4 ms·

The costs are more diffuse than this. First, the U.S. system costs twice as much as other systems because we have more people employed delivering care and they

by rsj_hn 5y ago

The costs are more diffuse than this. First, the U.S. system costs twice as much as other systems because we have more people employed delivering care and they make higher salaries. Doctors, nurses, they all make more in the U.S. than in Europe. So more people, getting paid higher wage, results in double the costs. But wait, the financing in the U.S. is quite predatory, so a lot of people pay nothing, and a few people are stuck with outrageous bills. It's like the infamous SF General Hospital that offered loads of free care to the poor and to immigrants and then refused to take any insurance so that normal people were regularly driven to bankruptcy if the ambulence took them there. The U.S. healthcare is one in which a half a million is spent on emergency care for an indigent person and 10 middle class families lose their life savings of 50K treating snakebites and broken arms. Once you wrap your head around this, you'll understand we have a very similar problem in higher education, and for very similar reasons.

LightG 5y ago
Ok, I'll take all of that at face value and as given. It just sounds completely broken over there and I'm not sure I will manage to wrap my head around it. All I know is simpler systems around the world exist and work such that those 10 middle class families would never get stiffed like that, whilst also looking after the needy. I can't fathom it.
- rsj_hn 5y ago
  > It just sounds completely broken over there and I'm not sure I will manage to wrap my head around it. Agreed. But that's the way it is, and it's important to understand why it's this way. When Europe and Australia adopted national healthcare systems, the industry was ~3-5% of GDP. So at that point it wasn't politically strong enough to resist either nationalization or strict controls. Then healthcare mushroomed in size, being ~10% of GDP in Europe and 20% of GDP in the U.S. So now, when you try to do the politics that the europeans did, it doesn't work. The industry is too powerful. Merely blaming the US for not doing what Europe did misses this essential point. There are millions of nurses, lab techs, administrators, and doctors, and they have money and they vote. So the left keeps looking for some villain -- greedy insurance executives, Wall Street, Evil Billionaires, etc. And basically refuses to understand that these are not the ones standing in the way of reform. It's the 13% of our labor force that earns 20% of national income, and these are not the same easy targets that the left can attack, because they are a large portion of the US middle class, and are core Democratic constituencies. That's why healthcare reform in the U.S. always focuses on having the government pay some of the costs charged to consumers rather then reducing the costs of providing healthcare. E.g. more subsidies for this bloated industry, which only results in costs rising even more, and then calls for even more subsidies when people can't afford to pay the costs. When what we should do is fire 50% of the staff and cut the pay of those that remain by another 50%. That's the only way to get affordable healthcare. And you have a similar problem with higher ed.
  - hallway_monitor 5y ago
    I think we can all agree the US healthcare system is broken. The above describes exactly why it can't just be "fixed"; only after taking those steps would moving to a universal solution make sense. No one, including healthcare workers, wants to be downsized or get a pay cut.
  - DFHippie 5y ago
    Yes, the healthcare system is politically powerful in the US, but also we have a culture war that has existed since the founding of the country such that half the country considers is highest political priority avenging slights and punishing the other half. Any sufficiently powerful minority can leverage this state of low level war to prevent any legislation that might harm them. Someone wants to prevent hog waste runoff from CAFOs? Inflame the culture war! Medical pricing is out of control? Inflame the culture war! People are being destroyed by payday lending and someone wants to address this? Inflame the culture war! Someone wants to reduce our profits by forcing us to internalize the costs of methane leaks? Inflame the culture war! There are a bunch of people itching to beat up their neighbors. Tell them that the people who want to fix something are their enemies and away they go. That is why the Land of the Free is such a shitshow.

by rsj_hn 5y ago

LightG 5y ago

Ok, I'll take all of that at face value and as given. It just sounds completely broken over there and I'm not sure I will manage to wrap my head around it. All I know is simpler systems around the world exist and work such that those 10 middle class families would never get stiffed like that, whilst also looking after the needy. I can't fathom it.

rsj_hn 5y ago
> It just sounds completely broken over there and I'm not sure I will manage to wrap my head around it. Agreed. But that's the way it is, and it's important to understand why it's this way. When Europe and Australia adopted national healthcare systems, the industry was ~3-5% of GDP. So at that point it wasn't politically strong enough to resist either nationalization or strict controls. Then healthcare mushroomed in size, being ~10% of GDP in Europe and 20% of GDP in the U.S. So now, when you try to do the politics that the europeans did, it doesn't work. The industry is too powerful. Merely blaming the US for not doing what Europe did misses this essential point. There are millions of nurses, lab techs, administrators, and doctors, and they have money and they vote. So the left keeps looking for some villain -- greedy insurance executives, Wall Street, Evil Billionaires, etc. And basically refuses to understand that these are not the ones standing in the way of reform. It's the 13% of our labor force that earns 20% of national income, and these are not the same easy targets that the left can attack, because they are a large portion of the US middle class, and are core Democratic constituencies. That's why healthcare reform in the U.S. always focuses on having the government pay some of the costs charged to consumers rather then reducing the costs of providing healthcare. E.g. more subsidies for this bloated industry, which only results in costs rising even more, and then calls for even more subsidies when people can't afford to pay the costs. When what we should do is fire 50% of the staff and cut the pay of those that remain by another 50%. That's the only way to get affordable healthcare. And you have a similar problem with higher ed.
- hallway_monitor 5y ago
  I think we can all agree the US healthcare system is broken. The above describes exactly why it can't just be "fixed"; only after taking those steps would moving to a universal solution make sense. No one, including healthcare workers, wants to be downsized or get a pay cut.
- DFHippie 5y ago
  Yes, the healthcare system is politically powerful in the US, but also we have a culture war that has existed since the founding of the country such that half the country considers is highest political priority avenging slights and punishing the other half. Any sufficiently powerful minority can leverage this state of low level war to prevent any legislation that might harm them. Someone wants to prevent hog waste runoff from CAFOs? Inflame the culture war! Medical pricing is out of control? Inflame the culture war! People are being destroyed by payday lending and someone wants to address this? Inflame the culture war! Someone wants to reduce our profits by forcing us to internalize the costs of methane leaks? Inflame the culture war! There are a bunch of people itching to beat up their neighbors. Tell them that the people who want to fix something are their enemies and away they go. That is why the Land of the Free is such a shitshow.