Topic: The Real Problems with American Healthcare (Read 856 times)

The Real Problems with American Healthcare


It doesn't work. The immediate help it seems to offer to patients, creates further problems down the road.
It works for making the medical industry rich.

Same. things can go bad if you're not insured and suddenly you find out you or your relative who wasn't insured had some undetected chronic issue all along that needs immediate management. I've already gone through it...

I would recommend everybody to buy health insurance. The younger you are the cheaper it will be and if you get any severe illness you might not be able to get insurance at all anymore. We never know what will happen in life. And if we can't pay for own medical bills than our family has to pay and it can get really expensive.

https://fee.org/articles/i-was-a-physician-at-a-federally-qualified-health-center-heres-why-i-no-longer-believe-government-health-care-can-work/

I can see how you would be able to pick your own doctor.

When your pro-rata fraction of his time allotted by Big Gov Socialism was 15 minutes or 15 microseconds is the question.

Are you trying to tell me that when they said you can pick your own doctor, they didn't mean from a tree?

Medicare for all can be funded with any amount of money.

It's very simple.

First, scrape off the total received funds those that are to be kept by various corrupt people and operations in Washington DC. For this, the more funds brought in, the better and bigger the parties are.

Then take the remaining funds and divide them up by the institutions and doctors providing service.

Yes, it's really that simple.

Whatever care you get is that fraction of available resources.

https://ijr.com/economist-claims-doubling-income-taxes-wouldnt-fund-medicare-for-all/

Does it conclude about high cost of malpractice insurance?

High cost of health insuarance.
High cost of Malpractice insurance.
High cost of auto insurance.
+ other insurances.

I think tagline should change to "In insurance,we trust"  or "The people,we neglect".

Anyways lot of facts are shared here but my question is what can be quickest and cheapest way to fix this system?

The real problem with American anti-healthcare is what's in front of the "healthcare" part... kinda out of sight.

Perhaps step back a second and look at the matter? The "facts" may not be what you think they are and may not have the effect of refuting argumentation as you think they may?

Personal experience is highly relevant. It gives us a feel of the vast gap between a UN chartered paid for set of propaganda and the reality on the ground, doesn't it?  Or it can verify the high quality of such data and the care that it represents. I have worked in survey design and statistical methods, so we don't need to try to impress each other with such things. Neither do you need to hold up your surveys as golden, which they certainly are not.

Advancing the state of understanding of a large and complex matter is not going to be found in politically biased polemics.

First of all those are all based on surveys, the lowest form of data to be had, a type that is exceptionally easy to manipulate. Second, these are all from 10 years ago before the hordes of millions of illegal migrants started crossing over in to Europe and to the US, which is clearly having an effect on supply and demand. Again, as I explained people keep saying we need to be more like these countries, and I argue that this was already attempted and failed, resulting in the current conditions. It is rather convenient then, as people who support these kinds of policies usually do, to blame "free market" and "capitalism" for the failed results of government subsidized rent seeking monopolies resulting from attempting these entitlement policies from the past while using that failure as an example of the policy's own virtues.

The procedure costs the same everywhere, it is just a matter of who pays for it.

The cost of an ultrasound can be broken down into 5 parts:
1 - The cost of the machine - For example, if an ultrasound machine costs $5,000, will last one year, has no downtime or maintenance costs, and can (and will) be used 10 times per day 365 days a year, the cost of the machine for one use is ~$1.37 (I have no idea what the specifics are, but the actual inputs can be put into this formula: (purchase price + maintenance costs over useful life) / # of times machine can be used)
2 - Cost of any disposable (single use) materials used to perform the procedure, such as the jelly, the cloth on the examination table, etc.
3 - Cost of the Nurse's or Doctor's, time, based on what the market is willing to pay.
4 - Administrative costs of the doctor's office, such as rent for the office, the salary of someone who handles billing/scheduling, the cost of malpractice insurance
5 - Profit for the doctor's office (or the entity who is performing the procedure).

If the machine is being purchased for $5,000, but the cost (including a reasonable profit to the manufacturer) is $50,000, then the manufacturer is paying a portion of the cost. If the free market value of a nurse's time is $50/hour, after accounting for benefits, breaks, PTO, and employer paid taxes, but the nurse is only earning $20/hour (after account for all of the above), she is (effectively) paying a portion of the cost.

The ultrasound procedure example is probably paid for mostly by taxpayers as a whole, however the above points bring me to a better example....

---

Costs of Drugs:

In general, the cost to produce an individual dose of a drug is very low, and will generally represent a small fraction of the amount received by the drug maker (for a drug sold in the US) for an individual dose. Most of the amount received by the manufacturer is the manufacturer recouping the cost of Research & Development of the drug. In general, it costs a lot to develop a drug, and there are many drugs that fail during the development phase. If a drug maker does not believe the R&D cost of a drug can be recouped, then it will not invest money into developing the drug.

There might be a particular drug that costs $0.90 to manufacturer and ship that is made in a plant in Nashville, TN. This same plant may ship the drug to New York City where it is sold by a pharmacy for $20/dose (plus the costs/profits of the various middlemen), but the same drug is sold for $1/dose in Norway due to price controls imposed by the government. The drug company makes a small profit off the manufacturing for drugs sold in Norway, however it would not recoup its R&D costs if the drug was sold for $1/dose everywhere. If Norway were willing to pay a "market" price (non-government controlled), the drug company might be able to lower the dose price of the drug to say $19.96 -- this is only a small decrease, but Norway is also a single small country, and if many  countries with large populations allowed a market price to be used, the price at which the drug company is confident it will recoup its R&D costs could be a lot less than $20/dose.

The US is, in effect subsidizing the costs of drugs overseas.

Trump has proposed a 'fix' for the above problem by limiting how much a drug company can sell a drug for in the US based on how much the drug is sold for in other countries. My belief is the goal of this is to force drug companies to stop selling drugs at government controlled prices overseas, which will make other countries with socialized medicine to decide to either pay a market price for a drug or not have access to the drug at all.

---

Malpractice Insurance/associated costs:

Unrelated to the above, the cost of Malpractice Insurance is very high. It was disputed above that some doctors will perform unnecessary procedures because a third party says to do so. I do not think it is common for doctors to perform unnecessary procedures, however it is more common for doctors to perform what could be described as unnecessary tests in order to avoid a potential malpractice lawsuit. This not only drives up the total cost of having an ailment, but also drives up the costs of these tests because of increased demand.

Malpractice lawsuits (the ultimate driver of malpractice insurance) can often lead to expensive settlements in favor of the patient that arguably are excessive. This is in part because these lawsuits are expensive to defend against even if frivolous (or not meeting the "frivolous" threshold, but not a case that would end in favor of the patient if it went to trial). Tort reform would be a step in the right direction to lowering these costs. It would be a huge step forward in reducing these costs if laws were passed giving medical professionals "safe harbor" against malpractice lawsuits if they meet certain criteria in their standard of care.

Except I didn't ignore it. I responded directly to it.

Go and find my source then if you think I copy and pasted (hint: I didn't. I read and critiqued the paper, like anyone who is actually interested in the facts.)

Well, yes. To disagree with the facts I have presented, you must have, at a minimum, read them and critiqued them. Otherwise you are simply writing them off based on your biases and preconceived notions.

What's this got to do with anything?

If they are so clearly made up, then they should be easy for you to refute.

Again, please present your facts which refute mine.

Personal experience and anecdotes are not on an equivalent level of evidence as methodologically sound studies.

You can continue to ignore the facts I have presented and talk about "Big Pharma" if you like - I will not be responding to these non-arguments any further. If you have any evidence to support your points, I'd be more than happy to discuss it.

I have done so in one case, which you conveniently ignored. But that's okay because you would have read up on the criticism of the 4% number, clipped and pasted that, and then you would have expected me to argue similarly on the 65% number. Where you went wrong there was to assume your audience would believe a number by Senator Pocahantas....

Your responses really resemble the canned "ready to clip and paste"  responses by climate alarmists used commonly on the web. That's why they are not convincing. To me they look like stuff made up by big Pharma and big Med for yet another (or the last, given the age of the citations) takeover of income streams in the government sector.

Basically you are ignoring facts to the contrary while pushing a polemic. That's more in line with propaganda methods than any effort to actually figure a problem out.

And by the way, I've been in numerous countries with "socialized medicine" so I kind of know first hand home much of this is true and not true.

Let's take a different look at this. Instead of exporting your favorite Euro-progressive-half-commie paradise's health care to the USA, let's export our Washington DC lobbyist industry to them, and see how they do with their legislation.

Feel free to present some actual data of your own then. If they are "biased propaganda" as you state, then refuting them should be an easy task.

I am seriously unimpressed with your one sided use of biased propaganda statistics.

They seem to make the point opposite to what you may think they are making.

Except none of that is true.

The US is decidedly middle-of-the-pack in terms of waiting times:
   

The US has a lower number of doctors per capita than the UK, France, Germany, Spain, Netherlands, Belgium, Italy, Switzerland, Canada, Australia, New Zealand, Russia, the OECD average, the EU average, the NATO average, and the G7 average: https://www.who.int/gho/health_workforce/physicians_density/en/

So we are pretending a huge load of people not paying into a system that subsidizes their healthcare doesn't have any detrimental effects? While we are at it lets pretend that conflicts arising from differences in culture do not directly result in issues such as more violence. Cultural homogeneity is known to have a stabilizing effect in many areas. The US has very little of this, Europe has quite a bit. Additionally you just totally ignored the point of the issue of scale. Not every system is scalable and there are diminishing returns when certain systems are scaled up, leaving you with less effective or ineffective results.




There are also zero nations that are exactly like the USA, the differences previously mentioned and well documented. You are comparing dissimilar countries and claiming the same system will work. This is proof of nothing. I am not suggesting we need more private industry, but less government involvement, and definitely not subsidies. Regulations need to be carefully considered, and nothing I have seen presented does this. The US healthcare system operates as a monopoly. Monopolies can not exist without them being protected by government regulation, furthermore they are illegal but only tolerated as they are perceived as a public good. Everything I have said has basis in logic, not "feelings" or "general ideological positions". I will leave that up to you making arguments from a moral position rather than a functional and logistic one.




All of them. They are all in varying stages of this process. Most importantly I am referring to the existing US system, which I had previously explained has already made the population the victim of this government mandate creep into entitlements and creating rent seeking systems as well as creating and protecting monopolies choosing winners and losers.





This is not a simple issue that "common sense" flippant "solutions" will solve, if it was that simple the issue wouldn't exist currently. Lots of really arrogant people like to think the answers are just so simple but the rest of the world is just too dumb to get it. I submit that the only thing common about your sense is that it is average.

Your little theoretical situation is meaningless for many reasons, primarily as a result of the fact all you are looking at is the individual and not the operation of the system as a whole. Again this comes from your position of arguing from a moral standpoint rather than a logistically functional one. What if they can get charitable assistance to cover the cost? What if they can get a payment plan? What if the person who is ill, is ill as a result of poor eating habits and drug abuse? Why should everyone pay for their bad choices, and who decides who gets that help?

Middlemen aside, the actual costs for these goods and services simply don't vaporize, they are passed on via taxes, or as is common in most nations with universal healthcare, increased waiting times, shortages of doctors and medicines, as well as other issues. Every choice has a cost, and you are only looking at the part you like while ignoring the parts you don't because you are operating from a basis of some undefined moral mandate.




I am sure your marginalization tactics work quite well on most people, but unfortunately you are the droid I am looking for no matter how much you tell me you are not. Don't speak for me please, I can do that for myself thanks. There is a reason the USA has grown so much and become so powerful, and a big part of it is our system of government. Being familiar with how and why it works, I understand that its writers were very intelligent men that realized government is like a liquid that will fill any crack or opening you allow it to enter in to, and then over time it will enter every facet of people's lives until the people become the servant of government, and not the government the servant of the people.

Again, you ignored my very logic based point that by creating dependence on the government for such a vital service, you are creating an imbalance between government and its people. With this powerful leverage, the people become the servant rather than the government serving the people. This alone is sufficient reason to limit the mandate of the government, not out of some lofty ideology, but as a knowledgeable human being that understands ANY CENTRALIZED SYSTEM can be subverted. Just plugging your ears and yelling "LALALALALA ITS MORAL THING TO DO LALALALALA" doesn't make this fact go away.

American government would rather spend $700 billion on the military.............

And it costs $0 in most other developed countries.*

*Before anyone starts with the usual nonsense, yes I know it is paid for through general taxation, but we have already established that citizens of other developed nations pay less in taxes towards healthcare than US citizens do, and don't have to pay out of pocket expenses and insurance premiums on top of that.

It is true for most of developing nation (not only equador). The ultrasound procedure that cost $900 in USA just cost less than $20 in developing nations. Even if you are covered by insurance and paying only 20% of cost , you still pay $180 (9 times more).

I understand there is difference in cost of living but $900 vs $20 does not justify that difference.

So.…. we're blaming diversity and immigrants for America's problems?


You're just proving my point. Like I said, there are zero developed countries that have anything like the US health system of private companies running the show on healthcare (and you're suggesting we need more of that). The US is an outlier. My proof that more Government involvement would be better for healthcare is literally EVERY other OECD nation. Yours for less is... what exactly? A feeling that the US health system is bad, and it must be the Government's fault? Some general ideological positions that you're trying to apply to the health system?

If you have any health literature to support your opinion, such as OECD data, studies, anything at all that shows why less Government involvement in the US system would be a net benefit, I'd love to read it.


I'm not sure what OECD health system in the world you are applying this too. Also the US taxpayer is already spending the same amount as other countries. The taxes for healthcare are the same as other countries, but then also get smacked with high private fees.

And the 'middle men' you mention of insurance agencies, banks, and lawyers is the problem I agree. You cut them out of the equation or reduce their role substantially - like other countries already do that have a cheaper and better system.


This thinking is why US gets nowhere on healthcare. You're taking an issue that has common sense answers (based on the experience of, well, the rest of the world) and put some idealistic free market competition dream over the top of it because it feels right deep down inside. Again, no other developed country lets the 'free market' determine if you die from a health issue or if it will make you broke.

Just to bring it down to a practical level of how this free market consumer choice health system actually works in the US -

Pretend you're unexpectedly seriously sick and need surgery. You need to be operated on within 24 hours or your chance of dying within a couple of weeks will go from 10% to 40%.  

In the US after your overpriced insurance (if you have it), your doctor still says you'll need to pay $10k in additional fees, but it could go up to $30k depending on whatever reasons they have.  

Your doctor is the expert, and you have a life or death health emergency. You're stressed and you think you can only just pay the bill.

It's at this point you want the uninformed potentially dying patient (or 'consumer') to start shopping around to see if they can find a cheaper/better life saving procedure at another clinic? Its at this point you want the person to check that they can't get the $30k procedure for $27k a couple cities away? Its at this point you want the person to question their doctor (who has your life in their hands) whether that extra $1k payment on the bill isn't over the top?

This isn't buying a TV trying to get the best deal in the free market. You just want to not die. But no, the 'market is cutthroat' and we can trust the market, doctors and big pharma to be reasonable players in a fair market that acts in your interest? please. Social policy issues should not be bystanders to free markets.

Just for a reference point - you know what happens in my country in the above example? I get treated and pay nothing except my taxes for healthcare (which are the same as what taxes the US pays on healthcare).


Here you are giving up. You are essentially saying that even if the health system would be better served by more Government involvement, it isn't directly permitted in the Constitution, so meh better not go there. I don't think you should see it like that as I'm pretty sure the founding fathers didn't have a concept of how the world would be today, and weren't thinking about the 21st century health care needs of the country. I would also find it unlikely they would support the current control of private companies over citizens.

You raised a few other points, which were mainly anti-government or establishment. I'm not trying to diminish those views and how they operate in other non-health (or social policy) fields, but for simplicity and to keep the points about healthcare, I'm looking at those as ideology pushing out evidence. Every other country does better than the US on healthcare. If the US wants to take the issue seriously, the bar is so low that they have plenty of nations to turn to for examples of what could work in the US.

In the real world of price, distribution and production this may not be what it seems at first glance.

I'm reminded of when - this is from memory, could be wrong - Hillary was responsible for consolidating one vaccine production issue into one order, where previously there had been six suppliers there was just one. Ramp up capability in case of a sudden demand was limited.

That was the bird flu issue.

Oftentimes, "consolidating buying power" leads to price changes exponentially less as the order size increases. Past a certain point the benefits are negligible.

On another, weakly related comparison, any of us would, in a crisis, take Walmart's distribution over FEMA's.

Yup, in short, we are screwed.

It'll take national uproar over an otherwise healthy child dying because their parents couldn't get a pill that costs $0.15 to create, but retails for $1k+. The only thing that'll make politicians oppose their backing is if they are at a greater risk of losing a more important backing. They'd probably tell 25% of their voters to get bent for pharmaceutical companies, but maybe not 75%.

And as great as our outlook is at that changing, we've just been talking about pharmaceutical companies that a lot of people already agree are "bad guys". Now lets see what we need to do to change the rest of it... Ecuador anyone? https://internationalliving.com/countries/ecuador/health/

hahaha....

I know where that's headed...

Too bad the pharmaceutical industry are the largest advertisers for mainstream media and the largest political donors...

Obviously you really know this subject, so we're in agreement.

Something just occurred to me.

There's only one person who could actually play hardball with the drug companies all the way down the line to a solution, and it's a guy who stood against both the Republican and Democrat parties, through truly difficult years, and that's Trump.

Right, if it was as simple as that, it wouldn't be that hard to get people on board. Everyone understands warehouse store's business model, the idea isn't really that special. The negotiation between individual insurance companies and pharmaceutical companies/hospitals/pharmacies is a massive inflationary mess. That was just an example of saying the buyers need more leverage than individual insurance companies can offer. Be it a government in charge of purchasing, or a small handful of private insurance companies (though then we get into monopoly laws), my main point however poorly communicated was that increasing some central power could be of help in cutting costs. The reason I said government, is because they are the only ones that can legally hold a monopoly.

As I'm sure you are aware, insurance company A agrees to pay X towards a medication. Paying more towards that medication allows them to keep more customers, but the drug companies know that. In exchange, they jack up their drug prices to get the insurance companies to pay more and more for them. That in turn raises premiums, but if they refuse to pay more towards them, they'll lose clients. Thats (partially) how you end up with $700 Epipens. No insurance company is going to stop covering an immediately life saving medication, so the price can be jacked up. That type of thing could be eliminated by someone with enough buying power to say that either the drug companies play ball or they won't be selling any products in the US.

As a side note, I'm aware of the plethora of other issues. Just saying play hardball with the drug companies isn't a complete solution to health care reform, its a very small step.

Let's say that's a Great Idea.

Get the people to agree, and have it put into committees in the House or Senate. Get it to a floor vote and then meld it with the other body's version.

By that time, you've got a sell-out to the very companies that were overcharging. That's the power of the lobbies and the way things work in DC.

It winds up a Bad Idea.

^^^ The neat thing about this is, the vet can form a Private Membership Association, and get away with this. The PMA is simply a detailed, written and signed agreement that the patient is accepting something from the vet in private. If it is in private - provided nothing dangerous is done - the medical and law enforcement have nothing to do with it.

The only reason why law enforcement goes into private homes at times when they are not invited is, the people don't know how to use the 70+ court cases, the Amendments, the Constitution, and the literal laws to keep LE out.

Google PMA and find out how to set up your own Private Membership Club, and how to make it outside the law.

A friend of mine that is a veterinarian ended up in the emergency room for three days, one day in intensive care, and then two in observation. She ended up leaving with a $200k bill, of which $60k was out of pocket. The absolute exact same treatment, medication, staff time, MRI, for a horse would have cost around $15k total, and that carries the risk of getting kicked in the head. Long story short, don't go to the doctor, go to the vet.

I can't say I'm completely on board with a government run system, but one of the things that I believe the government could do is be solely in charge of procuring medications, which would then be distributed to all of the usual pharmacies. Even those that scream communism can probably agree that if you consolidate buying power, there would be more negotiating power. Whether health is a right or a commodity is something American society decided a long time ago when people decided that it wasn't conducive to tourism and a happy population to let people die on street corners, even if they couldn't pay for the treatment. I'm a little hesitant to value statistics about the amount of care provided that goes unpaid, because its hard to gauge how much of it wouldn't go unpaid if the cost of care was reasonable in the first place. That said, rest assured the hospitals are writing off that bad debt for a tax break.

I'm sympathetic to a few socialist ideals but very against others. If I had to say what I'd think is the biggest (non ethical) problem surrounding healthcare, its the mix and matching of policies. In some cases, socialist policies are just the most efficient. In some cases, they overstep their bounds and result in government over involvement in areas they shouldn't be. A lot of American policies are a compromise between socialist and capitalist ideas, and the result is a inefficient mess. We really need to commit to one, because the middle ground results in paying for things that you don't get. Either drop the taxes significantly and cut social policies so that everyone can personally put their own saved tax money towards their own matters, or completely socialize policies to make sure everyone is adequately covered as cheaply as possible.

Though I suppose there isn't much to complain about, we just get taxed nearly as high as countries that provide guaranteed living conditions to everyone, and we don't get shit.

Every other OECD country is different than ours for one. None of them take in as many immigrants, none of them are as large by population, none of them have as much diversity as the USA does. You make a claim "there is virtually no evidence that the health system in the US would be better if there was less Government involvement." which is a quite ironic statement considering you are making a claim of no evidence while providing no evidence to support this position. The fact is there is plenty of evidence, just look at every government program ever. They always expand beyond their mandate, inflate prices because the customer doesn't care and its just "free money" to them that the public foots the bill for, then the prices get more and more bloated as the middle men like insurance agencies, banks, and lawyers start working their way in.

The marketplace is cutthroat. That means if one organization is full of worms, people can go to the more efficient worm free version because it provides better service at a lower cost. Unfortunately with government regulations a system of protectionism and rent seeking is set up for these companies which literally prevents competition and protects their monopolistic profiteering stranglehold. Don't make the mistake of thinking governments and corporations are different entities. While technically they are, largely they exist to serve each other in practice. This is why they need to be kept separate at all cost. I am not against regulation necessarily depending on how it is constructed, but this whole concept of government subsidy is a failure from the word go.

Finally, most important of all, all of these other dithering excuses aside, IT IS NOT THE US GOVERNMENTS MANDATE to provide you with anything other than what is explicitly mandated in the constitution. Again this goes back to the rights versus commodity arguments. You have a right to life, you do not have a right to mandate others spend years getting very expensive training to treat you for free just like you don't have a right to food unless you work for it. You have a right to liberty, but if your liberty infringes on the liberty of another, your right ends there. You have the 2nd amendment right to protect yourself with a firearm, you do not have a right to a free firearm. You have a right to have access to healthcare, you do not have a right to receive free healthcare.

Any time governments are allowed into these systems they inevitably destroy them. They add more and more bureaucracy that serves only to prevent actual competition and create systems of rent-seeking and protectionism for the huge mega-corporations. I argue that the current failures of our medical system are a DIRECT RESULT of GIVING government control over these issues, and attempting to subsidize them in the past that have failed, not the market economy itself. Much like people try to say "oh look the economy is failing we need more socialism!" when we have been introducing Socialist/Communist policy for many years which I argue is the actual cause of the failure these people championing more of the same claim to be able to save us from. Any time you create a system of dependence on what are supposed to be public servants, they now have leverage and therefore control over the population, transforming you into the servant of it and not vice versa.




We are somewhere on the second half of this chart.

I'll listen you your argument on that AFTER you enumerate the flaws in the 65% number.

Fair's fair.

I am familiar with the paper from which that article pulls its 4% figure, and it is flawed for a number of reasons.

It only considers adults below the age of 65. The elderly population are more likely to suffer from pretty much any major disease process, including the ones which cause the highest amount of debt; cancers, heart attacks and heart failure, strokes and rehabilitation, dementia, falls and fractures, etc.
It only considers adults who visited the hospital for the first time in 3 years. These are largely people who are relatively fit and healthy, and who present for either a purely elective procedure (tonsillectomy, varicose veins, etc.) or with a condition which requires one course of treatment to be fully resolved; appendicitis, chest infection, etc. It excludes anyone with chronic or serious diseases who will require multiple visits, which also happen to be the most expensive.

Given the above caveats that they looked almost exclusively at fit and well non-elderly adults without chronic or serious health problems, and a single visit to the hospital contributed to 4% of bankruptcies in this cohort, it is still a damning indictment of US healthcare.

All of your "data" and reasoning is suspect, but let's focus on just one item: Bankrupcies.

What you've ponderously quoted is a complete lie.

Really, just another in a long series of lies by our favorite Poncahantas, Elizabeth Warren.

The real number is not 65%, but 4%.

https://www.washingtonpost.com/blogs/post-partisan/wp/2018/03/26/the-truth-about-medical-bankruptcies/

TheHas has already laid out some great data in this thread, but I'll add a little more below.

As a percentage of GDP, the US pays absurdly more on healthcare than any other developed nation. As TheHas has pointed out, US citizens actually pay a similar amount of tax towards healthcare as most other developed nations, it's just that US citizens also pay absurd private premiums on top of these taxes. Most of this extra money is simply eaten up by middle men and insurance companies.


The next thing to look at it health outcomes. You would expect the US, since it spends so much more than other countries, would have far better outcomes. The complete opposite is true, with the US having the worst outcomes of any developed nation.
   

The best healthcare system in the developed world - the UK's - spends 2.5x less per person than the worst - the US. Not to mention that no one in the UK has ever gone bankrupt from a disease or accident. Medical fees account for around 2/3rds of all bankruptcies in the US.

Probably does say a lot. But that's pretty much the way it is. That's how strong the lobbies are in DC.

You take your "good idea" (we could debate that but leaving that for the moment...) put it in Washington and it becomes .... "bad."

I'm 77. and I am entitled to free "health care", this includes free drugs. They only times I've visited doctors are to give blood, or for repair jobs due to fighting or motor cycle accidents. I'm never ill, and I don't have colds or any of those other fiddly problems. So what do I attribute this to? I haven't been vaccinated since my pre-teen years, and I don't take any medication whatsoever. This includes pain killers, antacids, anti-biotics or any of the other products that weaken immune system. America would be much healthier if they stopped injecting poisons and disease into babies and adults, produced healthy food without perticides, growth hormones and preservatives, and stopped eating unhealthy food manufactured from diseased animals.

As a non American as well, I'm constantly amused at the mental gymnastics involved with UNIVERSAL HEALTHCARE = MAKE AMERICA COMMUNIST. 

The USA is the only country where people are one medical emergency away from declaring bankruptcy.
"Pre-existing condition" means something TOTALLY different in the US than the rest of the world!

Totally. Any OECD health data shows the same trends and health spending issues with the US, but apparently to many the answer for the US is to do more of the things (ie. privatizing healthcare) that make them an outlier in health spending, instead of doing more of the things that would make them more like the rest of the world!

I used to do policy development work in this space (not in the US though) and was always bemused by the US system, and the language and apparent unwillingness of many in the US to let the Government get more involved in healthcare. From an outsider looking in it always ended up a name calling match with shouts of 'socialist healthcare!' that don't actually mean anything in practice. It's a real shame and people's health outcomes and money keep going to waste.

So let me get this right. You're saying that because the US Government is in the pocket of private interest groups, that the answer is to do what they want by the Government doing even less, as because if they did more they would be so meek and powerless against these groups that their legislation would end up helping them?

That makes no sense. There is a difference between implementation issues and policy issues. What you are describing is an implementation issue whereby Government efforts get railroaded by private interest groups who hold too much influence in the US political system. An implementation issue doesn't mean that a policy idea or funding model is conceptually bad. It doesn't mean the idea of Government having a greater role in how healthcare is provided and funded in the US is a poor model. It is a good model as that is what happens in pretty much every other developed country, which again, have better, more efficient and less costly health systems.

If the US Government is so weak that they can't legislate to put the health needs for their citizens ahead of the profits of private companies, then that says a lot about the country.

It might have something to do with many users here being young and healthy. When you're using healthcare 15 minutes a year (if that) it might seem better to fork out $200 for that doctor's visit out of pocket instead of paying $1000s in taxes or health insurance premiums.

The free market does not bring innovation, don't fall for this lie.  Look at all the major technological innovations over the past 50 years, they came from government funded programs like NASA and the military.  GPs, Cell phones, internet, radio, etc.

For some reason what Bitcointalk users "think" is more important that observable facts....

The US literally has the worst and most inefficient healthcare system in the developed world and for some reason the answer found in this board is MOAR PROFIT will fix it, even as every other developed country proves them 100% wrong!

Agree with this. I work and study in the medical field although I'm not a doctor despite my username. While most medical professionals do the right thing there are a few I have seen that are a little too interested in getting the maximum payment even if their patients can't afford it. Sometimes they'll charge and prescribe things that their patient doesn't need.

It is a positive for countries that politicians and governments are responsible to voters for delivering a good health system. Like with many things in life problems start when competition and profits are the driving force. Health is too important and the stakes are too high to leave it to private companies.

Spending tax on health shouldn't be seen as a cost but an investment in the wellbeing and good of the country.

That's your opinion, but you are wrong. The reason is that in the USA the health care and Pharma companies are a powerful enough force to subvert legislation to their wishes. Thus your (or any) proposed "solution" simply becomes a tool for these forces to use to legislate themselves large chunks of our money.

You can't get around that.

There is no such thing as health care these days, Most "medicine" is allopathic, and is designed to suppress symptoms rather than cure illness. America wont regain its health until it stops poisoning it population with destructive drugs that weaken immune system, and destroy cartilage and other essentials. It is also designed to enrich the globalist pharma companies, and to help them with their global eugenics programmes.

I'm enjoying this discussion and I get where your head is at, but in this case more Government power and regulation is the answer.

I know this is bitcointalk and there is a tendency to lean towards being anti-centralization, and to have concerns about Government overreach. But there is virtually no evidence that the health system in the US would be better if there was less Government involvement. I can say that, because every other OECD country doing better than the US on healthcare has much more Government involvement.

If you're suggesting less Government involvement, then by default there would be more private company sway and freedom for doctors to treat and prescribe medicines as they wish, with essentially no Government body of oversight that can represent the consumer/citizen who needs healthcare. This is an issue. The power imbalance and information asymmetry between doctor and patient is massive, and there needs to be protections in place for a consumer to not get ripped off, receive poor treatment, or get given drugs they don't need.

As an example, those big pharma ads in the US about 'ask your doctor about how xyz drug can help you today' are criminal in other countries, because Government made the call that profits do not determine health treatment. Doctors are also not allowed to get kick backs from pharma companies for over prescribing their drugs. If you want health needs to come first, the answer is not less regulation and Government involvement, but more.

To put in perspective - none, and I mean none, of the OECD countries have a model anywhere close to the current US model which clearly suffers from private company profits prioritising consumer needs. The US should look to other OECD countries who are absolutely dominating the US system on providing a more affordable, efficient and a better health system. Many (not all) OECD countries do not even have a private insurance or private treatment component - it is all publicly and centrally funded, so Government can achieve economies of scale, set fair subsidy rates for drugs and work with the medical profession to subsidy treatments based on evidence (not on where doctors get kick backs from big pharma).

IMO this very US idea that 'Government should stay out of my life' just doesn't work when we are talking about healthcare. You want the Government accountable to meeting the health needs of the population, just like you want them accountable for national security, education and public infrastructure.

I don't need to make a philosophical argument to show it, I need to make it to point out these knee jerk reactions will not only make the problem worse, they will cause SO many more issues people have no concept of. People like to run around saying things like "healthcare is a right", and it simply can not be, because in order for some one to have that right you have to help yourself to the rights of others, be it time or resources. That is not how rights work.

IMO we need to strangle the insurance industry for starters, they along with the litigious nature of this nations laws are the primary culprits. These systems were abused until systems of protectionism were created, then those protective systems themselves became the systematic abuse. You will often find doctors who run a cash only practice will charge considerably less because of the removal of all of these compliance and documentation issues for example. Doctors spend more time doing paperwork than anything else, and that is retarded. Giving the government more power is not a solution because it is what got us here today.

Even IF you wanted to take the argument of right vs 'commodity', it is still irrelevant to judging how broken the US health system is and its expenditure. You don't need to make a philosophical or political argument to show it.

As an example, if you look here you'll see that the US Government spends the same as most other countries on health (public funding through taxes), but your private expenses (that is, your out-of-pocket costs when you see the doctor) are TRIPLE that of comparable countries.

So the taxes spent by US Government on health are the same as other countries, but you're still charged triple in private expenses. It's pathetic. In reality, even the whole 'oh I don't want to pay more taxes for healthcare' argument doesn't fly. Other countries pay pretty much the same in taxes for health purposes but don't get slugged with excessive private fees.

But reforms still don't happen as the US hyper capitalist mentality apparently even extends to people dying in hospital. I mean, really?

On top that, people jump to assumptions that it can be explained away by a philosophical argument of 'socialist healthcare' (its not socialist, but I'll put that to the side) not being right for the US. And that the US is making a choice of paying less tax = higher private costs vs paying more tax = less private costs. Well, clearly not actually - the amount of US tax revenue going to healthcare is the same as other OECD countries not less - the US health funding model just lets doctors, specialists, hospitals and big pharma get a nice pay day literally at your expense.

I was just trying to explain to someone how that the current issue is how we look at medicine in the US. I have started to put emphasis on medical industry. The sooner they get politicians who highlight that word, the sooner they can realize the problem. I fear politicians and media will play on people's fear and start coming out with terms like 'medical crisis' and 'medical bubble', just like was seen with the house/property industry. Industrialized causes result in industrialized outcomes. Right now what that means is as technology improves, only the wealthiest get access to the new tech, naturally. What people want is a more balanced system. One idea I heard recently is a lottery system where anyone who needs a specific treatment can 'win' a spot regardless of how full their pockets are. If only there was a way to have a provably fair lottery for it...

That idea only works when everyone agrees that every human life is valuable, however. Is it worth the time/resources to give a random lottery winner a better shot at life?

well usa is empire of capitalism, people that become doctor and stay doctor are usually socialists, thats why you neighbour cuba has a very good welfare system and usa has a horrible one that only serves the central bankers.

Healthcare is a commodity, not a right, and it is simple to prove. You have a right to travel, you have a right to defend yourself, you have a right to free speech. You do not have a right to the time and resources of others. In order to make healthcare a right you literally have to take time and resources from others by force, ie you take rights from some to give rights to others. The US healthcare system is broken, but if you can afford it you can get some of the best healthcare in the world right away, not 6 months after you get a referral which you waited another 6 months to get.

The best drug for big pharma isn't prevention or a cure. It is treatment. Especially an exclusive patented drug that provides ongoing 'treatment' for your condition and requires weekly/monthly top ups to improve your symptoms or increase your lifespan. Oh and it happens to be costly.

That is why all the research funding goes into treatments, rather than cures. What about vaccines and cures? Well Governments fund those or they don't get funded at all.

I could go on and on about this. Money in big pharma is also one of the reasons why relatively little funding is allocated to find new antibiotics. Anti-microbial resistance is a time bomb and I really hope we happen to find a new antibiotic within the next couple of decades even though most of the money goes elsewhere.

Big pharma pours money into the most profitable areas, not areas of greatest health need. A cure/treatment for male hairloss? Well that gets more funding than Malaria, which kills more than 400,000 people per year.

Outside of big pharma, the entire American healthcare system is broken. USA pays almost double per capita than other developed countries for healthcare, and doesn't get better outcomes (sometimes worse). In fact, based on life expectancy USA is actually worse than many countries - too much eating junk food and not going to the doctor early due to high upfront costs, so instead incurring greater costs down the track when serious conditions are left unchecked for too long.

And before people say 'oh well those OECD countries have higher taxes!' well the taxes they pay cover healthcare, which is half the price or better than the cost in the USA. If I had a choice between paying $1000 in taxes (which then goes to healthcare), or $2000 directly in healthcare for the same treatment, I know what I'd pick. Adding the middleman of the Government reduces healthcare expenditure by half.

Really, the American system is an example of how NOT to structure a healthcare funding model that puts the citizens needs first.

Pharma companies are charging the absurd prices for their medicines . Finding medicine is research field and money need to be paid for research but why the common medicine is also seeing price rise?

https://www.cnbc.com/2019/03/12/senate-panel-asks-cvs-and-other-middlemen-to-testify-about-drug-prices.html

https://www.cnbc.com/2019/04/09/cvs-cigna-humana-blame-big-pharma-for-high-drug-prices-in-senate-hearing.html

Govt. is aware of problem and they called bigshot pharma and they blamed drug makers. I guess it will go in circle until we find a solution.

"You think" when in reality the observable facts prove the exact opposite.  As mentioned we have many examples of good universal healthcare systems while literally ZERO examples of good for profit healthcare systems, and it isn't for lack of trying LMFAO!

I just personally think that we've never really had a market-related healthcare system, the government has been involved for far too long which has caused us to never even fathom what it would be like without the government involved.


Don't get me wrong Suchmoon, you could be right -- though I do think that the market is the best place to ensure prices, competition, innovation, etc.

But big Pharma/big hospital is eager to get into the profit through the rape of the US public in universal healthcare.

Doctors, however, are a luxury. You can't force them to do their job. They took years to study and go to school, especially the 'in demand' surgeons. They need to get that value back somehow.

On top of that you have an immigration system being taken advantage of by sick and injured people to cause even more stress on everything. The 'refugees' that get sent over are not more doctors, and that is what is needed.

Consumers are not rational when they're buying cheap plastic junk from China that they don't even need, they sure as hell are not going to be rational when they're in pain and in need of medical attention. So yes, I think it might actually literally kill quite a few people if they're forced to make financial decisions under duress. The goal should be to not have money in the equation at all. If there is fraud on the provider's side - that's where it should be addressed and not left for the patient to deal with. Healthcare is not a privilege and not a luxury. I doubt people get sick on purpose in order to abuse the system.

The problem is that we're too far deep in the rabbit hole hoping the market will solve healthcare problems that we are unable to admit it hasn't been working. We still hope that we can cure cancer with bandaids, we just haven't applied enough of them.

When I spoke I did not mean every single doctor, or every single patient was like that. I meant that their are doctors that are in it for the $ at the end of the day, some portion of people are like that in every profession.

Patients that are on some sort of healthcare plan that doesn't charge them (Medicare, Other gov plans, Work plans, etc) and simply has a deductible for the entire visit are going to be abused by those doctors that are just going to bill the insurance for more than they must. It's a rite of passage in the Healthcare industry.

In regard to Hospitals being able to veto the development of other hospitals. I think yes, this might be better for costs of the hospitals -- as a large hospital company is going to be able to negotiate better prices and (maybe) pass these cost savings onto consumers. The issue in my mind is that this stifles innovation and competition, as the Hospital that is already present doesn't have to change as they know no one is going to be able to take over their business. They're safe, and can just keep the status quo going.



I think that the customer seperation from the cost is a problem, it causes people to be lazy and to disregard the different prices that different companies are charging. The medical industry should be like every other industry in that regard, where you shop around for prices and see what's the best thing to work with. I'm not saying go to the cheapest doctor in town, but I don't think it would kill people to actually take some responsibility with their money instead of just using the first service (like they've always done) because of convenience.


I may go ahead and either make a post on this thread or an entirely new thread with the costs of illegal immigration, we'll see!

Sure, I am referring to the below fact sheet.
https://www.aha.org/system/files/2019-01/uncompensated-care-fact-sheet-jan-2019.pdf

38.4 billion of uncompensated care is provided last year. Hospital already know that they have to give uncompensated care so the charge very high to those who are able to pay.

One for article for your read.
https://www.modernhealthcare.com/article/20180106/NEWS/180109940/hospital-profits-uncompensated-care-climb

On top of  it Pharma companies are trying to show that they are caring for patient and will help in cost cutting of health care but in reality their profits are increasing.


Wishing you a good luck in researching this on deep but something is very wrong, even big corporation are not happy with the current system.

https://www.businesswire.com/news/home/20180130005676/en/Amazon-Berkshire-Hathaway-JPMorgan-Chase-partner-U.S

You will always find healthcare providers who honestly want to help people. They have different ways of going about it. Some of them who know that Big Pharma is only in it for the money, will still continue because they think that this is the best way to help people. Others will form PMAs so that they can treat people in exotic ways by contract, privately, thereby taking themselves and their patients out from under most of the controls and limits set by Big Pharma.

The further we get into understanding how complex the systems of nature are, the further we get into the idea of simply pushing nature in a direction a little, and then allowing nature to take over and do the health care.

AI doctor on Amazon, I'd like to see someone haggle with that motherfucker!

Profit is what ruins healthcare, destroys the environment, keeps people homeless, rewards shareholders and not the workers.


Doctors are basically taught by the pharma companies, they are really just paid to push off their new drugs and they will never tell anyone any type of natural cure.  How often have you heard a doctor recommend fasting?

They may not have doctors yet, but Amazon definitely has plenty of medical equipment to purchase. The only thing missing from the equation of becoming your own doctor is prescription medicines.

well you cant have people working in that sector for long with the exceptions:

1. profit seekers

2. national socialists

3. socalists.

4. oppressed people that obey a religious defacto enslavement.

I once had an idea of an app for choosing a cheap medical service, with customer ratings and all (don't anyone try to steal my idea, I'm gonna sue you for billions) and eventually came up with about a dozen or so reasons why it would be bad for health outcomes but probably quite profitable for some unscrupulous entrepreneur, "hack cheap cunt slicing me open" being one of them if perhaps not in so many words.

I wonder when Amazon starts adding doctors to its services. Probably needs to lobby to change some regulations first.

The problem lies with the supply and demand of doctors, after all the medical industry is just that. I have shopped around myself. These types of doctors that deal with surgery in the first place are not very abundant. This leaves us left with less trained doctors that charge less for their services because they are inexperienced. We have to balance the system somehow. What other system, that could function as efficiently or better in the US, can weigh the value that doctors deserve for years of hard study. Besides industrialization of the medical areas, what other option is there?

The problem with US healthcare:  It's singular focus is profit.

There a MANY examples of very effective and cost efficient universal healthcare, there are literally ZERO examples of successful purely for profit healthcare systems, but hey lets not let actual real world examples affect our thinking!

As Suchmoon mentioned this is really not difficult and literally the entire rest of the develop world moved on from this half a fucking century ago LOL.  Yup a few more more decades, a few more trillion dollars, a lowering level of healthcare and lowering age expectancy and eventually the US will figure out not EVERYTHING needs to be purely profit driven!

Now to start to fucking haggle with a doctor or to shop around for something like surgery FUCK that shit OMG, can my doctor focus on fixing my problems and not selling me his cheap ass services, fuck me sideways, I don't want some hack cheap cunt slicing me open with cut rate shit so he can do it cheaper...

Not really. With the massive deductibles and coinsurance payments these days the conversation is often the opposite. "Doctor, how much is it gonna cost?" (doctor has no clue, she doesn't do billing). "Sounds expensive, what's the risk if we don't do it?" (doctor is wasting her time solving financial problems for the patient instead of health problems).


You need to switch doctors . Most of those I've dealt with were passionate about their job, helpful to the extreme, if somewhat limited by the time they can afford to spend with the patient.

That's not to say there is no fraud, particularly in the prevalent pay-per-procedure model. I just don't think that adding monetary negotiation to the doctor-patient conversation is going to change much. It would probably reduce cost somewhat (you can skip MRI but you'll need to get X-ray done and have that appendicitis cut out no matter what) and would increase health problems (already happening with people skipping unaffordable doctor's visits and medications and ending up in emergency rooms).


I don't know your specific situation but adding more hospitals just for the sake of competition can backfire. One hospital that is 80% full replaced by two hospitals at 40% would probably result in fixed costs driving up the total cost of care and eventually one of them ending up bankrupt. Good for capitalism, sucks for health.

---

Healthcare demand is generally quite inelastic even when paying out of pocket. I think market-driven fixes are doomed to fail. There is a good reason why most of the developed world solved that problem the way they did. The US will probably experiment for a few more decades at the cost of trillions of dollars and millions of preventable health issues, and still end up with a single-payer system. If not at the federal level then at least in some states.

Where is this free medication you speak of.

The problem is that, some oligarchs that chosen medical as their industry are only mattering the business sense of their establishment/foundation. They built medical hospitals because of the reason of earning money and not just to provide the medical stuff to the people need. We will not be able to change this. This is the system already and they also have their point. Establishing a hospital means providing medical services that will give you a good amount of profit. The government couldn't even finance a single hospital to offer free medication the people needed.

maybe i didnt expressed my self clear enough

eraning money based on sold time is basically what puts you into becoming a "working poor"

while others just print money and spend it, you are the idiot that is forced to sell his time to survive.

without an ideology like national socialism, or socialism (i think nazism works better)

you wont get a sustainable workforce that provides high quality healthcare.

only alternative would be automation but then you get a tech worker problem as they will then develop powerful unions.

regards

Am not from America thuo but from my experience in the happening in the past am aware of the Obama health care bill/policy what happen to it, I believe the policy should have taken care of all this issues being raised if it still valid. And from all that you have outline from your post I can point out to just two factors that are responsible for this problem in the America healthcare, which are the problem of individuality and the politicians and this is not different from what we are facing in most part of the world.

I've never read into a stat about this -- I'm going to have to research this and get back to you, as I'd like to see the amount of healthcare serviced used by those that have no ability to pay and won't be paying their bills.


Earning money based on sold work is a VERY good system, though when people are separated from cost decisions, there is an artificially low amount of doctors allowed to become licensed, AND government money is being poured into the system -- then you're going to face an issue where prices remain artifically high.

Our profit-oriented culture wasn't supposed to be like this, it was supposed to be a market-oriented system instead of one riddled with regulations and artificial caps and minimums.


We don't have open borders by choice, it's just SO EASY for people to come across the border and stay in our country -- or to simply overstay their visa and stay here. Our healthcare system can't turn these people away (at least the emergency rooms)

I'll attempt to find a stat on illegal immigration healthcare use and the cost as well.

The problem is you have open borders. Insurees are paying for the non-insured who keep pouring in by the millions. This is not a sustainable system.

I prefer capitalism / free markets because I have tasted poor health services in my country. Health services that are free or subsidized will later become low quality. If people want healthcare, then they need to buy an insurance policy. I think European socialist systems would lead countries to bankruptcy if they wish to maintain health care quality.

healthcare in usa sucks because you have to appoint millions of well educated people without national socialism or other forms of socialism in the countries ideology

to earn money based on sold work.

healtcare in usa will only reach german standards for the masses in quality and affordability if you basically become nazis or socialist to the bones,

or if you mass automatise it.

but given the decadent and profit oriented culture you have you arent really able, the us economy will continue to enrich the rich and the central bankers and those few that are on their payroll.

I guess healthcare is costly because hospitals have to treat everybody even the patient is able to pay or not .so they charges a premium fees so that they can remain profitable at end.

Only option I find to cut the cost is to stay healthy.

what do you expect american healthcare servers only the central banks in the usa and those that serve them

Healthcare is one of the most debated issues in the American political system, those on the left are calling for a government takeover of the system. Stating that the best system is in the European socialist systems. Those are in the right are calling for reform as well, though not the same sort of reform --  relaxed government policy, and less government involvement.

Though I think both of these solutions have their flaws, I think there is a much better plan that neither party will agree too. Because the lobbyists on both sides will fight them tooth and nail.


1.American Medical Association Influence / Interest
The problem is the American Medical Association (AMA), for those that don't know who they are -- they are an association of physicians and medical students that have an enormous influence on healthcare-related decisions. This association has a vested interest in the status quo.

The AMA limits the number of doctors in the country and makes every single medical procedure in the country require a doctor to be present (or at least signing off on the procedure occurring) Most procedures don't need doctors, and they're merely being paid to sign off on a procedure for no reason. Remove them from the equation, and you've saved a large amount of money -- though you've angered doctors + the AMA and lowered their salaries as there is less demand.

2.Consumer seperation from cost decisions

Have you ever had a doctor tell you something along the lines of "You don't need this procedure, but the insurance company is going to cover it so why don't we just check anyway, we're just being safe!" This sort of behavior, this wasteful behavior that is filled with greed (on the side of the doctor) and carelessness from the patient is what causes a large amount of waste in the healthcare sector.

People don't care about what things cost, because either the government is paying (Medicare, low income, etc.), their company policy is paying, or something along these lines.

This gives the healthcare sector little (to no) incentive to lower costs because no one is shopping around for prices anyway.

If you want a prime example of people being close to cost decisions in a small sector, look to the LASIK eye / plastic surgery business. Cost has been falling for decades because people have to pay for these procedures out of pocket and are going to shop around for the combination of the best deal (price wise) and the best doctor.

3. Failure to allow for common sense reform

ALLOW FOR COMPETITION ACROSS STATE LINES FOR PRIVATE INSURANCE

This can only be summed up by corruption and greed; politicians don't want to anger the private insurance companies in their state by forcing them to compete with other states. Politicians are raking in large amounts of money from the healthcare sector; why would they make business harder for them by forcing them to compete.

Competition is vital in an industry where cost is EVERYTHING.

INCREASE IMMIGRATION OF DOCTORS / NURSES / MEDICAL PROFESSIONALS

If we have such high costs, and people want to come into our nation to either study to be a medical professional, or they are currently one and want to work, we should allow them to thrive like that. Give them a work visa, and let them come into this country to work. Every single new doctor you bring in lowers the cost for all of those as supply increases.

DON'T ALLOW HOSPITALS TO VETO NEW DEVELOPMENT

I don't know if this is an issue all around America, though I know where I live the Hospital around me is allowed to veto development of a new hospital in the area if they'd like to. I don't understand the rationale behind a decision like this, though all it is doing is allowing a Hospital to avoid competition which is vital to our market.

There are without a doubt other issues with the system, though these are the issues that I feel are hurting people the most. I'd love to hear what people think about other issues, and what should be done to fix these problems.