Hacker News Reader

> But if the deeper problem is there, is there any short term solution?

No.

> Sure we can start training people and make lots of incentives for people to enter the field, but that will take years.

Yes. But it should be done.

Also, there shouldn't be shortages of saline IV solution and bacteriostatic water -- but no one's rebuilding the factories destroyed by hurricanes in Puerto Rico because there's not "enough" of a shortage to make ROI on new factories.

Most medical supplies need to be moderately overproduced every year via subsidies just like our crops and basic foods are. Otherwise the rationality of the commodities markets will ensure there's constantly a light/partial shortage of basic healthcare goods like..."water".

Some things should not be ruthlessly efficient; what appears to be waste is tail risk premium. Alas, that “efficiency savings” becomes someone’s bonus or profit, and a loss for the rest of us.

Allow CEOs to keep their performance-based bonuses. However, add a stick to balance out that carrot, like capital punishment if your hospital falls below a certain level of patient outcome on the year.

Seriously though, if the people responsible for hospital cutbacks had to rely on the same level of care the average American gets, we would never have gotten to this state.

We have to compensate the supply chain for accepting the burden of being prepared for these risks. Today we pass “anti-gouging” laws declaring that we refuse to value it at all.

I personally think the way your question is framed is kind of an example of how insidious the influence of the current system is.

It's not a matter of "are there enough humans who have sufficient training in medicine who are willing and able to fill all those positions?" It's are there enough humans with sufficient training in whatever positions there could be to meet the health needs that exist?

Just for example: it's pretty clear many things done by physicians could be done by other providers, like pharmacists, psychologists, dentists, optometrists, if we broadened our idea of what those specialties (and their subspecialties) could look like. There are also probably types of providers that could exist that don't exist at all now, that we're not imagining because the healthcare system makes so many assumptions about what it looks like. Maybe all these things will involve additional training opportunities or whatever, but if you let people do what they are capable of, they'll find a way.

Sure, train more physicians. They'd be there. But you'll find even more people willing to do all sorts of things in ways we aren't currently imagining. We're constrained by convention.

Except that's the status quo. These days, all but the most intense of medical procedures is being done by increasingly less qualified people.

Nurse too expensive? Get a CPA!

Most of the time I go for checkups I see a CPA for the majority of the time, a nurse for less, and almost no time with a doctor. Excepts are usually for surgery or other intense operations.

This idea of "just let less holistically trained people do the work" honestly sucks. Dentists are better on average at teeth cleaning than dental cleaning specialists. MDs are better on average at putting IV needles in, etc

Given how many news stories there have been about people leaving the field due to the working conditions, low pay, and insurance red tape, it seems like getting rid of that enormous layer of inefficiency would do double duty both in terms of freeing up money for productive uses and not pushing experienced workers out.

You use the words "red-tape" and "inefficiency" there in a very patient-centric way.

Whereas from a profit point of view fewer doctors is good, more insurance red tape is good, effeciently increasing bills and billing customers is good.

The health system is set up to maximise profits. And it is doing so most effeciently. If you want a different outcome then you need a different system.

Medical resources will always be limited. There is no way to get around the fact that people are willing to spend nigh infinite amounts of money staying alive a little longer. There is no way around rationing. You either ration through the free market like in the 3rd world, ration via time like in Canada and England or do both like in the US.

Even with zero greed in the system we would still have to ration things.

I'd argue that we are not currently 'fighting greed' at all. The US healthcare system is not capable of prioritizing anything. It's a mishmash of corporate and government entities hobbled by regulation with no clear entity in charge.

> Sure we can start training people and make lots of incentives for people to enter the field, but that will take years.

Ok then. Get started on it now! This has been a known issue for decades, so I’m not expecting much action until it gets so bad that a revolt occurs.

The private insurance model is still a horribly broken concept that needs to be addressed as well. Single payer seems to be the only reasonable alternative to prevent the broken feedback loop (insurance companies are driven by higher premiums which are driven by higher costs so there is no accountability) of the current system.

> Surely capitalism [...] problem

Spoken like someone who's never lived NOT under capitalism. It amazes me how young people today say things like this, as if they are self evident. I used to think that I'd not wish that life on anyone, but really y'all could use some, to see the contrast.

> lived NOT under capitalism

What, for example, is "NOT capitalism?" You mean like communist countries? You seem to be making the old mistake of thinking communism and capitalism are opposites of one another.

What is more, the problems with the communist countries was massive cryptic bureaucratic systems preventing practical problems being solved. If you hadn't noticed (or just ignore OP entirely) we have this exact problem right now with the health care/insurance system under the capitalist US system.

This is what I mean by capitalism and communism aren't opposites. Capitalism is turning our society into something like what was seen under more oppressive communist governments. And simply voting as if "things are better here, now, than it was under communism" won't solve the very real, pressing problems that OP was talking about.

I lived "not under capitalism", and while I have many problems with that system, one of the few things that it actually could legitimately boast of was healthcare that was available to everyone, no matter how poor. I don't see any reason why the much richer capitalist societies can't afford the same thing, if they wanted to.

The deeper problem is the demographic pyramid. We have lots of old people and the younger generation is smaller. Of course there's not enough caretakers, which is why the US systematically imports them from other countries, leaving those countries with the same problems.

Ultimately, there is no escaping the market. No amount of public-funding, socialism, or outright communism can escape the simple facts of supply and demand. Right now, medicine is expensive because demand exceeds supply. Do insurance companies and bad administrations exacerbate that? Yes, of course they do. But they are only exacerbating an existing problem.

What you're saying maybe true in the long run but it's not true right now. There are more nurses holding nursing degrees that are not in bedside care than nurses performing bedside care right now in the United States.

These people could easily be brought back into bedside care but the pay and conditions are absolutely abysmal.

I don't disagree that the population pyramid shape is a root factor. And that shape is likely to get worse, not better as time goes on.

Given that it's not "solvable" (at least not without a nice pandemic targeting old people, who can be convinced not to protect themselves) it's worth then looking at "best", not necessarily "perfect", systems that may deal with it.

The approach of "best healthcare for those who can afford it" is one way to go. All resources ploughed into some sub-section of humanity, those who can pay the most.

Or we might go with "good healthcare for everyone", so alas limited heart transplants.

And I get it. There will be winners and losers. At an individual level you can have all the money in the world, and yet die when some poor person is ahead of you in a queue. "Surely the queue should be in order of net-wealth?".

No system is going to make every medical intervention on all patients all the time. We won't in fact live forever.

That doesn't necessarily mean that the current system is the best alternative. (unless you're a share-holder, then it clearly is.)

IIRC, that swapped a few years ago...Millenials are now the largest cohort followed by Gen-Z, Boomers and then Gen-X.

Given Gen-X is both the smallest and next cohort to start retiring, I'm guessing medicare, SSI, etc. will have a few years to 'catch-up' before the Millenials start retiring.