8 ms·

Literally every other developed country on Earth has universal healthcare in some degree. How do Americans accept that?

themodelplumber 5y ago
What makes you think all Americans accept it? Describing those working against this new norm is not exactly describing an underground movement.
- eropple 5y ago
  I mean, enough of us accept it that it has been historically politically suicide to do much about it. It's a pretty fair question to ask.
  - themodelplumber 5y ago
    Political suicide? Seems more like a political platform, unless facing an opposing platform is considered suicide...? Many candidates have won, and more seemed primed to win, with a more generous approach to American health care...
    - eropple 5y ago
      Right, but that's a pretty recent change, at least in the non-rivalrous care sense. Which is to say that "I deserve free care" has been a thing in ostensibly conservative camps, for a long time, but the notion that everyone deserves free or at least affordable care has only really started catching on recently. As recently as the nineties, a serious attempt at reform failed in a way that seriously hampered a Presidency, and the ACA is, while a significant improvement, also pretty compromised. The idea that UHC is a reasonable political platform, within the bounds of "normal" American political discourse, is pretty new.
      - themodelplumber 5y ago
        > at least in the non-rivalrous care sense Huh?
        eropple 5y ago
        There are large sections of the American populace who think that access to social support is zero-sum and universal access takes something from A if B also gets it. So while we have had Medicare and Medicaid for quite some time, the discussion has been resistant to actual universal health care largely due to these factors. You're right that that's changing, but the question being "WTF, America?" about why it's still not a thing is pretty valid to me. Put another way: it's been proven out, and to me pretty inarguably, that conservative Americans are pretty OK with socialism for themselves and for people like them--this is the genesis of the whole "keep the government out of my Medicare" meme, because it's real. And to people who adopt that workview, providing the same services to people who are unlike them codes as giving things to "undeserving" people. This remains true even as the "center" moves somewhat leftward and universal healthcare discussion becomes a tenable option in the Overton window--even many people in favor of things like UHC are in favor of UHC for themselves, not for everyone. Asking "what's wrong with you that you let this happen?" is, to me, quite fair.
salusinarduis 5y ago
Because a tremendous amount of political messaging is aimed to convince Americans that universal healthcare is bad in every regard.
greenonions 5y ago
Trust me we (some of us) hate it.
deleted 5y ago
[deleted]
snarf21 5y ago
It wasn't always this way but healthcare tied to employment is a holdover from WW II. We also have this weird residual of puritanical values that says we value hard work over everything else. So tying healthcare to employment fits right in. People only get what they deserve. "If you want healthcare, just get a job." The hypocrisy is that our policies are very un-Christian given their Christian origins.
- selykg 5y ago
  Similarly, retirement options need to stop being tied to employers as well. I've written my representatives about this, but I also want to see the 401k separate from the employer. Reduce fees, allow anyone to have a 401k, and like an IRA, contribute however they wish, while also allowing employers to contribute to an employer bucket to keep matches for employers to provide those. I switch jobs, my 401k can travel with me. Employers no longer need to supply one if they don't want to, they just have to support sending money to it via payroll deduction. There will be no more people who work but can't contribute to a 401k and lose that valuable option in addition to an IRA.
mfogikds 5y ago
What percentage of those countries are larger than California?
- hbrav 5y ago
  In population or area? And what is the significance of size?
- runako 5y ago
  This is pretty ignorant, but you can start with: - UK - Spain - Germany - Italy - France - And Canada is within a couple % of the size of California
brianwawok 5y ago
The top earning 50% of Americans with a stable w2 job (union + white collar jobs) get very "good" insurance where their job pays most of, while they pay a modest copay. The bottom earning 25% of Americans have 0 assets and 0 money, so health care is effectively free. Go to a hospital, they must treat you, you can't pay the bill, so it gets written off. The 26-49th percentile of people who have some money but no insurance are the people screwed by the current system. So the reason why American's tolerate it.. is it works decently for 75% of the population. And it is hard for 25% of the population to really change anything. And of those, many are young and healthy so they don't really care. So maybe we are talking about 12.5% of the population being actively screwed by the system at any given time...
- foldr 5y ago
  > Go to a hospital, they must treat you For emergency care, sure, but they don’t have to offer you expensive treatments for whatever health conditions you might have. It’s wishful thinking to think that poor Americans are getting adequate health care.
  - brianwawok 5y ago
    Right. It's not perfect, but it's pretty workable in a pinch. In no means am I saying the current system is good or the right way, but simply offering reasons why there aren't enough people up in arms about the status quo.
    - foldr 5y ago
      Err, no. Using emergency care as your only source of care is not “workable in a pinch”. It represents a vastly lower standard of care than that available to poor people in most first world countries. Face it: if someone you loved had no money and no health insurance, you wouldn’t feel reassured that they’d be able to access the care that they needed.
      - brianwawok 5y ago
wyager 5y ago
Almost every country on earth outside of aberrations with atypical revenue sources are much poorer than the US. Government healthcare is not an unambiguous win; at best, it moves you around on the Pareto frontier. Americans can identify this at some level and are skeptical of adopting political changes that would make us more like other (poorer) countries.
- dboreham 5y ago
  Meanwhile spending 1/6 of that massive GDP on healthcare...
  - wyager 5y ago
    Yeah, we do spend too much money buying very cost-ineffective healthcare for old people who are about to die anyway. Medicare is a utilitarian disaster.
- katbyte 5y ago
  I always hear this but dont think I’ve see proof - can you link to some?
  - wyager 5y ago
    This is a very broad request. Pick any metric of wealth (GDPPC is an OK start) and google “list of countries by <wealth metric>”. Dev salaries in different countries are something most people on HN should be familiar with - US is typically 2-5x higher than other first world countries.
- hbrav 5y ago
  Most of the EU has some form of universal health care. So does the UK, Canada, Japan, South Korea, Singapore. Those aren't poor countries.
  - wyager 5y ago
    EU countries except the ones I mentioned (with unusual revenue source) are generally much poorer than the US. So are Canada, Japan, South Korea. Even Singapore is slightly poorer per capita than US, and it has a lot of advantages. You can say “they’re not poor countries” - this is a meaningless subjective threshold. They are (sometimes a lot) poorer than the US. Look at every single country richer than the US - they all have some unusual revenue source (oil, tax refuge, financial services, etc.) (and most of that money comes from the US)
RcouF1uZ4gsC 5y ago
> Literally every other developed country on Earth has universal healthcare And pretty much every one of those countries has it's health care R&D subsidized by the US(via drug costs borne by the US market) and in most cases also has its security subsidized by the US. Basically, innovation in medical technology is underwritten by the US
- hef19898 5y ago
  Then give the EU all those BionTech vaccine doses back, I guess? Just kidding of course, we are happy too help!
- willvarfar 5y ago
  This is a popular narrative promoted by the US medical industry. However, it doesn’t stand up to scrutiny. Just the first debunking I find in a google search is https://www.mhaonline.com/blog/healthcare-debates-funding-medical-research https://www.mhaonline.com/blog/healthcare-debates-funding-me...
candiddevmike 5y ago
The healthcare industry employs a lot of people due to all of the redundancies, especially on the billing/insurance side. A few of these people make a lot of money. None of these people want to lose their job, possibly get a paycut, or switch careers, even if it helps everyone else in the country.
deleted 5y ago
[deleted]
Bhilai 5y ago
Its actually a pretty popular idea in the US. Why its not done is mostly a matter of one of the parties being obstructionist to any progress that's not a political win for them. > Among the public overall, 63% of U.S. adults say the government has the responsibility to provide health care coverage for all, up slightly from 59% last year. Roughly a third (37%) say this is not the responsibility of the federal government... Source: https://www.pewresearch.org/fact-tank/2020/09/29/increasing-share-of-americans-favor-a-single-government-program-to-provide-health-care-coverage/ https://www.pewresearch.org/fact-tank/2020/09/29/increasing-...
- pasquinelli 5y ago
  the democrats have had the votes, but chose not to use them. it isn't that the democrats are for it and the republicans are against it. both parties are against it. the democrats want to run on it though.
dboreham 5y ago
Jedi mind trick: "this is not the healthcare you are looking for". It be socialism...
deleted 5y ago
[deleted]
runako 5y ago
A hot-button issue that contributed to the UK decision to leave the EU was the notion that outsiders (defined broadly) would get access to social services. Similar concerns are playing across other EU countries & Australia. Immigrants getting access to social services is a contentious issue in many countries. In the United States, there are large ethnic groups that have not been full citizens for all that long. (The millennials are the first American generation to have all its members born as full citizens.) As a result, a very significant proportion of the US is seen (by a large minority) as not fully American, or not "real" Americans. The US is ~27% nonwhite, with demographic trends pointing toward a much browner populace in future decades. The US basically has the same tussle over outsiders getting social services, only a large part of our citizens are considered outsiders by the political process. Much of the messaging against universal healthcare is racist and disgusting; unfortunately it is effective.
pasquinelli 5y ago
let's say americans don't accept that. now what do they do? they vote for democrats, because that's the party that's most open to universal healthcare. and what do democrats do? they certainly don't pass universal healthcare legislation. it's only natural to accept what's out of your control.
- who_in_the_wind 5y ago
  This. Neither of our political parties is _actually_ pro universal health-care. The farthest left we go is neoliberal, and let's be honest: that's not a realistic solution to anything other than expanding the wealth gap and enabling the ultra-rich.
chriscjcj 5y ago
Because when we turn responsibilities over to the government in the U.S., they often have a tendency to do a really bad job of it. How was your last visit to the DMV? Every time I go, while I'm waiting and waiting and waiting, all I can think about is how many glaring, easy-to-fix inefficiencies I would fix "if I were in charge." I would imagine that anyone who has tried to get unemployment benefits in California over the last year might be a little less than enthusiastic about turning more responsibilities over to the government. https://abc7news.com/california-edd-ca-unemployment-extra-300-news-update/10917618/ https://abc7news.com/california-edd-ca-unemployment-extra-30... https://abc7news.com/7-on-your-side-7oys-michael-finney-edd/11023382/ https://abc7news.com/7-on-your-side-7oys-michael-finney-edd/... When folks are hesitant to put those same people in charge of something as vitally important as their health care, I understand where they're coming from.
- bobsmooth 5y ago
  In my country, doctors offices and hospitals are private entities. They're reimbursed by the government based on a fixed cost per procedure/service.
paulpauper 5y ago
The prices are absurd on the surface, but hardly anyone pays full sticker, even the uninsured. Accounting for taxes, Americans pay less for healthcare than in the UK. The NHS is free but its paid for in part by higher taxes for everyone. Canada has free healthcare but a lot is excluded too. The US is the world leader in diagnosis . world leader in benign biopsies. The fear of litigation probably leads to a lot of unnecessary tests and more costs.
- foldr 5y ago
  > Accounting for taxes, Americans pay less for healthcare than in the UK. Where are you getting this information from? Taxes in the UK are not much higher than taxes in the US (although of course you can’t really compare to “the US” at all because of interstate variation). In any case, the US has higher per capita government spending on healthcare, so even excluding health insurance payments, Americans on average are paying more in taxes towards healthcare than Brits. https://www.statista.com/statistics/283221/per-capita-health-expenditure-by-country/ https://www.statista.com/statistics/283221/per-capita-health...
baybal2 5y ago
Even without it being universal, US prices are grossly more expensive than private healthcare elsewhere, including countries with higher incomes than US. It's not a problem of 100% coverage, but strictly a supply side problem.
baybal2 5y ago
> So many other countries can do this. Why can’t we? Because 70 years of good life made Americans bad businessmen. Complete lack of entrepreneurial spirit, creativity, wits, and grit. "Business education" (the phrase itself is an oxymoron) based on regurgitation, and rote interpolation, without much to cultivate actual ability. A universal solution to overcoming adverse conditions I keep hearing is: "give up, and divest." Without somebody tough to do the hard thing competing with those billion dollar hospitals, any attempt to fix the issue by legislation is meaningless.
jhallenworld 5y ago
It's not from lack of trying: https://pnhp.org/a-brief-history-universal-health-care-efforts-in-the-us/ https://pnhp.org/a-brief-history-universal-health-care-effor...

What makes you think all Americans accept it? Describing those working against this new norm is not exactly describing an underground movement.

eropple 5y ago
I mean, enough of us accept it that it has been historically politically suicide to do much about it. It's a pretty fair question to ask.
- themodelplumber 5y ago
  Political suicide? Seems more like a political platform, unless facing an opposing platform is considered suicide...? Many candidates have won, and more seemed primed to win, with a more generous approach to American health care...
  - eropple 5y ago
    Right, but that's a pretty recent change, at least in the non-rivalrous care sense. Which is to say that "I deserve free care" has been a thing in ostensibly conservative camps, for a long time, but the notion that everyone deserves free or at least affordable care has only really started catching on recently. As recently as the nineties, a serious attempt at reform failed in a way that seriously hampered a Presidency, and the ACA is, while a significant improvement, also pretty compromised. The idea that UHC is a reasonable political platform, within the bounds of "normal" American political discourse, is pretty new.
    - themodelplumber 5y ago
      > at least in the non-rivalrous care sense Huh?
      - eropple 5y ago
        There are large sections of the American populace who think that access to social support is zero-sum and universal access takes something from A if B also gets it. So while we have had Medicare and Medicaid for quite some time, the discussion has been resistant to actual universal health care largely due to these factors. You're right that that's changing, but the question being "WTF, America?" about why it's still not a thing is pretty valid to me. Put another way: it's been proven out, and to me pretty inarguably, that conservative Americans are pretty OK with socialism for themselves and for people like them--this is the genesis of the whole "keep the government out of my Medicare" meme, because it's real. And to people who adopt that workview, providing the same services to people who are unlike them codes as giving things to "undeserving" people. This remains true even as the "center" moves somewhat leftward and universal healthcare discussion becomes a tenable option in the Overton window--even many people in favor of things like UHC are in favor of UHC for themselves, not for everyone. Asking "what's wrong with you that you let this happen?" is, to me, quite fair.

salusinarduis 5y ago

Because a tremendous amount of political messaging is aimed to convince Americans that universal healthcare is bad in every regard.

greenonions 5y ago

Trust me we (some of us) hate it.

deleted 5y ago

[deleted]

snarf21 5y ago

It wasn't always this way but healthcare tied to employment is a holdover from WW II. We also have this weird residual of puritanical values that says we value hard work over everything else. So tying healthcare to employment fits right in. People only get what they deserve. "If you want healthcare, just get a job." The hypocrisy is that our policies are very un-Christian given their Christian origins.

selykg 5y ago
Similarly, retirement options need to stop being tied to employers as well. I've written my representatives about this, but I also want to see the 401k separate from the employer. Reduce fees, allow anyone to have a 401k, and like an IRA, contribute however they wish, while also allowing employers to contribute to an employer bucket to keep matches for employers to provide those. I switch jobs, my 401k can travel with me. Employers no longer need to supply one if they don't want to, they just have to support sending money to it via payroll deduction. There will be no more people who work but can't contribute to a 401k and lose that valuable option in addition to an IRA.

mfogikds 5y ago

What percentage of those countries are larger than California?

hbrav 5y ago
In population or area? And what is the significance of size?
runako 5y ago
This is pretty ignorant, but you can start with: - UK - Spain - Germany - Italy - France - And Canada is within a couple % of the size of California

brianwawok 5y ago

The top earning 50% of Americans with a stable w2 job (union + white collar jobs) get very "good" insurance where their job pays most of, while they pay a modest copay. The bottom earning 25% of Americans have 0 assets and 0 money, so health care is effectively free. Go to a hospital, they must treat you, you can't pay the bill, so it gets written off. The 26-49th percentile of people who have some money but no insurance are the people screwed by the current system. So the reason why American's tolerate it.. is it works decently for 75% of the population. And it is hard for 25% of the population to really change anything. And of those, many are young and healthy so they don't really care. So maybe we are talking about 12.5% of the population being actively screwed by the system at any given time...

foldr 5y ago
> Go to a hospital, they must treat you For emergency care, sure, but they don’t have to offer you expensive treatments for whatever health conditions you might have. It’s wishful thinking to think that poor Americans are getting adequate health care.
- brianwawok 5y ago
  Right. It's not perfect, but it's pretty workable in a pinch. In no means am I saying the current system is good or the right way, but simply offering reasons why there aren't enough people up in arms about the status quo.
  - foldr 5y ago
    Err, no. Using emergency care as your only source of care is not “workable in a pinch”. It represents a vastly lower standard of care than that available to poor people in most first world countries. Face it: if someone you loved had no money and no health insurance, you wouldn’t feel reassured that they’d be able to access the care that they needed.
    - brianwawok 5y ago

wyager 5y ago

Almost every country on earth outside of aberrations with atypical revenue sources are much poorer than the US. Government healthcare is not an unambiguous win; at best, it moves you around on the Pareto frontier. Americans can identify this at some level and are skeptical of adopting political changes that would make us more like other (poorer) countries.

dboreham 5y ago
Meanwhile spending 1/6 of that massive GDP on healthcare...
- wyager 5y ago
  Yeah, we do spend too much money buying very cost-ineffective healthcare for old people who are about to die anyway. Medicare is a utilitarian disaster.
katbyte 5y ago
I always hear this but dont think I’ve see proof - can you link to some?
- wyager 5y ago
  This is a very broad request. Pick any metric of wealth (GDPPC is an OK start) and google “list of countries by <wealth metric>”. Dev salaries in different countries are something most people on HN should be familiar with - US is typically 2-5x higher than other first world countries.
hbrav 5y ago
Most of the EU has some form of universal health care. So does the UK, Canada, Japan, South Korea, Singapore. Those aren't poor countries.
- wyager 5y ago
  EU countries except the ones I mentioned (with unusual revenue source) are generally much poorer than the US. So are Canada, Japan, South Korea. Even Singapore is slightly poorer per capita than US, and it has a lot of advantages. You can say “they’re not poor countries” - this is a meaningless subjective threshold. They are (sometimes a lot) poorer than the US. Look at every single country richer than the US - they all have some unusual revenue source (oil, tax refuge, financial services, etc.) (and most of that money comes from the US)

RcouF1uZ4gsC 5y ago

> Literally every other developed country on Earth has universal healthcare And pretty much every one of those countries has it's health care R&D subsidized by the US(via drug costs borne by the US market) and in most cases also has its security subsidized by the US. Basically, innovation in medical technology is underwritten by the US

hef19898 5y ago
Then give the EU all those BionTech vaccine doses back, I guess? Just kidding of course, we are happy too help!
willvarfar 5y ago
This is a popular narrative promoted by the US medical industry. However, it doesn’t stand up to scrutiny. Just the first debunking I find in a google search is https://www.mhaonline.com/blog/healthcare-debates-funding-medical-research https://www.mhaonline.com/blog/healthcare-debates-funding-me...

candiddevmike 5y ago

The healthcare industry employs a lot of people due to all of the redundancies, especially on the billing/insurance side. A few of these people make a lot of money. None of these people want to lose their job, possibly get a paycut, or switch careers, even if it helps everyone else in the country.

deleted 5y ago

[deleted]

Bhilai 5y ago

Its actually a pretty popular idea in the US. Why its not done is mostly a matter of one of the parties being obstructionist to any progress that's not a political win for them. > Among the public overall, 63% of U.S. adults say the government has the responsibility to provide health care coverage for all, up slightly from 59% last year. Roughly a third (37%) say this is not the responsibility of the federal government... Source: https://www.pewresearch.org/fact-tank/2020/09/29/increasing-share-of-americans-favor-a-single-government-program-to-provide-health-care-coverage/ https://www.pewresearch.org/fact-tank/2020/09/29/increasing-...

pasquinelli 5y ago
the democrats have had the votes, but chose not to use them. it isn't that the democrats are for it and the republicans are against it. both parties are against it. the democrats want to run on it though.

dboreham 5y ago

Jedi mind trick: "this is not the healthcare you are looking for". It be socialism...

deleted 5y ago

[deleted]

runako 5y ago

A hot-button issue that contributed to the UK decision to leave the EU was the notion that outsiders (defined broadly) would get access to social services. Similar concerns are playing across other EU countries & Australia. Immigrants getting access to social services is a contentious issue in many countries. In the United States, there are large ethnic groups that have not been full citizens for all that long. (The millennials are the first American generation to have all its members born as full citizens.) As a result, a very significant proportion of the US is seen (by a large minority) as not fully American, or not "real" Americans. The US is ~27% nonwhite, with demographic trends pointing toward a much browner populace in future decades. The US basically has the same tussle over outsiders getting social services, only a large part of our citizens are considered outsiders by the political process. Much of the messaging against universal healthcare is racist and disgusting; unfortunately it is effective.

pasquinelli 5y ago

let's say americans don't accept that. now what do they do? they vote for democrats, because that's the party that's most open to universal healthcare. and what do democrats do? they certainly don't pass universal healthcare legislation. it's only natural to accept what's out of your control.

who_in_the_wind 5y ago
This. Neither of our political parties is _actually_ pro universal health-care. The farthest left we go is neoliberal, and let's be honest: that's not a realistic solution to anything other than expanding the wealth gap and enabling the ultra-rich.

chriscjcj 5y ago

Because when we turn responsibilities over to the government in the U.S., they often have a tendency to do a really bad job of it. How was your last visit to the DMV? Every time I go, while I'm waiting and waiting and waiting, all I can think about is how many glaring, easy-to-fix inefficiencies I would fix "if I were in charge." I would imagine that anyone who has tried to get unemployment benefits in California over the last year might be a little less than enthusiastic about turning more responsibilities over to the government. https://abc7news.com/california-edd-ca-unemployment-extra-300-news-update/10917618/ https://abc7news.com/california-edd-ca-unemployment-extra-30... https://abc7news.com/7-on-your-side-7oys-michael-finney-edd/11023382/ https://abc7news.com/7-on-your-side-7oys-michael-finney-edd/... When folks are hesitant to put those same people in charge of something as vitally important as their health care, I understand where they're coming from.

bobsmooth 5y ago
In my country, doctors offices and hospitals are private entities. They're reimbursed by the government based on a fixed cost per procedure/service.

paulpauper 5y ago

The prices are absurd on the surface, but hardly anyone pays full sticker, even the uninsured. Accounting for taxes, Americans pay less for healthcare than in the UK. The NHS is free but its paid for in part by higher taxes for everyone. Canada has free healthcare but a lot is excluded too. The US is the world leader in diagnosis . world leader in benign biopsies. The fear of litigation probably leads to a lot of unnecessary tests and more costs.

foldr 5y ago
> Accounting for taxes, Americans pay less for healthcare than in the UK. Where are you getting this information from? Taxes in the UK are not much higher than taxes in the US (although of course you can’t really compare to “the US” at all because of interstate variation). In any case, the US has higher per capita government spending on healthcare, so even excluding health insurance payments, Americans on average are paying more in taxes towards healthcare than Brits. https://www.statista.com/statistics/283221/per-capita-health-expenditure-by-country/ https://www.statista.com/statistics/283221/per-capita-health...

baybal2 5y ago

Even without it being universal, US prices are grossly more expensive than private healthcare elsewhere, including countries with higher incomes than US. It's not a problem of 100% coverage, but strictly a supply side problem.

baybal2 5y ago

> So many other countries can do this. Why can’t we? Because 70 years of good life made Americans bad businessmen. Complete lack of entrepreneurial spirit, creativity, wits, and grit. "Business education" (the phrase itself is an oxymoron) based on regurgitation, and rote interpolation, without much to cultivate actual ability. A universal solution to overcoming adverse conditions I keep hearing is: "give up, and divest." Without somebody tough to do the hard thing competing with those billion dollar hospitals, any attempt to fix the issue by legislation is meaningless.

jhallenworld 5y ago

It's not from lack of trying: https://pnhp.org/a-brief-history-universal-health-care-efforts-in-the-us/ https://pnhp.org/a-brief-history-universal-health-care-effor...