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A lot of these are tied to lack of healthcare. We need a universal healthcare system in America, I'm tired of arguing with people who claim that we can't do wh

by suby 7y ago

A lot of these are tied to lack of healthcare. We need a universal healthcare system in America, I'm tired of arguing with people who claim that we can't do what almost every (if not every) other western country has already done.

yepthatsreality 7y ago
Sounds like you’re arguing with insurance salesmen.
- cj 7y ago
  No. There is a very large number of people in the US who are (for whatever reason) against universal health care. I have family who can't afford health insurance. And those same people would vote against a president promising universal healthcare. I don't understand it. But a lot of people don't agree with universal health care (even many low/middle income people)
  - adamnemecek 7y ago
    They've been brainwashed.
  - rtpg 7y ago
    It's this thing where US political dialog has basically become "Well _I_ would like this but what about all these other people the media say won't like this? Won't someone think of them?" which short circuits to "Oh I don't want this" Lots of people who worry a hell of a lot about the federal deficit when talking about whether they would like to be able to afford going to the doctor. Nevermind that this discussion rarely covers the deficit when it comes time to give tax breaks to "job creators". Also the Democratic party is comically bad at politics in the US. Like "oh but you might lose your private insurance" is a discussion people in the primary are having _when you would be replacing private insurance with free healthcare_. What sort of positioning is even being had here? So many people are stuck in the 90s
    - Dumblydorr 7y ago
      If your tribal leaders support something, you do. Tribe comes before religion, race, or any other consideration, though admittedly many of those are correlated. In the end, for around 90% of Americans, its about R vs D.
    - cj 7y ago
      > Like "oh but you might lose your private insurance" is a discussion people in the primary are having _when you would be replacing private insurance with free healthcare_. What sort of positioning is even being had here? A common fear is that wait times to see a doctor would be much higher with universal healthcare compared to a system with private insurance. Horror stories about people in Canada and the EU waiting months for a procedure that would be available immediately to someone with private insurance if in the US. I don’t mean to start a health care debate in this thread. My main point is that there are reasonable (logical, rational) fears that people have causing them to be against universal healthcare. Understanding those fears and addressing them upfront is one way to get past them.
      - moate 7y ago
        "I don't want to wait in line, so make sure poor people can't go to doctors", which is the reason there are lines and wait times, is basically a cartoon villain argument and anyone making it should be treated as such.
        DHPersonal 7y ago
        The anxiety is not about the wait but rather the potential consequences of the delay, such as the potential death or prolonged suffering of a loved one.
        moate 7y ago
        Got it. "my sick dying relative > your sick dying relative". Total morally reasonable now, thanks for clearing that up. Why are there going to be lines and waits with expanded healthcare coverage? Because people who need to see doctors will be seeing doctors. If your logic train is "Expanding coverage will create lines, therefor don't expand coverage" and not "Expanding coverage will create lines and therefor we will need to find solutions to new problems when we expand coverage" IDK how you're not just doing some gatekeeping to keep services high for yourself at the expense of others.
  - endtime 7y ago
    I'm a US citizen who does not want the government to run healthcare. I'm also an immigrant from a country where it does. I've seen what my family in my country of origin has to deal with and...no thanks.
    - zamfi 7y ago
      Have you yet seen what you have to deal with here? All systems have problems. Other systems don’t seem to bankrupt or kill as many people.
      - endtime 7y ago
        Other systems kill plenty of people. What I have to deal with here could be far better, but I definitely prefer it to the NHS.
        zamfi 7y ago
        You'd be an outlier then. Also consider that as a "NYC Googler" you are not getting the true American healthcare experience.
        endtime 7y ago
        No true Scotsman, eh?
        zamfi 7y ago
        Not at all -- you work for (and I assume are insured through) a rich company that contracts with insurers who are incentivized to keep that company happy and maintain their contract. Most Americans don't. Google is also self-insured, which means that Google is actually paying for healthcare, not the insurer -- the insurer just manages the networks & relationships with providers, and it's just pure profit for them. Google, meanwhile, wants healthy employees. No one has an incentive to deny claims, so ultimately you are seeing the best side of the system, in which almost every actor wants good outcomes. Contrast this with Medicare or Medicaid, or private insurance on the individual level, where the incentive is to reduce "medical loss", the industry term for...actually paying for healthcare. Arguing with insurers over denied claims is par for the course -- so much so that some insurers just routinely deny things (and patient is on the hook) that their own plans say should be covered, with the hope that patients won't realize they can appeal. Having experienced both ends of this -- as a former Googler myself and in the individual market pre-ACA ("Obamacare") -- I can tell you the difference between the wealthy corporate insurance plans and the individual market is night and day.
  - ds 7y ago
    The reason is pretty simple to understand- Those who can afford health insurance dont want their standard of care reduced on a 'free for everyone' system. Looking at the existing bureaucratic issues the current 'free' health programs have ( VA, Medicare, Medicaid, etc.. ) seems to indicate their fears might be well placed. In the VA for instance, you can go months just to get a first visit. Basically, people who have a job and get health insurance dont want to be lumped in with the commoners and get worse care/longer wait times/less options/etc... Its fucked up, but its not hard to understand the pushback. They dont want their health care experience to turn into a 6 hour trip to the DMV.
    - ragebol 7y ago
      Which means there are more hospitals needed, more doctors and more nurses. So it may even create more jobs.
    - iforgotpassword 7y ago
      But does it really reduce your standard in those systems? I know it's really hard to properly compare the costs of something like this between countries, but it would be interesting to know how much you need to spend on healthcare in the US to get similar benefits as in some European country purely with public healthcare. Since another benefit of public health care is that you can be reasonably sure people around you are healthy and not dragging themselves to work with god knows what since they can't afford treatment. Be it your colleague or the cashier at the store. It's actually quite baffling how Americans generally seem much more generous, warm and helpful to their fellow human beings, but the idea of potentially paying for someone else's medical treatment seems absolutely outrageous to most.
      - leetcrew 7y ago
        > It's actually quite baffling how Americans generally seem much more generous, warm and helpful to their fellow human beings, but the idea of potentially paying for someone else's medical treatment seems absolutely outrageous to most. this is just my personal take as an american. I think the disconnect has to do with locality/proximity. americans who have some surplus income (ie savings and not living paycheck-to-paycheck) are quite willing to help people they know with cash or free labor and will happily donate time or money to help people in their broader community. what americans hate is being forced by the government to help people far outside their circle. I think partially we are suspicious that the money doesn't get where it's supposed to go intact, but there's also an element of "fuck them, what do those people over there have to do with me?" obviously this is suboptimal as entire communities can be disjoint and have serious imbalances in funds available. also it tends to leave a lot of efficiency from scale on the table. but perhaps this at least explains some of your bafflement.
  - dankohn1 7y ago
    Here's the explanation: "Why doesn’t the United States have universal health care? The answer has everything to do with race." https://www.nytimes.com/interactive/2019/08/14/magazine/universal-health-care-racism.html https://www.nytimes.com/interactive/2019/08/14/magazine/univ...
    - deogeo 7y ago
      Americans are so racist, they'd rather get bankrupted by illness and die, than have universal health care help black people. At the same time, they allow ~1 million mostly non-whites to legally immigrate every year. I think insurance/medical industry lobbying is a far more consistent explanation. In general, if a story starts by bringing up racism from 150 years ago, it's more concerned with building a narrative than with explaining the current state of affairs. Rather refreshingly, the NYT admits this: "It aims to reframe the country’s history, understanding 1619 as our true founding, and placing the consequences of slavery and the contributions of black Americans at the very center of the story we tell ourselves about who we are."
      - geofft 7y ago
        Not sure if you're being sarcastic—my experience of Americans is precisely as you say. There is a strong streak of "I don't care if it helps me, if it helps those people I don't want it to happen." Americans are also so transphobic that they'd rather have fewer soldiers defending the country, etc.
        deogeo 7y ago
        So why does the "I don't want to help people I don't like" attitude affect the healthcare system, but not immigration policy? That is why I don't think the explanation holds water. Plus, Americans do support universal healthcare: https://www.cnbc.com/2018/08/28/most-americans-now-support-medicare-for-all-and-free-college-tuition.html https://www.cnbc.com/2018/08/28/most-americans-now-support-m...
    - geofft 7y ago
      It's fascinating that HN downvotes comments pointing to America's historic struggles with race (which did, beyond a doubt, exist and leave a fingerprint on the political reality of our current country) when people ask questions for which race is a potential answer. It's happened to me before too, IIRC also with a cited claim. I mean, I totally understand avoiding the subject because it leads to flamewars, because some people respond very poorly to the suggestion that racism exists and has practical effects today. But then you're better off not having a discussion about the topic at all than a skewed, censored one where one plausible answer is just too politically incorrect to be debated.
  - SantalBlush 7y ago
    I don't think it's even about the money anymore, since nobody seems to take issue with massive deficit spending in the US. A lot of Americans see it as a threat to their sense of individualism, and that is why they fight it. To them, any government program which makes our lives easier will cause people to be lazy and dependent. If we want universal healthcare, we need to address that message.
    - mrhappyunhappy 7y ago
      Nobody works harder than a Japanese worker. And Japan has government-administered “universal” healthcare. The idea that access to affordable healthcare makes people lazy requires mental gymnastics and total ignorance.
  - paggle 7y ago
    Because the US has so many successful corporations, its politics is controlled by corporate interests to an extent not seen in most other developed countries (where the political “right” tends to be the nativists and the propertied class). The “small government” concept in the US creates a political incentive for government to be ineffective and wasteful creating a self fulfilling process through which any politically visible part of the US government is terribly ineffective and the pieces that are behind the scenes are excellent. That’s why universal health care is likely to be a terrible boondoggle in the US.
  - Tomte 7y ago
    There are always people a rung below you on the social ladder. "Sure, I would love to get healthcare. But I don't want /them/ to get it. Especially if they are immigrants." The tribal divide in American politics is another reason ("if they want it, it must be wrong), but since this level of hatred is quite recent, I think it cannot fully explain it.
  - DINKDINK 7y ago
    >I have family who can't afford [cotton pickers]. And those same people would vote against a president promising [to use violence to coerce cotton pickers to work at a wage lower than in a freed market or coerce money out of other people to pay the cotton pickers]. >I don't understand it. You don't understand because your voting principles are based on "I'll vote for whomever gives me 'free' things, regardless of the ethical implications". You don't understand why someone wouldn't vote for increasing the scope of state aggression. If you couldn't afford to drive a car because of gas prices, should we use state aggression to take oil from an oil-rich country?
    - dang 7y ago
      Please don't take HN threads further into ideological flamewar. Also, personal attacks will get you banned here, so please don't do that either. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
      - DINKDINK 7y ago
        Help me understand, which ideologies are allowed to be discussed? The person I replied to didn't understand why people don't vote for certain policies. I tried to help them understand the position of people who don't agree with increasing aggression.
        dang 7y ago
        It's not a question of one ideology rather than another. They're all equally bad when it comes to generic internet discussion, and especially flamewar. Such discussions have all been had a million times, they're all predictable and therefore tedious and therefore off topic here. HN is for curiosity. There's zero curiosity in "taxation is theft" (or "property is theft") flamewars. Ditto for "state aggression" here, which is a generic ideological tangent even from a subthread that was already one in its own right. If you want to understand further, I've written a lot about this in the past: https://hn.algolia.com/?sort=byDate&dateRange=all&type=comment&storyText=false&prefix&page=0&query=by:dang%20generic%20ideolog https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...
  - jpindar 7y ago
    Are they against universal healthcare, or against the politicians that happen to support it? Big difference.
Zenst 7y ago
If you look at the map of countries with universal healthcare the whole definition of western needs revising as it seems to be a Northern thing. https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care https://en.wikipedia.org/wiki/List_of_countries_with_univers... Indeed, it's like a wide band across the middle of the globe that do not have such standards.
- krastanov 7y ago
  It is the Europe + the Commonwealth + a few other countries. In my mind "geopolitical Western" usually means Europe + the Commonwealth, so I do not see it as much of a Northern thing.
  - Zenst 7y ago
    I was referring to the actual map of the World, instead of legacy labels that just seem out of touch in the modern World.
    - majewsky 7y ago
      Of course. If you define a term differently than the majority, you'll find to wonder why everyone uses that term incorrectly (from your PoV). "Western" with a capital W is different from "western" with a lower-case W. Insisting that people only use the latter definition is just pedantry.
      - Zenst 7y ago
        Well, everybody defines it differently, that's kinda the crux when the term "Western world" does not have a strict international definition. Let alone the historical definitions. So hardly any majority definition, which is why governments across the globe, don't use it. Hence I wasn't being pedant about a definition of it, sorry for that confusion. Merely stating that its use is just a historical hangover that in many area's, people have moved on and those that have not, have disparity in how it is defined. Heck - look at the Wiki entry for some insight into how diverse in definition it is, let alone the historical aspects. https://en.wikipedia.org/wiki/Western_world https://en.wikipedia.org/wiki/Western_world
mlthoughts2018 7y ago
I generally support universal healthcare in America despite the massive downsides of having the government administer it. But I think the debate about values and principles is way more complicated than you are acknowledging. A lot of it boils down to terminal subjective value systems. Do you value “freedom from” financial ruin more highly than “freedom to” spend your money however you see fit (e.g. low taxes)? There’s no easy high level argument for why someone should normatively prefer “freedom from” over “freedom to” ways of thinking. You won’t get anywhere just decrying the “freedom to” crowd and dismissing their sincerely held values and beliefs.
- suby 7y ago
  I dislike discussing this in terms of freedom, because I feel that it misses the severity of the situation. After all, how free one is when they're dead due to lack of healthcare? The CDC estimates that 45,000 Americans die each year due to lack of healthcare [0](from 2012). People are not going to the doctor when they have something treatable and preventable, because they're not covered. They'll go to the ER when whatever they have progresses far enough, and the associated monetary costs and risks to that persons life will be of course be higher because they let the problem persist. I also take issue with the idea that this would cost more than the current system does. We spend almost twice as much per capita than other industrialized nations with universal healthcare do.[1] There are cost savings involved when you get rid of the middlemen and redundancy that comes along with our current for profit system. The number I keep seeing in the media is that, for example, Sanders healthcare plan would cost 32 trillion dollars over a ten year period. Yet we're currently paying 34 trillion dollars.[2] [0]https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/ https://news.harvard.edu/gazette/story/2009/09/new-study-fin... [1]https://www.washingtonpost.com/news/wonk/wp/2018/03/13/the-real-reason-the-u-s-spends-twice-as-much-on-health-care-as-other-wealthy-countries/ https://www.washingtonpost.com/news/wonk/wp/2018/03/13/the-r... [2]https://abcnews.go.com/Politics/32-trillion-price-tag-sanders-medicare-program-koch/story?id=56938226 https://abcnews.go.com/Politics/32-trillion-price-tag-sander...
  - mlthoughts2018 7y ago
Mirioron 7y ago
But a lot of countries dubbed as having "universal healthcare" don't actually have universal healthcare. A lot of them only cover some services and still require you to pay into the system to receive care. It's not sunshine and rainbows in many European countries either. Maybe it is that way in the rich ones, but not all of them.
- srge 7y ago
  Sounds like you may not be from Europe. In Europe nothing is perfect but man, reading how the system works in the US is very depressing compared to how it works here.
  - Mirioron 7y ago
    I am from Europe. I'm speaking from experience here - I've had years with no access to healthcare. It just meant that I didn't go to a doctor when I was sick and I just ignored my chronic conditions (asthma with no inhaler during allergy season is not fun).
  - deleted 7y ago
    [deleted]
- krastanov 7y ago
  You are right, but it still makes sense to compare. I am from Bulgaria, the poorest country in the EU and I have been living in the US for a while with an ok salary for a scientist. I keep an average (for the country) health insurance in both countries. I feel more secure when I am in Bulgarian health jurisdiction price-wise and emergency-wise (simple things like knowing no one will try to trick me into paying for an ambulance ride, that there are no gotchas about which provider I need to see, that my insurance will never be prohibitively expensive to keep, etc).
  - Mirioron 7y ago
    I completely agree with that last part. That's one of the biggest arguments to move towards a more universal healthcare system.
hos234 7y ago
I like Bernie, but it's not simple. Canada has 60 shrinks per 100k ppl while the US has 4. Universal healthcare is not going to increase the number of shrinks over night. Another thing with the "all other western nations" line is the population in the US. There is really no western or "developed" nation with anywhere close to same number of people.
rayiner 7y ago
I’m a supporter of universal healthcare. But the fact that Germany or Denmark can do it doesn’t mean we can. Copenhagen is building a fully automated circle line subway beneath downtown for the same money it’s costing us to build a shorter light rail line through the DC suburbs. Moving a bit further afield, our schools are terrible despite our per-student spending being near the top of the OECD. We already spend as much public money on healthcare as most Western European countries do, without achieving universal coverage. Our non-military government spending per capita is slightly higher than Canada’s, and we get fewer services for it. Americans are uniquely bad at government compared to western countries. Look at it from the other side. If European governments were as inefficient at providing public services as Americans are, would Europeans support mass transit and universal healthcare? If it was going to cost $6 billion to build a light rail line through the suburbs, mightn’t the Danes say: “fuck it we’ll build a freeway?” Concrete example on the healthcare front. In Europe, universal healthcare is typically paid for with social insurance taxes primarily imposed on people making under $70,000. If you look at the proposals for Medicare for All that have been proposed by Democrats, you see two remarkable things: 1) Nobody proposes taxes to actually fund the expected cost; 2) Nobody proposed the level of middle class taxes (VAT and social insurance) typically imposed in European countries to find universal healthcare. Sanders’ proposal comes the closest, but is half the level of say France’s. There is an important political observation here: there is little support for European-style healthcare in the US. What would happen if we had a straight up/down vote on Germany’s healthcare system? Or France’s? Or the UK’s? The support that exists in the US is for universal healthcare that is paid for by billionaires and corporations rather than the middle class. That’s a system that exists nowhere in Western Europe. It’s completely unprecedented.
- dmm 7y ago
  There's a large political organization that intentionally sabotages govt effectiveness because they feel that is the best way to eliminate govt. I'm not saying that is the cause of all govt failure in the US bit it's a significant one.
  - rayiner 7y ago
    Having lived Chicago, Philadelphia, New York, Baltimore, and DC, where you have to search far and wide to find a republican, but where public services still suck (despite high taxes), I think the causation runs in the other direction. I think if you took a bunch of Danes and made them live in Baltimore for a few decades, they’d vote down any attempt at expanding government services too.
whenanother 7y ago
what is a bigger problem is that the us is seen as a place where companies (the wealthy) can avoid the cost of public services like universal healthcare, public transportation, and government backed pension that all other modern countries have. the us workers need to earn more to make up for the lack of government services. but this is not the case for foreign workers whether they are legal or not. foreign workers will always be able to underbid their us counterpart as if they ever get sick and/or old they can go back home. corporations are forcing the us working class to give them a discount on their labor costs. this is why so many companies have heir headquarters in the us. plus they have the added benefit of ip protection. the wealthy people of the world are literally raping the us working class. the american worker must be paid more to make up for the lack of social services. but us minimum wage is very low compared to other first world countries. clearly one solution is for the us working class to form a massive worker's union. but another possibly more realistic solution is to destroy the US's reputation as a haven for the protection of intellectual properties. If the US is less known for ip protection, the wealthy will stop fighting the working class from implementing social services. they will start moving their companies to the EU.
- rayiner 7y ago
  > what is a bigger problem is that the us is seen as a place where companies (the wealthy) can avoid the cost of public services like universal healthcare, public transportation, and government backed pension that all other modern countries have. “Other modern countries” don’t pay for these services through taxes on “companies.” Of the big 5 EU countries (which together comprise 70% of the EU population), 4 countries rely less on corporate taxes than the US. The UK is the only exception, with corporate taxes making up 8.3% of revenue, versus 7.6% in the US: https://www.oecd.org/tax/tax-policy/revenue-statistics-highlights-brochure.pdf https://www.oecd.org/tax/tax-policy/revenue-statistics-highl... (page 3). By contrast France is 4.5%. Nor do corporate taxes fund the Nordic welfare states. Corporate taxes make up between 4.9-6.2% of tax revenue (less than the US) in Denmark, Sweden, Finland, and Iceland. Norway is the only one that’s higher than the US, and that’s only because of the special 55% tax on oil company profits (the normal 23% Norwegian corporate tax is in line with the other Nordic countries, and lower than the US). In Germany, 65% of tax revenue comes from social insurance and consumption taxes, which are paid for by the middle class. (Those who make more than about $70,000 per year are exempted from having to purchase the mandatory health insurance, and from the corresponding payroll taxes.) In the US it’s under 40%. Put another way, Germany’s higher consumption taxes amount to 3.7% of GDP, and its higher social insurance taxes amount to 5% of GDP. That’s almost all of the difference in total tax burden between the US and Germany.
bartimus 7y ago
Then don't start the argument? Every other western country does it by piggy backing on all the innovation happening in the US. Next there's the costs. Universal healthcare isn't going to make it cheaper. It will get more expensive since it's hard to set up in such a way (read: free market force way) that certain people have ownership and can be held accountable. With a government solution everyone gets incentivized to avoid as much ownership as possible. When things go wrong is when the the blame game begins. Departments pointing their fingers at each other. Or pointing at the department that should've been. The easiest way to resolve conflicts is by simply accepting the money lost. It's just tax money anyway.
- arcturus17 7y ago
  We “piggy back” on US innovation - just like many other fields - but (a) we pay for everything we buy from America and (b) we’re still able to offer extended healthcare despite having in many cases comparable - or the same! - technology. Or are you suggesting that the American people must sacrifice their poor so that Europeans can “piggy back” on the gains?

by suby 7y ago

yepthatsreality 7y ago

Sounds like you’re arguing with insurance salesmen.

cj 7y ago
No. There is a very large number of people in the US who are (for whatever reason) against universal health care. I have family who can't afford health insurance. And those same people would vote against a president promising universal healthcare. I don't understand it. But a lot of people don't agree with universal health care (even many low/middle income people)
- adamnemecek 7y ago
  They've been brainwashed.
- rtpg 7y ago
  It's this thing where US political dialog has basically become "Well _I_ would like this but what about all these other people the media say won't like this? Won't someone think of them?" which short circuits to "Oh I don't want this" Lots of people who worry a hell of a lot about the federal deficit when talking about whether they would like to be able to afford going to the doctor. Nevermind that this discussion rarely covers the deficit when it comes time to give tax breaks to "job creators". Also the Democratic party is comically bad at politics in the US. Like "oh but you might lose your private insurance" is a discussion people in the primary are having _when you would be replacing private insurance with free healthcare_. What sort of positioning is even being had here? So many people are stuck in the 90s
  - Dumblydorr 7y ago
    If your tribal leaders support something, you do. Tribe comes before religion, race, or any other consideration, though admittedly many of those are correlated. In the end, for around 90% of Americans, its about R vs D.
  - cj 7y ago
    > Like "oh but you might lose your private insurance" is a discussion people in the primary are having _when you would be replacing private insurance with free healthcare_. What sort of positioning is even being had here? A common fear is that wait times to see a doctor would be much higher with universal healthcare compared to a system with private insurance. Horror stories about people in Canada and the EU waiting months for a procedure that would be available immediately to someone with private insurance if in the US. I don’t mean to start a health care debate in this thread. My main point is that there are reasonable (logical, rational) fears that people have causing them to be against universal healthcare. Understanding those fears and addressing them upfront is one way to get past them.
    - moate 7y ago
      "I don't want to wait in line, so make sure poor people can't go to doctors", which is the reason there are lines and wait times, is basically a cartoon villain argument and anyone making it should be treated as such.
      - DHPersonal 7y ago
        The anxiety is not about the wait but rather the potential consequences of the delay, such as the potential death or prolonged suffering of a loved one.
        moate 7y ago
        Got it. "my sick dying relative > your sick dying relative". Total morally reasonable now, thanks for clearing that up. Why are there going to be lines and waits with expanded healthcare coverage? Because people who need to see doctors will be seeing doctors. If your logic train is "Expanding coverage will create lines, therefor don't expand coverage" and not "Expanding coverage will create lines and therefor we will need to find solutions to new problems when we expand coverage" IDK how you're not just doing some gatekeeping to keep services high for yourself at the expense of others.
- endtime 7y ago
  I'm a US citizen who does not want the government to run healthcare. I'm also an immigrant from a country where it does. I've seen what my family in my country of origin has to deal with and...no thanks.
  - zamfi 7y ago
    Have you yet seen what you have to deal with here? All systems have problems. Other systems don’t seem to bankrupt or kill as many people.
    - endtime 7y ago
      Other systems kill plenty of people. What I have to deal with here could be far better, but I definitely prefer it to the NHS.
      - zamfi 7y ago
        You'd be an outlier then. Also consider that as a "NYC Googler" you are not getting the true American healthcare experience.
        endtime 7y ago
        No true Scotsman, eh?
        zamfi 7y ago
        Not at all -- you work for (and I assume are insured through) a rich company that contracts with insurers who are incentivized to keep that company happy and maintain their contract. Most Americans don't. Google is also self-insured, which means that Google is actually paying for healthcare, not the insurer -- the insurer just manages the networks & relationships with providers, and it's just pure profit for them. Google, meanwhile, wants healthy employees. No one has an incentive to deny claims, so ultimately you are seeing the best side of the system, in which almost every actor wants good outcomes. Contrast this with Medicare or Medicaid, or private insurance on the individual level, where the incentive is to reduce "medical loss", the industry term for...actually paying for healthcare. Arguing with insurers over denied claims is par for the course -- so much so that some insurers just routinely deny things (and patient is on the hook) that their own plans say should be covered, with the hope that patients won't realize they can appeal. Having experienced both ends of this -- as a former Googler myself and in the individual market pre-ACA ("Obamacare") -- I can tell you the difference between the wealthy corporate insurance plans and the individual market is night and day.
- ds 7y ago
  The reason is pretty simple to understand- Those who can afford health insurance dont want their standard of care reduced on a 'free for everyone' system. Looking at the existing bureaucratic issues the current 'free' health programs have ( VA, Medicare, Medicaid, etc.. ) seems to indicate their fears might be well placed. In the VA for instance, you can go months just to get a first visit. Basically, people who have a job and get health insurance dont want to be lumped in with the commoners and get worse care/longer wait times/less options/etc... Its fucked up, but its not hard to understand the pushback. They dont want their health care experience to turn into a 6 hour trip to the DMV.
  - ragebol 7y ago
    Which means there are more hospitals needed, more doctors and more nurses. So it may even create more jobs.
  - iforgotpassword 7y ago
    But does it really reduce your standard in those systems? I know it's really hard to properly compare the costs of something like this between countries, but it would be interesting to know how much you need to spend on healthcare in the US to get similar benefits as in some European country purely with public healthcare. Since another benefit of public health care is that you can be reasonably sure people around you are healthy and not dragging themselves to work with god knows what since they can't afford treatment. Be it your colleague or the cashier at the store. It's actually quite baffling how Americans generally seem much more generous, warm and helpful to their fellow human beings, but the idea of potentially paying for someone else's medical treatment seems absolutely outrageous to most.
    - leetcrew 7y ago
      > It's actually quite baffling how Americans generally seem much more generous, warm and helpful to their fellow human beings, but the idea of potentially paying for someone else's medical treatment seems absolutely outrageous to most. this is just my personal take as an american. I think the disconnect has to do with locality/proximity. americans who have some surplus income (ie savings and not living paycheck-to-paycheck) are quite willing to help people they know with cash or free labor and will happily donate time or money to help people in their broader community. what americans hate is being forced by the government to help people far outside their circle. I think partially we are suspicious that the money doesn't get where it's supposed to go intact, but there's also an element of "fuck them, what do those people over there have to do with me?" obviously this is suboptimal as entire communities can be disjoint and have serious imbalances in funds available. also it tends to leave a lot of efficiency from scale on the table. but perhaps this at least explains some of your bafflement.
- dankohn1 7y ago
  Here's the explanation: "Why doesn’t the United States have universal health care? The answer has everything to do with race." https://www.nytimes.com/interactive/2019/08/14/magazine/universal-health-care-racism.html https://www.nytimes.com/interactive/2019/08/14/magazine/univ...
  - deogeo 7y ago
    Americans are so racist, they'd rather get bankrupted by illness and die, than have universal health care help black people. At the same time, they allow ~1 million mostly non-whites to legally immigrate every year. I think insurance/medical industry lobbying is a far more consistent explanation. In general, if a story starts by bringing up racism from 150 years ago, it's more concerned with building a narrative than with explaining the current state of affairs. Rather refreshingly, the NYT admits this: "It aims to reframe the country’s history, understanding 1619 as our true founding, and placing the consequences of slavery and the contributions of black Americans at the very center of the story we tell ourselves about who we are."
    - geofft 7y ago
      Not sure if you're being sarcastic—my experience of Americans is precisely as you say. There is a strong streak of "I don't care if it helps me, if it helps those people I don't want it to happen." Americans are also so transphobic that they'd rather have fewer soldiers defending the country, etc.
      - deogeo 7y ago
        So why does the "I don't want to help people I don't like" attitude affect the healthcare system, but not immigration policy? That is why I don't think the explanation holds water. Plus, Americans do support universal healthcare: https://www.cnbc.com/2018/08/28/most-americans-now-support-medicare-for-all-and-free-college-tuition.html https://www.cnbc.com/2018/08/28/most-americans-now-support-m...
  - geofft 7y ago
    It's fascinating that HN downvotes comments pointing to America's historic struggles with race (which did, beyond a doubt, exist and leave a fingerprint on the political reality of our current country) when people ask questions for which race is a potential answer. It's happened to me before too, IIRC also with a cited claim. I mean, I totally understand avoiding the subject because it leads to flamewars, because some people respond very poorly to the suggestion that racism exists and has practical effects today. But then you're better off not having a discussion about the topic at all than a skewed, censored one where one plausible answer is just too politically incorrect to be debated.
- SantalBlush 7y ago
  I don't think it's even about the money anymore, since nobody seems to take issue with massive deficit spending in the US. A lot of Americans see it as a threat to their sense of individualism, and that is why they fight it. To them, any government program which makes our lives easier will cause people to be lazy and dependent. If we want universal healthcare, we need to address that message.
  - mrhappyunhappy 7y ago
    Nobody works harder than a Japanese worker. And Japan has government-administered “universal” healthcare. The idea that access to affordable healthcare makes people lazy requires mental gymnastics and total ignorance.
- paggle 7y ago
  Because the US has so many successful corporations, its politics is controlled by corporate interests to an extent not seen in most other developed countries (where the political “right” tends to be the nativists and the propertied class). The “small government” concept in the US creates a political incentive for government to be ineffective and wasteful creating a self fulfilling process through which any politically visible part of the US government is terribly ineffective and the pieces that are behind the scenes are excellent. That’s why universal health care is likely to be a terrible boondoggle in the US.
- Tomte 7y ago
  There are always people a rung below you on the social ladder. "Sure, I would love to get healthcare. But I don't want /them/ to get it. Especially if they are immigrants." The tribal divide in American politics is another reason ("if they want it, it must be wrong), but since this level of hatred is quite recent, I think it cannot fully explain it.
- DINKDINK 7y ago
  >I have family who can't afford [cotton pickers]. And those same people would vote against a president promising [to use violence to coerce cotton pickers to work at a wage lower than in a freed market or coerce money out of other people to pay the cotton pickers]. >I don't understand it. You don't understand because your voting principles are based on "I'll vote for whomever gives me 'free' things, regardless of the ethical implications". You don't understand why someone wouldn't vote for increasing the scope of state aggression. If you couldn't afford to drive a car because of gas prices, should we use state aggression to take oil from an oil-rich country?
  - dang 7y ago
    Please don't take HN threads further into ideological flamewar. Also, personal attacks will get you banned here, so please don't do that either. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
    - DINKDINK 7y ago
      Help me understand, which ideologies are allowed to be discussed? The person I replied to didn't understand why people don't vote for certain policies. I tried to help them understand the position of people who don't agree with increasing aggression.
      - dang 7y ago
        It's not a question of one ideology rather than another. They're all equally bad when it comes to generic internet discussion, and especially flamewar. Such discussions have all been had a million times, they're all predictable and therefore tedious and therefore off topic here. HN is for curiosity. There's zero curiosity in "taxation is theft" (or "property is theft") flamewars. Ditto for "state aggression" here, which is a generic ideological tangent even from a subthread that was already one in its own right. If you want to understand further, I've written a lot about this in the past: https://hn.algolia.com/?sort=byDate&dateRange=all&type=comment&storyText=false&prefix&page=0&query=by:dang%20generic%20ideolog https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...
- jpindar 7y ago
  Are they against universal healthcare, or against the politicians that happen to support it? Big difference.

Zenst 7y ago

If you look at the map of countries with universal healthcare the whole definition of western needs revising as it seems to be a Northern thing. https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care https://en.wikipedia.org/wiki/List_of_countries_with_univers... Indeed, it's like a wide band across the middle of the globe that do not have such standards.

krastanov 7y ago
It is the Europe + the Commonwealth + a few other countries. In my mind "geopolitical Western" usually means Europe + the Commonwealth, so I do not see it as much of a Northern thing.
- Zenst 7y ago
  I was referring to the actual map of the World, instead of legacy labels that just seem out of touch in the modern World.
  - majewsky 7y ago
    Of course. If you define a term differently than the majority, you'll find to wonder why everyone uses that term incorrectly (from your PoV). "Western" with a capital W is different from "western" with a lower-case W. Insisting that people only use the latter definition is just pedantry.
    - Zenst 7y ago
      Well, everybody defines it differently, that's kinda the crux when the term "Western world" does not have a strict international definition. Let alone the historical definitions. So hardly any majority definition, which is why governments across the globe, don't use it. Hence I wasn't being pedant about a definition of it, sorry for that confusion. Merely stating that its use is just a historical hangover that in many area's, people have moved on and those that have not, have disparity in how it is defined. Heck - look at the Wiki entry for some insight into how diverse in definition it is, let alone the historical aspects. https://en.wikipedia.org/wiki/Western_world https://en.wikipedia.org/wiki/Western_world

mlthoughts2018 7y ago

I generally support universal healthcare in America despite the massive downsides of having the government administer it. But I think the debate about values and principles is way more complicated than you are acknowledging. A lot of it boils down to terminal subjective value systems. Do you value “freedom from” financial ruin more highly than “freedom to” spend your money however you see fit (e.g. low taxes)? There’s no easy high level argument for why someone should normatively prefer “freedom from” over “freedom to” ways of thinking. You won’t get anywhere just decrying the “freedom to” crowd and dismissing their sincerely held values and beliefs.

suby 7y ago
I dislike discussing this in terms of freedom, because I feel that it misses the severity of the situation. After all, how free one is when they're dead due to lack of healthcare? The CDC estimates that 45,000 Americans die each year due to lack of healthcare [0](from 2012). People are not going to the doctor when they have something treatable and preventable, because they're not covered. They'll go to the ER when whatever they have progresses far enough, and the associated monetary costs and risks to that persons life will be of course be higher because they let the problem persist. I also take issue with the idea that this would cost more than the current system does. We spend almost twice as much per capita than other industrialized nations with universal healthcare do.[1] There are cost savings involved when you get rid of the middlemen and redundancy that comes along with our current for profit system. The number I keep seeing in the media is that, for example, Sanders healthcare plan would cost 32 trillion dollars over a ten year period. Yet we're currently paying 34 trillion dollars.[2] [0]https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/ https://news.harvard.edu/gazette/story/2009/09/new-study-fin... [1]https://www.washingtonpost.com/news/wonk/wp/2018/03/13/the-real-reason-the-u-s-spends-twice-as-much-on-health-care-as-other-wealthy-countries/ https://www.washingtonpost.com/news/wonk/wp/2018/03/13/the-r... [2]https://abcnews.go.com/Politics/32-trillion-price-tag-sanders-medicare-program-koch/story?id=56938226 https://abcnews.go.com/Politics/32-trillion-price-tag-sander...
- mlthoughts2018 7y ago

Mirioron 7y ago

But a lot of countries dubbed as having "universal healthcare" don't actually have universal healthcare. A lot of them only cover some services and still require you to pay into the system to receive care. It's not sunshine and rainbows in many European countries either. Maybe it is that way in the rich ones, but not all of them.

srge 7y ago
Sounds like you may not be from Europe. In Europe nothing is perfect but man, reading how the system works in the US is very depressing compared to how it works here.
- Mirioron 7y ago
  I am from Europe. I'm speaking from experience here - I've had years with no access to healthcare. It just meant that I didn't go to a doctor when I was sick and I just ignored my chronic conditions (asthma with no inhaler during allergy season is not fun).
- deleted 7y ago
  [deleted]
krastanov 7y ago
You are right, but it still makes sense to compare. I am from Bulgaria, the poorest country in the EU and I have been living in the US for a while with an ok salary for a scientist. I keep an average (for the country) health insurance in both countries. I feel more secure when I am in Bulgarian health jurisdiction price-wise and emergency-wise (simple things like knowing no one will try to trick me into paying for an ambulance ride, that there are no gotchas about which provider I need to see, that my insurance will never be prohibitively expensive to keep, etc).
- Mirioron 7y ago
  I completely agree with that last part. That's one of the biggest arguments to move towards a more universal healthcare system.

hos234 7y ago

I like Bernie, but it's not simple. Canada has 60 shrinks per 100k ppl while the US has 4. Universal healthcare is not going to increase the number of shrinks over night. Another thing with the "all other western nations" line is the population in the US. There is really no western or "developed" nation with anywhere close to same number of people.

rayiner 7y ago

I’m a supporter of universal healthcare. But the fact that Germany or Denmark can do it doesn’t mean we can. Copenhagen is building a fully automated circle line subway beneath downtown for the same money it’s costing us to build a shorter light rail line through the DC suburbs. Moving a bit further afield, our schools are terrible despite our per-student spending being near the top of the OECD. We already spend as much public money on healthcare as most Western European countries do, without achieving universal coverage. Our non-military government spending per capita is slightly higher than Canada’s, and we get fewer services for it. Americans are uniquely bad at government compared to western countries. Look at it from the other side. If European governments were as inefficient at providing public services as Americans are, would Europeans support mass transit and universal healthcare? If it was going to cost $6 billion to build a light rail line through the suburbs, mightn’t the Danes say: “fuck it we’ll build a freeway?” Concrete example on the healthcare front. In Europe, universal healthcare is typically paid for with social insurance taxes primarily imposed on people making under $70,000. If you look at the proposals for Medicare for All that have been proposed by Democrats, you see two remarkable things: 1) Nobody proposes taxes to actually fund the expected cost; 2) Nobody proposed the level of middle class taxes (VAT and social insurance) typically imposed in European countries to find universal healthcare. Sanders’ proposal comes the closest, but is half the level of say France’s. There is an important political observation here: there is little support for European-style healthcare in the US. What would happen if we had a straight up/down vote on Germany’s healthcare system? Or France’s? Or the UK’s? The support that exists in the US is for universal healthcare that is paid for by billionaires and corporations rather than the middle class. That’s a system that exists nowhere in Western Europe. It’s completely unprecedented.

dmm 7y ago
There's a large political organization that intentionally sabotages govt effectiveness because they feel that is the best way to eliminate govt. I'm not saying that is the cause of all govt failure in the US bit it's a significant one.
- rayiner 7y ago
  Having lived Chicago, Philadelphia, New York, Baltimore, and DC, where you have to search far and wide to find a republican, but where public services still suck (despite high taxes), I think the causation runs in the other direction. I think if you took a bunch of Danes and made them live in Baltimore for a few decades, they’d vote down any attempt at expanding government services too.

whenanother 7y ago

what is a bigger problem is that the us is seen as a place where companies (the wealthy) can avoid the cost of public services like universal healthcare, public transportation, and government backed pension that all other modern countries have. the us workers need to earn more to make up for the lack of government services. but this is not the case for foreign workers whether they are legal or not. foreign workers will always be able to underbid their us counterpart as if they ever get sick and/or old they can go back home. corporations are forcing the us working class to give them a discount on their labor costs. this is why so many companies have heir headquarters in the us. plus they have the added benefit of ip protection. the wealthy people of the world are literally raping the us working class. the american worker must be paid more to make up for the lack of social services. but us minimum wage is very low compared to other first world countries. clearly one solution is for the us working class to form a massive worker's union. but another possibly more realistic solution is to destroy the US's reputation as a haven for the protection of intellectual properties. If the US is less known for ip protection, the wealthy will stop fighting the working class from implementing social services. they will start moving their companies to the EU.

rayiner 7y ago
> what is a bigger problem is that the us is seen as a place where companies (the wealthy) can avoid the cost of public services like universal healthcare, public transportation, and government backed pension that all other modern countries have. “Other modern countries” don’t pay for these services through taxes on “companies.” Of the big 5 EU countries (which together comprise 70% of the EU population), 4 countries rely less on corporate taxes than the US. The UK is the only exception, with corporate taxes making up 8.3% of revenue, versus 7.6% in the US: https://www.oecd.org/tax/tax-policy/revenue-statistics-highlights-brochure.pdf https://www.oecd.org/tax/tax-policy/revenue-statistics-highl... (page 3). By contrast France is 4.5%. Nor do corporate taxes fund the Nordic welfare states. Corporate taxes make up between 4.9-6.2% of tax revenue (less than the US) in Denmark, Sweden, Finland, and Iceland. Norway is the only one that’s higher than the US, and that’s only because of the special 55% tax on oil company profits (the normal 23% Norwegian corporate tax is in line with the other Nordic countries, and lower than the US). In Germany, 65% of tax revenue comes from social insurance and consumption taxes, which are paid for by the middle class. (Those who make more than about $70,000 per year are exempted from having to purchase the mandatory health insurance, and from the corresponding payroll taxes.) In the US it’s under 40%. Put another way, Germany’s higher consumption taxes amount to 3.7% of GDP, and its higher social insurance taxes amount to 5% of GDP. That’s almost all of the difference in total tax burden between the US and Germany.

bartimus 7y ago

Then don't start the argument? Every other western country does it by piggy backing on all the innovation happening in the US. Next there's the costs. Universal healthcare isn't going to make it cheaper. It will get more expensive since it's hard to set up in such a way (read: free market force way) that certain people have ownership and can be held accountable. With a government solution everyone gets incentivized to avoid as much ownership as possible. When things go wrong is when the the blame game begins. Departments pointing their fingers at each other. Or pointing at the department that should've been. The easiest way to resolve conflicts is by simply accepting the money lost. It's just tax money anyway.

arcturus17 7y ago
We “piggy back” on US innovation - just like many other fields - but (a) we pay for everything we buy from America and (b) we’re still able to offer extended healthcare despite having in many cases comparable - or the same! - technology. Or are you suggesting that the American people must sacrifice their poor so that Europeans can “piggy back” on the gains?