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Posted this in the comments last week, but was curious to get some more thoughts on a potential path forward on the healthcare front that isn't just single-payer across the board:
I do occasionally wonder if you could get to a decent place via:
That's going to create some winners and losers, hospitals will be upset that more high cost people are on Medicare, but shifting people from Medicaid to commercial reimbursement rates should help out with that. The amount of bureaucratic nonsense saved by getting rid of Medicaid should be huge.
All a bit of pie in the sky dreaming anyways...
The whole situation is a mess, I like to think of healthcare economics like communism - yes you can absolutely up end the system and make it way better than what we have now, but when has that ever happened successfully?
The thing that probably gets the most complaints over in doctor land is that changes to the current medicaid structure is likely going to result in a further decline in safety net and rural hospitals. This trend has been ongoing for some time but loss of medicaid dollars will probably accelerate it greatly and people are expecting to see that with the current wave of budget cuts.
Two specific things off the top of my head that you'd have to watch for:
-It is very easy for the hospital to help you by signing you up for medicaid. Private insurance would likely find ways to block this. Hospitals rely heavily on this.
-Medicare and Medicaid are much lower overhead on the clinical side of things and less paperwork. Private insurance is a lot more work (although Medicare is trying to change that! Yay). Don't expect a reduction in medicaid to reduce bureaucratic costs and middleman costs.
Basically every other western nation manages to spend equivalent or less amounts of healthcare than the USA, and has equivalent or better outcomes. So yes, basically everyone else's system is better than the USA status quo.
Their are two problems with this line of thinking:
The U.S. is fundamentally a different place than Western Europe - we spend a lot of money on illegal immigrants, have a maximal amount of cost disease, we are more unhealthy (and importantly as other countries catch up they look more like us), we subsidize the rest of the world's medical research (maybe not fair, but we are the wealthiest country and nobody else will pick up the slack if we go away), we are more independently minded (people don't want to be forced onto insurance or into making certain decisions), medical malpractice is a huge drain, we don't have death panels and rationing, you can get care fast if you can afford it, etc. etc.
Fundamentally our healthcare system doesn't resemble anyone else's in both bad and good ways (don't believe the reddit left - the best care is in the USA).
Even putting aside those things good luck changing our system to resemble other's once reality comes into play (for instance forcing people onto plans).
They are better than the USA, which is the key benchmark. Canada is much more similar than Western Europe and also has historically out-performed the USA, although our healthcare system is getting fucked on pretty hard right now so idk how the stats match up post-COVID.
Unlikely currently, although given the USA is finally starting to (slowly) go pretty YIMBY on building a state-by-state basis, the USA does have a pretty blessed capacity to drive change in a way other countries do not.
This is one of the factors tanking Canada's healthcare system, although they're not illegal, just extremely net negative on "tax contributions - cost to society"
Strike me as a good argument to cut out the middlemen, as they need more expensive salaries
This is hard, no easy solutions here (Ozempic as a condition of Medicaid if you're obese?)
I'm torn on this, if the USA also captures most of the world's pharma profits than this is a net gain no? No idea how the math works out there though.
This is true but hilarious. Americans are violently against "taxes to pay for healthcare" but are completely fine with "employer subsidized insurance premiums that mean they get less cash in hand in exchange for access to healthcare" which is functionally just taxes but with more middlemen??!!?! And poor people I guess get less services versus single-payer, but then everyone subsidizes them anyway via higher medical bills to offset all the non-payments from the aforementioned poor people.
This is by far the easiest problem here to solve. Just legislate limits in damages or applicable suits. Although you will say "but will anyone actually do that" and the answer is "probably not" given it hasn't happened.
Are death panels real anywhere? I also feel like prices/medical bankruptcy (66% of all USA bankruptcy filings) are kind of analogous? If you can't afford chemo you sell everything you have until you run out of money to pay for it and die. Also you absolutely do have rationing, it's just in the form of prices versus bureaucratic limits. It can be debated which type of rationing is better, but the human demand for healthcare is infinite, supply never will be.
Profoundly true
Unfortunately profoundly true, I'm pretty black-pilled on western nations being able to pro-actively change anything until it explodes in their faces and they are forced too, at great cost.
In some ways I guess the USA's system is more survivable in that way. I can't really see it ever imploding, it'll just get shittier and shittier to get care from as all the costs/frictions drag on it. Unfortunately, I can see Canada's healthcare system imploding if it continues to be as mis-managed as it seems to be.
I believe the system as-designed has you sell everything until you qualify for Medicaid, at which point the state/feds should pay for almost all of the treatment. Now, Medicaid-accepting providers have a bit of a reputation for being, well, worse than other doctors (true also for Medicare, but less so because it pays out a bit more, IIRC), so the quality of care might drop. But it isn't supposed to be a death sentence there (in practice, I'm sure it happens).
While that's technically better than just dying, this is so fucking awful it's kind of funny to present this as an alternative.
"Hey man you're not dead, you're just destitute, sick, and are receiving the bare minimum amount of care we can get away with giving you. Have fun rebuilding from 0 once you're better, hope you aren't close to retirement!"
After typing that out, if you're north of ~50, might actually be more merciful to just not treat them and limit the suffering
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