Comment by vkou | Hacker News Reader

Comment by vkou | Hacker News Reader

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We have solved it - I can't think of an alternative system that would be any more optimized, towards the benefit of medical schools[1], doctors[2], hospitals[3], pharma firms[4], and insurance companies[5].

Oh, you meant solving it for actual people? That was never the goal of the self-serving architects of this rotten mess.

I don't expect the farmer to grow me food out of the goodness of his heart, but to quote Adam Smith, this is a conspiracy to the detriment of the public.

[1] Who charge absolutely ludicrous, jaw-dropping, nowhere-else-in-the-world-comes-close tuition.

[2] Who, after paying off the debts on their ludicrous tuition, are absolutely rolling in money.

[3] Who don't let their patients comparison-shop (Just try getting a straight answer on how much a routine procedure is going to cost), and in effect, can charge whatever prices they want.

[4] Who are happy to make billions of dollars off inefficiencies created by them, in the generic space.

[5] Who have created a captive market where not getting your healthcare through them is financially ruinous.

A lot of doctors in specialties are pulling in pretty decent money, but it's probably not as much as you're thinking. I say that as someone working with medical practices and physicians on a regular basis. Internal medicine, general practice and family docs are generally making less.

There are also a lot of things going on with consolidation and big medical groups, driven in part by pharmaceutical costs. As an example, we used to have several oncology practices as clients. We're not working with any of those anymore because they have all been bought out by hospitals or health systems. From talking with the doctors at the most recent one this was not because they got a big payday out of it but was instead because looking forward a few years they were not going to be able to afford to stock chemotherapy drugs. They sold out because they could see the time when the business was no longer sustainable as an independent practice.

I'm sure the doctors didn't come out of this hurting, but this was not a startup unicorn style exit.

Look to Europe, we solved this decades ago.

Or Canada or pretty much every developed country in the world.

There's been an ongoing shift of power and rights to the very wealthy over everyone else's interests. It's not new but it's becoming more and more obvious to the average citizen.

Here in the US, our culture still praises this behavior because it props up the carrot that is the American dream. It's a cultural problem where everyone has been convinced they're the next billionaire to reap the rewards of the broken political and economic system... they're just temporarily and shamefully poor for now.

So the problem runs far deeper than healthcare, it's everywhere. Healthcare is just an obvious target because it directly effects people when they're most vulnerable and it actually angers them enough to complain a little. We need a cultural shift that is reflected in our politics (if it's not too late already).

Unfortunately that philosophy has been heavily exported and a lot of social welfare programs are endangered across the world - up here in Canada we still don't have drug, dental or eyecare due to strong cartels in those market segments - this is particularly worrying for Dental which is less cosmetic then folks thought forty years ago and can actually contribute to general well-being.

Yes, but how does the European model benefit the real stakeholders - medical schools, doctors, hospitals, pharma, and insurers?

Those groups are going to hold any progress on this matter hostage. (Imagine the job losses! Imagine the loss in innovation! Imagine not being able to provide the best treatment money can buy! Imagine not being able to charge a million dollars for a medical education! Or being able to pay off my million dollar debt, accrued to finance my medical education!)

Medical schools are publicly funded universities, same for many hospitals. Doctors have decent funding by insurers (we have both single payer systems as well as competing ngo/private insurance companies, depending on country). Pharma gets to negotiate pricing with a central body and that's it. Of course big pharma cries all the time but ah well. Better than the US where people die because they can't afford insulin!

In some ways they've solved a lot of the problems we have, but europeans still don't have access to a lot of very powerfull drugs and proceedures that we do.

I feel like there's no way to have both things.

Which powerful drugs and procedures are not available in Europe?

I don't know about not being available in all of Europe, but here's a story from the UK a few years ago where a baby had a rare, but easily fixable, heart condition. There were no doctors in the UK who could perform the surgery, and the NHS initially refused to pay for the parents to come to the USA for surgery. The parents started a gofundme to pay for the travel and surgery, but the NHS eventually agreed to cover it after it became a big deal on the news.

https://www.bbc.co.uk/news/uk-england-40864598

> but europeans still don't have access to a lot of very powerful drugs and procedures that we do.

That's because of the impedence mismatch of legislation in Europe vs the US.

I'd say it's comparable to the story on how US eggs are illegal in Europe, and vice-versa.

https://www.latimes.com/food/dailydish/la-dd-heres-why-we-ne...

I see this kind of arguement a lot. It's also common to read about people traveling abroad to receive better treatment that will save their life.

I'm not sure which anecdotes to believe in this case.

Believe both. The US does some things better, others do other things better. And maybe you get more cutting edge stuff in the US but there is also a big risk to go bankrupt over standard stuff. Having lived in both Germany and US i find the US situation terrifying. If you have a serious health problem in the US it’s a total gamble whether you will go bankrupt or not. And there is no way to avoid that.

You solved a different problem than the US did. The problem you guys solved is how to provide high quality affordable healthcare. The problem the US solved was how to use healthcare to strip mine middle class wealth.

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