The rich are endangering their riches in this experiment. The pitch forks will have their field day eventually.
2014 https://www.politico.com/magazine/story/2014/06/the-pitchfor...
2014 https://www.politico.com/magazine/story/2014/06/the-pitchfor...
On top of that, mass media controls the narratives way too hard - just look how fast Luigi Mangione got out of the news.
What news would there be? He was arrested and locked up, his court case hasn’t started. Should we have “Luigi still in jail” headlines?
It was all show no thought. The big questions remain unanswered. Where are costs inflated between pharmaceuticals, providers, hospital administrators, insurance administrators and patients seeking unnecessary care? How do we reform insurance when most people hate our healthcare system while simultaneously liking their own coverage?
Luigi didn't add anything substantive to the debate. Instead, his role was in facilitating venting. Someone still has to come up with an idea beyond "I hate this."
> there was a debate beginning to form what drives someone to execute a healthcare executive on the street
On Twitter, maybe. For most people, it was another Manhattan mental-health case murder. The chase and his good looks provided salacious intrigue, but only for so long as he was on the run.
Pharma costs are inflated by R&D costs and promotion. Insurance overhead is actually relatively lean, but base cost is primarily driven by cost of goods, and to a lesser extent admin. Provider costs are inflated by high legal and regulatory liability, shortage of qualified staff to offset liability, and high admin.
At a the highest level, cost is driven by an inability to discover and set prices at market clearing rates.
Manufacturer dont sell fixed price product into a market, but negotiate complex bulk deals with PBMs, pushing some prices up and others down. Similarly, hospitals/providers dont set prices at clearing rates, but negotiate 1:1 pricing, with some products above and below cost.
Last, and I suspect most significantly, health plans cant meaningfully vary in provided care, only cost sharing. That is to say, a bronze plan must include the same medications and procedures at a gold plan, differing only in copay. This breaks the price feedback on COGs. (e.g. a generic only insurance plan is illegal, so name brands face reduced competition).
If I were Medical Czar, I would look at banning preferential pricing/institutional rebates for goods and services.
I would allow more heterogeneity in policies (e.g. generics only, no implants, limited oncology, ect). This would crush innovation, but also greatly reduce pricing as it moves from cutting edge, to 10 year old technology.
Provider shortage is a tougher nut to crack, but I think it would require radically altering the residency program as it exists today and loosening requirements for other healthcare professionals.
If I had to pick one, I would say heterogeneity of insurance plans as most fundamental.
Consumers must have some exposure to cost savings or liability for downward price pressure exerted and inferior substitutes to be selected. People will never pick a $20 treatment over a $20,000 unless they have skin in the game, even if it is 99% as effective.
I think this has to be instituted at a insurance policy level for a number of reasons. Charges are stochastic and in the future, while policy premiums are predictable and immediate, allowing consumers to see cost or savings across the entire policy and pre-commit.
Measurability is tough on this because it amounts to allowing inferior treatment, and I dont think this could be papered over, even if it brings down the price of all care and allows more treatment in aggregate.
Uniform pricing is much better on the messaging. It is adjacent to collective bargaining, just mediated by a market instead of a technocrat. It can be sold to the left as an attack shadowy rentseekers. It can be sold on the right as a free market reform. On the pragmatic front, it can It has a transparent pricing angle, where you could see prices, which current transparency legislation seems to fail. I also think there is a lot of negative will pent up about negotiated pricing and the idea of companies paying drastically lower prices than an individual because they can throw their weight around when bargaining.
"Remove the people between you and your doctor."
In all socialized systems the government decides what your doctor can do, 100% of the time. Of course from a patient perspective it looks much less restrictive, but that's only because your doctor never brings up treatments that aren't paid for.
One of the big issues with the US system is that the patient is put right in the middle of the decisions so sees all the rejections, has to deal with all the paperwork, and pays the price when things go wrong.
This is the admittedly huge emotional problem, but distinct from cost problem. Hospitals and insurance billing systems can be as dysfunctional as they want because all of the financial liability is outsourced to the patient.
If this outsourcing were not possible, insurance and hospitals would have worked the issue out long ago. I expect all treatment would be pre-approved by default, and hospitals would carry the cost of misbilling (like how a retail store eats a fee for credit card purchases)
Patients need to be more involved.
There is universal healthcare through compulsory national health insurance (premiums subsidized if needed).
However, the insurance only covers a portion. About 10-20% will come from a forced medical savings account.
Then there is the cash part of the cost.
The government has designed the entire system to make sure no patients pay $0 of their own money. Even indignant patients will work with a social worker to figure out what they can pay. If it's only $2, then they are billed $2.
It's a pretty good system in terms of keeping costs down, keeping patients involved in the cost of their care, yet ensuring nobody goes without critical healthcare.
The issue with the US is that it's kinda set up for patients to be at the center, but misses critical components (like price transparency) to the point that even though patients are required to manage their own healthcare financiing, they aren't actually given the tools to do it efficiently.
No, it wasn't; if the momentum was there, the debate would have been self-sustaining and not dependent on new news events relating to Mangione to sustain it.
> but the day he got caught, the debate got suppressed and no one is talking about it anymore.
The debate didn't get suppressed and didn't need to be; the “debate” in the major media wasn't a real debate, it was just a way to stretch attention to Mangione news for a few more commercial breaks, and once there were no more news events for it to leverage for that purpose, it was abandoned by the same people who had been driving it. And, to the extent that there were people engaging in social media and elsewhere who saw the debate as genuine, they didn't need to be suppressed, as they never had momentum, they just mistook cynical commercial manipulation for opportunity.
"Awareness" is almost never the limiting factor to policy change.
This is why awareness based movements such as occupy, BLM, and climate protests go nowhere. Everyone is aware of climate change, police brutality, or inequality.
Organized opposition with leverage and a compelling alternative is the bottleneck. Awareness isn't a policy position and doesn't advance debate.
Luigi did not have a thesis capable of changing minds. I dont know and haven't seen a single example of someone having their mind changed. Just people more fired up on their priors.
My point is that acting out until someone else comes up with a solution and someone else implements it almost never works. You have to change minds en masse.
People say this a lot, but it seems just as likely to me that the media is simply reflecting what we care about. Coverage fades because, broadly speaking, people have moved on from the story. Even more "intellectual media" like the Atlantic has moved on from it. I get that it’s uncomfortable to acknowledge, but an equally plausible explanation is that the public is far more interested in Blake Lively’s lawsuit than in Mangione or the state of healthcare in the U.S.
Yes, it’s a symbiotic relationship, but I think people are often too eager to blame a shadowy cabal rather than recognizing that it’s often just a reflection of what society actually values. Probably because, as stated, dismantling mass media seems like something that could possibly happen while changing the entirety of a nation is essentially impossible.
Republicans might make big changes but this has been the situation since Obama.
The history of modern revolutions is that the rich are fine. Hell, even in the French Revolution, most of the aristocracy fled with their lives and moveable riches. In the intervening centuries, mobility of both people and wealth has substantially increased.
Just remember that not all conspiracy theories are wrong, but there being so many popular ones from the left now is not a good sign regardless if they are right or wrong.
So everything I said was right, the people who responded to me validated it, they think there are conspiracies! That means there are a lot of conspiracy theories, I explicitly noted that I didn't say they were right or wrong.
All anyone can do is guess and imagine, because of this.
Everyone has to be a theory. Reason is extinct.
The effect of network organizations like Heritage Foundation or the decades-long work of the Koch brothers or the Murdoch clan on what Trump is doing is not to be underestimated.
Which is, of course, just as stupid as the 2020 MAGA conspiracies. His money sure as shit bought the election, but it wasn't by fucking with the votes.
Assuming any evidence exists, why did none of the people who could actually gather any file injuctions, lawsuits, etc? They had four months to do it, three of them while the incumbent still controlled the executive.
[@]https://www.democracydocket.com/news-alerts/trumps-doj-volun...
Gerrymandering is legal, if done by the books, which is the entire point of doing it. And the voter suppression caused by apathy due to FPTP (in the US and UK) or minimum-vote thresholds like the 5% rule here in Germany is built into the system, so even harder to legally challenge even though Germany may lose up to 20% of all cast votes in next week's election in the worst case because they are summarily dismissed this time.
"for are we not generous gods?" --Most Billionaires
Middle manager from Minnesota scraping in at the very bottom of the 0.1% wealth line, in a system with power-law dynamics, is a high-profile mugging.