The American Healthcare Conundrum • Hacker News Board

Re: The American Healthcare Conundrum

#481

Post by triceratops » Tue, Mar 17, 2026, 3:52 PM UTC

estearum wrote: post #472

triceratops wrote: post #463

Earlier quoted context omitted.

Why does the government need to spend money on slots at all? Do other countries do it like that?

Because it makes pretty much no economic sense for anyone else to do it One of many failure modes of the glorious and totally perfect Free Market Yes most other countries use public money to educate their doctors

> Because it makes pretty much no economic sense for anyone else to do it

I think other funding models simply haven't been explored. I'll pull one out of my ass. The hospital does it themselves. In exchange the doctor works at the hospital for the next N years, or pays a contract break penalty. The hospital can pay the doctor somewhat less than market rate and doesn't have to deal with staff turnover.

It should be obvious that other funding models will be invented if government funding goes away. Because the alternative is no new doctors and people start dying without treatment.

Re: The American Healthcare Conundrum

#482

Post by whatever1 » Tue, Mar 17, 2026, 3:52 PM UTC

turbotim wrote: post #333

whatever1 wrote: post #328

The problem with healthcare is that it can have infinite cost. The question that each society tries to answer is how much are they willing to pay to prolong the life of each individual. There are no right answers unfortunately, as all of them lead to preventable deaths. But some of them at least promote the concept of a caring society.

One example of this calculation is QALYs (Quality Adjusted Life Years) which is used in the UK to determine what drugs are worthwhile: https://www.nice.org.uk/news/articles/changes-to-nice-s-cost...

Adding a formula just hides the harshness of the decision. It does not change the fact that some people who could have been saved, will die as a result of the policy.

All answers are wrong. But at least the one that you highlight can help us track over time if we are making progress to saving more people.

Re: The American Healthcare Conundrum

#483

Post by orangecat » Tue, Mar 17, 2026, 3:58 PM UTC

nullpoint420 wrote: post #439

heyitsmedotjayb wrote: post #436

Earlier quoted context omitted.

> Last year this podcast said that nobody wants to solve this because solving it is going to eliminate (IIRC) hundreds of thousands of jobs. Which is a point to consider. Why not simply hire them to do something that isn't pointless - like dig ditches or clean garbage

You could say the same to tech workers after AI.

And you'd be right. Forbidding efficiency improvements in order to preserve jobs is the correct solution approximately never.

Re: The American Healthcare Conundrum

#484

Post by sneak » Tue, Mar 17, 2026, 3:58 PM UTC

hdgvhicv wrote: post #318

sneak wrote: post #275

Earlier quoted context omitted.

If everyone could control their weight via simply willing themselves to have more self-control, then nobody would be fat. Self-control is, ironically, not usually within one’s self control. Most people don’t contemplate very deeply about the gap between their will and their behavior. I’m extremely focused on self-determination and it’s absolutely astounding (and irritating) to me how little control I have over my act…

Companies make a fortune from creating that lack of “self control”

No, they didn’t create it. They created the circumstances where it causes certain types of purchasing and consumption behaviors. The lack of self control was always there, just waiting for those circumstances to bring out the effects of the lack of self control.

Most people vastly overestimate how much they are actually in charge of their life.

Re: The American Healthcare Conundrum

#485

Post by Ichthypresbyter » Tue, Mar 17, 2026, 3:59 PM UTC

estearum wrote: post #447

Taikonerd wrote: post #418

Earlier quoted context omitted.

> We can still have your employer provide a X% or $Y to an HSA account that the employee can buy health coverage wherever they like. (I'm not optimistic that this will ever happen politically) Doesn't this already partly exist? My (US) employer offers an HDHP (high-deductible health plan) that comes with an HSA. (It's not quite what you described, because you have to use the insurer that the company picked. I think y…

I think the mechanic they're trying to speak to is that due to insurance being tied to employer, no insurance plan (besides Medicare/Medicaid) is truly motivated to ensure good health outcomes beyond a ~4 year horizon. You'll switch jobs and get a different plan.

FEHB plans would also have this incentive. I think at least historically Federal employees didn't switch employers as much (though job-hopping between agencies happens), but more importantly if you retire from the Federal government you keep your health insurance.

Re: The American Healthcare Conundrum

#486

Post by pjc50 » Tue, Mar 17, 2026, 3:59 PM UTC

1234letshaveatw wrote: post #471

alexfoo wrote: post #347

Earlier quoted context omitted.

This always baffles me. There’s so much rampant profiteering in the US healthcare system it’s unbelievable. Other countries look at it from afar in utter disbelief. I’m glad I had no serious health problems when I lived there 25 years ago (and I had health insurance via my employer). In the UK prescriptions are effectively capped at about USD125 per year: https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-pr..…

What an amazing system! Poof! just like magic you can pretend that sophisticated medicines, that are years in development, should cost nothing just because! And then you can act all smug about it!

Cost nothing to the user, yes. You can then have the state, a sophisticated purchaser, decide what it's willing to pay.

Re: The American Healthcare Conundrum

#487

Post by thayne » Tue, Mar 17, 2026, 4:02 PM UTC

TuringNYC wrote: post #327

The problems are so vast it is difficult to even describe to outsiders. For example, if I purchase a particular medication at a local pharmacy, it costs $25. However, my insurer mandates that I purchase it via their Pharmacy Benefit Managers (PBM) Optum, which charges $125. Easy enough right, you price shop? Well then it doesnt count towards your deductible. The whole thing is an elaborate trap to not pay. Sometimes…

Another example, I needed to rent some medical equipment which was pretty inexpensive. But for some unfathomable reason the insurance required that if that was rented, I also had to rent some other equipment that was like 20x as expensive that I didn't need at all. As well as purchase some disposable stuff, that I would not use, and could not be returned or used by someone else. And paying for just the things I actually needed myself without insurance wasn't an option.

Re: The American Healthcare Conundrum

#488

Post by deltoidmaximus » Tue, Mar 17, 2026, 4:05 PM UTC

dzink wrote: post #262

Huge chunk of the costs come from the fact that Doctors pay astronomical malpractice insurance rates in some states with no tort reform. Some have to spend more than 100k on insurance - 1/3 of their total pay. Since some states allows multi-million dollar judgments from juries that raises insurance everywhere, which raises not only prices for everyone but also dramatically contributes to more procedures and tests bei…

Maybe if we didn't have enormously expensive healthcare that is tried to our employers the payouts would need to be so huge. If I'm injured by medical malpractice and can't work I'm going to need a lot of money to make me whole in the US, even more so if I need additional medical treatment.

Re: The American Healthcare Conundrum

#489

Post by kraig911 » Tue, Mar 17, 2026, 4:06 PM UTC

TuringNYC wrote: post #327

The problems are so vast it is difficult to even describe to outsiders. For example, if I purchase a particular medication at a local pharmacy, it costs $25. However, my insurer mandates that I purchase it via their Pharmacy Benefit Managers (PBM) Optum, which charges $125. Easy enough right, you price shop? Well then it doesnt count towards your deductible. The whole thing is an elaborate trap to not pay. Sometimes…

try being diabetic ugh. I am constantly grinding against made up barriers. 150$ in strips and about 500-700$ for insulin. Meanwhile I meet a friend and he's just buying the base insulin from walmart for about 50$ a vial.

Re: The American Healthcare Conundrum

#490

Post by 46493168 » Tue, Mar 17, 2026, 4:08 PM UTC

jkestner wrote: post #459

46493168 wrote: post #380

Earlier quoted context omitted.

The United States will never have universal healthcare because a subset of the population would rather pay more for worse health outcomes than participate in a system the provides abortions, HRT, or PreP, or any healthcare at all to Black people. See, for example, “Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland” by Jonathan Metzl

But they’re a subset. It can happen. The more critical, and yet smaller, subset is the people making bank from the current system. Get their money out of politics and watch resistance crumble.

Yes, precisely. The smaller subset that make bank from the current system directly benefit from us poors (aka non-billionaires) from blaming the person lower on the ladder.