What would you say is the biggest challenges with the US healthcare system in 2023?

[Anonymous]

The healthcare system in the US has changes a lot. What would you say is the biggest challenges facing the US health care system today?

[WindAtMyBack]

The health care system in the US is extremely good. But that makes it expensive.

A doctor orders an expensive test when there is only a very remote chance of it being positive. Let's say that 99% of the people are paying for something that does nothing, but it leads to a cure for 1%. Is that good or bad? Does it justify the extreme cost?

Is it a good health care system because it led to a cure for one out of a hundred people? Or is it a bad system because it costs so much?

That's just one example. But it's fairly typical of a large part of the system.

So if you want cheap, you go somewhere else. If you want good, you go to the US.

To address the actual question, the biggest challenge is actually identifying what the problems are, what the health care system should be, what compromises are acceptable since it's literally impossible to have the highest quality for everyone, and how the heck do you pay for it?

Probably an even bigger challenge is getting everyone to agree on it - especially considering that there are no "right" answers, only opinions and guesses.

Did you know that the US health care system is about 5% of the entire world GDP?

[Asker]

This is 100% related to the right vs privledge debate - it's very subjective and rooted in ideologic perceptions.

[monorprise]

Goverment.
The U. S. health care industry is perhaps one of the most goverment dominated industry in existence. The Goverment directly or indirectly drives and constrains the industry via countless rules.

1: The largest problem is removing price selection via the effective insurance mandates. This includes both direct mandates like Obamacare and the prior tax subsist mandates.

By removing the only people with any real control from any concern over the financial consequences of their choices. Goverment has guaranteed prices in health care have nowhere to go but up as fast as they can.
There is no reason for people to not choose the Cadillac, and treat it like crap.

2: Complicated web of other rules, liabilities and tax incentives drive the industry to endlessly fragment making it even more impractical for anyone to know what exactly they will be buying, for what price or from whom before its too late. This also facilitates corruption and backroom dealing.

This is of course a very dishonest business practice, but the medical industry is forced into this because a unified system is too big a liability target of the Goverment.

The effect of course is the same as insurance driving costs thou the roof, and frankly this is only tolerated because of insurance.

To fix this mess the Goverment needs to:
A: get out of the insurance subsidy business. Migrate people to Health savings accounts and raise the out of pocket maximum to the size of said account.

B: Require price transparency to break down the existing web.(States can do this)

[Yanifah]

"The U. S. health care industry is perhaps one of the most goverment dominated industry in existence."

Elaborate, please.

[monorprise]

@Yanifah I already did give you the 2 most critical areas.
Others include a range of Federal encouraged State legal schemes that effectively facilitate localized health care monopolies via giving existing players a say in the admittance of new players.

At the Federal Level 1986 COBRA law was a huge problem in that it really did force emergency healthcare providers to give away their goods and services for free. The direct result of this was an enormous consolation of the health care industry over the 90s and 2000s into even more consolidated localized monopolies able to redistribute the costs.

Anther big time costly regulation is the 'Federal' food and drug Administration habit of slow walking and formerly outright denying market access for new drugs made by new providers for no other reason than in the FDA's judgement they didn't work any better than existing drugs.

Effectively securing the monopoly of the providers that owns said patients and thus ability to charge whatever they want, while also slowing down innovation.

The CDC also helps in limiting the range of acceptable treatment options to include tecnoligy that is only available thou select providers.

Naturally said provider in both cases insure both the employees and the politicians who hired and allegedly command them always have "financial security and support".

All the while we the people consistently elect our 3 federal politicians every 2-6 years on unrelated issue of the day of far greater 'national' significance, assuming we even knew about such corruption and cronyism.

There is a reason our Founding fathers never put ANY such power over such domestic issues in the FEDERAL Constitution. In a country this large they knew dam well we would never be soo unified in every other issue as to be free to consistently cast our votes on managing theses domestic ones.

[monorprise]

@Yanifah I should probably point out that Federal & frankly some state courts are a large part of the problem too. This is generally called medical liability, but its far more significant than people and lawyers racking up costs for allegedly improper medical treatment.

The trouble comes from how you define 'proper' medical treatment, this is where institutions including the CDC, and FDA get even more power to sell to the highest bidder.
Doctors have to use theses treatment options because if they don't and something goes wrong, the court will make them pay.

[Yanifah]

Certainly a unique perspective.

[monorprise]

@Yanifah This perspective and information is by no means unique! Its simply not the sort of thing politicians and big media masters like to make a big deal of for frankly obvious reasons.

Theses issues are nonetheless spoken up regularly in economic and even medical circles on a case by case basis. The only reason bigger media and politicians tend to not pick it up and carry the issue forward is in both cases they are in the business of selling power.

For politicians this is rather straightforward.

Not only do Politicians tend not to run for office unless they personalty want to control things with such power. Politicians always run for office promising (selling their candidacy) to reward people with the use of said power to secure votes. Then once elected in every area of power they did not sell to secure said votes. Politicians are free to do either as they wish to trade for various forms of money and favors.

For Media its is just as straightforward, media really only wants your eyeballs and ears for the simple reason that it gives them the power of influence over you. Like politicians Media then uses this power to either push their own agenda or resells it to directly to advertisers or indirectly for money.

For the most part media power is soft as it can't make you do anything but when combined with politics they acquire significant power over politicians and thus the very valuable force as well.

In both cases regardless the largest organizations who benefit from theses localized monopolies are have long been using that money to help advance and secure their position in the market, both thou mere influence (advertising) and thou direct and indirect influence to get politicians to use said force.

This is happening all the time at every level of goverment. Much of it out in the open.

[Asker]

I think this matter definelty comes down to ideology-based perceptions. I gotta admit that i have a hard time understanding how regulation and monopoly is linked

[monorprise]

That is an easy concept. In modern language a "regulation" is a law or executive interpretation of a law which prohibits, or even requires something with the threat of some kind of force.

A company or group of companies will 'persuade' goverment leaders to make or alter theses legal requirements as to make entering their market prohibitively difficult. This is actually very easy to do as it simply requires leaders make rules that are more advantageous to existing player than new players.

In general a monopoly requires nobody else can do a particular task in a given area.

What is to keep anyone else from simply doing the task the same as the existing player?

In general that depends upon requirements of the task itself. As nature usually provides an infinite diversity of alternatives it is tecnoligy and goverment that really limits what people can do in practice. Goverment does this by constraining the tecnoligy and methods allowed to be used by way of said rules.

Thus all goverment must do to facilitate a monopoly is to constrain said option in such a way as to give existing players an insurmountable advantage.

Simply consider the list of advantage an existing player would have over a new player and the options for goverment to so advantage them are soo numerous its more difficult for politicians not to stumble upon.

An existing player has:
1: Size/money to deal with complexity. (they can hire compliance specialist)
2: Control of established tecnoligy and methods about which said rules are invariably made.(Others will have to pay for theses spesfic methods which may or may not be in part patented or depend upon finite resources.)
3: Political relevance in making said rules. (An existing player is around to tell politicians who are by no means experts in any particular field exactly what they could or should do to even more favor their own position and methods)

[Anonymous]

Healthcare in the US is privatized and for profit. The priority is making money, not treating patients.

[Asker]

I agree! Is it mostly for profit tho?

[Opinion Owner]

Insurance carriers are for profit.

[OddBeMe]

No control over pricing. Medicare actually does this the best. They have a “collective” (oh no communist!) of elderly Americans and can dictate terms to insurers and hospitals.

A public option, as in a govt option for health insurance could have done this.

[Asker]

Yes yes and yes! I wonder why they stopped talking about a public option completely...

[OddBeMe]

Because they hate it. What would Fed Ex be without the USPS?

[Pterodon]

Illegal aliens

[Asker]

Care to explain?

[Pterodon]

They take up resources that could be used for American citizens that are also homeless and hungry