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Comment by MrSkelter | Hacker News Reader

Healthcare reform isn’t actually hard. Every advanced country has done it bar the United States.

In every case costs have gone down and outcomes have improved.

You always build on what you have because you can’t pause healthcare for very obvious reasons.

Hence a lot of different systems all with the same aim. Controlled costs and universal coverage.

The idea the US is somehow different and cannot make the change is the result of propaganda and a mistaken belief that the current Us system is the worlds best despite its costs.

Healthcare reform is easy and there is an ocean of prior art.

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Yeah, and they all generally get there by paying practitioners much less than the US does (by integer multiples). Single-payer, which this working paper equates with "universal coverage", is in fact not the norm among universal systems; besides using Medicare to ration the supply of practitioners, the original sin of our system is employer-based coverage, not payer structure.

Health care is an absolutely massive industry (everywhere, not just in the United States), and slashing compensation in a massive industry by top-down fiat is in fact not an especially easy thing to do.

Funny how one of the arguments against Medicare in the 60s was that providers wouldn’t accept it.

Turns out when you have the choice of accepting lower payment per patient for Medicare or having a lot fewer patients, you choose the lower payment per patient.

I would expect the same situation here. Doctors would grumble, but no one would force them to accept patients on whatever “Medicare for all” would be called. Nothing other than market forces.

A number of things would probably have to change, including the cost of medical school. But the system right now is expensive and essentially unsustainable. So change is inevitable.

Nope. More and more providers are dropping out of Medicare, or imposing limits on the number of Medicare patients that they're willing to see. It's tough to sustain a financially viable medical practice on Medicare rates, especially for primary care in HCOL areas. Medicaid is even worse. There are a lot of patients who nominally have coverage but in practice are functionally uninsured because they can't find a local doctor to take them on.

Why do doctors need to be paid integer multiples more in the US than every other country on earth? This is not rhetorical, I mean it sincerely.

And I’m aware that medical debt is a big issue, but it seems like a chicken-or-the-egg type problem. Of course you can charge $500k for a medical degree when the doctor can make it back and then some in 5-10 years.

They don't! It's a huge problem! It's probably the problem in US health care, which, despite my own belief that single-payer is bad policy, is in fact a total shitshow.

I think there's also the gamified confusion of over how much goes to the physician versus how much goes to administrating orgs and liability coverage.

We have numbers for this, we don't need to derive them axiomatically. Practitioner compensation is the largest component of health provider spending. Liability coverage is the second largest component of admin spending, which is 25% of provider spending.

“We have numbers” is always refreshing, especially in a shell game. Cost of all licensed medical practitioners? Or overweighting incomes of outlier CEO physicians? 25% is a steep tax on health in any case.

At the point where you're just dismissing the CMS NHE, you're well into the terrain of unfalsifiability.

Fair enough, but it is a political topic, and there are different and more confusing slices of the healthcare system exposed to patients than org spending breakdowns. Not sure how many of this thread's comments could hold water if falsification were universally applied.

Just so that people reading this thread know that there is the medical expense version of the Bureau of Labor Statistics, and it lives inside Medicare (CMS), and it publishes data. Most things people are trying to derive axiomatically on this thread, you can just look up.

It's really easy now with Claude and GPT5; just ask them a question and tell them to answer it for you, with cites, from the NHE. (The data I argue from precedes widespread LLM research; I built a site for this a couple years ago and didn't bother to update my data, because I assume it didn't get much better.)

Claude, gpt, and ai in general still hallucinate. What data do you argue from and please cite your source.

Still no sources cited

Thomas is not hallucinating.

Still haven’t seen any sources or links, I do want to read up on it but never find proper sources other then “llm:”.

No, he mentioned it. Here’s a link:

https://www.cms.gov/data-research/statistics-trends-and-repo...

because in the us everything is integer multiple times more expensive

No, that's not why. Doctors also make drastically more than the median wage. Doctors make so much in the US because we have artificial scarcity of doctors.

i mean sure, but all skilled labor is trending towards 200-300K wages in the us.

if a "senior" software engineer can make half a mil, and an electrician can make 200k, of course doctor pay are high.

who is going to take 10-15 years of school and debt otherwise?

No it isn't! The median wage for an electrician in the United States is about $65,000. It's nowhere near $200,000. The median general skilled wage is lower than that.

"Gen Z electricians making $240-280k in data centers" was a viral ploy by Mike Rowe on a podcast to promote his trades-training hustle.

> "The electricians that I interviewed and met two months ago in a data center in Plano, Texas, all under 30 years old, all making $240,000 to $280,000 a year, all with as much overtime as they want, none with any debt, all three of whom were poached three times in the prior 18 months," Rowe said ...

Google AI summaries then pick up wealth/finance grifter social media clickbait about it and parrots it as a fact.

There are contract data-center electrical jobs paying $55-65/hr (some with signing bonuses, per-diems, and benefits on top), but they only come close to $200,000 takehome by working 12/7 with generous overtime. And these are 5+ years of experience, OSHA 30, journeyman license, bring-your-own-tools. They're also exceptional; most are still $25-40/hr.

Nurses are also highly-paid in the USA (relative to other developed countries), and they make up a large part of the wage expenditure in the system. This may not make a difference to your point, but it is important to note that doctors are not the whole problem.

For those that have never looked it up, the median RN salary in the US is about $100k a year. Germany and the UK are more like $60k.

It’s funny, because it’s a career that feels both overpaid and underpaid to me. I went to a college where almost half of the students were going for nursing - and you certainly don’t need to be especially intelligent.

At least to an outsider, some nursing fields seem damned easy. The nurse that sees me before my GP? Pretty easy job.

Other specialties? Like the nurses that needed to clean up my wife after she massively bled during/after a c-section and they had to give her medications that also caused all sorts of other fluids to intermingle with the blood? Or the nurses that had to stand there for 10 minutes squeezing our infant daughter’s heel in the NICU to try to get enough blood out while she screamed as hard as a little baby can?

$100k doesn’t seem like enough. Odd occupation. For $60k I’d rather work at Costco, that’s for certain.

>In every case costs have gone down and outcomes have improved.

this isn't really true though, if you look at survival rates of many diseases.

Can you give any examples?

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