4 ms·

The Americans simply will not reject their broken for-profit medical system wholesale. What I see is one more attempt at chipping away at it in hopes that maybe

The Americans simply will not reject their broken for-profit medical system wholesale. What I see is one more attempt at chipping away at it in hopes that maybe they can succeed piecemeal.

claytongulick 12d ago
I'm not sure anyone has solved the problem, though. "For profit" isn't really the problem, fee for service is. Value based arrangements and capitated payment structures are real improvements. When you don't have any market forces constraining utilization, you get massive access problems.
- Gigachad 12d ago
  I don’t think it’s useful to categorise these things as “solved” or “not solved”. They always exist on a scale. I can tell you I am infinitely more happy living with the Australian medical system than what the US has even if it isn’t flawless with zero issues left to deal with.
- robmccoll 12d ago
  The United States has both market forces and massive access problems. I'm not sure you can establish that causal relationship.
  - georgemcbay 12d ago
    > The United States has both market forces and massive access problems. It boggles my mind when I still occasionally hear people speaking out against all forms of single payer healthcare in the US saying they don't want to have to wait weeks/months to see a doctor like they do in Canada/UK/wherever. If I give them the benefit of the doubt of not being paid lobbyists for the medical insurance industry, I can only surmise these people haven't been to a non-emergency doctor since prior to 2020. Because even here in the US if you aren't fabulously wealthy with concierge medical you'll be waiting weeks/months to see a 'doctor'. And you'll almost certainly never actually see a doctor, you're going to see an overworked NP (no shade on NPs here, most of whom are great, just establishing how our medical system actually works in 2026).
    - LoganDark 12d ago
      I'm in the US, and I see my GP every two weeks + can arrange for an appointment within about a day or over the phone whenever I need it. If I need to be referred to a specialist though, I could be waiting months just for the initial consultation, and then months again before anything happens. Also, there just aren't specialists in my area for some things. Been trying to get a consult about dissociative disorder for years now. My GP is great though, he constantly tells me about exciting new papers he's been reading and he loves to share science and research level stuff. It's clear that he loves his job, it makes me super happy. (He's an MD, not NP, and he takes Medicaid)
    - milesskorpen 12d ago
      This is not my family's experience on distinctly not-concierge-medicine Kaiser Permanente in the Bay Area. Always meet with doctors (and NPs), have gotten in quickly when necessary, etc.
      - stephenhuey 12d ago
        California is the only state that regulates wait times for specialists. When you uttered the words "Bay Area" it signaled that you enjoy better service than most Americans. I know people in states very close to yours (as well as my own) who have had extensive wait times.
        JumpCrisscross 11d ago
        > California is the only state that regulates wait times for specialists Really?
    - throwup238 12d ago
      I don’t remember the last time I had to wait more than a few days to see a GP or more than a week for a specialist on an employer’s PPO insurance plan. I’ve had them at several employers ranging from university to FAANG so it’s not exactly something only fabulously wealthy people have access to. The problem is there is a huge bathtub curve in insurance quality between employers and the public market. It’s a rude awakening when you can’t afford COBRA rates and have to fall back to a “bronze plan” or whatever is available on the exchanges.
- prophesi 12d ago
  Not offering solutions here, because I think it's more multi-faceted than I know about. But when people are afraid to take on the debt of on-board EMS for a 911 call, and local pharmacies are forced out to be bought up by the top national pharmaceutical companies letting them rent-seek, I do think "for profit" is part of this multi-faceted problem.
- Wololooo 12d ago
  For profit IS the problem, the fundamental issue is that there are some services that needs to be run at a loss because the profit is the service which is being provided, that is the whole point of public service and paying taxes in order to have those operated. Now I'm not advocating for reckless spending, you can run services with reason while staying within a spending envelope, but there is a striking difference between entities that are specifically aligned for profit and those who aren't, and this is very noticeable in the health sector, in America, were wealth directly correlates with health.
999900000999 12d ago
Reagan and other racists succeeded in turning government benefits into a synonym for POC stealing from White Americans. It’s fine for a military defense contractor to go a few billion over budget for a weapons platform that barely works, but if a single mother uses food stamps to buy cake ingredients and then sells a few pieces of cake that’s a travesty. Millions of Americans, not just white, but plenty of Hispanics, Blacks and Asians too, voted to take away their own medical insurance. Because they know that they’re just temporarily embarrassed millionaires. Not the type of people who need handouts.

The Americans simply will not reject their broken for-profit medical system wholesale. What I see is one more attempt at chipping away at it in hopes that maybe they can succeed piecemeal.

claytongulick 12d ago

I'm not sure anyone has solved the problem, though. "For profit" isn't really the problem, fee for service is. Value based arrangements and capitated payment structures are real improvements. When you don't have any market forces constraining utilization, you get massive access problems.

Gigachad 12d ago
I don’t think it’s useful to categorise these things as “solved” or “not solved”. They always exist on a scale. I can tell you I am infinitely more happy living with the Australian medical system than what the US has even if it isn’t flawless with zero issues left to deal with.
robmccoll 12d ago
The United States has both market forces and massive access problems. I'm not sure you can establish that causal relationship.
- georgemcbay 12d ago
  > The United States has both market forces and massive access problems. It boggles my mind when I still occasionally hear people speaking out against all forms of single payer healthcare in the US saying they don't want to have to wait weeks/months to see a doctor like they do in Canada/UK/wherever. If I give them the benefit of the doubt of not being paid lobbyists for the medical insurance industry, I can only surmise these people haven't been to a non-emergency doctor since prior to 2020. Because even here in the US if you aren't fabulously wealthy with concierge medical you'll be waiting weeks/months to see a 'doctor'. And you'll almost certainly never actually see a doctor, you're going to see an overworked NP (no shade on NPs here, most of whom are great, just establishing how our medical system actually works in 2026).
  - LoganDark 12d ago
    I'm in the US, and I see my GP every two weeks + can arrange for an appointment within about a day or over the phone whenever I need it. If I need to be referred to a specialist though, I could be waiting months just for the initial consultation, and then months again before anything happens. Also, there just aren't specialists in my area for some things. Been trying to get a consult about dissociative disorder for years now. My GP is great though, he constantly tells me about exciting new papers he's been reading and he loves to share science and research level stuff. It's clear that he loves his job, it makes me super happy. (He's an MD, not NP, and he takes Medicaid)
  - milesskorpen 12d ago
    This is not my family's experience on distinctly not-concierge-medicine Kaiser Permanente in the Bay Area. Always meet with doctors (and NPs), have gotten in quickly when necessary, etc.
    - stephenhuey 12d ago
      California is the only state that regulates wait times for specialists. When you uttered the words "Bay Area" it signaled that you enjoy better service than most Americans. I know people in states very close to yours (as well as my own) who have had extensive wait times.
      - JumpCrisscross 11d ago
        > California is the only state that regulates wait times for specialists Really?
  - throwup238 12d ago
    I don’t remember the last time I had to wait more than a few days to see a GP or more than a week for a specialist on an employer’s PPO insurance plan. I’ve had them at several employers ranging from university to FAANG so it’s not exactly something only fabulously wealthy people have access to. The problem is there is a huge bathtub curve in insurance quality between employers and the public market. It’s a rude awakening when you can’t afford COBRA rates and have to fall back to a “bronze plan” or whatever is available on the exchanges.
prophesi 12d ago
Not offering solutions here, because I think it's more multi-faceted than I know about. But when people are afraid to take on the debt of on-board EMS for a 911 call, and local pharmacies are forced out to be bought up by the top national pharmaceutical companies letting them rent-seek, I do think "for profit" is part of this multi-faceted problem.
Wololooo 12d ago
For profit IS the problem, the fundamental issue is that there are some services that needs to be run at a loss because the profit is the service which is being provided, that is the whole point of public service and paying taxes in order to have those operated. Now I'm not advocating for reckless spending, you can run services with reason while staying within a spending envelope, but there is a striking difference between entities that are specifically aligned for profit and those who aren't, and this is very noticeable in the health sector, in America, were wealth directly correlates with health.

999900000999 12d ago

Reagan and other racists succeeded in turning government benefits into a synonym for POC stealing from White Americans. It’s fine for a military defense contractor to go a few billion over budget for a weapons platform that barely works, but if a single mother uses food stamps to buy cake ingredients and then sells a few pieces of cake that’s a travesty. Millions of Americans, not just white, but plenty of Hispanics, Blacks and Asians too, voted to take away their own medical insurance. Because they know that they’re just temporarily embarrassed millionaires. Not the type of people who need handouts.