5 ms·

I just want to walk into a place, ask for a price, pay with cash and get a xray (or anything else I want or need). The clusterfuck US healthcare is just show h

I just want to walk into a place, ask for a price, pay with cash and get a xray (or anything else I want or need). The clusterfuck US healthcare is just show how deeply dysfunctional the political system is. Health insurances should be banned. Everything should be paid in cash, prices posted at the door, and government should maybe co-pay to help low income and/or unfortunate (cancer and such), possibly funding most effective preventing healthcare to make sure everyone gets, all paid from normal taxes.

nxm 4y ago
See how the NHS is currently doing.
- flangola7 4y ago
  Being increasingly gutted by Tories.
- jimbokun 4y ago
  How's it doing? I imagine it's still a lot better than the high cost and poor outcomes we have here in the US.
- e2le 4y ago
  Not a good example. At the moment it's being criminally mismanaged by the conservative government. The NHS has seen better days.
  - closeparen 4y ago
    Of course it's a good example. The whole point of nationalizing things is to make them subject to politics, and an important consideration in nationalizing important services is that they will only run as well as your country's politics.
    - fakedang 4y ago
      While the NHS is subject to the whims of Tory politicians, it can still be kept trudging along through a period of incapable government thanks to the legion of civil servants running in the background. I don't think the US has any equivalent answer for the UK Civil service.
- bdw5204 4y ago
  There are more possible health care systems than the NHS and the worst of all worlds disaster that is US healthcare. I know British people love the NHS but I don't think the US should copy it given its bad outcomes and constant issues with Tories underfunding it (as if the "deficit hawk" wing of the Republicans that is currently blocking the debt ceiling increase wouldn't do the same thing to an American NHS). I think any kind of reform to US health care is going to require a substantial role for the market (ideally without coverage networks, deductibles or those insurance company death panels that refuse to pay for care that a doctor considers medically necessary) and probably an expanded role for Medicare, Medicaid and CHIP. There should probably also be a single payer malpractice insurance program so that doctors can start private practices again, a federal law requiring safe staffing ratios for nurses (maybe tying this to Medicare funds?) and antitrust action to break up hospital monopolies. Addressing college costs and cancelling all student loan debt would also help as many doctors are still repaying their med school loans decades after graduation.
  - autoexec 4y ago
    > I know British people love the NHS but I don't think the US should copy it given its bad outcomes keep in mind that for the vast majority of Americans the bad outcomes of the NHS would still be a massive improvement from what they have now which is basically no care at all. I know people who are solidly middle class but are putting off needed healthcare because of costs that wouldn't be any issue whatsoever if they were UK citizens and for lower income US families there's no NHS waiting list as long as "You will never be able to afford what you need" I agree that, if we were to look to implement some version of the NHS here, we should learn from their mistakes and shortcomings, but if we took it "as is" today it'd still be a net win for Americans.
- antisthenes 4y ago
  Just as good as the US system, at less than 1/2 the cost?
jimbokun 4y ago
National government run health insurance provided to everyone, along with a flat deductible for everyone scaled to income, would be an interesting model. You pay 100% up to deductible (out of pre-tax HSA), government insurance covers everything after that. It would be interesting to see how many people stay under the deductible, and not cost the government program anything. Along with publicly posting prices for most services, so people can spend their deductible most efficiently. This isn't very well thought through. But I'm trying to imagine a system that combines market forces for everyday health care expenses, paired with government health insurance for the truly massive expenses of traumatic health events.
- Brybry 4y ago
  Spending any money is a bigger deal to people with less (or no) money than people above a certain threshold. So one problem you end up with is people that won't go to the doctor for preventative care or before issues become worse (and thus more expensive to fix) to save money now. It's why the ACA specifically says preventive care, immunizations, medical screenings, etc. cannot be subject to copay or deductible or coinsurance.[1] [1] https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/
- Auracle 4y ago
  Once people realize they can vote to lower the deductible the system will quickly turn into just government run healthcare. I’ve had the same thought, but keep it private. Mandate everyone is on a high deductible plan with government support to make the deductibles lower for the truly poor. Make health insurance actual insurance again - instead of health plans. It’s the same basic idea but a little less vulnerable to the whims of politics. Of course, your idea is more palatable for democrats (though not very) and mine is more palatable for republicans, meaning neither will happen. Also, tie drug prices to the prices other countries pay damnit. The only reason something so obvious hasn’t happened can only be because of lobbying.
  - jimbokun 4y ago
    Interesting you advocate for free market insurance plans, but price controls for drugs.
ThePowerOfFuet 4y ago
> I just want to walk into a place, ask for a price, pay with cash and get a xray (or anything else I want or need). One small edit is how it actually works in much of the rest of the world: You just walk into a place, hand them your health card, and get an xray (or anything else you want or need).

nxm 4y ago

See how the NHS is currently doing.

flangola7 4y ago
Being increasingly gutted by Tories.
jimbokun 4y ago
How's it doing? I imagine it's still a lot better than the high cost and poor outcomes we have here in the US.
e2le 4y ago
Not a good example. At the moment it's being criminally mismanaged by the conservative government. The NHS has seen better days.
- closeparen 4y ago
  Of course it's a good example. The whole point of nationalizing things is to make them subject to politics, and an important consideration in nationalizing important services is that they will only run as well as your country's politics.
  - fakedang 4y ago
    While the NHS is subject to the whims of Tory politicians, it can still be kept trudging along through a period of incapable government thanks to the legion of civil servants running in the background. I don't think the US has any equivalent answer for the UK Civil service.
bdw5204 4y ago
There are more possible health care systems than the NHS and the worst of all worlds disaster that is US healthcare. I know British people love the NHS but I don't think the US should copy it given its bad outcomes and constant issues with Tories underfunding it (as if the "deficit hawk" wing of the Republicans that is currently blocking the debt ceiling increase wouldn't do the same thing to an American NHS). I think any kind of reform to US health care is going to require a substantial role for the market (ideally without coverage networks, deductibles or those insurance company death panels that refuse to pay for care that a doctor considers medically necessary) and probably an expanded role for Medicare, Medicaid and CHIP. There should probably also be a single payer malpractice insurance program so that doctors can start private practices again, a federal law requiring safe staffing ratios for nurses (maybe tying this to Medicare funds?) and antitrust action to break up hospital monopolies. Addressing college costs and cancelling all student loan debt would also help as many doctors are still repaying their med school loans decades after graduation.
- autoexec 4y ago
  > I know British people love the NHS but I don't think the US should copy it given its bad outcomes keep in mind that for the vast majority of Americans the bad outcomes of the NHS would still be a massive improvement from what they have now which is basically no care at all. I know people who are solidly middle class but are putting off needed healthcare because of costs that wouldn't be any issue whatsoever if they were UK citizens and for lower income US families there's no NHS waiting list as long as "You will never be able to afford what you need" I agree that, if we were to look to implement some version of the NHS here, we should learn from their mistakes and shortcomings, but if we took it "as is" today it'd still be a net win for Americans.
antisthenes 4y ago
Just as good as the US system, at less than 1/2 the cost?

jimbokun 4y ago

National government run health insurance provided to everyone, along with a flat deductible for everyone scaled to income, would be an interesting model. You pay 100% up to deductible (out of pre-tax HSA), government insurance covers everything after that. It would be interesting to see how many people stay under the deductible, and not cost the government program anything. Along with publicly posting prices for most services, so people can spend their deductible most efficiently. This isn't very well thought through. But I'm trying to imagine a system that combines market forces for everyday health care expenses, paired with government health insurance for the truly massive expenses of traumatic health events.

Brybry 4y ago
Spending any money is a bigger deal to people with less (or no) money than people above a certain threshold. So one problem you end up with is people that won't go to the doctor for preventative care or before issues become worse (and thus more expensive to fix) to save money now. It's why the ACA specifically says preventive care, immunizations, medical screenings, etc. cannot be subject to copay or deductible or coinsurance.[1] [1] https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/
Auracle 4y ago
Once people realize they can vote to lower the deductible the system will quickly turn into just government run healthcare. I’ve had the same thought, but keep it private. Mandate everyone is on a high deductible plan with government support to make the deductibles lower for the truly poor. Make health insurance actual insurance again - instead of health plans. It’s the same basic idea but a little less vulnerable to the whims of politics. Of course, your idea is more palatable for democrats (though not very) and mine is more palatable for republicans, meaning neither will happen. Also, tie drug prices to the prices other countries pay damnit. The only reason something so obvious hasn’t happened can only be because of lobbying.
- jimbokun 4y ago
  Interesting you advocate for free market insurance plans, but price controls for drugs.

ThePowerOfFuet 4y ago

> I just want to walk into a place, ask for a price, pay with cash and get a xray (or anything else I want or need). One small edit is how it actually works in much of the rest of the world: You just walk into a place, hand them your health card, and get an xray (or anything else you want or need).