8 ms·

Stuff like this simply shouldn’t happen in a developed country. It’s insane that this can’t get solved.

vkou 7y ago
We have solved it - I can't think of an alternative system that would be any more optimized, towards the benefit of medical schools[1], doctors[2], hospitals[3], pharma firms[4], and insurance companies[5]. Oh, you meant solving it for actual people? That was never the goal of the self-serving architects of this rotten mess. I don't expect the farmer to grow me food out of the goodness of his heart, but to quote Adam Smith, this is a conspiracy to the detriment of the public. [1] Who charge absolutely ludicrous, jaw-dropping, nowhere-else-in-the-world-comes-close tuition. [2] Who, after paying off the debts on their ludicrous tuition, are absolutely rolling in money. [3] Who don't let their patients comparison-shop (Just try getting a straight answer on how much a routine procedure is going to cost), and in effect, can charge whatever prices they want. [4] Who are happy to make billions of dollars off inefficiencies created by them, in the generic space. [5] Who have created a captive market where not getting your healthcare through them is financially ruinous.
- mschuster91 7y ago
  Look to Europe, we solved this decades ago.
  - samfisher83 7y ago
    Or Canada or pretty much every developed country in the world.
    - Frost1x 7y ago
      There's been an ongoing shift of power and rights to the very wealthy over everyone else's interests. It's not new but it's becoming more and more obvious to the average citizen. Here in the US, our culture still praises this behavior because it props up the carrot that is the American dream. It's a cultural problem where everyone has been convinced they're the next billionaire to reap the rewards of the broken political and economic system... they're just temporarily and shamefully poor for now. So the problem runs far deeper than healthcare, it's everywhere. Healthcare is just an obvious target because it directly effects people when they're most vulnerable and it actually angers them enough to complain a little. We need a cultural shift that is reflected in our politics (if it's not too late already).
      - munk-a 7y ago
        Unfortunately that philosophy has been heavily exported and a lot of social welfare programs are endangered across the world - up here in Canada we still don't have drug, dental or eyecare due to strong cartels in those market segments - this is particularly worrying for Dental which is less cosmetic then folks thought forty years ago and can actually contribute to general well-being.
  - vkou 7y ago
    Yes, but how does the European model benefit the real stakeholders - medical schools, doctors, hospitals, pharma, and insurers? Those groups are going to hold any progress on this matter hostage. (Imagine the job losses! Imagine the loss in innovation! Imagine not being able to provide the best treatment money can buy! Imagine not being able to charge a million dollars for a medical education! Or being able to pay off my million dollar debt, accrued to finance my medical education!)
    - mschuster91 7y ago
      Medical schools are publicly funded universities, same for many hospitals. Doctors have decent funding by insurers (we have both single payer systems as well as competing ngo/private insurance companies, depending on country). Pharma gets to negotiate pricing with a central body and that's it. Of course big pharma cries all the time but ah well. Better than the US where people die because they can't afford insulin!
  - swiley 7y ago
    In some ways they've solved a lot of the problems we have, but europeans still don't have access to a lot of very powerfull drugs and proceedures that we do. I feel like there's no way to have both things.
    - dr0verride 7y ago
      I see this kind of arguement a lot. It's also common to read about people traveling abroad to receive better treatment that will save their life. I'm not sure which anecdotes to believe in this case.
      - Ididntdothis 7y ago
        Believe both. The US does some things better, others do other things better. And maybe you get more cutting edge stuff in the US but there is also a big risk to go bankrupt over standard stuff. Having lived in both Germany and US i find the US situation terrifying. If you have a serious health problem in the US it’s a total gamble whether you will go bankrupt or not. And there is no way to avoid that.
    - Analemma_ 7y ago
      Which powerful drugs and procedures are not available in Europe?
      - dx87 7y ago
        I don't know about not being available in all of Europe, but here's a story from the UK a few years ago where a baby had a rare, but easily fixable, heart condition. There were no doctors in the UK who could perform the surgery, and the NHS initially refused to pay for the parents to come to the USA for surgery. The parents started a gofundme to pay for the travel and surgery, but the NHS eventually agreed to cover it after it became a big deal on the news. https://www.bbc.co.uk/news/uk-england-40864598 https://www.bbc.co.uk/news/uk-england-40864598
    - AceJohnny2 7y ago
      > but europeans still don't have access to a lot of very powerful drugs and procedures that we do. That's because of the impedence mismatch of legislation in Europe vs the US. I'd say it's comparable to the story on how US eggs are illegal in Europe, and vice-versa. https://www.latimes.com/food/dailydish/la-dd-heres-why-we-need-to-refrigerate-eggs-20140714-story.html https://www.latimes.com/food/dailydish/la-dd-heres-why-we-ne...
  - Gibbon1 7y ago
    You solved a different problem than the US did. The problem you guys solved is how to provide high quality affordable healthcare. The problem the US solved was how to use healthcare to strip mine middle class wealth.
- carc 7y ago
  You gave yourself away as ignorant when you tried to explain that the system is optimized for doctors. This is especially rich on a forum like hacker news, where we have many software developers who went to school for ~4-6 years and fairly regularly make as much as the doctors who round the hospitals, who also kept incurring debt and made basically no money until they were 30.
  - deleted 7y ago
    [deleted]
  - bigwavedave 7y ago
    Precisely. This is extremely evident in my family- my sister and her husband are incurring insane debt and he won't be finished with school until he's 30... As opposed to me, who's younger than he is, have been out of school for years, and currently make just as much as he hopes to make in five years. The system is not optimized for medical professionals, it's optimized for (it may sound dramatic, but it's the only word that fits) the cartels pulling the strings. And what happens if my brother passes away before graduating? Hunndreds of thousands of dollars of debt will remain. No, doctors are definitely not the prime villains.
    - Gibbon1 7y ago
      It's been awhile since I've seen numbers. But I think but actual doctor compensation especially minus student loan principal and interest isn't that big a piece of the pie. Sr Doctors often make what seems like an assload of money, but doctors careers are short and the high earning period is a fraction of that. Consider, doctors start working at 30, usually retire at 65. That's 25 years. First 10 years is spent paying off student loans and gaining clinical experience. Friend of mine is a Sr software engineer with a masters and 20 years of experience. His slightly younger brother is a newly minted Cardiac Surgeon.
      - lutorm 7y ago
        It's actually 35 years. But still.
- fencepost 7y ago
  A lot of doctors in specialties are pulling in pretty decent money, but it's probably not as much as you're thinking. I say that as someone working with medical practices and physicians on a regular basis. Internal medicine, general practice and family docs are generally making less. There are also a lot of things going on with consolidation and big medical groups, driven in part by pharmaceutical costs. As an example, we used to have several oncology practices as clients. We're not working with any of those anymore because they have all been bought out by hospitals or health systems. From talking with the doctors at the most recent one this was not because they got a big payday out of it but was instead because looking forward a few years they were not going to be able to afford to stock chemotherapy drugs. They sold out because they could see the time when the business was no longer sustainable as an independent practice. I'm sure the doctors didn't come out of this hurting, but this was not a startup unicorn style exit.
mschuster91 7y ago
Too many people with connections profit off of the current situation, the poorest people pay the price. This is why there is no demand for real change and why all previous efforts got essentially stonewalled.
- vkou 7y ago
  It's actually the middle class that pays the price, through insurance premiums, out-of-pocket co-pays, and high deductibles. Poor people have Medicaid. Medicaid, which even happens to pay reasonable amounts for procedures performed. The entire system would re-adjust into a sustainable steady-state, if all prices were equivalent to Medicaid reimbursements. But I suppose that under such a model, the average middle-aged surgeon wouldn't be able to afford their third summer home...
  - munk-a 7y ago
    Medicaid is probably the second best place to be in the US system after Medicare - but it suffers from extreme politicization of care (good luck trying to get HRT or an abortion on Medicaid), rationing, shortage of supply (not all providers are required to or will service Medicaid patients) and stringent requirements to ensure continued availability (these in particular are getting much worse under pushes to get rid of "welfare queens" _sigh_). That said, the only way to win is to not play - never get sick and emigrate before you have any serious health issues.
    - hansthehorse 7y ago
      Medicare is only good if you carry a separate policy to cover the 20% copay. It's really not to difficult to run up a 100k copay with one serious illness.
    - vkou 7y ago
      All of these problems come from Medicaid and Medicare paying a lot less for procedure performed (In line with what Canada, and Europe pays) than the public market. It's a drain on most hospital budgets. If all procedures performed were done at Medicaid-like prices, hospitals and physicians, and pharma firms, and, by proxy, insurers and medical schools would have to tighten their belts, and figure out how to cut costs. That's the entire point of such an exercise. We can't let health costs grow in an unbounded manner.
jorblumesea 7y ago
It's pretty clear why it hasn't been solved. US voters have no appetite to elect anyone who is remotely progressive, and the status quo politicians are bought and paid for by "lobbying" aka institutionalized bribery. The US system benefits corporations and the wealthy, not the common person.

vkou 7y ago

We have solved it - I can't think of an alternative system that would be any more optimized, towards the benefit of medical schools[1], doctors[2], hospitals[3], pharma firms[4], and insurance companies[5]. Oh, you meant solving it for actual people? That was never the goal of the self-serving architects of this rotten mess. I don't expect the farmer to grow me food out of the goodness of his heart, but to quote Adam Smith, this is a conspiracy to the detriment of the public. [1] Who charge absolutely ludicrous, jaw-dropping, nowhere-else-in-the-world-comes-close tuition. [2] Who, after paying off the debts on their ludicrous tuition, are absolutely rolling in money. [3] Who don't let their patients comparison-shop (Just try getting a straight answer on how much a routine procedure is going to cost), and in effect, can charge whatever prices they want. [4] Who are happy to make billions of dollars off inefficiencies created by them, in the generic space. [5] Who have created a captive market where not getting your healthcare through them is financially ruinous.

mschuster91 7y ago
Look to Europe, we solved this decades ago.
- samfisher83 7y ago
  Or Canada or pretty much every developed country in the world.
  - Frost1x 7y ago
    There's been an ongoing shift of power and rights to the very wealthy over everyone else's interests. It's not new but it's becoming more and more obvious to the average citizen. Here in the US, our culture still praises this behavior because it props up the carrot that is the American dream. It's a cultural problem where everyone has been convinced they're the next billionaire to reap the rewards of the broken political and economic system... they're just temporarily and shamefully poor for now. So the problem runs far deeper than healthcare, it's everywhere. Healthcare is just an obvious target because it directly effects people when they're most vulnerable and it actually angers them enough to complain a little. We need a cultural shift that is reflected in our politics (if it's not too late already).
    - munk-a 7y ago
      Unfortunately that philosophy has been heavily exported and a lot of social welfare programs are endangered across the world - up here in Canada we still don't have drug, dental or eyecare due to strong cartels in those market segments - this is particularly worrying for Dental which is less cosmetic then folks thought forty years ago and can actually contribute to general well-being.
- vkou 7y ago
  Yes, but how does the European model benefit the real stakeholders - medical schools, doctors, hospitals, pharma, and insurers? Those groups are going to hold any progress on this matter hostage. (Imagine the job losses! Imagine the loss in innovation! Imagine not being able to provide the best treatment money can buy! Imagine not being able to charge a million dollars for a medical education! Or being able to pay off my million dollar debt, accrued to finance my medical education!)
  - mschuster91 7y ago
    Medical schools are publicly funded universities, same for many hospitals. Doctors have decent funding by insurers (we have both single payer systems as well as competing ngo/private insurance companies, depending on country). Pharma gets to negotiate pricing with a central body and that's it. Of course big pharma cries all the time but ah well. Better than the US where people die because they can't afford insulin!
- swiley 7y ago
  In some ways they've solved a lot of the problems we have, but europeans still don't have access to a lot of very powerfull drugs and proceedures that we do. I feel like there's no way to have both things.
  - dr0verride 7y ago
    I see this kind of arguement a lot. It's also common to read about people traveling abroad to receive better treatment that will save their life. I'm not sure which anecdotes to believe in this case.
    - Ididntdothis 7y ago
      Believe both. The US does some things better, others do other things better. And maybe you get more cutting edge stuff in the US but there is also a big risk to go bankrupt over standard stuff. Having lived in both Germany and US i find the US situation terrifying. If you have a serious health problem in the US it’s a total gamble whether you will go bankrupt or not. And there is no way to avoid that.
  - Analemma_ 7y ago
    Which powerful drugs and procedures are not available in Europe?
    - dx87 7y ago
      I don't know about not being available in all of Europe, but here's a story from the UK a few years ago where a baby had a rare, but easily fixable, heart condition. There were no doctors in the UK who could perform the surgery, and the NHS initially refused to pay for the parents to come to the USA for surgery. The parents started a gofundme to pay for the travel and surgery, but the NHS eventually agreed to cover it after it became a big deal on the news. https://www.bbc.co.uk/news/uk-england-40864598 https://www.bbc.co.uk/news/uk-england-40864598
  - AceJohnny2 7y ago
    > but europeans still don't have access to a lot of very powerful drugs and procedures that we do. That's because of the impedence mismatch of legislation in Europe vs the US. I'd say it's comparable to the story on how US eggs are illegal in Europe, and vice-versa. https://www.latimes.com/food/dailydish/la-dd-heres-why-we-need-to-refrigerate-eggs-20140714-story.html https://www.latimes.com/food/dailydish/la-dd-heres-why-we-ne...
- Gibbon1 7y ago
  You solved a different problem than the US did. The problem you guys solved is how to provide high quality affordable healthcare. The problem the US solved was how to use healthcare to strip mine middle class wealth.
carc 7y ago
You gave yourself away as ignorant when you tried to explain that the system is optimized for doctors. This is especially rich on a forum like hacker news, where we have many software developers who went to school for ~4-6 years and fairly regularly make as much as the doctors who round the hospitals, who also kept incurring debt and made basically no money until they were 30.
- deleted 7y ago
  [deleted]
- bigwavedave 7y ago
  Precisely. This is extremely evident in my family- my sister and her husband are incurring insane debt and he won't be finished with school until he's 30... As opposed to me, who's younger than he is, have been out of school for years, and currently make just as much as he hopes to make in five years. The system is not optimized for medical professionals, it's optimized for (it may sound dramatic, but it's the only word that fits) the cartels pulling the strings. And what happens if my brother passes away before graduating? Hunndreds of thousands of dollars of debt will remain. No, doctors are definitely not the prime villains.
  - Gibbon1 7y ago
    It's been awhile since I've seen numbers. But I think but actual doctor compensation especially minus student loan principal and interest isn't that big a piece of the pie. Sr Doctors often make what seems like an assload of money, but doctors careers are short and the high earning period is a fraction of that. Consider, doctors start working at 30, usually retire at 65. That's 25 years. First 10 years is spent paying off student loans and gaining clinical experience. Friend of mine is a Sr software engineer with a masters and 20 years of experience. His slightly younger brother is a newly minted Cardiac Surgeon.
    - lutorm 7y ago
      It's actually 35 years. But still.
fencepost 7y ago
A lot of doctors in specialties are pulling in pretty decent money, but it's probably not as much as you're thinking. I say that as someone working with medical practices and physicians on a regular basis. Internal medicine, general practice and family docs are generally making less. There are also a lot of things going on with consolidation and big medical groups, driven in part by pharmaceutical costs. As an example, we used to have several oncology practices as clients. We're not working with any of those anymore because they have all been bought out by hospitals or health systems. From talking with the doctors at the most recent one this was not because they got a big payday out of it but was instead because looking forward a few years they were not going to be able to afford to stock chemotherapy drugs. They sold out because they could see the time when the business was no longer sustainable as an independent practice. I'm sure the doctors didn't come out of this hurting, but this was not a startup unicorn style exit.

mschuster91 7y ago

Too many people with connections profit off of the current situation, the poorest people pay the price. This is why there is no demand for real change and why all previous efforts got essentially stonewalled.

vkou 7y ago
It's actually the middle class that pays the price, through insurance premiums, out-of-pocket co-pays, and high deductibles. Poor people have Medicaid. Medicaid, which even happens to pay reasonable amounts for procedures performed. The entire system would re-adjust into a sustainable steady-state, if all prices were equivalent to Medicaid reimbursements. But I suppose that under such a model, the average middle-aged surgeon wouldn't be able to afford their third summer home...
- munk-a 7y ago
  Medicaid is probably the second best place to be in the US system after Medicare - but it suffers from extreme politicization of care (good luck trying to get HRT or an abortion on Medicaid), rationing, shortage of supply (not all providers are required to or will service Medicaid patients) and stringent requirements to ensure continued availability (these in particular are getting much worse under pushes to get rid of "welfare queens" _sigh_). That said, the only way to win is to not play - never get sick and emigrate before you have any serious health issues.
  - hansthehorse 7y ago
    Medicare is only good if you carry a separate policy to cover the 20% copay. It's really not to difficult to run up a 100k copay with one serious illness.
  - vkou 7y ago
    All of these problems come from Medicaid and Medicare paying a lot less for procedure performed (In line with what Canada, and Europe pays) than the public market. It's a drain on most hospital budgets. If all procedures performed were done at Medicaid-like prices, hospitals and physicians, and pharma firms, and, by proxy, insurers and medical schools would have to tighten their belts, and figure out how to cut costs. That's the entire point of such an exercise. We can't let health costs grow in an unbounded manner.

jorblumesea 7y ago

It's pretty clear why it hasn't been solved. US voters have no appetite to elect anyone who is remotely progressive, and the status quo politicians are bought and paid for by "lobbying" aka institutionalized bribery. The US system benefits corporations and the wealthy, not the common person.