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> I cannot comprehend why anyone would be against health care for all I think context is important here. Everyone, absolutely everyone, wants healthcare for a

> 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.

FireBeyond 6y ago
My thoughts, as a healthcare professional, who has lived in Scotland, Australia and now the US, and has worked for software companies who develop line of business apps for healthcare companies, and health insurance companies: > 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. Because up until that point, insurers had diligently been kicking people with any pre-existing conditions off insurance, and sharing that information with other insurers so you couldn't get coverage anywhere. Blame the insurer, not the ACA. > It is vital to also understand that Medicare has serious issues. In a nutshell, it isn't insurance. It's as vital to realize that healthcare insurance in the US isn't insurance either. It's amortized and bulk buying discounts for your healthcare. Hence not just deductibles, but copays, coinsurance, maximums, etc. All of these things are in place to ensure that you never become an unrecoupable weight to the insurer. That we have health "insurance", in the US, is one of the biggest cons. > 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. Doctors contribute to this. They also order piles of unnecessary tests when they, entirely coincidentally, happen to own DI (diagnostic imaging) equipment, facilities. In fact it's such a profitable way to "invest" for medical professionals that DI companies will help you find likeminded doctors to pool up with, will offer you guaranteed ROI, and will finance the purchase of the equipment, walk you through Certificate of Need processes where applicable. And then we wonder why doctors who own such stakes order in the order of two standard deviations more DI for their patients...
- robomartin 6y ago
  > Because up until that point, insurers had diligently been kicking people with any pre-existing conditions off insurance, and sharing that information with other insurers so you couldn't get coverage anywhere. Yes, and that's an opportunity for sensible regulation. For example, when you buy auto insurance there's a small amount added-on for "uninsured motorists". That's fine. That works. And that does not triple your insurance costs. In addition to this, no, the ACA did not fix this at all. All they did was throw people into Medicaid/Medicare. It is a false equivalency. Medicare/Medicaid isn't insurance and it does not provide the same level of care that real insurance does. There are doctors who flat-out refuse to see Medicare patients because they would have to provide that care at a loss. There's a fairness element here that I guess I don't understand why you might have trouble with. Let's extrapolate my family's health insurance costs out to ten years so we get a sense of the scale of the damage done by the ACA. In round numbers, it means over $200K. Yes, over $200K in costs from the ACA. Prior to ACA, about a third of that, less actually, because right now the ACA is doing shit for us due to the high deductibles. We are paying over $200K NOT to use something. This is insanity. And what it means, among other things, is that my wife's office will not see Medicare patients if they can help it. Every single employee's insurance has doubled or tripled. Their costs have gone up tremendously just on that front. I think their health insurance costs are in the half million dollars per year range. Over $200K in ten years for something we don't use because the deductibles are so high we have to pay cash. That is punitive. That is far from "healthcare for all". That is deeply discriminative. This kind of money represents a number of things, such as a secure retirement, paying for kids college, and just being able to save for rainy days (or pandemics). > That we have health "insurance", in the US, is one of the biggest cons. Agreed! And who sets the rules? Government. And who fucked it up? Government. And now we want to trust them with the entire system? C'mon. What we need is for a deep review of the equations that govern this industry, from student loan guarantees to tort reform, FDA costs and more. I am not delusional enough to think this will ever happen. Politicians don't tend to fix things unless they have to. Happy people are far less motivated to vote for someone than people who remain angry at a situation that can be blamed on the person they are running against. That's why nothing is ever fixed. From a political perspective it is far better to have a bunch of angry poor people than to truly work towards fixing the problem. Votes are king. Our political system is broken. It exists for our politicians, not the people or the nation. Yes, we need government, but what we have has devolved into a beast that works for itself and not us.

FireBeyond 6y ago

My thoughts, as a healthcare professional, who has lived in Scotland, Australia and now the US, and has worked for software companies who develop line of business apps for healthcare companies, and health insurance companies: > 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. Because up until that point, insurers had diligently been kicking people with any pre-existing conditions off insurance, and sharing that information with other insurers so you couldn't get coverage anywhere. Blame the insurer, not the ACA. > It is vital to also understand that Medicare has serious issues. In a nutshell, it isn't insurance. It's as vital to realize that healthcare insurance in the US isn't insurance either. It's amortized and bulk buying discounts for your healthcare. Hence not just deductibles, but copays, coinsurance, maximums, etc. All of these things are in place to ensure that you never become an unrecoupable weight to the insurer. That we have health "insurance", in the US, is one of the biggest cons. > 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. Doctors contribute to this. They also order piles of unnecessary tests when they, entirely coincidentally, happen to own DI (diagnostic imaging) equipment, facilities. In fact it's such a profitable way to "invest" for medical professionals that DI companies will help you find likeminded doctors to pool up with, will offer you guaranteed ROI, and will finance the purchase of the equipment, walk you through Certificate of Need processes where applicable. And then we wonder why doctors who own such stakes order in the order of two standard deviations more DI for their patients...

robomartin 6y ago
> Because up until that point, insurers had diligently been kicking people with any pre-existing conditions off insurance, and sharing that information with other insurers so you couldn't get coverage anywhere. Yes, and that's an opportunity for sensible regulation. For example, when you buy auto insurance there's a small amount added-on for "uninsured motorists". That's fine. That works. And that does not triple your insurance costs. In addition to this, no, the ACA did not fix this at all. All they did was throw people into Medicaid/Medicare. It is a false equivalency. Medicare/Medicaid isn't insurance and it does not provide the same level of care that real insurance does. There are doctors who flat-out refuse to see Medicare patients because they would have to provide that care at a loss. There's a fairness element here that I guess I don't understand why you might have trouble with. Let's extrapolate my family's health insurance costs out to ten years so we get a sense of the scale of the damage done by the ACA. In round numbers, it means over $200K. Yes, over $200K in costs from the ACA. Prior to ACA, about a third of that, less actually, because right now the ACA is doing shit for us due to the high deductibles. We are paying over $200K NOT to use something. This is insanity. And what it means, among other things, is that my wife's office will not see Medicare patients if they can help it. Every single employee's insurance has doubled or tripled. Their costs have gone up tremendously just on that front. I think their health insurance costs are in the half million dollars per year range. Over $200K in ten years for something we don't use because the deductibles are so high we have to pay cash. That is punitive. That is far from "healthcare for all". That is deeply discriminative. This kind of money represents a number of things, such as a secure retirement, paying for kids college, and just being able to save for rainy days (or pandemics). > That we have health "insurance", in the US, is one of the biggest cons. Agreed! And who sets the rules? Government. And who fucked it up? Government. And now we want to trust them with the entire system? C'mon. What we need is for a deep review of the equations that govern this industry, from student loan guarantees to tort reform, FDA costs and more. I am not delusional enough to think this will ever happen. Politicians don't tend to fix things unless they have to. Happy people are far less motivated to vote for someone than people who remain angry at a situation that can be blamed on the person they are running against. That's why nothing is ever fixed. From a political perspective it is far better to have a bunch of angry poor people than to truly work towards fixing the problem. Votes are king. Our political system is broken. It exists for our politicians, not the people or the nation. Yes, we need government, but what we have has devolved into a beast that works for itself and not us.