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I agree that if we are to maintain this opaque system where customers (patients) pay a flat rate for ludicrously overpriced insurance, and then have no insight

I agree that if we are to maintain this opaque system where customers (patients) pay a flat rate for ludicrously overpriced insurance, and then have no insight into prices nor ability to reduce them because they don’t pay for the actual services, then universal healthcare is better. However, universal healthcare is not a panacea as evidenced by many angry patients waiting for procedures in Canada and the UK - although they are leaps and bounds better off than many in the current USA system. An alternative would be to have transparent pricing and open the market much more to for-profit businesses. Notice how vasectomies and laser eye surgery, 2 procedures not typically covered by insurance, have become safer, cheaper, and more effective over the past 20 years as they have been forced to advertise directly to consumers and compete with other vendors. This is the opposite trajectory of almost everything else in the healthcare system. I’m not saying all procedures can become like this - obviously a heart attack is a heart attack - but there are many other specialist procedures that are indeed scheduled in advance that could benefit from a heavy dose of transparency and competition. As another example, I’ve been on the same medication for the past 8 years. I get the same dose, and it’s never changing. Yet my provider makes me visit every 3 months for a refill. They put me in a room and “check up” to make sure the meds are "going well". Often this 30 minute scheduled meeting is less than 5 minutes because my doctor just hits a button on the computer to refill it. Yet insurance pays 4 times a year for this unnecessary visit to a specialist doctor. It doesn't cost me anything (other than deductible) so I'm most annoyed about the time wasting, but I also know that the system is being bilked for thousands of dollars. Multiply that anecdote by a million other situations. I should just be able to buy my meds without being forced to go through a doctor.

mrep 7y ago
> As another example, I’ve been on the same medication for the 8 years. I get the same dose, and it’s never changing. Yet my provider makes me visit every 3 months for a refill. Know the feeling, my girlfriend has to get pap smears every 1 or 2 years in order to get birth control and she despises those checkups. Yeah, let's put more barriers to women getting birth control... Fortunately, I only have to deal with yearly eye exams to get contacts which are still super annoying but the pap smears sound awful.
- pravda 7y ago
  > Fortunately, I only have to deal with yearly eye exams to get contacts Try http://daysoft.com http://daysoft.com
- elliekelly 7y ago
  It's ridiculous that birth control even requires a prescription in the US but it's not an issue you ever hear debated or discussed. The reason? If it were OTC (and no longer covered by health insurance) it would be prohibitively expensive for many of the young women who need it the most. So instead we end up getting annual pap screening even though it's only necessary every 3-5 years. Quite a corner we've painted ourselves into with this whole health insurance mess.
  - astura 7y ago
    Birth control can safely be prescribed without a pap test. A pap test is merely a screening for cervical cancer. The fact that a medical provider would require a pap for a birth control prescription when that's not medically necessary is a problem. Overscreening for cervical cancer is also a big problem. Once every year is an inappropriate screening interval for most people.[1] In some states pharmacists can prescribe birth control pills after a consult.[1] There's no reason why we can't require insurance to cover birth control pills even if they are OTC. We can still have a pharmacist run it through insurance, you just don't need a doctor's note. [1] https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html https://www.cancer.org/cancer/cervical-cancer/prevention-and...
- hdfbdtbcdg 7y ago
  Do you know what the pap smear is for? Clue I know people who are only alive today because of regular check ups. And no every 5 years is nowhere near often enough!
  - astura 7y ago
    >And no every 5 years is nowhere near often enough! Not quite. https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html https://www.cancer.org/cancer/cervical-cancer/prevention-and... >All women should begin cervical cancer testing (screening) at age 21. Women aged 21 to 29, should have a Pap test every 3 years. HPV testing should not be used for screening in this age group (it may be used as a part of follow-up for an abnormal Pap test). Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every 5 years. This is called co-testing and should continue until age 65. Another reasonable option for women 30 to 65 is to get tested every 3 years with just the Pap test.
eropple 7y ago
Consider, perhaps, the alternate case: where your medications are not going well. Tons of people people will power through feeling awful and won't go see a doctor until they're half-dead. Is it not a societal good to make sure somebody at least gets eyes on a patient? To me, the failing here is the cursory lack-of-care of your doctor, not the notion that you should see a doctor to check in on your meds.
r00fus 7y ago
> I agree that if we are to maintain this opaque system where customers (patients) pay a flat rate for ludicrously overpriced insurance, and then have no insight into prices nor ability to reduce them because they don’t pay for the actual services, then universal healthcare is better. How do you square free-market ideals in a price-inelastic market? If my life is on the line, do I really decline the $10k required treatment? > However, universal healthcare is not a panacea as evidenced by many angry patients waiting for procedures in Canada and the UK - although they are leaps and bounds better off than many in the current USA system. This needs a cite. Most folks I know in Canada and France are satisfied with a wait time for non-urgent procedures, knowing that at least they won't be potentially getting bankrupted like folks in the US for random billing.
clavalle 7y ago
For the most part, I agree with you. But we need a fix and we need it yesterday. I think it is much more likely that we can implement Universal Healthcare than implement reforms that would bring transparency and other reforms that we'd need for a fully functional free market to the healthcare sector. Also, I have serious concerns about whether a purely profit-driven market system can even work when people are negotiating agreements with their lives and physical well-being on the line. I think the anomaly might be that the largely-free-market healthcare system in the US worked as well as it did for so long rather than the other way around. Truly, I think we owe a debt of gratitude to the people running healthcare businesses for the last hundred years, and those still trying to today that let some form of ethics beyond how much profit they can extract from desperate people guide them. Unfortunately, they are working at a severe disadvantage.
rosser 7y ago
The trope that waits are materially worse in single-payer systems is precisely that: a trope. I have had to wait "until some time early next year" to get a diagnostic procedure scheduled (my consult was in September), and the wait for, e.g., an initial visit with a dermatologist where I live is measured in months, for everyone. Just as a couple examples, which abound. EDIT: Phrasing.
- shados 7y ago
  The trope comes partly from some of us who have lived in both and saw the difference first hand. It also depends on where you are (eg: Im told Quebec is a lot worse than Ontario, though I've never gotten the chance to compare them). But when I lived in a single payer system, the thought of going to the ER was -terrifying-. Go in at 6am in excruciating pain, still waiting by 10pm unless you're spitting blood all over the place. The first time I went to the ER in the US, I walked straight by it because all I saw was a bunch of nurse looking bored and no one around...because it was empty. Subsequent time it was a bit more crowded, but never the horrors that I saw in my childhood. Now that Im older, for fairness reason I'd still take single payer any day. While I'm quite privileged, others are not, and I rather wait all day at the ER than knowing some people can get bankrupted by it. But the difference in wait times are still front and center in my memories.
  - selimthegrim 7y ago
    I saw someone get an MRI inside of three hours in a Montreal ER for an injured ankle and comparing it to America for cost and turnaround time was pretty impressed

mrep 7y ago

> As another example, I’ve been on the same medication for the 8 years. I get the same dose, and it’s never changing. Yet my provider makes me visit every 3 months for a refill. Know the feeling, my girlfriend has to get pap smears every 1 or 2 years in order to get birth control and she despises those checkups. Yeah, let's put more barriers to women getting birth control... Fortunately, I only have to deal with yearly eye exams to get contacts which are still super annoying but the pap smears sound awful.

pravda 7y ago
> Fortunately, I only have to deal with yearly eye exams to get contacts Try http://daysoft.com http://daysoft.com
elliekelly 7y ago
It's ridiculous that birth control even requires a prescription in the US but it's not an issue you ever hear debated or discussed. The reason? If it were OTC (and no longer covered by health insurance) it would be prohibitively expensive for many of the young women who need it the most. So instead we end up getting annual pap screening even though it's only necessary every 3-5 years. Quite a corner we've painted ourselves into with this whole health insurance mess.
- astura 7y ago
  Birth control can safely be prescribed without a pap test. A pap test is merely a screening for cervical cancer. The fact that a medical provider would require a pap for a birth control prescription when that's not medically necessary is a problem. Overscreening for cervical cancer is also a big problem. Once every year is an inappropriate screening interval for most people.[1] In some states pharmacists can prescribe birth control pills after a consult.[1] There's no reason why we can't require insurance to cover birth control pills even if they are OTC. We can still have a pharmacist run it through insurance, you just don't need a doctor's note. [1] https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html https://www.cancer.org/cancer/cervical-cancer/prevention-and...
hdfbdtbcdg 7y ago
Do you know what the pap smear is for? Clue I know people who are only alive today because of regular check ups. And no every 5 years is nowhere near often enough!
- astura 7y ago
  >And no every 5 years is nowhere near often enough! Not quite. https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html https://www.cancer.org/cancer/cervical-cancer/prevention-and... >All women should begin cervical cancer testing (screening) at age 21. Women aged 21 to 29, should have a Pap test every 3 years. HPV testing should not be used for screening in this age group (it may be used as a part of follow-up for an abnormal Pap test). Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every 5 years. This is called co-testing and should continue until age 65. Another reasonable option for women 30 to 65 is to get tested every 3 years with just the Pap test.

eropple 7y ago

Consider, perhaps, the alternate case: where your medications are not going well. Tons of people people will power through feeling awful and won't go see a doctor until they're half-dead. Is it not a societal good to make sure somebody at least gets eyes on a patient? To me, the failing here is the cursory lack-of-care of your doctor, not the notion that you should see a doctor to check in on your meds.

r00fus 7y ago

> I agree that if we are to maintain this opaque system where customers (patients) pay a flat rate for ludicrously overpriced insurance, and then have no insight into prices nor ability to reduce them because they don’t pay for the actual services, then universal healthcare is better. How do you square free-market ideals in a price-inelastic market? If my life is on the line, do I really decline the $10k required treatment? > However, universal healthcare is not a panacea as evidenced by many angry patients waiting for procedures in Canada and the UK - although they are leaps and bounds better off than many in the current USA system. This needs a cite. Most folks I know in Canada and France are satisfied with a wait time for non-urgent procedures, knowing that at least they won't be potentially getting bankrupted like folks in the US for random billing.

clavalle 7y ago

For the most part, I agree with you. But we need a fix and we need it yesterday. I think it is much more likely that we can implement Universal Healthcare than implement reforms that would bring transparency and other reforms that we'd need for a fully functional free market to the healthcare sector. Also, I have serious concerns about whether a purely profit-driven market system can even work when people are negotiating agreements with their lives and physical well-being on the line. I think the anomaly might be that the largely-free-market healthcare system in the US worked as well as it did for so long rather than the other way around. Truly, I think we owe a debt of gratitude to the people running healthcare businesses for the last hundred years, and those still trying to today that let some form of ethics beyond how much profit they can extract from desperate people guide them. Unfortunately, they are working at a severe disadvantage.

rosser 7y ago

The trope that waits are materially worse in single-payer systems is precisely that: a trope. I have had to wait "until some time early next year" to get a diagnostic procedure scheduled (my consult was in September), and the wait for, e.g., an initial visit with a dermatologist where I live is measured in months, for everyone. Just as a couple examples, which abound. EDIT: Phrasing.

shados 7y ago
The trope comes partly from some of us who have lived in both and saw the difference first hand. It also depends on where you are (eg: Im told Quebec is a lot worse than Ontario, though I've never gotten the chance to compare them). But when I lived in a single payer system, the thought of going to the ER was -terrifying-. Go in at 6am in excruciating pain, still waiting by 10pm unless you're spitting blood all over the place. The first time I went to the ER in the US, I walked straight by it because all I saw was a bunch of nurse looking bored and no one around...because it was empty. Subsequent time it was a bit more crowded, but never the horrors that I saw in my childhood. Now that Im older, for fairness reason I'd still take single payer any day. While I'm quite privileged, others are not, and I rather wait all day at the ER than knowing some people can get bankrupted by it. But the difference in wait times are still front and center in my memories.
- selimthegrim 7y ago
  I saw someone get an MRI inside of three hours in a Montreal ER for an injured ankle and comparing it to America for cost and turnaround time was pretty impressed