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This is why I think our government should not have much to do with healthcare other than to look after safety, accountability and exercise regulatory control wh

This is why I think our government should not have much to do with healthcare other than to look after safety, accountability and exercise regulatory control where absolutely necessary. They have made a mess out of the US healthcare system and healthcare is the last thing they address. BTW, my wife is also a physician and we have several additional physicians in our family both in the US and abroad. And, of course, through their respective networks you get to have interesting conversations with other physicians (I enjoy going to conferences with her for this reason). This is where my conclusion comes from. I developed this idea that we need to eject politicians from almost everything related to healthcare in the US save the areas I mentioned above. One example of this is the constant regurgitation of different hair-brained insurance schemes to "fix" healthcare. We don't have an insurance problem. No manipulation of insurance will fix healthcare. And, no, "Medicare for All" won't do it either, in fact, it will make a mess out of it. The problems we have are structural (at least that's my term for it). It starts with the cost of education. Government guaranteed loans have caused a situation where medical practitioners, at every level, graduate with massive debt. This establishes a floor on what they have to earn in order to not only make these payments but have a life, a family, enjoy life in general. Government needs to bug out of student loans, which would put significant downward pressure on the cost of an education. The next issue is equally large: Tort reform. Medical practitioners at every level have to carry very expensive insurance in order to protect themselves from often ridiculous lawsuits with equally ridiculous financial outcomes. Companies developing, manufacturing and selling any medical product have to allocate non-trivial costs to the potential of becoming entangled in brutally expensive lawsuits. Anyone who thinks a pair of forceps used in surgery is expensive has no idea how much of bringing that product to market was made expensive by the potential of unbounded litigation. Moving on, I would add to this an expensive (in time and money) regulatory infrastructure. Personal anecdote: I have had interest in developing innovative tools for the treatment of both Strabismus and SSD (single side deafness). These two afflictions, as far as I am concerned, are still in the stone age today. I actually developed prototypes a couple of decades back. And then I discovered it would cost tens of millions of dollars to put them through the regulatory process (only if you have a smooth straight path, far more if you stumble). So I moved on. Far easier to work in aerospace and robotics than to endure the financial torture and risk that an entrepreneur has to undertake to be in the medical industry. There's more, but I think the above are easily the top three. I would add to this the abject failure of not pushing through and having a solid nation wide medical information system that is efficient and patient focused. The fact that you can expect to have to fill out ten pages of the same questions at every doctor you visit is reprehensible at best. There is no amount of insurance or "Medicare for All" magic that will improve our healthcare system until we, at the very least, address the above, none. It's a farce. It's false promises for votes, I don't care who it is or which ideological extreme they come from. Notice that there is one thing in common with all of the above: They all address costs. Our healthcare system is ridiculously expensive because our costs are ridiculously high. Fix that and then any reasonable insurance scheme should be able to deliver access to excellent care at reasonable prices. And, yes, we should also be able to cover everyone in the process.

smsm42 7y ago
The system being ridiculously expensive is only half of the problem. The other half is that this expensiveness is completely random, opaque, nondeterministic and unpredictable. It's one think if the doctor says to you "you need a procedure which will cost $TONS_OF_MONEY", quite another if the doctor says "well, we'll do the procedure, but we won't tell you how much it costs except that it's a lot, and you'd be getting bills for months from now, and will have to become an expert in negotiating with various billing systems, and we will mercilessly try to fleece you like a sheep every time, just because why not, you're already on the hook for it and we'll ruin your credit for the next decade if you make any tiny mistake on the way". The former is bad enough. The latter is absolutely terrible. And the medical professionals, by not pushing for the solution for it, and just saying "it's not our business, we just do medicine and do not concern ourselves with the lowly matters of money" share the responsibility for it.
- robomartin 7y ago
  Well, half is a big chunk! Also, a lot of these problems are very much interrelated. Until you've been in the shoes of a practitioner who has to worry about getting sued into oblivion for every decision they make you can't really grok some of the things that happen in US medicine. I only know because my SO wears those shoes and we have a lot of medical professionals in the family and beyond. The fitness function they have to optimize for every day has consequences. And half or more of that has to do with what I discussed in my prior post.

smsm42 7y ago

The system being ridiculously expensive is only half of the problem. The other half is that this expensiveness is completely random, opaque, nondeterministic and unpredictable. It's one think if the doctor says to you "you need a procedure which will cost $TONS_OF_MONEY", quite another if the doctor says "well, we'll do the procedure, but we won't tell you how much it costs except that it's a lot, and you'd be getting bills for months from now, and will have to become an expert in negotiating with various billing systems, and we will mercilessly try to fleece you like a sheep every time, just because why not, you're already on the hook for it and we'll ruin your credit for the next decade if you make any tiny mistake on the way". The former is bad enough. The latter is absolutely terrible. And the medical professionals, by not pushing for the solution for it, and just saying "it's not our business, we just do medicine and do not concern ourselves with the lowly matters of money" share the responsibility for it.

robomartin 7y ago
Well, half is a big chunk! Also, a lot of these problems are very much interrelated. Until you've been in the shoes of a practitioner who has to worry about getting sued into oblivion for every decision they make you can't really grok some of the things that happen in US medicine. I only know because my SO wears those shoes and we have a lot of medical professionals in the family and beyond. The fitness function they have to optimize for every day has consequences. And half or more of that has to do with what I discussed in my prior post.