6 ms·

The problem with American healthcare is the attempt to compromise between healthcare as a universally available public utility and healthcare as a commodity on

by jaco6 2y ago

The problem with American healthcare is the attempt to compromise between healthcare as a universally available public utility and healthcare as a commodity on the private market. (Arguably this is a legacy of pre-modern healthcare, where hospitals were operated by charities run by nuns and funded by aristocrats and royal families, hence all the “Saint” names in hospitals nowadays). There’s a variety of weird examples of this mixed system: >Poor people use ERs for every day healthcare, usually they get away with paying nothing, no insurance >Working people with insurance pay more to enable this access for the destitute (or criminal) portion of the population >Old people are sort of entitled to free healthcare. They get medicare, but if they want everything, they have to pay for “supplements.” >Young people pay for the old people’s healthcare twice, on their payroll taxes and in the form of higher premiums. A 25 year old male should absolutely not have a $300/mo health premium. But he does, because his premium is paying for other’s care. This is a system pretending to be private, but it’s actually just inefficiently public. It would be more efficient to pay for it using taxes, both income and sales taxes, rather than letting some groups—the poor and the elderly—off the hook arbitrarily. Alternatively, abolish health insurance altogether—a notoriously inefficient and exploitative industry that does not suit the classic purpose of insurance (boat accidents and fires)—and see what happens. This is obviously a rather unpalatable option due to the chaos that would ensue, but it’s probably the best option.

JamesBarney 2y ago
> It would be more efficient to pay for it using taxes, both income and sales taxes, rather than letting some groups—the poor and the elderly—off the hook arbitrarily. I don't think this is true. Some countries with public healthcare are far more efficient than our system. But there are countries that have systems similar to ours that are far more efficient as well. We just have a really shitty system, and who pays for it isn't going to change that. It's a hard technocratic problem that doesn't have any easy answers. (Besides increasing the number of residency slots, removing the bachelor degree requirements and allowing foreign physicians to practice which are basically freebies.)
- ninalanyon 2y ago
  > But there are countries that have systems similar to ours Really? Which ones are they?
  - JamesBarney 2y ago
    Israel, Switzerland, and the Netherlands all rely on private insurance as well and still have vastly better systems than our own.
    - Retric 2y ago
      Netherlands has a mostly public system with heavily subsidized mandatory non-profit insurance under government oversight: Health insurers receive compensation for high risk individuals from the government,[5] and government subsidies pay about 75% of insurance costs. https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands Israel also has a public healthcare system in practice. Mandatory participation in 1 of 4 non profit insurance programs looks like private insurance but … https://en.wikipedia.org/wiki/Healthcare_in_Israel https://en.wikipedia.org/wiki/Healthcare_in_Israel For the health tax, wage-earners and the self-employed must pay 3.1% of their monthly salary up to 60% of the average prevailing market wage (appx. NIS 6,300 in 2020), and 5% of anything earned above it.[25] Employers are legally obligated to deduct insurance contributions from their employees' salaries, while the self-employed must arrange payment on their own. Pensioners have contributions deducted from their pensions, as do those receiving unemployment benefits. Those who are not working but have income must pay 5% of their income in health tax, while those who are not working and have no income must pay NIS 104 a month. Switzerland has a similar system with mandatory participation and non profit insurance programs. https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
      - JamesBarney 2y ago
        Yes health care is very different in every country in the world. There are a 1000 ways to do it well but the US is unique in having insane healthcare costs. Having non profit insurance companies isn't the difference, having mandatory health insurance isn't the difference. It's not that easy to fix.
Gibbon1 2y ago
There is the idea of elite over production. We have private health insurance in order to create a couple thousand upper class jobs. With a half dozen billionaires running things.

by jaco6 2y ago

JamesBarney 2y ago

> It would be more efficient to pay for it using taxes, both income and sales taxes, rather than letting some groups—the poor and the elderly—off the hook arbitrarily. I don't think this is true. Some countries with public healthcare are far more efficient than our system. But there are countries that have systems similar to ours that are far more efficient as well. We just have a really shitty system, and who pays for it isn't going to change that. It's a hard technocratic problem that doesn't have any easy answers. (Besides increasing the number of residency slots, removing the bachelor degree requirements and allowing foreign physicians to practice which are basically freebies.)

ninalanyon 2y ago
> But there are countries that have systems similar to ours Really? Which ones are they?
- JamesBarney 2y ago
  Israel, Switzerland, and the Netherlands all rely on private insurance as well and still have vastly better systems than our own.
  - Retric 2y ago
    Netherlands has a mostly public system with heavily subsidized mandatory non-profit insurance under government oversight: Health insurers receive compensation for high risk individuals from the government,[5] and government subsidies pay about 75% of insurance costs. https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands Israel also has a public healthcare system in practice. Mandatory participation in 1 of 4 non profit insurance programs looks like private insurance but … https://en.wikipedia.org/wiki/Healthcare_in_Israel https://en.wikipedia.org/wiki/Healthcare_in_Israel For the health tax, wage-earners and the self-employed must pay 3.1% of their monthly salary up to 60% of the average prevailing market wage (appx. NIS 6,300 in 2020), and 5% of anything earned above it.[25] Employers are legally obligated to deduct insurance contributions from their employees' salaries, while the self-employed must arrange payment on their own. Pensioners have contributions deducted from their pensions, as do those receiving unemployment benefits. Those who are not working but have income must pay 5% of their income in health tax, while those who are not working and have no income must pay NIS 104 a month. Switzerland has a similar system with mandatory participation and non profit insurance programs. https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
    - JamesBarney 2y ago
      Yes health care is very different in every country in the world. There are a 1000 ways to do it well but the US is unique in having insane healthcare costs. Having non profit insurance companies isn't the difference, having mandatory health insurance isn't the difference. It's not that easy to fix.

Gibbon1 2y ago

There is the idea of elite over production. We have private health insurance in order to create a couple thousand upper class jobs. With a half dozen billionaires running things.