Today in titles that trigger me: Where is the YIMBY movement for healthcare?.
YIMBY is too simplistic of a concept to be easily applied to healthcare. It relies on a single dimension — how easy is it to build housing — and any proposed policy can be easily placed on the NIMBY/YIMBY spectrum. And since everyone can agree on where a particular policy lies on that spectrum, creating alliances is easy.
No such luck for American healthcare, where there are many dimensions: accessibility of new procedures (clinical trial YIMBYism), accessibility of approved treatments (insurance YIMBYism), accessibility of healthcare providers (practitioner YIMBYism), accessibility of MDs in particular (doctor YIMBYism)… And even there it is not clear what the YIMBY-equivalent stance would be. Does clinical trial YIMBYism mean you want more trials, quicker trials, or just more drug approvals and doing away with trials entirely? If you are a doctor YIMBYist, do you want to increase the number of medical schools? Residency and fellowship slots? Enable more foreign medical graduates to enter practice? All of the above? But then how do you deal with practitioner YIMBYists, who want to do away with most doctors altogether and delegate most work to physician assistants, nurse practitioners and, at the end of the line, large language models?
There is not a single person in America who would say its healthcare system is working, and yet it is clear why there is no unified front on how to fix it.
To be clear, I quite like the ideas brought up in that leading article. The five sample issues it names — breakdown of the direct doctor/patient relationship, unclear fees for service, frequent insurance switching, no room for insurer creativity, too much money spent on end-of-life care — are spot on. If I had to pick one thing where I would want to be a YIMBYist, it is to remove any direct influence of the federal budget on healthcare. A large pot of money leads to hypertrophy of every other part of the system which down the line lead to many of the issues above. But is that really a YIMBY attitude?But alas the issues in question are too complex to be boiled down to a YIMBY-equivalent jingo, and to emphasize that point the article has an addendum linking to a 10,000-word report on the topic which at a glance seems to be raising the right points but I couldn’t really tell you since I have a day job that doesn’t leave much time for reading 10,000-word policy papers.