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I don’t believe in universal healthcare, and none of these approaches do much to convince me. I’m in agreement that the current situation is hot garbage, and i

I don’t believe in universal healthcare, and none of these approaches do much to convince me. I’m in agreement that the current situation is hot garbage, and it’s shitty for a lot of people. However, my insurance now is good enough for me and my family. Sure, it’d be nice if it was cheaper, but whatever. As I get older I find I can’t be bothered to lay awake at night worrying how everyone in the country gets healthcare anymore. I’ve simply accepted that this is the world we’ve been dealt and everyone needs to find their own way to survive. My main concerns are 3,4,5,6. I don’t see them as “fallacious”, I think it’s naive to assume universal healthcare will work exactly as planned with no unforeseen consequences, and I’m generally suspicious of people who do not list the risks along with the benefits.

kpU8efre7r 7y ago
I agree. This system is no secret. We all know this is how it works so why do people make poor choices and then later complain about their insurance? With that said, having a massive middle man (private health insurance) to act as bloat and added friction on the economy is bad for everyone. You may not be directly affected but you are definitely affected in other ways that aren't as obvious. I find this sort of thing is common in America. There is always an industry set up as a middle man that needs to get paid.
- LarryDarrell 7y ago
  "I got mine" "Don't make poor choices" I'm glad this isn't some sort of late stage capitalism drinking game.
  - kpU8efre7r 7y ago
    Thanks for adding to the discussion. I was going to add to my comment but didn't that: This is all an incredibly privileged mindset. Many people don't start on the same level with the same chances, that we do. It's hard to blame poor choices when it's not a choice. But at the end of the day that's a big appeal to emotion. The logical argument, is that the current system is a big honking added step in the system that adds nothing but subtracts a lot and whether or not "you've got yours" you are still affected by those who don't. Poor choices or not it's still in your own interest for the people to your left and right to be covered and get healthcare.
- conanbatt 7y ago
  The massive middle man is the state, not private insurance. For all the complaints about private health insurance profits, all combined are a blip of the federal health expenditures.
  - hedora 7y ago
    What “federal health expenditures” are you talking about? The Obamacare tax was something like 3%, and only for the extremely wealthy. In contrast, 33% of US healthcare costs go to insurance overhead, and >17% of our GDP goes to health care, so nearly 6% of the gdp goes to private insurance middle men. Source on 17%: https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/ https://www.statista.com/statistics/184968/us-health-expendi... Now, the entire federal government is currently spending 37% of GDP (though that includes deficit spending), so you posit that at least ~ 1/6th (6/37) of government spending is some healthcare program. Source on 37%: https://tradingeconomics.com/united-states/government-spending-to-gdp https://tradingeconomics.com/united-states/government-spendi... Medicare and health costs ~ $1T of the government’s $3.8T budget, which is a bit over 1/4th of the federal budget. That does meet the threshold of your claim, but only if much less than half of Medicare spending goes to actual health care. Source on 1T Medicare, etc spending: https://www.nationalpriorities.org/budget-basics/federal-budget-101/spending/ https://www.nationalpriorities.org/budget-basics/federal-bud... This study from 2001 concluded Medicare is about 80% efficient (20% waste): https://www.nber.org/papers/w8395 https://www.nber.org/papers/w8395 Note that the 20% Medicare waste number from the NBER study is not apples to apples with the 33% administrative overhead number, since it includes ineffective medical care (and all other wasted spending) that did not improve patient outcomes in the 20%, but the 33% number for insurers only counts useless paper pushing, and not ineffective care, etc, etc. So, private insurers really are squandering many more healthcare dollars, and are also much less efficient than the federal government.
    - deleted 7y ago
      [deleted]
    - conanbatt 7y ago
      > In contrast, 33% of US healthcare costs go to insurance overhead, and >17% of our GDP goes to health care, so nearly 6% of the gdp goes to private insurance middle men. 6% of GDP to private insurance? Math doesn't add up on this back-of-the-napkin math. That's an entire Apple of operating costs every year. The biggest insurance company, UnitedHealthcare, is worth 200 bill in the market. The gov could buy the big 5 insurance companies with half its yearly medicare budget. Don't confound paying to insurance and paying to providers! > So, private insurers really are squandering many more healthcare dollars, and are also much less efficient than the federal government. I will answer seriously in a second, but for real: how is it so obvious that the private market beats the government on almost anything at any time, even this very government (for example, education) and still, the level of debate is "government is more efficient". Government is never more efficient, because it doesn't care about efficiency. The comparison of efficiency between medicare and private insurance is grossly misrepresented by Bernie Sanders. First of all, there are some disingenuous numbers: it uses a measure of efficiency of total cost/admin costs, but that skewes severely in favor of medicare bacuse it has an older population that has more expensive treatment. Some economists looked into this and the cost of administration per patient is similar. Second, a great part of why medicare has less admin burden is that its collections are done through payroll taxes. This means the admin staff is included in other government agencies. This is not a public-advantage, because you can also use payroll taxes to pay for private insurance if you wish so, something that exists in some other countries. ( to my dismay, for the following topic). Another trick here is that medicare collects from everyone and pays for a few. That is a great way to never have to market, administrate or manage people on your plan: you are not going to use it? tough luck. You dont like it? tough luck. You don't have quality coverage in your area? Tough luck. This trick is so pervasive that even Bernie Sanders claims how medicare patients are so happy: why wouldn't they, the premium they should pay to maintain it is about 1k a month, and they pay 150! Forth, it is key to understand that medicare offerings are not market competitive. They pay half of what private insurance pays, and there is no way in hell you make that work. Private insurance subsidizes medicare patients, and doctors would abandon the network if they were forced to accept medicare rates. This is a long topic, but to re-frame the conversation: what makes healthcare in the us expensive is NOT private insurance. Most of the world has private insurance! even Canada! Even France! Spain, Norway, etc. US healthcare is expensive because it is one of the most tight regulated expensive markets in the US.
fzeroracer 7y ago
If that's something you accept, then you also must accept that the moment you get sick and your health insurance decides to screw you over, that no one will be there to help you. You'll go bankrupt. You'll become homeless at the later ages of your life. And you'll need to find your own way to survive on the streets. For me, since I saw first hand what the healthcare system did to my parents? No one should go through that. They had 'good enough' healthcare and it still financially and physically destroyed them. You think you have good enough health insurance? You don't.
- rossenberg79 7y ago
  So what? I accept the risk, like any other risk in life. Not sure why those risks mean I have to get on board with a complete overhaul to something I don’t believe will work, as if that will be less risky.
  - grecy 7y ago
    > So what? I accept the risk, like any other risk in life You say that now, but the reality is much different when it comes down to it. Like everyone else, you'll scream and cry like a stuck pig when it's your Mother/Sister/Daughter/Son who get unbelievably sick through no fault of their own and die early because of a lack of money. The system as it exists today is nothing short of disgraceful. It's sad that you just accept it and have no interest in improve it.
    - rossenberg79 7y ago
      You are stating that this is the reality as if it’s a certain thing. I don’t have reason to believe my insurance will suddenly drop coverage when I need it. I don’t think that’s a huge risk. Your hypothetical world isn’t all that safe either, because when the government says no, that answer is final. There is no other option, there is no other way even if I wanted to pay. That’s just as bad as coverage being dropped, and perhaps much more likely given my faith in the government to do things efficiently these days.
mnm1 7y ago
This is exactly why America has such a bad system of healthcare. People are selfish and don't care if anything bad happens to anyone else as long as it's not them. Let others die. Sure we could prevent it but why bother? They don't care to work on improving things. Why bother when you can ignore things and then complain or blame others when things don't work? Why talk about policies and plans when you can just ignore everything? No wonder we have no communities and no ties between people. No wonder we have such low voter turnouts. Everyone for himself and fuck everyone else whether they need help or not. Why bother after all? Fuck everyone else. That's the American way.
- rootusrootus 7y ago
  Possibly it's not that simple.
throwaway34241 7y ago
Are you against universal access to health care (why?) or just against single payer? Plenty of developed countries like Germany and France have better access to health care (that costs a lot less) while still being multi-payer with private insurances. Although in the US we just seem to only pay attention to Canada and the NHS so universal health care and single-payer are tied together. Honestly I think people's expectations have gotten much too high about single-payer solving all our problems. Clearly other developed countries have gotten their health care (relatively) in order without doing single payer. And we basically already have single payer for age 65+ and the costs there still aren't nearly in line with everyone else. The US definitely spends much more (as a % of GDP) than everyone else (to not dramatically better results) but single-payer or not doesn't seem to be the key difference.
- cameldrv 7y ago
  For sure. From having lived in Germany, it's not the payor that makes it cheap, it's the regulated prices. There is simply a (low) price that everyone pays when they go to the hospital. We also have something similar in the U.S., given that roughly half of medical care is paid for by the government. Medicare sets prices for each CPT code, and they do it through a formula that depends on geography, and something called Relative Value Units. This is done nominally by the Center for Medicare Services, but they rubber stamp the work of the Specialty Society Relative Value Scale Update Committee, which is a group of doctors appointed by their respective medical societies to decide how much Medicare should pay them. When doctors can simply tell the government how much they should be paid, what do you think is gonna happen?
  - conanbatt 7y ago
    People really do not get that the rotten core of the healthcare market is regulatory capture, and that a bigger healthcare system will mean bigger regulatory capture.
    - winter_blue 7y ago
      This. I'd love if public policy researchers could find ways to end or dramatically reduce the (basically corrupt) regulatory capture the health care industry orchestrates.
hedora 7y ago
Forgive me for asking, but do you personally deal with the paperwork generated by you and your family’s health care? At my last N employers, I’ve been lucky enough to choose between literally the best HMO in the US (on multiple metrics), and top-end insurance plans from a range of multiple companies (e.g., a $0 annual deductible plan or an HSA + high deductible plan, where the employer’s HSA contribution matches the annual deductible). The paperwork for the high deductible plan took multiple letters per doctor visit spread over multiple months, and more than doubled the paperwork we had to track for income taxes. This is completely unacceptable. The HMO is, well, an HMO, we have limited choices of doctors and specialists, but I swipe my credit card when I check in or pick up medicine, and that’s 100% of the paperwork, even for extended hospital stays. The only people in the US with better health care plans have what I have, and also a personal assistant (or heroic spouse) to abstract away how messed up the system is. For these reasons, I argue the US health care system has failed all but top <1%, and those people can already afford to fly to Europe and buy specialist care, I don’t see why they won’t be able to do so in the US after the rest of us get universal healthcare.
jowiar 7y ago
In plenty of other places it's worked hella better than what we have here. In the meantime, you, privileged jackass, go fuck yourself and let people who are trying to solve problems do something.
- Cyph0n 7y ago
  Let’s see how he/she enjoys the US healthcare system if ever out of a job...
- sctb 7y ago
  You can't make personal attacks here. Since we've asked you several times before to please follow the guidelines we've banned the account.
  - jowiar 7y ago
    Take a look at those past times, and you’ll find HN moderators defending Russian propagandists in the name of civility. I won’t miss this community — thanks for reminding me what a joke it all is.
magicalhippo 7y ago
FWIW, some views from Norway, which has universal healthcare. 3: Don't need health insurance so I'd say that's better. 4: We can chose our own primary doctor from the pool of available GPs. Available just means that some GPs have too many patients on their list already and don't have any slots available. You can switch primary GP once a month (IIRC). I switched a few times until I found one which I liked. Repeated the process when I moved. 5: I can see my GP whenever I feel like it, just need to set up an appointment. If you mean to see a specialist then yeah, I'd need my GP to refer me. Sometimes this can feel a bit unnecessary but mostly it's not a big issue IMHO. 6: If my GP doesn't have time for me, I'd just switch and find one who does.
- conanbatt 7y ago
  Its not private/public that makes healthcare expensive in the US. Medicare is also public and fairly unlimited and also way more expensive than Norway health. There's a big group of other issues at play. And universal healthcare in the US would be so massive that you can't compare it to a small country.
- sanderjd 7y ago
  > 3: Don't need health insurance so I'd say that's better. You do have health insurance, it's just provided by the government with premiums paid through taxes. When people express the concern that their insurance would get worse, they mean that the insurance provided by the government would be worse than what they currently have. There are a number of different things that people think make plans worse or better, which is a major contributor to the difficulty in having a clear discussion about this.
  - magicalhippo 7y ago
    > You do have health insurance, it's just provided by the government with premiums paid through taxes. Yes, I had a line about being taxed quite heavily but deleted it for reasons I've forgotten, and I missed updating point 3. I don't need to worry about my insurance though, what it covers etc.
tzs 7y ago
> I don’t believe in universal healthcare Who do you believe should not have healthcare?

kpU8efre7r 7y ago

I agree. This system is no secret. We all know this is how it works so why do people make poor choices and then later complain about their insurance? With that said, having a massive middle man (private health insurance) to act as bloat and added friction on the economy is bad for everyone. You may not be directly affected but you are definitely affected in other ways that aren't as obvious. I find this sort of thing is common in America. There is always an industry set up as a middle man that needs to get paid.

LarryDarrell 7y ago
"I got mine" "Don't make poor choices" I'm glad this isn't some sort of late stage capitalism drinking game.
- kpU8efre7r 7y ago
  Thanks for adding to the discussion. I was going to add to my comment but didn't that: This is all an incredibly privileged mindset. Many people don't start on the same level with the same chances, that we do. It's hard to blame poor choices when it's not a choice. But at the end of the day that's a big appeal to emotion. The logical argument, is that the current system is a big honking added step in the system that adds nothing but subtracts a lot and whether or not "you've got yours" you are still affected by those who don't. Poor choices or not it's still in your own interest for the people to your left and right to be covered and get healthcare.
conanbatt 7y ago
The massive middle man is the state, not private insurance. For all the complaints about private health insurance profits, all combined are a blip of the federal health expenditures.
- hedora 7y ago
  What “federal health expenditures” are you talking about? The Obamacare tax was something like 3%, and only for the extremely wealthy. In contrast, 33% of US healthcare costs go to insurance overhead, and >17% of our GDP goes to health care, so nearly 6% of the gdp goes to private insurance middle men. Source on 17%: https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/ https://www.statista.com/statistics/184968/us-health-expendi... Now, the entire federal government is currently spending 37% of GDP (though that includes deficit spending), so you posit that at least ~ 1/6th (6/37) of government spending is some healthcare program. Source on 37%: https://tradingeconomics.com/united-states/government-spending-to-gdp https://tradingeconomics.com/united-states/government-spendi... Medicare and health costs ~ $1T of the government’s $3.8T budget, which is a bit over 1/4th of the federal budget. That does meet the threshold of your claim, but only if much less than half of Medicare spending goes to actual health care. Source on 1T Medicare, etc spending: https://www.nationalpriorities.org/budget-basics/federal-budget-101/spending/ https://www.nationalpriorities.org/budget-basics/federal-bud... This study from 2001 concluded Medicare is about 80% efficient (20% waste): https://www.nber.org/papers/w8395 https://www.nber.org/papers/w8395 Note that the 20% Medicare waste number from the NBER study is not apples to apples with the 33% administrative overhead number, since it includes ineffective medical care (and all other wasted spending) that did not improve patient outcomes in the 20%, but the 33% number for insurers only counts useless paper pushing, and not ineffective care, etc, etc. So, private insurers really are squandering many more healthcare dollars, and are also much less efficient than the federal government.
  - deleted 7y ago
    [deleted]
  - conanbatt 7y ago
    > In contrast, 33% of US healthcare costs go to insurance overhead, and >17% of our GDP goes to health care, so nearly 6% of the gdp goes to private insurance middle men. 6% of GDP to private insurance? Math doesn't add up on this back-of-the-napkin math. That's an entire Apple of operating costs every year. The biggest insurance company, UnitedHealthcare, is worth 200 bill in the market. The gov could buy the big 5 insurance companies with half its yearly medicare budget. Don't confound paying to insurance and paying to providers! > So, private insurers really are squandering many more healthcare dollars, and are also much less efficient than the federal government. I will answer seriously in a second, but for real: how is it so obvious that the private market beats the government on almost anything at any time, even this very government (for example, education) and still, the level of debate is "government is more efficient". Government is never more efficient, because it doesn't care about efficiency. The comparison of efficiency between medicare and private insurance is grossly misrepresented by Bernie Sanders. First of all, there are some disingenuous numbers: it uses a measure of efficiency of total cost/admin costs, but that skewes severely in favor of medicare bacuse it has an older population that has more expensive treatment. Some economists looked into this and the cost of administration per patient is similar. Second, a great part of why medicare has less admin burden is that its collections are done through payroll taxes. This means the admin staff is included in other government agencies. This is not a public-advantage, because you can also use payroll taxes to pay for private insurance if you wish so, something that exists in some other countries. ( to my dismay, for the following topic). Another trick here is that medicare collects from everyone and pays for a few. That is a great way to never have to market, administrate or manage people on your plan: you are not going to use it? tough luck. You dont like it? tough luck. You don't have quality coverage in your area? Tough luck. This trick is so pervasive that even Bernie Sanders claims how medicare patients are so happy: why wouldn't they, the premium they should pay to maintain it is about 1k a month, and they pay 150! Forth, it is key to understand that medicare offerings are not market competitive. They pay half of what private insurance pays, and there is no way in hell you make that work. Private insurance subsidizes medicare patients, and doctors would abandon the network if they were forced to accept medicare rates. This is a long topic, but to re-frame the conversation: what makes healthcare in the us expensive is NOT private insurance. Most of the world has private insurance! even Canada! Even France! Spain, Norway, etc. US healthcare is expensive because it is one of the most tight regulated expensive markets in the US.

fzeroracer 7y ago

If that's something you accept, then you also must accept that the moment you get sick and your health insurance decides to screw you over, that no one will be there to help you. You'll go bankrupt. You'll become homeless at the later ages of your life. And you'll need to find your own way to survive on the streets. For me, since I saw first hand what the healthcare system did to my parents? No one should go through that. They had 'good enough' healthcare and it still financially and physically destroyed them. You think you have good enough health insurance? You don't.

rossenberg79 7y ago
So what? I accept the risk, like any other risk in life. Not sure why those risks mean I have to get on board with a complete overhaul to something I don’t believe will work, as if that will be less risky.
- grecy 7y ago
  > So what? I accept the risk, like any other risk in life You say that now, but the reality is much different when it comes down to it. Like everyone else, you'll scream and cry like a stuck pig when it's your Mother/Sister/Daughter/Son who get unbelievably sick through no fault of their own and die early because of a lack of money. The system as it exists today is nothing short of disgraceful. It's sad that you just accept it and have no interest in improve it.
  - rossenberg79 7y ago
    You are stating that this is the reality as if it’s a certain thing. I don’t have reason to believe my insurance will suddenly drop coverage when I need it. I don’t think that’s a huge risk. Your hypothetical world isn’t all that safe either, because when the government says no, that answer is final. There is no other option, there is no other way even if I wanted to pay. That’s just as bad as coverage being dropped, and perhaps much more likely given my faith in the government to do things efficiently these days.

mnm1 7y ago

This is exactly why America has such a bad system of healthcare. People are selfish and don't care if anything bad happens to anyone else as long as it's not them. Let others die. Sure we could prevent it but why bother? They don't care to work on improving things. Why bother when you can ignore things and then complain or blame others when things don't work? Why talk about policies and plans when you can just ignore everything? No wonder we have no communities and no ties between people. No wonder we have such low voter turnouts. Everyone for himself and fuck everyone else whether they need help or not. Why bother after all? Fuck everyone else. That's the American way.

rootusrootus 7y ago
Possibly it's not that simple.

throwaway34241 7y ago

Are you against universal access to health care (why?) or just against single payer? Plenty of developed countries like Germany and France have better access to health care (that costs a lot less) while still being multi-payer with private insurances. Although in the US we just seem to only pay attention to Canada and the NHS so universal health care and single-payer are tied together. Honestly I think people's expectations have gotten much too high about single-payer solving all our problems. Clearly other developed countries have gotten their health care (relatively) in order without doing single payer. And we basically already have single payer for age 65+ and the costs there still aren't nearly in line with everyone else. The US definitely spends much more (as a % of GDP) than everyone else (to not dramatically better results) but single-payer or not doesn't seem to be the key difference.

cameldrv 7y ago
For sure. From having lived in Germany, it's not the payor that makes it cheap, it's the regulated prices. There is simply a (low) price that everyone pays when they go to the hospital. We also have something similar in the U.S., given that roughly half of medical care is paid for by the government. Medicare sets prices for each CPT code, and they do it through a formula that depends on geography, and something called Relative Value Units. This is done nominally by the Center for Medicare Services, but they rubber stamp the work of the Specialty Society Relative Value Scale Update Committee, which is a group of doctors appointed by their respective medical societies to decide how much Medicare should pay them. When doctors can simply tell the government how much they should be paid, what do you think is gonna happen?
- conanbatt 7y ago
  People really do not get that the rotten core of the healthcare market is regulatory capture, and that a bigger healthcare system will mean bigger regulatory capture.
  - winter_blue 7y ago
    This. I'd love if public policy researchers could find ways to end or dramatically reduce the (basically corrupt) regulatory capture the health care industry orchestrates.

hedora 7y ago

Forgive me for asking, but do you personally deal with the paperwork generated by you and your family’s health care? At my last N employers, I’ve been lucky enough to choose between literally the best HMO in the US (on multiple metrics), and top-end insurance plans from a range of multiple companies (e.g., a $0 annual deductible plan or an HSA + high deductible plan, where the employer’s HSA contribution matches the annual deductible). The paperwork for the high deductible plan took multiple letters per doctor visit spread over multiple months, and more than doubled the paperwork we had to track for income taxes. This is completely unacceptable. The HMO is, well, an HMO, we have limited choices of doctors and specialists, but I swipe my credit card when I check in or pick up medicine, and that’s 100% of the paperwork, even for extended hospital stays. The only people in the US with better health care plans have what I have, and also a personal assistant (or heroic spouse) to abstract away how messed up the system is. For these reasons, I argue the US health care system has failed all but top <1%, and those people can already afford to fly to Europe and buy specialist care, I don’t see why they won’t be able to do so in the US after the rest of us get universal healthcare.

jowiar 7y ago

In plenty of other places it's worked hella better than what we have here. In the meantime, you, privileged jackass, go fuck yourself and let people who are trying to solve problems do something.

Cyph0n 7y ago
Let’s see how he/she enjoys the US healthcare system if ever out of a job...
sctb 7y ago
You can't make personal attacks here. Since we've asked you several times before to please follow the guidelines we've banned the account.
- jowiar 7y ago
  Take a look at those past times, and you’ll find HN moderators defending Russian propagandists in the name of civility. I won’t miss this community — thanks for reminding me what a joke it all is.

magicalhippo 7y ago

FWIW, some views from Norway, which has universal healthcare. 3: Don't need health insurance so I'd say that's better. 4: We can chose our own primary doctor from the pool of available GPs. Available just means that some GPs have too many patients on their list already and don't have any slots available. You can switch primary GP once a month (IIRC). I switched a few times until I found one which I liked. Repeated the process when I moved. 5: I can see my GP whenever I feel like it, just need to set up an appointment. If you mean to see a specialist then yeah, I'd need my GP to refer me. Sometimes this can feel a bit unnecessary but mostly it's not a big issue IMHO. 6: If my GP doesn't have time for me, I'd just switch and find one who does.

conanbatt 7y ago
Its not private/public that makes healthcare expensive in the US. Medicare is also public and fairly unlimited and also way more expensive than Norway health. There's a big group of other issues at play. And universal healthcare in the US would be so massive that you can't compare it to a small country.
sanderjd 7y ago
> 3: Don't need health insurance so I'd say that's better. You do have health insurance, it's just provided by the government with premiums paid through taxes. When people express the concern that their insurance would get worse, they mean that the insurance provided by the government would be worse than what they currently have. There are a number of different things that people think make plans worse or better, which is a major contributor to the difficulty in having a clear discussion about this.
- magicalhippo 7y ago
  > You do have health insurance, it's just provided by the government with premiums paid through taxes. Yes, I had a line about being taxed quite heavily but deleted it for reasons I've forgotten, and I missed updating point 3. I don't need to worry about my insurance though, what it covers etc.

tzs 7y ago

> I don’t believe in universal healthcare Who do you believe should not have healthcare?