The American Healthcare Conundrum • Hacker News Board

Re: The American Healthcare Conundrum

#561

Post by Nicook » Tue, Mar 17, 2026, 6:02 PM UTC

adventured wrote: post #551

bhelkey wrote: post #545

Public perception is that the US is not willing to pay for universal healthcare. However, the US spends enough money, it just spends it inefficiently. The US spends ~$900 Billion a year on Medicaid [1] and ~$1.1 Trillion a year on Medicare [2]. If the US spent this money as efficiently as Japan (or UK [3], ...) it could pay for Universal Healthcare without increasing its budget. [1] https://www.kff.org/medicaid/medic…

Incomes are dramatically higher in the US than in Japan. Their economy has imploded so badly due to debt + currency destruction that they're now just barely above Lithuania (which has come a long ways of course) on economic output per capita. Japan is no longer a primary economic power and their (perpetually falling) purchasing power + incomes represent that. US GDP per capita is estimated at $92,000 for 2026. Norway…

Japan is also way thingger than America, which the article points out: > The US spends ~$14,570 per person on healthcare. Japan spends ~$5,790 and has the highest life expectancy in the OECD. That gap is roughly $3 trillion per year.

Need to have people go in for checkups and get shamed for unhealthy habits, not really a money question.

Re: The American Healthcare Conundrum

#562

Post by techcam » Tue, Mar 17, 2026, 6:03 PM UTC

This resonates — most of the hard problems show up after you ship, not before.

Re: The American Healthcare Conundrum

#563

Post by dzink » Tue, Mar 17, 2026, 6:04 PM UTC

deltoidmaximus wrote: post #488

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.

The money that goes to the injured is dramatically smaller than the money that everyone in the system pays to cover the insurance liability calculated insurance rates when the payouts can be arbitrarily set by juries. So if one jury says 600 million for one egregious case, all insurance for all doctors and all care for all patients skyrockets to trillions based on the risk assessment of insurers at that point. It is better to manage the risk with better measures (some states have a damage pool)

Re: The American Healthcare Conundrum

#564

Post by SoftTalker » Tue, Mar 17, 2026, 6:04 PM UTC

mekdoonggi wrote: post #553

SoftTalker wrote: post #529

Earlier quoted context omitted.

Your private insurance isn't there (ideally) to pay for your preventative care, which you can easily pay for out of pocket. It's there to pay for the low-probability but very expensive scenarios, such as cancer, major accident/injury, etc. that would otherwise bankrupt you.

I understand how insurance is supposed to work. The problem is that private insurance captures all of the value I pay in during my working life, and doesn't have to pick up the tab when I inevitably get old and sick. To use car insurance as an example, it would be like if we had a government program for cars over 150k miles. You have to pay for both private and government insurance. The private company collects more…

The value is that it is there. Most insurance isn't used, or ever pays back what you paid into it. That's the point; that's how it's a viable product. There's no way to insure old, sick people, that's why the government does it. It would be like selling automobile insurance only to drunk drivers, or selling homeowners insurance to people whose houses are already on fire.

Re: The American Healthcare Conundrum

#565

Post by onlyrealcuzzo » Tue, Mar 17, 2026, 6:09 PM UTC

46493168 wrote: post #540

onlyrealcuzzo wrote: post #519

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. This subset does exist, but is smaller than the percentage of people who think the system is broken - and the solution is not to just open up the floodgates and make it ev…

>You FIRST have to fix the system before you open up the floodgates. I don't see any reason to fix the system on a nationwide level. Let the individual states figure it out. There's things that the top 5 US states for healthcare have in common, and there's things that the bottom 5 US states have in common [0]. They know how to talk to each other if they want to know more. [0] https://www.commonwealthfund.org/publicat…

> I don't see any reason to fix the system on a nationwide level. Let the individual states figure it out.

It's a problem because the nation already ineffectively covers the tail.

The state shall not fix what is not a problem for the state.

Re: The American Healthcare Conundrum

#566

Post by mlmonkey » Tue, Mar 17, 2026, 6:12 PM UTC

onraglanroad wrote: post #228

sudopsuedo wrote: post #221

Earlier quoted context omitted.

The 9.2% figure is pharma's direct share of NHE, but drugs are a net-positive externality. Cheap statins can stave off cardiac surgeries, GLP-1 can stave off bariatric surgeries, etc. It's ridiculous to conclude we would only save 9.2% on costs--this is not zero-sum. No comment on drug pricing and its incentives, the existence of America's prescription drug markets drives the new innovative drugs that the rest of the…

> the existence of America's prescription drug markets drives the new innovative drugs that the rest of the world picks up for cheap. That's the ludicrous propaganda that you've been fed but you really should be intelligent enough to dismiss it. The world would get along just fine without you overpaying for your drugs. You pay for marketing costs.

Agreed. I mean, where did the COVID mRNA vaccine come from? Which company makes the GLP-1 inhibitors like Ozempic and Mounjaro? Are these American companies?

Re: The American Healthcare Conundrum

#567

Post by pif » Tue, Mar 17, 2026, 6:14 PM UTC

joe_mamba wrote: post #464

bigfudge wrote: post #408

Earlier quoted context omitted.

This is unnecessarily confrontational. The real point here is that there better functioning democracies than the US. They have faults, but Scandinavia and much of northern Europe (partially excluding the UK) much better approximates what you call a fairytale than a US perspective might allow you to believe. Trust in and satisfaction with government institutions in Scandinavia and Finland are much, much higher than in…

>This is unnecessarily confrontational. Why? >but Scandinavia and much of northern Europe That's like 3-5 out of 195 countries and only 0,3%-0,5% of the world's population. Being born there is like winning the lottery so maybe take that into consideration when arguing with such examples since that's not the norm. Like what are the odds that people you talk to online are part of that 0,5%? So who's the one being needl…

> I'm talking from the perspective in Europe > > No law maker asked about the major decisions the EU made.

Idiot brexiteer talk...

Re: The American Healthcare Conundrum

#568

Post by nicoburns » Tue, Mar 17, 2026, 6:16 PM UTC

eitally wrote: post #536

nicoburns wrote: post #372

Earlier quoted context omitted.

I think this is mostly a problem with state funded healthcare budgets being cut (relative to population demographics) in these countries. If the UK or Spain spent anywhere even close to what the US spends on healthcare (per capita), I have no doubt that it's healthcare provision would be just as good. In the UK, healthcare provision was notably dramatically better 20-30 years ago under the same system (except for les…

I don't think so. With state funded healthcare you get rigid rulebooks and policies. In the capitalist-ish US model, if you are a successful advocate then you can get better than average care because there's enough flexibility in the system (in many cases, physicians can individually decide to over-extend for one patient if they choose to) to allow for this. Having a private payer market absolutely helps here.

Having care depend on "being a successful advocate" does not sound like a good thing to me! Albeit it's probably impossible to avoid entirely. We want good care for everyone.

I'm mostly familiar with the UK system, but medical professionals make pretty much all the decisions here, with a large degree of discretion according to their professional judgement (and they never have to adjust or delay their care based on whether you can pay). Except for some particularly expensive treatments (think CAR-T for cancer) which are not available at all in the state funded system. But you can still pay for those privately if you want to.

Re: The American Healthcare Conundrum

#569

Post by kstrauser » Tue, Mar 17, 2026, 6:16 PM UTC

mexicocitinluez wrote: post #361

kstrauser wrote: post #167

Earlier quoted context omitted.

Sure you’re not thinking of Medicaid? Medicare was generally pretty good for reimbursement. When my wife treated Medicaid patients, she often lost money on the cost of the supplies used to treat them, let alone rent and paying the staff etc etc. Most doctors who see Medicaid patients do it as basically pro bono. Some figured out how to game the system with economies of scale but it’s nearly impossible do do and maint…

> But Medi care was right with the commercial insurers on reimbursement. As I said in another comment, I'm with a provider and Medicare is easily one of our best payors. We actually have contracts with private insurers that say they have to reimburse us at least 80-85% of what Medicare would. They also give us the money up front, with a public formula that we can count on vs. a hidden formula that requires us to go b…

That back and forth is a huge time suck. Knowing that Medicare will reliably pay $X for code Y makes life vastly easier. Contrast with, say, UHC: “preapproval? That mean we agree to pay $Z, but only if we want to!”

Re: The American Healthcare Conundrum

#570

Post by gopher_space » Tue, Mar 17, 2026, 6:17 PM UTC

eitally wrote: post #536

nicoburns wrote: post #372

Earlier quoted context omitted.

I think this is mostly a problem with state funded healthcare budgets being cut (relative to population demographics) in these countries. If the UK or Spain spent anywhere even close to what the US spends on healthcare (per capita), I have no doubt that it's healthcare provision would be just as good. In the UK, healthcare provision was notably dramatically better 20-30 years ago under the same system (except for les…

I don't think so. With state funded healthcare you get rigid rulebooks and policies. In the capitalist-ish US model, if you are a successful advocate then you can get better than average care because there's enough flexibility in the system (in many cases, physicians can individually decide to over-extend for one patient if they choose to) to allow for this. Having a private payer market absolutely helps here.

> With state funded healthcare you get rigid rulebooks and policies.

We could just not do that. If you change the flow of control certain problems solve themselves. Think about a landscape where government funding multiplies the patient dollar, for example.