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Healthcare is little more than a jobs program at this point. I believe it is the largest industry by employment in every single state now. That compounds the

Healthcare is little more than a jobs program at this point. I believe it is the largest industry by employment in every single state now. That compounds the problem even further. Really fixing it would put a double digit percentage of people out of work. I'm all for it, but I can see why politicians are hesitant.

Avicebron 1y ago
> Really fixing it would put a double digit percentage of people out of work. I'm all for it, but I can see why politicians are hesitant. I'd love to hear what you think "really fixing it" is, please share. I can report that all (almost all?) of the hospitals and their networks both big and small in the area I am in have had layoffs this year of admin staff and healthcare professionals (nurses, doctors, etc). They have reduced bed counts, and cut programs and treatment options available. All of this was done in the name of the "affordability crisis" and is kind of like the 3rd wave of this kind of consolidation, belt-tightening behavior. And..prices haven't gone down, and they keep cutting.
- silisili 1y ago
  I don't know all the answers, but I can tell you that cutting doctors and services is not what I had in mind. Mainly the behemoth that is everything tangential to that, namely insurance and pharma, for two. I worked on the insurance side(in tech), and most people wouldn't believe the number of people involved between the doctor getting money from the patient. On the contrary of your statement, I would also do everything I could to allow more (capable, of course) people to become doctors each year, though I'm not sure what all that would entail. It feels criminal to me that we limit residency while a) every doctor I've ever visited is way oversubscribed and in a hurry, and b) specialist appointments are months out.
  - Avicebron 1y ago
    Ok, I pretty much agree with everything you suggest. Browsing HN has conditioned me to react to sentiment like "healthcare...it's a jobs program...solve it by putting people out of work (the market will magically fix it)" to essentially be code for "I support continued abuse and further deprivations against the poor"
    - SR2Z 1y ago
      Healthcare is one of the rare examples where pretty much any reasonable-sounding change probably can't help but make things better.
  - hcknwscommenter 1y ago
    Get rid of Pharma and there will be zero new drugs or treatments ever again. Have fun with that.
- deleted 1y ago
  [deleted]
- A_D_E_P_T 1y ago
  > I'd love to hear what you think "really fixing it" is, please share. I'm not that poster, but there's a really easy fix: Just model the system after Hong Kong's. There's a tax-funded public system available to every citizen, so that everybody gets treatment. In practice, this is mostly utilized by the poor, and for emergencies like broken bones. You can see specialists via the public system, but there can be a wait of weeks to months. This is all effectively free. You'll never see a bill, or the bill will be extremely small. (e.g., $100 for four days of inpatient care.) There's a private system for those willing to pay. This is unrestrained capitalism with little regulation and no parasitic middlemen. Want to see a specialist right now -- like later this afternoon, or first thing tomorrow morning? Sure. It'll usually be $200 or $300 out of pocket. No insurance necessarily involved. Diagnostics are also super fast -- same day or next day, usually. If you want an elective surgery, or if you want a superior tier of care (like a nicer hospital room, better food, more flexibility re scheduling,) you can pay for it privately... And usually without getting insurance companies involved. There is effectively no "prescription" system. With very few exceptions for narcotics and certain stimulants, if you need a drug of any kind, you can buy it OTC. This includes steroids, weird nootropics, viagra (lol at needing a prescription for this), and all kinds of stuff. This vastly reduces the burden on the system. Hong Kong's system is superior in every respect, and it's especially better at treating you like an adult. The American system is simultaneously complex and infantilizing.
  - llbbdd 1y ago
    Aside from the prescription part, this is exactly 1:1 how it works in the US. I say this having myself and my family utilize all of it extensively, public tax-funded emergency treatment, inpatient coverage, private doctors and specialists.
    - A_D_E_P_T 1y ago
      The public system in Hong Kong doesn't really cost anything. It's not that you get costs "waived" if you whine hard enough that you ought to be a charity case (which, by the way, is degrading,) and it's not that costs are passed on to a middleman. Medical treatment is transparently priced and simply inexpensive -- so it's simply not a cause of bankruptcy in Hong Kong, whereas, in the US... > https://worldpopulationreview.com/country-rankings/medical-bankruptcies-by-country https://worldpopulationreview.com/country-rankings/medical-b... Also, perhaps because it's a lot more laissez faire, the private system in Hong Kong is almost unimaginably superior to the private system in the US. It's far cheaper because pricing is transparent and most people pay cash! (Cutting out that middleman.) It's higher quality because there's a lot more competition, rather than collusion among a few major providers.
- casenmgreen 1y ago
  In the UK, with the NHS, it seems the focus of the NHS became management, rather than clinical care. One example I read of stuck with me; a superb nurse, who ran her ward extremely well, had to leave clinical nursing because as a career path, it was a dead end. She had to move into management, and her former ward descended into chaos. NHS budget has last I knew increased many times over since 1948, but the bed count went from about 450k down to about 100k - and those numbers were from more than ten years ago. A theory is presented to explain this, which is that the more money you put in, the more management you get, and the more management you get, the less time clinical staff have for clinical work; more money results in less clinical output - but more managerial output, which theory argues is the primary focus and product of NHS.
  - bell-cot 1y ago
    This problem is far broader than health care. Doesn't matter whether your actual "product" is hospital wards, sheet steel, romance novels, or mowed lawns - if your sector of the economy is not structured to have draconian penalties for bloated management/bureaucracy/overhead, then it will quickly develop ever-worsening bloat. Because it's always quicker & easier to scale up the desks & paperwork. And guess who makes the decisions about where to allocate resources?
    - BobbyTables2 1y ago
      Seems like large tech companies never have a shortage of management. Between the matrix style organizational structure and the many layers (project manager, program manager, director, VP, senior VP, BU president, etc…), I would love to know what, if anything, the higher levels actually DO.
      - bell-cot 1y ago
        > I would love to know what, if anything, the higher levels actually DO. In many org's, they mostly compete with other higher-levels for status. And the biggest signifiers of status are usually (1) how many lower-level managers ultimately report to you, and (2) how many layers those lower-level managers span.
- b112 1y ago
  Beyond it being normally weird, that's a very weird thing to do. With the aging population, we'll need more and more health care professionals. I'm not just referring to people over 60, even people 40 upwards require more care.
  - hirvi74 1y ago
    I am not trying to start any sort of political discussion. However, I do not think many of the layoffs that have hit healthcare workers are due to maximizing profits for hospitals nor due to the lack of demand for healthcare. If I am not mistaken, the current administration has enacted changes that have caused a significant reduction in federal grant funding for hospitals. So, many of the layoffs, as I understand it, are to make up for the coming losses in funding. I live in a state with plenty of rural areas. There are growing fears of some rural hospitals being forced to completely shut down due to funding cuts.
- nobodyandproud 1y ago
  I have a perspective shift that may help: Physicians are the peak of blue-collar work. Yes, a lot of physician work involves diagnoses; but it also involves getting one’s hand dirty. Hospitals are the peak of shop and factory work. My wife, who worked as an RN in the OR is far handier with shop tools than I am as it’s time-sensitive physical labor! Meanwhile the jobs program are all of the white collar variety; jobs that purport to support our healthcare workers includes 100% of the health insurance companies and programs. Thanks to a generational messaging since the 1980s and 1990s, we white collar workers have wormed our way into all aspects of industry.
2OEH8eoCRo0 1y ago
My father's doctor says she doesn't want healthcare reform or more doctors because then their salaries will tank.
- EvanAnderson 1y ago
  This was the reason behind the AMA lobbying for the freeze on federally-funded residency slots back in the mid-90s (which is still being felt today, even after AMA has changed their tune).
- nobodyandproud 1y ago
  We now have noctors, and the physician role is now in danger of becoming supplanted by incompetent mid-levels with better people skills.
JTbane 1y ago
>Really fixing it would put a double digit percentage of people out of work. Eh, I kind of disagree. It would put a lot of insurance people and hospital admins out of a job, but the boots-on-the-ground providers would be fine.
wahern 1y ago
> I believe it is the largest industry by employment in every single state now. This made be curious, so I looked around. FWIW, healthcare constitutes ~11% of the workforce in the US. It's ~16% in Germany, ~10% in the UK, and ~5% in France. As a percentage of GDP healthcare is far higher in the US, of course.
- silisili 1y ago
  It's actually a really hard thing to track, and BLS does a poor job of it in my opinion. That 11% covers most but not even all people at a clinic or hospital. It counts people from doctors to records specialist, but not say, janitors or IT, and nothing outside of that like insurance. And that's not necessarily wrong to do, but makes it hard to grasp the whole size. If you add in everyone in insurance, pharma, devices, and the jobs those support, that number seems to be closer to 17% of the workforce from what I could put together. Not sure if those in Europe do it similarly, but it just feels like a huge number of people. Maybe that is the result of demographics and a topheavy population, though.
  - victorbjorklund 1y ago
    Doubt european numbers count insurance (public or private) pharmacy etc or all the jobs that support healhcare in general (powerplants, construction workers, restaurants, etc)
    - Yeul 1y ago
      Well when you get really down to it what is the most important thing in the world? Your health. Not much point being rich if you're in chronic pain. And thanks to technology and science our first world society's got really good at keeping people alive and relatively comfortable.
  - mjevans 1y ago
    It also doesn't count family members providing care for loved ones 'unpaid'. Nor does it count any of the people who really should have more or better care but don't get it.
esseph 1y ago
I'm not so sure. If we fix healthcare costs we can spend more on hospitals. With more hospitals means more jobs and more competitive care costs. In addition, a lot of those insurance jobs are facing pressure from "AI".
Yeul 1y ago
That is not exclusively an American thing. In my country currently 17% of the workforce is in healthcare. Probably need to start exporting more old folks to 3rd world countries where they can live out their days in resorts.
- Ekaros 1y ago
  Or simply let them die when they are too old to survive without most basic automatable care. Say robot dropping food at the door.
BobbyTables2 1y ago
I find the real problem is not the doctors, but the hospitals. For a simple outpatient procedure, the fee from the hospital dwarfs that of the anesthesiologist and surgeon. For an inpatient stay, the hospital charges thousands of dollars per night for a room! Makes the Ritz Carlton look cheap!
nly 1y ago
To be fair, the NHS is the largest employer is the UK as well https://en.wikipedia.org/wiki/List_of_largest_United_Kingdom_employers https://en.wikipedia.org/wiki/List_of_largest_United_Kingdom... Keeping people healthy is labour intensive.

Avicebron 1y ago

> Really fixing it would put a double digit percentage of people out of work. I'm all for it, but I can see why politicians are hesitant. I'd love to hear what you think "really fixing it" is, please share. I can report that all (almost all?) of the hospitals and their networks both big and small in the area I am in have had layoffs this year of admin staff and healthcare professionals (nurses, doctors, etc). They have reduced bed counts, and cut programs and treatment options available. All of this was done in the name of the "affordability crisis" and is kind of like the 3rd wave of this kind of consolidation, belt-tightening behavior. And..prices haven't gone down, and they keep cutting.

silisili 1y ago
I don't know all the answers, but I can tell you that cutting doctors and services is not what I had in mind. Mainly the behemoth that is everything tangential to that, namely insurance and pharma, for two. I worked on the insurance side(in tech), and most people wouldn't believe the number of people involved between the doctor getting money from the patient. On the contrary of your statement, I would also do everything I could to allow more (capable, of course) people to become doctors each year, though I'm not sure what all that would entail. It feels criminal to me that we limit residency while a) every doctor I've ever visited is way oversubscribed and in a hurry, and b) specialist appointments are months out.
- Avicebron 1y ago
  Ok, I pretty much agree with everything you suggest. Browsing HN has conditioned me to react to sentiment like "healthcare...it's a jobs program...solve it by putting people out of work (the market will magically fix it)" to essentially be code for "I support continued abuse and further deprivations against the poor"
  - SR2Z 1y ago
    Healthcare is one of the rare examples where pretty much any reasonable-sounding change probably can't help but make things better.
- hcknwscommenter 1y ago
  Get rid of Pharma and there will be zero new drugs or treatments ever again. Have fun with that.
deleted 1y ago
[deleted]
A_D_E_P_T 1y ago
> I'd love to hear what you think "really fixing it" is, please share. I'm not that poster, but there's a really easy fix: Just model the system after Hong Kong's. There's a tax-funded public system available to every citizen, so that everybody gets treatment. In practice, this is mostly utilized by the poor, and for emergencies like broken bones. You can see specialists via the public system, but there can be a wait of weeks to months. This is all effectively free. You'll never see a bill, or the bill will be extremely small. (e.g., $100 for four days of inpatient care.) There's a private system for those willing to pay. This is unrestrained capitalism with little regulation and no parasitic middlemen. Want to see a specialist right now -- like later this afternoon, or first thing tomorrow morning? Sure. It'll usually be $200 or $300 out of pocket. No insurance necessarily involved. Diagnostics are also super fast -- same day or next day, usually. If you want an elective surgery, or if you want a superior tier of care (like a nicer hospital room, better food, more flexibility re scheduling,) you can pay for it privately... And usually without getting insurance companies involved. There is effectively no "prescription" system. With very few exceptions for narcotics and certain stimulants, if you need a drug of any kind, you can buy it OTC. This includes steroids, weird nootropics, viagra (lol at needing a prescription for this), and all kinds of stuff. This vastly reduces the burden on the system. Hong Kong's system is superior in every respect, and it's especially better at treating you like an adult. The American system is simultaneously complex and infantilizing.
- llbbdd 1y ago
  Aside from the prescription part, this is exactly 1:1 how it works in the US. I say this having myself and my family utilize all of it extensively, public tax-funded emergency treatment, inpatient coverage, private doctors and specialists.
  - A_D_E_P_T 1y ago
    The public system in Hong Kong doesn't really cost anything. It's not that you get costs "waived" if you whine hard enough that you ought to be a charity case (which, by the way, is degrading,) and it's not that costs are passed on to a middleman. Medical treatment is transparently priced and simply inexpensive -- so it's simply not a cause of bankruptcy in Hong Kong, whereas, in the US... > https://worldpopulationreview.com/country-rankings/medical-bankruptcies-by-country https://worldpopulationreview.com/country-rankings/medical-b... Also, perhaps because it's a lot more laissez faire, the private system in Hong Kong is almost unimaginably superior to the private system in the US. It's far cheaper because pricing is transparent and most people pay cash! (Cutting out that middleman.) It's higher quality because there's a lot more competition, rather than collusion among a few major providers.
casenmgreen 1y ago
In the UK, with the NHS, it seems the focus of the NHS became management, rather than clinical care. One example I read of stuck with me; a superb nurse, who ran her ward extremely well, had to leave clinical nursing because as a career path, it was a dead end. She had to move into management, and her former ward descended into chaos. NHS budget has last I knew increased many times over since 1948, but the bed count went from about 450k down to about 100k - and those numbers were from more than ten years ago. A theory is presented to explain this, which is that the more money you put in, the more management you get, and the more management you get, the less time clinical staff have for clinical work; more money results in less clinical output - but more managerial output, which theory argues is the primary focus and product of NHS.
- bell-cot 1y ago
  This problem is far broader than health care. Doesn't matter whether your actual "product" is hospital wards, sheet steel, romance novels, or mowed lawns - if your sector of the economy is not structured to have draconian penalties for bloated management/bureaucracy/overhead, then it will quickly develop ever-worsening bloat. Because it's always quicker & easier to scale up the desks & paperwork. And guess who makes the decisions about where to allocate resources?
  - BobbyTables2 1y ago
    Seems like large tech companies never have a shortage of management. Between the matrix style organizational structure and the many layers (project manager, program manager, director, VP, senior VP, BU president, etc…), I would love to know what, if anything, the higher levels actually DO.
    - bell-cot 1y ago
      > I would love to know what, if anything, the higher levels actually DO. In many org's, they mostly compete with other higher-levels for status. And the biggest signifiers of status are usually (1) how many lower-level managers ultimately report to you, and (2) how many layers those lower-level managers span.
b112 1y ago
Beyond it being normally weird, that's a very weird thing to do. With the aging population, we'll need more and more health care professionals. I'm not just referring to people over 60, even people 40 upwards require more care.
- hirvi74 1y ago
  I am not trying to start any sort of political discussion. However, I do not think many of the layoffs that have hit healthcare workers are due to maximizing profits for hospitals nor due to the lack of demand for healthcare. If I am not mistaken, the current administration has enacted changes that have caused a significant reduction in federal grant funding for hospitals. So, many of the layoffs, as I understand it, are to make up for the coming losses in funding. I live in a state with plenty of rural areas. There are growing fears of some rural hospitals being forced to completely shut down due to funding cuts.
nobodyandproud 1y ago
I have a perspective shift that may help: Physicians are the peak of blue-collar work. Yes, a lot of physician work involves diagnoses; but it also involves getting one’s hand dirty. Hospitals are the peak of shop and factory work. My wife, who worked as an RN in the OR is far handier with shop tools than I am as it’s time-sensitive physical labor! Meanwhile the jobs program are all of the white collar variety; jobs that purport to support our healthcare workers includes 100% of the health insurance companies and programs. Thanks to a generational messaging since the 1980s and 1990s, we white collar workers have wormed our way into all aspects of industry.

2OEH8eoCRo0 1y ago

My father's doctor says she doesn't want healthcare reform or more doctors because then their salaries will tank.

EvanAnderson 1y ago
This was the reason behind the AMA lobbying for the freeze on federally-funded residency slots back in the mid-90s (which is still being felt today, even after AMA has changed their tune).
nobodyandproud 1y ago
We now have noctors, and the physician role is now in danger of becoming supplanted by incompetent mid-levels with better people skills.

JTbane 1y ago

>Really fixing it would put a double digit percentage of people out of work. Eh, I kind of disagree. It would put a lot of insurance people and hospital admins out of a job, but the boots-on-the-ground providers would be fine.

wahern 1y ago

> I believe it is the largest industry by employment in every single state now. This made be curious, so I looked around. FWIW, healthcare constitutes ~11% of the workforce in the US. It's ~16% in Germany, ~10% in the UK, and ~5% in France. As a percentage of GDP healthcare is far higher in the US, of course.

silisili 1y ago
It's actually a really hard thing to track, and BLS does a poor job of it in my opinion. That 11% covers most but not even all people at a clinic or hospital. It counts people from doctors to records specialist, but not say, janitors or IT, and nothing outside of that like insurance. And that's not necessarily wrong to do, but makes it hard to grasp the whole size. If you add in everyone in insurance, pharma, devices, and the jobs those support, that number seems to be closer to 17% of the workforce from what I could put together. Not sure if those in Europe do it similarly, but it just feels like a huge number of people. Maybe that is the result of demographics and a topheavy population, though.
- victorbjorklund 1y ago
  Doubt european numbers count insurance (public or private) pharmacy etc or all the jobs that support healhcare in general (powerplants, construction workers, restaurants, etc)
  - Yeul 1y ago
    Well when you get really down to it what is the most important thing in the world? Your health. Not much point being rich if you're in chronic pain. And thanks to technology and science our first world society's got really good at keeping people alive and relatively comfortable.
- mjevans 1y ago
  It also doesn't count family members providing care for loved ones 'unpaid'. Nor does it count any of the people who really should have more or better care but don't get it.

esseph 1y ago

I'm not so sure. If we fix healthcare costs we can spend more on hospitals. With more hospitals means more jobs and more competitive care costs. In addition, a lot of those insurance jobs are facing pressure from "AI".

Yeul 1y ago

That is not exclusively an American thing. In my country currently 17% of the workforce is in healthcare. Probably need to start exporting more old folks to 3rd world countries where they can live out their days in resorts.

Ekaros 1y ago
Or simply let them die when they are too old to survive without most basic automatable care. Say robot dropping food at the door.

BobbyTables2 1y ago

I find the real problem is not the doctors, but the hospitals. For a simple outpatient procedure, the fee from the hospital dwarfs that of the anesthesiologist and surgeon. For an inpatient stay, the hospital charges thousands of dollars per night for a room! Makes the Ritz Carlton look cheap!

nly 1y ago

To be fair, the NHS is the largest employer is the UK as well https://en.wikipedia.org/wiki/List_of_largest_United_Kingdom_employers https://en.wikipedia.org/wiki/List_of_largest_United_Kingdom... Keeping people healthy is labour intensive.