[inglor_cz]

You avoid the problem with medical debt, to be precise.

You cannot really avoid the fundamental constraints - anywhere in the world, there are only so many doctors and so much money available for treatments. IDK if USA has a shortage of doctors, but plenty of European countries do. A country like Romania just cannot give its doctors big enough wages to stop them from seeking employment elsewhere, where they will get five to ten times as much (UK, Germany, Switzerland). As a result, local hospitals are seriously understaffed.

Where I live, having personal connections to good doctors gives you an advantage - you will be examined and treated faster. Then there is outright nepotism.

The outgroups are different than in America, but there are always people for whom the system sucks.

[mindslight]

That's a pretty poor way of pigeonholing the problem. Looking at the US healthcare system, it's obvious that many doctors' and nurses' talents are wasted doing bureaucratic paperwork. Simultaneously, if there is a genuine lack of healthcare providers, there is no price signal that would encourage more to enter the market.

What you say may be somewhat true in the context of transmuting the US's "private" bureaucracy into bona fide "government". But it's certainly not a "fundamental constraint" that's impossible to solve. Rather it's a failure of organization, whether critiqued in terms of bottom-up market failure or top-down governance failure.

[kortilla]

> Looking at the US healthcare system, it's obvious that many doctors' and nurses' talents are wasted doing bureaucratic paperwork.

This is incorrect. Most of the paperwork is done by administrative staff. Paying for that giant staff + the actual medical professionals is why things are so expensive.

Hospitals are not stupid, they won’t waste their most valuable resource (healthcare time) on bureaucratic paperwork.

[mindslight]

An oncology department I'm familiar with has an entire "nurse navigator" whose whole job is to submit "prior approval" requests to "insurance" companies justifying why patients need a specific treatment, plus the nurses employed by the "insurance" companies reading those requests. I believe it's similar for any moderately expensive specialty. A common career path is care nurse -> burnout -> administration. Most of the administration is made up of people who could be providing healthcare.

And no, hospitals' most valuable resource are their billing computers. I think when it comes to providing actual healthcare hospitals are very stupid. You cannot partition any knowledge worker's attention into 10 minute blocks and expect them to achieve anything useful, yet that is what their entire system is designed around. The hospital doesn't have unilateral say of course (an "insurance" company won't pay one doctor the "price" of two if they spend twice as long with a patient), but they're still content optimizing within that status quo outcome - completely scatterbrained care.

And it's not like individual doctors are well rested or happy when you talk to them. The system clearly takes their toll on them (eg disappearing for 5 minutes to go retrieve test results that didn't show up before your appointment). In fact I'd say the vast majority of human talent in the medical system ends up completely wasted.

[candiodari]

Capitalism, nepotism, public, private, insurance, nationalised healthcare ... the GP is saying that these are methods of dividing up available care, not methods for creating more available care.

X is the amount of medical care available

Y is the amount of medical care wanted

If Y < X there is no problem with any of the systems. And, obviously, a certain amount of inefficiency doesn't affect patient care. Plus, perhaps relevant today: when shit hits the fan we can scale up available care quickly.

If X > Y it doesn't matter which system you choose, someone will go without. You can change who goes without but you cannot fix the system by changing the method of dividing care.

Can things be somewhat improved with better organisation? Sure. Probably. But let's not overestimate it either. Let's take a dream scenario: optimal organisation can make 20% more care available. How much more care is wanted? I think we can safely say the US population wants 200% or more than the current system provides. Whilst nobody's opposed to improving organisations, it cannot fix the problem.

Fixing the problem is something you can only do by doubling the medical training available. That'll be a lot of extra dollars, none of which go anywhere near patient care for at least 10 years, so I would expect a lot of strong opposition from a lot of sides. But it's the only way to fix things.

[ajuc]

Looking at spending per capita it's clear that American problems aren't caused by lack of money in the system.

They are caused by high barriers of entry, which in turn are caused by entrenched elites gatekeeping jobs through absurdly high tuition fees, expecting everybody to take lots of student debt and a very litigation-friendly environment. These costs are then passed on to the general population through a byzantine system of health insurance that leaves a lot of people uninsured.

> Let's take a dream scenario: optimal organisation can make 20% more care available.

In 2020 UK spent 3278 GBP (~4400 USD) per capita on healthcare [1]. USA: 12,530 USD. That's about 3 times less or a difference of 200% [2].

In UK life expectancy is 81.2 years. In USA it is 78.79 years.

3 times more spent to get a worse outcome doesn't seem like "20% difference" to me. Of course there are other factors, but are they enough to overcome 3x difference? I don't think so.

You cannot compare healthcare systems on X doctors per Y patients basis, because the outcomes aren't linear. It's orders of magnitude more expansive to treat many health problems if you go to the doctor 2 years too late. And the outcomes are worse despite the higher costs. Guess what happens when people have to pay a lot for each visit - often they go too late.

[1] https://www.statista.com/statistics/472940/public-health-spe.... [2] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

[monopoledance]

The argument was about "free-market" insurance contracts tho.