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insert generic American progressive take about why we should have socialized healthcare here. My wife had an issue with her eye that was giving similar symptom

insert generic American progressive take about why we should have socialized healthcare here. My wife had an issue with her eye that was giving similar symptoms to macular degeneration [1] in 2016. I had insurance (it might have even been UHC, but I'm not 100% sure), so we went to an ophthalmologist's office, to get it looked at. When we get to the office, we find out that just the copay for this was going to be $550. I was kind of crap at saving money back then, and I had a job that didn't pay great, and I remember I had exactly $578.23 in my bank account at the time, and I still needed to pay my rent. I had to kind of awkwardly tell my wife "sorry, we don't have the money to have your eye looked at and pay our rent", so we leave without her getting any treatment. About 4-5 months later, I got a better job with much better health insurance, so she went to that same ophthalmologist, and our copay was less than $50. The entirety of the work that this ophthalmologist did was refer her to a retinal specialist. This means that I was initially going to have paid more than $500 just to get a god damned referral, and just to re-emphasize this, we had health insurance. I remember how upset and frustrated I was with that entire situation; it felt like I was doing things the "right" way by getting a desk job with health insurance and yet I still couldn't afford to get the treatment that my wife needed. It just felt...unfair? Like what exactly was I supposed to do differently here? It didn't really "change" my perspective on this, I had already been in favor of moving to a universal healthcare system, but this thoroughly solidified my perspective on it. [1] Fortunately, it wasn't that, it was an autoimmune thing. Still not great but better than we initially thought.

KittenInABox 2y ago
I have complicated feelings about universal healthcare... namely that the issue seems to be more-or-less not whether the system is socialized or private but if the healthcare system is provided adequate funding (via government or a private entity) to give acceptable outcomes on a population level. A lot of the detractors to private healthcare is simply that healthcare isn't being administered appropriately (pressure to only see patients for 15 minutes for example or to charge by procedure encouraging specialists where systemic issues go ignored) but so is the case for socialized medicine (waiting too long for specialists, understaffed hospitals).
- beezlebroxxxxxx 2y ago
  Providing a socialized system with adequate funding requires elected officials and voters to have appropriate and matched priorities. Voters, regardless of party in Canada for example, generally all agree that the socialized healthcare system needs more funding and to be a higher priority. I understand that when you remove party affiliation from the prompt a majority of Americans are also generally in favor of socialized healthcare and would like to see it expanded. Critics of socialized healthcare often point at things like waiting too long for specialists, or understaffed hospitals, presenting them as inherent to socialized medicine itself when it's more often the product of elected officials who simply don't think socialized healthcare deserves adequate funding, or are against the idea of socialized healthcare entirely. Politicians will often piss in your cup and insist to you it's champagne. There is, of course, the economic arguments around public vs. private health-care systems; but there are also the philosophical, moral, and ethical, arguments regardless of economics. Some things are expensive and yet we still understand they are a good and humane thing to do.
  - s1artibartfast 2y ago
    > Some things are expensive and yet we still understand they are a good and humane thing to do. I think this is often a sticking point for agreement. It is hard to get buy in without some level of guardrails on cost and impact. I dont want to bet my house, retirement, and children's future on the promise socialized healthcare will be a net savings for both the public and for me. For this reason, I think opt-in Medicare is a reasonable middle path, where governments can demonstrate the cost reductions and care, allowing people to voluntarily convert at their own pace. This would go a long way do dealing with the risk aversion, but I think many people ostensibly for socialized healthcare are too scared test if it could actually compete on price and value.
    - throwway120385 2y ago
      The thing about Medicare is you can only go to places that accept the Medicare plan, so people who opt-in will be de-facto taking a lower standard of care for a very long time until everyone opts-in. If you go to one of these places in my area the doctors treat you very differently even if you have really good insurance because they presume that you're poor and on Medicare.
buildbot 2y ago
Someone in my family has macular degradation, it seems like an awful and incredibly hard way to loose your vision slowly over years. Hopefully your wife's vision is not getting worse too fast, autoimmune sounds bad still, as someone with normal vision. Losing your eyesight is terrifying, in my opinion. Tying health insurance to your job has to be one of the worst parts of the American system.
- davidw 2y ago
  I did some software work, years ago on a 'perimeter' machine that projects points of light at varying intensities so that doctors can track macular degradation. https://www.icare-world.com/us/products/#perimeters https://www.icare-world.com/us/products/#perimeters It was interesting work in terms of the tech, but pretty sad stuff learning to the doctors come in to present information about the pathologies involved.
- tombert 2y ago
  It's definitely bad, but fortunately it has responded really well to immune-suppresers, and it's fortunately only one eye. There's definitely some level of permanent damage, she is unlikely to ever get it back to 100%, but it's certainly not as bad as it could be. > Tying health insurance to your job has to be one of the worst parts of the American system. Yeah, it gives companies so much more power than they really deserve. Not only can they cut off my income supply, which is more or less the nominal agreement we have as part of the capitalist transaction, but they also get to decide if I (or any of my dependents) get to get treatment for any kind of illness. The medicaid system in the US is actually not too bad, I was really grateful for that in the tail end of 2023 and beginning of 2024 when I was unemployed, but it's extremely concerning that (SOME UNNAMED POLITICIANS THAT I WON'T NAME BECAUSE I DON'T WANT TO BE FLAGGED BY SOMEONE WHO THINKS THAT BRINGING UP POLITICS IS SOMEHOW OUT OF THE SCOPE OF HN) want to drastically cut that program.
  - coderatlarge 2y ago
    What about cobra coverage?
ericmcer 2y ago
Agreed, good healthcare is a huge part of shackling you to your employer. Every time I think about quitting it gives me pause knowing it means a few risky months until I can get a new job and have coverage again. Insurance has also skyrocketed the cost of care, I was doing a weekly physio/massage visit and with good health insurance it was a $50 copay. I looked back at what the place was charging my insurance and it was ludicrous. They were billing my insurance $400-600 a week and every little thing they did was getting charged. All the cool like "extras" I thought they were doing for me were becoming $50-200 charges. I partially tore my achilles last year and most doctors I saw just wanted to check all the boxes so they could send a massive bill to my insurance. I ended up seeing 3 different doctors, a physical therapist and a physiotherapist before I finally found someone who really cared about helping me. It was $2000 out of pocket but he really went all out mapping my recovery and performing all kinds of interventions. I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap, check off their forms and then shuffle you off. It feels like we are getting further and further from the world where you know your doctor and they can say something like "you only needed a referral, lets just call this $40, see ya in a few months". Now it is someone you may never see again, who has no control over how much you are billed and who has 20 more patients coming in behind you.
- tombert 2y ago
  > I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap I hear this a lot, but that doesn't really seem to be what the data says? There have been a good number of studies comparing American healthcare to more socialized systems, and the outcomes are generally comparable or better in the socialized systems. That doesn't imply that if we just changed to a universal system tomorrow that we would have the same outcomes, every country is different, and it's not necessarily guaranteed that copying Sweden's system would automatically work here. But I do think that it's also not implied that it would lead to the bureaucratic chop-shop that people are afraid of.
  - s1artibartfast 2y ago
    It always comes down to who you compare. Most of the cited information on outcomes look at averages. US healthcare outcomes are bimodal. It is easy to sell the idea to people with poor coverage distribution. The harder sell is the people in the better distribution worried about taking a step down while carrying the cost for other people.
dfxm12 2y ago
Importantly, it's not just progressives that have takes about why we should have socialized healthcare. Maybe some people are afraid of the S word, but when you ask people about universal healthcare, support cuts across party lines. We especially saw this in the wake of other recent United Healthcare new. It just goes to show, aside from the few who keep beating the drum about this, Bernie Sanders, etc. this is just another issue that shows how the people in political power aren't there for you or me, they're there for their billionaire friends.
A_D_E_P_T 2y ago
You don't even need socialized healthcare, really. What you need is a system that doesn't exhibit the insane amount of regulatory capture that's on display in the US. I lived in Hong Kong for a while. In Hong Kong: (1) If you want to see a doctor, you just pay cash. Fees are reasonable. (~$50-80 for a GP up to $350-400 for a top specialist.) (2) There's no other way to pay. (If you have insurance, they might reimburse you later.) (3) You don't need referrals for anything. (If you need to see a specialist, you call a specialist directly and make an appointment. Many of them will see you on the same day you book an appointment.) (4) You don't need a prescription for just about anything. (Antibiotics and steroids -- and all the the most powerful non-recreational drugs -- are available OTC.) (5) ERs, emergency services, and things like childbirth are covered by the government, but the service is generally worse than you'd get if you pay out of pocket. The US system isn't more "capitalist" -- it's captured by special interests and middlemen to a mind boggling extent. And you don't necessarily need "socialized" healthcare -- you need a system that gives both patients and doctors more agency.
- sympil 2y ago
  Universal care is the moral option. Hong Kong was great for you because you had means. https://pmc.ncbi.nlm.nih.gov/articles/PMC6235271/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6235271/
  - A_D_E_P_T 2y ago
    I mean, sure, that's fair. But... The amount of money I spent on medical care in Hong Kong, per year, was probably 1/10th of what I'd have to spend on medical insurance alone if I were in the US. Because patients and practitioners have more agency, and because pricing is transparent, there's actual competition in the market. Sure, you need money, but it's less than you think, and there are fewer hoops to jump through, fewer roadblocks to treatment. The optimal system is probably something like that. A public system for emergencies, child delivery, and absolutely necessary treatments -- and a transparent, open, private system for everything else.
  - jt2190 2y ago
    Surprisingly, in the U.S. it’s people with means who can’t afford healthcare. Poor people are covered under various state and charity programs.
conductr 2y ago
I think this sums up the problem. People that have suffered by the affordability issue or hit some of the money traps (excessive charges for referrals, needing prescriptions for basic antibiotics and glasses/contacts, etc), seeing how different people pay vastly different prices, and so on. This group is likely to be in favor of universal healthcare. But there’s a whole other group that hasn’t had that friction yet, are lucky enough to have the “good insurance”, are completely naive, and/or just buying into the lie that this is all normal and what’s best for everyone. This group reads your comment and thinks “you just want me to pay for something because you can’t afford it” which is a very flawed take.
- ceejayoz 2y ago
  The "whole other group" also often has no idea how much their healthcare actually costs. I know folks who pay $0 or $50/month, because work picks the rest of it up. They think that's how much health insurance costs. It can be challenging to get them to believe that it's $3,600/month on the open market in my area for a family of four.
  - conductr 2y ago
    Agree. Obfuscating the cost is what American healthcare does best. Even within the industry, how well they do or if they meet their budgets/cover expenses is largely based on which type of card is in your wallet when you show up for an appointment
xyzzyz 2y ago
Just for context, here is what it would have looked like in socialized medicine system, the UK’s NHS: so we went to an ophthalmologist's office, to get it looked at In UK, you can’t just go to ophthalmologist’s office. You’d first need to schedule an appointment with your GP, who then would (or would not) give you a referral to a specialist. You then need to wait for something between 6-12 months (sometimes more, depending on your location) for an ophthalmologist appointment. You wouldn’t need to pay for it out of pocket, but you’d wish you had an option to pay the damn 500 quid so that you can start the treatment sooner.
- tokioyoyo 2y ago
  Counter point, when things are urgent, it gets done for free pretty fast in countries where I lived with such healthcare. Speaking from personal experience.
  - hn_acc1 2y ago
    Agreed. My parents in Canada both had cancer treatments without delay, they both recovered, etc. With $0 out of pocket. I'd at minimum have to pay the Kaiser max co-pay here for a similar problem.
- tombert 2y ago
  I had to wait almost six months to get her treatment here as well because I couldn't afford it. At least in the UK I wouldn't have been out the cash. Also, I hear lots of horror stories about wait-times in universal healthcare systems, but that always seems have smuggled in the premise of "you don't have wait times like this in the US", which has certainly not been my experience. I wanted to see an allergist in 2022, so I went to my health insurance portal, and called a few in the area, and the earliest appointment that I could find was almost four months out. My wife had to wait for months even from our good insurance to get approved for proper medication for her eye problem. What insurance do you have where you're not stuck with long bureaucratic waiting lists?
  - caycep 2y ago
jimbob45 2y ago
Surely price caps are the solution here, no? I don’t want big tickets items like Total Hip Replacements price-capped but referrals certainly are not a high-skilled line item.
udkl 2y ago
Universal health care isn't the only alternative. The fault is in the way private healthcare is structured in the US. Countries like Thailand and India have fully functioning and affordable private healthcare.
tourmalinetaco 2y ago
Under a “universal” healthcare system your wife would go in for free, and then take 3-6 months, if not longer, to get seen. And then the doctor refers you to the specialist, who will take another 1-2 months. And you pay for it via taxes anyway.

KittenInABox 2y ago

I have complicated feelings about universal healthcare... namely that the issue seems to be more-or-less not whether the system is socialized or private but if the healthcare system is provided adequate funding (via government or a private entity) to give acceptable outcomes on a population level. A lot of the detractors to private healthcare is simply that healthcare isn't being administered appropriately (pressure to only see patients for 15 minutes for example or to charge by procedure encouraging specialists where systemic issues go ignored) but so is the case for socialized medicine (waiting too long for specialists, understaffed hospitals).

beezlebroxxxxxx 2y ago
Providing a socialized system with adequate funding requires elected officials and voters to have appropriate and matched priorities. Voters, regardless of party in Canada for example, generally all agree that the socialized healthcare system needs more funding and to be a higher priority. I understand that when you remove party affiliation from the prompt a majority of Americans are also generally in favor of socialized healthcare and would like to see it expanded. Critics of socialized healthcare often point at things like waiting too long for specialists, or understaffed hospitals, presenting them as inherent to socialized medicine itself when it's more often the product of elected officials who simply don't think socialized healthcare deserves adequate funding, or are against the idea of socialized healthcare entirely. Politicians will often piss in your cup and insist to you it's champagne. There is, of course, the economic arguments around public vs. private health-care systems; but there are also the philosophical, moral, and ethical, arguments regardless of economics. Some things are expensive and yet we still understand they are a good and humane thing to do.
- s1artibartfast 2y ago
  > Some things are expensive and yet we still understand they are a good and humane thing to do. I think this is often a sticking point for agreement. It is hard to get buy in without some level of guardrails on cost and impact. I dont want to bet my house, retirement, and children's future on the promise socialized healthcare will be a net savings for both the public and for me. For this reason, I think opt-in Medicare is a reasonable middle path, where governments can demonstrate the cost reductions and care, allowing people to voluntarily convert at their own pace. This would go a long way do dealing with the risk aversion, but I think many people ostensibly for socialized healthcare are too scared test if it could actually compete on price and value.
  - throwway120385 2y ago
    The thing about Medicare is you can only go to places that accept the Medicare plan, so people who opt-in will be de-facto taking a lower standard of care for a very long time until everyone opts-in. If you go to one of these places in my area the doctors treat you very differently even if you have really good insurance because they presume that you're poor and on Medicare.

buildbot 2y ago

Someone in my family has macular degradation, it seems like an awful and incredibly hard way to loose your vision slowly over years. Hopefully your wife's vision is not getting worse too fast, autoimmune sounds bad still, as someone with normal vision. Losing your eyesight is terrifying, in my opinion. Tying health insurance to your job has to be one of the worst parts of the American system.

davidw 2y ago
I did some software work, years ago on a 'perimeter' machine that projects points of light at varying intensities so that doctors can track macular degradation. https://www.icare-world.com/us/products/#perimeters https://www.icare-world.com/us/products/#perimeters It was interesting work in terms of the tech, but pretty sad stuff learning to the doctors come in to present information about the pathologies involved.
tombert 2y ago
It's definitely bad, but fortunately it has responded really well to immune-suppresers, and it's fortunately only one eye. There's definitely some level of permanent damage, she is unlikely to ever get it back to 100%, but it's certainly not as bad as it could be. > Tying health insurance to your job has to be one of the worst parts of the American system. Yeah, it gives companies so much more power than they really deserve. Not only can they cut off my income supply, which is more or less the nominal agreement we have as part of the capitalist transaction, but they also get to decide if I (or any of my dependents) get to get treatment for any kind of illness. The medicaid system in the US is actually not too bad, I was really grateful for that in the tail end of 2023 and beginning of 2024 when I was unemployed, but it's extremely concerning that (SOME UNNAMED POLITICIANS THAT I WON'T NAME BECAUSE I DON'T WANT TO BE FLAGGED BY SOMEONE WHO THINKS THAT BRINGING UP POLITICS IS SOMEHOW OUT OF THE SCOPE OF HN) want to drastically cut that program.
- coderatlarge 2y ago
  What about cobra coverage?

ericmcer 2y ago

Agreed, good healthcare is a huge part of shackling you to your employer. Every time I think about quitting it gives me pause knowing it means a few risky months until I can get a new job and have coverage again. Insurance has also skyrocketed the cost of care, I was doing a weekly physio/massage visit and with good health insurance it was a $50 copay. I looked back at what the place was charging my insurance and it was ludicrous. They were billing my insurance $400-600 a week and every little thing they did was getting charged. All the cool like "extras" I thought they were doing for me were becoming $50-200 charges. I partially tore my achilles last year and most doctors I saw just wanted to check all the boxes so they could send a massive bill to my insurance. I ended up seeing 3 different doctors, a physical therapist and a physiotherapist before I finally found someone who really cared about helping me. It was $2000 out of pocket but he really went all out mapping my recovery and performing all kinds of interventions. I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap, check off their forms and then shuffle you off. It feels like we are getting further and further from the world where you know your doctor and they can say something like "you only needed a referral, lets just call this $40, see ya in a few months". Now it is someone you may never see again, who has no control over how much you are billed and who has 20 more patients coming in behind you.

tombert 2y ago
> I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap I hear this a lot, but that doesn't really seem to be what the data says? There have been a good number of studies comparing American healthcare to more socialized systems, and the outcomes are generally comparable or better in the socialized systems. That doesn't imply that if we just changed to a universal system tomorrow that we would have the same outcomes, every country is different, and it's not necessarily guaranteed that copying Sweden's system would automatically work here. But I do think that it's also not implied that it would lead to the bureaucratic chop-shop that people are afraid of.
- s1artibartfast 2y ago
  It always comes down to who you compare. Most of the cited information on outcomes look at averages. US healthcare outcomes are bimodal. It is easy to sell the idea to people with poor coverage distribution. The harder sell is the people in the better distribution worried about taking a step down while carrying the cost for other people.

dfxm12 2y ago

Importantly, it's not just progressives that have takes about why we should have socialized healthcare. Maybe some people are afraid of the S word, but when you ask people about universal healthcare, support cuts across party lines. We especially saw this in the wake of other recent United Healthcare new. It just goes to show, aside from the few who keep beating the drum about this, Bernie Sanders, etc. this is just another issue that shows how the people in political power aren't there for you or me, they're there for their billionaire friends.

A_D_E_P_T 2y ago

You don't even need socialized healthcare, really. What you need is a system that doesn't exhibit the insane amount of regulatory capture that's on display in the US. I lived in Hong Kong for a while. In Hong Kong: (1) If you want to see a doctor, you just pay cash. Fees are reasonable. (~$50-80 for a GP up to $350-400 for a top specialist.) (2) There's no other way to pay. (If you have insurance, they might reimburse you later.) (3) You don't need referrals for anything. (If you need to see a specialist, you call a specialist directly and make an appointment. Many of them will see you on the same day you book an appointment.) (4) You don't need a prescription for just about anything. (Antibiotics and steroids -- and all the the most powerful non-recreational drugs -- are available OTC.) (5) ERs, emergency services, and things like childbirth are covered by the government, but the service is generally worse than you'd get if you pay out of pocket. The US system isn't more "capitalist" -- it's captured by special interests and middlemen to a mind boggling extent. And you don't necessarily need "socialized" healthcare -- you need a system that gives both patients and doctors more agency.

sympil 2y ago
Universal care is the moral option. Hong Kong was great for you because you had means. https://pmc.ncbi.nlm.nih.gov/articles/PMC6235271/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6235271/
- A_D_E_P_T 2y ago
  I mean, sure, that's fair. But... The amount of money I spent on medical care in Hong Kong, per year, was probably 1/10th of what I'd have to spend on medical insurance alone if I were in the US. Because patients and practitioners have more agency, and because pricing is transparent, there's actual competition in the market. Sure, you need money, but it's less than you think, and there are fewer hoops to jump through, fewer roadblocks to treatment. The optimal system is probably something like that. A public system for emergencies, child delivery, and absolutely necessary treatments -- and a transparent, open, private system for everything else.
- jt2190 2y ago
  Surprisingly, in the U.S. it’s people with means who can’t afford healthcare. Poor people are covered under various state and charity programs.

conductr 2y ago

I think this sums up the problem. People that have suffered by the affordability issue or hit some of the money traps (excessive charges for referrals, needing prescriptions for basic antibiotics and glasses/contacts, etc), seeing how different people pay vastly different prices, and so on. This group is likely to be in favor of universal healthcare. But there’s a whole other group that hasn’t had that friction yet, are lucky enough to have the “good insurance”, are completely naive, and/or just buying into the lie that this is all normal and what’s best for everyone. This group reads your comment and thinks “you just want me to pay for something because you can’t afford it” which is a very flawed take.

ceejayoz 2y ago
The "whole other group" also often has no idea how much their healthcare actually costs. I know folks who pay $0 or $50/month, because work picks the rest of it up. They think that's how much health insurance costs. It can be challenging to get them to believe that it's $3,600/month on the open market in my area for a family of four.
- conductr 2y ago
  Agree. Obfuscating the cost is what American healthcare does best. Even within the industry, how well they do or if they meet their budgets/cover expenses is largely based on which type of card is in your wallet when you show up for an appointment

xyzzyz 2y ago

Just for context, here is what it would have looked like in socialized medicine system, the UK’s NHS: so we went to an ophthalmologist's office, to get it looked at In UK, you can’t just go to ophthalmologist’s office. You’d first need to schedule an appointment with your GP, who then would (or would not) give you a referral to a specialist. You then need to wait for something between 6-12 months (sometimes more, depending on your location) for an ophthalmologist appointment. You wouldn’t need to pay for it out of pocket, but you’d wish you had an option to pay the damn 500 quid so that you can start the treatment sooner.

tokioyoyo 2y ago
Counter point, when things are urgent, it gets done for free pretty fast in countries where I lived with such healthcare. Speaking from personal experience.
- hn_acc1 2y ago
  Agreed. My parents in Canada both had cancer treatments without delay, they both recovered, etc. With $0 out of pocket. I'd at minimum have to pay the Kaiser max co-pay here for a similar problem.
tombert 2y ago
I had to wait almost six months to get her treatment here as well because I couldn't afford it. At least in the UK I wouldn't have been out the cash. Also, I hear lots of horror stories about wait-times in universal healthcare systems, but that always seems have smuggled in the premise of "you don't have wait times like this in the US", which has certainly not been my experience. I wanted to see an allergist in 2022, so I went to my health insurance portal, and called a few in the area, and the earliest appointment that I could find was almost four months out. My wife had to wait for months even from our good insurance to get approved for proper medication for her eye problem. What insurance do you have where you're not stuck with long bureaucratic waiting lists?
- caycep 2y ago

jimbob45 2y ago

Surely price caps are the solution here, no? I don’t want big tickets items like Total Hip Replacements price-capped but referrals certainly are not a high-skilled line item.

udkl 2y ago

Universal health care isn't the only alternative. The fault is in the way private healthcare is structured in the US. Countries like Thailand and India have fully functioning and affordable private healthcare.

tourmalinetaco 2y ago

Under a “universal” healthcare system your wife would go in for free, and then take 3-6 months, if not longer, to get seen. And then the doctor refers you to the specialist, who will take another 1-2 months. And you pay for it via taxes anyway.