4 ms·

'It didn't use to be like this': woeful US healthcare system

30 points by howard941 2y ago

Taikonerd 2y ago
I wish that these "discussions about the US health insurance system" would lead to real change, but I'm pessimistic. The fact is that this is a deep, complicated topic, and the media cycle doesn't have the sustained focus for deep, complicated topics. We don't need 200 million people to care for a month; we need 200 thousand people to care for years and years to achieve reform.
- jrajav 2y ago
  I would bet a lot that more than 200k people in the US care very deeply about this. I agree that the crux of the issue is that the topic is deep and complicated and requires nuanced good-faith discussion and iteration over a long period of time to achieve good outcomes. However, I think the main blocker is that parties in America have succeeded in boiling it down to a naively simple and highly partisan issue, causing all progress to stagnate.
  - _DeadFred_ 2y ago
    None of the actors involved want it fixed. They just say 'it's really complicated and actually our part (insurance/doctors/hospitals) are doing it right, it's all the other parts that are broken. The nation has wanted to actively fix this since the 90s (30 years ago) and all that has happened is prices have gone up and we added ambulances to the list of unaffordable healthcare. After 30 years my take is no one involved is acting in good faith at this point and 'it's too complex to fix' means we gave you all time to fix it, you didn't, so we need to reboot from the ground up then.
    - Taikonerd 2y ago
      > so we need to reboot from the ground up then. Taiwan did exactly that in 1995: [0] Of course, rebooting your health system from scratch is sort of like rewriting your janky legacy software from scratch: more often fantasized about than done! [0]: The Leap to Single-Payer: What Taiwan Can Teach https://archive.is/m0go1 https://archive.is/m0go1
  - Taikonerd 2y ago
    Indeed. I've sometimes thought, "if we succeed in any big medical reform, it will be Medicare For All -- not because it's necessarily the best system, but because it's the easiest slogan to fit on a poster."
- llamaimperative 2y ago
  WSJ has been doing an excellent deep dive on United’s despicable vertical integration practices for a while. We had an administration that was pursuing an aggressive strategy against vertical integration, but I suspect that’ll fall by the wayside with the new FTC
- more_corn 2y ago
  It’s not complicated. We pay the world’s highest prices for the developed world’s worst outcomes. If we wanted to fix it we could simply copy the scheme used by whatever country gets the best outcomes at the lowest prices. It’s only complicated if your ideology doesn’t allow for evidence based decisions.
  - Taikonerd 2y ago
    Well, I would say: it's only complicated if it's constrained by politics... which it definitely is.
  - s1artibartfast 2y ago
    It is already more complicated than what you said. Outcomes for some are quite good and there are tons of differences between the US and any country to adjust for. Also, there is no country with both the best outcome and lowest price. Which balance of price and quality do you pick?
- potato3732842 2y ago
  It can't lead to change. Too many people's standard of living is dependent upon the status quo. https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/ https://www.statista.com/statistics/184968/us-health-expendi... That's 20% of the country that will be less well off if you "fix" healthcare in any meaningful way and the overwhelming majority of them will fight tooth and nail to prevent that from happening. That is a hell of a minority to overcome when the issue is one of personal economics (i.e one everyone will experience directly, not some abstract social policy thing that people will ignore as long as their lives are good), dare I say basically impossible in a democracy. (yes I know I'm assuming that the healthcare industry is a cross section of the country, no I don't care if that isn't 100% accurate)
y33t 2y ago
So I have a close family member dying right now from cancer. Had stage 4 for almost 10 years, and then insurance started denying scans (which in medical terms, cost next to nothing) and delaying surgeries (which led to the state getting involved). These months-long delays on surgeries, coupled with lack of information about the tumor due to not having scans, led to them getting the wrong surgery for a tumor (it had grown too big, which they didn't find out until they went in). Now it's blowing up and inoperable, when they could have taken care of it with a simple laparoscopic procedure when it was <1cm. This is a gold private plan, too, and they had paid premiums for decades. I'm absolutely disgusted in the US medical, insurance and legal systems after this. Nobody's going to jail for this. There's not even a fine. In fact, the system is working exactly as intended. Insurance just got sick of paying so they delayed everything so that this person would die and they could report higher earnings. What's really upsetting is seeing doctors and nurses discussing stories like this in the wake of Luigi Mangione, and these conversations just getting deleted from places like reddit. We're allowed to talk about the death of a health insurance CEO (as long as we aren't happy about it) but when the conversation shifts to the people who died prematurely due to him and his company's practices, it gets censored. Absolutely disgraceful. I don't believe in things like "deserve" (not after cancer anyway), but Brian Thompson should have got much worse than what he did.
- linotype 2y ago
  The fact that people are upset about the Healthcare CEOs death but not about the hundreds if not thousands of people he killed over the course of his career through denied claims/treatment says a lot about America.
  - MoreMoore 2y ago
    Well, I think it says more about mainstream media trying to paint Luigi as a villain and the CEO as an innocent victim, as well as social media suppressing any positive comments about Luigi. It's interesting to see the reach of the wealthy when Reddit started deleting entire posts and countless comments wholesale for simply being too supportive in any way. Everybody from the left to the right was ragging on insurance companies, but it took only a week before not a single post would show up anymore on all or popular. That's when reality of class warfare in modern society really sank in for me.
animitronix 2y ago
Executives should continue to be shot until morale improves.
iancmceachern 2y ago
As someone who has lived with a chronic lifelong condition since childhood, I know this struggle deeply. The only time I have had success is connecting with executives at the insurer on linkedin ( I work in medtech so that makes that easier) and then personally appealing to them, repeatedly, to help. Also, in every case, please report these things to the insurance boards in your state, your representatives, etc. Make it a process, get good at it. It's the only way to effect change.
iluvcommunism 2y ago
[dead]
treebeard901 2y ago
Medicine is science... Healthcare is a business.
- bdangubic 2y ago
  you are missing “in the united states” at the end of the sentence :)

30 points by howard941 2y ago

I wish that these "discussions about the US health insurance system" would lead to real change, but I'm pessimistic. The fact is that this is a deep, complicated topic, and the media cycle doesn't have the sustained focus for deep, complicated topics. We don't need 200 million people to care for a month; we need 200 thousand people to care for years and years to achieve reform.

jrajav 2y ago
I would bet a lot that more than 200k people in the US care very deeply about this. I agree that the crux of the issue is that the topic is deep and complicated and requires nuanced good-faith discussion and iteration over a long period of time to achieve good outcomes. However, I think the main blocker is that parties in America have succeeded in boiling it down to a naively simple and highly partisan issue, causing all progress to stagnate.
- _DeadFred_ 2y ago
  None of the actors involved want it fixed. They just say 'it's really complicated and actually our part (insurance/doctors/hospitals) are doing it right, it's all the other parts that are broken. The nation has wanted to actively fix this since the 90s (30 years ago) and all that has happened is prices have gone up and we added ambulances to the list of unaffordable healthcare. After 30 years my take is no one involved is acting in good faith at this point and 'it's too complex to fix' means we gave you all time to fix it, you didn't, so we need to reboot from the ground up then.
  - Taikonerd 2y ago
    > so we need to reboot from the ground up then. Taiwan did exactly that in 1995: [0] Of course, rebooting your health system from scratch is sort of like rewriting your janky legacy software from scratch: more often fantasized about than done! [0]: The Leap to Single-Payer: What Taiwan Can Teach https://archive.is/m0go1 https://archive.is/m0go1
- Taikonerd 2y ago
  Indeed. I've sometimes thought, "if we succeed in any big medical reform, it will be Medicare For All -- not because it's necessarily the best system, but because it's the easiest slogan to fit on a poster."
llamaimperative 2y ago
WSJ has been doing an excellent deep dive on United’s despicable vertical integration practices for a while. We had an administration that was pursuing an aggressive strategy against vertical integration, but I suspect that’ll fall by the wayside with the new FTC
more_corn 2y ago
It’s not complicated. We pay the world’s highest prices for the developed world’s worst outcomes. If we wanted to fix it we could simply copy the scheme used by whatever country gets the best outcomes at the lowest prices. It’s only complicated if your ideology doesn’t allow for evidence based decisions.
- Taikonerd 2y ago
  Well, I would say: it's only complicated if it's constrained by politics... which it definitely is.
- s1artibartfast 2y ago
  It is already more complicated than what you said. Outcomes for some are quite good and there are tons of differences between the US and any country to adjust for. Also, there is no country with both the best outcome and lowest price. Which balance of price and quality do you pick?
potato3732842 2y ago
It can't lead to change. Too many people's standard of living is dependent upon the status quo. https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/ https://www.statista.com/statistics/184968/us-health-expendi... That's 20% of the country that will be less well off if you "fix" healthcare in any meaningful way and the overwhelming majority of them will fight tooth and nail to prevent that from happening. That is a hell of a minority to overcome when the issue is one of personal economics (i.e one everyone will experience directly, not some abstract social policy thing that people will ignore as long as their lives are good), dare I say basically impossible in a democracy. (yes I know I'm assuming that the healthcare industry is a cross section of the country, no I don't care if that isn't 100% accurate)

y33t 2y ago

So I have a close family member dying right now from cancer. Had stage 4 for almost 10 years, and then insurance started denying scans (which in medical terms, cost next to nothing) and delaying surgeries (which led to the state getting involved). These months-long delays on surgeries, coupled with lack of information about the tumor due to not having scans, led to them getting the wrong surgery for a tumor (it had grown too big, which they didn't find out until they went in). Now it's blowing up and inoperable, when they could have taken care of it with a simple laparoscopic procedure when it was <1cm. This is a gold private plan, too, and they had paid premiums for decades. I'm absolutely disgusted in the US medical, insurance and legal systems after this. Nobody's going to jail for this. There's not even a fine. In fact, the system is working exactly as intended. Insurance just got sick of paying so they delayed everything so that this person would die and they could report higher earnings. What's really upsetting is seeing doctors and nurses discussing stories like this in the wake of Luigi Mangione, and these conversations just getting deleted from places like reddit. We're allowed to talk about the death of a health insurance CEO (as long as we aren't happy about it) but when the conversation shifts to the people who died prematurely due to him and his company's practices, it gets censored. Absolutely disgraceful. I don't believe in things like "deserve" (not after cancer anyway), but Brian Thompson should have got much worse than what he did.

linotype 2y ago
The fact that people are upset about the Healthcare CEOs death but not about the hundreds if not thousands of people he killed over the course of his career through denied claims/treatment says a lot about America.
- MoreMoore 2y ago
  Well, I think it says more about mainstream media trying to paint Luigi as a villain and the CEO as an innocent victim, as well as social media suppressing any positive comments about Luigi. It's interesting to see the reach of the wealthy when Reddit started deleting entire posts and countless comments wholesale for simply being too supportive in any way. Everybody from the left to the right was ragging on insurance companies, but it took only a week before not a single post would show up anymore on all or popular. That's when reality of class warfare in modern society really sank in for me.

animitronix 2y ago

Executives should continue to be shot until morale improves.

iancmceachern 2y ago

As someone who has lived with a chronic lifelong condition since childhood, I know this struggle deeply. The only time I have had success is connecting with executives at the insurer on linkedin ( I work in medtech so that makes that easier) and then personally appealing to them, repeatedly, to help. Also, in every case, please report these things to the insurance boards in your state, your representatives, etc. Make it a process, get good at it. It's the only way to effect change.

iluvcommunism 2y ago

[dead]

treebeard901 2y ago

Medicine is science... Healthcare is a business.

bdangubic 2y ago
you are missing “in the united states” at the end of the sentence :)