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> The rest of the developed world isn't a monolith. Singapore, Switzerland, the UK, Denmark, Germany, and the Netherlands all have wildly different healthcare s

> The rest of the developed world isn't a monolith. Singapore, Switzerland, the UK, Denmark, Germany, and the Netherlands all have wildly different healthcare systems, but all produce fairly good outcomes! All have dramatically different levels of privatization, market mechanisms, and welfare generosity. This is why I'm interested why so many people are obsessed with the idea that we need to completely burn down our system and start anew to improve it.

JohnFen 5y ago
> why so many people are obsessed with the idea that we need to completely burn down our system and start anew to improve it. I'm not only not obsessed with the idea, but I'm not sure that would be a desirable way to go. That said, the healthcare system in the US is way beyond broken, and I don't see how it can possibly be fixed by half measures. Something really drastic is required. It's not hard to see why some people reach the "burn it all down" position.
- bhupy 5y ago
  Depends on what you mean by "half measures". One way we can dramatically improve the status quo is by decoupling health insurance from employment (effectively bringing the US to parity with Switzerland). Tactically speaking, it could conceivably be achieved by enacting a series of what some might consider "half measures": - Simply getting rid of the Federal employer mandate as well as the payroll tax deductibility for group health insurance premiums could go a long way. A lot of employers really don't want to be in the business of hiring monster HR teams that spend the majority of their time becoming health insurance experts... - Expanding ICHRAs (https://news.ycombinator.com/item?id=22527102 https://news.ycombinator.com/item?id=22527102) can also go a long way.
  - username90 5y ago
    Making it illegal for health insurance companies to discriminate based on employment status would be a good first step. This includes not being allowed to giving rebates to company plans. Such a law would have popular support, but probably will never be done since politicians are friends with the insurance companies who needs the costs to be opaque.
- iammisc 5y ago
  What is broken about it really? Having been insured my whole life, I've never dealt with hospital issues, and we've had several major medical events (complicated pregnancies mainly, lots of time in the emergency room, etc). For the most part, I pay the max out-of-pocket every year, and then I pay nothing more. It's not particularly difficult to deal with. The only annoying part is after your first ER / doctor visits each year, you end up with a bunch of different random charges from people that you have to pay separately. It's an annoyance, but hardly one that requires us to 'burn it all down'. This year I have an HDHP and an HSA, so I have more of those, but I also have an HSA. As an example, my wife's first pregnancy probably cost about $200k nominally, but I paid... $2000-3000 at most. The only real 'issue' I see is the tying of health insurance to employment, but there are straightforwards ways to get around that (federal incentives to purchase your own health insurance, and then employers can pass along savings so employees can purchase themselves). For me, I've never been unemployed longer than COBRA so it's not been an issue. There are a lot of good things about America's system. My wife's pregnancies are extremely complicated. Many doctors said to give up. However, we searched and searched for a doctor to help, and we figured out what works. Basically, for unknown reasons (although many plausible ones that cannot be confirmed), she needs to take an expensive blood thinner during pregnancy or the baby dies. Since her tests don't come back for the 'standard' conditions this works for, it is difficult finding a doctor willing to prescribe. In fact, we didn't even know it was an option, until we went all over the country to various experts. Due to the free market, we were able to get to these experts in a matter of weeks. Similar experts in countries with socialized systems have long queues. When it comes to the medication, due to the fact that we are the ones that pay (via insurance), not the government, as long as we can pay, we can continue to live our lives and have our children. Based on our conversations with other women in my wife's position in countires with socialized medicine, they have to really advocate for themselves in ways we do not in order to get their government to even provide the medication or pay for it. Many wait months before they are able to get someone. Every once in a while the government revokes access because some bureaucrat says it's not medically indicated. We've never had that. Should her doctor decide to do that and sentence our child to certain death, we have several backup doctors willing to prescribe the medication. Some moms in other countries we're in contact with have been cut off from the medication and subsequently had miscarriages in the second or third trimester. This is insane. I'm glad to live here. We recently moved, and just scheduled a bunch of appointments and asked the doctors point blank whether they'd consider it based on her history. Some said no, others said yes. In a few weeks, we figured out what her friend over in Canada took many, many months to figure out. When it comes to pregnancy, months matter. 24 months of waiting can drastically change the spectra of outcomes in a women's pregnancy, especially given the age at which many women have children these days. Same with things like surgeries and such. My relatives in countries with socialized care are waiting many months for things Americans get in a few days.
jellicle 5y ago
You have to burn down the current system no matter which other system you have your eyes on as a desirable goal. The reason is simple: the system fights change.
username90 5y ago
Since everyone else seems to do better chances really high that burning it and just doing anything at all would be better than what we have today.
spaetzleesser 5y ago
"This is why I'm interested why so many people are obsessed with the idea that we need to completely burn down our system and start anew to improve it." I don't see how the current system can be reformed realistically. There are way too many well funded groups who benefit from the current situation and will fight any kind of change tooth and nail. In my view Medicare for All is the only realistic path. It works already and could be tweaked to accept more people. Unfortunately Biden doesn't want it so that opportunity is gone for the next decades probably.
- bhupy 5y ago
  > In my view Medicare for All is the only realistic path. > Unfortunately Biden doesn't want it so that opportunity is gone for the next decades probably. These two sentences are at odds with one another.
  - spaetzleesser 5y ago
    Why are they at odds?
    - bhupy 5y ago
      Because it’s obviously not the most realistic path if it has no hope of passing “for the next decades”. There are clearly other more realistic paths, in that case.
      - shoemakersteve 5y ago
        Wow, it's a good thing you caught that or else people may have been mislead. Phew. Crisis averted. We're lucky there are people as pedantic as you around.
      - spaetzleesser 5y ago
        It’s a path that has a very realistic implementation because all the systems are there already. Name another more realistic path besides leaving things the way they are and keeping f…ing over the country with outrageous costs.

JohnFen 5y ago

> why so many people are obsessed with the idea that we need to completely burn down our system and start anew to improve it. I'm not only not obsessed with the idea, but I'm not sure that would be a desirable way to go. That said, the healthcare system in the US is way beyond broken, and I don't see how it can possibly be fixed by half measures. Something really drastic is required. It's not hard to see why some people reach the "burn it all down" position.

bhupy 5y ago
Depends on what you mean by "half measures". One way we can dramatically improve the status quo is by decoupling health insurance from employment (effectively bringing the US to parity with Switzerland). Tactically speaking, it could conceivably be achieved by enacting a series of what some might consider "half measures": - Simply getting rid of the Federal employer mandate as well as the payroll tax deductibility for group health insurance premiums could go a long way. A lot of employers really don't want to be in the business of hiring monster HR teams that spend the majority of their time becoming health insurance experts... - Expanding ICHRAs (https://news.ycombinator.com/item?id=22527102 https://news.ycombinator.com/item?id=22527102) can also go a long way.
- username90 5y ago
  Making it illegal for health insurance companies to discriminate based on employment status would be a good first step. This includes not being allowed to giving rebates to company plans. Such a law would have popular support, but probably will never be done since politicians are friends with the insurance companies who needs the costs to be opaque.
iammisc 5y ago
What is broken about it really? Having been insured my whole life, I've never dealt with hospital issues, and we've had several major medical events (complicated pregnancies mainly, lots of time in the emergency room, etc). For the most part, I pay the max out-of-pocket every year, and then I pay nothing more. It's not particularly difficult to deal with. The only annoying part is after your first ER / doctor visits each year, you end up with a bunch of different random charges from people that you have to pay separately. It's an annoyance, but hardly one that requires us to 'burn it all down'. This year I have an HDHP and an HSA, so I have more of those, but I also have an HSA. As an example, my wife's first pregnancy probably cost about $200k nominally, but I paid... $2000-3000 at most. The only real 'issue' I see is the tying of health insurance to employment, but there are straightforwards ways to get around that (federal incentives to purchase your own health insurance, and then employers can pass along savings so employees can purchase themselves). For me, I've never been unemployed longer than COBRA so it's not been an issue. There are a lot of good things about America's system. My wife's pregnancies are extremely complicated. Many doctors said to give up. However, we searched and searched for a doctor to help, and we figured out what works. Basically, for unknown reasons (although many plausible ones that cannot be confirmed), she needs to take an expensive blood thinner during pregnancy or the baby dies. Since her tests don't come back for the 'standard' conditions this works for, it is difficult finding a doctor willing to prescribe. In fact, we didn't even know it was an option, until we went all over the country to various experts. Due to the free market, we were able to get to these experts in a matter of weeks. Similar experts in countries with socialized systems have long queues. When it comes to the medication, due to the fact that we are the ones that pay (via insurance), not the government, as long as we can pay, we can continue to live our lives and have our children. Based on our conversations with other women in my wife's position in countires with socialized medicine, they have to really advocate for themselves in ways we do not in order to get their government to even provide the medication or pay for it. Many wait months before they are able to get someone. Every once in a while the government revokes access because some bureaucrat says it's not medically indicated. We've never had that. Should her doctor decide to do that and sentence our child to certain death, we have several backup doctors willing to prescribe the medication. Some moms in other countries we're in contact with have been cut off from the medication and subsequently had miscarriages in the second or third trimester. This is insane. I'm glad to live here. We recently moved, and just scheduled a bunch of appointments and asked the doctors point blank whether they'd consider it based on her history. Some said no, others said yes. In a few weeks, we figured out what her friend over in Canada took many, many months to figure out. When it comes to pregnancy, months matter. 24 months of waiting can drastically change the spectra of outcomes in a women's pregnancy, especially given the age at which many women have children these days. Same with things like surgeries and such. My relatives in countries with socialized care are waiting many months for things Americans get in a few days.

jellicle 5y ago

You have to burn down the current system no matter which other system you have your eyes on as a desirable goal. The reason is simple: the system fights change.

username90 5y ago

Since everyone else seems to do better chances really high that burning it and just doing anything at all would be better than what we have today.

spaetzleesser 5y ago

"This is why I'm interested why so many people are obsessed with the idea that we need to completely burn down our system and start anew to improve it." I don't see how the current system can be reformed realistically. There are way too many well funded groups who benefit from the current situation and will fight any kind of change tooth and nail. In my view Medicare for All is the only realistic path. It works already and could be tweaked to accept more people. Unfortunately Biden doesn't want it so that opportunity is gone for the next decades probably.

bhupy 5y ago
> In my view Medicare for All is the only realistic path. > Unfortunately Biden doesn't want it so that opportunity is gone for the next decades probably. These two sentences are at odds with one another.
- spaetzleesser 5y ago
  Why are they at odds?
  - bhupy 5y ago
    Because it’s obviously not the most realistic path if it has no hope of passing “for the next decades”. There are clearly other more realistic paths, in that case.
    - shoemakersteve 5y ago
      Wow, it's a good thing you caught that or else people may have been mislead. Phew. Crisis averted. We're lucky there are people as pedantic as you around.
    - spaetzleesser 5y ago
      It’s a path that has a very realistic implementation because all the systems are there already. Name another more realistic path besides leaving things the way they are and keeping f…ing over the country with outrageous costs.