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Comment by hunglee2 | Hacker News Reader

I think everyone is aware of this by now - the question is, do we understand what is preventing reform? It seems that we need to move beyond the revelation that 'the system is bad' and starting doing something about it. If so, what?

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The issue is the medical-industrial complex in the US, intimately tied with a huge medical insurance industry, that spends a lot of money lobbying to fight against reform. And healthcare is already a heavily regulated industry so any political barriers become even harder to overcome. I believe Obamacare was an attempt to wiggle around to a (somewhat shitty) solution.

I suspect change will only come once the existing tensions towards healthcare expenses boil to an outrage. Talk to anyone in the US though, they will complain about their healthcare!

Well, some won’t and I think that exposes another issue: the poor outcomes have a lot to do with a lot of people not getting care or waiting too long due to cost. If money is no object the US healthcare system is as good as any (I bet you would see this if you broke down by socioeconomic status).

> If money is no object the US healthcare system is as good as any

I don't think so. The medical personnel are way too stressed. You having money does not change that the people that will see you suffer in an inhuman system.

Even apart from money, how on earth is it possible that the people who should know more better than anyone else the effects of stress and lack of sleep let doctors work in far too long shifts? How does the existence of 24 hour shifts make any sense?

The system has a lot more problems than just money.

Just one example link: https://bcmj.org/articles/sleep-deprivation-among-physicians

It's not just the US: https://www.theguardian.com/society/2022/jan/17/nhs-doctors-...

Also always interesting to read: https://old.reddit.com/r/medicine/

Well, as you say, that problem isn’t unique to the US.

Of course, though that is only the case for a very small minority of people.

There is a big overlap with those people and the people that ultimately make decisions affecting whether that system exists though.

As far as I can tell nobody agrees on the details of why the system is bad. I'll pick on the split between the medically assisted dying vs. preserve life at all costs camp as a simple example. Both sides could probably agree that the current situation is bad, but neither side is about to give ground on why or which direction to go next.

In my view, there are a lot of trivial and important changes that could make US healthcare cheaper, better and more available. As long as I don't specify any further details, everyone can agree with me.

All of that surplus spending is going to someone who isn't interested in seeing their cut reduced.

So what?

Both of the countries I've lived in have carried out health-related reforms (one a really big reform — almost half of hospital beds were closed, the other a much smaller reform). The people who lost income didn't matter for the success or failure of either reform.

So they can spend a lot of money to convince people that reforms are bad, they can buy influence among powerful politicians, and all the rest of the moves that make it so elite preferences do a lot to dictate policy the world over. Are we being naive here?

I think so, yes.

You're basically saying that there are lobbyists and that's an insurmountable obstacle, and throwing your hands up in the air. You're not, for example, trying to learn how the countries that executed reforms successfully did so.

EDIT: You could easily find a list online of the top ten health systems. Learning about the reforms carried out by each of those in the past 30 years requires effort, but it's really not impossible.

US health spend is bigger than the GDP of every country on that list. The biggest employer in nearly every congressional district is a healthcare system. It’s politically difficult.

You make it sound as if closing nearly half of a country's hospital beds is politically simple. Was done. Or as if nationalising most of a state's hospitals is politically simple. Was done. (In some people's opinion, not mine, but lots of people described it in those words, so it's a fair way to describe the political controversy of the reform.)

It's possible to learn how these things were done, or it's possible to just give up and say it's politically difficult.

Since Medicare has served as a model for some countries that provided universal care, I don’t think lessons are what we need. The problem is overcoming strong, bipartisan opposition.

Maybe I missed a rhetorical question but would-be reformers of the American health system were defeated by the efforts of moneyed interests (AMA, insurers, etc) in the past. It’s not that nobody thought of it. Argue about the wisdom of it if you want, but Obamacare was structured as it was with the idea of turning the industry into allies rather than implacable opponents.

No, I think the part you miss is that some people succeeded at difficult reforms. Consider a reform where control of parts of each hospital's budget is removed from the owners/management of most hospitals. Might meet with some resistance, wouldn't you say so? You Americans seem to have this idea that your entrenched interests are somehow uniquely skilled at defending the status quo. Something like: "American hospital systems are so much better at defending their budget than that hospital system, so therefore that learning how that reform was executed would be pointless."

Seems to me it's ideology and profit.

The US isn't the only country with a partisan, ideological driven political landscape but it is probably the loudest. Ideologues on the right are able to pander to their base by equating any healthcare reform as socialist, substandard, death panel creating and an affront to freedom. People will accept a bad deal if they think it is the right deal.

Healthcare companies benefit so much that they are one of the biggest lobbying industries in the US, spending $690 million a year on lobbying (quick Google result, so pinch of salt). The changes they want are those that will profit them more, so it benefit them to feed the ideologues.

> If so, what?

Bring it into the political discourse. And vote.

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