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Comment by el_jay | Hacker News Reader

Interesting, thank you. One remark:

> Modernization is hard, time consuming and very expensive. These regulations are a good driver for all that, but it takes time. Having been in some of these boardrooms there is not typically a cartel of evil executives figuring out how to screw patients. A lot of the time it is a group of relatively normal people trying to hold up a technological and business process house of cards with chewing gum, paper clips and hope.

It bears questioning how, in ”the richest country on Earth”, something as important as a hospital ends up held together with spit and twine.

Inside this richest country, the richest individuals and companies have been capturing ever-larger shares of GDP. Perhaps instead of growing private fortunes, this money could have gone towards modernising these regulated industries?

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> "the richest country on Earth"

This statistic is misleading. The US is only the richest country on Earth if you consider the mean wealth. By median wealth, the US is ranked 26th. The wealth gap is enormous, and if you're in the upper echelons of the pyramid your health outcomes are vastly better than the clownshoes shitshow that the rest of the country is subjected to.

The critique is perhaps not relevant here, since it suffices to say that the country's wealth can afford a health care system not held together by "spit and twine", irrespective of how that wealth is presently apportioned. The wealth gap is, as you say, enormous.

In fact, the wealth gap is but a reflection of the underlying cause of the problem: legislators corrupted to the interests of the donor class at severe cost to the actual constituents of those legislators.

The system's complexity is a feature, not a bug. Regulatory capture is real. And much of the regulatory system in health care exists to limit competition. The AMA is a cartel of doctors that limits degrees even for qualified candidates. and the hospitals also operate as geographical cartels.

The problem is that it was built by the last 50+ years of technology and regulations. The system is a product of its upbringing. A company could starts out with noble goals of doing better and slowly year by year sink into this morass and become just another “part of the problem” before it becomes obvious to everyone that it’s now just another entity making things worse.

These kinds of reforms would have had to begin decades ago to make much of a difference.

> “… noble goals of doing better…”

Compliance within regulation is a noble goal? I should think it’s ethical goal.

> The problem is that it was built by the last 50+ years of technology and regulations.

So... perhaps if we'd had a better goal 50 years ago - single payer or universal medicare or whatever you want to call it - we'd have decades of technical debt that propped up a fairer system, instead of an unfairer one?

Perhaps we need to change our goals today so that 20-30 years from now things will be better then?

I wonder if it is possible to design regulations with the intent that they may change and the data may require reformatting. At least a best standards practice of how these regulations should be written should be possible.

Richest Country - RiCo for shorter - is not a sentient being that sees and controls all...

What you refer to is actually a collection of hundreds of millions of individuals, with all sorts of interests, sentiments, ambitions, sometimes conflicting ones.

>It bears questioning how, in ”the richest country on Earth”, something as important as a hospital ends up held together with spit and twine.

Voters are incredibly scared of change because it's so vital. The current situation isn't caused by a lack of resources but a lack of focused will

If the incentive is not more money in most cases then it won’t work.

And those who generously give may not oversee how money is spent and likely squandered to a certain degree.

Takes an incredibly self sacrificing individual to risk it all, which is what this requires.

> It bears questioning how, in ”the richest country on Earth”, something as important as a hospital ends up held together with spit and twine.

In less rich countries they use paper records, which are worse. Everything is held together with spit and twine.

Not necessarily true. At least all my medical records in all the facilities I visited in the last 5 years were digitized and I live in an eastern European, post-communist country.

Nope, they just use a single national health insurer instead of many private ones. This changes the problem from many-to-many (as is in the US) to just many-to-one, which is immensely simpler.

There's a lot of this concept, that if it doesn't work in the US, everybody else must have failed even worse. Well, not really, many times it's actually the other way around. I won't bother with other more obvious examples but in this context, even Pakistan has a digital health system in the meantime.

I honestly think it's because Americans are told from birth they live in "The greatest country in the world". In that context, it feels like trying to fix anything is not really a worthy pursuit, because it's already better than everywhere else anyway. So even if healthcare sucks, it's better than everywhere else. (Which everyone in a developed country knows first hand is simply not true)

I personally think it's a very dangerous thing to believe, because it means there's no driving force to improve, and it's a part of the reason the country has stagnated so badly.

My wife did part of her nursing program in St Kitts. They used paper records.

She also says that, of the half-dozen medical record systems she has used (here in the US), Epic is one of the better ones. (read: least bad)

I'm sure if you talked to medical professionals in Pakistan they would bemoan their medical record system too. It seems to be popular sport in the medical community.

You could consider the fact that many countries have instant bank payments, ipV6 networks, better residential internet, have chip & pin and 10x less credit card fraud, have better justice system (lower recidivism, verdict is not determined by your wealth, etc), don't have the 'social security number is an identity', etc..

Of course many countries are worse, but surely you want to look at successes of others and replicate them.

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