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Coming from a country that has this, there should be caution: it gets more affordable, but you get what you pay for. In my country of origin, you get a partial

Coming from a country that has this, there should be caution: it gets more affordable, but you get what you pay for. In my country of origin, you get a partially-paid-for ride to the emergency room, where you pay for things like casts, non-ward rooms, dental care out of pocket. There is no prescription coverage. There is no optometry coverage. I would wait significant chunks of a year for procedures and diagnostics. To cover the things that aren't covered, most have private insurance through work or also out of pocket. Since moving to the US, it is more expensive (than next to nothing), but I actually get good care. Several conditions that were ignored or misdiagnosed for me are now cured. My life might be significantly shorter had I not come here. If NY does this, the near zero chance of my moving there ever would go to absolute 0. It is a terrible system for any place that does not have infinitesimal state or national government expenses and more-than-60% kind of taxes (e.g., Scandinavian countries).

seandoe 4y ago
Interesting, from where do you hail?
frozenport 4y ago
>> but you get what you pay for. Americans are already paying more than most places for healthcare but not getting a good return.
- space_fountain 4y ago
  Is this true even for individuals? I think one version of the problem might be that we pay too little for some peoples healthcare and too much for others, but do the people who pay the most still end up with worse results?
  - frozenport 4y ago
    The same procedure costs magnitudes more in the USA. It is true for everybody. An adjacent issue is that certain groups don't receive preventive care due to financial issues leading to increased long term costs. But note, even in all cases we're paying way too much.
marricks 4y ago
Who gets "good" care here? Senators and millionaires definitely do. But, most people don't get good care, many people are missing essential care (dental), and everyone has to wait. Often months. We in the US pay more per capita for worse care than most other developed nations (Canada/UK/Nordic countries). Name your country where the care is worse than the US please and let us know how much they pay for it per capita comparatively.
- nceqs3 4y ago
  You ever been to a Canadian hospital?
  - marricks 4y ago
    I have Canadian friends and it sounds better than when my older brother had to call their insurance company every months to get their anxiety meds covered because, for some reason, the insurance company lost the paper work for approving them every month. For a year. Funny because it’s just the sort of thing to cause more anxiety in an anxious person. I’d also love hear how many Canadian cancer survivors have to put up gofundmes or go bankrupt for care.
    - nceqs3 4y ago
      https://www.cbc.ca/amp/1.4495123 https://www.cbc.ca/amp/1.4495123
      - marricks 4y ago
        Who here is saying Canadians are perfect? I’m sure it’s easy to find individuals who had a better experience in the US.
  - throw0101a 4y ago
    > You ever been to a Canadian hospital? As a Canadian: yes. And the bill was $0 at the end of my father's heart bypass and valve replacement surgery. My friend's sister cancer treatment also had a bill of $0. Finished filing my taxes last month, and my average rate (provincial+federal) for last year was 21%. Happy to pay.
bitwizeshift 4y ago
Are you from Canada, or was that just an uncanny description of Canadian healthcare?
vmception 4y ago
For your first paragraph, I’ve seen that alot. My european friends from big economies there brag about their insurance coverage, some working in the states with some global coverage plan, and as soon as I ask about something seemingly basic: “oh thats elective or cosmetic, why would that be covered” I think there is a way to make it work with American expectations, American resources, no equivalent tax burden.
- notreallyserio 4y ago
  > and as soon as I ask about something seemingly basic Do you have an example?
droopyEyelids 4y ago
Two points: 1) In the USA, one must be pretty well situated to get the quality of healthcare you describe. MANY people go without prescriptions, and get inadequate care already. 2) If you add up what we pay in health insurance premiums plus employer contributions, especially if you have a family, we're generally in the same league of paycheck-subtraction as a European country with universal healthcare. So while I agree with your overall point that it could end up worse than where we started, I don't think thats a guaranteed outcome.
version_five 4y ago
Would healthcare overall in e.g New York be equivalent though? In Canada, we have "free" healthcare but literally have no other option so it's the Soviet style mess you'd expect a government monopoly to be. But would this bar paid healthcare? Couldn't people still have health insurance and get private care? Is there something preventing that?
- KoftaBob 4y ago
  This bill doesn't ban private insurance, it does however have this rule: "Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents." So in other words, private insurances can only be offered if they provide benefits that surpass whatever the public option has. I imagine that private insurances will logically offer more benefits regardless, otherwise why would someone pay extra to use them over the public option?
  - codefreeordie 4y ago
    that will mean, though, that it will be impossible to get insurance to actually cover the things that the public system "covers" if you wait 35,600 years for your turn
    - monocasa 4y ago
      Why? Wouldn't a line skip be by definition something that the public system isn't offering?
      - codefreeordie 4y ago
        I haven't read the full text of the bill, but presumably not. The intent will be to disallow private coverage for any service that the government would provide, specifically because they would want to make sure that people with money couldn't avoid the public system. That's how it ends up working in many places with government care
mtalantikite 4y ago
> If NY does this, the near zero chance of my moving there ever would go to absolute 0. Are they proposing kicking you off your insurance? From the bill: > SUMMARY OF SPECIFIC PROVISIONS: Every New York resident will be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no network restrictions, deductibles, or co-pays. Coverage would be publicly funded. The benefits will include comprehensive outpatient and inpatient medical care, long-term care, primary and preventive care, prescription drugs, laboratory tests, rehabilitative, dental, vision, hearing, etc. all benefits required by current state insurance law or provided by the state public employee package, Family Health Plus, Child Health Plus, Medicare, or Medicaid, and others added by the plan. As someone that has lived in NYC for 15 years, I'd really love to see this happen. Edit: > Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents. So yes, I guess it would be kicking those off of their current private insurance. It sounds like it'd force private insurers to offer plans that would augment off of a base of public care. I'm still fine with this.
- deleted 4y ago
  [deleted]
- ceeplusplus 4y ago
  I read through the bill and there are no specifics written on how the entire thing is supposed to be funded, other than saying that payroll taxes will be increased to fund it. My guess is that once the numbers come out on how much tax would have to be paid that this bill would be dead.
  - yazaddaruvala 4y ago
    Companies currently provide health insurance and pay per employee. Per employee costs go up due to health care payroll taxes. Per employee costs come down due to not paying for health insurance. Overall, net-neutral cost to companies and simplifies health care payments for hospitals, clinics, etc so fewer employees to explain and collect payments so cost of care comes down. Seems like a win - win - win.
Beltiras 4y ago
I live in Iceland. ETR is about 40% for me but I'm in a high tax bracket. None of the Scandinavian countries even have 60% marginal tax rate. EDIT: My MTR is ~42% so my ETR can't be 40%. I don't have a payslip to calculate and searching the interwebs isn't helping a lot right now.
- kmonsen 4y ago
  Same in Norway, max marginal rate caps out at almost 50%: https://www.skatteetaten.no/en/rates/maximum-effective-marginal-tax-rates/ https://www.skatteetaten.no/en/rates/maximum-effective-margi...
  - erosenbe0 4y ago
    In a high-tax US state like California the top marginal income tax is about 47%. This covers no health care unless you are over 65, disabled, or are below the medicaid threshold, which is low. There is also a lower rate om capital gains such as stock or real estate, sales (like a VAT), gas tax, vehicle tax, utility tax, phone tax, cable internet tax, etc. Plus, of course, employers are paying some extra payroll taxes per employee.
    - kmonsen 4y ago
      I lived in the UK, Norway, Switzerland and US (NYC and Bay Area). Except Switzerland I did not really notice a big tax change for any of the others. Sure in UK and Norway healthcare and University is free, but healthcare is provided by my employer in the states. So for me it is a wash. But hey in the US I get to pay for the largest army on the planet. What I would say is that in the US my taxes feel the most "unfair" since my tax rate is sort of the max. Richer people have ways of avoiding taxes and poorer people pay less tax.
      - erosenbe0 4y ago
        This is a good criticism. High wage-earners in the US like a hardworking GP doctor pay the biggest effective tax rates.
jeppesen-io 4y ago
> Coming from a country that has this, there should be caution It's big world - without knowing which country, this is of little help. I'd like to see a comparison of people forced into debt, bankruptcy or death due to the respective medical systems This hits home because I have a friend that got cancer with "good" U.S. insurance and if he did not fight the insurance company he'd be in debt for 1mm+
- chrisseaton 4y ago
  I'm from the UK, which is basically fully free-at-point-of-use healthcare (you pay a nominal fee for prescriptions, dentistry, optician) and is often championed as a great option. Reality is it's pretty grim. Don't know if I'd recommend it to other countries to be honest. Be careful what you wish for!
  - rootusrootus 4y ago
    > Reality is it's pretty grim. Don't know if I'd recommend it to other countries to be honest. As someone who's never experienced the UK health care system, and only know one person who has (as a foreigner, so they paid out of pocket and said the experience was positive, but otherwise not a good data point) ... I'd like to hear a bit more detail about how it's pretty grim, if you're willing to elaborate.
    - chrisseaton 4y ago
      I'd love to get you to listen in to a phone call where I try to get an appointment with my doctor. You'd have to be up at 0800 on the dot, while I desperately try to get into the phone queue. Then you'll hear me beg with the world's rudest receptionist for an appointment, which I won't get. There's no incentive for these people to be helpful or polite, because they get paid anyway and there's no market, so they aren't. My American colleagues see a doctor every year for a checkup to catch things like cancer before they're fatal. The NHS would laugh in my face if I said I wanted to see a doctor for a checkup, unless I literally had an arm falling off.
HalcyonicStorm 4y ago
I understand where you're coming from related to this. We (in the US) hear this critique with regards to the NHS or the Canadian healthcare system. The part you're missing is that there is an arms race of pricing between healthcare corporations (there have been massive mergers of hospital systems) and insurance companies in terms of prices. We, the patients, are caught in between the giants while prices are going sky high and we are at our most vulnerable. The hope is this will fix prices to a reasonable level so if we choose to go for private care, those prices will also be reasonable. A lot of specialists that I see ask for cash payments and don't accept insurance. They are also overbooked because a lot of healthcare providers are being driven out of industry from the conditions.
manuelabeledo 4y ago
I come from a country with universal healthcare too, and my experience is the opposite. Yes, to this day, it doesn’t cover dental or vision, which is BS if you ask me, and there is some co-pay for certain prescriptions; regardless, it is a fantastic system, and I miss it so much every time I need to go to the doctor here in the US. The main reason is uncertainty: in the US, I can never know how much something is going to be, even if it starts as a mere visit to a family doctor, because there are uncountable variables that may factor in the final cost. As a result of this, I try to avoid going to the doctor as much as I can, and it makes me think about all the people who really cannot afford healthcare, and don’t qualify for Medicare either.
- Teknoman117 4y ago
  > I can never know how much something is going to be I think the closest thing you can get to the cost experience of universal healthcare in the US is one of the better HMO providers like Kaiser. Everything is a known cost up front.
- jorblumesea 4y ago
  Most Americans have never experienced a system like that, and will fight tooth and nail against things they don't understand or have experienced. They are told by billionaires who run the media empires that universal healthcare is expensive, will ruin the country, will remove their ability to get appointments scheduled. Of course coming from any other country, this is ridiculous. But it goes to show you how out of touch many Americans are with how the rest of the world works.
  - OrvalWintermute 4y ago
    >Most Americans have never experienced a system like that, and will fight tooth and nail against things they don't understand or have experienced. They are told by billionaires who run the media empires that universal healthcare is expensive, will ruin the country, will remove their ability to get appointments scheduled. My wife, a practicing physician, did fellowships in multiple countries like this. I asked her for her opinion given her experience with their systems, and our systems, and also being on the provider end. "excellent emergent care, comparable to better US hospitals" "horrible waiting periods for elective care, and non-emergent surgeries"
standardUser 4y ago
"you get what you pay for" No country pays more for healthcare per capita than the US. If we could capture some of the huge chunk that goes to private insurance companies (each company has its own redundant staff and technology systems, their own execs all getting their own bonuses, etc), we could provide healthcare even better than we already provide in the US to those who can afford it or qualify for public programs.
- OrvalWintermute 4y ago
  > their own execs all getting their own bonuses, etc While we love to critique big insurance, and some of it may be earned, that industry is not known for the skyhigh profits OR margins like IT is. Here is an HMO for ya > OAKLAND, Calif. — Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals, and their respective subsidiaries (KFHP/H) reported 2021 annual financial results. Total operating revenues for 2021 were $93.1 billion compared to $88.7 billion in 2020. Total operating expenses were $92.5 billion compared to $86.5 billion in the prior year. Operating income was $611 million, or 0.7% of operating revenues, compared to $2.2 billion in 2020. Increased care delivery expenses due to COVID-19 surges contributed to the decline in operating income. > “After almost 2 years, the COVID-19 pandemic continues to impact Kaiser Permanente just as it does our daily lives,” said chair and chief executive officer Greg A. Adams. “We rapidly rolled out vaccines, and now boosters, and administered more than 9 million COVID-19 tests while managing new and unpredictable variants like delta and omicron as they surfaced. Throughout this crisis, gratitude goes to our dedicated employees and physicians who have remained focused on providing care and strong support for members and communities.” > Like other organizations, Kaiser Permanente benefited from strong investment performance due to robust financial markets during the year, resulting in total other income and expense of $7.5 billion compared to $4.1 billion in 2020. This sharp increase in investment performance more than offset the $1.6 billion decrease in operating income, resulting in 2021 net income of $8.1 billion compared to net income of $6.4 billion in 2020. > Capital spending totaled $3.5 billion compared to $4.0 billion the year prior. During 2021 Kaiser Permanente opened 11 medical offices. Kaiser Permanente now includes 734 medical offices, 39 owned and operated hospitals, and 58 retail and worksite clinics. and regular insurance > United Healthgroup Profit as % of Revenues 6%, Profits as % of Assets 7.8%, Profits as % of Stockholder Equity 23.5% for CY2021
systemvoltage 4y ago
Switzerland has private insurance just like the US and people I know that live in Zurich love it.
- tonfa 4y ago
  It's not exactly like the US tho. Basic insurance is mandatory for every resident, insurers can't refuse covererage (no preexisting conditions) and pricing of insurance is transparent (I don't think they can differentiate beyond a few variables). Afaik pricing of medical procedures is defined by government (probably with insurers and practitioners). It's high quality but fairly expensive (relative to GDP or salary vs other European countries)
- throw0101a 4y ago
  > Switzerland has private insurance just like the US and people I know that live in Zurich love it. Profits are regulated (sometimes down to zero) in CH. Profits are unregulated in the US.
  - systemvoltage 4y ago
    Only for the "soziale krankenversicherung" or basic plan. US has a massive free healthcare system called "Medicaid" which is similar to the basic plan for low income individuals and families, the scale of which is unknown to many: > Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017, as well as paying for half of all U.S. births in 2019. https://en.wikipedia.org/wiki/Medicaid https://en.wikipedia.org/wiki/Medicaid In addition, each state has other provisions. For example, California's Medical system is used by a third of California's population: > Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long term care and supports. https://en.wikipedia.org/wiki/Medi-Cal https://en.wikipedia.org/wiki/Medi-Cal
  - 1123581321 4y ago
    US health insurers are required to spend large majority of revenue paying claims, which does not cap profits absolutely but does proportionately.
Ar-Curunir 4y ago
Given that you were already unlikely to move to NYC, I’m not sure your opinion has much weight compared to that of existing New Yorkers…
sedatk 4y ago
Coming from Turkey that has this, I can 100% vouch for it. Prescriptions are partially covered. Private insurance and private hospitals is an option but that doesn't mean state hospitals are bad. Healthcare quality is very good in state hospitals. It's actually one of the only two categories in which Turkey's in a good standing among OECD countries. It has its own wrinkles of course. For example, doctors make less money and their working conditions are worse than private hospitals. Because of that, it's common to get asked to pay a "knife fee" in secret for operations. Some doctors ask for an expensive bottle of whiskey etc. I haven't experienced this myself but heard about those incidents many times. However, wait times aren't long. Appointments are organized electronically through E-State portal. Although wait times in ER can be long based on your triage, that's the case with United States anyway. The benefits of single payer healthcare outweigh the drawbacks by a wide margin. You never worry about unemployment. You don't have homeless people due to their mental problems as they're treated in mental clinics. You don't worry about "getting bankrupt" suddenly from an unforeseen health issue. Healthcare costs are low even if you're not insured. That means drugs are cheap even though state won't cover 100% of the cost. Even private insurance is cheap (~$1000 a year). Yes, taxes are high in Turkey, but healthcare system costs make up a very small portion of it (~5%).
majormajor 4y ago
The US spends more per capita than other countries on healthcare. But that doesn't mean the US would have to pay less per capita in a single-payer system. So we could keep getting what we pay for in terms of capacity, etc, if we want. You would expect a wealthy country to be able to pay a premium to get a premium.
- deleted 4y ago
  [deleted]
tablespoon 4y ago
> Coming from a country that has this, there should be caution: it gets more affordable, but you get what you pay for. In my country of origin, you get a partially-paid-for ride to the emergency room, where you pay for things like casts, non-ward rooms, dental care out of pocket. New York State will not necessarily implement the same program your home country has. > Since moving to the US, it is more expensive (than next to nothing), but I actually get good care. Several conditions that were ignored or misdiagnosed for me are now cured. My life might be significantly shorter had I not come here. It's not really news that the (relatively) rich can get better things by paying more. The well-known consequence of the US system is that many people get no care, because they don't have the money to afford it. That includes people with health insurance, which often doesn't pay for anything at all until you've paid thousands out-of-pocket to hit your deductible.

seandoe 4y ago

Interesting, from where do you hail?

frozenport 4y ago

>> but you get what you pay for. Americans are already paying more than most places for healthcare but not getting a good return.

space_fountain 4y ago
Is this true even for individuals? I think one version of the problem might be that we pay too little for some peoples healthcare and too much for others, but do the people who pay the most still end up with worse results?
- frozenport 4y ago
  The same procedure costs magnitudes more in the USA. It is true for everybody. An adjacent issue is that certain groups don't receive preventive care due to financial issues leading to increased long term costs. But note, even in all cases we're paying way too much.

marricks 4y ago

Who gets "good" care here? Senators and millionaires definitely do. But, most people don't get good care, many people are missing essential care (dental), and everyone has to wait. Often months. We in the US pay more per capita for worse care than most other developed nations (Canada/UK/Nordic countries). Name your country where the care is worse than the US please and let us know how much they pay for it per capita comparatively.

nceqs3 4y ago
You ever been to a Canadian hospital?
- marricks 4y ago
  I have Canadian friends and it sounds better than when my older brother had to call their insurance company every months to get their anxiety meds covered because, for some reason, the insurance company lost the paper work for approving them every month. For a year. Funny because it’s just the sort of thing to cause more anxiety in an anxious person. I’d also love hear how many Canadian cancer survivors have to put up gofundmes or go bankrupt for care.
  - nceqs3 4y ago
    https://www.cbc.ca/amp/1.4495123 https://www.cbc.ca/amp/1.4495123
    - marricks 4y ago
      Who here is saying Canadians are perfect? I’m sure it’s easy to find individuals who had a better experience in the US.
- throw0101a 4y ago
  > You ever been to a Canadian hospital? As a Canadian: yes. And the bill was $0 at the end of my father's heart bypass and valve replacement surgery. My friend's sister cancer treatment also had a bill of $0. Finished filing my taxes last month, and my average rate (provincial+federal) for last year was 21%. Happy to pay.

bitwizeshift 4y ago

Are you from Canada, or was that just an uncanny description of Canadian healthcare?

vmception 4y ago

For your first paragraph, I’ve seen that alot. My european friends from big economies there brag about their insurance coverage, some working in the states with some global coverage plan, and as soon as I ask about something seemingly basic: “oh thats elective or cosmetic, why would that be covered” I think there is a way to make it work with American expectations, American resources, no equivalent tax burden.

notreallyserio 4y ago
> and as soon as I ask about something seemingly basic Do you have an example?

droopyEyelids 4y ago

Two points: 1) In the USA, one must be pretty well situated to get the quality of healthcare you describe. MANY people go without prescriptions, and get inadequate care already. 2) If you add up what we pay in health insurance premiums plus employer contributions, especially if you have a family, we're generally in the same league of paycheck-subtraction as a European country with universal healthcare. So while I agree with your overall point that it could end up worse than where we started, I don't think thats a guaranteed outcome.

version_five 4y ago

Would healthcare overall in e.g New York be equivalent though? In Canada, we have "free" healthcare but literally have no other option so it's the Soviet style mess you'd expect a government monopoly to be. But would this bar paid healthcare? Couldn't people still have health insurance and get private care? Is there something preventing that?

KoftaBob 4y ago
This bill doesn't ban private insurance, it does however have this rule: "Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents." So in other words, private insurances can only be offered if they provide benefits that surpass whatever the public option has. I imagine that private insurances will logically offer more benefits regardless, otherwise why would someone pay extra to use them over the public option?
- codefreeordie 4y ago
  that will mean, though, that it will be impossible to get insurance to actually cover the things that the public system "covers" if you wait 35,600 years for your turn
  - monocasa 4y ago
    Why? Wouldn't a line skip be by definition something that the public system isn't offering?
    - codefreeordie 4y ago
      I haven't read the full text of the bill, but presumably not. The intent will be to disallow private coverage for any service that the government would provide, specifically because they would want to make sure that people with money couldn't avoid the public system. That's how it ends up working in many places with government care

mtalantikite 4y ago

> If NY does this, the near zero chance of my moving there ever would go to absolute 0. Are they proposing kicking you off your insurance? From the bill: > SUMMARY OF SPECIFIC PROVISIONS: Every New York resident will be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no network restrictions, deductibles, or co-pays. Coverage would be publicly funded. The benefits will include comprehensive outpatient and inpatient medical care, long-term care, primary and preventive care, prescription drugs, laboratory tests, rehabilitative, dental, vision, hearing, etc. all benefits required by current state insurance law or provided by the state public employee package, Family Health Plus, Child Health Plus, Medicare, or Medicaid, and others added by the plan. As someone that has lived in NYC for 15 years, I'd really love to see this happen. Edit: > Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents. So yes, I guess it would be kicking those off of their current private insurance. It sounds like it'd force private insurers to offer plans that would augment off of a base of public care. I'm still fine with this.

deleted 4y ago
[deleted]
ceeplusplus 4y ago
I read through the bill and there are no specifics written on how the entire thing is supposed to be funded, other than saying that payroll taxes will be increased to fund it. My guess is that once the numbers come out on how much tax would have to be paid that this bill would be dead.
- yazaddaruvala 4y ago
  Companies currently provide health insurance and pay per employee. Per employee costs go up due to health care payroll taxes. Per employee costs come down due to not paying for health insurance. Overall, net-neutral cost to companies and simplifies health care payments for hospitals, clinics, etc so fewer employees to explain and collect payments so cost of care comes down. Seems like a win - win - win.

Beltiras 4y ago

I live in Iceland. ETR is about 40% for me but I'm in a high tax bracket. None of the Scandinavian countries even have 60% marginal tax rate. EDIT: My MTR is ~42% so my ETR can't be 40%. I don't have a payslip to calculate and searching the interwebs isn't helping a lot right now.

kmonsen 4y ago
Same in Norway, max marginal rate caps out at almost 50%: https://www.skatteetaten.no/en/rates/maximum-effective-marginal-tax-rates/ https://www.skatteetaten.no/en/rates/maximum-effective-margi...
- erosenbe0 4y ago
  In a high-tax US state like California the top marginal income tax is about 47%. This covers no health care unless you are over 65, disabled, or are below the medicaid threshold, which is low. There is also a lower rate om capital gains such as stock or real estate, sales (like a VAT), gas tax, vehicle tax, utility tax, phone tax, cable internet tax, etc. Plus, of course, employers are paying some extra payroll taxes per employee.
  - kmonsen 4y ago
    I lived in the UK, Norway, Switzerland and US (NYC and Bay Area). Except Switzerland I did not really notice a big tax change for any of the others. Sure in UK and Norway healthcare and University is free, but healthcare is provided by my employer in the states. So for me it is a wash. But hey in the US I get to pay for the largest army on the planet. What I would say is that in the US my taxes feel the most "unfair" since my tax rate is sort of the max. Richer people have ways of avoiding taxes and poorer people pay less tax.
    - erosenbe0 4y ago
      This is a good criticism. High wage-earners in the US like a hardworking GP doctor pay the biggest effective tax rates.

jeppesen-io 4y ago

> Coming from a country that has this, there should be caution It's big world - without knowing which country, this is of little help. I'd like to see a comparison of people forced into debt, bankruptcy or death due to the respective medical systems This hits home because I have a friend that got cancer with "good" U.S. insurance and if he did not fight the insurance company he'd be in debt for 1mm+

chrisseaton 4y ago
I'm from the UK, which is basically fully free-at-point-of-use healthcare (you pay a nominal fee for prescriptions, dentistry, optician) and is often championed as a great option. Reality is it's pretty grim. Don't know if I'd recommend it to other countries to be honest. Be careful what you wish for!
- rootusrootus 4y ago
  > Reality is it's pretty grim. Don't know if I'd recommend it to other countries to be honest. As someone who's never experienced the UK health care system, and only know one person who has (as a foreigner, so they paid out of pocket and said the experience was positive, but otherwise not a good data point) ... I'd like to hear a bit more detail about how it's pretty grim, if you're willing to elaborate.
  - chrisseaton 4y ago
    I'd love to get you to listen in to a phone call where I try to get an appointment with my doctor. You'd have to be up at 0800 on the dot, while I desperately try to get into the phone queue. Then you'll hear me beg with the world's rudest receptionist for an appointment, which I won't get. There's no incentive for these people to be helpful or polite, because they get paid anyway and there's no market, so they aren't. My American colleagues see a doctor every year for a checkup to catch things like cancer before they're fatal. The NHS would laugh in my face if I said I wanted to see a doctor for a checkup, unless I literally had an arm falling off.

HalcyonicStorm 4y ago

I understand where you're coming from related to this. We (in the US) hear this critique with regards to the NHS or the Canadian healthcare system. The part you're missing is that there is an arms race of pricing between healthcare corporations (there have been massive mergers of hospital systems) and insurance companies in terms of prices. We, the patients, are caught in between the giants while prices are going sky high and we are at our most vulnerable. The hope is this will fix prices to a reasonable level so if we choose to go for private care, those prices will also be reasonable. A lot of specialists that I see ask for cash payments and don't accept insurance. They are also overbooked because a lot of healthcare providers are being driven out of industry from the conditions.

manuelabeledo 4y ago

I come from a country with universal healthcare too, and my experience is the opposite. Yes, to this day, it doesn’t cover dental or vision, which is BS if you ask me, and there is some co-pay for certain prescriptions; regardless, it is a fantastic system, and I miss it so much every time I need to go to the doctor here in the US. The main reason is uncertainty: in the US, I can never know how much something is going to be, even if it starts as a mere visit to a family doctor, because there are uncountable variables that may factor in the final cost. As a result of this, I try to avoid going to the doctor as much as I can, and it makes me think about all the people who really cannot afford healthcare, and don’t qualify for Medicare either.

Teknoman117 4y ago
> I can never know how much something is going to be I think the closest thing you can get to the cost experience of universal healthcare in the US is one of the better HMO providers like Kaiser. Everything is a known cost up front.
jorblumesea 4y ago
Most Americans have never experienced a system like that, and will fight tooth and nail against things they don't understand or have experienced. They are told by billionaires who run the media empires that universal healthcare is expensive, will ruin the country, will remove their ability to get appointments scheduled. Of course coming from any other country, this is ridiculous. But it goes to show you how out of touch many Americans are with how the rest of the world works.
- OrvalWintermute 4y ago
  >Most Americans have never experienced a system like that, and will fight tooth and nail against things they don't understand or have experienced. They are told by billionaires who run the media empires that universal healthcare is expensive, will ruin the country, will remove their ability to get appointments scheduled. My wife, a practicing physician, did fellowships in multiple countries like this. I asked her for her opinion given her experience with their systems, and our systems, and also being on the provider end. "excellent emergent care, comparable to better US hospitals" "horrible waiting periods for elective care, and non-emergent surgeries"

standardUser 4y ago

"you get what you pay for" No country pays more for healthcare per capita than the US. If we could capture some of the huge chunk that goes to private insurance companies (each company has its own redundant staff and technology systems, their own execs all getting their own bonuses, etc), we could provide healthcare even better than we already provide in the US to those who can afford it or qualify for public programs.

OrvalWintermute 4y ago
> their own execs all getting their own bonuses, etc While we love to critique big insurance, and some of it may be earned, that industry is not known for the skyhigh profits OR margins like IT is. Here is an HMO for ya > OAKLAND, Calif. — Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals, and their respective subsidiaries (KFHP/H) reported 2021 annual financial results. Total operating revenues for 2021 were $93.1 billion compared to $88.7 billion in 2020. Total operating expenses were $92.5 billion compared to $86.5 billion in the prior year. Operating income was $611 million, or 0.7% of operating revenues, compared to $2.2 billion in 2020. Increased care delivery expenses due to COVID-19 surges contributed to the decline in operating income. > “After almost 2 years, the COVID-19 pandemic continues to impact Kaiser Permanente just as it does our daily lives,” said chair and chief executive officer Greg A. Adams. “We rapidly rolled out vaccines, and now boosters, and administered more than 9 million COVID-19 tests while managing new and unpredictable variants like delta and omicron as they surfaced. Throughout this crisis, gratitude goes to our dedicated employees and physicians who have remained focused on providing care and strong support for members and communities.” > Like other organizations, Kaiser Permanente benefited from strong investment performance due to robust financial markets during the year, resulting in total other income and expense of $7.5 billion compared to $4.1 billion in 2020. This sharp increase in investment performance more than offset the $1.6 billion decrease in operating income, resulting in 2021 net income of $8.1 billion compared to net income of $6.4 billion in 2020. > Capital spending totaled $3.5 billion compared to $4.0 billion the year prior. During 2021 Kaiser Permanente opened 11 medical offices. Kaiser Permanente now includes 734 medical offices, 39 owned and operated hospitals, and 58 retail and worksite clinics. and regular insurance > United Healthgroup Profit as % of Revenues 6%, Profits as % of Assets 7.8%, Profits as % of Stockholder Equity 23.5% for CY2021

systemvoltage 4y ago

Switzerland has private insurance just like the US and people I know that live in Zurich love it.

tonfa 4y ago
It's not exactly like the US tho. Basic insurance is mandatory for every resident, insurers can't refuse covererage (no preexisting conditions) and pricing of insurance is transparent (I don't think they can differentiate beyond a few variables). Afaik pricing of medical procedures is defined by government (probably with insurers and practitioners). It's high quality but fairly expensive (relative to GDP or salary vs other European countries)
throw0101a 4y ago
> Switzerland has private insurance just like the US and people I know that live in Zurich love it. Profits are regulated (sometimes down to zero) in CH. Profits are unregulated in the US.
- systemvoltage 4y ago
  Only for the "soziale krankenversicherung" or basic plan. US has a massive free healthcare system called "Medicaid" which is similar to the basic plan for low income individuals and families, the scale of which is unknown to many: > Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017, as well as paying for half of all U.S. births in 2019. https://en.wikipedia.org/wiki/Medicaid https://en.wikipedia.org/wiki/Medicaid In addition, each state has other provisions. For example, California's Medical system is used by a third of California's population: > Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long term care and supports. https://en.wikipedia.org/wiki/Medi-Cal https://en.wikipedia.org/wiki/Medi-Cal
- 1123581321 4y ago
  US health insurers are required to spend large majority of revenue paying claims, which does not cap profits absolutely but does proportionately.

Ar-Curunir 4y ago

Given that you were already unlikely to move to NYC, I’m not sure your opinion has much weight compared to that of existing New Yorkers…

sedatk 4y ago

Coming from Turkey that has this, I can 100% vouch for it. Prescriptions are partially covered. Private insurance and private hospitals is an option but that doesn't mean state hospitals are bad. Healthcare quality is very good in state hospitals. It's actually one of the only two categories in which Turkey's in a good standing among OECD countries. It has its own wrinkles of course. For example, doctors make less money and their working conditions are worse than private hospitals. Because of that, it's common to get asked to pay a "knife fee" in secret for operations. Some doctors ask for an expensive bottle of whiskey etc. I haven't experienced this myself but heard about those incidents many times. However, wait times aren't long. Appointments are organized electronically through E-State portal. Although wait times in ER can be long based on your triage, that's the case with United States anyway. The benefits of single payer healthcare outweigh the drawbacks by a wide margin. You never worry about unemployment. You don't have homeless people due to their mental problems as they're treated in mental clinics. You don't worry about "getting bankrupt" suddenly from an unforeseen health issue. Healthcare costs are low even if you're not insured. That means drugs are cheap even though state won't cover 100% of the cost. Even private insurance is cheap (~$1000 a year). Yes, taxes are high in Turkey, but healthcare system costs make up a very small portion of it (~5%).

majormajor 4y ago

The US spends more per capita than other countries on healthcare. But that doesn't mean the US would have to pay less per capita in a single-payer system. So we could keep getting what we pay for in terms of capacity, etc, if we want. You would expect a wealthy country to be able to pay a premium to get a premium.

deleted 4y ago
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tablespoon 4y ago

> Coming from a country that has this, there should be caution: it gets more affordable, but you get what you pay for. In my country of origin, you get a partially-paid-for ride to the emergency room, where you pay for things like casts, non-ward rooms, dental care out of pocket. New York State will not necessarily implement the same program your home country has. > Since moving to the US, it is more expensive (than next to nothing), but I actually get good care. Several conditions that were ignored or misdiagnosed for me are now cured. My life might be significantly shorter had I not come here. It's not really news that the (relatively) rich can get better things by paying more. The well-known consequence of the US system is that many people get no care, because they don't have the money to afford it. That includes people with health insurance, which often doesn't pay for anything at all until you've paid thousands out-of-pocket to hit your deductible.