The biggest issue facing America

The simplest thing to do is pick out the best healthcare system in the world, and then replicate it exactly. So bring in the top officials from Singapore, put them on an independent commission to redesign the healthcare system, and force Congress to pass exactly the plan they come up with.<p>Read more about Singapore's healthcare system here: <a href="http://econlog.econlib.org/archives/2008/01/singapores_heal.html" rel="nofollow">http://econlog.econlib.org/archives/2008/01/singapores_heal....</a> <a href="http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model" rel="nofollow">http://www.american.com/archive/2008/may-june-magazine-conte...</a><p>But coming back to Earth, such a plan could never happen. If you approach the problem from the perspective of a hypothetical policy advisor, there is very little that is both a) politically possible and b) would actually improve the system. Raising the caps on medical school enrollment is an obvious fix that would reduce costs without costing taxpayers anything, but the doctors will try their hardest to block it. A mandate to buy insurance makes sense in theory, but in practice the required level of healthcare to buy gets set way, way, too high, and so a mandate ends up being a huge transfer from citizens to the healthcare industry. There are dozens of other examples. Our system is f<i></i>*ed up for a reason, and until the political system is reformed, policy reform is impossible.<p>In reality, healthcare spending will continue to rise until it simply cannot rise further. The spending will be distributed according to political power.

This might actually be a problem that politics just fails monumentally as a tool for fixing. Like trying to repair an MG with a herring.<p>There will come a time when technology will make it possible to keep someone alive indefinitely so long as you spend exponentially more money to do so. Everyone has been conditioned to think that they deserve the <i>best</i> healthcare regardless of what choices they've made in their lives. They will not accept that someone that has more money lives longer.<p>The only option is rationing. Either the naked market does it or the government does it. The perceived (and often genuine) inequality of the market practically guarantees that the voting public will demand the latter. This means that <i>someone</i> steps in and essentially decides who lives and dies. Some agency will perform the brutal calculus that decides that a Nobel winning scientist is a better investment to keep alive than a retired truck driver. Historically this has a terrible track record. Anyone willing to wield this power is usually the last person you'd want to actually do so.<p>Eventually technology will take us through this transitional period into a better time where healthcare, like food, is cheap enough that everyone can have as much as is needed and the only shortages will be caused by politics as is the case for food now.<p>It seems the best thing we can do as a species is knuckle down and drive through this transitional period as fast as we can. I'm kind of hoping that this current recession produces a few more of the "knuckle down and drive through" types as they seem to be in short supply these days.

It is a good start, but he doesn't have the detail at the local level to see what is going on - the prices are all over the map and there is no way to rationally determine what is expensive.<p>I have a weird plan where I pay a percentage of the total cost, but have to pay for everything first and then get reimbursed; but ultimately a more expensive operation ends up costing me more, so it always makes sense to shop around.<p>As a result, I know all the cash costs for an upcoming outpatient surgery I am having, and whether they offer cash discounts.<p>The difference between various hospitals and service centers is HUGE, like 5 to 8 times from one place to another.<p>Imaging center "A" : CT scan $232 ; Chest Xray: $33; EKG: $21<p>Hospitals "A" and "B" : CT scan &#62;$1000; Xray $185; EKG: &#62; $100<p>You end up renting the operating room (the surgeon has privileges at 4 different locations):<p>(new, shiny, modern) Surgery Center "A": $1200 with cash discount<p>Hospital "A" : no exact price, "range is $7K to $11K, typical is $9500"<p>Hospital "B" : no exact price, "range is about $7500, cash discount = $5000"<p>HOW can it even be reasonable that there is such a discrepancy in pricing? For one hospital, the CT scan "interpretation charge" was more than the $232 I spent on the entire scan + interpretation at the imaging place I went to.<p>(And yes, I used the exact same billing code in discussions with all the medical billing people I talked to.)

Hmm, no citations, no real references. The graph is 50% "estimated" from 2005 and pre-estimated values doesn't have the exponential growth thats demonstrated on the graph. Lets also keep in mind the new medicare/medicaid restrictions that is drastically effects what is being paid for by the state and what hospitals are now footing the bill for.<p>"Social security can be solved" sweet, lets get on that. glad he had some solutions in this article.<p>why is this on on HN btw?

I just finished "In Defense of Food." Michael Pollan makes a pretty good case that the health care issue is driven by processed food - causing obesity, type 2 diabetes, high blood pressure and cancer. Essentially if americans ate less processed food (and less food overall), there wouldn't be a healthcare issue.

A friend of mine got physically attacked by an old woman in a supermarket because he was wearing his scrubs. She didn't stop throwing shit at him until security took her away.

Why does the bad trend only start in the Estimated part of the graph?

some points:<p>- healthcare is not a business. get over it. the law says you cannot decline emergency care. there is no business model here, any more than there is in running the navy. its a cost.<p>- you care about public health. meaning, you care if other people are healthy. do you go to the mall or restaurants? if you do, you care if the person next to you has TB. infectous diseases doesn't care about your fully-paid premiums...it matters if other people are also healthy. this once again goes to the fact that healthcare is not a business.<p>- single payer is the only model that works. or would you prefer to spend another century experimenting with craptastic half-baked business/public hybrids? all health insurance companies must go. the government itself chooses single payer when it needs to run large healthcare plans. the VA, military, federal govt...they all go through single-payer.<p>- healthcare will be rationed. deal with it. water is rationed. the carpool lane is rationed. bandwidth is rationed. why would healthcare not be rationed?

These aren't the forums you're looking for.<p>You can go about your business.<p>Move along, move along.