Employers Took on Healthcare Costs, and the Fight Got Nasty

Even in those systems if you have more money you can get better and faster care. Something like 60% of Canadians have private insurance. I live near the border and several of my friends have visited the US for to bypass lines.

This is getting better. Most providers provide price transparency. The data is dirty and not consistent between providers but definitely a start.

Check out https://turquoise.health/patients a startup scraping and standardizing the data.

Time - Cost - Quality

Pick two. So you can have fast, cheap, but low quality food ('fast food'), or slow, cheap, good quality food (cooking at home), or fast, expensive, high quality food (decent restaurant).

By time I would also include mental overhead required, i.e. thinking about cooking. Unfortunately poor people often have neither the money or the time to choose quality.

The daft thing is that cooking individually, or indeed to order in a restaurant, is very inefficient. In fact it is possible to win on all 3, but this requires a communal style cafeteria as would be found in offices, schools, the military etc.

Wouldn't it be great if such cafeterias were available to the general public, with a limited but rotating good quality menu, using actual plates instead of single use plastic, bench seating such that singles would feel comfortable dining there, tap water on tap, self serve with trays.

You can find something like this in shopping malls, but often a wide menu instead of a rotating menu, so failing to scale and thus falling behind with quality

And they do this because they're only allowed to take a certain percentage of their revenue as profit. The more healthcare costs, the more they can charge and the more they can make.

The obvious answer here is that health insurance should not be privatized. Health insurance should be negotiating to keep costs low so that they can cover more, not letting costs skyrocket to make more profit.

Unless the wages of doctors, nurses, hospital staff and the employees of drug companies have gone up 200% the last 20 years I seriously doubt they are the root cause.

An interesting comparison might be veterinary care, which has also been increasing for quite some time. The typical insurance model for veterinary care is quite different than human healthcare insurance. However, one aspect in common is a consolidation of medical supply chain providers (decreased competition, rising costs for providers) and a proliferation of for-profit, private-equity backed, large healthcare providers who are able to negotiate prices and maximize profits by passing on price increases to those able to pay.

I know of many software engineers who make at least as much as doctors. It’s just not that lucrative anymore.

> but doctors, nurses, hospital staff and drug companies would still cost money.

Doctors, Nurses, and staff are employees. They cost money, yes.

Drug companies cost money, yes. We, in the US, pay them a massive amount of money to socialize the risk and privatize the success. We should probably investigate that as well. The primary issue, however, is insurance companies. They're for profit. They need their numbers to grow. How do they do that? Cover less, raise prices for medication and procedures, and raise premiums.

Much of the cost in the NHS is due to creeping privatisation and a mountain of PFI debt that could have been funded for a fraction fo the cost of what it bought.

NHS consultants working at their hospital privately. Hiring their own companies.

You're an NHS nurse, your pay has declined drastically in real terms and the job is increasingly stressful due to a staffing shortage. You spend part of each shift teaching a clueless agency nurse, who's costing the NHS 2-4x more than you, how things work.

The government has over the last two decades, gradually shifting more work to private services, despite paying more for less each time they do so.

The people responsible should be in jail.