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Comment by fallingknife | Hacker News Reader

We'll never be rid of it. It's politically impossible to get rid of. And I don't mean "political" as in D vs R.

The amount of money we spend on healthcare in excess of the OECD average is more than we spend on the military. 10% ish of that is the entire yearly profit of the healthcare industry. The other 90% is raw inefficiency. And where does that 90% go? Mostly to salaries. Eliminate our inefficient system, and you eliminate millions of middle class jobs.

No politician will do it. They may talk about it and campaign on it knowing it won't happen. But they will never pull the trigger because it would be political suicide.

Also, if you want to know more than you ever needed to about the US healthcare system and why it is so expensive I highly recommend this report: https://www.mckinsey.com/~/media/mckinsey/industries/healthc...

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This is such a crazy take. "Because the waste is so huge, it's impossible to do anything".

It's not like any individual reform is going to suddenly end all that waste and put everyone involved out of a job. Iterative small improvements make a real difference in people's lives, and won't provoke an immediate giant supply-side shock.

I don't pretend to have the answers to the question of "what reforms should we do?" but throwing our hands up and saying "nothing!" is not the answer.

Its kind of that way

How do you reduce inefficiencies and cut costs without compromising care?

You cut jobs that are redundant. America spends an insane amount of money on administrative overhead. 4x the average of other wealthy nations [1]. This is largely in part because our fragmented insurance system leads to excessive redundancy in administrative roles

So meaningful reform means cutting jobs. Or you do the shitty political move and preserve these useless jobs for the sake of keeping people employed because our social safety net is a joke and the cost cutting you do make is at the expense of compromising care and vulnerable populations (eg cutting Medicare and Medicaid benefits). Then you get more clinician burn out and struggle to fill key clinical roles/staffing issues, scheduling issues and longer appointment waiting periods, more deaths and complications from a lack of preventative care, more mental health issues and drug abuse in communities, etc. all of which is happening in the USA.

[1]https://www.pgpf.org/blog/2023/07/how-does-the-us-healthcare...

While I agree with you on this bleak outcome, it's more that it's a progressive vs conservative issue. Progressives make up a minority of the democrat party and 0 of the republican party.

The only way to really change this is voting for progressives when possible, though it's hard to convince others that this is what you need to do.

If you are in a blue state, vote in the primaries for the progressive candidates. If you are in red states, that's voting for democrats in general and the most centrist republicans in the primary.

The absolute worst thing to do is to not vote and let the most conservative candidates run wild.

This is not a D vs R / lib vs con issue. It is not a progressive vs centrist Democrat issue either. It's a healthcare industrial complex issue. The US spends 16.6% of GDP on healthcare. The OECD average is 9.7%. (https://stats.oecd.org/Index.aspx?DataSetCode=SHA). That 6.9% difference is $1.5 trillion! That's 2x defense spending!

That 6.9% of GP is supporting millions of jobs, and to remove an inefficiency like that would put them all out of work. It is not possible to do that in a democracy.

Solid take. It'd be much more fine if that 90% could convert over to something useful in times of crisis. But recent public health events have suggested otherwise.

I think the government could make progress by focusing on just cutting costs or just reducing inefficiencies. When the two are conflated and attempted at the same time, the incentives don't actually line up so nothing happens.

In my sector of useless healthcare bloat I see 99% H1B, perhaps its not typical but I don't know what political issue there is to cut those jobs.

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