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Comment by mmastrac | Hacker News Reader

The incentives in US health care are so upside-down that Americans pay significantly more for the same results as many of the other western nations. While the public systems of the UK and former colonies aren't perfect, they are still significantly cheaper to run for approximately the same outcomes. Ditto for other European countries.

I don't understand why this hasn't become a boil-over issue for Americans yet.

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Perhaps because it doesn’t impact you until it does, and we can’t seem to agree on what exactly is causing these outcomes. It’s a legitimately tangled problem, and I do believe how to unwind it is not well understood by anyone. (Ignoring single payer, which is more of a sidestep than a true fix)

Many people are also insulated by expensive insurance plans. HDHP are a long term play to generally make the public more familiar with the problem, as they will no longer be fully isolated from the prices.

I'll posit single-payer is much closer to a true fix than you give credit for.

A significant fraction of the additional cost in the US is due to all the administrative overhead that comes with negotiating prices with thousands of insurance providers, as well as dealing with not only primary insurance, but secondary, tertiary, and sometimes even quaternary insurance providers for any given patient. And, as mentioned elsewhere, it gets multiplexed over each doctor involved in your care, since each may work with a unique subset of insurance providers.

You don’t have to have single payer to get more transparency in pricing, for example.

> I don't understand why this hasn't become a boil-over issue for Americans yet.

Media keeps people distracted with idpol

A lot of people that vote have employer provided coverage (that appears affordable to them) or Medicare.

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