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Comment by nathanaldensr | Hacker News Reader

I love this article. I feel like it gets down to the real root of the problems with the complexity of Western culture. I feel like this perspective applies to a lot more than healthcare. It matches my own thoughts that technological complexity is getting so high that eventually it will be beyond our own understanding, both individually or in a group of any size. We as a species simply won't be able to make use of our own tools and systems because they are so complex.

Ah, the hubris of humanity...

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I'm as guilty as some people of just citing "excessive regulations" as a problem without mentioning the mechanics that make that a problem, since so many people see "regulation" as a good thing by just thinking of it as "regulating away the bad outcomes". But this article gets to one of the mechanisms I think of when I cite regulation as a problem; regulation casts in concrete a particular way of doing business, and makes it literally illegal to do it any other way. Can't even try something new as a one-off; it's illegal to do anything else. Doesn't matter how brilliant your idea is; it's illegal. Doesn't matter if you've got a startup with the software all ready to go; it's illegal. Are two regulations either interacting poorly, or outright contradictory? Not only is it illegal to not conform to both of them, now we've introduced an adhoc meta-regulatory regime with regard to how to address the overlaps, with the de facto force of law behind this unwritten metaregulation, and/or impedance mismatches between two bits of the industry resolving them in different ways.

Even if we stipulate that The Hypothetical Medical Regulation Act of 1983 was somehow the miraculous embodiment of perfect medical regulation for 1983, it would be causing major problems for the medical system today. Mere time would be enough to cause problems with medical regulations, and alas, they aren't perfect to start with, and they seem to be ever-growing in size, and there's no way the complexity growth is merely O(n). We've almost certainly passed the point where regulations are appearing for the sole purpose (if one did a full cause analysis) of dealing with the fact that regulations are blocking the system up.

(My biggest objection to "national healthcare" is that unless you find me some different authors to write it than our current Congress and current regulatory state, I have approximately 0.001% confidence that "nationalizing healthcare" will fix this. Advocates of nationalizing healthcare would have a much easier time convincing me if Obamacare had simplified health care, instead of massively adding to the pile of regulations and massively empowering more regulations going forward.)

Obamacare complicated health care because it was designed to preserve the existing system of insurance companies, employer-provided insurance, and patchwork regulations. So, of course, it introduced more patchwork regulations, along with subsidies to the existing players.

A single-payer system (Canadian style) would greatly simplify the health care system, largely by cutting out the insurance-company layer for most people. A British NHS-style system would arguably be even simpler, but is even more of a political non-starter in the US.

I think you sort of misunderstood my point. My point was that you'd have an easier time of selling me on it if Obamacare had actually simplified things. Which was one of the promises it made, after all. Explaining why it failed to do so does not contradict my point, it reinforces it.

In terms of Obamacare not simplifying things, my engineering answer is "Then why did we implement it?" If a goal is impossible for some reason, then the correct solution is not to try to obtain it, not to just cruft up the system harder anyhow. How many people can tell the same story of failure in their engineering jobs? Since this is the same set of people who want to bring us nationalized healthcare and want to write all the regulations for it, it does not encourage me to think well of their judgment in doing so.

I am abundantly confident that our current ruling class would find some way to muck it up. Even if we handed them The Pristine National Healthcare System Act of 2018, they'd have regulated it to death in just a handful of years. Our current ruling class doesn't seem to be able to sneeze in anything less than 50 pages of legislation and several hundred pages of accompanying regulations.

That's not how politics works. Everyone has a different opinion and priorities. Obamacare made the overall system better by providing more people with affordable access to healthcare, at the cost of increased complexity in some areas. It was a good trade-off. If everyone had insisted on perfection then nothing would have been changed at all.

The ACA originally was going to have a public health option (but it was removed because a senator at the time threatened to filibuster). Had that been included, I believe it could have led to something very similar to a single-payer system.

I really hope we are both wrong, but I agree with you. I worked in healthcare and health insurance, and I have a unique perspective on the mass of regulations from across the US. I see the same patterns in many areas, government, finance, manufacturing and more.

I think that as things have evolved more and more quickly (rate of technological change, complexity of systems, increasing amounts of information/data, amount of knowledge and requisite volume and velocity of learning required to keep up), it has surpassed our ability to absorb/reason effectively and it continues to get worse.

I think the reason humanity is struggling to try to get AI (to help us carry the load) is related.

I think that there is a trend here, at least in Western culture, we can see manifested by the size of industries. If you look at the biggest industries contribution to GDP, they are also some of the most complex industries[1]. It seems that, among other things, when you have many individual players and groups with competing agendas, money and complex systems, you have these issues.

Perhaps it is literally survival manifesting itself in the modern age.

Anecdotally, I also see people looking to the past for simpler techniques and "core" knowledge, trying to find more general, longer-term survival/coping skills that cut across time and technological change.

[1] https://www.worldatlas.com/articles/which-are-the-biggest-in...

This isn’t a problem with western culture in general. Other western countries have functioning healthcare systems at a fraction of the cost.

Most Western societies are able to operate healthcare systems that don't have this problem - and this "solution" is often advocated as a panacea for the coordination issues they face due to centralization.

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