14 ms·

Yes, this is more evidence of the failure of the American health care system. If the US healthcare system really cared about outcomes, it would want people to b

• notyourwork 6y ago
  I cannot comprehend why anyone would be against health care for all? It seems like such a silly thing to vote against the idea that everyone is healthy. There are lots of agenda items on the political spectrum but healthcare seems like such a strange thing to not be supportive of. Can someone help explain to me what the oppositions point of view is?
  • refulgentis 6y ago
    TL;DR gov't being involved in things is an absolute vice and/or actually the problem is not _enough_ free market I'm supportive of this being fair, it's not a negative take.
    • typon 6y ago
      I was going to ask why Americans don't privatize their military but looking at the proliferation of mercenary company like Blackwater taking over military operations in Afghanistan/Syria/Yemen, maybe Americans are slowly starting to put money where their mouth is.
  • cl0ckt0wer 6y ago
    Insurance companies pay a lot of money to ad companies and politicians to make sure they stay in business. Evil and straightforward.
  • sokoloff 6y ago
    I’m not opposed to a well-functioning healthcare for all, but I can guess at a few possible oppositions: (all of these are phrased as generic first-person statements but by people who are not me) 1. I don’t want my healthcare to be provided by the same people who brought me a lifetime of experiences at the Department of Motor Vehicles. 2. Healthcare is expensive. I’m already paying for healthcare for my family and we’re struggling to get ahead; why would I want to pay for healthcare for others as well? 3. Good healthcare is expensive and I can afford and buy the best health insurance. I don’t want the best to be unavailable to me and my family because we’re all on a “just OK” government system. 4. I’m a medical professional and think that I will make less money under a government-provided system of care. 5. I’m a prescription drug manufacturer. See #4. 6. I’m a biotech research company. See #4.
    • deleted 6y ago
      [deleted]
    • amelius 6y ago
      But have a look at other countries, e.g. Scandinavia, UK. Public healthcare doesn't need to be bad. And it doesn't exclude the possibility of private healthcare.
      • Jarwain 6y ago
        It's not that it doesn't need to be bad, but a lot of people don't trust the federal (or their state) gov to do it well
        • mirkules 6y ago
          I am an immigrant from a socialist, ex-communist country in the Balkans, where socialized medicine is the norm, as is having really good doctors. The few times I’ve had to go to the doctor there, either to be seen myself or to help my grandmother, was an awful experience. I’ve had to spend 2 weeks going from office to office until I could finally get an appointment (just an appointment!) for my almost-blind grandmother, for a simple cataract procedure. The procedure was scheduled ONE YEAR from the time of appointment, which meant she was blind in one eye for a whole year. That’s the absurdity of a socialized system. Everyone already knows the absurdities of this system here so I’ll skip that part of my rant. This issue is so polarizing, it occurred to me - why don’t we have a medicare-type system (call it m4a) for those who want it, and not for those who don’t? It’s about a 50-50 split anyway. The catch is, if you don’t pay tax for m4a, you can’t use it. This way, those who are concerned about “paying for others and receiving inferior service” don’t have to, and those who can’t or don’t want to deal with a privatized system are free to use it.
          • rootusrootus 6y ago
            > This issue is so polarizing, it occurred to me - why don’t we have a medicare-type system (call it m4a) for those who want it, and not for those who don’t? It’s about a 50-50 split anyway. I've been thinking about this a lot myself lately too. It seems like there is critical mass for the people who want universal healthcare, so why can't we make it happen? It doesn't seem that unreasonable to set up a dual system where people who want their taxes to pay for healthcare can get it, and the rest can make their way with the private insurance companies. Win/win. The difficulty would probably be in keeping the tax pools separate. And deciding at what point someone paying into the single payer system gained permanent eligibility even when unemployed. Things like that.
  • centimeter 6y ago
    > I cannot comprehend why anyone would be against health care for all? Then you probably shouldn't voice an opinion on the issue. If a lot of people disagree with you can't come up with a coherent explanation for why, then you almost certainly don't understand the problem space. > Can someone help explain to me what the oppositions point of view is? Government-run healthcare is not socially optimal. Edit: The people downvoting me are salty because they realize that they can't form a coherent argument for an opposing opinion. Guess what - I already know all of your talking points. I would engage with you on them, but this shitty website won't let me post more than like 5 times an hour.
    • dvdhnt 6y ago
      More people are in favor of universal healthcare than against it. No one fully understands the problem space, those that do only understand the parts they care about. However, the current system just doesn’t make economic sense for 90% of current and future Americans. Therefore, we should change the system, and given the success of universal healthcare schemes throughout the developed world, we ought to try it ourselves.
      • centimeter 6y ago
        > More people are in favor of universal healthcare than against it. In the US, you can get an answer in either direction depending on how you phrase the question. When you bring in the fact that this will cost money, people tend to flip. Most people in the US already have healthcare through the government or through their employer, so they don't actually really care enough for anyone to pull this off politically. > Therefore, we should change the system I agree, the current system is sub-optimal. > given the success of universal healthcare schemes throughout the developed world What success? Most countries with "universal healthcare" A) are poor relative to their demographic-imputed economic capacity B) have low-quality care compared to market-based healthcare systems, and even compared to the worst-of-both-worlds American healthcare system often have horrendous metrics on quality of doctors, procedure wait times, etc.
      • moduspol 6y ago
        Perhaps some of our richest, urban, and politically left states could show us the way. It's not like they don't have enough money or political support. Maybe unchecked immigration and a vast welfare state will work out just great. I'd just rather California prove it out first before we roll it out to the rest of us.
  • throwaway0a5e 6y ago
    >I cannot comprehend why anyone would be against health care for all? Because people keep coming up with schemes that involve things that are deal-breakers to various groups of people. Then you add up all the various groups and suddenly there's a significant majority/minority that will vote against universal healthcare. It doesn't help that voting for a politician is basically a blank check to do whatever for the course of the term. Many people are for universal healthcare but vote against it because they expect the politicians to botch it.
    • sudosysgen 6y ago
      But this isn't a full explanation, is it? There are schemes such as Medicare for All that a large majority of Americans accept, yet they aren't implemented. And even amongst the republican party almost the majority support Medicare for All, yet democrats don't support it, why?
      • koolba 6y ago
        People accept “Medicare for all” just like they accept the most recent “covid relief bill” with $1,400 checks per person. If you get into specifics and start including costs (taxes) into the equation, the popularity falls off a cliff.
        • throwawayboise 6y ago
          Yes, I was so happy to get a $1,400 payment that costs me $5,000. Not that I didn't deposit the check....
      • makomk 6y ago
        There are plenty of people that would support an imagined Medicare for All with the same cost that the UK's NHS has and the same level of care of the best US insurance plans, minus the bureaucracy and struggle to get treatment approved. Unfortunately, whilst this sells well to voters, any actual concrete implementation runs up against the fact that you can't actually have both - the NHS gets those low, low costs by not offering expensive treatments at all and having long waiting lists for most other things. Also, any major changes to US healthcare run into the issue that it involves a lot of well-paid jobs, and so a lot of the promises made by politicians along the lines of Medicare for All would involve making a lot of voters much less well-off by cutting their pay. That's not popular either.
  • jeffbee 6y ago
    Universal health care would help everybody including black people so there is a big contingent of American racists who will be against it on that basis alone, even if it's clearly cutting off their own noses.
    • spaetzleesser 6y ago
      Don’t make this about race. It doesn’t help the debate. It makes it worse.
      • jeffbee 6y ago
        It is about race. If you refuse to discuss that you will never understand American politics.
    • charlesu 6y ago
      There is an argument that this sentiment explains a lot of America’s strange choices as it relates to publicly funded everything. It certainly seems like a lot of our divestment in community resources followed the end of Jim Crow. It would explain the strange bedfellows that are wealthy elites and white supremacists (who lean Republican; obviously not all Republicans are racist). The elite gets the benefit of lower taxes and new business revenue from privatization of former government services; the racist gets knowledge that people they dislike are being hurt more than them. It’s a win-win.
      • Nasrudith 6y ago
        There is also heritage of the territories system like the homesteading act as very bottom up for various reasons. The approach specifically wasn't even to establish a state with an appointed governor or to send out survey corps and use them to establish "seed settlements", or even to start auctions in lands covered by existing forts but to do it from the bottom up with land allocations. Instead it was essentially a petition to join once a sufficient population was achieved and unified. They had a "national memory" of getting screwed over by the old world and having Pointy Haired Boss mercantalists telling them to travel for months across the atlantic for trade rather than trade with other colonies - and many of the founding fathers were smugglers for their scoffing laws not in their interest. Now the national memory is clearly memetic like well nations - their ancestors were likely actually still farmers or tradesworkers before emmigrating from their origin or immigrating to the states. Essentially the mentality is they /were/ the resources and didn't (while ignoring those they used as resources). Thus top-down anything is viewed with suspicion and "cutting a slice for yourself" as good. Corruption involving vote buying and extortiong likely also didn't help the trustworthiness to government institutions. Given those alone even if assuming ahistorical tolerance I wouldn't be surprised at publically funded X being looked at with a jaundiced eye as a "Okay how you are setting yourself up like a political boss - how are you trying to shove funds into your pocket this time?" Combine that with the longstanding elite education having a Greeco-Roman obsession's influnce and seeing the ironic effect of what seems like common sense "supply your own military with equipment so their means don't limit your defense" as effectively establishing a generalismo to gain personal armies. All of those point to ample reasons to view publically provided X with suspicion. The only reason public education did as well as it did was fear of catholic influence and them being better organized. The red scare had an internecine ancestor. "If they didn't provide education to the masses the Catholic church would and upset the general very peaceful in comparison to Europe balance of power." That notion of retaining that peace and not having "all of the bloody European wars for absolutley no gain" was very agreeable to all, especially emmigrants from said wars so Catholics wouldn't be too put out by "redundant funding" of what the church effecfively going to protestants as the church already gave it to their parishoners. The more I think about the more I can see both sympathetic and bigotted reasons for them to have been suspicious of "free X" as a trap. Either way the roots existed well before Jim Crow a specifically post civil war system. Even if the centuries of suffering of Jim Crow could be retconned away it would probably "just" leave the South looking more like the North sooner as opposed to public healthcare approaching its 1st centurty anniversary.
  • bronson 6y ago
    It generally boils down to people wanting to have elite health care, not the pedestrian health care everyone else gets. It's difficult for the American voter to even get accurate information. https://www.washingtonpost.com/outlook/2020/08/06/health-insurance-canada-lie/ https://www.washingtonpost.com/outlook/2020/08/06/health-ins...
    • KptMarchewa 6y ago
      You don't have to ban private for people that want to pay for more that public healthcare would provide.
      • throwawayboise 6y ago
        But then the best facilities and the best doctors would all be in private practice where they could earn more money, and the public care would be done by whoever was left over.
        • jakeinspace 6y ago
          I think that’s a bit of an exaggeration. Most healthcare workers got into the field for reasons other than money. And with a well-funded public healthcare system, I think the US could still support pretty good wages. For example, the VA and military can attract a pretty good standard of doctor, partially through the offer of paying for medical school and with excellent benefits. I don’t think that every top specialist will opt to serve the rich in private hospitals, or that there would even be adequate demand from those rich to require the supply of every top doctor.
        • arethuza 6y ago
          In the UK system its pretty common for senior doctors to work for both the socialized NHS and private hospitals.
        • KptMarchewa 6y ago
          That actually depends on implementation: there are countries where private practices practically don't exists besides people in the 1% who pay for the convenience and attention; and countries like Poland where a lot of people have work-provided healthcare benefits which mostly decrease wait time for specialists - very limited subset of healthcare overall, there are no common private cancer treatments etc. I don't think there is country where people buy very broad private coverage after having mandatory public one, so the scenario you're trying to present wouldn't happen: there would not be enough jobs for "all the best doctors" in private sector.
  • drstewart 6y ago
    >I cannot comprehend why anyone would be against health care for all? Nobody is against health care for all. Everyone wants that, people disagree on the optimal way to achieve that goal. It's like saying "I don't understand why anyone would be against housing for all?" while you're advocating for confiscating all private property and having everyone live in state-run housing. Which is fine, and maybe a good way to achieve that goal. But isn't the only way to do that.
    • wsatb 6y ago
      I'd like to believe this actually true, but I don't think so. Otherwise we would be able to have actually healthy debate about it. I think the reality is there is a very vocal group that wants state run healthcare and the other side thinks things are fine the way they are. If there's another way to do it, let's hear about it.
    • 0xcde4c3db 6y ago
      > Nobody is against health care for all. Few will say that explicitly in mixed company, but the gravitational pull seems pretty clear to me in the wider debate. Nobody is against health care for all who deserve it, but it's considered very gauche in most circles to directly argue that some people don't deserve health care, so I think it sublimates into complaints about stuff like the constitutionality of the ACA mandate or wait times for hip replacements in Canada or whatever.
  • 1123581321 6y ago
    Both sides would say that they are the ones supporting the nation's health and supporting people having access to healthcare. The reasons why typically have to do with the average quality of care and the cost--the same things you want to improve--however, while you advocate for removing the private market to improve health, they advocate for removing the government skew on the market to improve it. A lot of ink has been spilled over it, on both sides.
    • solosoyokaze 6y ago
      There's a third side and it's the one that's been winning: use regulatory capture to increase health industry profits. This is the side that brought you the ACA and individual mandate. The only reason the mandate existed was to protect insurance company profits. If you look at the cost of healthcare, it's skyrocketed post-ACA. While I'm a proponent of socialized medicine and M4A, without a doubt even the free market would be better than what we have.
  • danans 6y ago
    When everyone has something, we don't feel as special for having that thing. This should be reserved for expensive sneakers, cars, and luxuries, but some apply this perspective to health-care, and are disturbed that someone of less means should have access to the same hospitals and doctors as them. That's not the only reason of course, but it's often the unstated motivation behind the stated reasons for opposition to universal healthcare, like government rationing of care.
    • sokoloff 6y ago
      I don't think it's that people are "disturbed that someone of less means should have access to the same hospitals and doctors as them" but rather that that they don't want to have their own access to those doctors delayed, rationed, or removed. (It's not "I don't want others to have what I have" but rather "I don't want to lose what I have".) If I'm honest, I basically fall into that boat. When my son shattered his arm, we went straight to Boston Children's and got the best imaginable care. When my wife had a scary situation, I called several MD friends and found who were the best specialists to consult and we went down that road and got a good outcome thankfully. I sure hope to hell everyone has those same experiences at emotionally and mentally trying times. We've had generally very good experiences with our medical system and I'm reluctant to risk blowing all that up, trying to re-jigger the entire financial foundation of the industry, and hope that what comes out the other end is every bit as good but a lot cheaper. That sounds simultaneously fantastic and fantastical.
  • renewiltord 6y ago
    Sure, considering I was a frantic proponent of universal healthcare before I observed the US Gov's handling of the COVID crisis and the responses of Americans to it, I changed my mind. Here are some of my reasons: * I want to be able to be an informed participant in my healthcare. When the US Gov lied about mask efficacy so that there would be enough masks for healthcare professionals and when many Americans considered this acceptable, I lost faith in the government's ability to meet this need of mine. Either they were incompetent or malicious and neither trait is one I desire in someone treating me. * My life involves a wide variety of risk taking: I use drugs, motorcycle, bicycle, jump off bridges, etc. During the COVID crisis, many Americans stated a desire to allocate healthcare according to behaviour. I would prefer to pay to offset my risk rather than alter my behaviour. I fear the puritan streak in American politics will push me to the back of the line in healthcare despite my ability to offset any risk with money. * I am a software engineer. I am high income, relatively wealthy, and overall fairly comfortable. I am also in a profession that does not provide me a social cachet. During the COVID crisis, many Americans stated a desire to allocate healthcare according to a notion of value to society that elevates those with high social cachet. These are generally people who can be argued for: teachers ("they are taking care of our next generation"), medical professionals ("you don't think we should treat our healthcare heroes first?"), soldiers, firefighters, police, god knows what. I fear that people's dislike of my profession will push me to the back of the line. So now, no universal healthcare, thank you. And yes, I am quite familiar with the NHS. I've paid enough into it and have many family members who work for it. The existence of other successful systems does not mean that the US can replicate them. There is a path problem, a second system effect, and differing social norms. Well, there you have it, an actual statement of reasons from someone who actually opposes UHC.
    • nohuck13 6y ago
      I don't agree with you but you deserve corrective upvotes; this is a perfectly cogent and constructive dissenting view.
      • renewiltord 6y ago
        Thank you. As it so happens, I am aware that when a HNer requests an answer like this they are fully aware of two things: * They can stay righteous knowing that the mob that they are the vanguard of will apply suppressive pressure on their behalf * They can disclaim responsibility of knowledge of the mob * The fellow members of the mob will post answers "on behalf of" the side they oppose which will strawman those positions Interestingly, many HNers will disingenuously ask "for feedback" or "an honest discussion" knowing full well about this phenomenon. Therefore, I'm not upset by their reaction because I was braced for it. My position is logically sound. Objections come from different moral foundations and different circumstances, not from logical failure. And I can accept that you can also have an opposing logically sound conclusion rising from different axioms since our axioms are beyond our Aumann Agreement Horizon.
  • cwkoss 6y ago
    Democrats get tons of campaign donations from pharma and health insurance companies. They don't want to turn off the spigot.
    • pbourke 6y ago
      Yes if it weren’t for those pesky Democrats, we’d have had Republican universal healthcare by now.
      • solosoyokaze 6y ago
        Certainly they wouldn't support M4A, but it's definitely the Democrats that work to pass laws that increase the cost of healthcare. Prices have been spiraling out of control since the ACA.
        • jamroom 6y ago
          As someone who has been purchasing individual insurance since 2003, prices were spiraling out of control long before the ACA. My premium went up every single year outside the first couple years the ACA was in effect where they went down a little bit.
          • solosoyokaze 6y ago
            While it was certainly going up pre-ACA, if your costs went down due to the ACA then your case was extremely unusual. Costs are way up since it was enacted: https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-usspendingovertime_2 https://www.healthsystemtracker.org/chart-collection/u-s-spe...
        • Edman274 6y ago
          The graph of "how much does healthcare cost over time" on the link that you provided yourself to prove that costs have been "spiraling out of control" has had the same steepness since 1990. If it's spiraling out of control because of the ACA, then it's also spiraling out of control because of the Gulf War. At least now people with pre-existing conditions can be covered. We're not even done dealing with a pandemic that has infected 31 million people. Imagine a world where none of those people could ever get healthcare in the future because Covid-19 is a pre-existing condition.
  • wnevets 6y ago
    > I cannot comprehend why anyone would be against health care for all? It seems like such a silly thing to vote against the idea that everyone is healthy. There is a large number of people who are actively opposed to the "wrong" people receiving anything, even if it means cutting off their own nose.
    • ryandrake 6y ago
      Yup a lot of Americans would happily vote for themselves to suffer, if it meant that a group that they didn't like would suffer even more.
      • sharatvir 6y ago
        Just look at swimming pools and amusement parks for a parallel. White Americans felt that it was better to shut them down entirely rather than letting black Americans enjoy them also. They decided to remained something that they presumably enjoyed because another group was allowed to use it as well. Source: https://theconversation.com/the-forgotten-history-of-segregated-swimming-pools-and-amusement-parks-119586 https://theconversation.com/the-forgotten-history-of-segrega...
        • selimthegrim 6y ago
          Yes, New Orleans had an entire (very nice) public pool filled in Uptown thanks to this nonsense.
        • ryandrake 6y ago
          One voter quote I'll never forget sums this up: “I voted for him, and he’s the one who’s doing this,” she said of Mr. Trump. “I thought he was going to do good things. He’s not hurting the people he needs to be hurting.” 1: https://www.nytimes.com/2019/01/07/us/florida-government-shutdown-marianna.html https://www.nytimes.com/2019/01/07/us/florida-government-shu...
      • kevin_thibedeau 6y ago
        And then loudly proclaim that they are adherents of a certain prophet.
  • madengr 6y ago
    The open border policy of the current administration is reason enough to reject it.
  • bluedino 6y ago
    >> I cannot comprehend why anyone would be against health care for all A lot of people feel slighted that they work, or worked to pay for things and other people that don’t get those things for free. Health insurance is provided by your employer so it is one of those things.
  • jasonfarnon 6y ago
    Once my bad health-related decisions are costing others money, society has a much stronger case to stop me from making those decisions. And I don't want to leave the determination of what constitutes a bad health-related decision to the vote. Especially with how expansively the scope of public health and mental health has grown.
    • peter422 6y ago
      Who do you think are paying for your bad health related decisions now? Do you pay for 100% of your current costs out of pocket and will do so for your whole life?
    • renewiltord 6y ago
      Damned right. At the beginning of the pandemic, people were arguing that you shouldn't drive because you might risk an accident and use a hospital bed that could be used for a COVID patient. This is a degree of behavioural policing that I am not willing to accept.
      • greedo 6y ago
        So I'm sure you smoke, though most insurance policies charge through the roof if you do? And do you drive as fast as you want since hey, don't police my behavior? Our society polices behavior all the time. And we accept that as part of a smoothly functioning society that tries to be fair and equitable.
        • renewiltord 6y ago
          Right, but right now, you lack the ability to push me to the back of the line for healthcare because of my love for extreme sports and motorcycling. You may want to do that because you believe it is "fair and equitable" but you can't, because you're just another third party in this relationship between me, my provider, and my insurer. You may want everyone to only ride the lowest risk means of public transit, only eat the right food, only perform the right activities because you arrogate to yourself the right to police behaviour in pursuit of equity. You are welcome to want this, of course, and I do celebrate your openness in stating your objectives. But that's why we're opposed. I don't share your objectives. I am willing to accept some degree of inequity in the pursuit of some degree of individual freedom. For the record, I don't smoke. I do speed, like so many other people in California. But fortunately, my auto insurer adjusts me up for that. EDIT: I cannot reply to you, jay_kyburz, but I do not anticipate mere societal pressure. I anticipate legal rules placing me in a different line that only gets treatment after 'conventional risk' people. i.e. at some point I believe someone will say "Rich software engineers get treated for pulling their shoulder jumping off bridges while this brave firefighter had to wait (unstated that he had to wait to have a wart removed or something)" and then the outrage will roll up until anyone jumping off bridges for fun is now placed permanently behind everyone else.
  • op00to 6y ago
    “I worked for what I got, why should someone else get something for free”, 57 year old white housewife recently said this to me.
  • PhineasRex 6y ago
    Mostly propaganda; there's been a lot of scaremongering about long waitlists and "death panels" in countries with universal healthcare. And then on the political side it's just straight up corruption
  • da_big_ghey 6y ago
    I have no desire for to start flame war on subject, but since you are asking: because I am opose paying for health care for other persons. More even so when it is involving state force as collector of payments. I make votes not against "everyone is healthy" but against "i pay for everyone to be healthy". I also am having zero trust in governments with my health. Mask advice early 2020 is good example: pencil pusher decides to make decision maybe harmful to my health because he have adjuged it to be for "greater good". I have no trust that it will not happen in such a manner with my health, some one make a decision bad for me for "greater good".
    • flukus 6y ago
      > but since you are asking: because I am opose paying for health care for other persons That's what insurance is.
      • RhysU 6y ago
        But the person can not buy insurance. Or buy other insurance. Or buy less insurance. When the government forces it there is no choice.
      • da_big_ghey 6y ago
        Insureance has choice in it. I am buying what I please. Young healthy person is not in need for same coverage of middle age person: it is also use risk pools so that I am not group in with sickly persons. Data are showing that 5% of patients have create 50% of health costs; I am not wanting to pay these. https://www.forbes.com/sites/michaelbell/2013/01/10/why-5-of-patients-create-50-of-health-care-costs/?sh=41d086b228d7 https://www.forbes.com/sites/michaelbell/2013/01/10/why-5-of...
  • wsatb 6y ago
    I think in general people only care about what is going to impact them directly. If they already have healthcare, they assume those that don't are doing something wrong or simply just don't care. I have mine, you're on your own. The reality is quite different and there's so much money to be saved on healthcare long term if we do this.
  • sir_bearington 6y ago
    "Healthcare for all" and "single payer healthcare" are two very different things. Most countries still have private health insurance companies, but the government subsidizes healthcare. The main blocker of doing this in the US is that the focus tends to be on building a single payer state. ~80% of the population already has insurance through private companies, and they're mostly pleased with it.
    • tclancy 6y ago
      What percentage represents “mostly” here? We’re solidly upper middle class and I can’t think of many people who are. The only time I was when I worked for a California startup and that was like magic compared to insurance in New Hampshire.
  • mindslight 6y ago
    Because "for all" is generally taken to mean provided by the government, and history has shown that without functioning markets government guarantees are ultimately worth the paper they're printed on. And if we actually had a functioning market, then why does everybody need to go through the government, as opposed to only the people who actually need the financial assistance? We don't take "food for all" to mean that supermarkets are paid by the government. Rather there is a functioning market for most people, and subsidies to help those who cannot afford it. The competitive market keeps the overhead from getting out of hand and makes it so most people have the autonomy of paying for themselves on the spot, while the government provides a safety net for those who cannot. Now having said that, the entire healthcare system is presently a dumpster fire. The other side of the aisle has done very little to address this dumpster fire with market based solutions - eg make providers publish full price schedules that are uniform for all payers, issue estimates for all non-emergency care, prohibit providers billing arbitrary amounts post-facto, and strongly punish any fraudulent billing. Such reforms could certainly exist alongside increased access to health "insurance", but that political team has been mostly spreading FUD to keep the status quo rather than proposing solutions. Meanwhile Medicare is actually pretty good, it seems that Medicare For All is the only train leaving our current situation, and it therefore makes sense to get on it.
  • lr4444lr 6y ago
    People fear that we won't be able to afford the demand of everyone expecting to get what they get now with luxury plans plus everybody else under or uninsured getting more than before. Also, a lot of people's livelihoods directly come from the healthcare for profit system, and there haven't been serious proposals for how to transition that workforce, and a lot of pension and private retirement equity is also bound up in the profits of these companies.
  • rcoveson 6y ago
    You have so many replies and they're all so low quality. (EDIT: This was probably hasty of me, there are a number of good replies now. I had quoted some bad ones here, but that seems like it simply prolongs their effective life. I've removed those quotes.) On the other hand, perhaps you'd get better replies if you started with a better question. Nobody is "against health care for all". Nobody would "vote against the idea that everyone is healthy". A better question is: Should the US federal government (continue to) ensure that some level of health care is provided for all, and what level is that? "None" is an extremist answer; would you abolish the Emergency Medical Treatment and Active Labor Act, which requires most hospitals to treat any person in mortal need who shows up? "All" is the other extreme, although it's unclear whether it's an "extremist" answer if there are real countries that have implemented federally guaranteed "best-effort all health care for all". Which I don't know enough to answer. Do those places exist? Anyway, I think that's a better starting point for the conversation.
    • toomuchtodo 6y ago
      > Should the US federal government (continue to) ensure that some level of health care is provided for all, and what level is that? https://www.pewresearch.org/fact-tank/2020/09/29/increasing-share-of-americans-favor-a-single-government-program-to-provide-health-care-coverage/ https://www.pewresearch.org/fact-tank/2020/09/29/increasing-... ("Pew Research: Increasing share of Americans favor a single government program to provide health care coverage (2020)" https://www.pewresearch.org/fact-tank/2018/10/03/most-continue-to-say-ensuring-health-care-coverage-is-governments-responsibility/ https://www.pewresearch.org/fact-tank/2018/10/03/most-contin... ("Pew Research: Most continue to say ensuring health care coverage is government’s responsibility (2018)" I won't pollute the thread by bloating this comment with large citations, but both links are interesting reads as to who falls where on the spectrum.
    • deleted 6y ago
      [deleted]
    • tobmlt 6y ago
      I hate to get involved, as I am already feeling ill from stress today, but I can’t help but notice that the reasons being given as “things they’ve heard” as arguments against universal healthcare have nothing to do with the only reasonable argument I’ve actually heard. That argument is this: first look at the history - why is it that health care is so expensive? I (well not I, but scholars of this bent) argue some of the reasons for that are (a) price and wage controls during ww2 leading to employers subsidizing health care as a way to increase real wages while sticking to the letter of the law, so to speak, and this becoming a “sticky” practice leading to a general divorce of payee and payer in the health care system, as more and more people get employee subsidized insurance, and thus allowing prices to get distorted as the signal was hidden behind the subsidy, and meanwhile (b) the AMA, restricting the supply of doctors, bolstering their prestige, and wages. Etc etc Just talking from the point of view of the price system, meaning nothing against people with other arguments for the existence of the ama. So, if health insurance removes the direct price signal from health care provider to health care recipient, prices rise for years, and the problem festers and grows worse as politicians punt it down the road... Finally we come to the universal health care system as the answer. In this light it may be seen as a further divorce of payee and payer, such that cost will rise over the long time horizon, or effectiveness per dollar will drop, etc. On the other hand the public private quagmire that arose as a result of insurance company protectionist land grabs and back room deals between employers and insurers did no favors for outcomes under the present system. Anybody try a high deductible health plan this decade? What shit. It’s so bad that likely a universal system will be an improvement, even from this vantage.
  • adamsvystun 6y ago
    I don't think that majority of people are opposed to the idea that people who need healthcare should not get if they can't afford it. It's more that there are different ways of achieving that and there are different degrees of service you can deliver that satisfies that requirement. That's where people disagree I would think, and it creates a deadlock of sorts.
  • thereare5lights 6y ago
    There's lots of people in this country that think universal healthcare is socialism.
  • cal5k 6y ago
    Canadian here. We have an extreme version of this, which includes a ban on private pay for anything covered by the public system. It's a bad system, and what's worse is that it has become politically impossible to even talk of reform. Every politician just promises "more money for hospitals", "more money to reduce wait times", etc. and yet little progress is made on addressing these issues because nobody is willing to tackle the root causes, primarily misaligned incentives. Our wait times for elective surgeries are terrible. Our use of electronic health records is still patchy at best. Innovation is extremely difficult - health tech startups simply cannot sell into the giant health insurance bureaucracy without going under. Co-pays for "medically necessary services" are illegal, meaning there's rampant overuse that drives up costs. The patient experience is often brutal, because nobody is incentivized to provide a good one. If you have a chronic condition the odds are good that you will have poorly coordinated care. Specialist appointments can take months or sometimes over a year to get. We have far fewer imaging machines per capita than almost any other Western country. Getting an MRI or CT can take a long, long time. Instead of money, influence buys you faster access. Hockey players get primo access to imaging and specialists, as do politicians. If you know someone they can help you skip the line. So if you mean "Medicare for all" a la Canada, this is a disaster in the making. If you mean "it would be nice if we found a way to provide basic coverage for everyone", this is a laudable goal that is eminently achievable with a mixed public/private system, where public insurance should really focus on the basics. Healthcare is not as magically different from other industries as people think. Doctors still care about how much they get paid, how many hours they have to work, and how much time they get to spend with their families. Skill and efficiency varies widely across practitioners. Egos are involved. All of the human elements don't simply vanish because you declare that healthcare must be available to everyone for free. Markets do a lot of things well. America does not have truly free-market healthcare, unfortunately, but you do not want the Kafkaesque, bureaucratic disaster we have up north.
    • caconym_ 6y ago
      If everybody in Canada has realistic access to essential healthcare (including dental and vision), you’re already doing better than we are in America. A lot of your complaints apply to our system, too—in the sense that I’ve experienced them firsthand—but I honestly consider myself lucky just in that I can afford care (cushy tech job) and I’ve never caught a hospital bill large enough to clean me out (at least, not since I was a kid without a lot of money). Seriously. There are people in America who literally have to choose between fixing the constant pain of mouths full of rotten teeth and caring for their children. It’s not like there are no bright spots, but our outcomes are some of the worst (if not the worst) out of (ostensibly) first-world countries by most (if not all) attempts at objective measurement I’ve seen, and that’s generally not even including non-health outcomes like medical bankruptcy. I wouldn’t say extant socialized systems couldn’t be improved upon, but I tend to think people complaining about those systems are either a) in a position where they could afford care in America, which absolutely isn’t everyone, or b) just don’t know how good they have it.
  • dylan604 6y ago
    The biggest one I hear in my area: "I'm healthy, so why should I help pay for someone's health that choose to not live healty (drug addicts, etc)"
  • conanbatt 6y ago
    There is already a healthcare for all, the argument is on the mechanics on how to pay for it and who decides what services are provided.
  • DoreenMichele 6y ago
    I'm actually for universal coverage in the US, but rationing de facto exists in all systems and it's kind of a question of how, not if. So some people feel they are better off if that rationing is done some other way (like money). I'm for universal coverage because we know health costs go up when people can't get certain basics and we know this actually puts people at risk of homelessness. I worked in insurance for a few years. I worked for Aflac. They mostly do supplemental insurance and they made most of their money in Japan, a country with universal coverage. So some countries provide universal coverage and allow for supplemental coverage. My best understanding is this works fairly well and fixes some of the problems I've heard Canadians complain of in their system, though I could be misinformed. I don't have first-hand experience with either. One last argument that I think isn't entirely crazy talk: People who can get free care may neglect their health because they figure "it's free." This can end up being a big burden on not just the healthcare system but society in general for various reasons.
    • Clewza313 6y ago
      > People who can get free care may neglect their health because they figure "it's free." Surely more people neglect their health (as in, they may worry about it, but they don't do anything) because it costs money they don't have to go see a doctor?
      • DoreenMichele 6y ago
        It's more complicated than that. I was a military wife when I was diagnosed with a serious, incurable condition that is very expensive. Most of my medical care was free. I had the occasional small copay for drugs not carried by the military hospital. I began getting better by spending $300/month on supplements and making dietary changes. I was a homemaker, so it "wasn't my money" and my husband wasn't an ass about it, but money was always a sore point and I always felt very aware of some of the psychosocial stuff where everyone not only thought I was kind of a loon for pursuing "alternative" remedies, but I was also "being financially irresponsible" to do so. I got better. I feel justified. The world continues to call me a loon to my face. I can't win for losing, but it's made me very aware that if you give free drugs to people, some people will take drugs instead of doing things like eating healthy and exercising.
  • robomartin 6y ago
    > I cannot comprehend why anyone would be against health care for all I think context is important here. Everyone, absolutely everyone, wants healthcare for all. Ask anyone if they'd like to live in a country where you simply don't have to worry about health insurance and have everyone covered and everyone will say "yes". The devil, however, is in the details. The first problem is that the US public has no trust at all in their government's ability to do anything right. Let's not even talk about political parties. In general terms, our government seems to be filled with incompetent, partisan, power-hungry and petty individuals who would have trouble selling used cars in the real world. They are actually an insult to used car sales people, who have to work hard to earn a living. Examples of this abound. From the high-speed train to nowhere in California (and now we are talking about building trains again?), to half billion dollar websites that don't work, to, well, the DMV --everywhere--, pandemic response, etc., etc., ad nauseum, etc. Try to call a government organization for help and see what that feels like. IRS, DMV, your representatives. Yeah. I don't want these people anywhere close to my healthcare and quite a few people feel exactly the same way. They've gone too far already. Here's personal context: Before the ACA my family's health insurance cost $650 per month. We had excellent coverage, great doctors, good service, low costs, and all was well. We were forced into the ACA. The minute that happened our cost went up to $1,800 per month. Yes, that's over $20K per year for health insurance. Oh, but it doesn't end there. Our deductible went up to $5,000 per person per year. In other words, each of us has to spend $5,000 before any insurance coverage kicks in. There are five of us. Which means we would have to spend $25,000 in a year if all of us need medical attention before the wonderful ACA provides any coverage at all. And the doctors and clinics we now have to go to? I gave one of the clinics in the list a name: The place you go to if you want to die. Yes, we have mucked up health insurance in the US beyond recognition. Adding more government is the absolute worse thing we could do in the US. They are incompetent and will cause all kinds of pain. And the costs will be staggering. The ONLY way we can have government do the right thing is if every single politician had to, by law, use healthcare at, say, the median of what they create. They would have to live with what they create. Today that's not so. They have gold-plated healthcare for life. At no cost. We do not. Make them live by what they create and things could be different. You would have to ensure no loopholes at all. They would have to have nothing better than what the average person in the US has access to and they would have to pay for it themselves. I have always been a firm believer in the power of the entrepreneurial spirit. Yes, there are horror stories in every industry. And yet, by an overwhelming majority, it is hard to ignore the fact that entrepreneurship has lifted billions of people out of poverty and made billions of lives better everywhere. With proper oversight and careful regulation, the private sector would do a massively better job than government ever could in the US. That's just a fact. The comparison along one vector is as simple as what SpaceX has accomplished in such a short time vs. the massive aerospace contractors. Before anyone says "yeah, they got government money and were able to start from the foundation laid by NASA, etc.". First, don't diminish the amazing work they have done. Second, the traditional rocket/space companies have had DECADES of a running start, with even more government backing, contracts, exclusivity and support than SpaceX ever got. And yet the difference in results could not be starker. We need an Elon Musk to take on healthcare. If government thinks they can do better, fine. Allow private enterprise to give it a try in parallel with a government effort. Same rules. Let people choose. IMPORTANT: Sorry for the caps. It's better than the only emphasis available on HN. It is vital to also understand that Medicare has serious issues. In a nutshell, it isn't insurance. Yes, it covers a bunch of things up to age 50 (or 55, don't remember). After that it becomes a loan you have to repay. In other words, at the age when people start to need more and more medical care the system will provide you with care but it is a loan. What's worse is that the government, by law, has to collect on that loan and can --and does-- attach your estate. https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html https://www.medicaid.gov/medicaid/eligibility/estate-recover... What does this mean? It means that placing people into Medicare by the millions (as the ACA did) is likely the largest private property grab by a government in the history of humanity. OK, maybe a bit dramatic. However, this is factual in that the US governments (federal + state) have the right to your estate as a means to pay for what you owe for healthcare after the threshold age. In the US it is easy to amass a million dollars or more in healthcare cost as you get older. Not difficult at all. Which means your home and everything you own is on the line because you got placed into Medicare through the ACA. Under certain circumstances your children can be liable for your medical debt. The millions of people who got placed into these programs have no idea what they agreed to when they signed on the dotted line. No idea. And that, among other things, is why nobody in the US should ever trust government with their healthcare. There's more, but I don't have the time to get into it. My wife is a doctor. She and he colleagues should write a book on the horrors of government-driven medicine in the US. Things like doctors having to order piles of unnecessary tests because they fear career-ending malpractice lawsuits. Like I said, this post is but the tip of the iceberg. We can't say "but they do X in country Y". No two nations are the same, culturally, economically, politically, etc. Which means such a statement is invalid and irrelevant. What matters is what we do here. And our history, with regards to government competency, leaves much to be desired.
  • brightball 6y ago
    The biggest objection that I have with federal programs as a whole is that they cannot be undone if they’re bad. We’re all stuck with them. On the flip side I fully support state level programs because it allows for more direct refinement by the representatives and voters closest to it. If a federal program is implemented and everybody in Wyoming hates it, they have no real voice to change it.
    • bhupy 6y ago
      This is also exactly how Canada passed its Single Payer healthcare, Province-by-Province. Saskatchewan was the first Province to offer single payer in 1947, followed by Alberta in 1951, etc. By 1961, all Provinces had some form of a single payer healthcare system. To this day, Canada's single-payer system is Provincial, not Federal.
      • brightball 6y ago
        Somehow I’ve never heard that through all of this debate over the last decade.
        • bhupy 6y ago
          Maybe another potentially surprising fact: Canada’s Federal income tax is more or less identical to the US’s; and in fact the US imposes a slightly higher tax on ultra high earners than Canada. This works in Canada because Provinces levy high taxes as well, and 80% of government spending in Canada happens at the Provincial level. In other words, if Americans want to make the US more like Canada, there’s a really easy way to make the US more like Canada: the States.
      • refurb 6y ago
        Yes, it started within each province, but the Federal Govt passed laws in 1981 defining what each province had to offer. If you don't adhere to the rules, say bye-bye to federal funds. It would be fairer to say that the Canadian system is national with provincial implementation within that framework.
  • ChuckMcM 6y ago
    Well, if you are not from around here :-), the calculus is simple. The healthcare "industry" manages to levy anywhere from 4 to 6% tax on the GDP of the wealthiest nation on Earth, and instead of giving that tax to the Government it goes to a handful of individual corporations. That wealth sucking monster has its tendrils deep into every PAC and politician it can find. And like a giant organism that wants to survive. It employs hundreds of thousands of people who insure that the status quo, remains. Even people who aren't employed by the beast but are wealthy hold large quantities of "stocks" in the beast so that they, like small trigger fish on a shark, might benefit the wealth that spills over as the beast munches at the trough of human despair and disease. Yeah, it's a bit cynical, but I swear every bit of it is true.
    • hokumguru 6y ago
      That same beast produced a vaccine to Covid-19 in merely two days. I believe all but one of the major vaccines to the virus come from the USA. The machine is all-consuming but it surely doesn't all go to waste.
      • symlinkk 6y ago
        You could point to anything and say “look! it did something good!” but that doesn’t mean it can’t be improved upon.
      • sitic 6y ago
        Which vaccine would that be? The Pfizer one was developed by BioNTech in Germany (it's also produced by Fosun Pharma for China), the Johnson & Johnson one was developed by their Belgian subsidiary Janssen. I think only the Moderna (NIAID) and Novavax are truly "US-developed" vaccines. The AstraZeneca one was developed in the UK, Sputnik V by Russia, and CureVac is German. Besides, I don't think patient-healthcare spending (where the US is spending an additional 5-8% of GDP) affects that or where they were developed.
      • relaxing 6y ago
        That’s not remotely true. Even of the two RNA vaccines, Pfizer-BioNTech was developed in Germany. The Johnson & Johnson vaccine was developed in the Netherlands. Oxford-AstraZeneca is a UK product. And China, India and Russia each have multiple vaccines approved.
  • tyingq 6y ago
    "I cannot comprehend why anyone would be against health care for all?" I think it's because we imagine how it would pan out based on current costs. When I was running my own company, the premium for really good health insurance was $2400/month for one employee and their family. So, if you assume everyone will be given good insurance and do the math, there are some REALLY BIG new taxes coming your way to do that. Of course, it doesn't have to be that way, but we US citizens can't imagine the government doing it well without taxing us to death. At least some of that worry is well founded.
    • multiplegeorges 6y ago
      Yeah, a big new tax of (for example) $1500/month, but now you don't have to pay $2400/month.
      • tyingq 6y ago
        I don't think people imagine good insurance for everyone will be $1500/month. Maybe it would be, but it's hard to fathom given our terrible track record thus far.
  • drxtnndh 6y ago
    i dont want to pay for the treatment for people who made terrible decisions. people wont be healthy. they will succumb to the billion dollar advertising and garbage fastfood/snack business. the past month the media has been shilling the vaccine instead of telling people how important diet and exercise is. i havent been to the doctor in years. last time i went to the dentist he said i had the best gums he had ever seen. take care of your body. i only have health insurance in case something extreme happens. deepthroating fast food everyday and tryign to make me pay for your treament is bad.
  • 2OEH8eoCRo0 6y ago
    >I cannot comprehend why anyone would be against health care for all? Because that's not a policy. The debate is over which policy implementation is would be best or if the government should be involved at all. I personally like the idea of public option health insurance.
    • hanniabu 6y ago
      Bernie sanders put out a good piece on why it needs to be all in and can't be optional. Can't find it now but it delved into game theory. Maybe someone else happens to know where to find it and can link it.
  • BurningFrog 6y ago
    "Healthcare for all" is a goal, not a system. Everybody shares that goal, but there is huge disagreement about how to practically move towards it. Also, the US political system is incapable of changing anything important since a few decades...
  • hayst4ck 6y ago
    Disclaimer: I am in favor of health care for all. The best faith argument against health care for all is that it creates a strong incentive to limit freedom. If the government were responsible for everyone's healthcare, then it would want to reduce healthcare costs. If it were to reduce healthcare costs, it would have to understand and regulate or tax things that hurt health. Things that hurt health are things like sugar, tobacco, alcohol, advertising unhealthy stuff to children, sports, especially adventure sports, driving, etc. If the government can draw a direct correlation between sugar consumption and health costs, there is now a strong incentive to tax and regulate sugar. If people go skiing and that becomes a significant health cost (broken bones) you now have a strong incentive to tax skiing. For adventure sports, it's easy to imagine what is currently the balance between safety and excitement could end up being regulated past a point you would personally be happy with. This increases government size, increases government intervention, and limits both business "freedom" and individual freedom. The catch phrase for this line of thinking is "nanny state." Personally, I don't like being obese, and I don't like looking at obese people and "just don't eat sugar" is harder than it sounds. I am quite in favor of government intervention for the benefit of society as a whole in the form of things like sugar tax or sugar regulation, but I find the argument that this kind of intervention harms freedom compelling (just not more compelling than the benefits of giving up that freedom).
    • bumby 6y ago
      This is the exact argument that was used in some states regarding mandatory motorcycle helmet laws. It’s also possible to hold both views at the same time (paternalistic laws should be avoided and also society would be better off if everyone did exactly what the law intends)
    • lutorm 6y ago
      I am also in favor of health care for all, but I'm not necessarily in favor of subsidizing all kinds of reckless behaviors by having the public pick up the hospital bills either. Like, if you want to go, say, base jumping (just picking a risky recreational activity here), I'd be OK with saying "you need a separate insurance for that, if you hurt yourself the government isn't picking up your tab." That seems like a more straightforward way of handling the problem than to try to somehow tax base jumping. The trouble is, of course, where to draw the line. It's possible that the cost of these voluntary risks is just negligible compared to general health care.
  • foobiekr 6y ago
    I am very pro healthcare for all and single payer. Watching California screw up vaccination in pretty much every way possible, and then on top of that prefer wasting doses by preferentially shipping vaccines to the central valley and other areas in order to satisfy non-health-related "vaccine equity" has really started to change my mind.
  • dominotw 6y ago
    I have question. Wouldn't everyone want to go to the best hospital in the city if they have something serious like cancer. For example, wouldn't everyone want to northwestern in chicago? These top hospitals are always in well off areas of the the city. Wouldn't this be inequitable? Would govt interfere and make sure that these top hospitals are distributed equitably ?
  • hayst4ck 6y ago
    An argument that I find compelling is that the government is obviously corrupted by corporate influence. If you can find a talk on healthcare.gov by Mikey Dickerson, it's pretty alarming. Basically, the government attempted to run a website, they sent out to contractors for help, 100 contractors returned, and 100 contractors were glued together to create a non functioning website. Obama, embarrassed by this, came to silicon valley to ask top engineers at Facebook and Google to come fix the site. These engineers heeded the country's call for help, came in, and unfucked the website, largely by telling 90% of the contractors to fuck off. Now do you really want a government that can't run a basic website because they can't hire industry professionals at competitive pay to build it, but instead contracts out to businesses in a corrupt an ineffective way, to be running this? Corporate influence is so strong in America, and institutions have gotten so weak, it's hard to argue that OUR government can run this type of program. Especially considering half the country doesn't want it and won't hold the government accountable for it. Our situation is vastly more complex because of the American attitude on tax. "Taxes is theft" is a pretty common sentiment. The instant tax is involved 90% of Americans will hate the administration in power. So if you laid out a road map: 1. Convince the public you can do it 2. Convince the public they should pay for it 3. Actually implement it 4. Keep doctors and patients both happy How confident do you feel about any one of those points? I honestly don't feel confident about any of them. The only compelling argument against this line of thought is that most of the western world has done it successfully. What I am confident about is that we have to solve the American corruption problem before we can solve the healthcare problem.
  • hattmall 6y ago
    It's basically just profit. There's more money to be made by a system of price discrimination than there is by a system of universal healthcare. If you want to look at the root political cause the blame here lies squarely with the Democrats and Obama Administration. Prior to the passage of the ACA the prevailing consensus was for the Healthy Americans act. Look it up. Look at the Co-Sponsors, very much bipartisan, and very much universal healthcare. If not for the ACA americans would have had Universal Healthcare 10 years ago. The #1 thing that must be done is the decoupling of insurance from employment. The HAA does this and provides universal basic coverage, while still maintaining a private market for certain levels. It also still allows employers to contribute towards healthcare but in a much more transparent way. Right now, employers have a massive advantage in regards to healthcare as a benefit because they can offer you a plan that may cost them only $100 a month, but if you, on your own outside of your employers group policy attempt to purchase a similar plan it would likely cost $1000+ a month. Enacting universal healthcare in the US is not some impossible dream. It's a fairly straightforward process laid out decades ago and very nearly implemented in 2009. Detach insurance from employment, eliminate coverage groups entirely, all private insurance companies have to pool all customers into the same group. The government also underwrites certain types of coverage for these companies, mainly preventive and catastrophic. The government then offers a competing product to consumers. It is defaultly given to every citizen, paid for via taxes. If you choose to go to a private company you can get a tax credit for a certain portion of premium paid. There is no billing of customers, providers bill the government, the government can then in turn bill private insurers if a person is covered. Certain services may be a la carte per the private insurance. For example if you want expanded services not covered by the government policy, like more days in skilled nursing, physical therapy appointments, cosmetic, etc.
  • blendo 6y ago
    Two additional reasons I’ll submit: 1 The American Medical Association has long opposed it, and that org still maintains a halo of virtue 2 Democrats want it, so many Republicans reflexively oppose it
• centimeter 6y ago
  > It is clearly more economically efficient to treat malignant cancers earlier. This is not necessarily the case, because additional screening has costs - both direct costs of running the screening, but also hidden costs like costs associated with false positives (which represent the vast majority of cancer diagnoses). For example, we realized recently that for many years we had been too aggressively encouraging women to get breast cancer screenings, and it ended up not being socially optimal due to the high cost and false positive rate.
  • DanBC 6y ago
    Frustrating that you got downvoted. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recomme... > The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years. > . For women who are at average risk for breast cancer, most of the benefit of mammography results from biennial screening during ages 50 to 74 years. Of all of the age groups, women aged 60 to 69 years are most likely to avoid breast cancer death through mammography screening. While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger. The balance of benefits and harms is likely to improve as women move from their early to late 40s. > . In addition to false-positive results and unnecessary biopsies, all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime (known as "overdiagnosis"). Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent overtreatment. > . Women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s. > Go to the Clinical Considerations section for information on implementation of the C recommendation. Here's a page that details the false negative rates for this type of screening: https://www.uspreventiveservicestaskforce.org/uspstf/document/evidence-summary-false-positive-and-false-negative-rates-of-/breast-cancer-screening#bootstrap-panel--5 https://www.uspreventiveservicestaskforce.org/uspstf/documen... > Data based on results from a single screening round for women regularly receiving digital mammography indicated that false-positive results were common in all age groups (Table 1). The rate was highest among women aged 40 to 49 years (121.2 per 1000 women [95% CI, 105.6 to 138.7]) and decreased across age groups (P < 0.001). Rates of false-negative mammography results tended to increase with age, ranging from 1.0 to 1.5 per 1000 women, but did not statistically significantly differ across age groups. > For women with initially positive mammography results, rates of recommendations for additional imaging were highest among those aged 40 to 49 years (124.9 per 1000 women [CI, 109.3 to 142.3]) and decreased with increasing age (P < 0.001). Rates of recommendations for biopsy did not statistically significantly differ across age groups and ranged from 15.6 to 17.5 per 1000 women. > Rates of invasive breast cancer were lowest among women aged 40 to 49 years (2.2 per 1000 women [CI, 1.8 to 2.6]) and increased across age groups (P < 0.001). Rates of ductal carcinoma in situ also were lowest among women aged 40 to 49 years (1.6 per 1000 women [CI, 1.3 to 1.9]) and increased with age (P = 0.055). Women aged 70 to 79 years had the highest rates of invasive cancer (7.2 per 1000 women [CI, 6.4 to 8.1]) and ductal carcinoma in situ (2.3 per 1000 women [CI, 1.7 to 3.0]). Consequently, the yield of screening was more favorable for older women. For every case of invasive breast cancer detected by mammography screening in women aged 40 to 49 years, 464 women had mammography, 58 were recommended for additional imaging, and 10 were recommended for biopsy. In contrast, for women aged 70 to 79 years, for every case of invasive breast cancer detected by screening, 139 women had mammography, 11 were recommended for additional imaging, and 3 were recommended for biopsy.
• bluedino 6y ago
  A big part of it, for a lot of older people, is they will not go to the doctor, for various reasons. Religion, fear, stubbornness, ignorance... Even if they have Medicare. Try to get your old cranky uncle to go for yearly physical, much less a prostate exam. Some people refuse to take their heart medication, or insulin, etc. My father in law had a mild stroke and refused to go back for his checkups after. It’s tough to reason with them. Plenty of them can put off going in until they’re either forced to by relatives, or have an emergency. And a lot of times it’s too late by then.
  • frankbreetz 6y ago
    I don't see how this relates to a jump in medical treatment at 65
  • vlovich123 6y ago
    In case you're wondering why you got downvoted, my guess is that people have the following trivial counterargument. Even if all of that is true, that wouldn't explain the specific jump at 65. That's clear evidence that people want the medical treatment but it's not available to them without Medicare.
    • throwaway0a5e 6y ago
      The jump at 65 is likely in part because it's the official definition of old for basically everything in the US and it's a lot harder to justify being in denial about needing to see the doctor from that point forward.
    • deleted 6y ago
      [deleted]
  • DanBC 6y ago
    > much less a prostate exam What's the point of a prostate exam? Prostate screening doesn't save life, and it causes harm. People may want to do it if they know they have risk factors, but otherwise it's not recommended. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/recomme... > For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening. The advice for people 70 or older is stronger: The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older.
• lifeformed 6y ago
  > It is clearly more economically efficient to treat malignant cancers earlier. We (Americans) all end up paying more with the perverse system we have. Maybe it turns out that we're all actually saving money by having undiagnosed people die off early instead of paying for preventative care for everyone.
  • 650REDHAIR 6y ago
    I thought of that while reading the title and I didn't like it. :(