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I'm always fascinated when health care discussions start up on HN; watching Americans argue amongst themselves about single-payer or nationalized health care s

I'm always fascinated when health care discussions start up on HN; watching Americans argue amongst themselves about single-payer or nationalized health care systems as if those systems are dangerous thought experiments are mesmerizing. No matter how many people say "but a well regulated mandatory multi-payer type of system is working in Germany" or "nationalized medicine is working in Canada" it's all just ignored and the argument continues anew.

fwsgonzo 7y ago
I wonder if we really have to wait a full generation with the "new conditions" (such as national healthcare) already in place for the bickering to taper off. That is, the discussion about how much downtrodden-ness is OK as long as shareholders get increasing value. I mean, at one point for the hospitals to continue to operate at ever more profits you basically have to stop curing people and make them come back. You can combat that with more choices, but nobody is breaking up the banks, so why would they break up the big hospitals? https://3.bp.blogspot.com/-XZHRqu2UjeE/U7LUMgY49HI/AAAAAAAAP7E/k_BVMCdkoqs/s1600/big_bank_merger_chart.jpg https://3.bp.blogspot.com/-XZHRqu2UjeE/U7LUMgY49HI/AAAAAAAAP...
dsfyu404ed 7y ago
>No matter how many people say "but a well regulated mandatory multi-payer type of system is working in Germany" or "nationalized medicine is working in Canada" it's all just ignored and the argument continues anew. Practically nobody is saying that a single payer system or tightly regulated multi-payer system hasn't worked anywhere (we all know Canada exists) or can't work in the US. Everyone is arguing about the specific implementation because those are the details that make or break it. Anything would work on paper. Even free market with some good regulations to promote competition would probably work. It's the specific details of actually implementing something that works (and the ability of the people who would be doing the implementing to get those details right and not be corrupted by existing interests) that everyone is arguing over. Everyone with a brain realizes that when it comes to big systems involving lots of moving parts the fine tuning is what makes or breaks them. Look at all the various social services programs that were kneecapped over the years because someone came along and made a few small changes or some key feature was compromised out of existence. Everyone is bickering over every detail because every detail has the ability to cause massive amounts of hardship when applied at a societal level if said detail is done wrong. Simply put, healthcare is a hard issue because the stakes are so high that nobody is apathetic about it making compromise and consensus hard to reach.
- Retric 7y ago
  > Even free market with some good regulations to promote competition would probably work. One of the really interesting things about US healthcare is how much is spent on bureaucracy. Consider, the average surgeon does ~400 operations per year and they generally make less than 600k/year. That’s 1,500$ per operation for the surgeon. Even with support staff, infrastructure, and materials, the average surgery should be under 10k. Now let’s take an insurance that’s paying say 80% of it’s premiums for medical care. That’s 1 / 0.8 = a flat 25% price increase directly on top of whatever they add to healthcare provider’s costs in terms of additional paperwork and negotiation. Similarly, before it goes to insurance the cost is inflated at the healthcare provider level to cover administrative costs like unpaid bill collections etc.
  - zxcmx 7y ago
    From my POV its fair for the support services to cost a lot. The theatre or the nurses or the equipment or really anything we can account to facilities or administration might cost a lot and thats generally kind of ok. A junior programmer costs $250/hr from booz allen or whatever and I think a lot of people here understand why that is. They might not be able to fizz buzz so well but we expect the system to fizz and buzz eventually and expensively. You can't add up what a plumber spends on beer or pays an apprentice and try to say what he should charge for his business. What sucks is that despite the rhetoric theres actually no market. Want a market? Let people actually choose and make costs transparent.
    - Retric 7y ago
      By should I am speaking in terms of competitive markets resulting in prices reflecting the cost of production + minor profits. Cosmetic surgery prices are generally reflective of costs including advertising etc. It’s not cheap by any means, but you simply avoid overhead occurring in other parts of US healthcare. Dentistry is another example where prices are generally reflective of costs, at least compared to say hospitals.
- ianleeclark 7y ago
  > Even free market with some good regulations to promote competition would probably work. That's not a free market then. This is the hardest part of the entire discussion: everyone is attempting to not exercise political power because they have these grand notions that politics can be done for the benefit of all. I'm not saying M4A is impossible (in fact, I would prefer it if I still lived in the states), but the fact of the matter is that the donor class will feel the sting of this transition, so we go off and Chase fairy tales where both the donors and the people rationing insulin can both coexist. Ultimately you end up with contradictory notions like a regulated free market.
coldtea 7y ago
>No matter how many people say "but a well regulated mandatory multi-payer type of system is working in Germany" or "nationalized medicine is working in Canada" it's all just ignored and the argument continues anew. I don't think their problem (at least of one side of the debate) is whether it will work or not. Their issue is a moral one, whether they should ever pay into a health care pool for the benefit of other people. Those that think they can manage on their own don't see why that should happen. And as a protestant inspired culture that took it even further than the original protestants, they find this appalling. They'd rather see people die in the streets and step over them on the way to brunch, than have themselves, hardworking "good" persons that they are, contribute for the health of the poor and the "losers". Even more so if it's mandatory. Charity from their magnanimous heart, they can consider.
- Ensorceled 7y ago
  Yeah, I definitely get that from the subtext or, sometimes, the text. The weird thing is that it's cutting off their noses to spite their faces ... they spend MORE on insurance then they would in taxes. But in a lot of cases, it's like they will not (or can not) learn from what is going on in other countries. Maybe it's also US exceptionalism at play?
  - oblio 7y ago
    I think you can see a bit of the same thing with ID cards and unique identifiers. Most European countries have a state-issued ID card and an unique identifier for every citizen. The US has a million IDs from different institutions, states, corporations and they keep causing messes, still, having 1 ID card and a unique identifier is seen as bad for reasons that baffle me.
  - war1025 7y ago
    I think what it comes down to for many people is that their employer covers their health insurance premiums, and they fear that they would actually have to pay market value for health insurance if it were removed from the employer benefit umbrella. For a country that supposedly values small business, there are few things I could think of that would support small business more than public healthcare. Currently, large employers can get a group plan with very reasonable rates. Small employers are pretty much out of luck. It stands to reason to me that the bigger the pool, the more predictable and lower the costs. It's ridiculous to me that arbitrary groups of people can't go in on a health plan together. If a company with 50k employees can do it, why can't a city / state / random assortment of people?
nhebb 7y ago
It's complicated. The US spends more per capita (PPP) than any other country by good margin [1]. Of that, the US government pays roughly 50% of the total cost [2]. The net effect is that the US government already pays as much per capita as many European countries with socialized medicine. In short, we have a cost problem that's not being tackled. Pharmaceuticals are often targeted, but they're about 8% of our total healthcare costs. We really need politicians that will tackle the other aspects of cost. The countries that finance public healthcare have tax systems that are considered regressive by US standards. Some states have sales taxes, but we have no national VAT. As I understand it, some countries like Sweden have income taxes on lower income workers, whereas in the US, roughly 45% of households pay no federal income tax. You can only squeeze so much money out of the wealthy, but the numbers don't add up to cover the projected costs of nationalized healthcare in the US. Taxes would need to be raised across the board. It's easy for campaigning politicians to propose pie-in-the-sky plans, but proposing a financially plausible one would be political suicide. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... [2] https://en.wikipedia.org/wiki/List_of_countries_by_health_expenditure_covered_by_government https://en.wikipedia.org/wiki/List_of_countries_by_health_ex...
- axlee 7y ago
  They are are already paying twice as much as any other developed nation with a "free-market" approach to healthcare. I do not understand the mental gymnastics to reach the conclusion that citizens as a whole would pay more in a single-payer system. They might pay more taxes indeed, but their private insurance costs would disappear overnight. As for healthcare costs inflation, that would quickly disappear with the transparency mandated by a single-payer system. One of the arguments explaining the always-rising healthcare costs in the US is a complete darkness from the consumer side on the actual price of the healthcare they are getting, thus allowing gouging at every level.
  - dsfyu404ed 7y ago
    >I do not understand the mental gymnastics to reach the conclusion that citizens as a whole would pay more in a single-payer system The reasoning goes like this: The entrenched well funded (and money loosely translates to political power) interests influence the legislators doing the implementing in order to ensure a regulatory capture that allows them to continue swindling people at their current level but because it is now proxied through the additional overhead of government the net cost to the citizenry is greater than the current "get swindled directly" system and we have little/no net change in outcomes. Basically people don't trust the government to not screw it up so badly that it actually costs more. I'm sure the cost would come down over time but with the high cost and uncertainty involved that's a tough sell.
pjc50 7y ago
Yup. The UK has a particularly vicious variant of this - the nationalised state-provided monotlithic system has its weaknesses, but everybody in the media only ever discusses American-style privatisation rather than all the various hybrid models. The mere existence of the American system is kind of a threat to our system which currently has zero healthcare bankruptcies. (People also misleadingly claim that the UK system excludes private provision - it doesn't, it's just that only a small fraction of the population has it and the tax advantages are nonexistant. Optical and dental are also mostly private.)
- someguydave 7y ago
  The irony is that the US system is nowhere near the “free market”. Subsidies abound for the rich and the poor and old get free single-payer healthcare in the form of Medicare and Medicaid. Meanwhile veterans also have an entire single-payer system for themselves. The relatively few who “pay their own way” face incredible costs as few of the health providers actually compete for customers in an open and free market and so they charge crazy prices and get away with it.
freddie_mercury 7y ago
The same thing happens for everything. If it hasn't happened in America, Americans argue as if it is a theoretical idea that has never before been tried on Earth.
systemtest 7y ago
The Netherlands has private healthcare and private insurance companies and has the second best healthcare system in Europe. The price per capita is on Northern/Western European average at 5300 USD per person. World-wide we are the 8th most expensive country per capita which seems fair given our high wages. So even though we have the second best healthcare system and pay an average price for it, people still want to nationalise our system and revert the privatisation. Because "privatisation bad". It truly baffles me that people think it will be for the best. Perhaps the price will go down to the 4100 USD per capita that the nationalised UK system has has but I'm sure our quality would also drop to UK levels (16th place in Euro Health Consumer Index).
- alistairSH 7y ago
  Do you happen to know what's different between the model in the Netherlands vs the US? Is the insurance provided by employers? In the US, most plans are provided and heavily subsidized by the employer (because the tax code makes that palatable vs paying employees more). Do you have co-pays or deductibles? If so, how large are they? In past decades in the US, good plans had fairly low costs to the consumer ($20 GP visit, $50 ER visit was common). These days, because costs have gone up, many plans have converted to high deductibles with dedicated savings plans ($5000/year per individual OOP, but the person is allowed to save into a tax-deferred account that's a lot like our 401k retirement system, just used for health care).
  - systemtest 7y ago
    Employers pay the biggest source of income of our healthcare system through the zorgverzekeringswet. They pay around 6% on the income of their employees next to the income tax. Second biggest part are the private insurance companies that sell insurance for around €90 to €200 per month. The yearly deductible for all healthcare in the base package is €385 to €885, you can set this deductible yourself. Dental and physiotherapy are separate from general healthcare and have their own insurances and payment structures. They are all privately owned facilities. I usually pay my physiotherapist around €40 for a 30 minute session so I don't need insurance for it. But if you have regular appointments it would make sense to get private insurance for it. We don't have a lot of co-pay (eigen bijdrage). There are some parts in regard to post-natal care where a co-pay is required. Also on hearing aids, dentures, orthopaedic shoes, medicine and non-ambulance transportation to a health facility.
endtime 7y ago
It's not ignored. I don't know much about the German system, but I'm an immigrant from the UK and I much prefer the US system to the NHS, and I hear similar horror stories about Canada. Which is not to say the US system is good, just better. In the US, when I need a doctor, I get to see one right away. If the doctor recommends an MRI or ultrasound, I get it right away. No six month waits, no cancelled surgeries, no doctor strikes (!), no government deciding how to prioritize my medical needs, etc. What it ultimately comes down to is that medical resources are scarce (and always will be while medical technology is improving and thus some care is expensive), and having the government allocate them can be inefficient (governments are generally inefficient due to lack of competition, as are systems where the customer is disconnected from the cost). And yes, I care more about my own health care and that of my kids than I do about the health care of some stranger thousands of miles away. I have okay corporate health insurance and so the system works better for me than for some. (Some would argue that regulation rather than economic freedom are to blame for those people's worse experiences, but I'm not going to get into that other than to acknowledge it.) You might disagree with some of my perspective, but the snooty attitude that Americans are oblivious morons is unwarranted.
- deiznof 7y ago
  If you "needed" an MRI right away, you wouldn't be waiting 6 months, so you probably didn't need one. Not urgently, at least.
- LeifCarrotson 7y ago
  There can (and typically should) be a difference in one's personal preference and what one would advocate as public policy. Of course I am more emotionally attached to my own health and my kids than I care about one hypothetical unknown stranger thousands of miles away, just as you are. But if I stop and think for a moment I can't rationally justify a system that works well for 1 human (me) and works poorly for 100 other humans. As a relatively wealthy and well-educated American with great insurance (and easy access to other jobs with benefit packages should my employment situation change), yes, I benefit from the American system. But I wouldn't vote for representatives that advocated it. We're not yet approaching something that's a little bit worse for 99% of the country and a lot better for the remaining 1%, and I'm sure we will have many fun debates as to where we should balance the equation as we approach that point. I would have to be pretty selfish to vote for something that's objectively worse for most people in my country. However, it would in fact take an oblivious moron to advocate something that's simultaneously worse on average and also worse for them individually, and yet that's what we have in American politics today.
whodidntante 7y ago
Well,anecdotally,I am friends with a family where one of the spouses grew up in Canada. Their advice when we were planning a trip to Canada was to make sure not to get seriously ill while we were there. Not the first time I have heard of this attitude from Canadians or people from UK. I do not have anything good to say about our "system" (except that the doctors and nurses themselves are many times exceptional), but I also have seen enough of government run systems to know that that is not not an answer.
- skummetmaelk 7y ago
  You are presenting this argument as if people do not get worried about getting sick when traveling to the US. I can assure you that most people are extremely worried about that because of the insane costs involved and the problem of dealing with insurance.
- Ensorceled 7y ago
  Getting sick while traveling is always a crap shoot. There are many Canadians who have been convinced that our health care system is crap by the usual suspects. It isn't. Yes, if you live in a major center in the US (like near John Hopkins or Stanford Medical) and have great insurance, you will get some of the best health care in the world. The cost is your less wealthy neighbours are dying and going bankrupt.
slumdev 7y ago
I think there are usually two reasons. 1 - A significant portion of our economy is healthcare middlemen. With single payer or nationalized care, all of our Blue Crosses and Cignas (and the jobs associated) would evaporate overnight. I'm not arguing that we need trillions of dollars of our GDP locked up in middlemen, but it's very hard for a man to understand something when his salary depends on his not understanding it. 2 - We hear about long wait times in other countries. And the stories are mostly true. There's nothing wrong with waiting, but we've been conditioned to expect near-immediate resolutions. People in the United States with high-quality private insurance* can usually be seen by a specialist within a few weeks regardless of how severe or immediate their problem is. The truth is that unless that person has some kind of advanced or rapidly progressing disease, they could wait for months without any problems. But that would be a major change to the way we think. It would mean allocating care based on need, not based on ability to pay. *High-quality private insurance is usually one of the perks of working for a great company. I would argue that only a small minority of Americans have truly high-quality coverage. But all of the people who don't have high-quality coverage envy the others and vote with them, a la "temporarily embarrassed millionaire."
- SolaceQuantum 7y ago
  "2 - We hear about long wait times in other countries. And the stories are mostly true. There's nothing wrong with waiting, but we've been conditioned to expect near-immediate resolutions." Are you sure? I have to schedule several days if not a week in advance just to go to my PCP, much less a specialist. I also live in an area with no shortage of medical services.
  - slumdev 7y ago
    Is this sarcasm?
    - SolaceQuantum 7y ago
      No, not really. I've lived in Toronto and USA, and the times aren't really different IME.
linuxftw 7y ago
What you (and most Americans) fail to understand is the states are separate entities, more similar to the EU than the provinces of Canada. If California wants to have socialized health care for all it's residents, literally nothing is stopping them. Many states already have 100% government medical insurance for the poor. The reality is, government run systems are an absolute nightmare. Similar to government housing, you only use it if you can't afford the alternative.

fwsgonzo 7y ago

I wonder if we really have to wait a full generation with the "new conditions" (such as national healthcare) already in place for the bickering to taper off. That is, the discussion about how much downtrodden-ness is OK as long as shareholders get increasing value. I mean, at one point for the hospitals to continue to operate at ever more profits you basically have to stop curing people and make them come back. You can combat that with more choices, but nobody is breaking up the banks, so why would they break up the big hospitals? https://3.bp.blogspot.com/-XZHRqu2UjeE/U7LUMgY49HI/AAAAAAAAP7E/k_BVMCdkoqs/s1600/big_bank_merger_chart.jpg https://3.bp.blogspot.com/-XZHRqu2UjeE/U7LUMgY49HI/AAAAAAAAP...

dsfyu404ed 7y ago

>No matter how many people say "but a well regulated mandatory multi-payer type of system is working in Germany" or "nationalized medicine is working in Canada" it's all just ignored and the argument continues anew. Practically nobody is saying that a single payer system or tightly regulated multi-payer system hasn't worked anywhere (we all know Canada exists) or can't work in the US. Everyone is arguing about the specific implementation because those are the details that make or break it. Anything would work on paper. Even free market with some good regulations to promote competition would probably work. It's the specific details of actually implementing something that works (and the ability of the people who would be doing the implementing to get those details right and not be corrupted by existing interests) that everyone is arguing over. Everyone with a brain realizes that when it comes to big systems involving lots of moving parts the fine tuning is what makes or breaks them. Look at all the various social services programs that were kneecapped over the years because someone came along and made a few small changes or some key feature was compromised out of existence. Everyone is bickering over every detail because every detail has the ability to cause massive amounts of hardship when applied at a societal level if said detail is done wrong. Simply put, healthcare is a hard issue because the stakes are so high that nobody is apathetic about it making compromise and consensus hard to reach.

Retric 7y ago
> Even free market with some good regulations to promote competition would probably work. One of the really interesting things about US healthcare is how much is spent on bureaucracy. Consider, the average surgeon does ~400 operations per year and they generally make less than 600k/year. That’s 1,500$ per operation for the surgeon. Even with support staff, infrastructure, and materials, the average surgery should be under 10k. Now let’s take an insurance that’s paying say 80% of it’s premiums for medical care. That’s 1 / 0.8 = a flat 25% price increase directly on top of whatever they add to healthcare provider’s costs in terms of additional paperwork and negotiation. Similarly, before it goes to insurance the cost is inflated at the healthcare provider level to cover administrative costs like unpaid bill collections etc.
- zxcmx 7y ago
  From my POV its fair for the support services to cost a lot. The theatre or the nurses or the equipment or really anything we can account to facilities or administration might cost a lot and thats generally kind of ok. A junior programmer costs $250/hr from booz allen or whatever and I think a lot of people here understand why that is. They might not be able to fizz buzz so well but we expect the system to fizz and buzz eventually and expensively. You can't add up what a plumber spends on beer or pays an apprentice and try to say what he should charge for his business. What sucks is that despite the rhetoric theres actually no market. Want a market? Let people actually choose and make costs transparent.
  - Retric 7y ago
    By should I am speaking in terms of competitive markets resulting in prices reflecting the cost of production + minor profits. Cosmetic surgery prices are generally reflective of costs including advertising etc. It’s not cheap by any means, but you simply avoid overhead occurring in other parts of US healthcare. Dentistry is another example where prices are generally reflective of costs, at least compared to say hospitals.
ianleeclark 7y ago
> Even free market with some good regulations to promote competition would probably work. That's not a free market then. This is the hardest part of the entire discussion: everyone is attempting to not exercise political power because they have these grand notions that politics can be done for the benefit of all. I'm not saying M4A is impossible (in fact, I would prefer it if I still lived in the states), but the fact of the matter is that the donor class will feel the sting of this transition, so we go off and Chase fairy tales where both the donors and the people rationing insulin can both coexist. Ultimately you end up with contradictory notions like a regulated free market.

coldtea 7y ago

>No matter how many people say "but a well regulated mandatory multi-payer type of system is working in Germany" or "nationalized medicine is working in Canada" it's all just ignored and the argument continues anew. I don't think their problem (at least of one side of the debate) is whether it will work or not. Their issue is a moral one, whether they should ever pay into a health care pool for the benefit of other people. Those that think they can manage on their own don't see why that should happen. And as a protestant inspired culture that took it even further than the original protestants, they find this appalling. They'd rather see people die in the streets and step over them on the way to brunch, than have themselves, hardworking "good" persons that they are, contribute for the health of the poor and the "losers". Even more so if it's mandatory. Charity from their magnanimous heart, they can consider.

Ensorceled 7y ago
Yeah, I definitely get that from the subtext or, sometimes, the text. The weird thing is that it's cutting off their noses to spite their faces ... they spend MORE on insurance then they would in taxes. But in a lot of cases, it's like they will not (or can not) learn from what is going on in other countries. Maybe it's also US exceptionalism at play?
- oblio 7y ago
  I think you can see a bit of the same thing with ID cards and unique identifiers. Most European countries have a state-issued ID card and an unique identifier for every citizen. The US has a million IDs from different institutions, states, corporations and they keep causing messes, still, having 1 ID card and a unique identifier is seen as bad for reasons that baffle me.
- war1025 7y ago
  I think what it comes down to for many people is that their employer covers their health insurance premiums, and they fear that they would actually have to pay market value for health insurance if it were removed from the employer benefit umbrella. For a country that supposedly values small business, there are few things I could think of that would support small business more than public healthcare. Currently, large employers can get a group plan with very reasonable rates. Small employers are pretty much out of luck. It stands to reason to me that the bigger the pool, the more predictable and lower the costs. It's ridiculous to me that arbitrary groups of people can't go in on a health plan together. If a company with 50k employees can do it, why can't a city / state / random assortment of people?

nhebb 7y ago

It's complicated. The US spends more per capita (PPP) than any other country by good margin [1]. Of that, the US government pays roughly 50% of the total cost [2]. The net effect is that the US government already pays as much per capita as many European countries with socialized medicine. In short, we have a cost problem that's not being tackled. Pharmaceuticals are often targeted, but they're about 8% of our total healthcare costs. We really need politicians that will tackle the other aspects of cost. The countries that finance public healthcare have tax systems that are considered regressive by US standards. Some states have sales taxes, but we have no national VAT. As I understand it, some countries like Sweden have income taxes on lower income workers, whereas in the US, roughly 45% of households pay no federal income tax. You can only squeeze so much money out of the wealthy, but the numbers don't add up to cover the projected costs of nationalized healthcare in the US. Taxes would need to be raised across the board. It's easy for campaigning politicians to propose pie-in-the-sky plans, but proposing a financially plausible one would be political suicide. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... [2] https://en.wikipedia.org/wiki/List_of_countries_by_health_expenditure_covered_by_government https://en.wikipedia.org/wiki/List_of_countries_by_health_ex...

axlee 7y ago
They are are already paying twice as much as any other developed nation with a "free-market" approach to healthcare. I do not understand the mental gymnastics to reach the conclusion that citizens as a whole would pay more in a single-payer system. They might pay more taxes indeed, but their private insurance costs would disappear overnight. As for healthcare costs inflation, that would quickly disappear with the transparency mandated by a single-payer system. One of the arguments explaining the always-rising healthcare costs in the US is a complete darkness from the consumer side on the actual price of the healthcare they are getting, thus allowing gouging at every level.
- dsfyu404ed 7y ago
  >I do not understand the mental gymnastics to reach the conclusion that citizens as a whole would pay more in a single-payer system The reasoning goes like this: The entrenched well funded (and money loosely translates to political power) interests influence the legislators doing the implementing in order to ensure a regulatory capture that allows them to continue swindling people at their current level but because it is now proxied through the additional overhead of government the net cost to the citizenry is greater than the current "get swindled directly" system and we have little/no net change in outcomes. Basically people don't trust the government to not screw it up so badly that it actually costs more. I'm sure the cost would come down over time but with the high cost and uncertainty involved that's a tough sell.

pjc50 7y ago

Yup. The UK has a particularly vicious variant of this - the nationalised state-provided monotlithic system has its weaknesses, but everybody in the media only ever discusses American-style privatisation rather than all the various hybrid models. The mere existence of the American system is kind of a threat to our system which currently has zero healthcare bankruptcies. (People also misleadingly claim that the UK system excludes private provision - it doesn't, it's just that only a small fraction of the population has it and the tax advantages are nonexistant. Optical and dental are also mostly private.)

someguydave 7y ago
The irony is that the US system is nowhere near the “free market”. Subsidies abound for the rich and the poor and old get free single-payer healthcare in the form of Medicare and Medicaid. Meanwhile veterans also have an entire single-payer system for themselves. The relatively few who “pay their own way” face incredible costs as few of the health providers actually compete for customers in an open and free market and so they charge crazy prices and get away with it.

freddie_mercury 7y ago

The same thing happens for everything. If it hasn't happened in America, Americans argue as if it is a theoretical idea that has never before been tried on Earth.

systemtest 7y ago

The Netherlands has private healthcare and private insurance companies and has the second best healthcare system in Europe. The price per capita is on Northern/Western European average at 5300 USD per person. World-wide we are the 8th most expensive country per capita which seems fair given our high wages. So even though we have the second best healthcare system and pay an average price for it, people still want to nationalise our system and revert the privatisation. Because "privatisation bad". It truly baffles me that people think it will be for the best. Perhaps the price will go down to the 4100 USD per capita that the nationalised UK system has has but I'm sure our quality would also drop to UK levels (16th place in Euro Health Consumer Index).

alistairSH 7y ago
Do you happen to know what's different between the model in the Netherlands vs the US? Is the insurance provided by employers? In the US, most plans are provided and heavily subsidized by the employer (because the tax code makes that palatable vs paying employees more). Do you have co-pays or deductibles? If so, how large are they? In past decades in the US, good plans had fairly low costs to the consumer ($20 GP visit, $50 ER visit was common). These days, because costs have gone up, many plans have converted to high deductibles with dedicated savings plans ($5000/year per individual OOP, but the person is allowed to save into a tax-deferred account that's a lot like our 401k retirement system, just used for health care).
- systemtest 7y ago
  Employers pay the biggest source of income of our healthcare system through the zorgverzekeringswet. They pay around 6% on the income of their employees next to the income tax. Second biggest part are the private insurance companies that sell insurance for around €90 to €200 per month. The yearly deductible for all healthcare in the base package is €385 to €885, you can set this deductible yourself. Dental and physiotherapy are separate from general healthcare and have their own insurances and payment structures. They are all privately owned facilities. I usually pay my physiotherapist around €40 for a 30 minute session so I don't need insurance for it. But if you have regular appointments it would make sense to get private insurance for it. We don't have a lot of co-pay (eigen bijdrage). There are some parts in regard to post-natal care where a co-pay is required. Also on hearing aids, dentures, orthopaedic shoes, medicine and non-ambulance transportation to a health facility.

endtime 7y ago

It's not ignored. I don't know much about the German system, but I'm an immigrant from the UK and I much prefer the US system to the NHS, and I hear similar horror stories about Canada. Which is not to say the US system is good, just better. In the US, when I need a doctor, I get to see one right away. If the doctor recommends an MRI or ultrasound, I get it right away. No six month waits, no cancelled surgeries, no doctor strikes (!), no government deciding how to prioritize my medical needs, etc. What it ultimately comes down to is that medical resources are scarce (and always will be while medical technology is improving and thus some care is expensive), and having the government allocate them can be inefficient (governments are generally inefficient due to lack of competition, as are systems where the customer is disconnected from the cost). And yes, I care more about my own health care and that of my kids than I do about the health care of some stranger thousands of miles away. I have okay corporate health insurance and so the system works better for me than for some. (Some would argue that regulation rather than economic freedom are to blame for those people's worse experiences, but I'm not going to get into that other than to acknowledge it.) You might disagree with some of my perspective, but the snooty attitude that Americans are oblivious morons is unwarranted.

deiznof 7y ago
If you "needed" an MRI right away, you wouldn't be waiting 6 months, so you probably didn't need one. Not urgently, at least.
LeifCarrotson 7y ago
There can (and typically should) be a difference in one's personal preference and what one would advocate as public policy. Of course I am more emotionally attached to my own health and my kids than I care about one hypothetical unknown stranger thousands of miles away, just as you are. But if I stop and think for a moment I can't rationally justify a system that works well for 1 human (me) and works poorly for 100 other humans. As a relatively wealthy and well-educated American with great insurance (and easy access to other jobs with benefit packages should my employment situation change), yes, I benefit from the American system. But I wouldn't vote for representatives that advocated it. We're not yet approaching something that's a little bit worse for 99% of the country and a lot better for the remaining 1%, and I'm sure we will have many fun debates as to where we should balance the equation as we approach that point. I would have to be pretty selfish to vote for something that's objectively worse for most people in my country. However, it would in fact take an oblivious moron to advocate something that's simultaneously worse on average and also worse for them individually, and yet that's what we have in American politics today.

whodidntante 7y ago

Well,anecdotally,I am friends with a family where one of the spouses grew up in Canada. Their advice when we were planning a trip to Canada was to make sure not to get seriously ill while we were there. Not the first time I have heard of this attitude from Canadians or people from UK. I do not have anything good to say about our "system" (except that the doctors and nurses themselves are many times exceptional), but I also have seen enough of government run systems to know that that is not not an answer.

skummetmaelk 7y ago
You are presenting this argument as if people do not get worried about getting sick when traveling to the US. I can assure you that most people are extremely worried about that because of the insane costs involved and the problem of dealing with insurance.
Ensorceled 7y ago
Getting sick while traveling is always a crap shoot. There are many Canadians who have been convinced that our health care system is crap by the usual suspects. It isn't. Yes, if you live in a major center in the US (like near John Hopkins or Stanford Medical) and have great insurance, you will get some of the best health care in the world. The cost is your less wealthy neighbours are dying and going bankrupt.

slumdev 7y ago

I think there are usually two reasons. 1 - A significant portion of our economy is healthcare middlemen. With single payer or nationalized care, all of our Blue Crosses and Cignas (and the jobs associated) would evaporate overnight. I'm not arguing that we need trillions of dollars of our GDP locked up in middlemen, but it's very hard for a man to understand something when his salary depends on his not understanding it. 2 - We hear about long wait times in other countries. And the stories are mostly true. There's nothing wrong with waiting, but we've been conditioned to expect near-immediate resolutions. People in the United States with high-quality private insurance* can usually be seen by a specialist within a few weeks regardless of how severe or immediate their problem is. The truth is that unless that person has some kind of advanced or rapidly progressing disease, they could wait for months without any problems. But that would be a major change to the way we think. It would mean allocating care based on need, not based on ability to pay. *High-quality private insurance is usually one of the perks of working for a great company. I would argue that only a small minority of Americans have truly high-quality coverage. But all of the people who don't have high-quality coverage envy the others and vote with them, a la "temporarily embarrassed millionaire."

SolaceQuantum 7y ago
"2 - We hear about long wait times in other countries. And the stories are mostly true. There's nothing wrong with waiting, but we've been conditioned to expect near-immediate resolutions." Are you sure? I have to schedule several days if not a week in advance just to go to my PCP, much less a specialist. I also live in an area with no shortage of medical services.
- slumdev 7y ago
  Is this sarcasm?
  - SolaceQuantum 7y ago
    No, not really. I've lived in Toronto and USA, and the times aren't really different IME.

linuxftw 7y ago

What you (and most Americans) fail to understand is the states are separate entities, more similar to the EU than the provinces of Canada. If California wants to have socialized health care for all it's residents, literally nothing is stopping them. Many states already have 100% government medical insurance for the poor. The reality is, government run systems are an absolute nightmare. Similar to government housing, you only use it if you can't afford the alternative.