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> As a side note, this will probably sound amazing to many readers, but working both for myself and my startup my family went for over a decade without health i

> As a side note, this will probably sound amazing to many readers, but working both for myself and my startup my family went for over a decade without health insurance. It's utterly incomprehensible to me that the United States still hasn't gotten on board with universal health care (the tortured Obamacare plan notwithstanding).

sp332 15y ago
There's so much money and bureaucracy in the "health" industry and the insurance industries, that any nationalized system would be corrupt and probably not very effective. Plus, I think it was Thomas Jefferson that pointed out: Any government powerful enough to give you everything you want is powerful enough to take away everything you have. If we let the government think they have control over who gets healthy and who dies, and who has to pay so other people don't die, I don't see that ending well.
- davidw 15y ago
  > any nationalized system would be corrupt and probably not very effective. You can measure stuff like that, and "it turns out" (to use a celebrated phrase) that even countries like Italy (which does have problems of corruption and being not very effective in terms of the government) can provide care to everyone for a lower price than in the US, in terms of a percentage of GDP. You do have to wait for some stuff, but seeing a doctor is not one of them. My experience in Austria was that it was even better than Italy at providing pretty good care quickly, cheaply, and to pretty much everyone.
- RyanMcGreal 15y ago
  There are different ways to provide universal health care. Canada, for example, has a single-payer system in which most medical practices are private but they bill the public insurer. The system isn't perfect, obviously, but it is quite efficient at allocating money to actual health care rather than administrative overhead. Whole categories of business expenses (including, ahem, profits) just go away. On the other hand, Britain has a fully nationalized system in which doctors are public employees, and their system is even more efficient than the Canadian system. In fact, across OECD countries, the overall efficiency of the health care system seems to be positively correlated with the extent to which the government directly controls it. In the US, the public parts of the health care system are overall much more efficient at allocating resources to care than the private parts. Sidenote: I will pause here to draw a distinction between allocative efficiency, or the extent to which a system allocates capital where it will maximize ROI, and what we might call outcome efficiency, or the extent to which a system allocates resources where they will maximize effectiveness. Market based systems are better at allocative efficiency, but the evidence is that they are much worse at outcome efficiency. Market-based health care is great business, but it leaves far too many people under- and uninsured. This is because the principal economic imperative for a for-profit insurer is to collect premiums but not pay out benefits.
- kyouens 15y ago
  In my view, one of the reasons for runaway healthcare cost may the way that insurance coverage distances the patient / consumer from the true costs involved. (e.g. "My statin costs $5 a month because that's how much my co-pay is." No.) Insurance is necessary and useful for catastrophic events like the OP's. By contrast, for routine, predictable health care expenditures, insurance spreads the cost among policyholders / taxpayers to the extent that there is no conception of the actual cost of care. It's like having insurance to put gas in your car, or to pay your utility bill. Every time the money changes hands, you can bet the insurance company takes it's share. This model will allow (or even cause) drug companies and hospitals to keep costs high to protect reimbursements, all via back-room deals with huge insurance companies. Expensive, government-mandated (or provided) insurance coverage for routine health expenditures will get in between doctors and patients and will drain employers and taxpayers while the insurance companies get richer.

sp332 15y ago

There's so much money and bureaucracy in the "health" industry and the insurance industries, that any nationalized system would be corrupt and probably not very effective. Plus, I think it was Thomas Jefferson that pointed out: Any government powerful enough to give you everything you want is powerful enough to take away everything you have. If we let the government think they have control over who gets healthy and who dies, and who has to pay so other people don't die, I don't see that ending well.

davidw 15y ago
> any nationalized system would be corrupt and probably not very effective. You can measure stuff like that, and "it turns out" (to use a celebrated phrase) that even countries like Italy (which does have problems of corruption and being not very effective in terms of the government) can provide care to everyone for a lower price than in the US, in terms of a percentage of GDP. You do have to wait for some stuff, but seeing a doctor is not one of them. My experience in Austria was that it was even better than Italy at providing pretty good care quickly, cheaply, and to pretty much everyone.
RyanMcGreal 15y ago
There are different ways to provide universal health care. Canada, for example, has a single-payer system in which most medical practices are private but they bill the public insurer. The system isn't perfect, obviously, but it is quite efficient at allocating money to actual health care rather than administrative overhead. Whole categories of business expenses (including, ahem, profits) just go away. On the other hand, Britain has a fully nationalized system in which doctors are public employees, and their system is even more efficient than the Canadian system. In fact, across OECD countries, the overall efficiency of the health care system seems to be positively correlated with the extent to which the government directly controls it. In the US, the public parts of the health care system are overall much more efficient at allocating resources to care than the private parts. Sidenote: I will pause here to draw a distinction between allocative efficiency, or the extent to which a system allocates capital where it will maximize ROI, and what we might call outcome efficiency, or the extent to which a system allocates resources where they will maximize effectiveness. Market based systems are better at allocative efficiency, but the evidence is that they are much worse at outcome efficiency. Market-based health care is great business, but it leaves far too many people under- and uninsured. This is because the principal economic imperative for a for-profit insurer is to collect premiums but not pay out benefits.
kyouens 15y ago
In my view, one of the reasons for runaway healthcare cost may the way that insurance coverage distances the patient / consumer from the true costs involved. (e.g. "My statin costs $5 a month because that's how much my co-pay is." No.) Insurance is necessary and useful for catastrophic events like the OP's. By contrast, for routine, predictable health care expenditures, insurance spreads the cost among policyholders / taxpayers to the extent that there is no conception of the actual cost of care. It's like having insurance to put gas in your car, or to pay your utility bill. Every time the money changes hands, you can bet the insurance company takes it's share. This model will allow (or even cause) drug companies and hospitals to keep costs high to protect reimbursements, all via back-room deals with huge insurance companies. Expensive, government-mandated (or provided) insurance coverage for routine health expenditures will get in between doctors and patients and will drain employers and taxpayers while the insurance companies get richer.