expensive in the USA, but nowhere else?
- cat_plus_plus 2mo agoYeah, so long as you can mooch off US healthcare innovation like COVID vaccines and weight loss drugs. There is a difference between going to doctor and getting effective treatment, as anyone who dealt with cancer in Soviet Union can testify.
- forgetfreeman 2mo agoI'm guessing you aren't aware how much of that innovation comes from academic research instead of direct private investment by pharma companies, or that there is a thriving pharmaceutical industry in places like Europe. Ironically your chosen examples are based on innovations pioneered by a German biotech (BioNTech) and a Danish pharmaceutical company (Novo Nordisk). What relevance the Soviet Union might have 34 years after it's collapse is something of a mystery.
- dzonga 2mo agoI think the article is looking at the wrong abstraction. private healthcare - e.g if there's a lot of private clinics - people paid cash, then yeah healthcare costs would go down & most of the care was preventive not treatment. competition naturally will force prices down & since individuals payers won't be able to afford massive amounts, the market will adjust it's prices vs having one large payer (gvt) i.e public healthcare or many private large payers(current insurance industry). right now - the issue isn't private healthcare - but the wrong incentives to bill insurance companies massive amounts of money. then insurance companies countering back - by having large bureaucratic processes to avoid paying those large bills. typical complex systems.
- Grombobulous 2mo agoI see a bunch of comments with this same theme but to me it’s splitting hairs. The term “private healthcare” is mostly referring to the fact that there is no such thing as non-private healthcare for the majority of Americans.
- rootusrootus 2mo ago> is no such thing as non-private healthcare for the majority of Americans We're up to about a third now.
- preg_match 2mo agoThe current administration is hell-bent on changing that, both by nerfing Medicaid and making it much harder to qualify for. Medicaid is already mega-nerfed, you get de-facto lower quality healthcare on Medicaid.
- Synthetic7346 2mo agoOne thing that's never been clear to me is how either system plans on scaling healthcare. You have X doctors who can see (just a guess) 30X patients. Unless the number of doctors increase, some patients are going to be left out. In the current system it's those without employment. I'm other countries there's a waitlist. How can we make sure there's enough staff to provide adequate healthcare for everyone?
- throe849449 2mo agoForced labour? Poland has doctors on 32 hour shifts. Worker comes on monday morning, leaves tuesday evening. The night is spend on ER, with a few naps between patients. Perfectly legal!
- reticulates 2mo agoThe U.S. has waitlists too? The U.S. makes people wait based on how much money they have, socialized healthcare systems make people wait based on an assessment of need. The latter is obviously better, even though it is not perfect. You’ll find that most everyone living with socialized healthcare believes it to be adequate when compared to the U.S. system. Adequate does not mean without flaws, adequate doesn’t mean available on demand, adequate means has good outcomes. Very few countries with a similar economy have as poor healthcare outcomes as the U.S.
- maerF0x0 2mo ago> You’ll find that most everyone living with socialized healthcare believes it to be adequate when compared to the U.S. system This is not true for Canadians. Many have to travel to the US, India, or otherwise abroad to purchase the healthcare they desire which is not available to them in Canada. In Canada you have to get sick enough for the system to triage you into the quotas. But maybe you want to stay healthy before things get too bad?
- reticulates 2mo agoThe conclusion you're drawing does not follow. Canadians can be frustrated with the Canadian healthcare system and also believe it to be adequate when compared to the U.S. healthcare system. Canadians who are surveyed about healthcare typically say: the system is broken and needs to be fixed AND the socialized nature of it must be protected. Canadians are unhappy with underfunding, Canadians want more funding, they do not want the U.S. system.
- bell-cot 2mo ago> ... my vote ... is for universal healthcare. The only real downside to it is that a bunch of companies that have entrenched their positions taking advantage of ordinary people will be denied a little profit. Make that "many, many billions of dollars of profit". Then add on the probably-millions of jobs which the staggering inefficiencies of the current system support. (Everything from lobbyists for those companies, to the minions stamping "Denied" on health insurance claims, to the opposing medical billing staff who work for doctors & hospitals & such that need to get paid, to ...) It'd be lovely if the leviathan could be slain, but don't hold your breath.
- abeppu 2mo agoIn the US market, where union participation is also very low, it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but: - job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point - except when subject to some kind of union negotiated contract, the employer can change their insurance options from year to year as they try to save costs, but it's not regarded as a mass pay cut when they do - there's no standard metric on "how much do our employees pay on healthcare" (i.e. employee premium contributions, deductibles, copays), "how much time do employees spend on the phone with the insurance company", and certainly no way to feed in your last year's records of health-care to see "on plan Y you would have paid C" Though I think the private health insurance system is a dumb waste of overhead and paperwork and misaligned incentives, I do think that people would be more willing to switch jobs if they could know their plan was at least as good as the one they were leaving, both in money spent and in employee satisfaction. Opacity, in part owing to lack of commitment from employers, makes this harder.
- kevincox 2mo agoNot to mention that tying your insurance to your job is a *huge* pain. If you switch jobs or get fired you need to deal with coverage gaps, considering individual coverage for the duration, and you may need to switch care providers depending on what your new coverage is. It is just a really awful system overall.
- giovannibonetti 2mo ago> It is just a really awful system overall. You mean for the user. It is great for the insurance companies, though, since tying health insurance to employment indirectly keeps the average user age lower, thus making the overall scheme more profitable. As a general rule, people use health benefits more as they age.
- gruez 2mo ago>- there's no standard metric on "how much do our employees pay on healthcare" (i.e. employee premium contributions, deductibles, copays), "how much time do employees spend on the phone with the insurance company", and certainly no way to feed in your last year's records of health-care to see "on plan Y you would have paid C" "how much companies/employees pay for healthcare" is a poor metric too, because it would depend on the demographics of the company. You'd expect a startup of 30-somethings would have lower premiums than a company of boomers, even for the same coverage.
- tamimio 2mo agoI don’t think it’s just healthcare, you have mortgages for inflated housing prices, expensive groceries and bills, and other expenses that make most people go to the route of boring stable job rather than innovative startup that might be out of business in a year and/or paying peanuts. Look at Canada for example, you can have a boring government job looking at excel sheets in the few hours you “actually” work in that week and still make $140k a year plus generous benefits, meanwhile you can grind your ass in a startup doing embedded firmware development and paid $70k a year with barely any benefits, hell, I have seen “senior robotic engineers” with a job descriptions enough to launch rockets and the pay is $60k! Obviously people will go with the first option, innovation won’t feed their kids.
- cdrnsf 2mo agoI'd love to decouple insurance form employment and I'd also love to do away with the private insurance system in the US. I've always had insurance and the experience has been as uniformly poor, regardless of provider, as it is continuous. Any positive interactions and outcomes have felt like happy accidents, not the system working. Remove the private actors, the adversarial billing, the friction with providers. It, at its best, ranges from bad to outright awful. (I'd also love to do away with tax prep — the government knows what is owed, so why make folks prepare their own count and hope it matches?)
- akramachamarei 2mo ago> the experience has been […] uniformly poor […] Any positive interactions and outcomes have felt like happy accidents Which is to say, not uniformly poor? > I'd also love to do away with tax prep — the government knows what is owed Sometimes! We would probably have to simplify the tax code first. Otherwise instead of spreading out the work of identifying income and tax credit eligibility amongst taxpayers and such upon them who are most proximal to this knowledge, we would have a centralized body need to know all of the things that you and I know about ourselves, such as how many kids we have, what kind of car we drive, whether we use solar power, whether we invest in crypto, whether we earned money from gifts or gambling or dividends or farming. Or we could just simplify the code, which I would like.
- cdrnsf 2mo agoPerhaps mountains of frustration punctuated by relief that soon vanishes? I’d cap income at $5 million a year and strip the tax code down to something devoid of exceptions, but I’m in no position to do that.
- akramachamarei 2mo ago...What do you mean "cap"?
- cdrnsf 2mo ago
- 999900000999 2mo agoWe could easily do this and it would actually be significantly cheaper. But I can’t imagine it happening nationwide. Maybe cities can create their own public options, say a flat 3% income tax and you get health insurance. So much progress isn’t made in the US due to the welfare queen myth. Heavily intertwined with racism, many imagine “lazy” people getting something they didn’t absolutely earn.
- SlightlyLeftPad 2mo agoThat “lazy people” getting something they didn’t absolutely earn is a core right wing narrative that has been very successfully propagandized for decades. People are still going to need work to pay for everything else. No one is going to stop working once the crushing weight of medical debt is lifted. It’s easy to debunk but I don’t see much effort going into this right now.
- TitaRusell 2mo agoDoctors take an oath to treat everyone. Conservatives may say that poor people deserve to die in a ditch no doctor is going to let that happen. I don't know about you but I don't want my GP to be a Mengele!
- SlightlyLeftPad 2mo agoI think it’s well known that the problems we have with healthcare in the US are not caused by the doctors.
- Taikonerd 2mo ago> But I can’t imagine it happening nationwide. Maybe cities can create their own public options, say a flat 3% income tax and you get health insurance. It's interesting: 3 states (Vermont, Colorado, and Massachusetts) did recently try to make state-level single-payer systems. https://www.thirdway.org/report/single-payer-health-care-a-tale-of-3-states https://www.thirdway.org/report/single-payer-health-care-a-t...
- 2mo ago
- Grombobulous 2mo agoUniversal single-payer healthcare is one of the most pro-business and traditionally conservative with a lower case C thing you can imagine. It’s pretty much a no-brainer cost reduction for everyone. This doesn’t even mean you need to get rid of private insurance companies (see: Germany).
- maerF0x0 2mo agoSingle payer maybe, but single provider? Never.
- Grombobulous 2mo agoWhile I agree that there’s probably a benefit of diversifying providers in most situations, I would take single provider over “I can’t afford care at all.” Also, single provider countries like the UK still have private healthcare. A LOT of private healthcare. This idea that single provider/single payer will make most people’s care worse and remove everyone’s options has felt to me a lot like industry propaganda.
- maerF0x0 2mo agoSo long as there is a relatively open market, where companies who wish to compete can do so fairly (ie the gov't isn't making them play with a handicap), I'm open to a public fund for some forms of healthcare expenditures with a cap. One of the challenges about talking about the subject is that it's often spoken in absolutes, instead of the spectrum and mosaic that healthcare is. for example you could have a socialized subsidy to healthcare expenditure (like Canada does for Universities). You could have certain things be free for anyone, like maybe certain kinds of preventative care. You could have a periodic or lifetime cap for example maybe we say "We cap your lifetime care at 500K, sometimes life sucks and we're not going to bankrupt the country to try and save every last person" But unfortunately nuance is very uncomfortable to discuss
- ed312 2mo agoThe cost reduction alone from everyone paying the same price (for the same service at the same facility of course) must be staggering. I agree - I don't see any need to ban any private insurance or providers and that's also aligned with a traditionally (lower case c) conservative free market view too.
- bigchungus007 2mo ago[dead]
- Schlagbohrer 2mo agoIt also kills many, many people, so, the profit motive needs to be permanently and forever abolished from healthcare. In the US doctors look at patients with dollar signs in their eyes and simply ask, "How much money can I squeeze out of this NPC?" leading to countless abuses, from unecessary and harmful procedures being forced on non-consenting patients (like infant genital mutilation) to denial of needed healthcare because it isn't profitable enough and has an opportunity cost.
- maerF0x0 2mo agoI agree with you about Infant genital mutilation (circumcision) but disagree the issue is the doctors themselves. I think the shrinking pool of competition is the major issue. (Hospitals being privatized with VC money etc)
- DrScientist 2mo ago> but disagree the issue is the doctors themselves Who's fault was the opioid epidemic in the US? I know a lot of blame has been levelled at the pharma involved, and rightly so, however every single one of those patients that got hooked via prescriptions had them from their doctor. Those doctors aren't suppose to be automatons, just blindly follow Pharma marketing materials, they are suppose to be highly paid experts who's overriding concern is a duty of care to the patient. There are many reasons the opioid epidemic was an almost uniquely US experience, but the private incentives for doctors was one of them. Purdue was telling everyone around the world the same thing - but apparently only US doctors were fooled.
- maerF0x0 2mo agoThere's a cluster of issues and, as an engineer, I've learned to focus less on the final actor and more on the roots that lead to that outcome. 1. Why are high risk drugs not a multiparty sign off? (think like company financial controls) 2. Why are doctors saddled with such intense debt that they then are financially pressured to make unethical choices? (School seats not scaling with population, and doctors organizations lobbying for supply side restrictions) 3. Why are people turning to opioids? (Globalism that sent their jobs abroad without care, poverty/familial/societal degradation in regions -- basically the anti-rat park scenario, in some populations it's exacerbated by the idea a white person cannot be poor/oppressed such that their issues are exacerbated by their denial)
- mrbluecoat 2mo agoSigh, another US Healthcare article that states the obvious and won't change our reality. This topic is such an insta-depression trigger.
- nonford150 2mo agoTypically, all single payer medical cost schemes are based on government facilities and intervention. Many Americans have little faith in their government to do anything, much less handle there medical care costs. This is why the employer model still exists. Americans are different - they see themselves as not Europe or Asians - and they are proud of that. The "rugged individual" is still an ideal many cling to as part of their identity.
- nba456_ 2mo agono it doesn't
- hendry 2mo ago“Just get seen” lol from uk
- jmyeet 2mo ago> 1 in 4 American workers stay in their jobs because of the healthcare. It suppresses wages and working conditions - and prevents innovators from heading out on their own. Yes. That is the point. This is how capitalism works. Just look at the story of Tetris as the pefect example of capitalism in action. Some Soviet programmers invented it in their spare time when they had access to computers, as enthusiasts. What did capitalism add? Licensing and sub-licensing agreements. Or, to put it another way, just building enclosures. The idea that capitalism fosters innovation is a fairy tale. Companies reach a point where the only way to satisfy the market's need for growing profits is by cutting costs and raising prices. All of the inflation we've seen from the pandemic has been the "raising prices" part. AI exists for dynamic pricing. Dynamic pricing is nothing more than raising prices. Nobody is using dynamic prices to reduce prices. Why would they? But the big part of AI is in labor displacement. This suppresses wages. Those who kept their jobs aren't asking for raises and aren't saying no to extra unpaid labor. Because they're in fear of losing their jobs. That's not a side effect. It's the goal. US healthcare, if you can call it that, is part of this economic coercion. Being expensive to access out of employment is a feature not a bug. Everybody wins. Employers keep people who want to live. Healthcare company profits go up. You, as the individual? Nobody cares about you. Get back to work. The end state for all this is something that looks like South Asian brick kilns where workers have debt they can never escape. Westerners are being loaded up with debt for a reason: to enrich various companies and to make sure we can't leave our jobs.
- akramachamarei 2mo ago> Soviet programmers invented it in their spare time when they had access to computers, as enthusiasts. What did capitalism add? Capitalism created the computers whose Soviet copies were Tetris' native platform, it made the languages Pajitnov used and the machines he ported it to. It incentivized people to bring Tetris to the rest of the world, and who knows, it might have spread on its own eventually, just for free, but maybe not. > All of the inflation we've seen from the pandemic has been the "raising prices" part. Superficially true, but vacuous. In anyway that matters this is flagrantly and amazingly false. But maybe you weren't aware of the $931 billion US dollars of stimulus paid to individuals, or you may not be familiar with the principle of supply and demand. More dollars in supply, the less the value of each dollar. Prices change to match the devalued currency. > Being expensive to access out of employment is a feature not a bug. I think this may qualify as a bug, to which you can credit the Revenue Act of 1954 for codifying the tax break given to companies who provide healthcare directly rather than pay that money as income to the employee. Classic example of a stale law. Now, vested interests may be keeping it in place, but I also see no significant awareness on the voter side of this issue nor the will to reform this discriminatory tax policy.
- mbgerring 2mo agoMy partner and I both just got new jobs after a long period of unemployment. Neither of our new employers offer subsidized health insurance. We both have chronic conditions for which we need regular access to medication. The financial cliff we will both go over going from Medicaid to paying for health insurance via Covered California, and likely paying higher prices for medication in addition to astronomically high (and increasing!) monthly premiums, is going to eat a huge percentage of our increased incomes. I have no idea who is supposed to benefit from this system, other than the private health insurance companies.
- tptacek 2mo agoSince this is a comparison between entire economies --- not just health care but the impact on economic mobility as a whole --- an inconvenient fact for this analysis is that PMC Americans are generally better off under our private insurance system than they would be if they relocated to the UK; as in, they come out financially ahead, after pricing in insurance and provider fees. Another problem with this analysis is that the UK's national health system isn't the only example of a major developed country with a functioning health system. Many countries without the US's problems have private providers and private health insurance. It's plainly obvious that the US has severe problems. Ideological polarization has fixated the discussion on a contest between public single payer and everybody-for-themselves private insurance. But the core problems have not much at all to do with insurance. They are, probably: (1) Most Americans get their health insurance through their job, as a path-dependent consequence of bad 1950s tax policy. This in turn insulates insurers from their customers and breaks most of the mechanisms an ordinary market (like food, or transportation, or tax preparation) has from going off the rails. (2) Americans pay doctors (and providers generally) anywhere from 2-5x more than other countries do. Providers account for the overwhelming majority of all health spending; compared to providers, drugs are almost a rounding error. This in turn is probably a consequence of policy decisions we made in the early 1990s, when the AMA lobbied Medicare to cap the number of residencies funded every year, which in turn generates artificial scarcity.
- snapplebobapple 2mo agoThe problem is public is also terrible. What makes the difference is the ecosystem of policy and enforcement. Without that it will always>just find unique ways to be terrible. Look at my home coubtry of Canada. Also terrible just in completely different ways.
- sershe 2mo agoIt's really understandable that this is posted on hacker news, where innovators from public healthcare startup hotspots like the UK and France gather to look with pity at their stagnating counterparts stuck with more private systems like the US, or even Netherlands or Switzerland if only Europe is considered.
- Obscurity4340 2mo agoBecause HOW COULD THEY NOT!??