Medicine has a lot of things that make it naturally not work like a normal good or service market. To deal with some of these issues, it's a heavily regulated field, but many of these regulations also make it ripe for exploitation by for-profit entities.
https://www.axios.com/2025/03/17/private-equity-health-care-...
“We’ve tried nothing and we’re all out of options.” seems to be the equilibrium we keep arriving at, despite it being unsustainable.
Your healthcare is entirely decided by people who are not your doctors. Every medicine you take, how long you go to the doctor, what surgeries you can get - your insurer unilaterally decides this. Not your doctor.
There's no voting system or merit system. You can't just simply find a better doctor - because your doctor is an empty vessel, they make no decisions. You have, legitimately, zero recourse.
Shooting someone is then very rational. We have made that one of the only choices, period. The insurance companies have all but guaranteed this outcome.
A fully public single payer system would mean bureaucrats would produce a report concluding that more doctors are needed to keep costs from spiraling, and the number of residency slots would be increased. A more freer market would mean hospitals/doctors were paying for all of their own residency slots and they'd up the number through price signals. Instead, we have neither feedback mechanism.
If you're referring to my second paragraph - the difference is that the medicare part of the system does not have to fully contend with the resulting cost from doctor shortages as it sets its own prices below market rate.
The larger overall point is that system is only responsible for half of what we experience with American health care - the shortage part. But then we don't even get the benefits of the price controls until we reach Medicare age.
Obviously, the system has an enormous problem: it costs too much, because medical providers operate cartels that jack prices up.
> medical providers operate cartels that jack prices up.
These two statements are in direct conflict. If it were a thriving private-sector market, then providers wouldn't be able to form cartels that jack prices up.
I'd say Medicare is a good chunk of what's giving us the worst of both worlds. It's full of mandates that warp the entire system, but then fails to take responsibility for the warped system. Like sure we both agree that Medicare should fund drastically more residency slots. But my point is that the problem is Medicare doesn't actually have to pay the full cost of the high prices it has created with things like the residency slot shortage.
> where people's medical costs drastically increase, publicly-funded single-payer kicks in; before that, people with (actuarially) far lower costs
This analysis is entirely backwards on so many fronts. I'm not even really a proponent of single payer, but your point pushes me in that direction. Higher variance but lower average costs earlier in life are exactly where it would be most effective to spend public funds - keeping more people from financial ruin per dollar spent, more productive and enjoyable years of life, younger people are more likely to proactively obtain/consent to medical care, better outcomes from interventions being done earlier.
Imagine the opposite of what you're championing - use public funds to try to keep everyone alive until they've had 65 years of life, after which point part of your retirement savings would be a plan that determines how many resources might be spent on giving you a few extra years of not-so-great life. That seems both more efficient and more fair to me.
I don't understand your strident "entirely backwards" argument, since I'm literally stating the premise of Medicare; I didn't make any of that up.
And sure, there are many metrics by which to evaluate a health care system. It feels like the US system is somewhere from poor to mediocre on most of them, and only excels in outcomes for the extremely rich (enough money to stomach paying for your own concierge doctor to diligently follow your case and make up for the system's failings). Which is why your succinct description of the government-induced supply shortage resonated with me, and why I keep coming back to the general condemnation of "the worst of both worlds". But it seems like you aren't spending enough effort reading my comments to get my substantive points.
For-profit hospitals have waiting lists too. I had to wait 6 weeks to see one doc, who referred me to another doc. I waited 3 weeks to see that, then was referred to yet another. Another 5 weeks to see the third, and another 5 weeks to see a fourth. Each time I have to take time and money out of my schedule to do this important runaround.
Give me that socialized healthcare please.
At least you immediately get the treatment you need, in the case of the latter.
I live in a rural area and there’s a hospital system here that owns basically all the providers - everything is all remarkably expensive and booked out way into the future. There’s a smaller independent provider that I recently looked into but they’re scheduling new patients out by more than a year!
Bruh, where I am in European socialized medicine land, six weeks wait for an MRI is rookie numbers. How about 6-12 months. Sure, you might die until you get your turn, but at least it's "free"*.
*) paid form everyone's taxes
EDIT: Spot checking in a Canadian town with similar demographics as my own shows wait times roughly comparable to mine, and nothing anywhere near 6-12 months - worst case is about 14 weeks.
EDIT: Just checked NHS too, most recent month had ~3% of MRIs waitlisted more than 13 weeks, so pretty similar in that European country as well.
Not only do we pay significantly more, but we have significantly worse health care outcomes. The hallucination and delusion that Americans get "good healthcare" because they pay so much is just not true. We, objectively, get worse healthcare.
They are very common in orthopedic medicine.
That said, there is a pretty big difference between screening and elective medicine.
I dont see data as the problem, but the decision making around it. Preventing the generation of data may be a solution, but I dont care for it as a strategy.
I’m in my early 40s and have had 1. Everyone I know well has had 1 or (more typically) none, including my parents and in-laws, so I figured ~2 lifetime MRIs would be in the right ballpark
How it's going : https://canjhealthtechnol.ca/index.php/cjht/article/download...