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I don't understand how people can be so anti-universal healthcare in the US. When you have an $8k deductible, your insurance is basically a gift to the CEO's ya

I don't understand how people can be so anti-universal healthcare in the US. When you have an $8k deductible, your insurance is basically a gift to the CEO's yacht fund.

minikites 5y ago
The people who are against universal healthcare usually pitch it as an argument for "choice", as if I'm going to compare prices when I have a ruptured appendix. It's also usually couched in anti-government sentiment, where they draw comparisons to "lines at the DMV", as if other countries with universal healthcare have people dying while waiting in line for care, something that also doesn't happen.
- yerwhat01010 5y ago
  > as if other countries with universal healthcare have people dying while waiting in line for care This absolutely does happen in the UK, although I'd pick our health over the US's any day of the week.
  - avianlyric 5y ago
    It's also worth mentioning that private health care and insurance both exist in the UK. Individuals still get the choice to go to any private doctor they want, they'll just have to pay for it themselves. Just like the US, except the NHS provides an excellent safety net for everyone without private insurance or the means to pay for private care.
    - arethuza 5y ago
      In most cases its the same doctors working in private hospitals and for the NHS.
      - Silhouette 5y ago
        And in some cases it involves NHS facilities too. There are definitely some questionable aspects of our public/private healthcare. But again, this isn't always how it works, and the ethics involved are also complicated.
        arethuza 5y ago
        I know someone whose condition rapidly deteriorated while receiving treatment in a private hospital and when things were looking really bad they got transferred to an NHS hospital.
        Silhouette 5y ago
        I hope the person you know was OK. That transfer is actually not surprising. Emergency/intensive care is almost always NHS here. Private options tend to be better in situations like having multiple treatments available where one is significantly more effective or more reliable but also costs a lot more. Sometimes the NHS will only offer a cheaper but inferior alternative, which sounds horrible until you think that there is a huge but ultimately pooled budget and any time policy allows more spending on one treatment there is always someone losing out somewhere else.
    - CountDrewku 5y ago
      The US has safety nets as well, they're just not as generous as the UK's.
  - Silhouette 5y ago
    Agreed on both points. The UK system is far from perfect but for balance we should also say that it is not normal or expected for something as bad as that to happen here. Even in recent times, with the extra pressures of COVID, critical care has mostly kept up and the emergency overflow facilities that were built very quickly in case of overwhelming demand mostly went unused. Obviously there will always be limits and the available resources will run out if one of them is reached. In the aftermath of a major incident or an unusually busy period it can happen. I expect a lot of us from the UK might agree that the limits need to be raised further by investing more into the NHS. But I would still choose this type of system over a US-style one every time. I've never heard of anyone here dying because they couldn't afford tens of thousands for routine medication to treat a common condition.
- deleted 5y ago
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- Y_Y 5y ago
  I'm a big fan of universal healthcare, and have made great use of both public and private hospitals in Europe and the US. Everywhere I've lived (except the US) has had a totally free public system, and every time I've still paid for private insurance. I'm not rich by any means, and I don't have any particularly special requirements. I'm not even looking for better doctors or machines, since they are mostly shared or equivalent between public and private care. The only reason it's worth it for me to spend money on private insurance is waiting times. On the private system, I can see a consultant in one month instead of six, or get a surgery in three months instead of three years. This is all for non-emergency care of course. There are lots of elderly people waiting on operations like hip replacement on the public system, and it's expected that some will die before their turn comes up. It's a compromise that's built into the way the government operates their national health system. It not obviously the wrong way to do things, since carrying out all these operations would be very expensive and have limited benefit in terms of quality and quantity of life. It also sucks for the people waiting, especially since others who can afford to skip the line by paying (usually through private insurance) may even be seen by the same surgeon in the same OR. I don't mean to argue for or against this system, but just to point out that people often die waiting for (non-emergency) care in at least several large public healthcare systems in highly-developed countries in Europe.
  - hef19898 5y ago
    The countries I have direct experience with, France and Germany, don't have any issues with people dying while waiting for procedures. Experts are usually readily available, so there are exceptions. I don't know of any public health care system in developed countries that have really these issues. I do know so, that a lot of that comes from a PR campaign run by US insurances against the Canadian system.
    - Y_Y 5y ago
      When you say they don't have any issues, do you mean it doesn't happen? I'm more familiar with the Spanish, Irish and UK systems. I tried to find a nice document giving numbers for what I was describing, but most of what I can find is anecdotal, and the official reports are weren't quantitative. Here's an article from an Irish newspaper last year that gives a rough guess (though of course there are other factors): https://www.irishtimes.com/news/health/are-patient-waiting-lists-shrinking-for-the-right-reasons-1.4147197 https://www.irishtimes.com/news/health/are-patient-waiting-l... I'm certainly open to US insurance companies paying me to shill on hn against Canadian healthcare, but right now I'm only saying these things out of the goodness of my heart.
inglor_cz 5y ago
Single payer healthcare systems in Europe were introduced a long time ago. Back then, politics was different, not least because of an imminent threat of the Soviet Bloc just around the corner and a need to answer it by "carrot", too, not just "stick". They are now status quo, but in another version of history, where such systems would have to be introduced today, I am not certain whether they could clear the political obstacles, much like the U.S.
- js2 5y ago
  Efforts at introducing single-payer healthcare in the U.S. go back at least as far as 1935. https://www.healthcare-now.org/legislation/national-timeline/ https://www.healthcare-now.org/legislation/national-timeline...
- intsunny 5y ago
  As an American who immigrated to Europe four years ago, I disagree that modern-Europe would not be able to recreate their healthcare systems under today's polticial climate. Ironically it is because of the USA that many Europeans are keenly aware of the davistating consequences of allowing for a hyper-capitalistic approach to healthcare. People here often assume the worst about that system, and are completely bewildered when I tell them how it actually works. (Especially in regards to having children, parental leave, and childc care.)
- hef19898 5y ago
  Social security nets in Europe date back to time we used to have Emperors and Kings, before WW1. They are thus older than the USSR.
  - qwytw 5y ago
    Bismarck mainly introduced some rudimentary social security to decrease worker support for socialist parties, so it was a reaction to socialism (albeit not directly the USSR) from the start. However before WW2 it was very limited in all countries (and much smaller scale than for example what's currently available in the US) before the 40's and 50's.
  - 5y ago
tiahura 5y ago
Your comment misses the point. There are two reasons why this bill is so high: 1. Some doctors and some hospitals are make tremendous amount of money - hospital revenue is about $1T and doctor revenue is about .5T. 2. This country has an insatiable demand for expensive healthcare. There’s no country with universal coverage where a child with little chance for survival would have received this level of care.
- Jenk 5y ago
  The UK gives this level of care to many people routinely.
  - hef19898 5y ago
    As do France and Germany.
    - tiagod 5y ago
      Portugal too. Our system is far from perfect (the best medication is sometimes prohibitively expensive for some people who really need it - chronic patients, pensioners) but there are many examples of our national health system investing heavily in particular individuals with little chance for survival. A recent example is health system paying for Zolgensma, the most expensive medication in the world, leading to millions of expense per year[1][2] on this medication alone for a very small amount of babies. [1] https://tvi24.iol.pt/sociedade/saude/estado-gastou-4-1-milhoes-de-euros-em-medicamento-para-a-atrofia-muscular-espinal https://tvi24.iol.pt/sociedade/saude/estado-gastou-4-1-milho... [2] https://www.politico.eu/article/europe-eyes-arrival-of-worlds-priciest-drug/ https://www.politico.eu/article/europe-eyes-arrival-of-world...
  - simonh 5y ago
    It also does so to anyone who needs it regardless of ability to pay, and at overall half the cost of health care per person in the population compared to the US. You can also still pay for enhanced private health care if you want.
  - 5y ago
adrianN 5y ago
Whether or not a policy with a deductible like that is a gift to the CEO's yacht fund depends on the monthly payments and is, imho, orthogonal to a discussion about universal healthcare.
- _huayra_ 5y ago
  Considering how hard they actually fight when you actually have to get care (e.g. having the doctor submit tons of justification that you actually need the required treatment vs. some half-assed cheaper approach), I don't think the monthly payments actually matter.
wang_li 5y ago
The US has universal care, it passed in 2009 and it establishes that everyone does their part and buy insurance. It establishes help for low income individuals. There are caps on annual expenses. You may not like how it’s structured. You may not like the amount that people are expected to pay. But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations. And I’m fine with that.
- ceejayoz 5y ago
  > But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations. The folks at the poverty line with a "free" fully subsidized Bronze ACA plan has an enormous deductible that may be $6-12k before that coverage actually starts paying out. The ACA's max out-of-pocket for a family in 2021 is $17,100. (https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...) That's not meaningful access to healthcare for someone making $30k a year.
  - only_as_i_fall 5y ago
    And people wonder why the us has such poor health outcomes
  - leesalminen 5y ago
    My uncle-in-law just signed up for health insurance under ACA in Colorado. He pays a $22/mo premium and has a $700 max out of pocket. Yes, 2 zeros. I was totally shocked but I reviewed all his paperwork and it’s true. Meanwhile I’m paying $1,200/mo for a young and healthy family of 3 with a $7,000 max out of pocket.
  - wang_li 5y ago
    Out of pocket expenses for any individual is capped $8550 regardless of whether they have family coverage or individual coverage. Additionally, those earning less than 250% the federal poverty level qualify for additional cost sharing reductions (CSR) which dramatically lower the out of pocket expenses, e.g deductibles and copays. Details will vary but a family of four with a household income of $30k with CSR would have their deductible reduced to a few hundred dollars and annual out of packet caps also to the hundreds of dollars range. The same plan without CSR might have a $7000 deductible. But CSR is available in the situation you describe. http://www.healthreformbeyondthebasics.org/cost-sharing-charges-in-marketplace-health-insurance-plans-part-2/ http://www.healthreformbeyondthebasics.org/cost-sharing-char... Regardless, this is arguing over the burden that Obama, Pelosi, et. al. decided was appropriate for Americans. It's not a question of whether there is universal health care in the US. There undeniably is.
IG_Semmelweiss 5y ago
There are really bad things with the current system, but you asked a question. People are exposed on a regular basis to the DMV, the SBA, to Social Security or to Medicare. Then they compare that experience with the avg experience with a commercial insurer, and it does feel like a better experience (of course, if their employer can afford it) Worse, there are stories of friends in places like CAN, where insider doctors hurriedly email their friends about a new doctor X that is available for appointments, in order to skip a 6 month wait... The system in the US is a mess, but those people reason that its the least worst option of the available choices. If they could be given a 3rd or 4th choice, like for example, make take health insurance companies and turn them into public utilities so the "CEO" is not getting his "yatch fund" from taxpayers, that's worth talking about (as longas you don't forget to look to CA, and their wonderful brownouts + utility-enabled wildfires)
- js2 5y ago
  > People are exposed on a regular basis to the DMV, the SBA, to Social Security or to Medicare. Then they compare that experience with the avg experience with a commercial insurer, and it does feel like a better experience (of course, if their employer can afford it) That’s not what surveys show: > Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all. https://news.gallup.com/poll/186527/americans-government-health-plans-satisfied.aspx https://news.gallup.com/poll/186527/americans-government-hea... CMS also publishes assessments of its own performance: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS https://www.cms.gov/Research-Statistics-Data-and-Systems/Res...
  - iammisc 5y ago
    Selection effects. The poor and elderly are likely to be on Medicare and other public programs. If you can't afford healthcare and get it for free of course you'll be happy It's like my charcoal Weber. I found it on the side of the road. Its dirty, dinged, and the wheels are falling off. But it was free and I can grill on it, so I'm extremely happy with it On the other hand if I paid for a Weber and got that, I'd be pissed.
nodejs_rulez_1 5y ago
At least with some caveats, like less funds for 35+ year old parents.
cmrdporcupine 5y ago
There are many problems with our Canadian system, it's certainly not perfect. And single payer is not the only way to approach this problem. But I'm overall happy with its compromises in our system. Like any economic resource, it's rationed. But it's rationed, generally, on the basis of need. And that "from each according to their abilities to each according to their needs" philosophy may be the ideological curse on it that will prevent it from ever having adoption in the US with its virulent anti-communist past. It would never happen in Canada now, it was a product of the 1960s and early 70s and the way things were then. And it's consistently under threat from its ideological foes here, even if it's immensely popular among the Canadian public. What boggles my mind about the US system is the blatant way it makes working people dependant on employment for health coverage. In a way it's a form of feudalism, tying people physically to their employment.
- minikites 5y ago
  >In a way it's a form of feudalism, tying people physically to their employment. This is a feature, as far as major companies and lobbying organizations are concerned. It's a major reason behind the resistance to universal healthcare because the duress of losing health insurance is the only way some companies keep their employees.
- gruez 5y ago
  >In a way it's a form of feudalism, tying people physically to their employment. uhh, what? Is employment in general "a form of feudalism" because people depend on it to fund their basic needs?
  - WillDaSilva 5y ago
    People can quit their job, and then meet their needs using their savings (if they have any), or welfare. The same is not true for health insurance.
    - gruez 5y ago
      They can't get health insurance on healthcare.gov?
Rucadi 5y ago
There are countries with private healthcare that works (And IS better than public healthcare). The problem is specific to USA.
- gruez 5y ago
  >There are countries with private healthcare that works list them?
  - mabub24 5y ago
    Switzerland has a system that basically works like a beefed up and less hogtied ACA. It's a very heavily regulated private market that would likely not be considered ideal for America, though some have suggested it as an option.
    - _huayra_ 5y ago
      Basically the LaMal basic insurance is not allowed to make a profit, so you get them aggressively trying to upsell you on complementary insurance.
  - iammisc 5y ago
    Israel has a private system with lots of regulations. It is private though
  - pseudoramble 5y ago
    Agreed - I'd like to see the list too, because I'm genuinely interested in trying to find a better health care system than what the US has. I like poking around through here to compare and contrast options: https://www.commonwealthfund.org/international-health-policy-center/system-profiles https://www.commonwealthfund.org/international-health-policy.... Some things I notice mainly are that the countries with private health insurance have at least two other things the US lacks: 1. They provide universal health care. 2. They have regulations of the market. How they go about doing that varies a bit, but I believe these are critical points we miss for all the various reasons we see in this link and in many other discussions on the topic. I think often in the US when we talk about private-sector, we also implicitly also mean for-profit, whereas many of the other options require them to be private non-profits. I think it's notable they are de-prioritized or outright banned, though I'll admit I don't really know if this is a critical detail or not. So I think to the GP point, perhaps this is a way to change private sector options for the better?
xienze 5y ago
> I don't understand how people can be so anti-universal healthcare in the US. Because I have zero faith that it will end up costing me less, and have a similar level of quality. I’m in tech. Combined HHI is something in the $200s. I pay about $300 per month for the entire family, $5K out of pocket max. So in a worst case scenario, let’s say healthcare costs me $9K per year. That’s what, 4% of my HHI? Will a universal healthcare plan hit me via taxes for 4% or less? Fat fucking chance. And again, we’re not even talking about quality of care, just price. In the end, the poor will benefit greatly, the rich will carry on as usual, and people in the middle will get squeezed to death.
- bananapub 5y ago
  yikes, dude.
- gambiting 5y ago
  I....just have no words. Do you really believe everything you wrote? And like....that's probably the worst example of individualism and "me first" attitude I've seen on this website.
  - disgruntledphd2 5y ago
    My favourite assumption is that people with 200k household income are in the middle. Mind you, that kind of belief is super common amongst people (like me) who are in the top decile of income.
- ceejayoz 5y ago
  > Because I have zero faith that it will end up costing me less, and have a similar level of quality. The US spends 2-3x per capita (counting both public and private spending; https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm) than the rest of the OECD, with remarkably similar health outcomes. > I pay about $300 per month for the entire family, $5K out of pocket max. You're just paying your healthcare tax to your employer (in the form of lost salary; they're not chipping in the other $1-2k/month out of charity) instead of the government. It's silly to only count your contribution instead of the overall per-capita cost of healthcare.
failuser 5y ago
$8k deductible might be reasonable if $250k bills are the norm. It is not spoken out loud a lot (more during COVID), but the people who are against universal healthcare are likely pro high birth rate and survival of the fittest (unless they have money, of course).
- EvRev 5y ago
  You need a high birthrate to continue to suppress wages, don't forget about that! Once to population curve starts to flatten out, I do not see private insure prices going down as they will not be able to let go of the profit hence driving prices up higher.
marcinzm 5y ago
I've heard a lot of negative stories about the British health system including people waiting 6+ months to see doctors (while in pain or having other symptoms that lower quality of life significantly). If you think an American universal health system will be somehow better than that then I suspect you're a lot more optimistic about the US government than most people. edit: I do love echo chambers, someone asks a question about why a certain groups thinks a certain way, you answer and you get downvoted. Why bother being on a discussion forum if you don't ever want to hear what the other side sees things as even when directly asked? Especially amusing since I do support universal healthcare but actually try to understand why people oppose it rather than covering my eyes and ears whenever they talk.
- qmmmur 5y ago
  Because it's been decimated by the Tories for ten years now.
  - marcinzm 5y ago
    And the US elected Trump, why do you think the same thing wouldn't happen in the US within a decade?
    - qmmmur 5y ago
      I'm not going to argue hypotheticals,, but even a decimated NHS is far better than the US system.
      - marcinzm 5y ago
        Many American's don't however since they hear the bad stories but are perfectly happy with the care they get under their insurance. Which was the question asked and not "which health system is objectively better."
- adrianN 5y ago
  Shouldn't the point of comparison be the current state of US healthcare, were many people don't get to see a doctor at all because they're uninsured and poor? (Or at least that's the impression I get as an outsider from discussions on the Internet about the topic)
forgingahead 5y ago
The issue is less about coverage and more about the insane, opaque, and fradulent medical care pricing in the US. No other industry has such a black box cost structure to it. Coverage is very important, but it must be done in tandem with cost transparency and freedom to choose different insurance plans.
shados 5y ago
Because in the US, if you're reasonably healthy, employed, live in a city with good hospitals and have private insurance, it "feels" better. It's easier to get better care. I'm Canadian, now living in the US, and I'll be honest: for the first couple of years, where I had some medium sized health issues, the US system felt so much better. The hospital I was treated at was leagues better than anything I saw in Canada. The amount I had to pay on my paychecks was lower than the complementary insurance I had in Canada. I had dental insurance everywhere I worked! My teeth are a trainwreck from the years I didn't have access to good dental insurance). So if someone was to dig in my old social media posts, they'd see my old stance of "I would prefer universal healthcare because its more fair, but if I was only thinking about myself, the US system is better". Then, as anyone who knows better could have predicted, it went downhill and I was proven wrong. If you have something that's hard to diagnose, the insurance starts fighting against you/your provider to get lesser care (eg: getting a full sleep study is super hard because insurance companies will just want you to take a cheap at home sleep apnea test. If you have a sleep disorder that's not sleep apnea, good fucking luck). Some providers will not talk to you if they're not in contract with your insurance. Good luck getting behavioral health care. Lots of clinics are in bed with very specific insurance, and will not even take self pay. So you have to call 15 of them because even the ones on your insurer's website may not want to speak with you. The paperwork. Holy shit the paperwork. I had surgery once, and I was still getting bills for it 6 months later. SO MANY BILLS. Some of them were absolute bullshit, but who has time to call insurance and hospitals over and over and over to fight every single one when there's douzens for a single procedure. So I just paid the co-insurance fees and suck it up. I never had a way to tell when I was getting "the last bill". In the end, I'm reasonably well off, and I have pretty much the best insurance one can have (no deductible, no employee contribution on paycheck, covers virtually everything), and it's STILL a pain in the ass. A pain enough that I've offered some providers to just pay cash to avoid the bullshit. THEY SAID NO and sent me on my way. Oh, and if I want to start a business, work for a pre-seed startup, or just want to take some time between jobs, I need to coordinate with my significant other to make sure they are not planning on quitting any time soon so we don't have to deal with COBRA or worse. Yeah, give me the Canadian system any day now.
- stackbutterflow 5y ago
da_big_ghey 5y ago
Healthcare is scarce and i prefer market allocation to a wait list for allocation. Nation with government health care is also having scarcity problem, some things on waitlist. With a market i can throw more money at health problems, waitlist i am at the mercy of bureaucrat. This is better for me since I have worked very hard on making money and these days i have some extra i can spend for this. I am healthy also, young somewhat, and wanting to be in healthy young risk pool to lower my costs not be in giant all-nation pool where I am accepting more financial burden.
CountDrewku 5y ago
How much do you think gets taken out of your paycheck before you get it in country's with universal healthcare? And that happens even if you don't use it. And who the hell has an 8k deductible? This choice isn't 8k deductible or "free" healthcare. That's a farce.
- ceejayoz 5y ago
  > How much do you think gets taken out of your paycheck before you get it in country's with universal healthcare? Less. https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm has a chart of all OECD healthcare spending, both public and private. The US clearly stands out at the end. Employer-provided healthcare "gets taken out of your paycheck" all the same, just less visibly. This is a significant part of the political problem in the US; the true costs are hidden. > And who the hell has an 8k deductible? Most folks on an ACA Bronze plan. https://news.ehealthinsurance.com/insights-blog/lower-premiums-but-higher-out-of-pocket-costs-for-2020-aca-consumers https://news.ehealthinsurance.com/insights-blog/lower-premiu... "For a family of four, average Bronze plan deductibles are rising by 3% (from $13,017 to $13,394), while the average maximum out-of-pocket limit is increasing 4% (from $14,916 to $15,462)."
  - CountDrewku 5y ago
    You realize they choose the bronze plan so they can pay less right? They're not forced into having an 8k deductible. They do this so they can have less taken out of pocket and only really use the healthcare in a major emergency. This would support the idea that people prefer the US system and not universal healthcare.
    - ceejayoz 5y ago
      They choose the Bronze plan because it's literally all they can afford. My family's ACA Platinum plan costs me $2,200/month this year, and there's still $4k of copays a year to meet.
Dumblydorr 5y ago
The simplest answer: the Senate overweights rural voters, who in turn hate government spending and big government. Until the Senate is representative of the US population, we will never have sweeping programs like this. Even if the Senate is fixed, the supreme court could likely strike down any legislation that's too progressive, since it's now 6-3 conservative lean due to the Senate and McConnells robbery of the Garland spot. It's a messed up system, sigh.
maccolgan 5y ago
AFAICT, Universe healthcare is akin to a single monopolist insurer who bases the premium on your income, not your medical profile. (Plus the hospitals and pharma industry self-organizes into a cartel) I don't understand how anyone rational can agree that's fair.
refurb 5y ago
The reason universal wouldn’t work is cost is an issue. You can’t just say, sure, we’ll pay for everything. Recipe for exploding healthcare costs. So how to reign costs in? Cut physician salaries? Not likely. Limit procedures? Maybe. Stop paying for the latest cancer drugs the day the FDA approves them? Probably. Not exactly easy to accomplish.
- ceejayoz 5y ago
  You know universal coverage exists, right? Europe, Japan, Australia, New Zealand... you can't claim it's impossible to structure when there are dozens of functional examples out there. "Universal coverage" is not "we pay for everything without question or approval process". In both systems, there are people who decide what's covered, and for whom. As for "exploding costs", the US is more expensive - in both public and private spending - than the "universal coverage" spots. https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm

I don't understand how people can be so anti-universal healthcare in the US. When you have an $8k deductible, your insurance is basically a gift to the CEO's yacht fund.

minikites 5y ago

The people who are against universal healthcare usually pitch it as an argument for "choice", as if I'm going to compare prices when I have a ruptured appendix. It's also usually couched in anti-government sentiment, where they draw comparisons to "lines at the DMV", as if other countries with universal healthcare have people dying while waiting in line for care, something that also doesn't happen.

yerwhat01010 5y ago
> as if other countries with universal healthcare have people dying while waiting in line for care This absolutely does happen in the UK, although I'd pick our health over the US's any day of the week.
- avianlyric 5y ago
  It's also worth mentioning that private health care and insurance both exist in the UK. Individuals still get the choice to go to any private doctor they want, they'll just have to pay for it themselves. Just like the US, except the NHS provides an excellent safety net for everyone without private insurance or the means to pay for private care.
  - arethuza 5y ago
    In most cases its the same doctors working in private hospitals and for the NHS.
    - Silhouette 5y ago
      And in some cases it involves NHS facilities too. There are definitely some questionable aspects of our public/private healthcare. But again, this isn't always how it works, and the ethics involved are also complicated.
      - arethuza 5y ago
        I know someone whose condition rapidly deteriorated while receiving treatment in a private hospital and when things were looking really bad they got transferred to an NHS hospital.
        Silhouette 5y ago
        I hope the person you know was OK. That transfer is actually not surprising. Emergency/intensive care is almost always NHS here. Private options tend to be better in situations like having multiple treatments available where one is significantly more effective or more reliable but also costs a lot more. Sometimes the NHS will only offer a cheaper but inferior alternative, which sounds horrible until you think that there is a huge but ultimately pooled budget and any time policy allows more spending on one treatment there is always someone losing out somewhere else.
  - CountDrewku 5y ago
    The US has safety nets as well, they're just not as generous as the UK's.
- Silhouette 5y ago
  Agreed on both points. The UK system is far from perfect but for balance we should also say that it is not normal or expected for something as bad as that to happen here. Even in recent times, with the extra pressures of COVID, critical care has mostly kept up and the emergency overflow facilities that were built very quickly in case of overwhelming demand mostly went unused. Obviously there will always be limits and the available resources will run out if one of them is reached. In the aftermath of a major incident or an unusually busy period it can happen. I expect a lot of us from the UK might agree that the limits need to be raised further by investing more into the NHS. But I would still choose this type of system over a US-style one every time. I've never heard of anyone here dying because they couldn't afford tens of thousands for routine medication to treat a common condition.
deleted 5y ago
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Y_Y 5y ago
I'm a big fan of universal healthcare, and have made great use of both public and private hospitals in Europe and the US. Everywhere I've lived (except the US) has had a totally free public system, and every time I've still paid for private insurance. I'm not rich by any means, and I don't have any particularly special requirements. I'm not even looking for better doctors or machines, since they are mostly shared or equivalent between public and private care. The only reason it's worth it for me to spend money on private insurance is waiting times. On the private system, I can see a consultant in one month instead of six, or get a surgery in three months instead of three years. This is all for non-emergency care of course. There are lots of elderly people waiting on operations like hip replacement on the public system, and it's expected that some will die before their turn comes up. It's a compromise that's built into the way the government operates their national health system. It not obviously the wrong way to do things, since carrying out all these operations would be very expensive and have limited benefit in terms of quality and quantity of life. It also sucks for the people waiting, especially since others who can afford to skip the line by paying (usually through private insurance) may even be seen by the same surgeon in the same OR. I don't mean to argue for or against this system, but just to point out that people often die waiting for (non-emergency) care in at least several large public healthcare systems in highly-developed countries in Europe.
- hef19898 5y ago
  The countries I have direct experience with, France and Germany, don't have any issues with people dying while waiting for procedures. Experts are usually readily available, so there are exceptions. I don't know of any public health care system in developed countries that have really these issues. I do know so, that a lot of that comes from a PR campaign run by US insurances against the Canadian system.
  - Y_Y 5y ago
    When you say they don't have any issues, do you mean it doesn't happen? I'm more familiar with the Spanish, Irish and UK systems. I tried to find a nice document giving numbers for what I was describing, but most of what I can find is anecdotal, and the official reports are weren't quantitative. Here's an article from an Irish newspaper last year that gives a rough guess (though of course there are other factors): https://www.irishtimes.com/news/health/are-patient-waiting-lists-shrinking-for-the-right-reasons-1.4147197 https://www.irishtimes.com/news/health/are-patient-waiting-l... I'm certainly open to US insurance companies paying me to shill on hn against Canadian healthcare, but right now I'm only saying these things out of the goodness of my heart.

inglor_cz 5y ago

Single payer healthcare systems in Europe were introduced a long time ago. Back then, politics was different, not least because of an imminent threat of the Soviet Bloc just around the corner and a need to answer it by "carrot", too, not just "stick". They are now status quo, but in another version of history, where such systems would have to be introduced today, I am not certain whether they could clear the political obstacles, much like the U.S.

js2 5y ago
Efforts at introducing single-payer healthcare in the U.S. go back at least as far as 1935. https://www.healthcare-now.org/legislation/national-timeline/ https://www.healthcare-now.org/legislation/national-timeline...
intsunny 5y ago
As an American who immigrated to Europe four years ago, I disagree that modern-Europe would not be able to recreate their healthcare systems under today's polticial climate. Ironically it is because of the USA that many Europeans are keenly aware of the davistating consequences of allowing for a hyper-capitalistic approach to healthcare. People here often assume the worst about that system, and are completely bewildered when I tell them how it actually works. (Especially in regards to having children, parental leave, and childc care.)
hef19898 5y ago
Social security nets in Europe date back to time we used to have Emperors and Kings, before WW1. They are thus older than the USSR.
- qwytw 5y ago
  Bismarck mainly introduced some rudimentary social security to decrease worker support for socialist parties, so it was a reaction to socialism (albeit not directly the USSR) from the start. However before WW2 it was very limited in all countries (and much smaller scale than for example what's currently available in the US) before the 40's and 50's.
- 5y ago

tiahura 5y ago

Your comment misses the point. There are two reasons why this bill is so high: 1. Some doctors and some hospitals are make tremendous amount of money - hospital revenue is about $1T and doctor revenue is about .5T. 2. This country has an insatiable demand for expensive healthcare. There’s no country with universal coverage where a child with little chance for survival would have received this level of care.

Jenk 5y ago
The UK gives this level of care to many people routinely.
- hef19898 5y ago
  As do France and Germany.
  - tiagod 5y ago
    Portugal too. Our system is far from perfect (the best medication is sometimes prohibitively expensive for some people who really need it - chronic patients, pensioners) but there are many examples of our national health system investing heavily in particular individuals with little chance for survival. A recent example is health system paying for Zolgensma, the most expensive medication in the world, leading to millions of expense per year[1][2] on this medication alone for a very small amount of babies. [1] https://tvi24.iol.pt/sociedade/saude/estado-gastou-4-1-milhoes-de-euros-em-medicamento-para-a-atrofia-muscular-espinal https://tvi24.iol.pt/sociedade/saude/estado-gastou-4-1-milho... [2] https://www.politico.eu/article/europe-eyes-arrival-of-worlds-priciest-drug/ https://www.politico.eu/article/europe-eyes-arrival-of-world...
- simonh 5y ago
  It also does so to anyone who needs it regardless of ability to pay, and at overall half the cost of health care per person in the population compared to the US. You can also still pay for enhanced private health care if you want.
- 5y ago

adrianN 5y ago

Whether or not a policy with a deductible like that is a gift to the CEO's yacht fund depends on the monthly payments and is, imho, orthogonal to a discussion about universal healthcare.

_huayra_ 5y ago
Considering how hard they actually fight when you actually have to get care (e.g. having the doctor submit tons of justification that you actually need the required treatment vs. some half-assed cheaper approach), I don't think the monthly payments actually matter.

wang_li 5y ago

The US has universal care, it passed in 2009 and it establishes that everyone does their part and buy insurance. It establishes help for low income individuals. There are caps on annual expenses. You may not like how it’s structured. You may not like the amount that people are expected to pay. But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations. And I’m fine with that.

ceejayoz 5y ago
> But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations. The folks at the poverty line with a "free" fully subsidized Bronze ACA plan has an enormous deductible that may be $6-12k before that coverage actually starts paying out. The ACA's max out-of-pocket for a family in 2021 is $17,100. (https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...) That's not meaningful access to healthcare for someone making $30k a year.
- only_as_i_fall 5y ago
  And people wonder why the us has such poor health outcomes
- leesalminen 5y ago
  My uncle-in-law just signed up for health insurance under ACA in Colorado. He pays a $22/mo premium and has a $700 max out of pocket. Yes, 2 zeros. I was totally shocked but I reviewed all his paperwork and it’s true. Meanwhile I’m paying $1,200/mo for a young and healthy family of 3 with a $7,000 max out of pocket.
- wang_li 5y ago
  Out of pocket expenses for any individual is capped $8550 regardless of whether they have family coverage or individual coverage. Additionally, those earning less than 250% the federal poverty level qualify for additional cost sharing reductions (CSR) which dramatically lower the out of pocket expenses, e.g deductibles and copays. Details will vary but a family of four with a household income of $30k with CSR would have their deductible reduced to a few hundred dollars and annual out of packet caps also to the hundreds of dollars range. The same plan without CSR might have a $7000 deductible. But CSR is available in the situation you describe. http://www.healthreformbeyondthebasics.org/cost-sharing-charges-in-marketplace-health-insurance-plans-part-2/ http://www.healthreformbeyondthebasics.org/cost-sharing-char... Regardless, this is arguing over the burden that Obama, Pelosi, et. al. decided was appropriate for Americans. It's not a question of whether there is universal health care in the US. There undeniably is.

IG_Semmelweiss 5y ago

There are really bad things with the current system, but you asked a question. People are exposed on a regular basis to the DMV, the SBA, to Social Security or to Medicare. Then they compare that experience with the avg experience with a commercial insurer, and it does feel like a better experience (of course, if their employer can afford it) Worse, there are stories of friends in places like CAN, where insider doctors hurriedly email their friends about a new doctor X that is available for appointments, in order to skip a 6 month wait... The system in the US is a mess, but those people reason that its the least worst option of the available choices. If they could be given a 3rd or 4th choice, like for example, make take health insurance companies and turn them into public utilities so the "CEO" is not getting his "yatch fund" from taxpayers, that's worth talking about (as longas you don't forget to look to CA, and their wonderful brownouts + utility-enabled wildfires)

js2 5y ago
> People are exposed on a regular basis to the DMV, the SBA, to Social Security or to Medicare. Then they compare that experience with the avg experience with a commercial insurer, and it does feel like a better experience (of course, if their employer can afford it) That’s not what surveys show: > Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all. https://news.gallup.com/poll/186527/americans-government-health-plans-satisfied.aspx https://news.gallup.com/poll/186527/americans-government-hea... CMS also publishes assessments of its own performance: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS https://www.cms.gov/Research-Statistics-Data-and-Systems/Res...
- iammisc 5y ago
  Selection effects. The poor and elderly are likely to be on Medicare and other public programs. If you can't afford healthcare and get it for free of course you'll be happy It's like my charcoal Weber. I found it on the side of the road. Its dirty, dinged, and the wheels are falling off. But it was free and I can grill on it, so I'm extremely happy with it On the other hand if I paid for a Weber and got that, I'd be pissed.

nodejs_rulez_1 5y ago

At least with some caveats, like less funds for 35+ year old parents.

cmrdporcupine 5y ago

There are many problems with our Canadian system, it's certainly not perfect. And single payer is not the only way to approach this problem. But I'm overall happy with its compromises in our system. Like any economic resource, it's rationed. But it's rationed, generally, on the basis of need. And that "from each according to their abilities to each according to their needs" philosophy may be the ideological curse on it that will prevent it from ever having adoption in the US with its virulent anti-communist past. It would never happen in Canada now, it was a product of the 1960s and early 70s and the way things were then. And it's consistently under threat from its ideological foes here, even if it's immensely popular among the Canadian public. What boggles my mind about the US system is the blatant way it makes working people dependant on employment for health coverage. In a way it's a form of feudalism, tying people physically to their employment.

minikites 5y ago
>In a way it's a form of feudalism, tying people physically to their employment. This is a feature, as far as major companies and lobbying organizations are concerned. It's a major reason behind the resistance to universal healthcare because the duress of losing health insurance is the only way some companies keep their employees.
gruez 5y ago
>In a way it's a form of feudalism, tying people physically to their employment. uhh, what? Is employment in general "a form of feudalism" because people depend on it to fund their basic needs?
- WillDaSilva 5y ago
  People can quit their job, and then meet their needs using their savings (if they have any), or welfare. The same is not true for health insurance.
  - gruez 5y ago
    They can't get health insurance on healthcare.gov?

Rucadi 5y ago

There are countries with private healthcare that works (And IS better than public healthcare). The problem is specific to USA.

gruez 5y ago
>There are countries with private healthcare that works list them?
- mabub24 5y ago
  Switzerland has a system that basically works like a beefed up and less hogtied ACA. It's a very heavily regulated private market that would likely not be considered ideal for America, though some have suggested it as an option.
  - _huayra_ 5y ago
    Basically the LaMal basic insurance is not allowed to make a profit, so you get them aggressively trying to upsell you on complementary insurance.
- iammisc 5y ago
  Israel has a private system with lots of regulations. It is private though
- pseudoramble 5y ago
  Agreed - I'd like to see the list too, because I'm genuinely interested in trying to find a better health care system than what the US has. I like poking around through here to compare and contrast options: https://www.commonwealthfund.org/international-health-policy-center/system-profiles https://www.commonwealthfund.org/international-health-policy.... Some things I notice mainly are that the countries with private health insurance have at least two other things the US lacks: 1. They provide universal health care. 2. They have regulations of the market. How they go about doing that varies a bit, but I believe these are critical points we miss for all the various reasons we see in this link and in many other discussions on the topic. I think often in the US when we talk about private-sector, we also implicitly also mean for-profit, whereas many of the other options require them to be private non-profits. I think it's notable they are de-prioritized or outright banned, though I'll admit I don't really know if this is a critical detail or not. So I think to the GP point, perhaps this is a way to change private sector options for the better?

xienze 5y ago

> I don't understand how people can be so anti-universal healthcare in the US. Because I have zero faith that it will end up costing me less, and have a similar level of quality. I’m in tech. Combined HHI is something in the $200s. I pay about $300 per month for the entire family, $5K out of pocket max. So in a worst case scenario, let’s say healthcare costs me $9K per year. That’s what, 4% of my HHI? Will a universal healthcare plan hit me via taxes for 4% or less? Fat fucking chance. And again, we’re not even talking about quality of care, just price. In the end, the poor will benefit greatly, the rich will carry on as usual, and people in the middle will get squeezed to death.

bananapub 5y ago
yikes, dude.
gambiting 5y ago
I....just have no words. Do you really believe everything you wrote? And like....that's probably the worst example of individualism and "me first" attitude I've seen on this website.
- disgruntledphd2 5y ago
  My favourite assumption is that people with 200k household income are in the middle. Mind you, that kind of belief is super common amongst people (like me) who are in the top decile of income.
ceejayoz 5y ago
> Because I have zero faith that it will end up costing me less, and have a similar level of quality. The US spends 2-3x per capita (counting both public and private spending; https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm) than the rest of the OECD, with remarkably similar health outcomes. > I pay about $300 per month for the entire family, $5K out of pocket max. You're just paying your healthcare tax to your employer (in the form of lost salary; they're not chipping in the other $1-2k/month out of charity) instead of the government. It's silly to only count your contribution instead of the overall per-capita cost of healthcare.

failuser 5y ago

$8k deductible might be reasonable if $250k bills are the norm. It is not spoken out loud a lot (more during COVID), but the people who are against universal healthcare are likely pro high birth rate and survival of the fittest (unless they have money, of course).

EvRev 5y ago
You need a high birthrate to continue to suppress wages, don't forget about that! Once to population curve starts to flatten out, I do not see private insure prices going down as they will not be able to let go of the profit hence driving prices up higher.

marcinzm 5y ago

I've heard a lot of negative stories about the British health system including people waiting 6+ months to see doctors (while in pain or having other symptoms that lower quality of life significantly). If you think an American universal health system will be somehow better than that then I suspect you're a lot more optimistic about the US government than most people. edit: I do love echo chambers, someone asks a question about why a certain groups thinks a certain way, you answer and you get downvoted. Why bother being on a discussion forum if you don't ever want to hear what the other side sees things as even when directly asked? Especially amusing since I do support universal healthcare but actually try to understand why people oppose it rather than covering my eyes and ears whenever they talk.

qmmmur 5y ago
Because it's been decimated by the Tories for ten years now.
- marcinzm 5y ago
  And the US elected Trump, why do you think the same thing wouldn't happen in the US within a decade?
  - qmmmur 5y ago
    I'm not going to argue hypotheticals,, but even a decimated NHS is far better than the US system.
    - marcinzm 5y ago
      Many American's don't however since they hear the bad stories but are perfectly happy with the care they get under their insurance. Which was the question asked and not "which health system is objectively better."
adrianN 5y ago
Shouldn't the point of comparison be the current state of US healthcare, were many people don't get to see a doctor at all because they're uninsured and poor? (Or at least that's the impression I get as an outsider from discussions on the Internet about the topic)

forgingahead 5y ago

The issue is less about coverage and more about the insane, opaque, and fradulent medical care pricing in the US. No other industry has such a black box cost structure to it. Coverage is very important, but it must be done in tandem with cost transparency and freedom to choose different insurance plans.

shados 5y ago

Because in the US, if you're reasonably healthy, employed, live in a city with good hospitals and have private insurance, it "feels" better. It's easier to get better care. I'm Canadian, now living in the US, and I'll be honest: for the first couple of years, where I had some medium sized health issues, the US system felt so much better. The hospital I was treated at was leagues better than anything I saw in Canada. The amount I had to pay on my paychecks was lower than the complementary insurance I had in Canada. I had dental insurance everywhere I worked! My teeth are a trainwreck from the years I didn't have access to good dental insurance). So if someone was to dig in my old social media posts, they'd see my old stance of "I would prefer universal healthcare because its more fair, but if I was only thinking about myself, the US system is better". Then, as anyone who knows better could have predicted, it went downhill and I was proven wrong. If you have something that's hard to diagnose, the insurance starts fighting against you/your provider to get lesser care (eg: getting a full sleep study is super hard because insurance companies will just want you to take a cheap at home sleep apnea test. If you have a sleep disorder that's not sleep apnea, good fucking luck). Some providers will not talk to you if they're not in contract with your insurance. Good luck getting behavioral health care. Lots of clinics are in bed with very specific insurance, and will not even take self pay. So you have to call 15 of them because even the ones on your insurer's website may not want to speak with you. The paperwork. Holy shit the paperwork. I had surgery once, and I was still getting bills for it 6 months later. SO MANY BILLS. Some of them were absolute bullshit, but who has time to call insurance and hospitals over and over and over to fight every single one when there's douzens for a single procedure. So I just paid the co-insurance fees and suck it up. I never had a way to tell when I was getting "the last bill". In the end, I'm reasonably well off, and I have pretty much the best insurance one can have (no deductible, no employee contribution on paycheck, covers virtually everything), and it's STILL a pain in the ass. A pain enough that I've offered some providers to just pay cash to avoid the bullshit. THEY SAID NO and sent me on my way. Oh, and if I want to start a business, work for a pre-seed startup, or just want to take some time between jobs, I need to coordinate with my significant other to make sure they are not planning on quitting any time soon so we don't have to deal with COBRA or worse. Yeah, give me the Canadian system any day now.

stackbutterflow 5y ago

da_big_ghey 5y ago

Healthcare is scarce and i prefer market allocation to a wait list for allocation. Nation with government health care is also having scarcity problem, some things on waitlist. With a market i can throw more money at health problems, waitlist i am at the mercy of bureaucrat. This is better for me since I have worked very hard on making money and these days i have some extra i can spend for this. I am healthy also, young somewhat, and wanting to be in healthy young risk pool to lower my costs not be in giant all-nation pool where I am accepting more financial burden.

CountDrewku 5y ago

How much do you think gets taken out of your paycheck before you get it in country's with universal healthcare? And that happens even if you don't use it. And who the hell has an 8k deductible? This choice isn't 8k deductible or "free" healthcare. That's a farce.

ceejayoz 5y ago
> How much do you think gets taken out of your paycheck before you get it in country's with universal healthcare? Less. https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm has a chart of all OECD healthcare spending, both public and private. The US clearly stands out at the end. Employer-provided healthcare "gets taken out of your paycheck" all the same, just less visibly. This is a significant part of the political problem in the US; the true costs are hidden. > And who the hell has an 8k deductible? Most folks on an ACA Bronze plan. https://news.ehealthinsurance.com/insights-blog/lower-premiums-but-higher-out-of-pocket-costs-for-2020-aca-consumers https://news.ehealthinsurance.com/insights-blog/lower-premiu... "For a family of four, average Bronze plan deductibles are rising by 3% (from $13,017 to $13,394), while the average maximum out-of-pocket limit is increasing 4% (from $14,916 to $15,462)."
- CountDrewku 5y ago
  You realize they choose the bronze plan so they can pay less right? They're not forced into having an 8k deductible. They do this so they can have less taken out of pocket and only really use the healthcare in a major emergency. This would support the idea that people prefer the US system and not universal healthcare.
  - ceejayoz 5y ago
    They choose the Bronze plan because it's literally all they can afford. My family's ACA Platinum plan costs me $2,200/month this year, and there's still $4k of copays a year to meet.

Dumblydorr 5y ago

The simplest answer: the Senate overweights rural voters, who in turn hate government spending and big government. Until the Senate is representative of the US population, we will never have sweeping programs like this. Even if the Senate is fixed, the supreme court could likely strike down any legislation that's too progressive, since it's now 6-3 conservative lean due to the Senate and McConnells robbery of the Garland spot. It's a messed up system, sigh.

maccolgan 5y ago

AFAICT, Universe healthcare is akin to a single monopolist insurer who bases the premium on your income, not your medical profile. (Plus the hospitals and pharma industry self-organizes into a cartel) I don't understand how anyone rational can agree that's fair.

refurb 5y ago

The reason universal wouldn’t work is cost is an issue. You can’t just say, sure, we’ll pay for everything. Recipe for exploding healthcare costs. So how to reign costs in? Cut physician salaries? Not likely. Limit procedures? Maybe. Stop paying for the latest cancer drugs the day the FDA approves them? Probably. Not exactly easy to accomplish.

ceejayoz 5y ago
You know universal coverage exists, right? Europe, Japan, Australia, New Zealand... you can't claim it's impossible to structure when there are dozens of functional examples out there. "Universal coverage" is not "we pay for everything without question or approval process". In both systems, there are people who decide what's covered, and for whom. As for "exploding costs", the US is more expensive - in both public and private spending - than the "universal coverage" spots. https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm