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> we should not accept any health care reform proposal that any of the American Medical Association, the Pharmaceutical Research and Manufacturers of America,

> we should not accept any health care reform proposal that any of the American Medical Association, the Pharmaceutical Research and Manufacturers of America, or the American Hospital Association are generally supportive of. That seems like a lot of people to piss off to get any reform done. Wouldn't an actual smart negotiator play off one against the other, and make the doctors support the initiative at the expense of the pharma industry, or vice versa?

dclowd9901 3y ago
Hm. That’s a good point. Provide government care and it pays more than private insurance (which it should if economies of scale are employed). That would basically gut the private industry entirely.
ericmay 3y ago
You’re right it’s a lot of “people” to piss off, but in this context it’s like being a sheep trying to negotiate what’s for dinner with a wolf. Speaking of negotiators. These groups have very skilled so they wouldn’t just let themselves be played off against each other to their own detriment.
vidanay 3y ago
I feel like "piss off a lot of people" is a general prerequisite to any substantial reform on any topic. Almost anything that requires reform is going to be at the point where it is being abused and (inordinately) capitalized on.
- cloche 3y ago
  There's always winners and losers with any type of change. Look at COVID. Some companies thrived and had their best years ever and others went bankrupt and closed down. A lot of negotiators talk about win-win agreements which may be true with just two parties. I think once you get beyond that, no true win-win agreement is possible and some people are going to lose out. Trying to appease every single interest group is what leads to a lack of progress.
screye 3y ago
Coal miners, car companies, and sears catalog were not consulted when their industry was disrupted. No one is entitled to a gravy train, especially when your entire industry is cartelized. Middle men jobs, no matter how good, need to be on the chopping block if all they do is be extractive pests. They can't both be protected from the pressures of the free market, and not have any accountability from an improved service standpoint. As for the actual workers, Doctors can charge what they like, but they shouldn't be able to limit the supply of doctors within the nation. That is NIMBY mentality.
- parineum 3y ago
  Those companies weren't disrupted by a democratic government for which all of their employees have a vote. The government acts at the behest of the governed so they need to get support from at least some of those groups because a lot of families rely on someone working in one of them.
  - pigsinzen 3y ago
    The government has been directly interfering with this industry since the ACA (“Obamacare”) was enacted; forcing everyone to purchase health insurance.
    - actionfromafar 3y ago
      And not before? This industry exists because of government
      - pigsinzen 3y ago
        Before as well, of course. But prior to the ACA there was no requirement for every individual filing taxes to show they had coverage, or most businesses (even relatively small ones) to offer benefits packages. It also changed small medical practices because suddenly everyone wanted to use this insurance they were paying for. No longer could it just be a doctor and maybe a couple of medical staff; they needed medical coders, specialized software, and so forth. Some decided to join large hospital networks (for worse, from what I have generally heard). And this cascaded into multiple sub-industries developing around this revenue stream and the medical system. Everyone trying to sell something and grab their piece of the pie. It was not great before, but you could go see a doctor and literally pay a small amount of cash for an appointment. Many won’t even accept anyone without insurance now. Edit: as mburns@ pointed out, the IRS no longer asks individuals about their health insurance status since 2019.
irrational 3y ago
I’d rather piss off a single generation of these workers and get true hard reform for all future generations.
logifail 3y ago
> make the doctors support the initiative at the expense of the pharma industry (Full disclosure: family member works for Big Pharma) You might not get them to admit it out loud, but Big Pharma sees the USA as the cash cow that funds R&D for everyone on the planet. If a potential product can't or won't ever make it to market in the USA, or if there aren't enough potential patients in the USA to be prescribed said product, then it might never get off the drawing board. It's (unfortunately) that simple.
- paulmd 3y ago
  If the capitalistic system doesn’t produce results, we can do like India and have state-funded drug R&D and so on. https://en.wikipedia.org/wiki/Ormeloxifene https://en.wikipedia.org/wiki/Ormeloxifene Frankly this system is already deep into market failure in the US and should be reformed anyway. We are not getting important drugs approved here because they can’t make it through approval despite track records of safe and efficacious use in hundreds of millions of people. That’s an intense life-wasting market failure.
  - deleted 3y ago
    [deleted]
- tuatoru 3y ago
  Yes, a lot of people don't understand the sheer amount of labor and time that is required to bring a new drug to market. (Edit: Or the number of things that are tried but don't pan out for one reason or another. The success rate is very low.) I myself have only the vaguest understanding. Someone has to pay for it all. We need India to get rich ASAP, so Indians can start paying for it. :-)
  - MrOwen 3y ago
    Surprise, surprise but a huge chunk (maybe even the majority of?) of drug research is conducted by academic institutions using government funded grants. Then the drug companies come swoop up the research, refine it, mass produce, and market. They shouldn't be able to get such a free ride from all this government funded research imo. The taxpayers already funded the research so why are they getting the short end of the stick?
huevosabio 3y ago
I think most of the issues in the US are due to a sizeable amount of people are systematically ripping the rest off. Healthcare? Doctors, hospitals, insurance, etc all are taking a bigger cut than they should. You'll get a ton of pissed people if you want to solve it. Housing? Nimbys are just regular homeowners that block housing to implicitly (or explicitly) protect their property value. Solving that gets a ton of homeowners pissed. Universities? Tons of university admins and loan programs that benefit from restricting tertiary education supply. Fixing is pissing lots of people. So much of our economy is captured by large cohorts of people that are not explicitly conspiring to do so, but their incentives moves them to behave like that.

dclowd9901 3y ago

Hm. That’s a good point. Provide government care and it pays more than private insurance (which it should if economies of scale are employed). That would basically gut the private industry entirely.

ericmay 3y ago

You’re right it’s a lot of “people” to piss off, but in this context it’s like being a sheep trying to negotiate what’s for dinner with a wolf. Speaking of negotiators. These groups have very skilled so they wouldn’t just let themselves be played off against each other to their own detriment.

vidanay 3y ago

I feel like "piss off a lot of people" is a general prerequisite to any substantial reform on any topic. Almost anything that requires reform is going to be at the point where it is being abused and (inordinately) capitalized on.

cloche 3y ago
There's always winners and losers with any type of change. Look at COVID. Some companies thrived and had their best years ever and others went bankrupt and closed down. A lot of negotiators talk about win-win agreements which may be true with just two parties. I think once you get beyond that, no true win-win agreement is possible and some people are going to lose out. Trying to appease every single interest group is what leads to a lack of progress.

screye 3y ago

Coal miners, car companies, and sears catalog were not consulted when their industry was disrupted. No one is entitled to a gravy train, especially when your entire industry is cartelized. Middle men jobs, no matter how good, need to be on the chopping block if all they do is be extractive pests. They can't both be protected from the pressures of the free market, and not have any accountability from an improved service standpoint. As for the actual workers, Doctors can charge what they like, but they shouldn't be able to limit the supply of doctors within the nation. That is NIMBY mentality.

parineum 3y ago
Those companies weren't disrupted by a democratic government for which all of their employees have a vote. The government acts at the behest of the governed so they need to get support from at least some of those groups because a lot of families rely on someone working in one of them.
- pigsinzen 3y ago
  The government has been directly interfering with this industry since the ACA (“Obamacare”) was enacted; forcing everyone to purchase health insurance.
  - actionfromafar 3y ago
    And not before? This industry exists because of government
    - pigsinzen 3y ago
      Before as well, of course. But prior to the ACA there was no requirement for every individual filing taxes to show they had coverage, or most businesses (even relatively small ones) to offer benefits packages. It also changed small medical practices because suddenly everyone wanted to use this insurance they were paying for. No longer could it just be a doctor and maybe a couple of medical staff; they needed medical coders, specialized software, and so forth. Some decided to join large hospital networks (for worse, from what I have generally heard). And this cascaded into multiple sub-industries developing around this revenue stream and the medical system. Everyone trying to sell something and grab their piece of the pie. It was not great before, but you could go see a doctor and literally pay a small amount of cash for an appointment. Many won’t even accept anyone without insurance now. Edit: as mburns@ pointed out, the IRS no longer asks individuals about their health insurance status since 2019.

irrational 3y ago

I’d rather piss off a single generation of these workers and get true hard reform for all future generations.

logifail 3y ago

> make the doctors support the initiative at the expense of the pharma industry (Full disclosure: family member works for Big Pharma) You might not get them to admit it out loud, but Big Pharma sees the USA as the cash cow that funds R&D for everyone on the planet. If a potential product can't or won't ever make it to market in the USA, or if there aren't enough potential patients in the USA to be prescribed said product, then it might never get off the drawing board. It's (unfortunately) that simple.

paulmd 3y ago
If the capitalistic system doesn’t produce results, we can do like India and have state-funded drug R&D and so on. https://en.wikipedia.org/wiki/Ormeloxifene https://en.wikipedia.org/wiki/Ormeloxifene Frankly this system is already deep into market failure in the US and should be reformed anyway. We are not getting important drugs approved here because they can’t make it through approval despite track records of safe and efficacious use in hundreds of millions of people. That’s an intense life-wasting market failure.
- deleted 3y ago
  [deleted]
tuatoru 3y ago
Yes, a lot of people don't understand the sheer amount of labor and time that is required to bring a new drug to market. (Edit: Or the number of things that are tried but don't pan out for one reason or another. The success rate is very low.) I myself have only the vaguest understanding. Someone has to pay for it all. We need India to get rich ASAP, so Indians can start paying for it. :-)
- MrOwen 3y ago
  Surprise, surprise but a huge chunk (maybe even the majority of?) of drug research is conducted by academic institutions using government funded grants. Then the drug companies come swoop up the research, refine it, mass produce, and market. They shouldn't be able to get such a free ride from all this government funded research imo. The taxpayers already funded the research so why are they getting the short end of the stick?

huevosabio 3y ago

I think most of the issues in the US are due to a sizeable amount of people are systematically ripping the rest off. Healthcare? Doctors, hospitals, insurance, etc all are taking a bigger cut than they should. You'll get a ton of pissed people if you want to solve it. Housing? Nimbys are just regular homeowners that block housing to implicitly (or explicitly) protect their property value. Solving that gets a ton of homeowners pissed. Universities? Tons of university admins and loan programs that benefit from restricting tertiary education supply. Fixing is pissing lots of people. So much of our economy is captured by large cohorts of people that are not explicitly conspiring to do so, but their incentives moves them to behave like that.