> 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.
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.
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"
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.
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?
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.
> 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.
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.
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.
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.
> 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.
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.
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...
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.
Nearly identical with a coat of paint. Every "horror story" I've heard about having to beg with the health system here is tellingly parroted by people who do not have experience with the system. It is the default to get itemized bills when you are insured and the outcome is the same. And again, there is nothing unusual about private care in the US - I pay cash, direct, a small amount monthly, for excellent private care. The ghost people claim to haunt US healthcare is mostly propaganda that for some reason is consumed wholesale by people outside the US who have no stake in it.
You are completely wrong, and I can almost hear in my mind how you think something you are promoting as true, is 'basically true' - but please know there are plenty of people reading HN from afar and may come to expect 'free healthcare in US (just go to the ER!)' from your comments.
No it is not.
Lots of experience with the health system in the US, for me, and helping many other navigate the systems.
It's not even close to identical. If you go to ER here and you can't pay, they may provide you with a certain level of 'care' to 'stabilize you' (as the law says they are supposed to, and the feds send some money to hospitals to cover some of this), and you will get billed, and collections calling, and credit report issues, and threats to sue and have your property auctioned (have held one of these letters in my hand, complete with a list of property that was in my name.
Even worse, the 'care' you may get is normally crap. For example I have seen the same people with same condition, at one hospital get a quick surgery and leave with a colostomy bag for rest of life, and other person at other hospital with insurance get placed in a room and treated for weeks - then left with a warning to avoid seeds.
I have seen so many examples of places leaves humans to rot with no insurance - hospitals.
Even with insurance, you can find yourself waiting 6-8 weeks for a doc appointment. I have so many examples.
On reread: worth noting that the link you provided for some reason includes "missed more than 2 weeks of work" under "medical bankruptcy". I won't dismiss that out of hand without knowing more but that smells bad.
No, it’s not. Yes, we have Medicaid in the U.S., which makes everything free for the poor, but GP is saying that effectively everybody (including the not-so-poor) can get this level of care in Hong Kong. Definitely not true in the U.S.!
Pricing transparency also does not exist here as GP is claiming it does in Hong Kong. I am supposed to get certain imaging tests done every year, and I never know how much those will cost me until after I have already done them (in the U.S.). Maybe there is some way to get a non-binding estimate ahead of time, but I have never received such a thing and am not even sure it is possible. So I can’t easily “shop around”—or if can, tell me how because I (and I think most people) don’t know how.
I most certainly cannot pay $300 to see a specialist the same day in the U.S. I would have to pay that much to see my GP after waiting 6 weeks despite my employer paying more than $20k/year to insure my family. To see a specialist, I would have to wait a few months and probably pay $1-2k for one visit, not counting any tests or imaging that is ordered.
The description of Hong Kong’s system sounds amazing if true.
How free do you want it? Emergency healthcare is free at point of service in the US. Most other healthcare is covered partially or entirely if you're employed, which you should be. I've had hundreds of thousands of dollars of inpatient medical care for my family that I paid nothing for. Every other metric just starts to deal with the impact of taxes on the definition of free. I'm sure there are countries with systems that are fuzzier feeling to use, but this one works just fine until someone invents infinite unlimited free doctors to replace it.
I agree the US system mostly works for well-employed people.
It is worth recognizing though that not all employed people get medical benefits. Indeed many minimum wage jobs, low income jobs, "casual" jobs etc come with no medical benefits.
It's also worth noting that I some states it's OK to get fired for being sick. At which point you may lose those benefits.
Plus in poor economic times (like being a federal worker right now) losing your medical because you lost your job, seems like a suboptimal outcome.
But I agree with your last statement, this system works just fine, for a large enough group, so there's little political incentive to change it.
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.