As software developers we can probably empathize. I know I have been working on production code and found years old comments written by me along the following lines:

//Hacky solution to get a working prototype, should be refactored before deployment.

Legislative and regulatory debt can be a problem just like technical debt.

> Legislative and regulatory debt can be a problem just like technical debt

I really wish there was more appreciation for this outside of tech. I'm disdainful of a lot of SV libertarianism, to say the least, but will gladly make common cause on this one point.

Debt implies that we know there is a shortcoming and want/need to fix it, but don't have the time or knowledge.

The healthcare situation in the US may have started out as a hacky WW2 era fix, but has been explicitly and aggressively lobbied against for years at the highests levels of government.

Framing it in a technocratic context as "technical debt, but for laws and stuff" completely misses the intense crusade against it in the US.

I'm not sure it misses the point. Technical debt is always poltical too, whether it's system admin / database admin work being automated away (or not!), or manager<->engineer friction on costs and deadlines.

I’m glad this is being raised, because it’s almost never discussed in the same “why is American healthcare so screwed up” discussion. It’s also a relatively important point re: the arguments people make against for-profit healthcare, precisely because we’ve had a system for almost a century where third parties are negotiating prices with providers under heavy regulation/incentivizing of the government.

There is nothing as permanent as a temporary solution.