[danielschonfeld]

American healthcare is the epitome of capitalism run amok.

It’s terrible and the only thing worse than the exorbitant fees is the complete and utter lack of consideration to the patient’s time.

[aeturnum]

I have a partner who's a nurse practitioner in primary care and I just want to emphasize how hellish it is for people on the inside as well. The economic model of running a healthcare business is entirely based on their ability to bill for provider time. Healthcare providers have very high costs to match their very high fees and also pay a bunch of people to 'help' providers see more patients. A big part of this mix is also that it is not enough to provide healthcare - you are actually paid for providing documentation that you carried out the specific care that you "should have done" given the case notes. Ensuring you properly annotate the files of patients (for the benefit of generating the right charge codes! Nothing to do with patient care) is another burden that's required to sustainably provide care. As a result the costs "per provider" are much higher than the provider themselves - you also need medical assistants who do every piece of work the provider isn't legally required to do, billing staff to properly bill that work, admin staff to manage their schedule in detail, etc.

The lack of regard for patient schedules is a direct result of how insanely packed the schedules of providers are. Fifteen minutes per patient is luxurious and my partner spends a lot of time after work entering notes for patients she saw that day (she "works" 32 hours / 4 days a week, which is really closer to 40-45 all told). My understanding is that the clinic does not have a high profit margin (serving medical / medicare patients + high overall costs), so every patient counts, and the admin staff will add people w/o permission. It's common for her to find patients scheduled over her breaks or for her to be scheduled after she should have left the building. Burnout has always been bad but it's reaching epidemic levels now in the wake of covid, which further restricts the supply of healthcare and makes people wait longer to be seen.

[mindslight]

I think people tend to get stuck on the ridiculous charges/billing and don't often get to the point where they appreciate just how bad the provided healthcare is, and how much it utterly destroys patient agency by replacing it with bureaucracy. The provider/"insurer" dynamic is really the deep set home of the rot. As a table stakes reform, health "insurance" companies need to be prevented from managing healthcare and relegated to purely financial payers, but doing so would put so many low-level bureaucrats out of work it's politically untenable.

For a recent event, I got a whole nurse calling me from the "insurance" company, out of the blue, seemingly just to chat about the medical situation and how things are going. I haven't figured out what her KPIs are, but I doubt she remains so friendly when you bump up against them! And she obviously represents a severe misallocation of labor - the industry would be better off if someone with her education (and likely experience) was actually providing healthcare.

[wolverine876]

Somehow, US healthcare is ~ 2-3x expensive as equivalents in other wealthy countries, which get better outcomes. Who is collecting this extra money? It's not the medical professionals, you say (and I believe).

[anon-sre-srm]

No, the worst part is dying of a painful terminal illness while being sued into bankruptcy in your dying days having to fight to keep minimal possessions because the hospitals and doctors want money.

[bdzr]

It's really not, it's a frankenstein of a system with capitalist and socialist traits. If it were capitalism run amok, a consumer would be able to figure out the price of something as though it were a cup of coffee. Pricing is completely opaque and provides nearly zero demand for providers to compete.

[alistairSH]

It's not socialist (Medicaid/Medicare notwithstanding). But, it's definitely not "ECON-101 free-market capitalism" either. Lots of regulatory capture from both medical and insurance providers. Plus a bunch of self-inflicted dysfunction because we keep electing ding-dongs into Congress.

[smallmancontrov]

So why is our healthcare twice as expensive as the countries who actually do have socialized health care? When is that competition going to kick in and bring down costs?

https://www.healthsystemtracker.org/chart-collection/health-...

[recursive]

How much time would you spend shopping around while you're bleeding out from a head wound? What would you use for negotiation leverage?

[EvanAnderson]

The American healthcare "system" is dysfunctional because parties who profit from the status quo keep the public bickering about inflammatory issues and distracted from making meaningful change. (My favorite example is "death panels".)

Since the American system doesn't allow people who can't pay for emergency care to die the system ends having a socialist component. Socialism is such a hot-button issue that we can't have mature conversation about funding it. Almost any conversation about it gets caught-up in partisan and "personal responsibility" bickering.

It would be easier if we just let people who can't pay die.

That's repugnant and wrong, but it would certainly make the conversation easier.

[mindslight]

I'm in agreement that healthcare is sorely lacking many individualist incentives, including market ones [0], but can we not pigeonhole anything we don't like as "socialism" ? It just makes for a terrible time talking past one another.

[0] hint: receiving bills for charges you never assented to is not a foundation of a working market, and should obviously be illegal.

[cratermoon]

Ah yes, of course, https://bitworking.org/news/2008/01/the-free-market-fairy/

[Ekaros]

It is perfect example of crony-capitalism... Under socialism basic care would come from one pot. And state would tell what everything can costs.

[danielschonfeld]

Respectfully save me the Ayn Rand. Some of us live in the real world and not the political utopias of our minds.

[Matheus28]

It’s been a long time since I’ve seen someone say something this wrong on HN. Calling the American health care system socialist in any way is laughable.

[avgDev]

Tell me you don't know anything about healthcare without telling me you don't know anything about healthcare.

[j-j-j-j]

None of that stuff would be possible without government. It's a statism run amok.

It's the same story every time. Something works relatively OK (US health care before 20 century big-gov), huge changes to incentive structure and overheads are introduced by statists ignoring higher order effects, everything goes downhill, statists blame capitalism.

Let me legally not have insurance, pay anyone in cash for my health care (no licensens and government enforced monopolies), and buy any medicine I'd like and opt out of this madness completely and let's compare with real capitalism.

[wwweston]

It's always been legal not to have insurance (though there was a brief period where externalizing costs that way was taxed). You can pay cash for health care as you like now with any provider who cares to negotiate with you on a cash basis. There's even a variety of non-MD providers whose licensure ranges from more accessible through informal to non-existent should you object to credentials as distorting.

If you try doing health care this way for long enough, you might even discover which incentives are poorly aligned without collective policy of some kind, but who knows, maybe not.

[plagiarist]

We can surely fix this mess via same invisible hand that sent people down the horses aisle in the farm goods warehouses to use deworming medicine as a preventative antiviral.