6 ms·

Why is this news worthy? US Healthcare is littered with various middlemen who have control of different parts of system and regions and any national program won

Why is this news worthy? US Healthcare is littered with various middlemen who have control of different parts of system and regions and any national program won't have flat price because of these middlemen. EDIT: These middlemen have lobbied Congress to prohibit Medicare from using any government power to force this middlemen to cooperate.

alistairSH 2y ago
It's not new news, but it's certainly worth repeating in the hopes people will eventually listen. Our system costs way too much for the outcomes we receive in return (the whole system, not just the socialized parts). ACA sort of helped, at least with coverage, but not really with prices. And yet people are terrified of "socialized medicine" ignoring the fact that a significant portion of the population is already successfully receiving socialized care through Medicare, Medicaid, veterans benefits, etc. Le Sigh.
- munk-a 2y ago
  Medicaid in particular is managed by states and the service, reimbursement and access varies wildly between different locales. There is an elephant in the room that rarely gets the attention it deserves is that 17.3% of the US GDP is contained in the healthcare system. This problem has grown so large that if we fixed it suddenly we could see a tenth of our GDP simply vanish overnight and it'd cause economic shockwaves across America. Twenty years ago this problem could have been solved in a relatively smooth manner - at this point I don't even know if my personal dream of a perfect solution would cause more harm to average people's lives than it'd help. We are up a creek and determinedly throwing every paddle we find as far as we can manage.
  - alistairSH 2y ago
    Somewhere between 15-30% of health care spending in the US can be classified as "waste" or "administrative overhead" (values and descriptions vary by study). Even if we cut that 15% waste in its entirety, that's moving us from 17.3% to 14.8%. Is that going to leave some administrative staff looking for jobs? Absolutely. But, I don't see that totally crashing the economy, not when that money is freed up for productive spending (more cars, more travel, more dining out, whatever).
    - deleted 2y ago
      [deleted]
    - munk-a 2y ago
      In the long term the market will absolutely adjust to more efficiently using that potential - but that's the long term. If America suddenly socialized health insurance millions of people[1] would be out of a job. The long term outlook of the economy would much better - but the short term would be extremely painful. 1. UHC appears to be about 440,000, CVS about 300,000, Elevance (aka Anthem) 104,900 - those are just a trio of the larger insurers out of hundreds.
      - alistairSH 2y ago
        That's assuming every job at those companies is absolute waste/overhead. I'm not convinced that's true. If we kill private insurance and move to Medicaid-for-All (I'm not suggesting this is the right approach, just thinking aloud here), the size of the Medicaid bureaucracy would have to grow, offering some of those former UHC/CVS/Anthem employees an "easy" transition into similar work. Anyways, no change this big would ever be made overnight. So, phase in changes over 5-10 years. Problem "solved".
        stackskipton 2y ago
        It's not solved. I know many on this website have probably changed technology they used and used to learning but that's not the case for vast majority of people. They just want a job, pushing the buttons/emails, collecting a paycheck and doing not work thing. As non FAANG person, the number of developers I've met who continue to greenfield in Java 8 and .Net Framework is mind blowing and any attempt to make them learn something new falls on deaf ears.
  - IncreasePosts 2y ago
    Wasn't Obama swayed against a single payer system, because eliminating all the middle men would end up with like 2 million people going unemployed?
    - alistairSH 2y ago
      More likely he was swayed because ACA was closer to a sure thing than anything remotely socialized.
    - mrguyorama 2y ago
      Obama was "swayed" because there were several "democrats" whose vote was required to pass anything who explicitly said they would not vote for single payer. People get this weird idea that democrats "aren't doing anything", but you need votes in the US system to do anything and democrats consistently lose elections. The people who stayed home and didn't vote will then insist that democrats didn't do enough to win their vote. But you can't do anything in the US without votes.
      - semiquaver 2y ago
        > whose vote was required to pass The 111th Congress had a historically large majority that has not been seen by either party since. https://en.m.wikipedia.org/wiki/111th_United_States_Congress https://en.m.wikipedia.org/wiki/111th_United_States_Congress They had more than enough votes: the ACA passed the senate 60-39. The senate filibuster that led them to compromise on the public option is a procedural rule that can be altered by simple majority, not a law.
        alistairSH 2y ago
        Removing the filibuster is a "nuclear option" - once it's gone, when the Senate inevitably swings the other way, the new majority will make use of it's absence to ram through whatever they want. There are arguments that this would actually be preferable and moderating, but that's a whole other debate. The 60 member supermajority was also fragile. And only lasted 72 days. There was a time limit on passing anything major. None of which is to say your wrong, only that there was a bit more nuance than "Dems had majority and flubbed".
  - dgfitz 2y ago
    I had to look it up, defense spending is 2.3ish% of GDP, and healthcare is 17.3% of GDP. There does seem to be a lot more fat to cut in healthcare than defense. I have never seen that number before, that is fascinating.
- potato3732842 2y ago
  Why would socializing or privatizing fix anything? The root problem is that there's too much fluff and middle men and bureaucracy and paper trail and it all has to be paid for.
  - alistairSH 2y ago
    Simple answer: economies of scale. Would that be better than a true "free/open market"? No idea. But, it seems we get the worst of both systems in the US, which has led to all sorts of regulatory capture, massive administrative waste, etc.
    - Amezarak 2y ago
      I support M4A for other reasons, but as of today the US governments(s) spend more on health care per citizen than many/most European countries with universal health care. A little more than a third of Americans are on Medicaid and/or Medicare. The scale is already there and the costs are already out of control. I think the GP is right that the inefficiencies are baked in at every possible level. M4A makes people's lives easier, but it won't solve the cost problem. We're at a point where we need massive reform of the entire system, not just nationalization (or privatization, if you want to go that way), and there would be a lot of people unemployed (or suddenly asked to do a lot more work[1]) and a lot of pain re-aligning people's expectations around medical care. [1] One example of this is the degree of specialization and division of labor that is just wasteful. A friend has a medical job where he is on-call to monitor a machine. He does nothing else. He rarely works more than a few hours a week. Another example: a family member needed an ultrasound. The doctor's office had an ultrasound. The doctor wanted an ultrasound. It was urgent. The ultrasound tech had recently quit. He ordered an ultrasound from an imaging center with a two-month wait time instead of simply doing a very easy ultrasound himself, which he would be the one required to interpret anyway. He wasn't busy either; he chatted about golf for almost a half-hour. In his mind, it was simply not his job. (Perhaps insurance also won't compensate doctors for performing ultrasounds, only techs. Who knows.)
      - alistairSH 2y ago
- myko 2y ago
  I switched to VA healthcare totally since the PACT Act was signed. So nice not to have to worry about this shit anymore.

alistairSH 2y ago

It's not new news, but it's certainly worth repeating in the hopes people will eventually listen. Our system costs way too much for the outcomes we receive in return (the whole system, not just the socialized parts). ACA sort of helped, at least with coverage, but not really with prices. And yet people are terrified of "socialized medicine" ignoring the fact that a significant portion of the population is already successfully receiving socialized care through Medicare, Medicaid, veterans benefits, etc. Le Sigh.

munk-a 2y ago
Medicaid in particular is managed by states and the service, reimbursement and access varies wildly between different locales. There is an elephant in the room that rarely gets the attention it deserves is that 17.3% of the US GDP is contained in the healthcare system. This problem has grown so large that if we fixed it suddenly we could see a tenth of our GDP simply vanish overnight and it'd cause economic shockwaves across America. Twenty years ago this problem could have been solved in a relatively smooth manner - at this point I don't even know if my personal dream of a perfect solution would cause more harm to average people's lives than it'd help. We are up a creek and determinedly throwing every paddle we find as far as we can manage.
- alistairSH 2y ago
  Somewhere between 15-30% of health care spending in the US can be classified as "waste" or "administrative overhead" (values and descriptions vary by study). Even if we cut that 15% waste in its entirety, that's moving us from 17.3% to 14.8%. Is that going to leave some administrative staff looking for jobs? Absolutely. But, I don't see that totally crashing the economy, not when that money is freed up for productive spending (more cars, more travel, more dining out, whatever).
  - deleted 2y ago
    [deleted]
  - munk-a 2y ago
    In the long term the market will absolutely adjust to more efficiently using that potential - but that's the long term. If America suddenly socialized health insurance millions of people[1] would be out of a job. The long term outlook of the economy would much better - but the short term would be extremely painful. 1. UHC appears to be about 440,000, CVS about 300,000, Elevance (aka Anthem) 104,900 - those are just a trio of the larger insurers out of hundreds.
    - alistairSH 2y ago
      That's assuming every job at those companies is absolute waste/overhead. I'm not convinced that's true. If we kill private insurance and move to Medicaid-for-All (I'm not suggesting this is the right approach, just thinking aloud here), the size of the Medicaid bureaucracy would have to grow, offering some of those former UHC/CVS/Anthem employees an "easy" transition into similar work. Anyways, no change this big would ever be made overnight. So, phase in changes over 5-10 years. Problem "solved".
      - stackskipton 2y ago
        It's not solved. I know many on this website have probably changed technology they used and used to learning but that's not the case for vast majority of people. They just want a job, pushing the buttons/emails, collecting a paycheck and doing not work thing. As non FAANG person, the number of developers I've met who continue to greenfield in Java 8 and .Net Framework is mind blowing and any attempt to make them learn something new falls on deaf ears.
- IncreasePosts 2y ago
  Wasn't Obama swayed against a single payer system, because eliminating all the middle men would end up with like 2 million people going unemployed?
  - alistairSH 2y ago
    More likely he was swayed because ACA was closer to a sure thing than anything remotely socialized.
  - mrguyorama 2y ago
    Obama was "swayed" because there were several "democrats" whose vote was required to pass anything who explicitly said they would not vote for single payer. People get this weird idea that democrats "aren't doing anything", but you need votes in the US system to do anything and democrats consistently lose elections. The people who stayed home and didn't vote will then insist that democrats didn't do enough to win their vote. But you can't do anything in the US without votes.
    - semiquaver 2y ago
      > whose vote was required to pass The 111th Congress had a historically large majority that has not been seen by either party since. https://en.m.wikipedia.org/wiki/111th_United_States_Congress https://en.m.wikipedia.org/wiki/111th_United_States_Congress They had more than enough votes: the ACA passed the senate 60-39. The senate filibuster that led them to compromise on the public option is a procedural rule that can be altered by simple majority, not a law.
      - alistairSH 2y ago
        Removing the filibuster is a "nuclear option" - once it's gone, when the Senate inevitably swings the other way, the new majority will make use of it's absence to ram through whatever they want. There are arguments that this would actually be preferable and moderating, but that's a whole other debate. The 60 member supermajority was also fragile. And only lasted 72 days. There was a time limit on passing anything major. None of which is to say your wrong, only that there was a bit more nuance than "Dems had majority and flubbed".
- dgfitz 2y ago
  I had to look it up, defense spending is 2.3ish% of GDP, and healthcare is 17.3% of GDP. There does seem to be a lot more fat to cut in healthcare than defense. I have never seen that number before, that is fascinating.
potato3732842 2y ago
Why would socializing or privatizing fix anything? The root problem is that there's too much fluff and middle men and bureaucracy and paper trail and it all has to be paid for.
- alistairSH 2y ago
  Simple answer: economies of scale. Would that be better than a true "free/open market"? No idea. But, it seems we get the worst of both systems in the US, which has led to all sorts of regulatory capture, massive administrative waste, etc.
  - Amezarak 2y ago
    I support M4A for other reasons, but as of today the US governments(s) spend more on health care per citizen than many/most European countries with universal health care. A little more than a third of Americans are on Medicaid and/or Medicare. The scale is already there and the costs are already out of control. I think the GP is right that the inefficiencies are baked in at every possible level. M4A makes people's lives easier, but it won't solve the cost problem. We're at a point where we need massive reform of the entire system, not just nationalization (or privatization, if you want to go that way), and there would be a lot of people unemployed (or suddenly asked to do a lot more work[1]) and a lot of pain re-aligning people's expectations around medical care. [1] One example of this is the degree of specialization and division of labor that is just wasteful. A friend has a medical job where he is on-call to monitor a machine. He does nothing else. He rarely works more than a few hours a week. Another example: a family member needed an ultrasound. The doctor's office had an ultrasound. The doctor wanted an ultrasound. It was urgent. The ultrasound tech had recently quit. He ordered an ultrasound from an imaging center with a two-month wait time instead of simply doing a very easy ultrasound himself, which he would be the one required to interpret anyway. He wasn't busy either; he chatted about golf for almost a half-hour. In his mind, it was simply not his job. (Perhaps insurance also won't compensate doctors for performing ultrasounds, only techs. Who knows.)
    - alistairSH 2y ago
myko 2y ago
I switched to VA healthcare totally since the PACT Act was signed. So nice not to have to worry about this shit anymore.