Part of the reason why there is no effort to fix this, to keep you a slave to a job that provides healthcare. Imagine the reduction in labor supply and increase in labor costs if healthcare did not require employment. On can, in many cases (facts intensive), bail to a developed country with healthcare if you want to realize this dream earlier than whenever the US will achieve the outcome (and your life situation supports doing so). It could potentially takes years, if not longer (~5-10 years), for the US to fix healthcare as the situation continues to degrade for those who need affordable healthcare today.

https://news.ycombinator.com/item?id=47161587 (expat resources for those potentially interested)

https://relocateme.substack.com (a product of andrewstetsenko here, no affiliation, I just like resources that can help humans achieve their success criteria)

https://healthcareinfusion.org/ (for healthcare workers interested in Canada, likely does not apply to many here, but please share with others who might be seeking a path)

(i see this problem as a vulnerability management and exposure exercise to attempt to solve for, ymmv, no affiliation with any resources recommended)

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tptacek a day ago | parent [-]

That's not how this system came into being. It's a path-dependent quirk of the tax codes of the 1940s. We got into this predicament because of WW2-era wage controls (a dollar spent on health care by your employer was literally worth more than a dollar in wages).

This is one major reason why most of the world's universal systems make private insurance work, and it doesn't blow up the way ours does. But I don't think employers are any happier about it than you are!

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toomuchtodo a day ago | parent [-]

You are of course correct on how we got here, I argue we are still here for many reasons, one of which is what I stated. I mean, there is no will to fix healthcare, but lots of will to spend $100B+ to go to war with Iran, right? I simply do not see anyone who cares enough to fix this exceptional mess, even taking into account the coordination problem of doing so. We could treat this as an emergency requiring a fix, but we don't. Why? We can certainly find this will for, "low ROI nation state actions".

Can we afford it? Doesn't stop trillions of dollars for DoD spending for middle east wars or tax cuts for the wealthy, so that isn't an argument, that's subjective cover for not fixing it, we do lots of things we cannot afford (current sovereign debt outstanding is ~$40T, as of this comment). Can't be done? Almost every other OECD country has solved this in some way. Therefore, as a scholar of systems, the root cause I am left with via Occam's razor is "This is an active choice to not fix this suboptimal system, where the fix would be both more economically efficient and humane, For Reasons while the electorate is lied to or paid lip service."

Employers, who supposedly are unhappy with their healthcare costs, could form a coalition and lobby for legislation and fund PACs to fund candidates who would fix this state by state with universal healthcare systems (Canda's universal healthcare system started in a single province as an experiment, for example). Why don't they? Are the costs not high enough yet? They can't argue they don't have enough power, they already, in many ways, bend the US government to their will. They have the power, they actively choose to not use it to fix this system failure.

https://en.wikipedia.org/wiki/The_purpose_of_a_system_is_wha...

https://en.wikipedia.org/wiki/Five_whys

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tptacek a day ago | parent [-]

We spend more on pension and benefits than we do on wars. The United States government is a benefits manager with a standing army.

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toomuchtodo a day ago | parent [-]

The evidence shows we could spend less and deliver more within the scope of healthcare delivery (this piece). We actively choose not to. The Pentagon hasn't passed an audit eight years in a row, I hear little that "we cannot afford to keep funding the military at these levels and with such inefficiency."

https://usafacts.org/government-spending/

https://usafacts.org/articles/how-much-of-the-federal-budget...

https://www.militarytimes.com/news/pentagon-congress/2025/12...

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tptacek a day ago | parent [-]

I don't want to sound like I'm fundamentally arguing with you, because if I could swap our system with Germany's I'd do so in a heartbeat. But (a) the "money that should be going into health care and education is going to military" argument is highly rebuttable, so I'd be careful hanging my hat on it, and (b) everybody, literally everybody (except the AMA) agrees we're spending too much on health care --- the problem is that money goes to practitioners, so it's very tricky to talk about clawing it back.

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toomuchtodo a day ago | parent [-]

I appreciate you keeping me honest on this topic.

	▲	tptacek a day ago \| parent [-]
		Back atcha!