WE NEED TO ELEVATE ACCESS TO HEALTHCARE TO A BASIC HUMAN RIGHT.

That does NOT happen without being critical of what we have.

We need a system where 100% of US citizens are covered and have access to healthcare at a reasonable cost for most of us and at no cost for those who, through whatever circumstance, cannot pay.

What I find interesting about these discussions is that people react badly to comments from someone like me --judging by replies and downvotes-- without ever asking questions to understand perspective. You are one of the few, in my many years on HN, who actually seems interested in actually having a conversation. This doesn't just happen with healthcare, climate change is another topic where people react with uninformed irrational emotion.

Basic concept:

If you want a better world, you have to hold politicians accountable and
you have to push for better results. If you don't, well, here we are,
at the edge of world war three.

Healthcare in the US is a disaster. And this is the case because of a million and one reasons. Nobody can point at a single variable that causes the entire train wreck. Unwinding this on an HN post is impossible. I might be off by a factor of two or more in saying that a full analysis of how we got here might require a 1000 to 2000 page report. So, clearly, for those jumping on my throat for a super-simple example, no HN comment will ever do this mess justice. Chill.

Chill, and understand that we ALL want the same things. The difference is that some of us also want sensible solutions with accountability. In order to improve things, you have to be critical of what you have where that criticism is warranted. You are not going to ever lose weight if you never accept the fact that you are eating too much, eating the wrong things and not exercising enough. The concept is simple, and it applies to lots of things in life, including healthcare.

Obamacare/ACA is a mess on top of our prior mess.

On top of that, we had a President that just lied to the people he was supposed to be working for at almost every level. My family's health insurance cost TRIPLED, from somewhere around $7K per year to over $21K per year. If you include the increases in deductibles and other factors, it's more like $35K per year. When you have a President promising families that they are going to save $2,500 per year and, in reality, they are spending $28K more for less care. Well, this is wrong.

BTW, discussing how much my wife's practice charges their clients is irrelevant. Not going there. My wife and I think it is an absolute travesty that such things have to exist. She would much rather have an open practice. However, she is interested in being able to provide quality care. The effects of Obamacare on medical practices doctors have created a situation where they have to churn through 30, 40, 50 people per day --per doctor-- for things to make financial sense. THAT is the travesty. and that is the consequence of adding Obamacare on top of a system that already was shit to begin with.

How do you get to what I said in the very first sentence in this comment?

We know how. It is conceptually simple. However, it is very hard to execute due to the fact that people don't seem to want to use honest critical thinking:

- You have to abandon ideological cargo-cult mentalities
- You have to be willing to go where the data takes you
- You have to accept that you might reach conclusions that are uncomfortable
- You have to accept that there might be realities that are very difficult to reconcile
- You have to leave politics behind you
- You have to be willing to make honest fact-based assessments
- You have to engage in solid root cause analysis, no matter where it leads
- You have to understand that there's a vast ocean of cost structures that drive this
- You have to understand that there's a vast ocean of regulatory issues that make this difficult
- You have to develop a model that honestly includes thousands of variables driving the problem
- You have to be willing to push reforms out to every problem branch identified
- You have to be interested in the objective, rather than political alignment
- You have to accept lots of things that might not be comfortable
- You have to commit not punishing one group in favor of any other
- You have to understand that the objective will require establishing limits where necessary
- You have to be clinical about the analysis, not emotional or ideological
- Etc.

The list is many times longer than these few points. This is not an easy problem. It is a million times harder when people are not willing to honestly identify what is wrong and go after relevant solutions. It is a million times harder still when people are willing to have politicians lie to us all and fuck things up deeper and wider because they want to protect their ideological alignment.

As examples, I'll give you two problem branches that need to be chased. These are just two of the, likely thousands, we should address with political neutrality and devoid of emotion. Because, frankly, some of these things boil down to just math, accounting.

Every business has a cost structure. Healthcare is not an exception to this simple truth. If you want healthcare cost to come down, you have to attack the cost structure. If you want to sell a burger for $5, the ingredients can't cost you $10.

NO. NO. NO. Insurance companies are NOT THE PROBLEM. They are the effect. The cause is the entire cost structure that drives what they have to do.

Simple example: If you live in a town where everyone is having car accidents at three times the rate of the next town, insurance companies are going to have to charge more. It's simple math. Healthcare is no different.

Where is the cost structure. As I said, two examples. I'll boost that up to three:

1- Cost of education
2- Cost of litigation
3- Regulatory burden

1: The cost of education in this country is ridiculous. At the base of the many branches of the cost structure that drives healthcare costs at every level is the cost of education. Every medical practitioner, scientist and engineer working within the medical industry has, as their baseline, very large student loans to support.

Nobody can work for a salary that does not allow them to cover their own personal cost structure and beyond that, save money and have a life. Everyone needs to retire at some point. You can't work for exactly the money you owe every month. Your "personal enterprise" has to generate a profit.

2: Investigate the amount of money medical practitioners, clinics, hospitals and medical technology companies have to spend on insurance and protecting themselves from the insanity that our litigious society can be. These costs are far from trivial. And, yes, these costs make it into the business equation that drives the cost of healthcare.

3: While regulation and oversight is important, it is obvious that things have gone way too far. As a personal example, a couple of decades ago I became interested in developing a specialized hearing aid for people with a somewhat rare (1 in 100K population) condition called "Acoustic Neuroma". I was ready to invest a significant amount of money to develop this solution. I quickly discovered the FDA approval of this relatively simple in-ear device would cost a minimum of $10MM and as much as $25M (or more). I just dropped it. It made no sense.

Drug and medical product companies have to spend incredible amounts of money to deliver products into the healthcare system. These costs, once again, have to be passed on.

There's so much to unpack. Like I said, thousand of pages and analysis. This is impossible without being brutally honest about root-cause analysis.

By the time an insurance company becomes involved in calculating a premium, all of the above, and much, much, more, have populated the variables they have to use to get to that premium. They are often painted as the culprit. This is so wrong it is probably over three standard deviations away from the mean of the analysis of the healthcare cost structure.

Final example: Our food is shit. Our own food is making people sick. Americans are being poisoned by the very food our FDA (and whoever else) allows onto our shelves. How can healthcare costs possibly be lower when what you start with is a population who's default condition could be labeled as poisoned and unhealthy as fuck due to the food we consume.

No, insurance companies are the least of our problems. That's what Obamacare and every single other proposal from any politician on any side has always missed. They focus on insurance costs and ignore the massive iceberg of root causes underlying the problem.

If we want healthcare to be elevated to the level of a basic human right, we have to be honest about where we are and find real solutions.