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Comment by TaurenHunter | Hacker News Reader

That is probably analogous to what happens in the American healthcare sector with physicians/hospitals/insurance carriers/pharma/etc. Each one padding their bills making it horrendously expensive for everyone at the end of the chain.

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The padding in healthcare is part of the system. One part is to have high prices so insurance can negotiate them down. And for hospitals in particular, prices are padded to subsidize emergency care for the indigent (which they have to provide without regard to ability to pay; thanks Reagan).

How can you not be grateful for that? You don't have money, so you should die? Is that really what you mean?

How about government is paying for treatment of people too poor to pay themselves and everyone is paying their share to finance that spending? And as a bonus everyone else will also get their medical treatment financed this way?

That's a hyperbolic misstatement of the situation on the ground. Poor people use free emergency rooms as primary care instead of paying for primary care physicians. That's a cost disaster no matter what you think should be done about health care. We'd be much better off with actually free primary care for the poor, and it would at least make sense to prevent the emergency room misuse since it's so wasteful. But it's politically untenable in the US to fix a broken system in any direction people don't like, even when it's Pareto optimal.

This is the story in Canada as well, but way more than the very poor, because there are not enough primary care physicians where needed, and not enough people pursue family medicine. Why would you? What med student looks at the prospect of administering a dinky small business on top of actually practicing medicine, pay well but not great, and have zero equity when they retire? So we land in a similar position because the change might be publicly funded group practices instead of pay per service which has better optics.

Yeah it seems partial privatization is inevitable or at least the default outcome, at least in Ontario. No other way out that’s also politically viable to enact.

See "We've got you covered" for an analysis of reallocating current US healthcare spending into a general healthcare program that aligns with your thinking.

https://www.penguinrandomhouse.com/books/690632/weve-got-you...

> But it's politically untenable in the US to fix a broken system in any direction people don't like

It’s not even obvious to me that people don’t like the notion of sane, socialized healthcare. They’ve just been trained not to like the name.

Yeah, it would certainly be cheaper if those uppity poors just died instead.

Did... did you just chide Reagan because his healthcare policy was not sociopathic enough? I'll admit, that's new. Impressive.

> One part is to have high prices so insurance can negotiate them down.

One basic truism in business is that "Everybody wants a discount".

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