4 ms·

The U.S. healthcare system cannot be fixed. Period. Full-stop. The only solution is to nuke it from orbit, pave it over, and start again. It's very easy to poin

by bane 6y ago

The U.S. healthcare system cannot be fixed. Period. Full-stop. The only solution is to nuke it from orbit, pave it over, and start again. It's very easy to point the finger at the conservative party as the one who's screwed it all up, but the other parties are not really putting forward models for successful healthcare systems. If one were to sit down and try to create the most absurd approach to healthcare that guaranteed high cost and poor outcomes you couldn't come up with the idiocy that our system has become. It's completely untenable, a failure at every single level from medical school to funeral services. The fact that there are so many smart people working in healthcare defies belief in the absolute fucking disaster it is. Even in the interaction between health providers and insurance companies, the billing practices have moved so far beyond fraud and are so widespread that nobody can even comprehend or describe how fucking broken just that one part of it is. Without getting into details, the healthcare industry is absolutely mortified of a law that requires them to provide patients expected costs before care and to publicize those cost for comparison. I can't believe that some startup hasn't glassdoored billing practices yet by patients simply uploading screenshots of their bills when they get them. note we just went through a bizarre medical experience where surgery was billed out at a total of something like $70k, the "negotiated" price was more like $7k, and we payed out of pocket something like $700. At one point the insurance company turned down the bill from the surgeon, who promptly simply submitted a bill from a "surgical assistant" who we never met or knew existed for the exact same dollar amount which was also denied, and then resubmitted the original bill which was approved and promptly "negotiated" to 10% of the original bill amount in the end. In the meanwhile we had absolutely no idea if we owed $30k for this bill, $30, $300, or $300k. No idea at all. It beggars belief that congress, who is mostly made up of people who are obviously experiencing their own medical journeys, can't put together some easily bipartisan approaches to price visibility.

zie 6y ago
Senators and congresspeople get their own very high quality insurance. They have no incentive to fix it, their own health care is world-class.
- bane 6y ago
  That's too easy an answer. They get basically the same options for health insurance as other federal employees. And that insurance is not materially different from the insurance you'd get from any other major employer.
  - zie 6y ago
    Mostly true: https://www.snopes.com/fact-check/members-congress-health-care/ https://www.snopes.com/fact-check/members-congress-health-ca...
  - leetcrew 6y ago
    I don't think that's quite true. BCBS FEP offers some fantastic plans that would be pretty hard to match at a private employer.
  - zie 6y ago
    They get world-class insurance. They do pay for it, but I never said it was free. Incentives matter. If Senators & Congress people were given only medicare and not their ACA Gold plan + perks, medicare would probably be a lot better off.
- pxeboot 6y ago
  Many companies maintain VIP lists to provide better service to celebrities and politicians. When a senator calls Comcast, they are not talking to the same call center the average customer is.
- mbg721 6y ago
  Having high-quality insurance doesn't really fix the issues with US healthcare; you can still go broke with decent insurance, and the billing only gets screwier the more middlemen are involved. (Congresscritters' real insurance is that if their particular claims were denied, it would be newsworthy.) We know that our healthcare system is messed-up, but we're wary of socialized medicine because we've seen failures everywhere that Washington has been involved so far. The middle-class expects a result not like some well-run Nordic paradise, but more like what we already have, only with more forms and longer waits.
nitwit005 6y ago
> The U.S. healthcare system cannot be fixed. Period. Full-stop. The only solution is to nuke it from orbit, pave it over, and start again. It's very easy to point the finger at the conservative party as the one who's screwed it all up, but the other parties are not really putting forward models for successful healthcare systems. I wouldn't say the Republicans are fully responsible for the state of things, but they can't seem to agree within the party on a basic concept. I recall John Boehner saying he laughed at Republican promises to swiftly repeal the Affordable Care Act, commenting "Republicans never ever agree on health care". And, well, he was proven right. If you can't unite your party on a big fix, then the only thing you can pass is some sort of limited fix, which tends to just add more complexity to the whole thing over time.
primitivesuave 6y ago
I agree with your initial sentiment completely. I joined my current cofounders (from medical/business backgrounds) for a health tech startup, sold on the dream of saving lives with technology. If my CEO didn't play the game by the absurd rules that are in place, I wouldn't have enough financial incentive to swallow my idealism and stick around. My point being, there are plenty of smart people in this system building cool features and chalking it up as progress, but we don't have any power to institute any kind of fundamental change. No healthcare leader will ever acknowledge the flaws in the system, because the people who get promoted up the bureaucracy are the ones who know how to play the game. The people at the top are the champions of collecting the maximum amount of money for the minimum amount of care.
- gremlinsinc 6y ago
  What about an intra-hospital alliance of sorts, basically build a software platform that covers billing/etc and turns your local hospital into the insurer. You pay 5% of your income for example. If you're traveling they pay the other hospital, either at the normal ins. rates or the rates that hospitals... Example: All the hospitals in utah join. I live in a small town with 45k people. Only hospital in the county, which is about 60k people. So the hospital gets 60K * 5% of income - Medicare/Medicaid who would be billed normally. They get this monthly so they could budget their bills by this income. Anyone traveling who gets sick in their location the hospital they are subscribed to pays their bill. Hospitals in the network all agree on pricing schemes that are fair so there's really no gouging or alternative prices. Since the payee is other hospitals and they could be on the other side of the price for patients it makes sense to make it reasonable. Localities could require all residents move to a hospital as insurer model to make the system more streamlined. A tech provider would create software / erp that automatically does the billing so basically you replace billing people on both sides of insurance. There's probably a lot of small quirks I'm unaware of... but this seems like it could work the larger (multi-state/all 50 states) the network as a whole they could even have significant power to bring down drug prices and equipment purchases for MRI machines/etc as basically a big union of healthcare providers. Primary care physicians would basically get a "cut" of the subscription monthly + co-pays. You could pick your "regular" Dentist, PCP, Eyecare, and other "centers" you go to at least a few times per year, and they could divy out funds to them on a recurring basis for the same goal of creating MRR for small healthcare providers locally.
disabled 6y ago
Remember this. This is actually a very good reason to emigrate from the US, even if you have to pay US taxes for life. If you look at the predicted life expectancy of an American in 2045 for example, you would know it is time to be "making plans". You would also know that the price differential on salaries between America and other places in the world as a person in STEM is not worth the payoff long-term. Plus, you cannot put a price on your health. This is just one eerie statistic, for example: Medical error—the third leading cause of death in the US https://www.bmj.com/content/353/bmj.i2139 https://www.bmj.com/content/353/bmj.i2139 You cannot evade a statistic like that by going to the "best hospitals" or by receiving the "best healthcare" in America, or by having "good insurance". By the way, I did become a dual US|EU citizen over American healthcare, as somebody who is chronically ill with 2 rare immune-mediated neurological diseases affecting my peripheral nervous system, plus type 1 diabetes (autoimmune and insulin dependent).
yibg 6y ago
The system is working very well, just not for people you think it should be working for.
tim333 6y ago
The medical part of the healthcare system - doctors, hospitals, the machines that go ping[0] - seem ok. It's the financial side - insurance billing and so on that needs nuking. Talking about bombing stuff Wikipedia has: >Charles Webster, official historian of the NHS, wrote in 2002 that "the Luftwaffe achieved in months what had defeated politicians and planners for at least two decades." [0] https://youtu.be/arCITMfxvEc https://youtu.be/arCITMfxvEc
nunie123 6y ago
> I can't believe that some startup hasn't glassdoored billing practices yet by patients simply uploading screenshots of their bills when they get them. I believe this is what Sidecar Health is working on: https://sidecarhealthinsurance.com https://sidecarhealthinsurance.com

by bane 6y ago

zie 6y ago

Senators and congresspeople get their own very high quality insurance. They have no incentive to fix it, their own health care is world-class.

bane 6y ago
That's too easy an answer. They get basically the same options for health insurance as other federal employees. And that insurance is not materially different from the insurance you'd get from any other major employer.
- zie 6y ago
  Mostly true: https://www.snopes.com/fact-check/members-congress-health-care/ https://www.snopes.com/fact-check/members-congress-health-ca...
- leetcrew 6y ago
  I don't think that's quite true. BCBS FEP offers some fantastic plans that would be pretty hard to match at a private employer.
- zie 6y ago
  They get world-class insurance. They do pay for it, but I never said it was free. Incentives matter. If Senators & Congress people were given only medicare and not their ACA Gold plan + perks, medicare would probably be a lot better off.
pxeboot 6y ago
Many companies maintain VIP lists to provide better service to celebrities and politicians. When a senator calls Comcast, they are not talking to the same call center the average customer is.
mbg721 6y ago
Having high-quality insurance doesn't really fix the issues with US healthcare; you can still go broke with decent insurance, and the billing only gets screwier the more middlemen are involved. (Congresscritters' real insurance is that if their particular claims were denied, it would be newsworthy.) We know that our healthcare system is messed-up, but we're wary of socialized medicine because we've seen failures everywhere that Washington has been involved so far. The middle-class expects a result not like some well-run Nordic paradise, but more like what we already have, only with more forms and longer waits.

nitwit005 6y ago

> The U.S. healthcare system cannot be fixed. Period. Full-stop. The only solution is to nuke it from orbit, pave it over, and start again. It's very easy to point the finger at the conservative party as the one who's screwed it all up, but the other parties are not really putting forward models for successful healthcare systems. I wouldn't say the Republicans are fully responsible for the state of things, but they can't seem to agree within the party on a basic concept. I recall John Boehner saying he laughed at Republican promises to swiftly repeal the Affordable Care Act, commenting "Republicans never ever agree on health care". And, well, he was proven right. If you can't unite your party on a big fix, then the only thing you can pass is some sort of limited fix, which tends to just add more complexity to the whole thing over time.

primitivesuave 6y ago

I agree with your initial sentiment completely. I joined my current cofounders (from medical/business backgrounds) for a health tech startup, sold on the dream of saving lives with technology. If my CEO didn't play the game by the absurd rules that are in place, I wouldn't have enough financial incentive to swallow my idealism and stick around. My point being, there are plenty of smart people in this system building cool features and chalking it up as progress, but we don't have any power to institute any kind of fundamental change. No healthcare leader will ever acknowledge the flaws in the system, because the people who get promoted up the bureaucracy are the ones who know how to play the game. The people at the top are the champions of collecting the maximum amount of money for the minimum amount of care.

gremlinsinc 6y ago
What about an intra-hospital alliance of sorts, basically build a software platform that covers billing/etc and turns your local hospital into the insurer. You pay 5% of your income for example. If you're traveling they pay the other hospital, either at the normal ins. rates or the rates that hospitals... Example: All the hospitals in utah join. I live in a small town with 45k people. Only hospital in the county, which is about 60k people. So the hospital gets 60K * 5% of income - Medicare/Medicaid who would be billed normally. They get this monthly so they could budget their bills by this income. Anyone traveling who gets sick in their location the hospital they are subscribed to pays their bill. Hospitals in the network all agree on pricing schemes that are fair so there's really no gouging or alternative prices. Since the payee is other hospitals and they could be on the other side of the price for patients it makes sense to make it reasonable. Localities could require all residents move to a hospital as insurer model to make the system more streamlined. A tech provider would create software / erp that automatically does the billing so basically you replace billing people on both sides of insurance. There's probably a lot of small quirks I'm unaware of... but this seems like it could work the larger (multi-state/all 50 states) the network as a whole they could even have significant power to bring down drug prices and equipment purchases for MRI machines/etc as basically a big union of healthcare providers. Primary care physicians would basically get a "cut" of the subscription monthly + co-pays. You could pick your "regular" Dentist, PCP, Eyecare, and other "centers" you go to at least a few times per year, and they could divy out funds to them on a recurring basis for the same goal of creating MRR for small healthcare providers locally.

disabled 6y ago

Remember this. This is actually a very good reason to emigrate from the US, even if you have to pay US taxes for life. If you look at the predicted life expectancy of an American in 2045 for example, you would know it is time to be "making plans". You would also know that the price differential on salaries between America and other places in the world as a person in STEM is not worth the payoff long-term. Plus, you cannot put a price on your health. This is just one eerie statistic, for example: Medical error—the third leading cause of death in the US https://www.bmj.com/content/353/bmj.i2139 https://www.bmj.com/content/353/bmj.i2139 You cannot evade a statistic like that by going to the "best hospitals" or by receiving the "best healthcare" in America, or by having "good insurance". By the way, I did become a dual US|EU citizen over American healthcare, as somebody who is chronically ill with 2 rare immune-mediated neurological diseases affecting my peripheral nervous system, plus type 1 diabetes (autoimmune and insulin dependent).

yibg 6y ago

The system is working very well, just not for people you think it should be working for.

tim333 6y ago

The medical part of the healthcare system - doctors, hospitals, the machines that go ping[0] - seem ok. It's the financial side - insurance billing and so on that needs nuking. Talking about bombing stuff Wikipedia has: >Charles Webster, official historian of the NHS, wrote in 2002 that "the Luftwaffe achieved in months what had defeated politicians and planners for at least two decades." [0] https://youtu.be/arCITMfxvEc https://youtu.be/arCITMfxvEc

nunie123 6y ago

> I can't believe that some startup hasn't glassdoored billing practices yet by patients simply uploading screenshots of their bills when they get them. I believe this is what Sidecar Health is working on: https://sidecarhealthinsurance.com https://sidecarhealthinsurance.com