As to OP, the simplest solution is to move out of the US early enough or become “poor” enough and be in a wealthy blue state by the time you get to this predicament.
I believe it is the largest industry by employment in every single state now.
That compounds the problem even further. Really fixing it would put a double digit percentage of people out of work. I'm all for it, but I can see why politicians are hesitant.
I'd love to hear what you think "really fixing it" is, please share.
I can report that all (almost all?) of the hospitals and their networks both big and small in the area I am in have had layoffs this year of admin staff and healthcare professionals (nurses, doctors, etc). They have reduced bed counts, and cut programs and treatment options available. All of this was done in the name of the "affordability crisis" and is kind of like the 3rd wave of this kind of consolidation, belt-tightening behavior. And..prices haven't gone down, and they keep cutting.
Eh, I kind of disagree. It would put a lot of insurance people and hospital admins out of a job, but the boots-on-the-ground providers would be fine.
On the contrary of your statement, I would also do everything I could to allow more (capable, of course) people to become doctors each year, though I'm not sure what all that would entail. It feels criminal to me that we limit residency while a) every doctor I've ever visited is way oversubscribed and in a hurry, and b) specialist appointments are months out.
Browsing HN has conditioned me to react to sentiment like "healthcare...it's a jobs program...solve it by putting people out of work (the market will magically fix it)" to essentially be code for "I support continued abuse and further deprivations against the poor"
This made be curious, so I looked around. FWIW, healthcare constitutes ~11% of the workforce in the US. It's ~16% in Germany, ~10% in the UK, and ~5% in France.
As a percentage of GDP healthcare is far higher in the US, of course.
If you add in everyone in insurance, pharma, devices, and the jobs those support, that number seems to be closer to 17% of the workforce from what I could put together.
Not sure if those in Europe do it similarly, but it just feels like a huge number of people. Maybe that is the result of demographics and a topheavy population, though.
If we fix healthcare costs we can spend more on hospitals. With more hospitals means more jobs and more competitive care costs.
In addition, a lot of those insurance jobs are facing pressure from "AI".
I'm not that poster, but there's a really easy fix: Just model the system after Hong Kong's.
There's a tax-funded public system available to every citizen, so that everybody gets treatment. In practice, this is mostly utilized by the poor, and for emergencies like broken bones. You can see specialists via the public system, but there can be a wait of weeks to months. This is all effectively free. You'll never see a bill, or the bill will be extremely small. (e.g., $100 for four days of inpatient care.)
There's a private system for those willing to pay. This is unrestrained capitalism with little regulation and no parasitic middlemen. Want to see a specialist right now -- like later this afternoon, or first thing tomorrow morning? Sure. It'll usually be $200 or $300 out of pocket. No insurance necessarily involved. Diagnostics are also super fast -- same day or next day, usually. If you want an elective surgery, or if you want a superior tier of care (like a nicer hospital room, better food, more flexibility re scheduling,) you can pay for it privately... And usually without getting insurance companies involved.
There is effectively no "prescription" system. With very few exceptions for narcotics and certain stimulants, if you need a drug of any kind, you can buy it OTC. This includes steroids, weird nootropics, viagra (lol at needing a prescription for this), and all kinds of stuff. This vastly reduces the burden on the system.
Hong Kong's system is superior in every respect, and it's especially better at treating you like an adult. The American system is simultaneously complex and infantilizing.
Nor does it count any of the people who really should have more or better care but don't get it.
> https://worldpopulationreview.com/country-rankings/medical-b...
Also, perhaps because it's a lot more laissez faire, the private system in Hong Kong is almost unimaginably superior to the private system in the US. It's far cheaper because pricing is transparent and most people pay cash! (Cutting out that middleman.) It's higher quality because there's a lot more competition, rather than collusion among a few major providers.
NHS budget has last I knew increased many times over since 1948, but the bed count went from about 450k down to about 100k - and those numbers were from more than ten years ago.
A theory is presented to explain this, which is that the more money you put in, the more management you get, and the more management you get, the less time clinical staff have for clinical work; more money results in less clinical output - but more managerial output, which theory argues is the primary focus and product of NHS.
For a simple outpatient procedure, the fee from the hospital dwarfs that of the anesthesiologist and surgeon.
For an inpatient stay, the hospital charges thousands of dollars per night for a room! Makes the Ritz Carlton look cheap!
And thanks to technology and science our first world society's got really good at keeping people alive and relatively comfortable.
Whereas the software industry, with near zero government involvement, has had enormous improvements in function and has pushed the cost to literally zero.
The US health care system is broken because health care is a natural monopoly that US free-market ideology dictates be run with (fake) "free markets" with result being a variety of companies profiting by abusing the system.
USA is very very good at complicated, cutting edge medical care but not efficient at delivering routine care.
What's most frustrating about this-- just take the poultry industry. To bring the cost to zero, all it would take is a single hacker to steal one government-regulated chicken and click "Copy" in its elusive little context menu[1].
Try telling that to a young person today. If you're like me you'll get the so-called "Gen Z Stare" in response.
1: Assume a 2d chicken.
Super inflated prices nobody pays? - law on “U&C prices”
Consolidation of small oncology clinics into huge hospital systems? - law on 340B prices
All of these laws were put into place in an attempt at regulating prices, and as a result, entities exploited the law to give themselves even more profit than if the laws never existed.
Now that’s not to argue the government is solely at fault, but it’s remarkable how much government intervention had made the US system worse, not better.
That's not true by the definition of "nationalization" (government ownership)
Switzerland and Netherlands are entirely private insurance. Most European countries have a public system and private system. It's very common for people to purchase supplemental insurance on top of what the government provides.
17% of GDP is spent on healthcare. Claiming 60% of that is just "middleman overhead" makes no sense when the highest European countries spend 70% of what the US spends on healthcare.
If you want an actual analysis of why US healthcare costs are higher, I'd recommend the McKinsey study that compared category spending vs OECD countries. Exhibit 2 on page 4.
https://www.mckinsey.com/~/media/mckinsey/dotcom/client_serv...
Administrative costs are way higher in the US, but it only accounts for 15% of the higher cost.
The biggest driver is outpatient care - Americans get way more healthcare and it costs more (quantity * price).
> health care is a natural monopoly
It obviously isn't, because it wasn't a monopoly before the 1960s when the government got involved in it.
Yes, VCs do put money into pharma, but that's private money very much expecting an (overall) profitable return. (Ironically most of that profit comes from Americans who have little or no way to collectively bargain on pricing.)
And yes, for bigger companies, there are tax breaks etc, but most of those are regular tax breaks that any company gets.
I won't get into the chronic disease stats. Other than to say that good primary Healthcare tends to reduce the incidence of chronic diseases.
Quality of care is hard to gauge on a national basis. It's a highly localized product, so experience can be different in very small geographic areas. Equally "quality of care" is s metric with many axies.
Naturally for-profit medical advertises a lot, and they strongly push the "quality of care" message. So the general perception of that is "private is better". How much of that is true, how much is perception, is up for debate. My personal experience (which counts for nothing) having experienced both, is that the standard of medical care is the same. (Fewer tvs in public care though.)
I'm not sure what importing doctors has to do with anything, or if it's even true. Personally I don't really care where a Dr is from.
It is worth recognizing though that not all employed people get medical benefits. Indeed many minimum wage jobs, low income jobs, "casual" jobs etc come with no medical benefits.
It's also worth noting that I some states it's OK to get fired for being sick. At which point you may lose those benefits.
Plus in poor economic times (like being a federal worker right now) losing your medical because you lost your job, seems like a suboptimal outcome.
But I agree with your last statement, this system works just fine, for a large enough group, so there's little political incentive to change it.
Prices do vary between companies but many people just use the official insurance comparison tool and choose the cheapest as the services are completely identical. I'm completely against that system and would prefer a national health insurance like Japan.
This is utterly false. Agencies like NIH, BARDA, and NSF fund early-stage biomedical R&D by providing SBIR/STTR grants to biotech and pharma startups. They also fund basic research and clinical trials as well as translational studies.
There is the Orphan Drug Tax Credit and R&D Tax Credit. Also, access to NIH labs, etc.
There is a whole plethora of funding. Moderna’s mRNA platform was heavily backed by NIH and BARDA even before COVID.
Thats what i meant by US subsidizing pharma for the whole world. I didn't mean the us govt.
Would they continue to exist if every single country in the world is doing "collective bargaining"?
Yeah even your high net worth client that pays 50k in premiums every year wipes you out when they get some complicated form of cancer.
Edit this actually came up in a videogame called Cyberpunk. A lot of people here on HN consider themselves code wizards indispensable to their employer. Google will replace your multiple sclerosis ass.
With the aging population, we'll need more and more health care professionals. I'm not just referring to people over 60, even people 40 upwards require more care.
The same as any fancy restaurant meal is free: They gonna bill ya later
Pricing transparency also does not exist here as GP is claiming it does in Hong Kong. I am supposed to get certain imaging tests done every year, and I never know how much those will cost me until after I have already done them (in the U.S.). Maybe there is some way to get a non-binding estimate ahead of time, but I have never received such a thing and am not even sure it is possible. So I can’t easily “shop around”—or if can, tell me how because I (and I think most people) don’t know how.
I most certainly cannot pay $300 to see a specialist the same day in the U.S. I would have to pay that much to see my GP after waiting 6 weeks despite my employer paying more than $20k/year to insure my family. To see a specialist, I would have to wait a few months and probably pay $1-2k for one visit, not counting any tests or imaging that is ordered.
The description of Hong Kong’s system sounds amazing if true.
Yes, a lot of physician work involves diagnoses; but it also involves getting one’s hand dirty. Hospitals are the peak of shop and factory work.
My wife, who worked as an RN in the OR is far handier with shop tools than I am as it’s time-sensitive physical labor!
Meanwhile the jobs program are all of the white collar variety; jobs that purport to support our healthcare workers includes 100% of the health insurance companies and programs.
Thanks to a generational messaging since the 1980s and 1990s, we white collar workers have wormed our way into all aspects of industry.
If I am not mistaken, the current administration has enacted changes that have caused a significant reduction in federal grant funding for hospitals. So, many of the layoffs, as I understand it, are to make up for the coming losses in funding.
I live in a state with plenty of rural areas. There are growing fears of some rural hospitals being forced to completely shut down due to funding cuts.
And, well, it sucked. People died, black people got injected with radiation, and we experimented on humans.
Ultimately, I don't want poor people to just... die. Because that's bad. So we need some sort of guarantees.
Or, we don't: in which case, I hope you're content scraping bodies off the freeway for free. Someone has to do it if we're not paying for their healthcare and disposal costs. Hope you're not busy next weekend!
curious. what kind of statistics would that show up?
When i was looking into clinical trials for prostate cancer. almost 80% of experimental cutting edge medicine was in usa. They even have spl k2 visa for International patients to participate.
https://en.wikipedia.org/wiki/List_of_largest_United_Kingdom...
Keeping people healthy is labour intensive.
Between the matrix style organizational structure and the many layers (project manager, program manager, director, VP, senior VP, BU president, etc…), I would love to know what, if anything, the higher levels actually DO.
No it is not.
Lots of experience with the health system in the US, for me, and helping many other navigate the systems.
It's not even close to identical. If you go to ER here and you can't pay, they may provide you with a certain level of 'care' to 'stabilize you' (as the law says they are supposed to, and the feds send some money to hospitals to cover some of this), and you will get billed, and collections calling, and credit report issues, and threats to sue and have your property auctioned (have held one of these letters in my hand, complete with a list of property that was in my name.
Even worse, the 'care' you may get is normally crap. For example I have seen the same people with same condition, at one hospital get a quick surgery and leave with a colostomy bag for rest of life, and other person at other hospital with insurance get placed in a room and treated for weeks - then left with a warning to avoid seeds.
I have seen so many examples of places leaves humans to rot with no insurance - hospitals.
Even with insurance, you can find yourself waiting 6-8 weeks for a doc appointment. I have so many examples.
Those were experiments done by the government or funded by the government.
In many org's, they mostly compete with other higher-levels for status.
And the biggest signifiers of status are usually (1) how many lower-level managers ultimately report to you, and (2) how many layers those lower-level managers span.
If someone can't afford healthcare, and in your vision we should refuse to provide it, then they die. That means, unfortunately, you are advocating for their death.
Which is fine, maybe. Except that we still have to deal with that. If they can't afford to dispose of their own bodies, now what?
No matter how you cut it, we either go back to the government or everything is awful.
Me asking you if you want to scrape bodies off the freeway isnt rhetorical. It might seem that way, because it's so extreme, but that's the reality here.
Someone, somewhere, has to pay for that. We already established that the person themselves cannot do it.
Should it be you? Should it be me? Or should it be everyone? If you answer everyone, congratulations, you've reinvented taxes.
The issue here is that these are already solved problems. Why do you think governments invented taxes hundreds of years ago? To steal from you? Look at the big picture.
Look how cheap your cell phone is, despite the amazing engineering that went into it. Pretty much everyone has a cell phone, both rich and poor.
This isn't an argument - this is an ideology, a pure faith.
There's no mechanism for this. Some things are just expensive.
Performing a surgery is expensive no matter what. It requires advanced machines and multiple humans with ideally decades of specialized training.
There may be "cheap" surgeries if there's no regulation, in the same way we have cheap shit on Temu - it's junk and doesn't work.
The cell phone reference you made kind of says it all - yes we have cheap cell phones. Most of them are shit.
We don't want shit medicine, shit surgeries, or shit chemotherapy. We want stuff that works.
Also, elephant in the room: products and services are necessarily different.
A phone is a PRODUCT. Medical care is a SERVICE. The difference being cheap products are good, sometimes, cheap services are bad.
We don't want a surgery to cost 100 dollars because that means the doctors are making, like, 2 bucks an hour. Which means we're living in a third world shit hole.
You don't want to live in a third world shit hole, do you? Great, then we're on the same page.
And, elephant number 2: healthcare can never, under any circumstances, be a free market. No matter how hard you try.
When you get sick and need to go to the hospital you might naively think the market of hospitals is thousands. This is wrong. Its actually a monopoly - there is only one hospital you can go to.
This is because of what healthcare is fundamentally - a service to keep you alive. You will go to whatever hospital is closest, because the human will to live transcends markets and even money as a concept.
This means, in a free market, it's not free at all - it's filled with only monopolies who can effectively charge whatever they want - which is exactly what we see.
The only places this doesn't happen is in places in which healthcare is nationalized. Because said countries know a free market is impossible, they don't even try, and they avoid the monopolization that's inevitable.
Some other people will naively point to systems in which there are both public and private options - and note that the private options are cheap and effective.
But that's only the case because of the public options. When private care has to compete with low cost public care, it will be cheap. If you remove that competition by privatizing all healthcare, then they can, once again, effectively charge whatever they want.