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Comment by weakfish | Hacker News Reader

Sounds like poor implementation, not a reflection on the concept. Which sucks - don’t get me wrong, that needs to be improved!

Private insurance has all the wrong incentives, and IMO profit should never be linked to the health of a human for that reason.

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In cases of public healthcare the problem is almost always a shortage, doctor shortage, bed shortage, nurse shortage, tech shortage etc.

The perfect system is a public healthcare with true abundance.

There is a saying I healthcare: you can optimize for access, cost, and quality but you only get to choose two. So for “true abundance” (access) you will generally have to put up with higher cost or lower quality. How you find the appropriate balance is the hard part.

Same could be said about case with private insurance and poor implementation.

Government-led services are almost always inefficient. From my point of view the best is a private insurance but with heavy government regulation. Looks like Switzerland is going that way.

This could be a tech-heavy lens, but I feel like some of the innovation in healthcare is driven by a profit motive (and funded by same in a lot of cases).

I don’t know if removing all profit from the system results in an optimal outcome, but I suspect it does not.

My understanding is that most early stage medical research on finding specific targets for drugs, and often drug discovery itself is publicly funded. Private funding only really takes over once you start trialling the drug in animals and then humans.

It’s not just drugs; look at the difference in medical equipment now versus 40 years ago.

I’d sure rather pay a little extra and have 2024 equipment than 1984. That 2024 equipment exists because someone imagined they could make a profit if they successfully created it.

Surely the profit motive in selling medicines or equipment to doctors is decoupled from the profit motive of doctors, hospitals, and other providers, currently governed by the insurance industry? Countries with public healthcare still have health industries for the former.

The doctors and hospitals can't buy that equipment if they don't make any gross profit from patients (or some proxy for patients).

Public healthcare systems are funded by taxes. There are also private nonprofit hospitals that are ironically profitable:

https://www.npr.org/sections/money/2019/10/15/769792903/how-...

However the trials in humans are really the primary source of cost and risk in drug development. It’d be great if there was some mechanism to push royalties back to the public agencies that funded the basic research though.

The only real incentive to provide good service in any industry is money and competitive free market.

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