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A lot of Americans seem to not understand what exactly this would entail. Like, the details really matter. Would it be federal, or state-wide? How would it be

by cal5k 4y ago

A lot of Americans seem to not understand what exactly this would entail. Like, the details really matter. Would it be federal, or state-wide? How would it be funded? Would it be public "option", or would private pay be banned like in Canada? How would compensation rates be updated, and how often? Ask any hospital administrator what they think of Medicare/Medicaid rates, and they'll probably answer that they're set too low and that they lose money on Medicare/Medicaid patients. The details on "universal healthcare" can range from heavily-regulated private insurance - Germany for example - to outright bans on private pay for items insured by the government (Canada). A lot of Americans seem to want some sort of federal system that provides insurance for everything, which seems like the best way to get the most expensive, least capable system imaginable. Imagine having yet another insanely expensive, totally underfunded entitlement program that politicians can continuously pad with new promises every 2-4 years when they need to get re-elected. The Canadian experience (source: Canadian currently living in the US) is one you do not want to replicate, so be wary - Canadians have little confidence in their system at this point, even though it's quite expensive relative to European peers - and we have shockingly low numbers of imaging machines, hospital beds, urgent care clinics, etc. per capita, all well having administrative bloat that makes university administration look positively lean by comparison. People love to fret about this politician or that politician, but the reality is that Canada got the incentives totally wrong because they sounded nice. No out-of-pocket expenses? No evil private medicine? No profit from healthcare! As it turns out, central planning fails in healthcare just like it fails everywhere else. So "ensuring everyone has access to reasonably good healthcare" is an excellent goal, but "giving any level of government a monopoly on healthcare insurance" will be the death knell of the generally excellent healthcare Americans have access to if you have insurance.

petesergeant 4y ago
> As it turns out, central planning fails in healthcare just like it fails everywhere else Virtually every rich country except America manages to provide “free at point of use” healthcare because of government intervention. And of note, if you’re not happy with what the government provides in most of these countries, you can usually top up to gold-plated health care at a fraction of the cost in the US. Last I checked, the US also managed to do this just fine where it has to: the VHA spends about as much as the NHS does and also gets excellent outcomes. Talking about “the Canadian experience” seems strange to me: don’t each of the provinces/territories do it differently? The Manitobans in my family seem very happy with the provision they get. Regardless, 75% of Canadians are “proud” of Canadian health provision[0]. Most rich countries (that aren’t America) also have essentially instant and free transfers between bank accounts … because either the government intervened or threatened to intervene. 0: https://biv.com/article/2020/08/covid-19-crisis-has-failed-erode-faith-canadian-health-care https://biv.com/article/2020/08/covid-19-crisis-has-failed-e...
- cal5k 4y ago
  Healthcare is a provincial jurisdiction, but the federal government provides a lot of the funding and attaches strings - the chief one being participation in the "Canada Health Act" which mandates a ban on private pay for publicly-insured services. It's a bad system and since that article was published public sentiment has been worsening: https://nationalpost.com/news/canada/first-reading-canadian-health-care-is-even-worse-than-you-thought https://nationalpost.com/news/canada/first-reading-canadian-... Most people who have glowing things to say about it have had minimal interactions with the system. The overall data shows predictable results when government intervention completely skews market incentives: the patient experience blows, administration is bloated to hell, it lacks capacity, and it bleeds healthcare professionals across the border where pay and working conditions are generally better. The fact that anyone defends the system as it's currently designed is honestly baffling to me. If you took another essential industry - food - and applied similar incentives (any food paid for by government can't be purchased privately, government sets the rates, etc.) most people would correctly predict it would be disastrous.
  - petesergeant 4y ago
    > Most people who have glowing things to say about it have had minimal interactions with the system On this, I’m curious about your experiences with the US system: do you buy your own or is it provisioned via an employer? Have you mostly been financially secure while interacting with it?
EMIRELADERO 4y ago
What would you think about this implementation? -Private insurance is allowed to exist and compete with the public offering -Everyone is entitled by law to the public health system for any kind of injury or health need. -The hospitals used by the public health system are government-owned. They are run by government bureocrats and staffed with private employees (the doctors, nurses, janitorial staff, etc) -The hospitals are managed by the respective jurisdictions in which they are, but they have to follow the basic model that the federal government imposes through the national health ministry.
- cal5k 4y ago
  Government-owned hospitals are a bad idea in my view, because there's no incentive to provide good customer (patient) service, innovate, or move elective procedures to specialized surgical centres outside of a hospital centre. Nor any incentives to provide convenient non-hospital urgent care clinics like you see all over America. The best hospital systems in the world, like Mayo Clinic and Cleveland Clinic, are generally non-profits operating in a mixed system where they take private insurance, out-of-pocket payments, and medicare/medicaid. They have to remain competitive otherwise they won't attract customers from out-of-state or out-of-country. If you basically force patients on the public system to only use certain government-run hospitals, you're dooming them to an inferior experience than what you could get by perhaps enhancing access to public pay for some services.
  - EMIRELADERO 4y ago
    > Government-owned hospitals are a bad idea in my view, because there's no incentive to provide good customer (patient) service, innovate, or move elective procedures to specialized surgical centres outside of a hospital centre. 1) The incentive to innovate in the overall medical field is fulfilled by the existence of private hospitals, which according to my OC wouldn't be banned or cease to exist. They would coexist alongside the public ones. 2) Behind your statement lies the necessary asumption that the medical staff would not provide a good service to their patients because the government would pay them less than private hospitals. While it is a spectrum, most decent doctors won't treat their patients worse because they are getting paid less, something that is not the patient's fault nor responsibility. Besides, one does not choose to get ill or suddenly feel in need of medical care. Your use of the word "customer" to refer to a medical patient sickens me.
rnk 4y ago
Your point is wrong. Pretty much every other western country has much better health care than the US, better outcomes, less disease, longer life. People say they don't want to be like Canada- yet in Canada people have better outcomes than america. It's just a lazy argument to say central planning fails in healthcare, because it generally works well in other countries.
- myko 4y ago
  It's interesting to me, an American with a lot of family members who are Canadian, to hear my fellow Americans arguments against the clearly superior Canadian health care system. The biggest complaint I hear about the Canadian system are wait times, but those affect the expensive US system, too. My wife needed back surgery and couldn't get it scheduled until 6 months out in the US, after jumping through health insurance hoops (useless procedures to check boxes) for 6 months prior to that. Ended up in the ER told "don't move or you might not walk again" while she had to wait 2 days, writhing in pain (but not allowed to move!) until a surgeon performed her surgery 4 months earlier than scheduled. And we paid 10s of thousands of dollars, which took years to pay off.
- cal5k 4y ago
  Oh, okay. Let's ignore social determinants of health then and just say yes, Canada's system is prima facie superior. Case closed! Let's all adopt Canada's system Outcomes aren't uniformly better, by the way. Canada routinely ranks near the bottom of the OECD and like one notch above America, but in America you can get the best healthcare in the world (Mayo Clinic, Cleveland Clinic, etc.) Canada has no equivalent - the small Cleveland Clinic presence in Canada hasn't bothered trying to open a hospital because it would basically be impossible, unlike in the UK where private hospitals still exist. The healthcare professionals in Canada are very well-trained, but there are too few of them and they're smothered in useless bureaucracy.
- fibonacc 4y ago
  Someone from rich part of vancouver die waiting in hospital bed because of shortage of workers. another day on the news, someone suffered a stroke and because the ambulance didn't come on time she is partially paralyzed. another couple had a miscarriage with the mother dying because surgical tools were not sanitized properly. some desperate and sick of waiting travel to US or abroad (Korea, Japan). family doctor, nurse shortage is half the problem. canadian medical school breadth of teaching is generalist and do not go deep enough. there are now calls for privatization. i wish people would stop fetishizing canadian public health care, its better than nothing but behind the rest.

by cal5k 4y ago

petesergeant 4y ago

> As it turns out, central planning fails in healthcare just like it fails everywhere else Virtually every rich country except America manages to provide “free at point of use” healthcare because of government intervention. And of note, if you’re not happy with what the government provides in most of these countries, you can usually top up to gold-plated health care at a fraction of the cost in the US. Last I checked, the US also managed to do this just fine where it has to: the VHA spends about as much as the NHS does and also gets excellent outcomes. Talking about “the Canadian experience” seems strange to me: don’t each of the provinces/territories do it differently? The Manitobans in my family seem very happy with the provision they get. Regardless, 75% of Canadians are “proud” of Canadian health provision[0]. Most rich countries (that aren’t America) also have essentially instant and free transfers between bank accounts … because either the government intervened or threatened to intervene. 0: https://biv.com/article/2020/08/covid-19-crisis-has-failed-erode-faith-canadian-health-care https://biv.com/article/2020/08/covid-19-crisis-has-failed-e...

cal5k 4y ago
Healthcare is a provincial jurisdiction, but the federal government provides a lot of the funding and attaches strings - the chief one being participation in the "Canada Health Act" which mandates a ban on private pay for publicly-insured services. It's a bad system and since that article was published public sentiment has been worsening: https://nationalpost.com/news/canada/first-reading-canadian-health-care-is-even-worse-than-you-thought https://nationalpost.com/news/canada/first-reading-canadian-... Most people who have glowing things to say about it have had minimal interactions with the system. The overall data shows predictable results when government intervention completely skews market incentives: the patient experience blows, administration is bloated to hell, it lacks capacity, and it bleeds healthcare professionals across the border where pay and working conditions are generally better. The fact that anyone defends the system as it's currently designed is honestly baffling to me. If you took another essential industry - food - and applied similar incentives (any food paid for by government can't be purchased privately, government sets the rates, etc.) most people would correctly predict it would be disastrous.
- petesergeant 4y ago
  > Most people who have glowing things to say about it have had minimal interactions with the system On this, I’m curious about your experiences with the US system: do you buy your own or is it provisioned via an employer? Have you mostly been financially secure while interacting with it?

EMIRELADERO 4y ago

What would you think about this implementation? -Private insurance is allowed to exist and compete with the public offering -Everyone is entitled by law to the public health system for any kind of injury or health need. -The hospitals used by the public health system are government-owned. They are run by government bureocrats and staffed with private employees (the doctors, nurses, janitorial staff, etc) -The hospitals are managed by the respective jurisdictions in which they are, but they have to follow the basic model that the federal government imposes through the national health ministry.

cal5k 4y ago
Government-owned hospitals are a bad idea in my view, because there's no incentive to provide good customer (patient) service, innovate, or move elective procedures to specialized surgical centres outside of a hospital centre. Nor any incentives to provide convenient non-hospital urgent care clinics like you see all over America. The best hospital systems in the world, like Mayo Clinic and Cleveland Clinic, are generally non-profits operating in a mixed system where they take private insurance, out-of-pocket payments, and medicare/medicaid. They have to remain competitive otherwise they won't attract customers from out-of-state or out-of-country. If you basically force patients on the public system to only use certain government-run hospitals, you're dooming them to an inferior experience than what you could get by perhaps enhancing access to public pay for some services.
- EMIRELADERO 4y ago
  > Government-owned hospitals are a bad idea in my view, because there's no incentive to provide good customer (patient) service, innovate, or move elective procedures to specialized surgical centres outside of a hospital centre. 1) The incentive to innovate in the overall medical field is fulfilled by the existence of private hospitals, which according to my OC wouldn't be banned or cease to exist. They would coexist alongside the public ones. 2) Behind your statement lies the necessary asumption that the medical staff would not provide a good service to their patients because the government would pay them less than private hospitals. While it is a spectrum, most decent doctors won't treat their patients worse because they are getting paid less, something that is not the patient's fault nor responsibility. Besides, one does not choose to get ill or suddenly feel in need of medical care. Your use of the word "customer" to refer to a medical patient sickens me.

rnk 4y ago

Your point is wrong. Pretty much every other western country has much better health care than the US, better outcomes, less disease, longer life. People say they don't want to be like Canada- yet in Canada people have better outcomes than america. It's just a lazy argument to say central planning fails in healthcare, because it generally works well in other countries.

myko 4y ago
It's interesting to me, an American with a lot of family members who are Canadian, to hear my fellow Americans arguments against the clearly superior Canadian health care system. The biggest complaint I hear about the Canadian system are wait times, but those affect the expensive US system, too. My wife needed back surgery and couldn't get it scheduled until 6 months out in the US, after jumping through health insurance hoops (useless procedures to check boxes) for 6 months prior to that. Ended up in the ER told "don't move or you might not walk again" while she had to wait 2 days, writhing in pain (but not allowed to move!) until a surgeon performed her surgery 4 months earlier than scheduled. And we paid 10s of thousands of dollars, which took years to pay off.
cal5k 4y ago
Oh, okay. Let's ignore social determinants of health then and just say yes, Canada's system is prima facie superior. Case closed! Let's all adopt Canada's system Outcomes aren't uniformly better, by the way. Canada routinely ranks near the bottom of the OECD and like one notch above America, but in America you can get the best healthcare in the world (Mayo Clinic, Cleveland Clinic, etc.) Canada has no equivalent - the small Cleveland Clinic presence in Canada hasn't bothered trying to open a hospital because it would basically be impossible, unlike in the UK where private hospitals still exist. The healthcare professionals in Canada are very well-trained, but there are too few of them and they're smothered in useless bureaucracy.
fibonacc 4y ago
Someone from rich part of vancouver die waiting in hospital bed because of shortage of workers. another day on the news, someone suffered a stroke and because the ambulance didn't come on time she is partially paralyzed. another couple had a miscarriage with the mother dying because surgical tools were not sanitized properly. some desperate and sick of waiting travel to US or abroad (Korea, Japan). family doctor, nurse shortage is half the problem. canadian medical school breadth of teaching is generalist and do not go deep enough. there are now calls for privatization. i wish people would stop fetishizing canadian public health care, its better than nothing but behind the rest.