[jmye]

I didn’t realize you were looking for a sourced essay.

Medicare-for-all extends a fee for service model that results in poor care, poorer outcomes, massively increases expense, and simultaneously lowers physician reimbursements. Given the increasing doctor shortage, that’s an issue that will be immediately exacerbated. Further, the FFS model incentivizes throughput, not quality of care. Your care won’t get better.

[BeefDinnerPurge]

So how do places like Hong Kong make this work? Because they do. My out of pocket expenses there uninsured are less than my copayments fully insured here.

https://journals.lww.com/jcma/Fulltext/2015/10000/Overview_o...

I suspect every reason you will cite is something we could both address as a nation and we will refuse to do so because freedom or some other idiocy. I truly give up. I threw money at family's medical crisis and prevailed. Most can't. More should be able to do so.

Even California is looking to places like Houston to mine ideas for improving their raging homeless problem. If you're not going to steal from the best, why bother doing anything?

[jmye]

Do you think there might be other differences between Hong Kong and the United States that could account for differing challenges in providing healthcare?

I’m not clear why you’re giving up - it’s not an intractable problem. Some folks need to give up on “healthcare only for the rich/cities” and some folks need to stop having strong opinions about a very, very complicated industry they don’t understand at even a surface level (not directed at anyone specifically - it’s a common US problem with healthcare discussions/solutions).

Cost/utilization/availability challenges are fully solvable, if one is committed to a solution and not a message.

[BeefDinnerPurge]

I've literally never been about only healthcare for the cities or 100% medicare for all, I literally said it ought to be a baseline on which to build something better. It's much like how we can't even agree as a nation that coal sucks and replace it with renewables/nuclear/natural gas on the way to something better.

So here we are, paralyzed indefinitely, throwing more money at a broken system annually. But also, so many in tech build things from strong opinions about very complicated things, and they are inadequate, but at least they're not doing the same thing over and over and expecting a different result.

I will say this though. I have yet to see private equity do anything besides make an existing problematic situation worse. And if that's what you mean by a difference between America and Hong Kong, yep, I agree.

[jmye]

Neither comment was directed at you and I’m sorry if they read that way - M4A (specifically) discussions usually center on people who live in a big city and are solving only for that. I’ve also agreed in several comments that single payer is a likely component of the right solution, but that current proposals are woefully insufficient, to the point of not even being solutions. I’m all in for incremental improvements (the ACA was certainly one), but not if it just trades my pain point for creating five new ones for you.

The difference between HK and the US starts at the fact that one is 1100km^2, and the other is 9.8 million km^2. Solutions that work well in what’s essentially a really dense city don’t, necessarily, work across a massive country with a distributed, diverse population that faces very different, area-specific challenges.

I’ll add, apropos of nothing, that the fastest way to make healthcare in this country better is to fix education costs. If we dramatically increase the number of people in med school/nursing school, and simultaneously dramatically decrease what they owe upon graduation, you will see far more high quality providers enter the system who will be far more able to practice in places that really need them.