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None, no, and no. The Clinton administration sought to overhaul the healthcare system and there was lots of testimony by employees of insurance companies whose

None, no, and no. The Clinton administration sought to overhaul the healthcare system and there was lots of testimony by employees of insurance companies whose job was to improperly deny claims. Americans have an irrational fear of socialism and if you can convince them that something is socialist they will be against it. What is interesting today is that Republicans campaigned for years on getting rid of Obamacare. When they finally got control of Congress and the Presidency they did not kill it. Eventually there will be another overhaul because these companies just can’t help but be shitty.

lotsofpulp 2y ago
Because the real role of managed care organizations (MCOs, health insurance companies) is to take the heat for government leaders for having a tiered healthcare system where individuals get access to healthcare based on their socioeconomic position. If you are a government leader and you offer healthcare to everyone, you are now clearly responsible for any failures. But with an MCO in the middle, fingers can be pointed all over the place. Different formularies and prior authorization rules can be set for different populations. For example, reimbursement can be lower for Medicaid patients (poorer/younger people), so they end up with less access to doctors, and higher for Medicare (older, likelier to vote), so more doctors are available there. Senators can get their own plan, and the military another, and the tech company employees yet another, and fast food employees, and so on and so forth. This system benefits all the leaders, so it is not going anywhere. In fact, I would bet UK and Canada move towards this.
- skhunted 2y ago
  And yet many countries have successful universal healthcare.
  - lotsofpulp 2y ago
    I imagine those are dependent on population pyramids not turning upside down. But they seem to be at least flattening, if not turning upside down in all developed countries, hence my prediction of why there would be a change. I keep reading about NHS in the UK having issues holding it together.
    - silverquiet 2y ago
      There's a PA at my general practitioner's office who's got to be about 80; it seems like a lot of healthcare jobs can be done into old age. I think about going the PA route after my next layoff actually because it seems like a job that could be a better fit for me.
    - skhunted 2y ago
      The population pyramid is in better shape than many other countries with universal healthcare. Instead of imagining or searching for plausible sounding excuses study the issue a bit. A government run healthcare system can do much better than our current system and in a much more moral way.
    - halostatue 2y ago
      The NHS (and many other UK institutions) has been starved of cash for fifteen years by the Tories led by increasingly incompetent PMs (I mean, seriously, if the best PM in the last fifteen years is David Cameron; frankly, a head of lettuce would have done better than most of the Tory caucus).
    - gambiting 2y ago
      >>I keep reading about NHS in the UK having issues holding it together I'm in the UK and yep, the system is on the verge of collapse, but it feels like it's entirely by design so it can be finally privatised and killed off once and for all - it feels inevitable at this point. Basically right now it works for: - maternity - anything child related - emergency services(to an extent, unless you are literally dying you will still wait hours for an ambulance). Everything else is so massively underfunded it's a miracle it exists at all. A friend was referred to see a psychiatrist on the NHS recently - you know what the wait time is to see a psychiatrist on the NHS in our region? 210 weeks. About 4 years.
  - JumpCrisscross 2y ago
    > yet many countries have successful universal healthcare Few which provide the level of care the upper middle class and above have come to expect in America. If you make more than $100 yo 167k (85th and 95th percentiles [1]), a good fraction of HN readers, you should be able to virtually walk into any medical establishment and get not only seen within a few days, but also tested and imaged by the latest technology, and consulted on by some of the best doctors in the world. You will do this without worrying about costs, because your employer has chosen an insurer who pitched on experience in addition to cost, because you have the market power to change jobs (or be heard by management) if your healthcare sucks. Universal healthcare means everyone on a PPO falls to the middle class’s HMO-esque standards. For us privileged few, that’s a tough pill to swallow. That is the fundamental injustice and tradeoff that locks us into the status quo, not some paranoia about socialism. [1] https://en.m.wikipedia.org/wiki/Affluence_in_the_United_States https://en.m.wikipedia.org/wiki/Affluence_in_the_United_Stat...
    - skhunted 2y ago
      This is entirely wrong. My household income exceeds $300,000. My wife is a physician. It takes months to get an appointment with an ENT or dermatologist. In Germany, despite not being a citizen or having travel insurance I got an appointment with a dermatologist in 1 day. The cost was around 40 euros. These are anecdotes but they are just as valid as, “you should be able to virtually walk into..” statements. It was fear of socialism that caused the outrage at Clinton’s healthcare proposals. The fear and outrage was so great that for the first time in decades Republicans took control of the House of Representatives in 1994. Look up the number of times things being labeled communism and socialism has been used to try to halt legislation.
      - JumpCrisscross 2y ago
        > It takes months to get an appointment with an ENT or dermatologist Out of curiosity, where are you? (I should have geographically qualified my statement.) In New York, the Bay Area and even western Wyoming (in a wealthy enclave), I have never waited more than a week for an appointment. > fear and outrage was so great that for the first time in decades Republicans took control of the House of Representatives in 1992 Fair enough, will further qualify by last decades. The bracket I’m speaking of knows European healthcare. They understand it is generally high quality and much cheaper. But being able to demand an MRI or the surgeon of your choice when something goes wrong is a real perk, and the one politicians are talking about when they reference public medicine.
ethagnawl 2y ago
> What is interesting today is that Republicans campaigned for years on getting rid of Obamacare. What is perennially interesting is that Republicans (Baby Boomers specifically, in this case) claim to hate "socialized medicine" but every time cuts to Medicare are floated under the guise of "fiscal responsibility" or whatever they're DOA. It's a trite observation at this point they are truly the fuck-you-got-mine generation. Sadly, one of the only things that _has_ trickled down from their generation is the belief that "socialized medicine" is evil. A maddeningly large percentage of Gen-Xers, Millennials and beyond have fallen for this line of reasoning. The ironic part, in my direct experience, is that a lot of those folks are the ones getting health insurance from the federal/local governments through the military, emergency response positions, sanitation, etc. So, again, got-mine-fuck-yours. As a counterpoint, I know a number of people in Europe who have been able to take entrepreneurial risks that either aren't realistic or responsible for people in the U.S. who are tied to their jobs for the sake of healthcare, medical/maternity/paternity/etc. leave, etc. One of them recently had a major health crisis that would have devastated an upstart entrepreneur in the U.S. and was actually able to focus on recovering instead of hustling side gigs or taking out predatory loans to ensure he didn't lose his house or his ability to send his kids to daycare. It's been very enlightening to watch play out in real-time.
- ryandrake 2y ago
  > What is perennially interesting is that Republicans (Baby Boomers specifically, in this case) claim to hate "socialized medicine" but every time cuts to Medicare are floated under the guise of "fiscal responsibility" or whatever they're DOA. Existing socialized medicine, that helps them, is OK. New socialized medicine, which might help other people, is not OK. The politics involved here are not complex.

lotsofpulp 2y ago

Because the real role of managed care organizations (MCOs, health insurance companies) is to take the heat for government leaders for having a tiered healthcare system where individuals get access to healthcare based on their socioeconomic position. If you are a government leader and you offer healthcare to everyone, you are now clearly responsible for any failures. But with an MCO in the middle, fingers can be pointed all over the place. Different formularies and prior authorization rules can be set for different populations. For example, reimbursement can be lower for Medicaid patients (poorer/younger people), so they end up with less access to doctors, and higher for Medicare (older, likelier to vote), so more doctors are available there. Senators can get their own plan, and the military another, and the tech company employees yet another, and fast food employees, and so on and so forth. This system benefits all the leaders, so it is not going anywhere. In fact, I would bet UK and Canada move towards this.

skhunted 2y ago
And yet many countries have successful universal healthcare.
- lotsofpulp 2y ago
  I imagine those are dependent on population pyramids not turning upside down. But they seem to be at least flattening, if not turning upside down in all developed countries, hence my prediction of why there would be a change. I keep reading about NHS in the UK having issues holding it together.
  - silverquiet 2y ago
    There's a PA at my general practitioner's office who's got to be about 80; it seems like a lot of healthcare jobs can be done into old age. I think about going the PA route after my next layoff actually because it seems like a job that could be a better fit for me.
  - skhunted 2y ago
    The population pyramid is in better shape than many other countries with universal healthcare. Instead of imagining or searching for plausible sounding excuses study the issue a bit. A government run healthcare system can do much better than our current system and in a much more moral way.
  - halostatue 2y ago
    The NHS (and many other UK institutions) has been starved of cash for fifteen years by the Tories led by increasingly incompetent PMs (I mean, seriously, if the best PM in the last fifteen years is David Cameron; frankly, a head of lettuce would have done better than most of the Tory caucus).
  - gambiting 2y ago
    >>I keep reading about NHS in the UK having issues holding it together I'm in the UK and yep, the system is on the verge of collapse, but it feels like it's entirely by design so it can be finally privatised and killed off once and for all - it feels inevitable at this point. Basically right now it works for: - maternity - anything child related - emergency services(to an extent, unless you are literally dying you will still wait hours for an ambulance). Everything else is so massively underfunded it's a miracle it exists at all. A friend was referred to see a psychiatrist on the NHS recently - you know what the wait time is to see a psychiatrist on the NHS in our region? 210 weeks. About 4 years.
- JumpCrisscross 2y ago
  > yet many countries have successful universal healthcare Few which provide the level of care the upper middle class and above have come to expect in America. If you make more than $100 yo 167k (85th and 95th percentiles [1]), a good fraction of HN readers, you should be able to virtually walk into any medical establishment and get not only seen within a few days, but also tested and imaged by the latest technology, and consulted on by some of the best doctors in the world. You will do this without worrying about costs, because your employer has chosen an insurer who pitched on experience in addition to cost, because you have the market power to change jobs (or be heard by management) if your healthcare sucks. Universal healthcare means everyone on a PPO falls to the middle class’s HMO-esque standards. For us privileged few, that’s a tough pill to swallow. That is the fundamental injustice and tradeoff that locks us into the status quo, not some paranoia about socialism. [1] https://en.m.wikipedia.org/wiki/Affluence_in_the_United_States https://en.m.wikipedia.org/wiki/Affluence_in_the_United_Stat...
  - skhunted 2y ago
    This is entirely wrong. My household income exceeds $300,000. My wife is a physician. It takes months to get an appointment with an ENT or dermatologist. In Germany, despite not being a citizen or having travel insurance I got an appointment with a dermatologist in 1 day. The cost was around 40 euros. These are anecdotes but they are just as valid as, “you should be able to virtually walk into..” statements. It was fear of socialism that caused the outrage at Clinton’s healthcare proposals. The fear and outrage was so great that for the first time in decades Republicans took control of the House of Representatives in 1994. Look up the number of times things being labeled communism and socialism has been used to try to halt legislation.
    - JumpCrisscross 2y ago
      > It takes months to get an appointment with an ENT or dermatologist Out of curiosity, where are you? (I should have geographically qualified my statement.) In New York, the Bay Area and even western Wyoming (in a wealthy enclave), I have never waited more than a week for an appointment. > fear and outrage was so great that for the first time in decades Republicans took control of the House of Representatives in 1992 Fair enough, will further qualify by last decades. The bracket I’m speaking of knows European healthcare. They understand it is generally high quality and much cheaper. But being able to demand an MRI or the surgeon of your choice when something goes wrong is a real perk, and the one politicians are talking about when they reference public medicine.

ethagnawl 2y ago

> What is interesting today is that Republicans campaigned for years on getting rid of Obamacare. What is perennially interesting is that Republicans (Baby Boomers specifically, in this case) claim to hate "socialized medicine" but every time cuts to Medicare are floated under the guise of "fiscal responsibility" or whatever they're DOA. It's a trite observation at this point they are truly the fuck-you-got-mine generation. Sadly, one of the only things that _has_ trickled down from their generation is the belief that "socialized medicine" is evil. A maddeningly large percentage of Gen-Xers, Millennials and beyond have fallen for this line of reasoning. The ironic part, in my direct experience, is that a lot of those folks are the ones getting health insurance from the federal/local governments through the military, emergency response positions, sanitation, etc. So, again, got-mine-fuck-yours. As a counterpoint, I know a number of people in Europe who have been able to take entrepreneurial risks that either aren't realistic or responsible for people in the U.S. who are tied to their jobs for the sake of healthcare, medical/maternity/paternity/etc. leave, etc. One of them recently had a major health crisis that would have devastated an upstart entrepreneur in the U.S. and was actually able to focus on recovering instead of hustling side gigs or taking out predatory loans to ensure he didn't lose his house or his ability to send his kids to daycare. It's been very enlightening to watch play out in real-time.

ryandrake 2y ago
> What is perennially interesting is that Republicans (Baby Boomers specifically, in this case) claim to hate "socialized medicine" but every time cuts to Medicare are floated under the guise of "fiscal responsibility" or whatever they're DOA. Existing socialized medicine, that helps them, is OK. New socialized medicine, which might help other people, is not OK. The politics involved here are not complex.