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Comment by notfried | Hacker News Reader

I like this. It'd be great to see such a table of the key issues with proposed solutions, to highlight how the waste isn't an insurmountable impossibility to solve. Having said that, federal lobbying by the healthcare industry was $750 million in 2024 [1], and this is the blocker that needs to be addressed first to be able to enact change.

[1] https://www.managedhealthcareexecutive.com/view/health-syste...

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We rarely discuss the primary source of health care cost differences in the United States -- US doctors get paid a lot more than elsewhere. I haven't seen a credible proposal to address that. Most of the salary difference can be blamed on deliberately created shortages of doctors in many specialities. Not enough medical school slots (horror stories among my kid's friends of not getting accepted) and then also shortages of residencies that allow foreign trained doctors to work in the US. The only change in recent memory is replacing some primary care physician services with nurse practitioners.

Idk why but I feel the need to add an empty “co-sign” comment. It is 100% this and I have so many stories from friends who are doctors and nurses that back up every detail.

One note: the doctors won’t agree or want to hear this, as they too are human, but listen to how they talk about nurses. Hit me once I had both a CRNA (advanced nursing degree in anesthesiology) and an anesthesiologist friend

Edit: glad I did add an empty cosign, right after replying, the parent is now downvoted to gray. And gets it much, much, better info than any other comment, and I read all of them. Last thing I’ll throw out to back it up is, check into who decides how many seats there are at med schools. Can’t remember the exact name but it’s basically the doctors union / professional organization. AMA?

I really don’t think doctor salaries are the primary difference when they make up less than 10 % of health care costs:

> However, new research by Stanford health economist Maria Polyakova and colleagues — using unique data on physician income — shows that physicians’ personal earnings account for only 8.6 percent of national health-care spending

https://siepr.stanford.edu/news/just-how-much-do-physicians-...

That’s the thing about American health care costs. We pay so much more than everyone else, but there’s no obvious single thing that costs more, or even a few factors together. It’s a ton of different things all adding up. Which means it’s very hard to fix, because there are so many different things you’d have to fix.

This is a more comprehensive survey that’s light on methods but from a respected industry watcher with similar conclusions:

https://www.commonwealthfund.org/publications/issue-briefs/2...

Doctors are only part of the problem. Nurses and all of the other skilled positions also all suck up huge amounts of money because there are shortages of all of them.

It was bad even before COVID, it’s even worse now. There are tons of regulations prohibiting the significant increase in creating new doctors and nurses (and air traffic controllers, but that’s a different but remarkably similar story).

Limits on new providers, and tons of corrupt regulation keeping people from opening new medical schools, clinics, and hospitals.

A ton of it is simple supply and demand - and the supply side is capped. Go to a place with a functioning competitive market and the prices (and wages) are a fraction of what they are in the US.

Again like doctors, nurse wages aren’t a major factor in the discrepancy between US healthcare costs and elsewhere. They are a factor, in a death by a thousand cuts situation.

In a source posted by another commenter, their wages are accountable for 5% of the difference.

I also don’t think it’s accurate to say regulations are what’s prohibiting an increase in nurses. They don’t have a government imposed mechanism like residency funding that creates a bottleneck like the one in medical training.

We have a nurse shortage because we have an aging population increasing demand, it’s a tough job, and people are leaving the profession.

But why is it a tough job? Partially it's the shift hours, they could offer it with less hours and more nurses for example. But they don't due to undersupply, and on it goes.

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