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When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury. This is especially s

by sykh 8y ago

When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury. This is especially so in a nation as wealthy as the U.S. The American healthcare system is immoral and I hope it drastically changes. Americans need to change their underlying notions of what it means to be a society. An author was once made fun of for suggesting that it takes a village to raise a child. When it comes to public funding for public goods we tend to worry about some poor person getting something they don’t deserve. The go it alone I’ve got mine, fuck you attitude is unhealthy. Until we change our collective view in what the purpose of a government and society is things won’t change significantly. Even so called champions of progressivism in the U.S. Senate voted against allowing the importation of medicine from Canada. It seems the public interest is subordinate to private interests and often times with immoral consequences.

merpnderp 8y ago
If you think the private healthcare system is immoral, you should take a look at the 100% government ran healthcare system that is the VA. You literally couldn't make up worse things than their administration has been caught doing with little or to consequence. If the VA is the best the US government can do, with some of the most sympathetic citizens, then it is incapable of doing better than our private system.
- e40 8y ago
  This is one of the straw men that is often brought up. There are a million reasons why the VA is messed up, most of which have NOTHING to do with healthcare. Congress has underfunded our troops for decades, related to healthcare and not. Something as simple as body armor is often purchased with personal money. A woman that works for me is high up in the Marines and I hear stories that disgust me. I do not know how Congress gets away with this. The stories are out there, but the American people seem to not give a you know what. Please don't conflate the problems of the VA with Universal Healthcare.
  - RangerScience 8y ago
    I haven't heard these stories and would like to. Where can I find more?
    - e40 8y ago
      Here's one https://www.military.com/daily-news/2016/02/26/lacking-basic-gear-special-operators-stuck-buying-own-equipment.html https://www.military.com/daily-news/2016/02/26/lacking-basic... Do a search for "us troops buying own". You'll find lots.
  - imglorp 8y ago
    I'm curious why there are more than one public health system. There's the VA, the IHS (Indian Health Services), and of course medicare/medicaid. Why are these not all the same system? It's not like we're different species.... edit, If this is a benefits/paperwork thing, then shouldn't that be separate from the care provider network?
    - Hozzle 8y ago
      Fun fact: Those systems cost more tax money than most other developed nations spend on full UHC. Either per person or as a per cent of GDP.
    - e40 8y ago
      It's the nature of the beast, in the US, I think. I believe if there were a Universal system, all of the others would go away. That would be a good thing.
- fergie 8y ago
  "If you think the private healthcare system is immoral, you should take a look at the 100% government ran healthcare system that is the VA" Or you could actually read the linked Economist article
- SideburnsOfDoom 8y ago
  But other countries can do this. So the hard question then is, why is the US government so uniquely bad at doing things that it doesn't want to do?
  - knz 8y ago
    Is the issue the US government? Or the lobbying to protect special interest groups?
    - SideburnsOfDoom 8y ago
      From a far enough distance, they look like interconnected parts of the same system.
- monocasa 8y ago
  The VA was a good system not too long ago, but the past couple decades has seen it get extremely underfunded in a starve the beast strategy. It used to be a black eye in the Republican's view of healthcare, but they sure fixed that.
  - Hozzle 8y ago
    The VA is much the same as all the other US healthcare setups. A system with the controls taken off, trying to operate in a jungle of different systems and bureaucracies. IN most nations with a VA-style (Beveridge) setup, there is great media interest in the least failing or hint of scandal. And they mean politicians lose a lot of votes. The VA hasn't enjoyed that feedback system until recently.
  - rukittenme 8y ago
    What makes you think universal healthcare would be any different? If you recognize the VA's failings, and you blame Republicans for it, what's to stop them from doing it to every "good" idea you have? If a few motivated politicians can ruin the lives of millions those politicians shouldn't have that power in the first place.
    - Sangermaine 8y ago
      >What makes you think universal healthcare would be any different? Because America isn't the entire world and there are many places where socialized healthcare of various forms have been very successfully implemented for a long time. The idea peddled by conservatives in America that the only options for socialized healthcare are inevitable failure or tyranny is simply, demonstrably nonsense. It's exactly this kind of parochial, limited mindset that needs to change.
      - rukittenme 8y ago
        Oh yes. Everyone who disagrees with me has a limited mindset. You could have used your open mind to read about a European (within this comment thread) who is having trouble with "the right" in his country: > This is a principal reason why the US was crossed off my list of countries where I would work and live. I fight against the privatization that is occurring within healthcare in my native country, Iceland. We used to have the Scandinavian model but decades of attacks from the right-wing Independence Party has broken our healthcare system. The next phase described by Chomsky is handing it over to private capital since people are outraged that it doesn't work anymore. I'm sickened by the development and feel a little like an old man screaming at the desert wind. It's exactly your kind of Utopian mindset that needs to change. Please read the news of countries other than the US. You might be surprised at the amount of controversy that surrounds universal healthcare systems.
- Pharylon 8y ago
  The VA has gotten a lot of bad headlines, but I work with a vet who absolutely loved the VA. He brags about the quality and speed of his healthcare all the time. This is in Charlotte, NC. Different offices might be different.
  - mter 8y ago
    The thing with the VA isn't that it's all bad. It's that the percentage of completely inept people seems higher than in a normal hospital. Normal hospitals don't have multiple scandals of reusing insulin pens on different people, reusing colonoscopy bags, killing people, paralyzing people and periodically losing all of our records. A lot of veterans who are covered by the VA are like me. Technically covered because of service connected disabilities, but I will never use it.
    - dnomad 8y ago
      Again, this is not true. Read the studies comparing VA care to private care. You're actually better off going to a VA hospital than most private hospitals.
      - mter 8y ago
        I've been to a VA hospital. My brother/dad/uncle have been to the same VA hospital. Our experiences have all been poor. If you were told that you'd get an appointment some time in the future and they sent you a notice randomly in the mail a few months later, you probably wouldn't be happy with the service. If your doctor was over an hour late, you wouldn't be happy. If you had a friend that was paralyzed after a spinal tap (my dad's buddy) then you probably wouldn't hold the VA in high regard. You are the first veteran I've ever met who had good experiences at the VA and who doesn't know anyone that has been crippled by the VA.
        Clubber 8y ago
        >If your doctor was over an hour late, you wouldn't be happy. Doctors aren't on time in privatized offices either. It's always a long wait for me. But you're right about the not being happy about it. >If you had a friend that was paralyzed after a spinal tap (my dad's buddy) then you probably wouldn't hold the VA in high regard. Yes, but that happens in private hospitals as well. They aren't all that great in the US either. >f you were told that you'd get an appointment some time in the future and they sent you a notice randomly in the mail a few months later, you probably wouldn't be happy with the service. Ya that sucks. Private industry has solved the scheduling problem with DSS and template based schedules. My uncle didn't have a good experience with the VA either. He had dementia and the nurse questioned him about it and he said "I have diabetes," which he did, but he didn't know what was going on. The nurse of course said, "we don't treat diabetes," or something like that and sent him away. All the while his sister was telling her about the dementia, she just didn't want to hear it. I could tell you horror stories about private hospitals too and how after being admitted, they shipped him to a nursing home an hour away wearing nothing but a gown in winter. No calls, no nothing. I guess the bottom line is right now, the US sucks at healthcare, period. I'm sure being a highly politicized wedge issue doesn't help matters much. (The VA, universal healthcare, skyrocketing costs in the private industry, etc).
- simonbarker87 8y ago
  The point isn’t really to compare it to the current best that the US governmeny can do. With the US’s historic view on universal/“free at the point of access” health care it is hardly surprising that the VA is a mess. What you should compare it to is the best that other governments have done, in which case there are many examples of excellent universal healthcare from public insurance based all the way through to the UK’s NHS - which does an excellent job despite below inflation budget increases and endless media hyped scandals.
- Symmetry 8y ago
  The VA is far from perfect and is really noticeably worse than many other country's nationalized health systems. But it's not obviously worse than private health insurance in the US and generally veterans are as happy with their health care as other people. I think the VA example tends to dispel the notion that single payer would save that much money but it works about as well as other approaches, of which the US has way too many.
  - chimeracoder 8y ago
    > The VA is far from perfect and is really noticeably worse than many other country's nationalized health systems. But it's not obviously worse than private health insurance in the US and generally veterans are as happy with their health care as other people If you want to convince people to support a single-payer system, this is quite possibly the worst argument you could use. Any veteran or anybody who has had any experience whatsoever with the VA will instantly assume you don't know what you're talking about. The VA is, on the whole, atrocitous. There are a couple of regions which do relatively well, because the system is federated, but on the whole, it's almost universally considered to be a disaster, even by people who are supportive of the program's existence. If you want to convince people that a single-payer system wouldn't end up like the VA, start by acknowledging the problems with the VA, not denying them.
    - dnomad 8y ago
      > The VA is, on the whole, atrocitous. There are a couple of regions which do relatively well, because the system is federated, but on the whole, it's almost universally considered to be a disaster, even by people who are supportive of the program's existence. Yeah, this is bullshit. The VA and its effectiveness has been studied quite a bit. Its quality has been found to generally exceed the quality of private hospitals. The media and conservatives paint this idea that the VA is "atrocious" but it has no basis in reality. The scientific evidence for universal healthcare is overwhelming. The only "controversy" -- exactly like the "controversy" around climate change -- exists within people who have carefully decided to ignore the evidence and buy into the propaganda. The problem here is not the VA. The problem here is that many Americans have abandoned reality.
- lg 8y ago
  no reason why single-payer means government-run hospitals
- Fomite 8y ago
  For a large number of different outcomes, the VA is superior to private care. It has a disproportionate footprint because "The VA does something bad!" is national news, while "SmallSizeMidwestCity Memorial does something bad!" isn't. It's not perfect, by any means, and struggles with cost constraints (veterans are sympathetic, but sympathetic doesn't mean well supported), but many of its quality outcomes are superior. See, for example, https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2618816 https://jamanetwork.com/journals/jamainternalmedicine/articl...
  - maxsilver 8y ago
    Your getting downvoted for this, and I have no idea why. Have other folks actually stepped inside a VA facility? Many of them are old/outdated/underfunded it's true. But some of them truly do offer superior care to a typical private hospital (in staff, facilities, and outcomes). The VA system could use significant improvement, absolutely. But if the fear-mongering 'worst case scenario' is that everyone gets VA levels of healthcare, that's still a huge win for all of America. That's a great baseline standard to start with, that no one should ever fear falling below. If an uninsured American is critically injured, the options today are "A: Die" or "B: Bankruptcy". Having a new option "C: Universal VA-levels of healthcare" would be a win for literally every American, even for Americans who are lucky enough to already have great private insurance and who would never need/use this option themselves.
    - mter 8y ago
      > But some of them truly do offer superior care to a typical private hospital Which ones? Because that has not been my experience at the hawaii facility. From my appointment time being written down on a piece of paper then they send me my actual appointment date a few months later to the doctor being an hour+ late, my personal experiences have been subpar. Add in how doctors/nurses at multiple hospitals do comically incompetent things like reusing insulin pens/colonoscopy bags/not washing equipment, the general sense of incompetence when they lose my records every few years, or talking to my buddies who got out and ended up working at the VA and have told me that they'll never get treated there, and I do not have the same sense of "superior care" that you're talking about. If I want hep C, I'll go to the VA. If I want medical care, I'll go anywhere else or just not go to a doctor.
- sykh 8y ago
  The people on TRICARE don’t seek to leave the system, do they? That’s a government run healthcare system. Do Medicare recipients seek to leave it? That’s a government run healthcare system. Universal healthcare can be implemented poorly but it doesn’t have to be. It can be done right. There are lots of examples of this.
  - creaghpatr 8y ago
    >Do Medicare recipients seek to leave it? No, because it's free, but 1/3 of Medicare recipients opt to receive their coverage through private insurers that typically add on additional coverage, an indicator that Medicare alone is not enough for a large segment of the population, or that they prefer a private insurer even with government subsidization. https://www.kff.org/medicare/fact-sheet/medicare-advantage/ https://www.kff.org/medicare/fact-sheet/medicare-advantage/
    - sykh 8y ago
      Excellent. We are in agreement that the American government can and does provide a health insurance program that covers lots of people and has the property that people don’t seek to leave it. Perhaps the idea that everyone be covered in such a system is not so far fetched.
      - chimeracoder 8y ago
        > We are in agreement that the American government can and does provide a health insurance program that covers lots of people and has the property that people don’t seek to leave it. People literally are leaving it, to the fullest extent that they legally can. It's not a small number, either. About 40% of Medicare patients aren't on the government-run system at all, and that number has consistently grown over the years.
        Clubber 8y ago
        They supplement it, I don't believe they are leaving it, unless they are wealthy and can afford to pay out of pocket because they want to use a doctor that is not participating in the medicare program. Do you have a cite?
- Sangermaine 8y ago
  >If the VA is the best the US government can do Who said it was?
- chiefalchemist 8y ago
  > "If the VA is the best the US government can do..." It's not the best Uncle Sam can do. It's the best it wants to do. It's the (minimal) "best" is has to do. Sure there's plenty of verbal grandstanding - by both politicians, the public, and the private sector (e.g., NFL) - about supporting the vets and their families, but actions speak louder than words. (Verbally) supporting the vets is good branding. It's that simple. That's all it takes. Put another way, if the US brought back the draft and the armed forces made up a wider cross-section of society (i.e. poor, rich and in between) priorities would change. Actions would speak louder than the words.
- dnomad 8y ago
  This is a lie. By virtually every measure the VA is the most cost effective and best quality care that Americans can get. * The VA is very cost effective. It is much cheaper than any private sector health plan or Medicare. Instead of buying into the propaganda go straight to the source [1] and look at the actual facts. * The VA enjoys very strong customer satisfaction. You wouldn't know this because the media and conservatives work together to denigrate the VA every chance they get but you should actually talk to people on the VA plan. Surveys of actual VA customers [2] indicates they're quite happy with their free, comprehensive government healthcare. (Shocker.) * Study [3] after study [4] has shown that VA hospitals are better than private, profit-driven hospitals. Most Americans would kill for VA coverage. It far exceeds anything they will ever receive unless they make it to the 1%. And this is why it's so very important to keep spreading this lie that the VA is this gross, evil system where all the patients are just waiting to die and ignored by incompetent and indifferent government bureaucrats. And this is the real problem. You can't have real discussions about health care in America because, frankly, most Americans don't live in the real world. They've been led to believe objective nonsense and you simply can't build anything off such a foundation. [1] https://www.cbo.gov/publication/49763 https://www.cbo.gov/publication/49763 [2] https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2537 https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2537 [3] https://link.springer.com/article/10.1007/s11606-016-3775-2 https://link.springer.com/article/10.1007/s11606-016-3775-2 [4]https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2618816?redirect=true https://jamanetwork.com/journals/jamainternalmedicine/articl...
- ajross 8y ago
  > You literally couldn't make up worse things than their administration has been caught doing with little or to consequence. I literally could. The scandals you're referring to basically come down to them having been cooking books about care records. Bad, but not exactly in the realm of "literally nothing worse" hyperbole. In fact the VA tends to produce health care outcomes that are well within the range of US citizens in the same income bracket (which is to say, not great relative to the rest of hte industrialized world, but not bad) at a cost that is much less than that of private insurance. Really, you could do a lot worse. The criticism of the VA tends to be very similar to the criticism of the NHS in the UK. It's valid as far as it goes, but... neither UK citizens nor US vets are suffering serious catastrophes here. They're getting care and living decent, healthy lives by any reasonable standard. Literally.
  - XorNot 8y ago
    Also the problems with the VA generally stem from the reality that US politicians "support the troops" right up until they're home and maybe not so enthusiastic about the war anymore.
Adutude 8y ago
I couldn't agree more. I don't think U.S. has a real progressive party, the choices are off the rails conservatism, or conservative lite. IMO, a progressive/liberal is concerned someone might go hungry, a conservative is concerned that they might miss out because someone got some food they didn't earn/deserve.
Beltiras 8y ago
This is a principal reason why the US was crossed off my list of countries where I would work and live. I fight against the privatization that is occurring within healthcare in my native country, Iceland. We used to have the Scandinavian model but decades of attacks from the right-wing Independence Party has broken our healthcare system. The next phase described by Chomsky is handing it over to private capital since people are outraged that it doesn't work anymore. I'm sickened by the development and feel a little like an old man screaming at the desert wind.
- sykh 8y ago
  I don’t understand why you were downvoted. That you were downvoted for your comment suggests how bad things are in the U.S. for a progressive like me.
  - coolaliasbro 8y ago
    Thank you for engaging other commenters who do not yet see the benefits of regulating society and the economy according to what's best for the populace versus private individuals (ie, corporations, et al). HN and /r/LateStageCapitalism are my two primary sources of current events and public discourse. Here's a link to the Reddit thread for anyone interested: https://www.reddit.com/r/LateStageCapitalism/ https://www.reddit.com/r/LateStageCapitalism/
  - Beltiras 8y ago
    It's way easier to downvote and move on than to make solid arguments and change minds. Maybe they fear that their libertarian world view will crumble when confronted with some evidence.
gambiting 8y ago
There was a good comment(I have it saved somewhere) explaining this quite well - some places in the world(European nations mostly) got so fucked over by history, over and over and over again that as societies they realized you cannot "pull yourself by your bootstraps" and provide for yourself in all circumstances. Just in the 20th century it was possible to see your country ravaged by two world wars, change ideologies three times, change the dominant religion and ownership of land between major powers few times in just few decades.....the societies have realized that the only way to make it work is by providing certain services to everyone, free of charge, purely because they are citizens with no strings attached(and no, this has nothing to do with communism). Meanwhile, in US, the "pioneer" ideal still reigned - anyone could achieve anything, given enough hard work. That ideal didn't exist in Europe at the time, or was crushed so thoroughly its destruction echoed through society - you could be the most hardworking person in Europe, but if someone decided they were going to pillage your land, rape your family and send you all to concentration camps - that was going to happen. No amount of positive thinking and hard work was going to prevent it. So yes, to my granparents it's absolutely obvious that everyone should have equal chances - healthcare should be funded by the state, as should education and child-bearing. They still get really upset over the fact that despite all education being 100% free in this country students still have to pay for their own housing - why should they? The state wants to have well educated citizens, why the hell should the students be paying anything to study. Once again, this has nothing to do with communism, but I am sure Americans would label it as such.
- toasterlovin 8y ago
  The US and Europe are not really great comparisons for a bunch of reasons, but the fundamental one is that Europe has been at Malthusian population limits for a long time, whereas North America has had an essentially unlimited, unpopulated frontier that new people could move to and create lives for themselves. Thus, the American notion of pulling your self up by your bootstraps was a workable one. Since North America was first colonized by Europeans, Americans have moved west and made a future for themselves and their descendants by using hard work to harvest the bounty of nature. But Europe has been full for thousands of years. You can't just move West, work some land, and raise a family; there are already other people wherever you would want to go.
rukittenme 8y ago
> When it comes to public funding for public goods we tend to worry about some poor person getting something they don’t deserve. The go it alone I’ve got mine, fuck you attitude is unhealthy. 1/3 of our GDP goes to "the village". We spend trillions every year on the things you want most. Education, healthcare, environmental protections. You name it; we spend money on it! 70 million people use medicaid. 44 million people use medicare. 22 million veterans eligible for the VA. 22 million government employees who receive healthcare benefits paid for by the state. We are drowning in the healthcare spending you pretend doesn't exist.
- Daishiman 8y ago
  You're not drowning. You're wasting spending on things that don't matter, like privately funded education and privately funded health care. The solutions already exist and they're out there. Lowering spending just for the sake of it is not one of them.
- sykh 8y ago
  Our spending on healthcare is grossly and immorally inefficient. A change is needed. One reason for the ineffiency is that public welfare is subordinate to special interests. All universal healthcare systems in the world are cheaper on a per capita basis than the American system. A change is needed. I’m not advocating for more money. I’m advocating for a change in perspective by our leaders.
  - fastball 8y ago
    Just because something has worked for other countries does not mean it will work for the US.
    - sykh 8y ago
      Never said otherwise. I made the statement in response to the view that government run necessarily means inefficient. Clearly the converse is true. There are lots of examples.
    - 8y ago
conanbatt 8y ago
> When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury. You can't start any economic argument by saying that paying any cost is a must. You will get fleeced. It is not true that universal healthcare pays for everything. The most expensive and experimental treatments will not be covered ever by the system, and it shouldnt.
- sykh 8y ago
  It is a well known fact that all medical care systems ration care. A person in America who gets cancer, say, often times faces bankrupt and financial ruin. The same can not be said of people in other wealthy nations. I fail to see your point. All healthcare systems ration care. Not all of them lead to financial ruin at the rate the American healthcare system does. My statement stands. A person ought not face financial ruin. It may be the case that there aren’t enough resources to treat the disease it this does not negate the belief that they shouldn’t face financial ruin.
  - DamnYuppie 8y ago
    They don't face financial ruin, unless they don't have health insurance and or they opt for various drugs that aren't covered by their plan. Before everyone screams that all things should be covered please consider that due diligence has actually been done and the drug was considered to either not be effective or not needed based upon other existing treatments.
    - sykh 8y ago
      The idea of universal care is that everyone have insurance. Before Obamacare my sister got cancer. She wasn’t lucky enough to have an employer nice enough to provide insurance through her job. Even people with insurance often times face financial ruin. Especially before Obamacare was enacted.
    - coolaliasbro 8y ago
      Wrong--it is certainly the case that many insured individuals are left insolvent after necessary but costly medical procedures.
clarkevans 8y ago
> It seems the public interest is subordinate to private interests and often times with immoral consequences. This perspective of public vs private interest is rather puzzling to me -- it's more a matter of short-term vs long-term thinking. In the long-term, it's in the private interest of those having sustainable companies to have a broad base of educated and healthy workers to employ. The short-term interest of any single firm has a different calculus, but all private companies would benefit from a stronger public education and health system. The goal of government, in my opinion, is to focus on long-term objectives: ensuring a sustainable healthy and educated population. It's similar case for education. It's not that I'm paying for someone else's kids school so much as I'm paying so that one day, when I need a smart educated nurse to take care of me... it'll likely happen at a reasonable price because there are so many educated people who have decided to be nurses.
- HankB99 8y ago
  I agree with the long term / short term dichotomy. I believe the same dynamic is at work WRT the concentration of wealth in the US. I understand the short term desire to accumulate wealth. I do it myself. It seems to me that if trends continue, there will be less and less income for the other 99% to spend. (Yes, I'm mixing income and wealth here because I believe that the desire to increase wealth on the part of the wealthy results in downward pressure on income for the rest of us.) In my Econ 101 class they spoke of the velocity of money - how much gets spent. It seems to me that the velocity has to go down as earnings go down and at that point, the ability to accumulate wealth would start to decrease. (These thoughts ignore the possibility that those who are not wealthy could provoke social upheaval. I don't know if that's a real possibility.)
  - redbeard0x0a 8y ago
    I think it is a possibility, the wealthy are building doomsday bunkers. There is writing on the wall, they just need to outlast the uprising and then come out and buy up everything really cheap.
- ekianjo 8y ago
  > The goal of government, in my opinion, is to focus on long-term objectives: ensuring a sustainable healthy and educated population. You can't ensure health unless you have wealth in the first place. You can see that things moved in that order in the past 300 years: the more wealthy a country was, the longer people lived and the better they could face different conditions. The greatest strides against mortality were accomplished long before the welfare state as an expression ever existed.
mc32 8y ago
Universal healthcare benefits people with no coverage, which is good, but it also, in the case of nationalized healthcare, i.e. not privately run, leads also to lower quality care for people already with coverage where experience is people who can afford it, will when other than the most routine things, seek private care. Given that, it looks like a two tiered system might work best. One which works like the current system and also another for the not quite indigent but can’t afford the current system (indigent are covered by Medicaid).
- beagle3 8y ago
  What works well outside of the US is that the single-payer government run (or at least government mandated) provides a standard level of care, which more often than not includes wellness and life threatening care (and a lot in-between), and one can buy additional coverage in the private market - but the basic standard care is considered a right, and doesn't disappear just because you have some additional coverage.
- dv_dt 8y ago
  When you look at other modern nations, all with better performing healthcare systems than the US, there is a mix of arrangements. The common factor is public gov't control of drug prices and procedures. The arrangement of how the administration of the care is allocated varies all across the spectrum, from fully nationalized, to hybrids, to mostly private administration. But I'm inclined to think that public health experts setting cost ceilings by drug & procedure is the critical element.
rogerb 8y ago
There's a simple thought experiment that helps: - an american citizen break his leg, he is not insured. Do you A: let him die B: take care of him ? if your answer is A - you are a terrible person, but you hold a consistent position. if your answer is B - the only question that remains is what is the most economic, efficient way to take care of this person ? b is universal health care. if you think you can do A with emergency care, consider how inefficient and expensive this is, and who ends up paying for it.
- SamReidHughes 8y ago
  What if they're not an American citizen? What if they're also in a different country?
  - knieveltech 8y ago
    What if they aren't? Are there criteria that can be met that make the decision to leave someone injured on the side of the road morally sound?
    - SamReidHughes 8y ago
      We aren't on the side of any roads here.
      - knieveltech 8y ago
        Fine. Sidewalk, in the middle of a restaurant, in your livingroom, at the airport. Pick a location and then feel free to explain what selection criteria make ignoring the injuries of another moral.
        SamReidHughes 8y ago
        Okay. I pick any of the injuries of others that you're ignoring right now.
fastball 8y ago
It's immoral for people to pay for the time and work of others?
- Andre_Wanglin 8y ago
  Apparently doctors should only work for the public good and accept (relatively) piddling wages but startup tech bros and VCs are absolutely entitled to their billions.
  - sykh 8y ago
    Nice false dichotomy you have there. There are other possibilities than the status quo or doctors getting piddling wages.
    - Andre_Wanglin 8y ago
      I did not perpetrate a false dichotomy, I mocked the hypocrisy of any user of this site seeking to limit the compensation of anyone.
dv_dt 8y ago
Not only is universal healthcare more moral, it has been demonstrated as more economically efficient many times over. You only need to start by comparing the per-capita costs paid for healthcare in the US vs every other modern nation in the world. The US pays more than double the average of the other nations and we get much less performance for it. There are no modern nations that pay as much as the US in absolute terms, nor as high a percentage of our GDP. https://www.pbs.org/newshour/health/health-costs-how-the-us-compares-with-other-countries https://www.pbs.org/newshour/health/health-costs-how-the-us-... The other nation's systems have mixes of full nationalized care to administrative combinations of private insurance, so there is some leeway there. But all of them contain public controls on the cost of drugs and procedures. And that demonstrably works with both better prices, and better outcomes in total measures like life expectancy. Edit: Btw the PBS article is from 2012, with data up to 2010. In later years, US life expectancy has had years which it has dropped, and even when growing, it lags the nations modern peers (while approaching nations such a Mexico..). There are some forces there that aren't all healthcare, but healthcare is central to life expectancy... https://www.cnbc.com/2017/02/22/us-life-expectancy-is-low-and-is-now-projected-to-be-on-par-with-mexico-by-2030.html https://www.cnbc.com/2017/02/22/us-life-expectancy-is-low-an...
- grey-sunshine 8y ago
  Paying a huge percentage of your GDP... Don't you think it might be cultural?
andys627 8y ago
> Americans need to change their underlying notions of what it means to be a society. We want it (https://www.pbs.org/newshour/health/62-percent-u-s-want-federal-government-ensure-health-care-poll-says https://www.pbs.org/newshour/health/62-percent-u-s-want-fede...)... Our politicians just aren't doing it.
- a_tractor 8y ago
  I wonder what % of that 62% are actually net taxpayers? http://www.taxpolicycenter.org/taxvox/closer-look-those-who-pay-no-income-or-payroll-taxes http://www.taxpolicycenter.org/taxvox/closer-look-those-who-... http://www.pewresearch.org/fact-tank/2017/10/06/a-closer-look-at-who-does-and-doesnt-pay-u-s-income-tax/ http://www.pewresearch.org/fact-tank/2017/10/06/a-closer-loo... https://taxfoundation.org/distribution-tax-and-spending-policies-united-states/ https://taxfoundation.org/distribution-tax-and-spending-poli... >American’s lowest-income families receive $5.28 worth of government spending (federal, state, and local) for every $1 they pay in total taxes. Can't be hard to find enough people willing to vote for more benefits, especially if they know they aren't the ones paying for anything.
TimJYoung 8y ago
Back in 2004 when John Kerry was running for POS (that's President of the United States, he-he), he had a great idea (that I'm sure came from elsewhere, but a good idea is a good idea). The US government would become the "insurer of last resort" and cover catastrophic claims above a certain amount: http://www.washingtonpost.com/wp-dyn/articles/A16748-2004Jun4.html http://www.washingtonpost.com/wp-dyn/articles/A16748-2004Jun... For his efforts, he was practically called a "Commie" by the Republican party, despite the fact that the proposed mandates were fairly mild and the plan worked within the existing employer-provided health insurance system. It was a good crack at the ~20% of the population that accounts for the majority of healthcare spending, and eliminates the possibility of someone losing their home and savings because of a serious illness. Plus, I'm sure that the levers could be tweaked a bit to get better outcomes.
Andre_Wanglin 8y ago
>When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury. This is especially so in a nation as wealthy as the U.S. The American healthcare system is immoral and I hope it drastically changes. If no one has to worry about the monetary effects of their health choices, poor health choices are incentivized and those who make poor choices are subsidized by those who make good health decisions. The vast majority of healthcare spending in the US is already on preventable chronic conditions yet everyone keeps gorging themselves further into obesity, diabetes, hypertension, CVD, etc. Almost no one is against paying into a risk pool that hedges against unforeseen health problems even though they may never directly benefit. If I pay my entire life to cover someone else's cancer, that's fine with me. What we are sure as hell opposed to is a creating an entire system based on perverse incentives that punishes people doing their best to save their pool from spending on them and rewards those whose voluntary actions are the driving force behind increased costs. And the US healthcare industry is not some libertarian wild west show, it is highly regulated and dominated by the edicts of CMS yet the state of the public's health continues to worsen in ways our forebears who optimistically, though naively, created these programs could never imagine.
- sykh 8y ago
  Thank you for exemplifying the attitude I decried. I wish people like would leave the U.S. Live elsewhere. Escape the burden of possibly having your tax dollars help someone else by emigrating.
  - Andre_Wanglin 8y ago
    I invite you to do likewise. We will be quite well enough without ignorant busybodies posturing as moral crusaders hectoring us into enabling further deprivation of our property and liberty.
    - sykh 8y ago
      As the good book says, "For the love of money is the root of all evil". I'm not posturing. I actually do have a moral code that I try to abide by. The fact that all other wealthy nations provide what is colloquially called "universal healthcare" is an indication that yours is the abhorrent view. It would be worth your while to consider why your view, in just about all other advanced nations, is considered a fringe one.
ataturk 8y ago
Here we go with this bullshit again! IMMORAL! Um, whose morality are we talking about? You sound like a shrill, smug, teetotaler in 1930! When a person gets a life-threatening condition in China, they may not get care at all. Is that "immoral" or just a reflection on how a non-market-based system uses rationing to determine, based on party loyalty, who lives and who dies? How about in the socialist paradise of Venezuela? Is there full on collectivist healthcare system immoral or just stupid? You can't even get treated for a gunshot wound in Venezuela right now. You might get a dirty bandage off of a corpse if you're lucky that day. US healthcare has massive problems, but when you need it, you can obtain care. I don't know why people have such a hard time paying for things they need except that US higher education has completely messed with so many people's brains in this regard and so they have come to believe that strangers owe them something or that human nature is somehow different today than it has ever been. You are not entitled to live, your outcomes in this world are almost completely random and placing an oppressive, confiscatory government on top of your head is not improving your chances of survival.
deleted 8y ago
[deleted]
nojvek 8y ago
Social security age keeps on rising as baby boomers retire. America is the wealthiest country on the planet, yet the country where most people go bankrupt or commit suicide because they can’t afford healthcare costs. US spends astronomic amounts on weapons development than keeping its citizens healhy and happy. Fermi was right. We’ll eventually destroy ourselves before we find another intelligent civilization. May be the great filter is that no one in the universe got healthcare right and they vanished. /s

by sykh 8y ago

merpnderp 8y ago

If you think the private healthcare system is immoral, you should take a look at the 100% government ran healthcare system that is the VA. You literally couldn't make up worse things than their administration has been caught doing with little or to consequence. If the VA is the best the US government can do, with some of the most sympathetic citizens, then it is incapable of doing better than our private system.

e40 8y ago
This is one of the straw men that is often brought up. There are a million reasons why the VA is messed up, most of which have NOTHING to do with healthcare. Congress has underfunded our troops for decades, related to healthcare and not. Something as simple as body armor is often purchased with personal money. A woman that works for me is high up in the Marines and I hear stories that disgust me. I do not know how Congress gets away with this. The stories are out there, but the American people seem to not give a you know what. Please don't conflate the problems of the VA with Universal Healthcare.
- RangerScience 8y ago
  I haven't heard these stories and would like to. Where can I find more?
  - e40 8y ago
    Here's one https://www.military.com/daily-news/2016/02/26/lacking-basic-gear-special-operators-stuck-buying-own-equipment.html https://www.military.com/daily-news/2016/02/26/lacking-basic... Do a search for "us troops buying own". You'll find lots.
- imglorp 8y ago
  I'm curious why there are more than one public health system. There's the VA, the IHS (Indian Health Services), and of course medicare/medicaid. Why are these not all the same system? It's not like we're different species.... edit, If this is a benefits/paperwork thing, then shouldn't that be separate from the care provider network?
  - Hozzle 8y ago
    Fun fact: Those systems cost more tax money than most other developed nations spend on full UHC. Either per person or as a per cent of GDP.
  - e40 8y ago
    It's the nature of the beast, in the US, I think. I believe if there were a Universal system, all of the others would go away. That would be a good thing.
fergie 8y ago
"If you think the private healthcare system is immoral, you should take a look at the 100% government ran healthcare system that is the VA" Or you could actually read the linked Economist article
SideburnsOfDoom 8y ago
But other countries can do this. So the hard question then is, why is the US government so uniquely bad at doing things that it doesn't want to do?
- knz 8y ago
  Is the issue the US government? Or the lobbying to protect special interest groups?
  - SideburnsOfDoom 8y ago
    From a far enough distance, they look like interconnected parts of the same system.
monocasa 8y ago
The VA was a good system not too long ago, but the past couple decades has seen it get extremely underfunded in a starve the beast strategy. It used to be a black eye in the Republican's view of healthcare, but they sure fixed that.
- Hozzle 8y ago
  The VA is much the same as all the other US healthcare setups. A system with the controls taken off, trying to operate in a jungle of different systems and bureaucracies. IN most nations with a VA-style (Beveridge) setup, there is great media interest in the least failing or hint of scandal. And they mean politicians lose a lot of votes. The VA hasn't enjoyed that feedback system until recently.
- rukittenme 8y ago
  What makes you think universal healthcare would be any different? If you recognize the VA's failings, and you blame Republicans for it, what's to stop them from doing it to every "good" idea you have? If a few motivated politicians can ruin the lives of millions those politicians shouldn't have that power in the first place.
  - Sangermaine 8y ago
    >What makes you think universal healthcare would be any different? Because America isn't the entire world and there are many places where socialized healthcare of various forms have been very successfully implemented for a long time. The idea peddled by conservatives in America that the only options for socialized healthcare are inevitable failure or tyranny is simply, demonstrably nonsense. It's exactly this kind of parochial, limited mindset that needs to change.
    - rukittenme 8y ago
      Oh yes. Everyone who disagrees with me has a limited mindset. You could have used your open mind to read about a European (within this comment thread) who is having trouble with "the right" in his country: > This is a principal reason why the US was crossed off my list of countries where I would work and live. I fight against the privatization that is occurring within healthcare in my native country, Iceland. We used to have the Scandinavian model but decades of attacks from the right-wing Independence Party has broken our healthcare system. The next phase described by Chomsky is handing it over to private capital since people are outraged that it doesn't work anymore. I'm sickened by the development and feel a little like an old man screaming at the desert wind. It's exactly your kind of Utopian mindset that needs to change. Please read the news of countries other than the US. You might be surprised at the amount of controversy that surrounds universal healthcare systems.
Pharylon 8y ago
The VA has gotten a lot of bad headlines, but I work with a vet who absolutely loved the VA. He brags about the quality and speed of his healthcare all the time. This is in Charlotte, NC. Different offices might be different.
- mter 8y ago
  The thing with the VA isn't that it's all bad. It's that the percentage of completely inept people seems higher than in a normal hospital. Normal hospitals don't have multiple scandals of reusing insulin pens on different people, reusing colonoscopy bags, killing people, paralyzing people and periodically losing all of our records. A lot of veterans who are covered by the VA are like me. Technically covered because of service connected disabilities, but I will never use it.
  - dnomad 8y ago
    Again, this is not true. Read the studies comparing VA care to private care. You're actually better off going to a VA hospital than most private hospitals.
    - mter 8y ago
      I've been to a VA hospital. My brother/dad/uncle have been to the same VA hospital. Our experiences have all been poor. If you were told that you'd get an appointment some time in the future and they sent you a notice randomly in the mail a few months later, you probably wouldn't be happy with the service. If your doctor was over an hour late, you wouldn't be happy. If you had a friend that was paralyzed after a spinal tap (my dad's buddy) then you probably wouldn't hold the VA in high regard. You are the first veteran I've ever met who had good experiences at the VA and who doesn't know anyone that has been crippled by the VA.
      - Clubber 8y ago
        >If your doctor was over an hour late, you wouldn't be happy. Doctors aren't on time in privatized offices either. It's always a long wait for me. But you're right about the not being happy about it. >If you had a friend that was paralyzed after a spinal tap (my dad's buddy) then you probably wouldn't hold the VA in high regard. Yes, but that happens in private hospitals as well. They aren't all that great in the US either. >f you were told that you'd get an appointment some time in the future and they sent you a notice randomly in the mail a few months later, you probably wouldn't be happy with the service. Ya that sucks. Private industry has solved the scheduling problem with DSS and template based schedules. My uncle didn't have a good experience with the VA either. He had dementia and the nurse questioned him about it and he said "I have diabetes," which he did, but he didn't know what was going on. The nurse of course said, "we don't treat diabetes," or something like that and sent him away. All the while his sister was telling her about the dementia, she just didn't want to hear it. I could tell you horror stories about private hospitals too and how after being admitted, they shipped him to a nursing home an hour away wearing nothing but a gown in winter. No calls, no nothing. I guess the bottom line is right now, the US sucks at healthcare, period. I'm sure being a highly politicized wedge issue doesn't help matters much. (The VA, universal healthcare, skyrocketing costs in the private industry, etc).
simonbarker87 8y ago
The point isn’t really to compare it to the current best that the US governmeny can do. With the US’s historic view on universal/“free at the point of access” health care it is hardly surprising that the VA is a mess. What you should compare it to is the best that other governments have done, in which case there are many examples of excellent universal healthcare from public insurance based all the way through to the UK’s NHS - which does an excellent job despite below inflation budget increases and endless media hyped scandals.
Symmetry 8y ago
The VA is far from perfect and is really noticeably worse than many other country's nationalized health systems. But it's not obviously worse than private health insurance in the US and generally veterans are as happy with their health care as other people. I think the VA example tends to dispel the notion that single payer would save that much money but it works about as well as other approaches, of which the US has way too many.
- chimeracoder 8y ago
  > The VA is far from perfect and is really noticeably worse than many other country's nationalized health systems. But it's not obviously worse than private health insurance in the US and generally veterans are as happy with their health care as other people If you want to convince people to support a single-payer system, this is quite possibly the worst argument you could use. Any veteran or anybody who has had any experience whatsoever with the VA will instantly assume you don't know what you're talking about. The VA is, on the whole, atrocitous. There are a couple of regions which do relatively well, because the system is federated, but on the whole, it's almost universally considered to be a disaster, even by people who are supportive of the program's existence. If you want to convince people that a single-payer system wouldn't end up like the VA, start by acknowledging the problems with the VA, not denying them.
  - dnomad 8y ago
    > The VA is, on the whole, atrocitous. There are a couple of regions which do relatively well, because the system is federated, but on the whole, it's almost universally considered to be a disaster, even by people who are supportive of the program's existence. Yeah, this is bullshit. The VA and its effectiveness has been studied quite a bit. Its quality has been found to generally exceed the quality of private hospitals. The media and conservatives paint this idea that the VA is "atrocious" but it has no basis in reality. The scientific evidence for universal healthcare is overwhelming. The only "controversy" -- exactly like the "controversy" around climate change -- exists within people who have carefully decided to ignore the evidence and buy into the propaganda. The problem here is not the VA. The problem here is that many Americans have abandoned reality.
lg 8y ago
no reason why single-payer means government-run hospitals
Fomite 8y ago
For a large number of different outcomes, the VA is superior to private care. It has a disproportionate footprint because "The VA does something bad!" is national news, while "SmallSizeMidwestCity Memorial does something bad!" isn't. It's not perfect, by any means, and struggles with cost constraints (veterans are sympathetic, but sympathetic doesn't mean well supported), but many of its quality outcomes are superior. See, for example, https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2618816 https://jamanetwork.com/journals/jamainternalmedicine/articl...
- maxsilver 8y ago
  Your getting downvoted for this, and I have no idea why. Have other folks actually stepped inside a VA facility? Many of them are old/outdated/underfunded it's true. But some of them truly do offer superior care to a typical private hospital (in staff, facilities, and outcomes). The VA system could use significant improvement, absolutely. But if the fear-mongering 'worst case scenario' is that everyone gets VA levels of healthcare, that's still a huge win for all of America. That's a great baseline standard to start with, that no one should ever fear falling below. If an uninsured American is critically injured, the options today are "A: Die" or "B: Bankruptcy". Having a new option "C: Universal VA-levels of healthcare" would be a win for literally every American, even for Americans who are lucky enough to already have great private insurance and who would never need/use this option themselves.
  - mter 8y ago
    > But some of them truly do offer superior care to a typical private hospital Which ones? Because that has not been my experience at the hawaii facility. From my appointment time being written down on a piece of paper then they send me my actual appointment date a few months later to the doctor being an hour+ late, my personal experiences have been subpar. Add in how doctors/nurses at multiple hospitals do comically incompetent things like reusing insulin pens/colonoscopy bags/not washing equipment, the general sense of incompetence when they lose my records every few years, or talking to my buddies who got out and ended up working at the VA and have told me that they'll never get treated there, and I do not have the same sense of "superior care" that you're talking about. If I want hep C, I'll go to the VA. If I want medical care, I'll go anywhere else or just not go to a doctor.
sykh 8y ago
The people on TRICARE don’t seek to leave the system, do they? That’s a government run healthcare system. Do Medicare recipients seek to leave it? That’s a government run healthcare system. Universal healthcare can be implemented poorly but it doesn’t have to be. It can be done right. There are lots of examples of this.
- creaghpatr 8y ago
  >Do Medicare recipients seek to leave it? No, because it's free, but 1/3 of Medicare recipients opt to receive their coverage through private insurers that typically add on additional coverage, an indicator that Medicare alone is not enough for a large segment of the population, or that they prefer a private insurer even with government subsidization. https://www.kff.org/medicare/fact-sheet/medicare-advantage/ https://www.kff.org/medicare/fact-sheet/medicare-advantage/
  - sykh 8y ago
    Excellent. We are in agreement that the American government can and does provide a health insurance program that covers lots of people and has the property that people don’t seek to leave it. Perhaps the idea that everyone be covered in such a system is not so far fetched.
    - chimeracoder 8y ago
      > We are in agreement that the American government can and does provide a health insurance program that covers lots of people and has the property that people don’t seek to leave it. People literally are leaving it, to the fullest extent that they legally can. It's not a small number, either. About 40% of Medicare patients aren't on the government-run system at all, and that number has consistently grown over the years.
      - Clubber 8y ago
        They supplement it, I don't believe they are leaving it, unless they are wealthy and can afford to pay out of pocket because they want to use a doctor that is not participating in the medicare program. Do you have a cite?
Sangermaine 8y ago
>If the VA is the best the US government can do Who said it was?
chiefalchemist 8y ago
> "If the VA is the best the US government can do..." It's not the best Uncle Sam can do. It's the best it wants to do. It's the (minimal) "best" is has to do. Sure there's plenty of verbal grandstanding - by both politicians, the public, and the private sector (e.g., NFL) - about supporting the vets and their families, but actions speak louder than words. (Verbally) supporting the vets is good branding. It's that simple. That's all it takes. Put another way, if the US brought back the draft and the armed forces made up a wider cross-section of society (i.e. poor, rich and in between) priorities would change. Actions would speak louder than the words.
dnomad 8y ago
This is a lie. By virtually every measure the VA is the most cost effective and best quality care that Americans can get. * The VA is very cost effective. It is much cheaper than any private sector health plan or Medicare. Instead of buying into the propaganda go straight to the source [1] and look at the actual facts. * The VA enjoys very strong customer satisfaction. You wouldn't know this because the media and conservatives work together to denigrate the VA every chance they get but you should actually talk to people on the VA plan. Surveys of actual VA customers [2] indicates they're quite happy with their free, comprehensive government healthcare. (Shocker.) * Study [3] after study [4] has shown that VA hospitals are better than private, profit-driven hospitals. Most Americans would kill for VA coverage. It far exceeds anything they will ever receive unless they make it to the 1%. And this is why it's so very important to keep spreading this lie that the VA is this gross, evil system where all the patients are just waiting to die and ignored by incompetent and indifferent government bureaucrats. And this is the real problem. You can't have real discussions about health care in America because, frankly, most Americans don't live in the real world. They've been led to believe objective nonsense and you simply can't build anything off such a foundation. [1] https://www.cbo.gov/publication/49763 https://www.cbo.gov/publication/49763 [2] https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2537 https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2537 [3] https://link.springer.com/article/10.1007/s11606-016-3775-2 https://link.springer.com/article/10.1007/s11606-016-3775-2 [4]https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2618816?redirect=true https://jamanetwork.com/journals/jamainternalmedicine/articl...
ajross 8y ago
> You literally couldn't make up worse things than their administration has been caught doing with little or to consequence. I literally could. The scandals you're referring to basically come down to them having been cooking books about care records. Bad, but not exactly in the realm of "literally nothing worse" hyperbole. In fact the VA tends to produce health care outcomes that are well within the range of US citizens in the same income bracket (which is to say, not great relative to the rest of hte industrialized world, but not bad) at a cost that is much less than that of private insurance. Really, you could do a lot worse. The criticism of the VA tends to be very similar to the criticism of the NHS in the UK. It's valid as far as it goes, but... neither UK citizens nor US vets are suffering serious catastrophes here. They're getting care and living decent, healthy lives by any reasonable standard. Literally.
- XorNot 8y ago
  Also the problems with the VA generally stem from the reality that US politicians "support the troops" right up until they're home and maybe not so enthusiastic about the war anymore.

Adutude 8y ago

I couldn't agree more. I don't think U.S. has a real progressive party, the choices are off the rails conservatism, or conservative lite. IMO, a progressive/liberal is concerned someone might go hungry, a conservative is concerned that they might miss out because someone got some food they didn't earn/deserve.

Beltiras 8y ago

This is a principal reason why the US was crossed off my list of countries where I would work and live. I fight against the privatization that is occurring within healthcare in my native country, Iceland. We used to have the Scandinavian model but decades of attacks from the right-wing Independence Party has broken our healthcare system. The next phase described by Chomsky is handing it over to private capital since people are outraged that it doesn't work anymore. I'm sickened by the development and feel a little like an old man screaming at the desert wind.

sykh 8y ago
I don’t understand why you were downvoted. That you were downvoted for your comment suggests how bad things are in the U.S. for a progressive like me.
- coolaliasbro 8y ago
  Thank you for engaging other commenters who do not yet see the benefits of regulating society and the economy according to what's best for the populace versus private individuals (ie, corporations, et al). HN and /r/LateStageCapitalism are my two primary sources of current events and public discourse. Here's a link to the Reddit thread for anyone interested: https://www.reddit.com/r/LateStageCapitalism/ https://www.reddit.com/r/LateStageCapitalism/
- Beltiras 8y ago
  It's way easier to downvote and move on than to make solid arguments and change minds. Maybe they fear that their libertarian world view will crumble when confronted with some evidence.

gambiting 8y ago

There was a good comment(I have it saved somewhere) explaining this quite well - some places in the world(European nations mostly) got so fucked over by history, over and over and over again that as societies they realized you cannot "pull yourself by your bootstraps" and provide for yourself in all circumstances. Just in the 20th century it was possible to see your country ravaged by two world wars, change ideologies three times, change the dominant religion and ownership of land between major powers few times in just few decades.....the societies have realized that the only way to make it work is by providing certain services to everyone, free of charge, purely because they are citizens with no strings attached(and no, this has nothing to do with communism). Meanwhile, in US, the "pioneer" ideal still reigned - anyone could achieve anything, given enough hard work. That ideal didn't exist in Europe at the time, or was crushed so thoroughly its destruction echoed through society - you could be the most hardworking person in Europe, but if someone decided they were going to pillage your land, rape your family and send you all to concentration camps - that was going to happen. No amount of positive thinking and hard work was going to prevent it. So yes, to my granparents it's absolutely obvious that everyone should have equal chances - healthcare should be funded by the state, as should education and child-bearing. They still get really upset over the fact that despite all education being 100% free in this country students still have to pay for their own housing - why should they? The state wants to have well educated citizens, why the hell should the students be paying anything to study. Once again, this has nothing to do with communism, but I am sure Americans would label it as such.

toasterlovin 8y ago
The US and Europe are not really great comparisons for a bunch of reasons, but the fundamental one is that Europe has been at Malthusian population limits for a long time, whereas North America has had an essentially unlimited, unpopulated frontier that new people could move to and create lives for themselves. Thus, the American notion of pulling your self up by your bootstraps was a workable one. Since North America was first colonized by Europeans, Americans have moved west and made a future for themselves and their descendants by using hard work to harvest the bounty of nature. But Europe has been full for thousands of years. You can't just move West, work some land, and raise a family; there are already other people wherever you would want to go.

rukittenme 8y ago

> When it comes to public funding for public goods we tend to worry about some poor person getting something they don’t deserve. The go it alone I’ve got mine, fuck you attitude is unhealthy. 1/3 of our GDP goes to "the village". We spend trillions every year on the things you want most. Education, healthcare, environmental protections. You name it; we spend money on it! 70 million people use medicaid. 44 million people use medicare. 22 million veterans eligible for the VA. 22 million government employees who receive healthcare benefits paid for by the state. We are drowning in the healthcare spending you pretend doesn't exist.

Daishiman 8y ago
You're not drowning. You're wasting spending on things that don't matter, like privately funded education and privately funded health care. The solutions already exist and they're out there. Lowering spending just for the sake of it is not one of them.
sykh 8y ago
Our spending on healthcare is grossly and immorally inefficient. A change is needed. One reason for the ineffiency is that public welfare is subordinate to special interests. All universal healthcare systems in the world are cheaper on a per capita basis than the American system. A change is needed. I’m not advocating for more money. I’m advocating for a change in perspective by our leaders.
- fastball 8y ago
  Just because something has worked for other countries does not mean it will work for the US.
  - sykh 8y ago
    Never said otherwise. I made the statement in response to the view that government run necessarily means inefficient. Clearly the converse is true. There are lots of examples.
  - 8y ago

conanbatt 8y ago

> When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury. You can't start any economic argument by saying that paying any cost is a must. You will get fleeced. It is not true that universal healthcare pays for everything. The most expensive and experimental treatments will not be covered ever by the system, and it shouldnt.

sykh 8y ago
It is a well known fact that all medical care systems ration care. A person in America who gets cancer, say, often times faces bankrupt and financial ruin. The same can not be said of people in other wealthy nations. I fail to see your point. All healthcare systems ration care. Not all of them lead to financial ruin at the rate the American healthcare system does. My statement stands. A person ought not face financial ruin. It may be the case that there aren’t enough resources to treat the disease it this does not negate the belief that they shouldn’t face financial ruin.
- DamnYuppie 8y ago
  They don't face financial ruin, unless they don't have health insurance and or they opt for various drugs that aren't covered by their plan. Before everyone screams that all things should be covered please consider that due diligence has actually been done and the drug was considered to either not be effective or not needed based upon other existing treatments.
  - sykh 8y ago
    The idea of universal care is that everyone have insurance. Before Obamacare my sister got cancer. She wasn’t lucky enough to have an employer nice enough to provide insurance through her job. Even people with insurance often times face financial ruin. Especially before Obamacare was enacted.
  - coolaliasbro 8y ago
    Wrong--it is certainly the case that many insured individuals are left insolvent after necessary but costly medical procedures.

clarkevans 8y ago

> It seems the public interest is subordinate to private interests and often times with immoral consequences. This perspective of public vs private interest is rather puzzling to me -- it's more a matter of short-term vs long-term thinking. In the long-term, it's in the private interest of those having sustainable companies to have a broad base of educated and healthy workers to employ. The short-term interest of any single firm has a different calculus, but all private companies would benefit from a stronger public education and health system. The goal of government, in my opinion, is to focus on long-term objectives: ensuring a sustainable healthy and educated population. It's similar case for education. It's not that I'm paying for someone else's kids school so much as I'm paying so that one day, when I need a smart educated nurse to take care of me... it'll likely happen at a reasonable price because there are so many educated people who have decided to be nurses.

HankB99 8y ago
I agree with the long term / short term dichotomy. I believe the same dynamic is at work WRT the concentration of wealth in the US. I understand the short term desire to accumulate wealth. I do it myself. It seems to me that if trends continue, there will be less and less income for the other 99% to spend. (Yes, I'm mixing income and wealth here because I believe that the desire to increase wealth on the part of the wealthy results in downward pressure on income for the rest of us.) In my Econ 101 class they spoke of the velocity of money - how much gets spent. It seems to me that the velocity has to go down as earnings go down and at that point, the ability to accumulate wealth would start to decrease. (These thoughts ignore the possibility that those who are not wealthy could provoke social upheaval. I don't know if that's a real possibility.)
- redbeard0x0a 8y ago
  I think it is a possibility, the wealthy are building doomsday bunkers. There is writing on the wall, they just need to outlast the uprising and then come out and buy up everything really cheap.
ekianjo 8y ago
> The goal of government, in my opinion, is to focus on long-term objectives: ensuring a sustainable healthy and educated population. You can't ensure health unless you have wealth in the first place. You can see that things moved in that order in the past 300 years: the more wealthy a country was, the longer people lived and the better they could face different conditions. The greatest strides against mortality were accomplished long before the welfare state as an expression ever existed.

mc32 8y ago

Universal healthcare benefits people with no coverage, which is good, but it also, in the case of nationalized healthcare, i.e. not privately run, leads also to lower quality care for people already with coverage where experience is people who can afford it, will when other than the most routine things, seek private care. Given that, it looks like a two tiered system might work best. One which works like the current system and also another for the not quite indigent but can’t afford the current system (indigent are covered by Medicaid).

beagle3 8y ago
What works well outside of the US is that the single-payer government run (or at least government mandated) provides a standard level of care, which more often than not includes wellness and life threatening care (and a lot in-between), and one can buy additional coverage in the private market - but the basic standard care is considered a right, and doesn't disappear just because you have some additional coverage.
dv_dt 8y ago
When you look at other modern nations, all with better performing healthcare systems than the US, there is a mix of arrangements. The common factor is public gov't control of drug prices and procedures. The arrangement of how the administration of the care is allocated varies all across the spectrum, from fully nationalized, to hybrids, to mostly private administration. But I'm inclined to think that public health experts setting cost ceilings by drug & procedure is the critical element.

rogerb 8y ago

There's a simple thought experiment that helps: - an american citizen break his leg, he is not insured. Do you A: let him die B: take care of him ? if your answer is A - you are a terrible person, but you hold a consistent position. if your answer is B - the only question that remains is what is the most economic, efficient way to take care of this person ? b is universal health care. if you think you can do A with emergency care, consider how inefficient and expensive this is, and who ends up paying for it.

SamReidHughes 8y ago
What if they're not an American citizen? What if they're also in a different country?
- knieveltech 8y ago
  What if they aren't? Are there criteria that can be met that make the decision to leave someone injured on the side of the road morally sound?
  - SamReidHughes 8y ago
    We aren't on the side of any roads here.
    - knieveltech 8y ago
      Fine. Sidewalk, in the middle of a restaurant, in your livingroom, at the airport. Pick a location and then feel free to explain what selection criteria make ignoring the injuries of another moral.
      - SamReidHughes 8y ago
        Okay. I pick any of the injuries of others that you're ignoring right now.

fastball 8y ago

It's immoral for people to pay for the time and work of others?

Andre_Wanglin 8y ago
Apparently doctors should only work for the public good and accept (relatively) piddling wages but startup tech bros and VCs are absolutely entitled to their billions.
- sykh 8y ago
  Nice false dichotomy you have there. There are other possibilities than the status quo or doctors getting piddling wages.
  - Andre_Wanglin 8y ago
    I did not perpetrate a false dichotomy, I mocked the hypocrisy of any user of this site seeking to limit the compensation of anyone.

dv_dt 8y ago

Not only is universal healthcare more moral, it has been demonstrated as more economically efficient many times over. You only need to start by comparing the per-capita costs paid for healthcare in the US vs every other modern nation in the world. The US pays more than double the average of the other nations and we get much less performance for it. There are no modern nations that pay as much as the US in absolute terms, nor as high a percentage of our GDP. https://www.pbs.org/newshour/health/health-costs-how-the-us-compares-with-other-countries https://www.pbs.org/newshour/health/health-costs-how-the-us-... The other nation's systems have mixes of full nationalized care to administrative combinations of private insurance, so there is some leeway there. But all of them contain public controls on the cost of drugs and procedures. And that demonstrably works with both better prices, and better outcomes in total measures like life expectancy. Edit: Btw the PBS article is from 2012, with data up to 2010. In later years, US life expectancy has had years which it has dropped, and even when growing, it lags the nations modern peers (while approaching nations such a Mexico..). There are some forces there that aren't all healthcare, but healthcare is central to life expectancy... https://www.cnbc.com/2017/02/22/us-life-expectancy-is-low-and-is-now-projected-to-be-on-par-with-mexico-by-2030.html https://www.cnbc.com/2017/02/22/us-life-expectancy-is-low-an...

grey-sunshine 8y ago
Paying a huge percentage of your GDP... Don't you think it might be cultural?

andys627 8y ago

> Americans need to change their underlying notions of what it means to be a society. We want it (https://www.pbs.org/newshour/health/62-percent-u-s-want-federal-government-ensure-health-care-poll-says https://www.pbs.org/newshour/health/62-percent-u-s-want-fede...)... Our politicians just aren't doing it.

a_tractor 8y ago
I wonder what % of that 62% are actually net taxpayers? http://www.taxpolicycenter.org/taxvox/closer-look-those-who-pay-no-income-or-payroll-taxes http://www.taxpolicycenter.org/taxvox/closer-look-those-who-... http://www.pewresearch.org/fact-tank/2017/10/06/a-closer-look-at-who-does-and-doesnt-pay-u-s-income-tax/ http://www.pewresearch.org/fact-tank/2017/10/06/a-closer-loo... https://taxfoundation.org/distribution-tax-and-spending-policies-united-states/ https://taxfoundation.org/distribution-tax-and-spending-poli... >American’s lowest-income families receive $5.28 worth of government spending (federal, state, and local) for every $1 they pay in total taxes. Can't be hard to find enough people willing to vote for more benefits, especially if they know they aren't the ones paying for anything.

TimJYoung 8y ago

Back in 2004 when John Kerry was running for POS (that's President of the United States, he-he), he had a great idea (that I'm sure came from elsewhere, but a good idea is a good idea). The US government would become the "insurer of last resort" and cover catastrophic claims above a certain amount: http://www.washingtonpost.com/wp-dyn/articles/A16748-2004Jun4.html http://www.washingtonpost.com/wp-dyn/articles/A16748-2004Jun... For his efforts, he was practically called a "Commie" by the Republican party, despite the fact that the proposed mandates were fairly mild and the plan worked within the existing employer-provided health insurance system. It was a good crack at the ~20% of the population that accounts for the majority of healthcare spending, and eliminates the possibility of someone losing their home and savings because of a serious illness. Plus, I'm sure that the levers could be tweaked a bit to get better outcomes.

Andre_Wanglin 8y ago

>When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury. This is especially so in a nation as wealthy as the U.S. The American healthcare system is immoral and I hope it drastically changes. If no one has to worry about the monetary effects of their health choices, poor health choices are incentivized and those who make poor choices are subsidized by those who make good health decisions. The vast majority of healthcare spending in the US is already on preventable chronic conditions yet everyone keeps gorging themselves further into obesity, diabetes, hypertension, CVD, etc. Almost no one is against paying into a risk pool that hedges against unforeseen health problems even though they may never directly benefit. If I pay my entire life to cover someone else's cancer, that's fine with me. What we are sure as hell opposed to is a creating an entire system based on perverse incentives that punishes people doing their best to save their pool from spending on them and rewards those whose voluntary actions are the driving force behind increased costs. And the US healthcare industry is not some libertarian wild west show, it is highly regulated and dominated by the edicts of CMS yet the state of the public's health continues to worsen in ways our forebears who optimistically, though naively, created these programs could never imagine.

sykh 8y ago
Thank you for exemplifying the attitude I decried. I wish people like would leave the U.S. Live elsewhere. Escape the burden of possibly having your tax dollars help someone else by emigrating.
- Andre_Wanglin 8y ago
  I invite you to do likewise. We will be quite well enough without ignorant busybodies posturing as moral crusaders hectoring us into enabling further deprivation of our property and liberty.
  - sykh 8y ago
    As the good book says, "For the love of money is the root of all evil". I'm not posturing. I actually do have a moral code that I try to abide by. The fact that all other wealthy nations provide what is colloquially called "universal healthcare" is an indication that yours is the abhorrent view. It would be worth your while to consider why your view, in just about all other advanced nations, is considered a fringe one.

ataturk 8y ago

Here we go with this bullshit again! IMMORAL! Um, whose morality are we talking about? You sound like a shrill, smug, teetotaler in 1930! When a person gets a life-threatening condition in China, they may not get care at all. Is that "immoral" or just a reflection on how a non-market-based system uses rationing to determine, based on party loyalty, who lives and who dies? How about in the socialist paradise of Venezuela? Is there full on collectivist healthcare system immoral or just stupid? You can't even get treated for a gunshot wound in Venezuela right now. You might get a dirty bandage off of a corpse if you're lucky that day. US healthcare has massive problems, but when you need it, you can obtain care. I don't know why people have such a hard time paying for things they need except that US higher education has completely messed with so many people's brains in this regard and so they have come to believe that strangers owe them something or that human nature is somehow different today than it has ever been. You are not entitled to live, your outcomes in this world are almost completely random and placing an oppressive, confiscatory government on top of your head is not improving your chances of survival.

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nojvek 8y ago

Social security age keeps on rising as baby boomers retire. America is the wealthiest country on the planet, yet the country where most people go bankrupt or commit suicide because they can’t afford healthcare costs. US spends astronomic amounts on weapons development than keeping its citizens healhy and happy. Fermi was right. We’ll eventually destroy ourselves before we find another intelligent civilization. May be the great filter is that no one in the universe got healthcare right and they vanished. /s