No, it wasn't; if the momentum was there, the debate would have been self-sustaining and not dependent on new news events relating to Mangione to sustain it.
> but the day he got caught, the debate got suppressed and no one is talking about it anymore.
The debate didn't get suppressed and didn't need to be; the “debate” in the major media wasn't a real debate, it was just a way to stretch attention to Mangione news for a few more commercial breaks, and once there were no more news events for it to leverage for that purpose, it was abandoned by the same people who had been driving it. And, to the extent that there were people engaging in social media and elsewhere who saw the debate as genuine, they didn't need to be suppressed, as they never had momentum, they just mistook cynical commercial manipulation for opportunity.
It was all show no thought. The big questions remain unanswered. Where are costs inflated between pharmaceuticals, providers, hospital administrators, insurance administrators and patients seeking unnecessary care? How do we reform insurance when most people hate our healthcare system while simultaneously liking their own coverage?
Luigi didn't add anything substantive to the debate. Instead, his role was in facilitating venting. Someone still has to come up with an idea beyond "I hate this."
> there was a debate beginning to form what drives someone to execute a healthcare executive on the street
On Twitter, maybe. For most people, it was another Manhattan mental-health case murder. The chase and his good looks provided salacious intrigue, but only for so long as he was on the run.
Pharma costs are inflated by R&D costs and promotion. Insurance overhead is actually relatively lean, but base cost is primarily driven by cost of goods, and to a lesser extent admin. Provider costs are inflated by high legal and regulatory liability, shortage of qualified staff to offset liability, and high admin.
At a the highest level, cost is driven by an inability to discover and set prices at market clearing rates.
Manufacturer dont sell fixed price product into a market, but negotiate complex bulk deals with PBMs, pushing some prices up and others down. Similarly, hospitals/providers dont set prices at clearing rates, but negotiate 1:1 pricing, with some products above and below cost.
Last, and I suspect most significantly, health plans cant meaningfully vary in provided care, only cost sharing. That is to say, a bronze plan must include the same medications and procedures at a gold plan, differing only in copay. This breaks the price feedback on COGs. (e.g. a generic only insurance plan is illegal, so name brands face reduced competition).
If I were Medical Czar, I would look at banning preferential pricing/institutional rebates for goods and services.
I would allow more heterogeneity in policies (e.g. generics only, no implants, limited oncology, ect). This would crush innovation, but also greatly reduce pricing as it moves from cutting edge, to 10 year old technology.
Provider shortage is a tougher nut to crack, but I think it would require radically altering the residency program as it exists today and loosening requirements for other healthcare professionals.
