[rpiguy]

Irrational yes. Broken, no just optimized differently than other systems. The system is optimized to serve those who can afford it and those who are very poor and get it for free, but not those in between. It is optimized to generate profit, but also new treatments. Rich people from all over the world come here for surgery and treatment.

The pricing system is intentionally designed to be opaque so that everyone except the consumer benefits. It is not uncommon for a top surgeon to make 500-750K per year, nurses are paid well above the median and can make over 100K with overtime, hospital administrators, insurance companies... the way pricing and billing is handled protects all those interests.

Sounds like something you would want to fix, right? Well that too is complicated. Healthcare is one of the only sectors that is growing middle class jobs. A hospital is one of the only places someone with an associates degree and a certification can make 60K per year.

Furthermore, it is one of the only growing industries that provides many opportunities for women. Not many women want to move to Montana to frack shale oil.

Start socializing medicine and all that job growth and opportunity disappears.

It is a tough problem to solve. The utter irrationality of it used to drive me nuts and still does sometimes, but I prefer it to the alternatives.

[VHRanger]

> Start socializing medicine and all that job growth and opportunity disappears.

Pegging growth to systemic inefficiency is monumentally stupid.

This is only a few steps of abstraction away from simply paying those nurses to dig holes then fill them back up, macroeconomically.

[rpiguy]

Growth occurs organically in a market system. It does not in a socialized system. I was not associating growth with inefficiency - I was associating high pay with it.

[jugg1es]

The premise of your argument falls apart if you really think about it for a minute. Switching to a single-payer model doesn't mean healthcare jobs disappear. It would kill off the insurance companies, but it would not reduce the demand for skilled healthcare workers. It seems like you are arguing that 'socializing' medicine requires that we get rid of hospitals entirely. We could still have for-profit hospitals if we drastically reduced the size of the private insurance market.

I feel like you are making a lot of assumptions about how we would fix our health care system that are unfounded.

[rpiguy]

No socialized system pays what our system pays.

[eptcyka]

Just because the industry is good at generating revenue doesn't necessarily mean that the quality of service is any better. Do you have some data to back up your claim that medical services in the United States are world leading? Are they better than what one would receive in Europe or Japan or South Korea?

Personally, I think it's unethical to keep a process inefficient even if the inefficiencies are profitable. And healthcare in the states is anything but cost-efficient.

[jjoonathan]

About 5 years ago I took a health care policy class and we looked into this. In terms of outcomes, the U.S. was thoroughly mediocre, except for breast cancer and diabetes, where we were at the head of the pack (in terms of treatment) but not, say, better by a multiple.

The fact that the US has many leading medical research institutions is often abused to argue that we have the best care, but it's largely irrelevant for the overwhelming majority of delivered care and even more irrelevant for outcomes.

[rpiguy]

As I said it’s optimized differently.

[MrBuddyCasino]

> Furthermore, it is one of the only growing industries that provides many opportunities for women. Not many women want to move to Montana to frack shale oil.

Is this supposed to be a good argument to drive desperate people into bankruptcy?

[jjoonathan]

It's not a good argument, but if you want to defend the indefensible, your options are limited.

[rpiguy]

Did I ever argue against improving the system or imply these bankruptcies should happen? I just said I’d take this system over alternatives not that it couldn’t be improved.