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Comment by mattmcknight | Hacker News Reader

It will be interesting to see what happens as that funding is starting to be phased out. https://www.kff.org/medicaid/issue-brief/fiscal-implications...

Meanwhile, finding lower cost ways of providing health care still seems elusive in the face of provider and pharma legal efforts.

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Providing lower-cost ways of providing health care is directly contrary to the interests of anyone with political or economic power in our country: the hospitals and pharmaceutical companies that directly benefit from high prices, the politicians who receive bribes in exchange for passing laws that keeps prices high (or just failing to pass laws that would lower prices), and the typical employer who can use the increasing importance of health insurance and the threat of medical bankruptcy as leverage against his employees when negotiating work conditions and pay.

Our health care system is, like basically any other institution of note in the US, first and foremost a means to effect the transfer of wealth to our economic and political elites from the rest of us. We need to first come to recognize that our system is currently working as intended before we can think clearly on what to do about it and take effective action.

"Our system is currently working as intended" implies that someone designed the system to work the way it does. What you're really arguing is that no actor is incentivized to improve things, and multiple actors are incentivized to preserve the status quo.

I'd argue that strident condemnations (ala your "our system is currently working as intended") is actually one of the features of the US political system that tends to create/preserve a subpar status quo: https://twitter.com/JohnArnoldFndtn/status/11063022464493690...

I don't believe that the US has a monopoly on greedy businesspeople or politicians, relative to other countries. But I do find myself wondering if the toxicity of our politics tends to filter out candidates with a good faith desire to serve the public. People who enjoy conflict tend to be jerks.

EDIT -- Here is some specific evidence that US elites are not uniquely rapacious:

A solid majority of Giving Pledge signatories hail from the US: https://gpcatalysis.blob.core.windows.net/gphostedcontent-pr... From the bottom of https://givingpledge.org/

While the US only has 735 of the world's 2640 billionaires: https://en.wikipedia.org/wiki/List_of_countries_by_number_of...

> "Our system is currently working as intended" implies that someone designed the system to work the way it does

I disagree

It is intended to be profit maximizing.

That it is

You linked me to a website for a US organization that apparently encourages the extremely wealthy to create more tax shelters for themselves, and followed that up by pointing out that the US accounts for 28% of the world's billionaires while making up 4% of its population.

I'm not sure what point you were trying to make. I don't think we have a monopoly on greedy businesspeople or politicians either, but I do think that as the epicenter of global capitalism, we dominate the market. You can't hope to solve problems if you won't allow yourself to accurately define them.

>You linked me to a website for a US organization that apparently encourages the extremely wealthy to create more tax shelters for themselves

It's true that the tax code encourages philanthropy. That's not the same thing as philanthropy being purely a tax shelter.

I hope you don't actually believe that providing health care is exorbitantly expensive. Providing health care is absolutely not exorbitantly expensive. It just isn't. Paying the prices that our hospitals, insurance companies, and drug companies charge is exorbitantly expensive.

I think it depends on the definition of “exorbitantly”. US healthcare costs are absolutely extreme but even European countries with universal healthcare still struggle with healthcare expenditure.

> The report shows that global spending on health continually rose between 2000 and 2018 and reached US$ 8.3 trillion or 10% of global GDP

https://www.who.int/publications-detail-redirect/97892400177...

I'm trying to decide why we need to clutch our pearls because health care is 10% of global GDP? Is health care somehow an illegitimate expenditure?

I think people just scoff at the price tag of a lot of medical expenses, though the bill you see your insurance provider get is pretty fake IMO.

How would you propose to resolve that? Should we cut physician pay in half to match their European peers?

https://www.medscape.com/viewarticle/997263

I propose cutting administrative costs by 90%. A bunch of paper pushers in meetings all day making too much money driving up the cost of everything they touch.

That is not a realistic proposal. What specific costs can be eliminated?

Just layoff hospital staff until it hurts. Easy.

Which staff?

Anyone who can't explain what they do in a single sentence.

> Just layoff hospital staff until it hurts.

This is so obviously the wrong answer it is painful that anyone would write it down even in an internet forum.

https://dd17w042cevyt.cloudfront.net/pdf/vision/healthcare-d... shows that while it is easy to blame administrative costs for healthcare, most money goes to "patient benefits"

This sounds great, but really what it is doing is transferring money to pharam company profits: https://www.zippia.com/advice/us-pharmaceutical-statistics/

> Easy.

It really isn't.

That's a good area to start, although 90% might be optimistic.

See this paper: Pozen, Alexis and David M. Cutler. 2010. Medical spending differences in the United States and Canada: The role of prices, procedures, and administrative expenses. Inquiry 47(2): 124-134.

https://dash.harvard.edu/bitstream/handle/1/5343032/Medical%...

Look at Table 1 and Table 2, page 19/20; the difference in cost due to salaries/income is $490 per capita, the difference in cost due to administrative overhead is $616 per capita.

Throw it all away and go single-payer like the rest of the world. This isn’t some unknown mystery to be discovered. It’s been implemented and proven over and over again.

Payer profit margins only account for a small fraction of total spending. Single payer won't solve the problem.

That doesn't save much money. You have to attack the costs. The rest of the world is not on single payer, you know?

Again, the "costs" are not the problem. The prices are. Please stop perpetuating the cost myth.

First fix the difference in drug pricing between the US and other countries.

> Prescription drug prices in the United States are significantly higher than in other nations, with prices in the United States averaging 2.56 times those seen in 32 other nations. ... The gap between prices in the United States and other countries is even larger for brand-named drugs, with U.S. prices averaging 3.44 times those in comparison nations. ... “Brand-name drugs are the primary driver of the higher prescription drug prices in the United States

https://www.rand.org/news/press/2021/01/28.html

So you're asking for price fixing? Who should set the prices?

The simple answer here is to just allow us to buy it in other countries to get around the price discrimination.

I think breaking the hold of the AMA on things like residency slots that has caused physician shortages. Increasing supply should eventually have an effect on wages.

We could also move to 5 or 6 year degrees for doctors, like Ireland, instead of 4+4 schemes.

We can do more targeted immigration for doctors.

We can continue to expand the activities that can be done by non-doctors.

We can massively reduce the number of things that require a prescription.

Can you read? That's literally what I said. (with the exception of insurance, which is just a reflection of the prices charged by providers and drug companies)

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