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Comment by afthonos | Hacker News Reader

Everyone hates “the system”, including the people in it. But every party of the system is perfectly fair and reasonable for the people benefitting from it, even if they hate every other part. So every part of the system will have people fighting for it—and if you try to change the whole system, the entire system will fight you. It’s an equilibrium, even if it’s obviously far from optimal.

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And it has only gotten worse with time.

https://www.statista.com/statistics/184968/us-health-expendi...

That's 20% of the country that will be less well off if you "fix" healthcare in any meaningful way and the overwhelming majority of them will fight tooth and nail to prevent that from happening.

That is a hell of a minority to overcome when the issue is one of personal economics (i.e one everyone will experience directly, not some abstract social policy thing that people will ignore as long as their lives are good), dare I say basically impossible in a democracy.

(yes I know I'm assuming that the healthcare industry is a cross section of the country, no I don't care if that isn't 100% accurate)

Excellent comment, succinctly summarizing how a systems thinking perspective translates the monster of health care in a large system of interconnected parts, each with its own stakeholders. Trying to change a single part triggers a reaction from everyone.

Tough ecosystem to change. But, at the same time, seems to be the one needing change the most.

> every party of the system is perfectly fair and reasonable for the people benefitting from it

This observation has value. However, if we hold it exclusively in mind we might lose focus of how prioritizing consumers strongly benefits society.

There's an old essay "Meditations on Moloch" which is an exploration of themes around why humans create systems with destructive outcomes even when no individual wants them: https://slatestarcodex.com/2014/07/30/meditations-on-moloch/

This is a really good read. It talks about all kinds of systems which become their own entity. Nobody likes them. They make things worse for everybody. But somehow we get trapped in these downward spirals and there’s seemingly no way out.

Surely some people do actually want suffering, or at the very least are indifferent to causing suffering to advance their goals? I don't feel like there's some weird paradox, but rather that the system makes it too easy for sociopathic types to rise to the top.

I think this is related to fundamental attribution error. The system is messed up and therefore attracts messed up people in leadership positions, not the other around.

I guess I miscommunicated the thrust of my argument. It seems to me that the paradox presented in the linked article hinges on an assumption that "nobody wants" there to be suffering. This seems flawed to me. There are plenty of people - some of whom are in positions of great power - who are content to generate a large degree of suffering in order to advance personal goals. This is currently very clear in Ukraine and Gaza. But it applies equally well to people that drive shady mergers and acquisitions at the cost of the consumer, or people that push drugs at the cost of addicts' health and relationships.

It's not "nobody wants this", but "sufficiently many people are sufficiently apathetic to continue this state of affairs".

I still expect people to raise awareness if and when they're caught in a perverse incentive/Moloch situation so as to give the public greater insight into how it can be fixed.

Health insurers ... don't seem to do that.

Earlier comment: https://news.ycombinator.com/item?id=42435020

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