That seems like a lot of people to piss off to get any reform done.
Wouldn't an actual smart negotiator play off one against the other, and make the doctors support the initiative at the expense of the pharma industry, or vice versa?
Speaking of negotiators. These groups have very skilled so they wouldn’t just let themselves be played off against each other to their own detriment.
A lot of negotiators talk about win-win agreements which may be true with just two parties. I think once you get beyond that, no true win-win agreement is possible and some people are going to lose out. Trying to appease every single interest group is what leads to a lack of progress.
Middle men jobs, no matter how good, need to be on the chopping block if all they do is be extractive pests. They can't both be protected from the pressures of the free market, and not have any accountability from an improved service standpoint.
As for the actual workers, Doctors can charge what they like, but they shouldn't be able to limit the supply of doctors within the nation. That is NIMBY mentality.
The government acts at the behest of the governed so they need to get support from at least some of those groups because a lot of families rely on someone working in one of them.
Can defend why Obamacare marked government interference and , for example, not medicare?
It also changed small medical practices because suddenly everyone wanted to use this insurance they were paying for. No longer could it just be a doctor and maybe a couple of medical staff; they needed medical coders, specialized software, and so forth. Some decided to join large hospital networks (for worse, from what I have generally heard).
And this cascaded into multiple sub-industries developing around this revenue stream and the medical system. Everyone trying to sell something and grab their piece of the pie.
It was not great before, but you could go see a doctor and literally pay a small amount of cash for an appointment. Many won’t even accept anyone without insurance now.
Edit: as mburns@ pointed out, the IRS no longer asks individuals about their health insurance status since 2019.
US here. I remember a Princeton Study from 2014 that found no correlation between public opinion and public policy.
https://www.cambridge.org/core/journals/perspectives-on-poli...
I suspect that the disruption will come outside of the regulatory realm: As prices go high enough it's cheaper to get the same treatment in Mexico, or have an AI be your primary care provider, the US system will fall. It will not be this year, and probably not this decade, but eventually such level of waste crashes big.
(Full disclosure: family member works for Big Pharma)
You might not get them to admit it out loud, but Big Pharma sees the USA as the cash cow that funds R&D for everyone on the planet. If a potential product can't or won't ever make it to market in the USA, or if there aren't enough potential patients in the USA to be prescribed said product, then it might never get off the drawing board.
It's (unfortunately) that simple.
We need India to get rich ASAP, so Indians can start paying for it. :-)
Trials are punishingly expensive.
Edit: protocol development. Drug interactions. Poisonings, Doctor education -- er, marketing. Incorporation into manuals. There's a lot that happens after the research talent has strutted its stuff.
Edit edit: oh, yeah developing manufacturing and logistics as well. The 'D' part of "R & D" is usually over 95% of the total for a reason.
https://www.raps.org/news-and-articles/news-articles/2019/7/...
https://en.wikipedia.org/wiki/Ormeloxifene
Frankly this system is already deep into market failure in the US and should be reformed anyway. We are not getting important drugs approved here because they can’t make it through approval despite track records of safe and efficacious use in hundreds of millions of people. That’s an intense life-wasting market failure.
Healthcare? Doctors, hospitals, insurance, etc all are taking a bigger cut than they should. You'll get a ton of pissed people if you want to solve it.
Housing? Nimbys are just regular homeowners that block housing to implicitly (or explicitly) protect their property value. Solving that gets a ton of homeowners pissed.
Universities? Tons of university admins and loan programs that benefit from restricting tertiary education supply. Fixing is pissing lots of people.
So much of our economy is captured by large cohorts of people that are not explicitly conspiring to do so, but their incentives moves them to behave like that.
Worst part of the privatization of the Swedish school system is that we know that the tax-money we pay to educate our kids is being diverted to Neo-Nazi funders and Saudi oil funds.
None of the entrenched interests really seemed to mind.. Wonder if Obama does that wink to his PE friends when they meet
You don't have to be a sole proprietor for those at the top to take a ridiculous level of compensation.
> Nonprofit hospitals are under increasing scrutiny for skimping on charity care, relentlessly pursuing payments from low-income patients, and paying executives massive multi-million-dollar salaries—all while earning tax breaks totaling billions.
https://arstechnica.com/health/2023/10/nonprofit-hospitals-s...
> ...insurers, chemists, drug distributors and pharmacy-benefit managers (PBMs)—sitting between patients and their treatments. In 2022 the combined revenue of the nine biggest middlemen—call them big health—equated to nearly 45% of America’s health-care bill, up from 25% in 2013. Big health accounts for eight of the top 25 companies by revenue in the S&P 500 index of America’s leading stocks, compared with four for big tech and none for big pharma.
It goes on to detail their profit relative to the S&P as well.
Why? We're currently undergoing a major shift in labor wrt to automation, AI which will absolutely destroy entire sectors. Not a lot of people give a shit, it's considered good for the bottom line and for profitability. But when it comes to healthcare, the narrative is that we suddenly care about labor? People applauded the tech layoffs but the parasitic private insurance overhead is just too important? Disgusting
There’s a parallel to that observation: these parasites are a major part of the S&P (not as much as the article claims, per another comment) which means if they decline it will look like a secular decline in the market (=> peoples’ retirement savings) which will cause vocal anguish.
That latter phenomenon is why bills like the IRA splash out so much money on the fossil fuel companies.
I don’t think AI diagnosis is going to change costs noticeably because tests and treatment is so much more expensive and you need people to provide that.
A lot of people __do__ give a shit and this is a very common conversation among blue collar workers. I've heard about it every Christmas for the past 5 years from people who don't know how to google. Mass shifting in jobs has always been a big conversation but there's just a big divide between the working class where people aren't talking together as much.
We have coal miners complaining about "big solar" taking their jobs. We have the whole "just teach to code" fiasco. We have a lot of discussions about Amazon. And I can keep going. If you think this is a "suddenly care" type of thing then you're likely in a bubble or not paying attention (a different bubble).
Basically a bunch of journalists told laid off coal miners that they should just learn to code, which some people saw as callous. Then in 2019 Buzzfeed and Huffpo and a few other places laid off a bunch of journalists. People started tweeting "learn to code" at them and they weren't happy about it.
Plus, we all know code bootcamps don't make great programmers. And if we're being extra honest, LLMs have a good chance of replacing low quality coders, so now in hindsight the advice comes off as even more pejorative and low quality. Hindsight is always 20/20.
I don’t know if the outcome you want is the outcome you’re gonna get with that strategy. Might want to consider the humans actually affected and how they might react instead of treating everyone as some faceless cabal of evildoers bent on pulling money out of your pocket.
As an example, in many countries where they have socialized healthcare, nurses and doctors do often go on strike, which has always resulted in worse care during those times...
Speaking of which, I am not sure why doctors are allowed to limit the number of doctors who can become licensed each year.
I agree with your concerns with the AMA et al. It’s clear that we are way overpaying SOME doctors and hospitals.
It’s also clear that our demand for medical treatment is almost insatiable and about as inelastic as it gets.
Ie we need to tell some drs and hospitals, fu the gravy train is over; but we also need to tell Joe Public, no you don’t have an existential right to wegovy.
And small and big fortunes. Don't forget that those that protect fortunes are way more effective than all other.
This is why we should not accept any health care reform proposal that any of the American Medical Association, the Pharmaceutical Research and Manufacturers of America, or the American Hospital Association are generally supportive of. Whatever we try, they should be vehemently against, just like they were with Medicare.