
We Need to Design Health Care Reform That Puts Patients Before Profits - howard941
https://rooseveltinstitute.org/why-we-need-to-design-health-care-reform-that-puts-patients-before-profits/
======
rayiner
The U.S. spends $3.5 trillion annually on healthcare. _Worldwide_ profits for
the 112 publicly traded healthcare industry companies amount to $50 billion
per quarter: [https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-
Phar...](https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Pharmas-
Profits). Even if all those profits are allocated to the U.S., that's about
5.7% of healthcare spending. (And completely consistent with most other
industries.)

Hyper-focusing on profits is misguided. Many countries with costs much lower
than ours have for-profit hospitals, pharmaceutical companies, etc. Public
operation of the health system would surely eliminate the profit, but why do
we have reason to believe it will reduce the other $3.3 billion? We can point
to European countries that have much lower costs overall, but those countries
seem to provide many public services at much lower cost than we do (education,
transit, etc.). Canada's government expenditures (excluding defense for both
countries), is somehow slightly lower than the U.S., even though Canada offers
universal healthcare.

The public rhetoric frustrates me as someone who favors universal healthcare.
Demonizing corporations and rich people is red meat for partisans, but it’s
not a solution. How do we pay for this system? How do we cut costs? Making
healthcare into a public service in the US risks turning into the same thing
we have with education, transit, and infrastructure. We spend tons of money,
often more than European countries, and get very little in return. And the
only solutions folks offer are to dismantle the public system (on the right),
or to demand even more funding (on the left).

~~~
claudeganon
> The public rhetoric frustrates me as someone who favors universal
> healthcare. Demonizing corporations and rich people is red meat for
> partisans, but it’s not a solution. How do we pay for this system? How do we
> cut costs?

There are already two pieces of legislation, the Jayapal and Sanders bills,
they account for their costs. Tim Faust’s new book likewise walks through all
of these concerns in detail:

[https://www.mhpbooks.com/books/health-justice-
now/](https://www.mhpbooks.com/books/health-justice-now/)

And I don’t think people are “demonizing” corporations, so much as they are
being more and more exposed to fundamental cruelty and parasitism of the
American healthcare system. As costs spiral out of control and inequality
compounds in the US, a far greater swathe of people are finding themselves on
the receiving end of its violence and deprivation. I’d suggest you look at the
work of disability activists like Ady Barkan to get a better picture.

~~~
tptacek
You're using "account for their costs" in a different sense than I think
Rayiner meant. When Sanders "accounts for his costs", he means that they've
added up the total projected costs of their plan and then accounted for it
with tax revenue.

That's fine, but it doesn't address the fundamental problem of US health care
costs, which is --- regardless of "who pays" \--- "why does it cost so fucking
much". If all we do is move our exorbitant costs off customer bills and
invoices and into our tax code, we haven't actually solved anything; in fact,
in some sense, we've provided cover to the inefficiencies and incompetencies
in the system that are overcharging us.

Single payer or private system or something in between, I don't much care, but
I'd like to see a proposal about US health care that is serious about
_reducing cost_ , not about accounting for existing costs differently.

~~~
claudeganon
As I mentioned to Raiyner, you should really read Tim Faust’s book to
understand how single-payer can drive down costs, but I’ll highlight this from
one of his articles:

“ As the sole purchaser, the federal government is immediately able to set
just prices for health care services (for example, by negotiating the cost of
drugs). With the weight of the full cost of health care falling squarely on
its shoulders, it has an incentive to develop infrastructure and provide
accessible primary care for all people, diverting money from low-frequency
crisis care to high-frequency primary and preventive medicine.

It can also create evidence-driven guidelines for how to handle episodes of
complex care and adjust payments based on adherence to these guidelines. This
promotes good care for all patients and respects providers’ agency to provide
the best care they can, instead of the current mess, where payment per-service
can incentivize unscrupulous providers to bilk payers by either ratcheting up
individual unnecessary services (when paid per-service) or providing less care
(when paid per-patient).”

[https://www.jacobinmag.com/2017/10/single-payer-medicare-
for...](https://www.jacobinmag.com/2017/10/single-payer-medicare-for-all-
bernie-sanders)

~~~
rayiner
These are just general concepts. It’s on the same level as “the market will
drive down prices because hospitals and insurers will compete.” What I’m
talking about is actual data about what is entailed, for example in “bilk[ing]
payers.”

~~~
claudeganon
Then see thaumaturgy’s comment above about how suppliers and insurances do
this in the current system.

------
tptacek
The problem with US health care is that it costs too much.

The elephant in the room in US health care costs is inefficiency on the
provider side. Payer-side reforms have limited impact, because contrary to
rhetoric from both sides of the debate, we could probably zero out
administrative costs entirely and still deliver little more than a grocery
store discount to American consumers.

However we structure payment, we're still going to have overprescription of
outpatient procedures, a shortage of doctors who as a result make drastically
more than their counterparts in Europe, bed vacancies in inefficiently
provisioned hospitals, diagnostic procedures that vary wildly between
providers just a few miles from each other, and a total lack of price
transparency to enable consumers (and their doctors) to collaborate and make
decisions about care.

There's not much evidence that our government-run health programs (Medicare in
particular) is up to the task of solving these problems; Medicare has a
central role in how the current health care system is organized, and some of
these problems stem directly from decisions made by Medicare.

~~~
TaylorAlexander
There’s always room for critique, but millions of Americans need something to
change. How can we get coverage to the poorest people effectively?

~~~
tptacek
I think it's easy to misread what I wrote as saying that the current system is
OK, or there aren't giant, urgent problems that need to be addressed. There
are huge problems. The concern I have is that payer-side reforms are a
sideshow.

~~~
TaylorAlexander
Sorry, I didn’t mean to suggest that you had taken this position. I just
really want to move the conversation forward. So there are problems with
Medicare, but you seem to know about this so I’m curious what you would
suggest we do to provide coverage to millions of poor Americans currently
going without. I’m no policy expert and I thought M4A is a great idea. Thanks!

~~~
tptacek
I don't know. What I'm advocating is that any discussion of the US health care
problem start with a breakdown of where the money is going in our system.
There are competing breakdowns, but _any_ of them would be better than the
default presumption we seem to have that the problem with health care is
"insurance companies and prescription drugs". No breakdown I've seen on any
side of this debate shows that either of those things are the true driver of
costs in our system.

I'm not defending either the current private health insurance system, which I
think needs drastic reform, or the market for prescription drugs, which is
dysfunctional in a bunch of ways. But I am unconvinced that the public
intuition about the overall health care problem is well informed.

~~~
TaylorAlexander
Ah I see. Thanks for sharing that. It’s all so vague to me. There’s so many
different analyses and so many experts who will attest to competing facts.

My priorities are just:

1) Ensure universal coverage for all Americans.

2) Structure it so costs are at least as reasonable as those in other
countries with similar systems.

So for me, universal coverage immediately is a hard requirement and of course
it must be done as fiscally responsible as we can manage. But we can always
refine the system to lower cost later. We can’t replace the lives lost due to
inadequate coverage.

------
disabled
As an American with 2 rare immune-mediated neurological diseases, that affect
my peripheral nervous system, I can almost guarantee you that decent health
care reform will not happen in the foreseeable future.

By the way, both of these diseases are in pharmaceutical remission, due to
taking a blood product that has immunomodulatory properties. I will have to
take it for life. My medical insurance literally pays hundreds of thousands of
dollars per year, under contract, for it.

The Affordable Care Act is practically guaranteed to be either partially or
completely overturned next year (Summer 2020), based on previous rare cases in
modern history where the Solicitor General did not defend a case at the
Supreme Court.

My whole life is literally riding on whatever the Supreme Court churns out
next year, due to the complexity of my care. In the case of a partial or
complete overturn, I will most likely have to leave the US. But, I am
fortunate to be an EU citizen.

I have been making plans for leaving the US for a couple of years now. The
matter is extremely complicated with my health care needs, and I literally
cannot afford to make a mistake.

Frankly, I do not feel welcome anymore in my homeland (the United States)
either.

~~~
Scoundreller
Do be sure to check that any new country will pay for the same thing.

Single-payer/socialized healthcare can mean “Just Saying No” to expensive
interventions.

~~~
disabled
Yes, and this is one of the main issues. Overall it is a logistical disaster.
But, I have to say that engineering school helps you tackle logistical
nightmares like this.

------
Zelphyr
I know a medical provider who works for a small family medicine practice
recently purchased by a large hospital group in our area. They're being told,
"You guys need to be sending more people to our hospitals."

So for these organizations, patients who are sick and suffering are seen as a
product.

A day of reckoning is coming for these organizations because the sick and
suffering are getting fed up with being treated like a product.

~~~
aaavl2821
Large hospitals systems have been forming regional monopolies for the last few
decades. First they would buy other hospitals to increase negotiating leverage
with insurers, then they started buying outpatient clinics to control patient
flow. They can also increase the amount they charge at outpatient clinics once
the larger hospital system buys them.

Hospital spend represents 30% of US healthcare spend, and physician spend
represents 20%. Physician employment by hospitals is at an all-time high.
Busting local healthcare monopolies would do a ton to lower healthcare costs

Unfortunately that is difficult. The hospital lobby spends about as much as
the pharma lobby. But the hospital industry has much more "soft" political
power. Hospitals are one of the biggest employers in almost every county. So
for a politician to fight hospitals would mean fighting their largest
employers.

Hopefully more people become aware of this behavior by hospitals. You dont
read much about it in the media. I'd imagine this has is because no one is
incentivized to call out this behavior by hospitals

~~~
creaghpatr
Healthcare stocks comprise a not insignificant part of many Americans' 401k
portfolios, the downstream economic effects of dismantling healthcare would
extend way beyond the hospital/pharma industry.

~~~
bad-joke
That 401k isn't going to be very useful if you can't afford healthcare.

~~~
TheOtherHobbes
And even less useful if you're bankrupted by it.

------
helpPeople
Until Americans find Physicians (and Pharmacists) as the enemy, it will never
happen.

They(AMA and APA) are top lobbyists that entrench themselves using
monopolistic practices.

Sure school can cost 500k, but with 200 to 300k+ per year salaries, they can
kill that debt. (This is their common defense)

~~~
kerkeslager
With my skillset (software engineer) I can easily pull low six figures. And
I'm confident that doctors provide more value than I do. I'm pretty sure I've
never saved anyone's life. So I have zero problem paying doctors 2 or 3 times
my pay, which is about what you're saying they get paid.

Health insurance CEOs make, in some cases, literally hundreds of times my
salary, while literally killing people for profit.

I'm going to go out on a limb and say you've misidentified the problem.

Now, certainly bringing down the cost of medical education, and allowing
people with less education (i.e. nurse practitioners) to do more, would both
help lower the cost of healthcare. But if we're talking about who we should
consider "the enemy", it's certainly not doctors.

The entire _raison d 'être_ of capitalism is that it's supposedly
meritocratic. Are you really claiming that curing illness and sometimes saving
people's lives isn't meritable?

~~~
leetcrew
not sure what kind of work you do, but if you make tools that save people time
and you have many users, it could add up to many lifetimes not spent on some
menial task. not quite the same, but I would argue that helping many people
allocate their time towards activities they actually value is just as
important as saving individual lives.

~~~
EpicEng
>I would argue that helping many people allocate their time towards activities
they actually value is just as important as saving individual lives.

I think you'd pretty easily get trounced making that argument. People would
much rather be alive to do something less efficiently than to... not be alive
at all. This argument is a bit insane to me.

~~~
leetcrew
think about the people you care about. would you rather live more years or
spend more time with them over a shorter life? what would they prefer? it's an
inherently subjective question, and I don't think the answer is obvious. I
certainly don't think one of the answers is "insane".

~~~
EpicEng
Why are you assuming that I would spend less time with e.g. my wife if she
were less efficient in performing some menial task? It would take her longer
_to complete_, but that doesn't mean she wouldn't still quit working at 5.
Besides, most of the software we write is pretty inconsequential as far as
most people are concerned.

~~~
leetcrew
> Why are you assuming that I would spend less time with e.g. my wife if she
> were less efficient in performing some menial task?

because "helping many people allocate their time towards activities they
actually value" was an important premise I stated in the post you originally
replied to? I deliberately excluded stuff that merely improves productivity at
work (although not everyone is fortunate enough to have a job where they can
just leave at five if the work isn't done).

~~~
EpicEng
Then you're going to have to give me some examples. All in all I think doctors
and medical scientists are more important to the world than the vast majority
of us (since we have to make it an either/or for the sake of argument), so get
specific.

~~~
leetcrew
I for one am quite grateful to the engineers who implement electronic
automatic billing. when I was a kid, it seemed like my dad spent a lot of time
sorting through mail and writing/mailing individual checks for services. now
it's automatically billed to the credit card, the credit card gets autopaid
from checking, and he just has to make sure there's enough in his checking at
the end of the month. that's not a huge amount of time and thought saved, but
it's not nothing either. there's a lot of this stuff that we take advantage of
in our lives without really noticing, I think.

~~~
EpicEng
Automatic billing...

Meanwhile, median life expectancy has skyrocketed, in large part due to new
medical treatments and early detection methods. Unless your father was
spending 20-30% of each day paying bills, I don't think that's going to do it.
I remain unconvinced.

Let's also not forget the drain on interpersonal relations that software has
brought about. If your father would have spent that time ok on FB instead I'm
not sure we gained anything.

------
breck
One of the key steps that needs to happen is to ditch Intellectual Monopoly
laws. If you have a system that provides 100x+ the financial incentive to sell
patented drugs, regardless of efficacy, then you will have many more people
out hawking harmful drugs than the boring mainstream alternatives. See Purdue
for a great case study on this.

Anyone who talks about "drug development cost is expensive" yadada has no clue
what they are talking about. The only reason it's expensive is because people
are on a fishing expedition for novelties that have at least some contrived
way of demonstrating efficacy (you only need to hoodwink the public with your
drug long enough for you and your reps(dealers?) to make short run monopoly
profits). In the age of big pharma Americans have gotten _less healthy_. Time
for Intellectual Monopoly laws to go.

------
claudeganon
> We can and must design the next round of insurance reforms with patients as
> a priority. With low deductibles that actually facilitate the consumption of
> care, our health care system can directly benefit the well-being of low- and
> middle-income people—not just the holders of for-profit hospital stock.

No, we need to get rid of private insurance with Medicare for All. The amount
of money, corruption, and lobbying insurance companies engage in is
staggering, especially given that their whole profit model is designed around
limiting or denying access to healthcare. Denying access to treatment for the
disabled, the chronically ill, and others, often unto their deaths or
bankruptcy.

In a more civilized country, corporations that have behaved like US insurance
companies have would have been done away with along time ago.

~~~
dsfyu404ed
>No, we need to get rid of private insurance

Insurance works well for rare events. Using insurance for an annual physical
(or any other routine thing) is just pissing money away.

Cutting insurance out of routine and preventative care will require far less
political capital and should have a massive impact on costs. No need to go all
the way to eliminating private insurance. A government option would have
benefits but there's no reason private insurance can't exist also.

~~~
headcanon
Seems like a reasonable ask. Gov't pays for preventative care like physicals,
flu shots, and STI testing (sort of already happening on the last bit through
Planned Parenthood), insurance takes care of traumatic events.

Seems to me though the greatest cost in healthcare, and thus causing the
greatest amount of contention, are chronic ailments that can't really be
classified as preventative or traumatic, and require constant doctor visits to
treat.

Care for the elderly is a similar story since they make up most doctor visits
and are the biggest consumers of medications overall.

~~~
balls187
What if we pay for affordable preventative care, and the government covers the
cost of traumatic events?

~~~
kerkeslager
What about chronic diseases that require frequent treatment?

~~~
TheOtherHobbes
What about them? The point of collaborative health care is that risks,
benefits, and costs are spread out, to everyone's benefit.

There is no magic market finger threatening to push you into bankruptcy and/or
an early grave just because cancer picked you instead of someone else, and
your co-pays are higher than you can afford. Ditto for chronic congenital
conditions. It's all the same.

Yes, you're probably contributing to someone else's care, especially when
you're young and healthy.

So what? You won't be young forever, and you probably won't be healthy forever
either. Meanwhile whatever care you need is provided to you _at lower
individual cost than a privatised system_ \- with the added benefit that it
also provides significant employment, supports medical research, and provides
private-sector opportunities for specialised suppliers of technology,
consulting, and other solutions.

The only people who appear to lose out are shareholders. They have to make
their money elsewhere. In fact their opportunities are enhanced rather than
diminished, because affordable low-risk public health care leaves more money
on the table for investment and new business development.

~~~
kerkeslager
It seems you've interpreted my comment as being against public healthcare,
when in fact I am rabidly for public healthcare.

I was pointing out that a part-private, part-public solution still doesn't
really handle medical care well. We need a fully-public healthcare system.

------
gnopgnip
> We can and must design the next round of insurance reforms with patients as
> a priority. With low deductibles that actually facilitate the consumption of
> care, our health care system can directly benefit the well-being of low- and
> middle-income people—not just the holders of for-profit hospital stock.

We have this already to an extent with managed care. The old system of fee for
service incentivizes healthcare providers to treat the symptom and not the
root cause. As of 2016 over 80% of Medicaid and Medicare patients patients are
on a form of managed care plan instead of a fee for service. And Medicaid and
Medicare are responsible for about 40% of Americans. Additionally there are
systems like Kaiser that have similar incentives in the private market.

~~~
Frost1x
There are still plenty of abuses in managed care plans that I've seen (I'm
closely related to several healthcare professionals working in home healthcare
and in/outpatient service providers).

For example, often times, healthcare professionals are encouraged/pressured to
report improvements during the managed care plan at ambiguous levels (lie) to
continue regimes to the allowable extent before they're discharged. Those
patients are frequently then readmitted for the same or other health problems
after new hospital visits. Healthcare providers are often pressured to not
report their judgement tells them a specific treatment program won't help a
patient much in their professional opinion.

Ultimately, the incentive for continued treatment to maximize profit is still
there, the approaches just change/adapt to fit within new rule systems.

It's really down to individual healthcare professionals to resist continual
unethical business pressures concerned with profit over patient outcome which
can put their employment/livelihood at risk if they don't have their own
practice. This happens in large and small healthcare providers from my sample
pool of 3 huge national providers, 3 local/regional hospitals, and several in
home healthcare from varied business size.

The only leverage healthcare professionals have is that they're in such high
demand and under supplied that they can often resist these pressures. If that
changes, their hours are often reduced or they're replaced by people with more
ethical flexibility.

So we (our society) still don't care about patient outcomes. We can pretend we
do and often the healthcare professional working directly with you probably
does care about your outcomes (most people aren't sociopaths) but they may
have to frequently weight milking you and your insurance provider against
their livelihoods which shouldn't be the case (healthcare will always have
continual demand, pretty much guaranteed business).

~~~
gnopgnip
Most of the managed healthcare plans base the patient outcomes on a number of
factors, and the doctors report is either not a factor at all or a small
factor. If the patients are being readmitted multiple times that will outweigh
what is misreported.

But more generally I agree that there will always be financial pressure
weighing against ethical issues or patient outcomes. But a managed care plan
is strictly better than fee for service in aligning patient outcomes and
incentives for healthcare providers. And there is market pressure going the
other way, patients can switch healthcare plans or switch providers if they
have a better alternative with better outcomes.

------
zarro
Contrarian viewpoint: NOT focusing on the profits is the cause of the problem.

Hypothesis: Prices are high because of inefficiencies in the markets caused by
bad laws attempting to subsidize one class of people by another. Hospitals
aren't able to refuse treatment by law to those that can't afford to pay for
their services and insurance companies are coerced to insure unprofitable
people by law and the net effect is to try and coerce people into a
redistribution of money from people that require more care from those that
require less care to cover these expenditures.

Because there is no mechanism to coerce people to do this willingly that's
efficient enough for the increasing demands of those requiring care, both
industries to give the invoices to the government (who created the problem)
thereby getting rid of the requirement to think about how they will fund their
expenditures - making it the governments problem to figure out.

This thereby allows them to continue uncontrolled expenditure resulting in
exuberant prices in an ever increasing downward spiral to catastrophe as in
effect they are spending 'other peoples money' in the hopes that "eventually
these invoices will be paid" through some sort of government sponsored
coercion mechanism forcing socialized heath care or some other such method
with the same result.

Its really quite simple and clever and funny how it still works.

-5% of the population accounts for more than half of all health spending.

-50% of the population with the lowest spending accounts for only 3% of all total health spending.

Edit: Anytime I share this viewpoint, a bunch of either misguided or
prejudiced people downvote me. I'm guessing its because they don't understand
the argument completely, or see its logic, but disagree with its implications.

------
pimmen
I don’t understand the American obsession with designing new systems
yourselves when there’s already plenty of alternatives out there that have
been tried and true for generations. Health care that’s affordable, offers
longer life expectancy, costs less as a percentage of GDP and available to
even the poorest citizens have already been implemented in countries across
the globe, in Europe and East Asia in particular but also in Canada and
Australia.

Why is it that if a US politician says ”our system is bad, the system from
France/Germany/UK/Sweden/Japan is beating us in almost every metric, let’s
switch” is met with boos but someone who says ”I have an completely untested
idea that’s our old system with some quirks that looks like it was designed by
a committee without a vision, let’s try it” is met with cheers?

------
legitster
I have a non-profit healthcare plan and go to a non-profit hospital. It costs
the same.

This completely misses the issue.

------
dudul
Honestly, I'm not gonna read this thing. This is just the usual weekly "health
care is fucked" HN post. They always say the same thing, they always show the
same data, rarely suggest any real path forward (one that works in the context
of lobbies, corruption, for-profit institutions, etc). In my book (and I'm not
an expert even though I've worked in the benefits industry), 2 things are
completely fucked up in this domain: 1) insurance being tied to your employer,
2) not being able to know the cost of a procedure before hand. Fix that, and
you're done.

------
chiefalchemist
More than that, we need to design a system that puts general health/wellness
before health care. That is, we need to live a more healthy and have a
prevention mindset.

If we prevent the preventable those resources can be used for the
unpreventable. But if overall demand drops, so will price/cost.

------
bashallah
Like Japan, reward doctors when they _cure_ patients.

~~~
AimForTheBushes
I don't like this because they may unknowingly introduce a biased form of
triage.

~~~
bashallah
Don’t let the providing doctor triage.

They should be providing care anyways.

Nurses triage.

------
cmsonger
It maybe is obvious, or maybe it's controversial, but patients will never be
put before profits by for profit corporations.

~~~
tptacek
Is it obvious? I went to a fancy Japanese dinner last night. It was,
obviously, a for-profit venture. At any point during that dinner, was anyone
in the restaurant worried about the restaurant putting its "profits" above its
patrons?

~~~
thaumasiotes
They weren't worried about it, but it was happening anyway.

~~~
tptacek
Your argument is that a nonprofit Japanese restaurant could have delivered a
better experience to me?

~~~
c0nducktr
I'd wager a nonprofit Japanese restaurant could have provided your meal at a
lower cost.

~~~
tptacek
How? Why doesn't anyone open a nonprofit restaurant and outcompete the for-
profit ones?

~~~
thaumasiotes
Clearly, because profit-seeking infiltrators would sneak in and corrupt the
whole affair.

------
alexandernst
You don’t need to design anything because that already exists in Europe. It’s
called public health care.

------
OliverJones
The situation is slightly more complex than this article recognizes.

1\. When a hospital, either for-profit or not-for-profit, must provide free
care to a patient, it comes out of their hide. Enough of this free care can
force the hospital to demand higher rates. See
[https://hmsa.com/portal/provider/zav_pel.fh.DIA.650.htm](https://hmsa.com/portal/provider/zav_pel.fh.DIA.650.htm)
Medicare and Medicaid foots part of the free care bill. And, yes, patients who
turn up at emergency departments get some free care. It makes the news when a
hospital kicks patients to the curb because they can't pay.

2\. Enough free care can bankrupt a hospital or force it to close. In under-
served areas (rural) this is, umm, not good for the community served by the
hospital.

3\. Corporations -- hey fellow HN readers, our employers -- must offer private
health insurance. This is a HUGE pain in the neck for executives (some HN
readers, that's you and me). They have to scare up health plans their
companies and employees can afford, so they must waste their time doing that
instead of, I dunno, designing products or calling on prospective customers.
Sure, we get entrepreneurs trying to help with this. Zenefits. Need I say
more? It's time-wasting madness.

4\. Corporations must pay insane amounts of money for health plans for their
people. And it's compound insanity. That's like compound interest, but worse.

5\. Employees (that's you and me, HN readers) have to waste our time and spend
our money on our part of health insurance costs.

6\. "Medicare for all" invokes a health-care payment system that's proven to
work at scale, and is reasonably accountable to all its stakeholders. (Except
for part D / drugs / the subject of another rant for another day.)

My point: in the long run, being business-centric is the SAME THING as being
patient-centric. In this area, Mitt Romney was right: "corporations are
people."

I am baffled by politicians' complaints that some kind of government option
for paying for health care is bad because it will raise taxes. Don't they know
what we know? Paying for health care is already a massive tax on both
employers and employees.

It's just hidden by a shell game. It's not actually a tax, it's a tax
deduction. If you believe this, maybe I can rent you a some space in the huge
dirigible hangar at Moffett Field. Cheap. Send me your bitcoin.

Can you imagine how much more successful a YC company might be if they didn't
have to sweat this health-insurance stuff? Can you imagine how much more
successful GM and Tesla would be if they knew their workers' health care was
covered?

How come captains of industry and bigshot VCs aren't demanding better?

Yeah, some companies will suffer when this changes. But almost all companies
suffer now.

------
kryogen1c
<yowling about free markets and capitalism>

the profit motive is what has driven healthcare to what is possible today. if
there is an uncoupling of health outcomes and profit motive, the solution is
not to delete the profit motive! the government needs to enact only the
necessary and sufficient regulation to realign making money with the desired
results. avoid regulatory capture, make the information transparent and
available.

i dont understand this demonization of capitalism. the world involved in (and
adjacent to) capitalism is, by almost _every.single.measure_, vastly better
than even as recently as 50 years ago. communist china sure didnt do that.

its capable of corruption! lets fix that corruption and not throw the baby out
with the bathwater

public schools and subsidized, inflated, university tuition are examples of
roads we dont want to travel down.

------
Merrill
This can be done by converting "for profit" corporations into "not for profit"
corporations and having them finance investments with debt instead of equity.

~~~
dgzl
And what about the rights of the stakeholders of those for-profit
corporations?

~~~
zentiggr
If those stakeholders are sponsoring the cash grab mentality that has the
health industry so messed up right now, then screw em.

Sell off every private company involved and legally mandate that they can only
sell to non-profit entities, and let every shareholder that's gouging everyone
else scream or cry or whine however they want. The more noise they make, the
more harm you know they were causing.

Sick and tired of greed making all these layers of corporate corruption,
market lockup, government process tailoring, and outright deception the status
quo.

------
4ntonius8lock
I'm really not sure why this isn't mentioned:

USA should commission a study of health care systems in other countries.
Include costs, challenges, issues of bringing it to scale in US, etc.

Then we can implement something based on real world experience and data.

It seems that these highly complex topics are dealt at the ideological level
only. Which is absurd, as details can make anything from any ideology
horrible. It makes me think of times when other common sense issues that
should be data driven were treated in such a way. In the end, the curvature of
the world is really independent of any ideological constructs that were
created, but the ideological constructs made discussing the data virtually
impossible at the time.

~~~
aaavl2821
There is plenty of data on this available. It isn't perfect but it's there.
The problem isn't lack of data, its lack of awareness of the data. Most people
learn about the healthcare system by reading newspapers and other media, and
from what I've seen coverage of healthcare in most US media is very political
and seldom data-driven

Check out here to start, there are plenty of other resources:
[https://data.oecd.org/healthres/health-
spending.htm](https://data.oecd.org/healthres/health-spending.htm)

~~~
4ntonius8lock
Raw data there is.

I'm talking about a report that says:

After analyzing the health care systems of X, Y and Z countries, a commission
suggest A, B and C changes to the US healthcare system. A major commission
organized and created by an organization that has proven capable of developing
long term, large scale plans for the greater good of the country (think the
army corp of engineers, but it doesn't have to be them, just something that is
as objective as possible)

I'm also a bit surprised that the ideological bend is so strong, even on
'hacker' news, that net-net I'm getting down-voted on a what I think is
essentially a call to look at data and create cohesive reporting to guide
public policy.

Maybe there is such a study. I'd be glad to know about it.

~~~
aaavl2821
That's fair, there are think tanks that do this sort of work, but I think it
is a hard problem.

Yes even on HN I find that most people are pretty dogmatic about healthcare.
People tend to react rationally to the data when presented, but are also happy
to make aggressive statements that are unsupported by data

~~~
4ntonius8lock
I don't have much experience with Think Tanks, but I've found the ones I've
looked at to be highly partial to those funding them.

This country is very capable of smart, logical thinking. We've basically
eradicated the issues of flooding. If we apply that type of
thinking/organization, the issue could be tackled. But both sides, left and
right, would have to want truth over vindication. We need to demand
commissions to investigate, instead of trying to validate pre-conceived
ideological notions.

If people reading the article asked for it, politicians would take note and
would likely commission a good study. That's the beauty of our system (despite
it's glaring flaws)

