Comment by testplzignore | Hacker News Reader

Comment by testplzignore | Hacker News Reader

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In the software world, we would fork or rewrite, and deprecate the old version. I think we should do the same for healthcare. The existing system is unmaintainable spaghetti code that needs to be deleted.

Create a new single payer healthcare system that is completely separate from anything existing now. Don't attempt to incorporate any existing insurance, regulations, medical records, etc. Allow the new system to ignore any existing drug patents. Get a few brand-new hospitals, a few hundred doctors fresh out of med school/residency, and tens of thousands of people using it - probably do this in a single city, a la Google Fiber. Spend a couple years working out the kinks.

Once that is done, migrate everyone to the new system over the course of a decade or so. Any existing hospitals, doctors, and patients are free to stick with the existing system, but I suspect they'll learn to regret that decision.

There are no technical or medical roadblocks to this that I can see. The only obstacles are political and legal, which can be overcome in one or two election cycles.

> Create a new single payer healthcare system that is completely separate from anything existing now.

We don't have to create some new system from scratch. Medicare already exists, and it's extremely efficient[0]. Medicare-for-everyone is arguably the best path forward to a national healthcare system.

[0] https://www.healthaffairs.org/do/10.1377/hblog20110920.01339...

> According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.

There is some old "baggage" that you'll necessarily need: written procedures; the experience of, uh, experienced medical staff; and patients' histories. If you can bring those along without polluting the new system, you might be onto something.

It's arrogant to assume that a new system will be better than the old one merely because it was re-written from scratch. Many companies died because someone said "let's rewrite this bit of software" and the project ended up failing because people vastly underestimated the difficulty of the re-write. Even though they were smart professionals who knew how to write software well.

Considering that software companies frequently fail to succeed at re-writes with something as inconsequential as software, what makes you think society can do it with something as consequential as healthcare? Especially considering that healthcare is in many ways much harder and more poorly understood than software?

One advantage we have is that other countries have systems we could copy. Its not a complete re-write.

This is like saying that Netscape can re-write Navigator because they can copy Internet Explorer. It ignores that Netscape and Microsoft had totally different reasons for the choices they made, and that changing those choices in a re-write was very non-trivial for Netscape, to the point where it ceased to be a company.

You will likely find similar problems with this in attempting to replicate other health care systems. Indeed, you could complain that the mess we are in now is the result of doing a poor job replicating Switzerland's health insurance laws.

> In the software world, we would fork or rewrite, and deprecate the old version.

Yes and no. Can you name even one specific example of this being done with software on a scale within even an order of magnitude of "healthcare"?

Certainly people fork and rewrite software all the time. But almost all of those projects fail to replace the 'old version'.

And even large software projects that are rewritten are often (heroically) written so as to be (maximally) compatible with the ecosystem of users.

> The only obstacles are political and legal, which can be overcome in one or two election cycles.

This is both wildly optimistic and pessimistic. Vermont voters passed a single-payer referendum (but the government decided to cancel the plans because of the estimated cost). I'm not sure that there's much of anything stopping a single city from doing so (besides things like free-healthcare tourism).

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