What's the path forward? Where do we go from here?
But, a lot of people don't like Kaiser. You have to be ok with getting good enough care, and not really be trying to seek 'the best' care. Integration is so nice though. I'm sure Kaiser never puts you in the situation where the Dr says I'm not sure which drug will be covered, let's try A, the pharmacist says A isn't covered, ask your Dr to write a script for B, and your Dr doesn't answer the phone so you have to decide to either pay $250 for A or wait over the weekend to start your kid's treatment.
If we could use tax dollars to make Kaiser national, and scale that large without losing the efficiency and results, we'd be in darned good shape.
Eliminate other private health insurance and if people want above and beyond service they can negotiate directly with providers and pay out of pocket for that.
It's hard to do that without turning it into the NHS.
I certainly don't want a free for all system like the US has (and I suspect the Tories want) but it isn't great at the moment.
You can but as soon as something gets serious they dump you back on the NHS.
Politicians - mostly the tories but Blair's government take a lot of blame too - have defined "not privatising the NHS" as only meaning keeping it free at point of use. But in the background, NHS trusts have been forced to sell land and buildings that they used to own and rent it back from the new private owners, and many areas have seen both staff and equipment privatised, from agency staff (where instead of hiring cleaners or nurses or whatever, they instead hire agency staff, where the hourly cost to the NHS is double or more what an employee would cost with most of that increase going to the agency companies not to the workers) to private hospitals (where instead of investing in a new operating theatre, or whatever, they pay to have NHS patients operated on in private hospitals), etc.
The NHS is far from perfect, but the lesson we learn from those imperfections shouldn't be that nationalised healthcare is bad, but that underfunding it and then using that underfunding to justify privatising lots of stuff in the background is not a good way to run a nationalised health service.
The root problem is that many politicians would like to see the NHS fall to pieces so that an American healthcare system can create lots of opportunities for companies to make money, but because the NHS is hugely popular it would be political suicide to make that an official policy, so instead they've taken this approach which not only creates these short term opportunities for companies to come in and profit as mentioned above, but also gradually erodes the it's popularity with the long term goal being that eventually it won't be political suicide to say "Look the NHS is a failed experiment, we need to replace it with American style private companies and healthcare insurance".
Linky?
Doctors: It's like working for any other hospital; it's not bad.
I was never healthier. The other Kaisers in Oregon aren’t geographically collocated so there’s less of an effect and they’re far away from me so I don’t use them anymore, sadly
But it all starts with voting for people who want to fix it, and not for people who just want to burn it down or maintain the status quo.
Learn medicine, and practice outside of of the mainstream clandestinely (a past real world example would be abortion clinics on ships). It needs a group of committed/smart people to pull it off, so not easy. Also it cannot be offered to the public at large for several obvious reasons.
As a general rule one cannot involve 'average' people in such an endeavor. All organization settle down to the lowest common denominator. When it come to large organizations in govt/health/etc. they are prone to increasing corruption and bureaucracy if average people are involved.
There is a fifth one that imposes costs: our comprehensively unhealthy food, health, and lifestyle in America that capitalism feeds upon with addictive high-margin food and drink, with overworked workers that can barely have time to raise kids (our healthy demographics are due to immigration) much less a healthy lifestyle. The entertainment complex certainly doesn't help either.
Providers: you need comprehensive family care to avoid specialist care being needed, an increase in supply of doctors, decreasing their educational loan burden (which strongly incentivizes specializataion, and a system that involves specialists). I think advanced AI systems can do much more day-to-day tracking and diagnosis/information, but of course that is a personal information nightmare. Actually I don't mean advanced. I think current AI is plenty good enough. Unfortunately only insurance companies will employ these systems or pay for them.
Insurance: Probably need a medicare-for-all option. We were close to this with Obamacare but FUCKING JOE LIEBERMAN killed it. Exhibit A in why the Democrats with full control of government will never get anything done.
Drug/Device companies: reduce patents, I don't know, maybe allow price negotiation (which is just mind blowing in a "free market" economy), reform the FDA to make bringing drugs to market cheaper.
Lawyers: caps caps caps so there isn't costly malpractice insurance. Maybe would also necessitate a federal review board to weed out "bad doctors".
But the biggest is probably governmental direction to actually get people to be able to eat and live active lives. Maybe GLP-1 will help, but the quiet time bomb of increasing obesity in Americans each decade is probably a sneaky large amount of our costs.
Otherwise, on the nihilistic side, keep doing whatever our society is doing which is causing men to kill themselves in huge rates (soma ... uh... I mean opioids were also doing this as well) before they reach their ultra-expensive late stage of life.
Anyway, none of that is happening (except, sadly, the nihilistic solution is the most realistically happening).
Maybe setup huge provider networks across the border in Mexico and Canada served by high speed transit, so large portions of the world get health maintenance in functioning health care systems, and only do hospitalization and emergency care here?
We recently tried this with some vaccines and now a large segment of the population is now vaccine-hesitant.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10257562/
> Lawyers: caps caps caps so there isn’t costly malpractice insurance.
Caps don’t always result in improved health outcomes.
https://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?p...
> Maybe would also necessitate a federal review board to weed out "bad doctors".
This exists; each state medical board has a procedure for reviewing medical licenses.
Forced vaccination was the problem here.
Uh, definitely not. The drug discovery and trial process is every bit as complex and expensive as it is for a reason. If you're serious about lowering the cost of getting compounds through the pipeline the first thing that should go is private equity's growing chokehold on the provider practices that perform clinical studies.