The American Healthcare Conundrum • Hacker News Board

Re: The American Healthcare Conundrum

#501

Post by ethbr1 » Tue, Mar 17, 2026, 4:22 PM UTC

anon7000 wrote: post #373

cmiles8 wrote: post #337

Earlier quoted context omitted.

Prescriptions are a total racket. A good portion of actual medication literally costs a few dollars at most. Then there’s layer upon layer of bloat and bureaucracy that add no value but drive the cost up 10x or more. It’s totally bonkers. When these Rx cards and Marc Cuban CostPlus drugs came out where you just pay cash and a fraction of the price I thought there must be some catch or scam here. But turns out no, the…

> It’s their job to get better prices at scale and yet somehow they manage to sell at prices far worse Maybe on paper, in reality their job is to return as much profit as possible to shareholders. Convoluted bureaucracy, complicated regulations, layers of useless middlemen… they all help to reduce competition and increase profits. There are industries where the “free” market doesn’t work, partly because “human well-b…

> The entire point of the insurance business model is to avoid paying for [human well-being] as much as possible

For-profit health insurance. Which imho should be illegal.

A lot of the US' quasi free-market, in-name-only health insurance problems would be solved by:

1. Requiring all insurers to be not-for-profit (critically: also including all corporate owners of insurers too)

2. Tying financial incentives and disincentives to outcome-based KPIs

Re: The American Healthcare Conundrum

#502

Post by iwontberude » Tue, Mar 17, 2026, 4:23 PM UTC

throwaway173738 wrote: post #400

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…

Oh you must have United Healthcare. Yeah they do this with IVF drugs too, and I’m sure with chemotherapy drugs. Plus it all has to be shipped so if you’re mid-cycle and the doctor orders a different medication you either waste the benefits or pay out of pocket. And they structure all their pricing so the fertility benefit covers a cycle but the medications aren’t fully covered so you pay out of pocket in medication t…

If you are on UnitedHealth and reading this, switch to Kaiser HMO next open enrollment, you will not regret it. It’s worth far more than the UnitedHealth PPO, they have plenty of availability for appointments and lots of remote options. They don’t skimp on screenings and radiology, their pharmacy is fairly priced. You can go in for a single appointment and get 4 things accomplished (physical checkup, blood draw, prescription transfer, physical therapy sign up and more) in 45 minutes. The people are nice and you have tons of locations nearby.

Re: The American Healthcare Conundrum

#503

Post by hirako2000 » Tue, Mar 17, 2026, 4:25 PM UTC

zk_haider wrote: post #498

Healthcare is the one industry we need AI or automation to take over large parts, and a hostile Uber style industry take-over. Make treatment stupidly cheap with innovations, watch the corrupt racket unfold.

Mark Cuban is at it. I doubt the Uber trick would work. Because as with banks, innovative and more efficient businesses get bought out. Or engage in the racket once they make it.

Re: The American Healthcare Conundrum

#504

Post by estearum » Tue, Mar 17, 2026, 4:25 PM UTC

triceratops wrote: post #481

estearum wrote: post #472

Earlier quoted context omitted.

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 ob…

Residency training costs like $750,000 to $1.5MM per physician

Primary care doctors would have to work 12-15 years while giving up 25% of their gross salary just to pay for the residency program. They'd also have to pay x% of their salary to pay for their debt from med school training before the residency.

People just wouldn't go into the field, which is already happening even in a world where the residency is funded. The economics of being a doctor are simply not that great anymore, especially relative to other things you could do.

> 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.

There is an infinite number of jobs that would be great to have but we can't reasonably fund and so don't exist.

We currently live in a timeline where there are no new personal one-to-one tutors for middle schoolers and therefore every single middle schooler in the country receives subpar education, causing vast amounts of economics losses as compared to if they could be trained more thoroughly.

But that's just the way it is!

Re: The American Healthcare Conundrum

#505

Post by rickydroll » Tue, Mar 17, 2026, 4:26 PM UTC

onlyrealcuzzo wrote: post #437

rickydroll wrote: post #434

Earlier quoted context omitted.

Breaking the existing system will be extremely difficult. I have decade-long relationships with all of my doctors. The thought of a health plan that forces me to change all my doctor relationships is anger-provoking and exhausting. New doctors don't know me, they don't know my history, and haven't seen the medical shit show you've been through and why your treatment is the way it is. Then they think they can change y…

> I have decade-long relationships with all of my doctors. The thought of a health plan that forces me to change all my doctor relationships is anger-provoking and exhausting. You are clearly not in the bottom 50% of health care spenders. You would be in the group that would keep private insurance and be happy. > One Medical looks interesting, but I wonder how they keep the price that low. Is it subsidized? No. > Are…

That's a mighty big assumption you're making. I've had private insurance for years, and I've always been unhappy with it because of treatment delays, Treatment denials, pre-approvals, and unrealistic copay limitations.

Many of my health needs are not expensive, but my body's reaction to treatments is. Frequently, cheap drugs are all side effects and no benefit. Also, private insurance has bizarre coverage gaps. For example, ambulance costs. When I had a heart attack, I drove myself for 45 minutes to the nearest hospital with a cath lab rather than take an ambulance and end up with God knows how many thousands of dollars in uncovered ambulance fees. Then there are things like cardiac rehab, which go a long way toward restoring cardiac health. 12 weeks, three times a week at $50 copays, was an expense I wasn't counting on. When I qualified for Medicare, the quality of care improved significantly. Usually, wait times for service are much lower than with private insurance.

I also resent private insurance because my premium dollars go toward enriching stockholders rather than providing care for all policyholders.

Re: The American Healthcare Conundrum

#506

Post by snarfy » Tue, Mar 17, 2026, 4:29 PM UTC

If healthcare was cost competitive there would be prices listed like a fast food restaurant.

Re: The American Healthcare Conundrum

#507

Post by onlyrealcuzzo » Tue, Mar 17, 2026, 4:36 PM UTC

UncleOxidant wrote: post #492

onlyrealcuzzo wrote: post #391

Earlier quoted context omitted.

> You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it, which is when they get old. I strongly think that covering everyone in the existing system is not the best way to go. The existing system is designed to cost as much as possible, and we have way too much demand for treatment (as is) and not enough supply. ER…

> We simply do not have enough doctors We're going to need to make more doctors. To do that we'll need to identify kids in high school that would be good candidates and offer full-ride scholarships where needed. And we need to improve science education at the high school level to help with all of this.

> To do that we'll need to identify kids in high school that would be good candidates and offer full-ride scholarships where needed. And we need to improve science education at the high school level to help with all of this.

We could import them.

We have tons of options. But the medical industry likes a shortage, because they like high wages, so I won't hold my breath.

They pick the rules. The rules favor them.

That's going to remain true for the foreseeable future, and on the list of problems, that's at the absolute bottom of things to fix that would actually move the needle.

The cost you spend on DIRECT HEALTHCARE is only ~20-30% of all spending. The rest is administration, drugs, insurance overhead, profits, ACTUAL insurance costs, cost overruns due to insurance making everything as expensive as possible to scrape 15% off the top, fraud, legal fees, etc.

The biggest benefit to moving to a centralized insurer is that fraud is centralized.

If you're a Republican and skeptical of government, you might assume the government will let massive fraud slip through to insiders, and you don't like that.

If you're a Democrat, and think the government can generally be good, you think the government can catch a lot of the fraud and cut total costs by 10% to get to fraud levels that are similar to other advanced countries (with similar systems).

Re: The American Healthcare Conundrum

#508

Post by jonas21 » Tue, Mar 17, 2026, 4:37 PM UTC

JKCalhoun wrote: post #144

legitster wrote: post #91

Earlier quoted context omitted.

The US also has GDP per capita of $90k and Japan has a GDP per capita of ~ $35k. Put another way, in both countries a hip replacement surgery is almost exactly 1/8 of someone's per capita GDP.

Too bad Walmart greeter isn't making "per capita GDP".

The Walmart greeter also isn't paying for the bulk of their healthcare expenses because Walmart provides subsidized health insurance to all employees who work at least 30 hours per week. All US employers with at least 50 employees are required to do so under the ACA. If the greeter worked fewer than 30 hr/wk, they wouldn't get insurance through Walmart, but they would likely qualify for an ACA subsidy that covered close to the entire cost of a health insurance plan on the marketplace.

The statement, "The US spends ~$14,570 per person on healthcare. Japan spends ~$5,790" is about the average amount that the country as a whole is spending per person on healthcare, not what any given individual is paying. Per-capita GDP (i.e. the average economic output per person) is the most relevant comparison.

Re: The American Healthcare Conundrum

#509

Post by nsvd2 » Tue, Mar 17, 2026, 4:40 PM UTC

anon7000 wrote: post #373

cmiles8 wrote: post #337

Earlier quoted context omitted.

Prescriptions are a total racket. A good portion of actual medication literally costs a few dollars at most. Then there’s layer upon layer of bloat and bureaucracy that add no value but drive the cost up 10x or more. It’s totally bonkers. When these Rx cards and Marc Cuban CostPlus drugs came out where you just pay cash and a fraction of the price I thought there must be some catch or scam here. But turns out no, the…

> It’s their job to get better prices at scale and yet somehow they manage to sell at prices far worse Maybe on paper, in reality their job is to return as much profit as possible to shareholders. Convoluted bureaucracy, complicated regulations, layers of useless middlemen… they all help to reduce competition and increase profits. There are industries where the “free” market doesn’t work, partly because “human well-b…

In no way shape or form is the medical industry in the US a free market, it's one of the most heavily regulated sectors in the economy. Remember when the government wanted to make purchasing health insurance mandatory? Forcing employers to pay for their employees health insurance greatly distorts the market. And many other things...

By the way, as much as people complain about the profit seeking motives of insurers, many of them have been performing abmysally in the last six months. As it turns out, our current system is bad for just about everyone.

Re: The American Healthcare Conundrum

#510

Post by orange-mentor » Tue, Mar 17, 2026, 4:40 PM UTC

wat10000 wrote: post #100

underlipton wrote: post #80

No debate about the viability of Medicare-For-All is made in good faith, at this point. The only valid debates are about implementation. No one should entertain any move conversations about whether we should go to a single-payer system, only how we should.

Why? I’m in favor of reform and making our system more like other developed nations. But single payer isn’t the only way it’s done, not even the most common way.

The reason is because Medicare for All is viable both politically and implementation-wise. It's been studied for decades and the bills are already written. Just phase it in by stepping it down: 65+, 55+, 45+, everybody.

All providers already accept Medicare.

The only disruptions will be to private insurance, which is a backdoor white-collar, make-work jobs program for millions of Americans. But most jobs are bullshit anyways. That's a broader problem and we don't need to sacrifice lives to deal with it.