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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, complicat

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)

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)