From all my research, I've come to the conclusion that while there are things that are broken about the US system, it's not as fundamentally broken as people ma

From all my research, I've come to the conclusion that while there are things that are broken about the US system, it's not as fundamentally broken as people make it out to be. Let's say there are two variables you can optimize for, X and Y, and that there are tradeoffs between optimizations such as optimizing for X often reduces Y and optimizing for Y often reduces X. The problem with the popular discussion today is that no one ever acknowledges what the US system does well. They only talk about what it does poorly. If you don't acknowledge what it does well, it's trivially easy to come up with solutions that address the things it does poorly, but often at the expense of creating a new replacement that now does poorly at the thing that the previous system did well. In the US, the system is remarkably effective at optimizing for financial incentives. The replacement system many people argue for will likely lay waste to optimizing for financial incentives. This doesn't come without a cost however. Eliminate the financial incentives and you will at minimum get less of two very important things: (1) investment by companies and capital markets in R&D, and (2) investment in a career in the field of drug R&D by individuals deciding what career to pursue. The loss of one or both would be devastating to the development of novel treatments in perpetuity. As a general heuristic, I've found it valuable to figure out what a system does well before I propose a solution to replace it. If I can't articulate what a system does well, it's typically a sign that I don't yet understand the system well enough and don't understand what that system's designers were optimizing for when it was first implemented. This heuristic is applicable to all pretty much all systems, not just health care.