<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>bruce511</author><text>In the USA its all about the money. Those &amp;quot;political forces&amp;quot; are not a grassroots movement, people in the street demanding insurance-based healthcare.&lt;p&gt;No, it&amp;#x27;s well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies.&lt;p&gt;And make no mistake, they&amp;#x27;re not going to roll over.&lt;p&gt;And sure, doctors are depressed because they&amp;#x27;re finally coming to realise that medical care (in the US) is not about &amp;quot;helping sick people&amp;quot; (despite their good intentions.)&lt;p&gt;Doctors and nurses set out with the noblest goals, then find themselves inside a system where the one true goal is to separate people from their money. They rile against &amp;quot;adminustrators&amp;quot; while at the same time failing to note that those administrators are the _reason_ for yhd business, and actual doctoring is just medical janitoring.&lt;p&gt;Yay free markets!</text><parent_chain><item><author>wrp</author><text>I&amp;#x27;ve read that a single-payer system is very unlikely in the USA, due to political forces. The tremendous inefficiency of the American medical system increases costs, but also provides more jobs, and those job-holders vote.</text></item><item><author>orbz</author><text>I’ve been working in the health tech space for awhile now and it’s sad how you’re not alone in noticing this. It’s the dirty secret of the entire industry, and there’s too many things disincentivizing any fixes.&lt;p&gt;The more I witness this the more I realize that having a single payer is necessary to actually break up enough of the monopoly to get some traction on this problem. Until then there are too many middle men and bureaucrats blocking this change.&lt;p&gt;Thanks for fighting the good fight so far.</text></item></parent_chain></comment><story><title>The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician</title><text>I am a Millennial primary care physician. I began training before COVID hit, so I have perspective as someone who practiced medicine before, during, and after the pandemic. There are multiple, long-standing issues in medicine, many that have been unmasked by COVID but have been festering for a long time:&lt;p&gt;Doctors don’t run hospitals. Due to EMTALA, every single patient that shows up to your emergency department has to be treated. When insurance companies and private equity realized that you can’t say no to doing the work, then why should they pay you? Ultra lean staffing prior to covid led to the sh*tshow during the pandemic and, now that everyone is quitting, things are now in total collapse.&lt;p&gt;Go to any hospital in the country and, even if you have a serious problem like a heart attack, sepsis, a kidney stone blocking off your ureter while your kidney fills up with pus and you’re turning grey and shivering because you’re dying, well, chances are you’re going to be lying in a bed in the hallway.&lt;p&gt;Up in the ICU hopeless 95 year olds will sit on ventilators and other life support machines for weeks because doctors don’t have any discretion in stopping futile care. You can be a 30 year old pregnant woman, and you will die waiting for your ICU bed in the emergency room. There are 30 rooms in the ER, but 3 nurses overnight…what do you think happens if you have an accident and urinate or have a bowel movement in the bed? That’s exactly what happens. Good luck getting pain medicine for your kidney stone, there’s 10 other patients and they’re all sicker than you.</text></story>
<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>noobermin</author><text>That is far too simple, as if citizens voting made a difference. Today, single-payer systems are overwhelmingly popular in the US, but one has yet to be implemented. The political corruption (known as &amp;quot;campaign contributions&amp;quot; which is &amp;quot;free speech&amp;quot; in the US after the citizens united decision) ensures that it won&amp;#x27;t happen, despite it being overwhelmingly positive in polling year after year on both sides of the aisle.</text><parent_chain><item><author>wrp</author><text>I&amp;#x27;ve read that a single-payer system is very unlikely in the USA, due to political forces. The tremendous inefficiency of the American medical system increases costs, but also provides more jobs, and those job-holders vote.</text></item><item><author>orbz</author><text>I’ve been working in the health tech space for awhile now and it’s sad how you’re not alone in noticing this. It’s the dirty secret of the entire industry, and there’s too many things disincentivizing any fixes.&lt;p&gt;The more I witness this the more I realize that having a single payer is necessary to actually break up enough of the monopoly to get some traction on this problem. Until then there are too many middle men and bureaucrats blocking this change.&lt;p&gt;Thanks for fighting the good fight so far.</text></item></parent_chain></comment><story><title>The Collapse of U.S. Healthcare – The Perspective of a Primary Care Physician</title><text>I am a Millennial primary care physician. I began training before COVID hit, so I have perspective as someone who practiced medicine before, during, and after the pandemic. There are multiple, long-standing issues in medicine, many that have been unmasked by COVID but have been festering for a long time:&lt;p&gt;Doctors don’t run hospitals. Due to EMTALA, every single patient that shows up to your emergency department has to be treated. When insurance companies and private equity realized that you can’t say no to doing the work, then why should they pay you? Ultra lean staffing prior to covid led to the sh*tshow during the pandemic and, now that everyone is quitting, things are now in total collapse.&lt;p&gt;Go to any hospital in the country and, even if you have a serious problem like a heart attack, sepsis, a kidney stone blocking off your ureter while your kidney fills up with pus and you’re turning grey and shivering because you’re dying, well, chances are you’re going to be lying in a bed in the hallway.&lt;p&gt;Up in the ICU hopeless 95 year olds will sit on ventilators and other life support machines for weeks because doctors don’t have any discretion in stopping futile care. You can be a 30 year old pregnant woman, and you will die waiting for your ICU bed in the emergency room. There are 30 rooms in the ER, but 3 nurses overnight…what do you think happens if you have an accident and urinate or have a bowel movement in the bed? That’s exactly what happens. Good luck getting pain medicine for your kidney stone, there’s 10 other patients and they’re all sicker than you.</text></story>