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> as someone living in Australia where theres a public health care system that looks after everyone... costs less than half your pre-obamacare insurance > I ca

> as someone living in Australia where theres a public health care system that looks after everyone... costs less than half your pre-obamacare insurance > I cant fathom why the majority of Americans are ok with their weird sociopathic Job = Health Insurance based system. Agree with everything in your comment. I think I can say everyone in the US wants a solution for this, including the idea of healthcare not being financially crippling for anyone. It is easy to wrongly reduce any issue to a single variable. Politicians love doing this because they can then identify good and bad and use that to divide the population for votes. The truth is that everything in life is a complex multivariate problem. Few take the time to take a deep dive into the tree of variables in order to understand. While not a comprehensive explanation, I'll attempt to at least provide some perspective, particularly for those not living in the US and likely, because of that, not having direct visibility into the web of issues. From my perspective, there are four macro issues that drive our cost structures. I'll keep it short. Happy to expand on any of these if interested. 1: Education: K-12 2: Education: University 3: Student loans 4: Laws, lawyers, lawsuits, liability Like I said, there are many variables beyond these. Primary and Secondary Education We send our kids to school from 5 to 17/18 years of age. After twelve years of schooling young adults come out of these institutions with no marketable skills whatsoever. Our high school graduates are only good for stacking boxes and, with training, making coffee. They are ignorant and pretty much useless without an additional 6 to 24 months of training. They are sold the idea that minimum wage should be a living wage because we are training people who can only qualify for minimum wage jobs. Except that faulty economic ideologies is constantly eroding living standards at every level. Politicians pushed the $15/hr minimum wage as a solution for all the problems. Today, with inflation and rising cost structures (some of it driven by the doubling of the minimum wage), earning $15 per hour is likely less --in terms of purchasing power-- than it was before selling people that fantasy. Education is at the core of a number of problems in this country. How does that affect healthcare? You are creating generations of poor people with no or low skills. This means they have trouble financially contributing to the greater good. University Education If I remember correctly, the university drop-out rate is such that only about 25% (if not less) of first year students in the US graduate. This is connected to the prior issue as well as other factors. Once again, we end-up with a massive number of people who will likely suffer from financial struggles for life. The fact that K-12 schools do not prepare students well means a significant number of them have to either take (and pay for) remedial coursework or eventually drop out. Most drop out. In addition to this, our university programs waste student time by forcing them to take irrelevant coursework. This is particularly visible in the STEM fields. Students have to engage in about a years' worth of irrelevant non-STEM coursework. I define "irrelevant" to mean: Coursework that no employer cares about at all and will have no effect in advancing anyone professionally. We could graduate people 25% faster and with 25% lower student debt if we just excised irrelevant coursework. What's ironic about this is that anyone would agree that someone pursuing a degree in art would be wasting their time and money if forced to take a year filled with mathematics, physics, chemistry and other STEM topics. And yet, for some strange reason, we force our STEM students to spend tens of thousands of dollars and waste an entire year taking courses like "Young Karl Marx". No bullshit, my son was forced to take this course at a major university while pursuing his degree in CS. Forced? Yes. A sociology module was required for graduation. Magically, this was the only available class for something like two quarters. In other words, he would have had to delay his graduation by half a year or "choose" to take this irrelevant and utterly useless class. And pay for it, of course. What does this have to do with healthcare? Hang on, we are getting there. <continued>

robomartin 4y ago
<continued from above> Student Loans Government subsidized and guaranteed student loans cause massive increases in the cost of tertiary education. Who in their right mind would give an 18 year old with no work history or finances to justify it a loan for hundreds of thousands of dollars? The answer is: Nobody. Unless the government guarantees you'll get paid. In which case you have nothing whatsoever to lose. Young adults have no clue what they are walking into and buy into the scheme, not knowing what awaits them. One particularly sad example I have of this is a young lady who was a member of the FRC robotics team I mentored for many years. She was duped --I have to use the word, no other way to describe it-- into accepting admission into a university that was going to charge her $300K for a degree in mechanical engineering. I and other professionals mentoring the team advised her against doing this. We explained what $300K in debt for a degree in mechanical engineering was a formula for financial slavery for three decades, or more. Well, we could not beat the marketing machine. She graduated with a little over $300K in debt and is absolutely hating life today. This is where we make a connection that starts with K-12 and culminates with university outcomes and the healthcare systems. An MD, depending on specialty, graduates with about $300K in debt. That's actually a bad number because it is an average, and averages are horrible metrics to apply to a population. The number can easily reach $500K, particularly when you include all elements, not just tuition. Here's the connection: There's an ecosystem of professionals, all of whom participate in delivering healthcare through their own specialties. The MD, nurses, PA's, radiologists, etc. are the most visible layer. The next layer is likely an array of engineers, biologists, chemists and other university-degreed professionals working either directly for the hospitals or for tech and pharmaceutical companies that are an integral part of the healthcare dependency tree. When you are on the table in an operating room, the team surrounding you likely has a collective student loan debt in the order of two million dollars, if not more. One layer removed are other nurses and support personnel at the hospital. That is also likely debt that must be serviced in the millions of dollars. The people who build the equipment in that operating room, conduct research and develop drugs and other tools represent hundreds of millions of dollars in student debt. One can follow that cost structure tree as far as one might wish. This means that healthcare in the US has a non-trivial baseline cost of doing business that is inextricably linked to the quality and cost of our education. That's an important baseline to understand. You cannot fix healthcare costs in the US without fixing this complex element of a complex equation. At a minimum, the government should have nothing to do with student loans. University costs should not be subsidized. Students should pay fair market value for what their degrees can actually deliver. Curriculum would also be fine-tuned as part of this process. Nobody wants to spend thousands of dollars for a course on "Underwater Basket Weaving" when it is irrelevant and has no value. Let the student decide, do not force irrelevant material on them and charge inflated rates for it. The journey to this point includes additional variables that have not been accounted for. One example of this is the fact that K-12 education is dominated and ruled by regional teacher unions, none of which truly exists as real advocates for excellence in education. The effects of such a structure ripple all the way up into university, graduation rates and the cost of remedial education. These result also dominate life outcomes for those who either don't attend university or drop out. They leave K-12 without marketable skills that could seriously improve their lives and improve society. BTW, my wife is a doctor; we actually live the above realities. We is over 50 years old and we still have somewhere around $80K in student debt to pay for her degree. Lawyers While this isn't intended to be an exhaustive analysis of the problem of healthcare cost in the US, it is important to bring this element into it, because it isn't trivial. Doctors in the US have to spend tens of thousands of dollars per year on professional insurance to protect from lawyers. Hospitals have to spend millions of dollars per year on legal costs. Companies serving the healthcare industry have to do the same. Pharmaceutical companies have to spend billions of dollars. The baseline costs I mentioned above are, in fact, just the tip of the iceberg. Every single element of the healthcare story in the US, be it people, supplies, equipment or drugs, has massive legal and liability costs associated with them. If your medical practice has to protect against a potential hundred-million-dollar lawsuit, there will be a non-trivial cost associated with this. Same with hospitals, the EKG machine manufacturer and even the company making the pillows you put on the beds at the hospital. One turn of the crank and all of these baseline costs add-up to a situation where the "system" has to charge insane amounts of money for everything or it will collapse under its own weight. Doctors have to order two, three, ten times as many tests for everything, just to cover their ass in case there's a lawsuit. Companies have to spend tens, hundreds, billions of dollars for similar reasons. When your baseline costs are driven by such cost structures, there is no amount of income redistribution that is going to fix any of it. Making me pay four times what I was paying before Obamacare does absolutely nothing --not one thing-- to fix the fundamental issue of a seriously fucked cost structure to deliver healthcare. I'll stop here. The topic tends to be emotional for some because it is human nature to pretty much just care for self rather than to take a higher level view, explore root causes and take the pain required to actually solve problems for everyone. Objectively speaking, in the US, we need to fix education at every level, stop subsidizing ridiculous university cost structures and curriculum, fix our laws to reduce and mitigate the horrendous costs of doing business and focus on delivery quality care for everyone at a reasonable price. At this juncture, if we fired all politicians and did the right things, it could take 25 to 50 years to see the results. That's part of the problem and an indication of just how messed-up things have become.

robomartin 4y ago

<continued from above> Student Loans Government subsidized and guaranteed student loans cause massive increases in the cost of tertiary education. Who in their right mind would give an 18 year old with no work history or finances to justify it a loan for hundreds of thousands of dollars? The answer is: Nobody. Unless the government guarantees you'll get paid. In which case you have nothing whatsoever to lose. Young adults have no clue what they are walking into and buy into the scheme, not knowing what awaits them. One particularly sad example I have of this is a young lady who was a member of the FRC robotics team I mentored for many years. She was duped --I have to use the word, no other way to describe it-- into accepting admission into a university that was going to charge her $300K for a degree in mechanical engineering. I and other professionals mentoring the team advised her against doing this. We explained what $300K in debt for a degree in mechanical engineering was a formula for financial slavery for three decades, or more. Well, we could not beat the marketing machine. She graduated with a little over $300K in debt and is absolutely hating life today. This is where we make a connection that starts with K-12 and culminates with university outcomes and the healthcare systems. An MD, depending on specialty, graduates with about $300K in debt. That's actually a bad number because it is an average, and averages are horrible metrics to apply to a population. The number can easily reach $500K, particularly when you include all elements, not just tuition. Here's the connection: There's an ecosystem of professionals, all of whom participate in delivering healthcare through their own specialties. The MD, nurses, PA's, radiologists, etc. are the most visible layer. The next layer is likely an array of engineers, biologists, chemists and other university-degreed professionals working either directly for the hospitals or for tech and pharmaceutical companies that are an integral part of the healthcare dependency tree. When you are on the table in an operating room, the team surrounding you likely has a collective student loan debt in the order of two million dollars, if not more. One layer removed are other nurses and support personnel at the hospital. That is also likely debt that must be serviced in the millions of dollars. The people who build the equipment in that operating room, conduct research and develop drugs and other tools represent hundreds of millions of dollars in student debt. One can follow that cost structure tree as far as one might wish. This means that healthcare in the US has a non-trivial baseline cost of doing business that is inextricably linked to the quality and cost of our education. That's an important baseline to understand. You cannot fix healthcare costs in the US without fixing this complex element of a complex equation. At a minimum, the government should have nothing to do with student loans. University costs should not be subsidized. Students should pay fair market value for what their degrees can actually deliver. Curriculum would also be fine-tuned as part of this process. Nobody wants to spend thousands of dollars for a course on "Underwater Basket Weaving" when it is irrelevant and has no value. Let the student decide, do not force irrelevant material on them and charge inflated rates for it. The journey to this point includes additional variables that have not been accounted for. One example of this is the fact that K-12 education is dominated and ruled by regional teacher unions, none of which truly exists as real advocates for excellence in education. The effects of such a structure ripple all the way up into university, graduation rates and the cost of remedial education. These result also dominate life outcomes for those who either don't attend university or drop out. They leave K-12 without marketable skills that could seriously improve their lives and improve society. BTW, my wife is a doctor; we actually live the above realities. We is over 50 years old and we still have somewhere around $80K in student debt to pay for her degree. Lawyers While this isn't intended to be an exhaustive analysis of the problem of healthcare cost in the US, it is important to bring this element into it, because it isn't trivial. Doctors in the US have to spend tens of thousands of dollars per year on professional insurance to protect from lawyers. Hospitals have to spend millions of dollars per year on legal costs. Companies serving the healthcare industry have to do the same. Pharmaceutical companies have to spend billions of dollars. The baseline costs I mentioned above are, in fact, just the tip of the iceberg. Every single element of the healthcare story in the US, be it people, supplies, equipment or drugs, has massive legal and liability costs associated with them. If your medical practice has to protect against a potential hundred-million-dollar lawsuit, there will be a non-trivial cost associated with this. Same with hospitals, the EKG machine manufacturer and even the company making the pillows you put on the beds at the hospital. One turn of the crank and all of these baseline costs add-up to a situation where the "system" has to charge insane amounts of money for everything or it will collapse under its own weight. Doctors have to order two, three, ten times as many tests for everything, just to cover their ass in case there's a lawsuit. Companies have to spend tens, hundreds, billions of dollars for similar reasons. When your baseline costs are driven by such cost structures, there is no amount of income redistribution that is going to fix any of it. Making me pay four times what I was paying before Obamacare does absolutely nothing --not one thing-- to fix the fundamental issue of a seriously fucked cost structure to deliver healthcare. I'll stop here. The topic tends to be emotional for some because it is human nature to pretty much just care for self rather than to take a higher level view, explore root causes and take the pain required to actually solve problems for everyone. Objectively speaking, in the US, we need to fix education at every level, stop subsidizing ridiculous university cost structures and curriculum, fix our laws to reduce and mitigate the horrendous costs of doing business and focus on delivery quality care for everyone at a reasonable price. At this juncture, if we fired all politicians and did the right things, it could take 25 to 50 years to see the results. That's part of the problem and an indication of just how messed-up things have become.