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Comment by natsucks | Hacker News Reader

"the thing I miss most is the NHS. It’s been treated like a political football since I left and is apparently a shell of its former self — not because the idea is bad and can’t work but because conservative politicians, some of whom have received funding from private healthcare companies, have deliberately sabotaged it."

really it could not be because government is bad at managing massive programs and provides no incentive for high performance and efficiency....

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Real truth is that health care just is massively expensive. Any efficiency gains that are also somewhat limited have been overshot by more "products".

Nurses and doctors can only handle so many patients. This has not increased that much compared to say farming or most other areas. And while there has been some gains. There is also lot more produces and costs of those.

Why is healthcare so uniquely expensive in the USA, but nowhere else?

It is expensive in every developed country. USA just have made everyone involved to try to maximise their profits by shadiest possible practises.

Other places are less expensive. But it does not mean they are cheap. At least in as far as you think of general cost of living. The cost might not be directly visible, but it is there in some way.

One answer is it is more expensive compared to most of the rest of the first world countries because it was more expensive compared to them 50 years ago, and over that time the growth rates in health costs have been fairly similar for us and them.

The question then is why was it more expensive then? I've not seen much on that.

US healthcare is very expensive because it's horribly inefficient. There's lots of insurers, lots of providers, and lots of treatments. The intersections of all of that are complex and requires huge amount of overhead to resolve.

Not to mention, the entire point of insurance is to provide that overhead. They want to deny coverage, obviously, so they're going to waste doctor's time on peer-to-peer and force their own customers to aggressively advocate for their own care. It's a huge waste of time for everyone involved, but the insurance company wants that waste of time, that's what they're optimizing for. They've gotten really good at both calling all the shots and wasting time.

Your doctor is more or less a vessel for the insurance company. The insurance company is your doctor: they decide how long visits are, what you can visit for, what medications you can take, which procedures you can get, when you can get those procedures, how much they will cost, and how you will have to pay. Your doctor gets a tiny bit of freedom. Maybe they can prescribe you a medicine out of, like, 3 predetermined choices. After, of course, you've completed all the testing. And after you've tried medicines A through C. And after you've been monitored for whatever time period the insurance decides.

Yes, that's all very expensive.

Indeed. It's been argued that people intensive activities, like healthcare, thus become relatively more expensive as other, more automation friendly, industries become highly optinised.

ie the relative price of a new car versus a heart transplant is going to continually drop such that we spend more and more as a percentage of GDP on things like health ( and social ) care.

So it's not sure much that health care has become more expensive, as much as relatively more expensive.

The other strong effect is nobodies life is saved, death is simply delayed, and the older you get the more problems you have.

So as well as historically being relatively resistent to automation, success breeds more need.

The NHS is known for being pretty efficient when compared to other healthcare systems, especially the US. The problem is that there is no money and healthcare is getting more expensive.

There are incentives for high performance and efficiency. GPs are private partnerships contracted to treat patients. They can keep profits.

There's been attempts to do more private outsourcing (with the NHS still paying), but they tend to work out less efficient when you consider the whole system, because, for example they might only treat the easy cases and leave the hard ones to the normal hospitals.

Socialized programs require strict definitions and firm hands on drawing lines of inclusions and limits to balance the budget.

So do insurance based ones. And if you aren't 100% insured, that limit depends on how rich you and your parents are, and the balancing is often between health and other things.

Yes and no.

While there are some centralized decisions ( we are paying only for one round of IVF, or this drug isn't good value for money ), most of it is delegated to front line doctors - by the simple mechanism of faced with a fixed time/budget they triage based on medical need.

Note that the UK system is actually a rather odd hybrid of public and private due to historic reasons. It's quite easy to queue jump the waiting for an initial consultant by going private, and then be referred back to the public system for treatment.

Seeing how the US GOP has intentionally sabotaged the USPS with fiscal responsibility burdens unlike any other agency, then declare it fiscally untenable and in need of privatization: yes, I completely believe it possible conservatives will sabotage the function of government in order to demonstrate to voters that government is ineffective.

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