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Notes -
Re: United Health CEO, I feel that I'm among the extreme minority of the population that thinks it's bad to celebrate political assassinations and also that it is a social good for companies to offer insurance in the US. I am astounded by how relatively unprofitable being an insurance company is and also why anyone would go into this industry and put up with the abuse and general scorn.
Imagine being at a party and saying you work at a health insurance company. Total hatred from almost everyone.
It's amazing that people do this at all?
It is a very important job. Somebody has to tell doctors and patients no. That said, I sure wouldn’t want to do it.
I think it is hypothetically possible for a health insurance CEO to be so cartoonishly evil that murdering him on the street becomes ethically justified. I haven’t seen the evidence yet. I assume if it existed it would be plastered all over the internet.
I'm still not sure what makes socialized or single-payer systems inherently less cruel. They are rationing care too? Not only do they have longer waits, but from what I can tell the providers often follow the government's story: you have abdominal cancer? So sorry. It's fatal. Consider assisted suicide.
At no point is the patient informed that you can actually do a long shot treatment for this, and it's very expensive. And it's only available in the US.
Canada performs 14,000 assisted suicides a year. Are we really sure all of those persons have terminal illnesses? Or is the same cold hearted private health care denial of payment still there, but translated into denial of all hope as well?
I'm not even sure it's wrong! If a patient has a cancer with a very bad prognosis and the treatments are expensive and kind of grim, it might actually be better to lie to them and say they're fucked instead of telling them to try to raise $200,000 in a few months and maybe you have a small chance at surviving.
But I hardly ever see socialism enjoyers acknowledging that this is the system they plan to build. They just smugly declare that in our system all receive treatment regardless of means.
Yep.
Healthcare in the U.S. is comically complicated, expensive, and frustrating - with an intense human cost in what we do to the people who work in it.
In return we get best in the world access to care, immense human capital investment, the highest quality of care in the world (both for the poor and even more so for the rich - outcome problems are driven by our poor health in the country aka obesity). In addition because of the amount of profit available we do a huge portion of the world's research.
When people talk reforming the system they almost always propose things that are sure to break one of those pillars (like introducing rationing) with much more questionable ability to actually decrease costs.
Funny, I was pretty gung-ho about M4A until I read that Elizabeth Warren's own research she linked which showed how meager the efficiency wins would be. Surely the system is super expensive because it's very weakly coordinated! but apparently single-payer's biggest crusader doesn't think so?
I think cost disease in general teaches me we aren't going to improve the cost side of the system with M4A. Too many bad actors and hands reaching into the till. If I was god, or failing that a dictator, I could probably do it (with appropriate subject matter experts obviously). But nobody is, so zero chance of that happening.
A good example is physician salaries. Obviously I care about this because I'm a doctor and want to get paid, but a lot of people want to crash MD salaries as much as possible, it will be one of the first things that happens when M4A inevitably happens. It also doesn't do much to help costs because MD salaries aren't a major driving factor. However you'll get a dramatic reduction in quality and shortages as people flee the field. A lot of nurses retired from bedside nursing because of a lawsuit result that was totally justified and wouldn't negatively impact nurses at all, they just didn't like the vibes. The jobs are so miserable that people are champing at the bit to leave and cutting salaries drastically is only going to hasten that.
And that's just one specific line item in the many catastrophes that would inevitably happen.
There are plenty of things we can do to improve things without crashing the system however. Tort reform is the obvious example. You don't even need to remove the ability to sue, just put in expert juries (and that doesn't need to be all doctors) instead. As it is now you can follow the standard of care and still be sued for all that you are worth. The protection isn't to never make a mistake, because you can still get sued for not making a mistake, instead its to provide the "safest" care possible which is super expensive and can actually be a negative for patients (unnecessary imaging leads to increase in lifetime cancer risk but is hard to sue over thirty years later).
Fix the things that are actually fixable first and see how stuff looks.
Make all insurance functionally non-profits, cap administrative salaries, etc as another example
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