Yes, insurers are a big part of the problem. But it's not the whole problem. I can't find the link now. But I linked to a story about how Louisiana (I think) had "magnetized" the majority of their hospitals such that the capacity for broad spectrum care was isolated to few locations, difficult to get to for many people. That's just one example of bad logistics. I also think we've discussed EMTALA <https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA>, which *sounds* great. But the reality is that EDs don't cover area or population well at all. And it's a bit ridiculous that EDs are expected to accept psych patients just so they can be sedated and occupy a bed. Etc. These issues are largely independent of insurance.
I think it's more related to our obsession with individualism, the rationalist conceit that we all want to, or even *can*, pick and choose what's best for us. And the myth of meritocracy doubles down on it because stupidity, greed, and myopia aren't immediately painful ... if they're painful at all. It doesn't even work when, say, choosing to eat fast food, much less when choosing whether to pay into a risk pool. Individualism extrapolates up to the myopic focus of corporations on quarterly performance over longer term robustness and niche-filling products/services. And I suppose it extrapolates up to states as well. Even if there are multiple paths to nearly equivalent optima, each unit (human, hospital, corporation, state) has to share some values with the others in order for the the optima to be commensurate. On 1/20/22 11:41, Marcus Daniels wrote:
It seems largely constrained by insurers. They specify how hospitals and patients need to ask request service. I wonder how the states vary in how they handle public health overrides of the insurers, like with COVID-19? How can any random person get to the best possible hospital for a treatment? That just isn't optimized in general.
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