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We wouldn't have this problem if we have universal healthcare in America, no? The US system is so dumb not to mention inefficient.

epistasis 1y ago
Universal healthcare doesn't change the overall cost. To a large degree, the ACA/Obamacare was a good stab at getting universal healthcare! The change in this article is about undoing universality, by changing the subsidies for those with lower income. To structurally reduce the fraction of GDP devoted to healthcare, we need to make far bigger changes. A lot of the setup right now is to subsidize those on Medicare by those on private insurance programs. The cross-subsidization goes very deep, and anything that might reduce costs also has the risk of undoing cross-subsidization. With half the country refusing to reform health care for the past 30 years, and the other half having their hands tied behind their back on trying to improve health care, we have built a gigantic overly complex system that's very hard to unwind.
- lazide 1y ago
  Yup. Eventually it’ll likely be burned to the ground (uh, I mean ‘reformed’) but folks are trying to squeeze what they can out now.
- narrator 1y ago
  Whatever the problem with health care in America is, the solution is not more money. We already spend double what all other countries spend as a percent of GDP and we have worse outcomes. There are a lot of similar mysteries in America. For example, why does it cost a billion dollars a mile to do subways which is 20x almost everywhere else.
- AnimalMuppet 1y ago
  > Universal healthcare doesn't change the overall cost. It can, at least to some degree. Every doctor's office has people who run through the insurance maze, trying to get services paid for. And every insurance company has people on the other side, trying to find ways to not pay for stuff. Having only one organization to deal with would simplify that; having one organization with clear, transparent rules would simplify it more.
- the_gastropod 1y ago
  > Universal healthcare doesn't change the overall cost I get the sense I'm probably preaching to the choir here. But, the U.S. spends almost 2x what comparable countries (with universal healthcare) spend on healthcare. And we get worse than average results on virtually every measure. This, of course, makes sense. When you're running healthcare as a for-profit business, part of our expenses are... profit to pay out shareholders. And advertisement budgets. And middlemen (insurance). And employees to do things like decline coverage. Medical employees to deal with insurance companies declining coverage. Etc. etc. There's a whole industry that only exists to support our private healthcare system that would cease to exist in a universal healthcare system.
- forgotusername6 1y ago
  Surely the complete removal of insurance and advertising from the US healthcare system would have an impact on the overall cost. Not to mention the amount of early preventative care that could be carried out instead of people waiting until it was really serious due to fear of medical bills.
  - andy99 1y ago
    Yes, the problem is insurance, not who pays for healthcare. There's not universal government funded car maintenance and it works just fine for the most part. Insuring predictable, recurring costs is a scam. There's room, either private or public, to backstop catastrophes, but not the rest.
  - epistasis 1y ago
    We are about twice as expensive as healthcare system from other similar countries. Eliminating all administrative fees from insurance, all advertising, does not close that gap. There's a lot more going on!
- runako 1y ago
  > Universal healthcare doesn't change the overall cost. Something like 15% of US healthcare spending goes towards administrative fees just around insurance. That's order of $800 billion annually, roughly $1,500 per American, that does not contribute in any way to improving health. This is roughly the size of the US defense budget that we spend on gating healthcare. There are knock-on effects of our system that increase some costs, such as people skipping preventative care or medications due to high costs or lack of insurance and then ending up in higher-cost emergency care. Or see the recent trend of physicians documenting how much of their time spent arguing with insurance companies on behalf of patients, time not spent providing medical care (and thereby increasing costs).
  - franktankbank 1y ago
    > Something like 15% of US healthcare spending goes towards administrative fees just around insurance. True parasites.
lazide 1y ago
It depends on what problem you’re referring too. Many socialized healthcare systems have huge backlogs right now. Ration on price. Or availability. Or quality. Eventually, every system ends up with one of the three. Sometimes 2.
- 9cb14c1ec0 1y ago
  My Canadian father-in-law had to wait over a year before being able to see a neurologist about his suspected Parkinsons symptoms. Fortunately, he's well off enough that he was able to afford medical treatment in another country, but many people trapped in such systems are not.
  - betaby 1y ago
    Half of my work colleagues received health care abroad. Wait times in Quebec are insane. Yes, constant joint pain may be not 'life threatening' yet degrades quality of life significantly. Basically if you are not actively dying you can't get access to healthcare in Quebec.
  - lurking_swe 1y ago
    Just to share a perspective from someone who used to live in New York… I had what I suspected was a mild concussion with some annoying symptoms at the time. I could see a neurologist within 3 days IF my schedule was flexible (it was not). I ended up getting seen 10 days later. a year is just crazy.
- XorNot 1y ago
  "Backlog" - there is never a moment that this isn't just wrong. I'm from Australia. If I want to "skip the line" I can just pay to do so. Private practice exists. People don't, because it's expensive and they can't afford it. This is exactly like the US, except in the US you just don't get healthcare at all and die instead. The "backlog" in any public healthcare system is a triage line. If you actually need care, you get it immediately. If you can live with it but keep it monitored, you might not for longer then is optimally comfortable if you can't afford private consults. In the US, again, you just don't get anything.
danielmarkbruce 1y ago
Try living in a few different countries. The US healthcare system is amazing if you have good insurance - really freaking amazing.
- Freedom2 1y ago
  I've lived in over 7 countries and the US healthcare system is by far the worst one I've personally experienced.
  - danielmarkbruce 1y ago
    Maybe you didn't have good health insurance? If you have children or anything big happen, you want to be in major metro area of the US with broad network, expensive insurance. It's the best in the world, by miles.
    - nielsbot 1y ago
      But what about people in the US who don't have the good insurance? Should they not get healthcare?
      - danielmarkbruce 1y ago
        I'm just describing what it's like if you have the right insurance and live in a big metro. There are a lot of takes on what the system should be...
- fzeroracer 1y ago
  I live in the US and have good insurance. Our healthcare system is garbage.
  - lotsoweiners 1y ago
    Please explain because it sounds like you might not have as good of insurance as you think. I have good insurance and pay basically nothing out of pocket beyond around $200 deductible.
2OEH8eoCRo0 1y ago
I like the idea of a public insurance option. Would bolt right onto our current system and help bring costs down.
- cj 1y ago
  What would a public insurance option involve? Do you mean insurance that's provided at-cost without a company profiting? Insurance companies are already required to spend at least 80% (or 85%) of the premiums they collect on paying out claims. If they spend less, they are required to give rebates / premium refunds to policy holders. It wouldn't be crazy to increase that percentage even more, since it's effectively a cap on the profit margin insurers are allowed to earn on premiums.
  - Rebelgecko 1y ago
    If a company's profits are capped at x% of the money they spend, aren't they incentivized to support higher medical costs?
    - cj 1y ago
      In theory, they'd be incentivized by the free market to provide the best coverage for the lowest cost to retain and get new customers. But not sure how well that holds up in practice.
  - morkalork 1y ago
    The universal healthcare system in many countries is like they said, a publicly funded and operated insurer. I can look in the government portal and see what each healthcare provider billed to the public system for example. One can also have their private insurance cover services or just pay out of pocket. But copying that part blindly in the USA is doomed to fail because along with the universal coverage, there are also strict regulations on what services can be offered privately, how much can be charged for services and what must be covered by private insurance (a fun example I experienced recently was my private insurance not wanting to cover a certain drug treatment; if one doesn't have insurance, the government will pay 100% for the drugs but if you do, they force the private insurer to cover the cost). All areas where there USA is lacking.
betaby 1y ago
> We wouldn't have this problem if we have universal healthcare in America, no? No. Try living in Quebec.
wakawaka28 1y ago
The expense problem (which is overstated in the article) would just shift from premiums to taxes if there was "universal healthcare" in America. Besides that, a large part of the expenses comes from subsidizing drugs that get sold abroad for low prices. It's easy to whine about "dumb Americans" when your own country is subsidized by them

epistasis 1y ago

Universal healthcare doesn't change the overall cost. To a large degree, the ACA/Obamacare was a good stab at getting universal healthcare! The change in this article is about undoing universality, by changing the subsidies for those with lower income. To structurally reduce the fraction of GDP devoted to healthcare, we need to make far bigger changes. A lot of the setup right now is to subsidize those on Medicare by those on private insurance programs. The cross-subsidization goes very deep, and anything that might reduce costs also has the risk of undoing cross-subsidization. With half the country refusing to reform health care for the past 30 years, and the other half having their hands tied behind their back on trying to improve health care, we have built a gigantic overly complex system that's very hard to unwind.

lazide 1y ago
Yup. Eventually it’ll likely be burned to the ground (uh, I mean ‘reformed’) but folks are trying to squeeze what they can out now.
narrator 1y ago
Whatever the problem with health care in America is, the solution is not more money. We already spend double what all other countries spend as a percent of GDP and we have worse outcomes. There are a lot of similar mysteries in America. For example, why does it cost a billion dollars a mile to do subways which is 20x almost everywhere else.
AnimalMuppet 1y ago
> Universal healthcare doesn't change the overall cost. It can, at least to some degree. Every doctor's office has people who run through the insurance maze, trying to get services paid for. And every insurance company has people on the other side, trying to find ways to not pay for stuff. Having only one organization to deal with would simplify that; having one organization with clear, transparent rules would simplify it more.
the_gastropod 1y ago
> Universal healthcare doesn't change the overall cost I get the sense I'm probably preaching to the choir here. But, the U.S. spends almost 2x what comparable countries (with universal healthcare) spend on healthcare. And we get worse than average results on virtually every measure. This, of course, makes sense. When you're running healthcare as a for-profit business, part of our expenses are... profit to pay out shareholders. And advertisement budgets. And middlemen (insurance). And employees to do things like decline coverage. Medical employees to deal with insurance companies declining coverage. Etc. etc. There's a whole industry that only exists to support our private healthcare system that would cease to exist in a universal healthcare system.
forgotusername6 1y ago
Surely the complete removal of insurance and advertising from the US healthcare system would have an impact on the overall cost. Not to mention the amount of early preventative care that could be carried out instead of people waiting until it was really serious due to fear of medical bills.
- andy99 1y ago
  Yes, the problem is insurance, not who pays for healthcare. There's not universal government funded car maintenance and it works just fine for the most part. Insuring predictable, recurring costs is a scam. There's room, either private or public, to backstop catastrophes, but not the rest.
- epistasis 1y ago
  We are about twice as expensive as healthcare system from other similar countries. Eliminating all administrative fees from insurance, all advertising, does not close that gap. There's a lot more going on!
runako 1y ago
> Universal healthcare doesn't change the overall cost. Something like 15% of US healthcare spending goes towards administrative fees just around insurance. That's order of $800 billion annually, roughly $1,500 per American, that does not contribute in any way to improving health. This is roughly the size of the US defense budget that we spend on gating healthcare. There are knock-on effects of our system that increase some costs, such as people skipping preventative care or medications due to high costs or lack of insurance and then ending up in higher-cost emergency care. Or see the recent trend of physicians documenting how much of their time spent arguing with insurance companies on behalf of patients, time not spent providing medical care (and thereby increasing costs).
- franktankbank 1y ago
  > Something like 15% of US healthcare spending goes towards administrative fees just around insurance. True parasites.

lazide 1y ago

It depends on what problem you’re referring too. Many socialized healthcare systems have huge backlogs right now. Ration on price. Or availability. Or quality. Eventually, every system ends up with one of the three. Sometimes 2.

9cb14c1ec0 1y ago
My Canadian father-in-law had to wait over a year before being able to see a neurologist about his suspected Parkinsons symptoms. Fortunately, he's well off enough that he was able to afford medical treatment in another country, but many people trapped in such systems are not.
- betaby 1y ago
  Half of my work colleagues received health care abroad. Wait times in Quebec are insane. Yes, constant joint pain may be not 'life threatening' yet degrades quality of life significantly. Basically if you are not actively dying you can't get access to healthcare in Quebec.
- lurking_swe 1y ago
  Just to share a perspective from someone who used to live in New York… I had what I suspected was a mild concussion with some annoying symptoms at the time. I could see a neurologist within 3 days IF my schedule was flexible (it was not). I ended up getting seen 10 days later. a year is just crazy.
XorNot 1y ago
"Backlog" - there is never a moment that this isn't just wrong. I'm from Australia. If I want to "skip the line" I can just pay to do so. Private practice exists. People don't, because it's expensive and they can't afford it. This is exactly like the US, except in the US you just don't get healthcare at all and die instead. The "backlog" in any public healthcare system is a triage line. If you actually need care, you get it immediately. If you can live with it but keep it monitored, you might not for longer then is optimally comfortable if you can't afford private consults. In the US, again, you just don't get anything.

danielmarkbruce 1y ago

Try living in a few different countries. The US healthcare system is amazing if you have good insurance - really freaking amazing.

Freedom2 1y ago
I've lived in over 7 countries and the US healthcare system is by far the worst one I've personally experienced.
- danielmarkbruce 1y ago
  Maybe you didn't have good health insurance? If you have children or anything big happen, you want to be in major metro area of the US with broad network, expensive insurance. It's the best in the world, by miles.
  - nielsbot 1y ago
    But what about people in the US who don't have the good insurance? Should they not get healthcare?
    - danielmarkbruce 1y ago
      I'm just describing what it's like if you have the right insurance and live in a big metro. There are a lot of takes on what the system should be...
fzeroracer 1y ago
I live in the US and have good insurance. Our healthcare system is garbage.
- lotsoweiners 1y ago
  Please explain because it sounds like you might not have as good of insurance as you think. I have good insurance and pay basically nothing out of pocket beyond around $200 deductible.

2OEH8eoCRo0 1y ago

I like the idea of a public insurance option. Would bolt right onto our current system and help bring costs down.

cj 1y ago
What would a public insurance option involve? Do you mean insurance that's provided at-cost without a company profiting? Insurance companies are already required to spend at least 80% (or 85%) of the premiums they collect on paying out claims. If they spend less, they are required to give rebates / premium refunds to policy holders. It wouldn't be crazy to increase that percentage even more, since it's effectively a cap on the profit margin insurers are allowed to earn on premiums.
- Rebelgecko 1y ago
  If a company's profits are capped at x% of the money they spend, aren't they incentivized to support higher medical costs?
  - cj 1y ago
    In theory, they'd be incentivized by the free market to provide the best coverage for the lowest cost to retain and get new customers. But not sure how well that holds up in practice.
- morkalork 1y ago
  The universal healthcare system in many countries is like they said, a publicly funded and operated insurer. I can look in the government portal and see what each healthcare provider billed to the public system for example. One can also have their private insurance cover services or just pay out of pocket. But copying that part blindly in the USA is doomed to fail because along with the universal coverage, there are also strict regulations on what services can be offered privately, how much can be charged for services and what must be covered by private insurance (a fun example I experienced recently was my private insurance not wanting to cover a certain drug treatment; if one doesn't have insurance, the government will pay 100% for the drugs but if you do, they force the private insurer to cover the cost). All areas where there USA is lacking.

betaby 1y ago

> We wouldn't have this problem if we have universal healthcare in America, no? No. Try living in Quebec.

wakawaka28 1y ago

The expense problem (which is overstated in the article) would just shift from premiums to taxes if there was "universal healthcare" in America. Besides that, a large part of the expenses comes from subsidizing drugs that get sold abroad for low prices. It's easy to whine about "dumb Americans" when your own country is subsidized by them