'It didn't use to be like this': woeful US healthcare system | Hacker News Reader

'It didn't use to be like this': woeful US healthcare system

theguardian.com

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I wish that these "discussions about the US health insurance system" would lead to real change, but I'm pessimistic.

The fact is that this is a deep, complicated topic, and the media cycle doesn't have the sustained focus for deep, complicated topics. We don't need 200 million people to care for a month; we need 200 thousand people to care for years and years to achieve reform.

I would bet a lot that more than 200k people in the US care very deeply about this. I agree that the crux of the issue is that the topic is deep and complicated and requires nuanced good-faith discussion and iteration over a long period of time to achieve good outcomes. However, I think the main blocker is that parties in America have succeeded in boiling it down to a naively simple and highly partisan issue, causing all progress to stagnate.

None of the actors involved want it fixed. They just say 'it's really complicated and actually our part (insurance/doctors/hospitals) are doing it right, it's all the other parts that are broken.

The nation has wanted to actively fix this since the 90s (30 years ago) and all that has happened is prices have gone up and we added ambulances to the list of unaffordable healthcare. After 30 years my take is no one involved is acting in good faith at this point and 'it's too complex to fix' means we gave you all time to fix it, you didn't, so we need to reboot from the ground up then.

> so we need to reboot from the ground up then.

Taiwan did exactly that in 1995: [0]

Of course, rebooting your health system from scratch is sort of like rewriting your janky legacy software from scratch: more often fantasized about than done!

[0]: The Leap to Single-Payer: What Taiwan Can Teach https://archive.is/m0go1

Indeed. I've sometimes thought, "if we succeed in any big medical reform, it will be Medicare For All -- not because it's necessarily the best system, but because it's the easiest slogan to fit on a poster."

WSJ has been doing an excellent deep dive on United’s despicable vertical integration practices for a while.

We had an administration that was pursuing an aggressive strategy against vertical integration, but I suspect that’ll fall by the wayside with the new FTC

It’s not complicated. We pay the world’s highest prices for the developed world’s worst outcomes. If we wanted to fix it we could simply copy the scheme used by whatever country gets the best outcomes at the lowest prices.

It’s only complicated if your ideology doesn’t allow for evidence based decisions.

Well, I would say: it's only complicated if it's constrained by politics... which it definitely is.

It is already more complicated than what you said. Outcomes for some are quite good and there are tons of differences between the US and any country to adjust for.

Also, there is no country with both the best outcome and lowest price. Which balance of price and quality do you pick?

It can't lead to change. Too many people's standard of living is dependent upon the status quo.

https://www.statista.com/statistics/184968/us-health-expendi...

That's 20% of the country that will be less well off if you "fix" healthcare in any meaningful way and the overwhelming majority of them will fight tooth and nail to prevent that from happening.

That is a hell of a minority to overcome when the issue is one of personal economics (i.e one everyone will experience directly, not some abstract social policy thing that people will ignore as long as their lives are good), dare I say basically impossible in a democracy.

(yes I know I'm assuming that the healthcare industry is a cross section of the country, no I don't care if that isn't 100% accurate)

So I have a close family member dying right now from cancer. Had stage 4 for almost 10 years, and then insurance started denying scans (which in medical terms, cost next to nothing) and delaying surgeries (which led to the state getting involved). These months-long delays on surgeries, coupled with lack of information about the tumor due to not having scans, led to them getting the wrong surgery for a tumor (it had grown too big, which they didn't find out until they went in). Now it's blowing up and inoperable, when they could have taken care of it with a simple laparoscopic procedure when it was <1cm. This is a gold private plan, too, and they had paid premiums for decades.

I'm absolutely disgusted in the US medical, insurance and legal systems after this. Nobody's going to jail for this. There's not even a fine. In fact, the system is working exactly as intended. Insurance just got sick of paying so they delayed everything so that this person would die and they could report higher earnings.

What's really upsetting is seeing doctors and nurses discussing stories like this in the wake of Luigi Mangione, and these conversations just getting deleted from places like reddit. We're allowed to talk about the death of a health insurance CEO (as long as we aren't happy about it) but when the conversation shifts to the people who died prematurely due to him and his company's practices, it gets censored. Absolutely disgraceful.

I don't believe in things like "deserve" (not after cancer anyway), but Brian Thompson should have got much worse than what he did.

The fact that people are upset about the Healthcare CEOs death but not about the hundreds if not thousands of people he killed over the course of his career through denied claims/treatment says a lot about America.

Well, I think it says more about mainstream media trying to paint Luigi as a villain and the CEO as an innocent victim, as well as social media suppressing any positive comments about Luigi. It's interesting to see the reach of the wealthy when Reddit started deleting entire posts and countless comments wholesale for simply being too supportive in any way. Everybody from the left to the right was ragging on insurance companies, but it took only a week before not a single post would show up anymore on all or popular.

That's when reality of class warfare in modern society really sank in for me.

Stalin says hi (a million deaths is statistics).

Someone should(TM) make a news website about each dead healthcare denied case, and add details about what was denied, by which agency, in the style of a crime report...

They'll cheer for a guy who puts a bullet in a CEO but won't say a word to their friend/relative/spouse who works in healthcare about the fact that they are a fractional enabler of the evil.

I guess the dead CEO is just a cog that was happy to be part of the system, but your comment makes me think how the US Internet is approaching the version China has. But hey, this is a capitalist system, so the censorship is done by private firms!

At least there aren't yet "reeducation" visits from "Homeland Security" over private messages (which are E2EE if we believe our cloud feudal lords - btw Zuck, how was dinner with Trump?)

It's sad how the tech world has chosen to go. They started out pretending to be a source for good/improvement. Now we have things like Ellison thinking it's acceptable to publicly talk about having AI monitoring everyone all the time 'so that people will be on their best behavior'. Literal Minority Report is now a totally acceptable public policy push position among the tech elites.

https://www.youtube.com/watch?v=sQqQtgRdjZU

We need some cumulative abuse laws in this country. At some point the cumulative damage done to so many families by insurance companies 'strategic friction' policies/denials/manipulating people so insurance can pay for a lesser level of care rises to criminal when you are talking tens of thousands of people having to deal with artificial delays ('strategic friction') introduced by insurance companies and the associated tens of thousands of hours of stress, actual deaths, etc.

It should not be legal for executives at a single company to inflict tens of thousands of hours of anguish on Americans as part of that companies 'strategic friction' policy. At some point the abuse of TENS OF THOUSANDS in the hopes that those manipulated by 'strategic friction' will reduce the level of care they try to receive should rise to criminal, even if the people being abused happen to have a business arrangement with the company whose management have approved the abuse to increase the company's profit.

What gets me about the neoliberal ideology that's got a strangle hold on us is it studiously ignores the psychic stress and damage it's inflicting on people as if there won't be blow back eventually.

With insurance companies they are pulling this stuff right when people are at their most vulnerable state. I feel like the system is really playing with fire. And worse the people with power are intentionally isolated to the worst of it. You think a congressman or CEO gets anything denied, no they don't.

>We need some cumulative abuse laws in this country.

I dream of it but I think a large part of the reason we'll never see it is because just about every state and municipality of note has one or a few bureaucracies who make a healthy profit behaving in this way or by deputizing 3rd party contractors to do so.

Try disputing an obviously wrong EZpass ticket if you don't believe me...

> stage 4 for almost 10 years

Is this prostate cancer ?

> then insurance started denying scans

Did they give a reason ?

I'm sorry, that's awful.

When your insurance company denied the scans, did they explain why not? Something like, "your plan only covers X scans per year"? Or was it just a "no" and that's it?

Im sorry for your loss, and am going through something similar, but I think this is an oversimplification of what is a very complex problem.

If it is soley a problem of chasing profits, souldn't it have been cheaper for the health insurance to take care of it with the simple laparoscopic procedure than 10 years of stage 4 care? Similarly, profits are capped as a percent of what is spent on patients, so they don't actually make more for denying care.

The reality is we have a messy stochastic system for rationing care which causes a lot of unnecessary pain and confusion because there is lack of clarity on what is covered, and patients are put in the middle of negotiations between hospitals and insurance.

Do you happen to know the name of the insurer?

As someone who has lived with a chronic lifelong condition since childhood, I know this struggle deeply.

The only time I have had success is connecting with executives at the insurer on linkedin ( I work in medtech so that makes that easier) and then personally appealing to them, repeatedly, to help.

Also, in every case, please report these things to the insurance boards in your state, your representatives, etc.

Make it a process, get good at it. It's the only way to effect change.

Executives should continue to be shot until morale improves.

Medicine is science... Healthcare is a business.

you are missing “in the united states” at the end of the sentence :)

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