[nolongerthere]

Article is paywalled but the healthcare system is death by a thousand cuts, there's no one boogeyman to blame, it's a very classic tragedy of the commons. Anyone claiming they've found the root cause of the broken healthcare system is selling you a bill of goods.

[llamaimperative]

True but “there’s no one boogeyman to blame” should read as “there are many, many boogeymen, all of whom bear blame, and all of whom need to corrected/removed/circumvented/improved.”

[Galatians4_16]

If only we could take our money elsewhere, but we are mandated to pay with insurance, which makes them the defacto customer, to decide with the doctors, cutting us out of the process (which is handy under circumstances where the patient can't talk; There's a use case for everything, but coercion and blanket enforcement seems to ruin everything)

[bluGill]

We can't even choose our insurance - it comes from your employer with no choice (or no real choice - I have two slightly different choices from United Health Care). All the negotiation on how it works is done by HR not me, and HR likes the current rules as it makes it hard for me to leave.

In theory I can bypass my employer insurance - but if I do I throw away thousands of dollars that my employer is paying directly and so anything I find elsewhere either cannot be as good, or is has to cost a lot more money.

[tracker1]

Even then, good luck... I couldn't find a personal plan either the Health gov compliant plans or out of pocket that matched my employer insurance... I'm pretty sure if I try again, I'll wind up creating a company again, using one of the HR based collective payroll options just for better Insurance options.

The system sucks a lot, and for a lot of different reasons. Namely is that there's no room for individual negotiation, and there are dozens of pricing models for the same drugs, procedures, etc.

[ToucanLoucan]

We don't do that in America. We pick whichever boogeymen are more scary to our given political team and make that the only cause while arguing back and forth and not actually doing anything while we all get robbed fucking blind and pay our politicians six figure salaries for doing fuck-all.

I fucking hate it here.

[llamaimperative]

Not really. The current administration has been going after healthcare on several fronts: lots of FTC enforcement against PE in healthcare; increased number of funded medical residency slots; allowed Medicare to negotiate prices directly with drug companies; attempted to stop excessive consolidation in healthcare businesses.

All of these are reasonable attempts to solve big, important problems and I don't think it's helpful to throw your hands in the air and say no one is trying to do anything.

[tracker1]

The Medicare negotiation allowed has still been VERY limited. It should be granted full out by congress, as well as combined for federal employee and VA coverage as well as congress itself... they should all have the same coverage, thus the same incentives. Open/public pricing models would be a good start. As would domestic production and multiple supplier requirements for medications and devices just from a security stand point.

In general the current FTC is better than most in my lifetime, that said, there are plenty of other areas of Govt that are really bad, and even the FTC and SEC could be doing much, much more. It's a mixed bag.

Contrary to a lot of replies, I don't think that another Trump presidency would be particularly worse in these areas as they are pretty populist in nature. Trump isn't a die hard conservative, he's really a populist first.

[llamaimperative]

Agreed it all can and should be better. That doesn't mean "it doesn't matter which administration" etc. There are meaningful differences and the sane thing is to prefer the better option over the worse option, even if neither is particularly perfect or downright evil.

When it comes to improving systems like these, incompetence, hamfistedness, and inaction can be plenty damaging by themselves. "I will roll back ACA and replace it with [crickets for 4+ years]" is a worse alternative.

[tracker1]

If course there are differences between different administrations. Unfortunately, the best I can hope for is one that I agree with even 60% of the time.

And even then, some issues are far more important and foundational than others.

[ToucanLoucan]

And the next republican president, Trump or otherwise, will undo it all on day one.

We need ACTUAL SOLUTIONS. Changes to existing laws, or new laws. Consensus governance, not just executive orders.

[llamaimperative]

Sure, but that's not a "both sides" problem. Lay blame where blame lies.

[ToucanLoucan]

I do. We have the Democrats who are mostly alright and well meaning, with exceptions but in practice are not capable of handling what the Republicans have become, which is theocratic-fascists. And the Republicans are filling the legislature with dipshits who scream about Jewish space-lasers and want to regress us socially to the 1920's.

They both suck, one side notably more so.

[jewayne]

I think the root cause is transparent for all to see. Humans need their bodies. And profit-maximizing entities of multiple kinds have figured this out, and bought politicians to prevent laws from reining them in.

That's all.

[bookofjoe]

Try this: https://www.wsj.com/health/healthcare/you-can-thank-private-...

[DaveExeter]

The problem is health insurance! Get rid of that and most problems vanish.

[lenerdenator]

A problem is that health insurance has no bare minimum to compete against. There is no saying "alright, fine, your rates are insane so I'm gonna just go with the state-operated option". That's more-or-less what happens in most Western countries; you can still get private insurance which gets you faster/better treatment, but if you're a fairly healthy person who just wants to cover their bases for a catastrophic occurrence, the state will do that for you. If the private guy wants any of your money, he has to justify it with more than "what happens if you get in a bad car accident or get a cancer diagnosis?".

In the US private insurance is the only way to go, and many of them are operated by people who have profit motives, even if they themselves work for an entity that is non-profit.

[bluGill]

In the US private insurance from your employer is the only way to go. My company puts in a lot of money towards my health insurance that I lose if try to find someone else. I can in theory find a different private insurance but there is no competition as no private can afford to compete with deal my company has - either they have to provide substantially worse service or they have to charge substantially more than my employer.

Since I don't have a real choice nobody tries to serve me. Complex billing and codes I don't understand - the people paying the bills like that.

[Symmetry]

Most Americans are only familiar with the US system and the completely socialized systems in Canada and Britain. Something like the French system isn't really politically on the table here.

[tracker1]

I'm of a similar mindset... even though I'm very libertarian in mindset... I think that all the current spending between Medicare/aid, VA Medical, Federal Employees and other programs would be better served by a govt backed non-profit insurance corporation, maybe a little more self-goverened than say the USPS. If federal employees and politicians had to deal with the same "plan" as everyone else as a baseline option, that would provide for better competition. Full negotiating power would also be necessary.

This should be combined with a 50% domestic production and at least dual sourcing requirements for all FDA regulated medications and devices. Both for strategic security, as demonstrated during the pandemic and necessary given political shifts. It would also have the side effects of requiring licensure of medical patents as well as at least some more open knowledge.

Blocking pharma ads would help a lot as well. Unfortunately, pharma is the single biggest advertiser as well as one of the biggest political donation blocks by a wide margin.

[bdzr]

> Blocking pharma ads would help a lot as well.

I don't really see how blocking ads for things help, I also think they serve a really valuable purpose. IME Doctors are so stuck in their first decade of work (CE programs are mostly a joke) that there actually needs to be a forcing function to get them to learn about new drugs. If they start irresponsibly prescribing drugs then that's not the fault of a company advertising drugs that have gone through the most rigorous approval process that exists in the world.

[tracker1]

There are pharma reps all over doctors offices. They're definitely aware.

People are generally over medicated and the drug pricing has nothing to do with actual costs for either research or production. Similarly for advertising highly processed "food".

[JTbane]

IMO there should be a medicare-for-all option that would provide the bare minimum of care, funded by increasing the FICA tax rate.

No doubt this would be politically unpopular with the right-wing and libertarians.

[schmidtleonard]

Providers point at insurance and drug companies.

Insurance points at providers and drug companies.

Drug companies point at providers and insurance.

Don't let any of them fool you, there are three heads on this monster and when they aren't busy blaming the other two heads they do a remarkably even job of splitting the loot.

[jewayne]

This. They all benefit from the lack of price consistency/transparency. Nothing in our system has a single price - why charge what the market will bear, when you can charge the individual as much as they can personally bear, and make 3X as much?