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Comment by davidfekke | Hacker News Reader

"You can have state of art Healthcare, or you can have Universal healthcare, you can't have both." -- Malcolm Gladwell

The way that universal health coverage saves money is by rationing care. You do not save lives when you ration care.

That's a very weird framework and dichotomy you have there. Try untangling yourself out of it by considering some empirical facts, for example, hospitals acquired by private equity often have worse outcomes.

> private equity acquisition was associated with a 25.4% increase in hospital-acquired conditions, which was driven by falls and central line–associated bloodstream infections

https://pmc.ncbi.nlm.nih.gov/articles/PMC10751598/

> Medicare beneficiaries in the emergency departments of private equity hospitals experienced seven additional deaths per 10,000 visits after acquisition relative to hospitals that were not acquired by private equity, the team found. This rise represented a 13 percent increase from a baseline of 52 deaths per 10,000 visits

https://hms.harvard.edu/news/deaths-rose-emergency-rooms-aft...

This is certainly true to an extent, but it ignores some big problems with fee for service. The biggest one is that incentives between patients and providers are not aligned, which means more than 10% of healthcare provided in the US is wasteful stuff the provider knows is unnecessary but prescribes anyway because it makes them money. There are real opportunities to save money without making outcomes worse, in fact, if we stop doing useless stuff that leaves more time to treat people with real issues.

What's the point of "state of the art healthcare" if it's only for rich people? If Jeff Bezos and I get the exact same health issue - say, some form of cancer, we're going to have radically different treatments and mostly likely outcomes. His will be "state of the art", mine will (hopefully) be good, but definitely not be like his.

Malcolm Gladwell is a massive charlatan and hack. Seeing tech bros use him to discuss healthcare policy (Malcom Gladwell is neither a health professional, public health expert, nor has he worked in the healthcare industry in any real capacity, nor has he ever discussed the plight of workers in the US once during his entire career) feels on point for out of touch our industry is.

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