I think it's relevant to HN because a lot of us with families and/or in middle age can't risk quitting our jobs to start startups without assurance that we'll be able to buy adequate health insurance at a price we can afford -- and every dollar counts in a startup. I know I've seen people post here that Obamacare was an enabling factor for them, and it's now obviously at risk. So the policy discussion about what it should be replaced with is very relevant to us.
This piece, along with others I've read recently, suggests to me the following overview of the problem:
() The market for health care services is highly distorted. Not only is there no price transparency, but patients don't even have the authority to make purchase decisions on their own behalf -- that's done for them by the doctors. To the extent patients have any say in the matter, they are unlikely to be in an emotional state conducive to hard-nosed negotiating, if there is any urgency to the matter at all.
() Multiple special interest groups have gotten themselves politically entrenched. The service providers may be the most successful of these, but there are also the insurance companies and the malpractice lawyers. The amount of money flowing through the system supports armies of lobbyists, who have compromised legislators of both parties.
() There are no easy solutions here, no free lunches. You can’t have all the good parts of an unregulated insurance market (freedom to buy what you want, when you want, with market pricing) without the bad parts (steadily rising premiums and insurance that is unaffordable for people who are old and sick). At the same time, you can’t have all the good parts of a socialized system (universal coverage at affordable prices) without freedom-reducing mandates and regulations and large doses of subsidies from some people to other people. [0]
So, HNers, what's the solution? Would love to hear people's thoughts.
Personally I can't resist fantasizing that Trump will come to the same conclusion I have: single payer is the only solution. It would be like Nixon going to China. Trump (whose election I vigorously opposed) is unencumbered by considerations of who donates how much to which Congressional campaigns. And for all his flaws, he's a hell of a salesman. If he gets it into his head that this is the solution, it could really happen.
A pipe dream, I know. But would you like to see it? If not, what do you think would be better?
[0] https://www.washingtonpost.com/news/wonk/wp/2016/11/12/donal...