[brenschluss]

Knowing little about this - a genuine suspicion is - is this a feature, not a bug? As in - doesn’t this arise out of an incentive for health insurance companies NOT to cover procedures? I can only imagine that this bureaucratic tangle reduces insurance coverage by a very significant percentage. Aka - the kind of communication inefficiency must be profitable, no?

[throwup238]

> As in - doesn’t this arise out of an incentive for health insurance companies NOT to cover procedures?

It's not that they're incentivized to not cover procedures, it's that everyone is incentivized to cover their ass unless regulations are really explicit. Since suing insurance companies is impractical for most people, it's really hard to turn that ass-covering in your favor unless a regulator gets involved.

Even something as basic as sharing notes becomes an ass-covering exercise lest someone use those notes against the doctor in malpractice suit or the data accidentally leaks leading to a HIPAA violation.

[fzeroracer]

It is a feature. People need to look at this from the same angle as dark patterns. The goal with all of these interconnected but disjointed systems is so that the person holding the bag is constantly changed.

It's unfortunate that the author of this article in question manages to take away the wrong impression.

> It’s obvious how to fix health care. Just make everything run systematically, like FedEx or Amazon. There are no technical or business obstacles to this. Anyone who understands IT and/or business can see how to do it.

> Health care is notionally a profit-driven free market. This looks like an easy opportunity to make trillions of dollars by making the world better for everyone. Why doesn’t someone do that?

The thing they miss is that healthcare companies are already making trillions of dollars. They make trillions because the system they designed is working as intended. You look at other countries and how their healthcare systems work and you will see a vast difference in functionality and efficiency. Because they know healthcare being a for-profit driven industry with weak government controls leads to the shitshow we have in America.

[ethbr1]

> You look at other countries and how their healthcare systems work and you will see a vast difference in functionality and efficiency. Because they know healthcare being a for-profit driven industry with weak government controls leads to the shitshow we have in America.

You can't boil healthcare down to a single reason.

At minimum, there are supply (providers and facilities) and demand (insurers and patients) sides, each of which have their issues and solutions.

There is no magic bullet that any country has found to solve the problem, other than -- have enough providers and facilities for patient demand and find a way to make it worth their while.

[tekla]

One of the things I've observed from lots of interaction with Doctors is that that US health care is FUCKING AMAZING, and that drives up cost.

Everyone wants top quality health care, everyone wants tests, everyone wants scans, everyone wants to cover their fucking ass. Take multiple X-Rays when there is no good reason to, to prevent lawsuits. the guy who lied about taking Heroin gets a full lab workup for no good reason.

USA has top tier health care. It's simply not economical to give it to everyone who demands it, and Insurance companies are not dumb and believe everything that gets submitted.

[bruce511]

I'm not downvoting you, but your take is perhaps a tad cynical.

I get your point - yes doctors have a lot of tools at their disposal, and yes using those tools comes at a cost, but wouldn't you want to use those tools if you were in that position?

X-rays are not exactly cutting edge- if a fracture is suspected they are fundamental. Bloodwork etc are key diagnostic indicators. Sure people lie ("Everybody Lies" - House [1]) tests are helpful to understand those lies.

It absolutely can be economical to give everyone the best possible health care - especially at the primary diagnostic stage. That being true, yes, every part of the system is independently determined to maximise their profit. From the X-ray operator to the blood-test-maker.

It's worth remembering that these common tools, that have been around for decades, are still more expensive (by a lot) in the US than elsewhere. Yes, health insurance makes massive profit. But so does precisely everyone else involved at any level.

So if it is "not economic" perhaps its more any issue of "greed" than math.

[1] House is an old TV show about computer support, using medicine as a metaphor.

[mikem170]

> USA has top tier health care. It's simply not economical to give it to everyone who demands it

I've always thought that this is something basic that we need to address as part of any health care reform.

We can't afford to give everyone unlimited health care, so how do we determine the limits?

I assume that a lot of socialized health care systems end up using waiting lists, perhaps based on the patient's age, treatment cost, and probability of a positive outcome, with the option of going outside the system and paying for more/quicker care, for those who can afford it.

One person I discussed this with assumed that there was plenty of money to give everyone care as good as billionaires get. I don't assume that's true. Has it worked out that way anywhere else?

[Waterluvian]

I think for-profit healthcare can do a lot of unnecessary tests and treatments that fall far into diminishing returns or worse.

It’s not necessarily a good thing to want unlimited healthcare for all. Proper use of a scarce resource doesn’t necessarily mean it’s about rationing it with waiting lists and selective treatment. You can probably get quite far by first not overtreating a lot of people.

[ufocia]

Why do we assume that healthcare is a scarce resource? Sure, maybe some diagnostic/treatment equipment is not available everywhere, but the labor/cost issue seems to be created by regulatory capture, i.e. self-imposed barriers to entry. I agree that it is not in the best interest of the apex providers to change that. Telemedicine could be hugely disruptive if allowed to be practiced cross border between states. So would open collaboration of doctors between countries, e.g. I heard that some pathology operations are already utilizing labor in other countries, but having a domestic pathologist review the findings and signing off.