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Notes -
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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