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by egorfine 1y ago

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tboyd47 1y ago
It's not a democracy. You were told wrong, it's a republic.
- galangalalgol 1y ago
  Well it was a democratic republic. Now it is an electoral autocracy. He fixed it so good those christians will never have (or be able) to vote again. Just like he said he would. A Republic where the representatives are chosen by a popular vote are still democracies.
  - tboyd47 1y ago
    The representatives are chosen by the Electoral College, not the popular vote. The U.S. is not a democracy.
    - galangalalgol 1y ago
      Representatives are chosen directly by the voters of their districts and senators directly by the voters of their state. Electors are selected however their state decides, so yeah, the president isn't necessarily democratically chosen. Neither are judges. In practice though the electors are chosen based on the state vote. Saying the us wasn't a democracy is narrowing the definition of democracy quite a bit.
      - tboyd47 1y ago
        It's a constitutional republic. Democracy is optional. We'll either discover it now or discover it later.
zarmsdos 1y ago
Decades of right-wing propaganda, unfortunately. They tend to have an emotional reaction against any sort of socialized anything, including healthcare.
- gosub100 1y ago
  Left wing won't solve it either. They profit from the crisis by promising each election and not delivering.
  - zarmsdos 1y ago
    That's true. I wouldn't even call them left-wing, to be honest.
micromacrofoot 1y ago
It's precisely as many have said over decades at this point: the poor in our country hate themselves to the extent that they view being poor as a personal failing, and voting for free services for everyone is therefore dishonorable. I talk to people like this every day and it's frustrating.
ziofill 1y ago
Non-US person here too. From what I understand the majority of Americans want a single-payer healthcare system, but too many people in government are paid by insurance companies and affiliates to not change how things work.
dragonwriter 1y ago
> I have heard the US is a democracy. It is certainly not a direct democracy where each individual policy is resolved by separate independent voting, no. > So then insurance-based healthcare is what American people truly want? Pretty consistently, no, but there is not any single alternative that a majority of the American people prefer recently (for a while, as far back as the 1990s, there was a clear popular majority for universal single-payer), and more importantly, it is not the only issue that factors into people’s voting decisions.
baby 1y ago
As soon as someone introduce these ideas people think they're a communist. See Mamdani in NY right now.
nine_zeros 1y ago
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selfmodruntime 1y ago
The US is gigantic. Imagine if every EU member, however rich, poor, or corrupt from Bulgaria to Germany had to enact one healthcare system.
- egorfine 1y ago
  India is larger and yet.
  - selfmodruntime 1y ago
    And yet even its major cities are filled with sewage, 400 million are without healthcare and less than 50% of its people have reliable access to clean drinking water?
andy99 1y ago
Edit: just saw an earlier better comment saying the same thing: https://news.ycombinator.com/item?id=45737190 https://news.ycombinator.com/item?id=45737190 Countries with “free” also healthcare ration it and don’t cover everything. Socialized insurance is still insurance, and at least in Canada it’s the only game in town, so if you have a procedure that is denied or not available your choice is basically to go to the US and pay for it and be in the same position as an uninsured American.
stronglikedan 1y ago
Yes, but we also want universal healthcare. What we don't want is only universal healthcare with death panels like the UK and Canada has. Give us universal health care where we can also get insurance if we want, and we'll vote it in. That's never what comes up though. I firmly believe we could gut medicare/medicaid and the savings from the bureaucratic administration costs alone could pay for universal healthcare.
- polski-g 1y ago
  UK/CA healthcare sounds like hell. Every doctor is under the government, so even if you have money for a procedure the government doesn't want to cover, you can't get it done. And of course because there is no rationing by price there is rationing by time, so you end up with 13mo waits for an MRI.
  - dragonwriter 1y ago
    Leaving aside the subjective impressions, the objective parts of that description are only accurate for CA, not UK, healthcare; the UK has optional add-on private insurance and care on top of the universal public system.
- trollbridge 1y ago
  Note that Massachusetts and San Francisco have universal healthcare. Mass. is also home to one of the best healthcare systems and children’s hospital in the word.
somethingsome 1y ago
Hum.. At least where I live in europe, you still need to battle with insurances for any non trivial problem.. We get a health care coverage for the common stuff, but many things are not covered, or not covered enough.. Then you need insurances.. And it's always a battle.. Same for other kind of insurances such as issues with the house, etc..
FpUser 1y ago
Non US as well. Life saving saving surgeries get denied, delayed and otherwise screwed all the time. Not sure where exactly it is worse since absolutely atrocious cases can be found in every G7 country never mind the rest
frogperson 1y ago
The are advertised as a democracy, but ever since Citizens United was passed we became an Oligarchy. Money now takes the place of votes since the rich can donate unlimited funds to a candidate. Candidates have zero incentive to serve the public.
msla 1y ago
The same way European people put up with the insane NHS and its refusal to care for the people who support it financially and supposedly support it politically. https://edition.cnn.com/2024/03/13/uk/england-nhs-puberty-blockers-trans-children-intl-gbr https://edition.cnn.com/2024/03/13/uk/england-nhs-puberty-bl... The NHS and its bizarre political agenda is an example of what can happen when a government controls access to health care.
- pjc50 1y ago
  A good example that "public" campaigning can work, but not necessarily for the better - there's been a systematic campaign to delegitimize trans healthcare. There's comparable examples from other places; Ireland has come a long way in getting the church out of reproductive health, but there are still problems. And of course it doesn't matter whether it's public or private, abortion care is at risk in many US states. The UK does allow you to go private, remember.
qgin 1y ago
We have a lot of people being constantly brainwashed that we have the most amazing system in the world and that any attempt to change it is communism.
zulban 1y ago
You've implied the answer to your own question. The USA is not a democracy. The opinions of almost all Americans have no impact on policy. It's a well researched fact. Having an election day where people vote doesn't mean you live in a democracy.
bluesounddirect 1y ago
Then what sort of feel good stories about AI would we have . The US needs to adopt a single flat income / corp tax, government provided healthcare, and move on to the rest of life.
thatfrenchguy 1y ago
Add a French and American person, in the US you hear "insurance did not approve", in France it's more "you can't get an appointment / the surgery provider does not have any spots unless you go to their spots in their private hospital". The French system is more predictable (because any vaguely sane healthcare system has a price for a code instead of negotiated rates, negotiated rates is the most inefficient way to run this market) & you can get cost estimates though. And in both countries, if you live in a small town in both systems, the healthcare you will receive will suck.
- knollimar 1y ago
  Do negotiated rates not affect quality of care? I work in contracting and negotiated rates allow me to add quality, while systems like price codes incentivize minimum effort/outcomes. I know doctors probably take their jobs more seriously, but I'd be surprised if it doesn't bleed over into healthcare quality.
  - thatfrenchguy 1y ago
    Negotiated rates are per code here though, and doctors generally aren’t the ones doing the actual coding for the visit in the US, they have folks going through your doctor’s notes and figuring out the codes. Another reason why the overhead of health care is so high in the US.
levocardia 1y ago
Why do you put up with long wait times and lower-quality care in your home country?
- janalsncm 1y ago
  It is very interesting that you do not where they are from but you assume longer wait times and lower quality of care. This suggests you believe the US has the shortest wait times and highest quality of care, which is objectively not true.
deleted 1y ago
[deleted]
lucasban 1y ago
One thing also to keep in mind, is that this experience is not uniform throughout the US. Many Americans like -their- employer based insurance, even if they don’t like the system. I personally pay nothing for visits and nominal fees ($1-10) for prescriptions. I have not been hospitalized while on this insurance, but my understanding is that it is relatively low cost. I also have no monthly premium. Meanwhile, my mother works at a small business, pays a significant percentage of her income for insurance from the ACA marketplaces (the public marketplaces created during the Obama administration) with the current subsidies, subsidies that are in question under the current administration. The American healthcare payment system is broken, but we aren’t all living through the worst case scenario experiences that get the attention. Add to that the amount of money and effort that went into turning healthcare reform into yet another partisan issue, and there’s a good recipe for maintaining a broken status quo for a while yet.
BobbyTables2 1y ago
Its too easy to convince enough of the population to actively vote against their own interests.
- DaSHacka 1y ago
  How right you are, and more than you know
fallingfrog 1y ago
No, we all hate it, but the number of senators and members of congress who would vote to replace it could be counted with one hand. The reason is simple: the insurance companies give those senators millions and millions of dollars and nobody has the cash to beat them. And we've given up at this point. As the song goes: "Everybody knows that the dice are loaded Everybody rolls with their fingers crossed Everybody knows the war is over Everybody knows the good guys lost Everybody knows the fight was fixed The poor stay poor, the rich get rich That's how it goes Everybody knows"
billy99k 1y ago
The alternative is no surgery and no choice, which is what happens with government-run healthcare.
- Freedom2 1y ago
  I doubt this comment is true, given that other countries with government run healthcare have surgeries and choice. Do you happen to have any evidence that every country with government run healthcare has no choice or surgeries at all? Your comment seems to imply as such.
bko 1y ago
US person here. I have insurance through my employer as do most Americans. And most are happy with their insurance. I can go to the doctor often same day, I can see a specialist and pay just a co-pay of between $25-50. I had some bills but my out of pocket max is something like $5k, which I have saved up. The benefits of living in the US is that the same kind of work (engineer) pays about 3x as much here and you pay a lot less taxes (save many multiples of my out of pocket max). So I prefer to live in a vibrant economy and take care of my own insurance.
BurningFrog 1y ago
In European countries the procedures that are denied or very expensive in the US are often simply not offered. There is a national health budget, and not everything fits in it. The doctors have to tell the patients that there is nothing they can do, and that's that. The patient ends up just as dead, but there is nothing to get furious about like when the doctors could fix it, but only if someone pays for it.
ab_testing 1y ago
I think the root cause of the problem is not insurance companies but they definitely do play a part. The real reasons are multiple but can be listed as below. 1 A very high cost of drugs due to no intervention by the government as part of free market philosophy. This means that the same insulin that costs $25 in Canada can be sold for up to $1000 per month. New introduced drugs for Alzheimer's or other diseases can cost up to 50k per year - again because no price controls. 2. Insanely high prices of services due to a captive market - example a ten minute ambulance ride can cost up from $1000 to $5000. The private ambulance companies know they can charge a high base rate because they are connected to a city or municipality via contracts. Bribes as campaign funds are popular here. E.g. a new York based ambulance operator paid 45k in campaign funds to NY's governor elect and got a contract worth one billion dollars https://www.wkbw.com/news/state-news/report-nysdoh-awards-multi-billion-dollar-contract-to-hochul-campaign-donor https://www.wkbw.com/news/state-news/report-nysdoh-awards-mu... 3. Overcharging by hospitals for medicines and services again due to a captive audience. The hospitals are free to maintain various price books and you are not told what each service will cost at the time of administration of service. lately the hospitals have been forced to open up their price books but they are so convoluted that no normal human can decipher those prices. Thus a ten cent aspirin would cost you $25 in the hospital and a MRI can run up to 15k. 4. Very high charges for doctors due to strict control on the number of MD positions and no increase in colleges or D seats over multiple years. https://www.aamc.org/news/press-releases/new-aamc-report-shows-continuing-projected-physician-shortage https://www.aamc.org/news/press-releases/new-aamc-report-sho... 5. Insurance companies have a for profit motive and need to extract their profits from premiums paid. Thus they fight tooth and nail to deny procedures and medications and set up convoluted processes for appeals. 6. Extensive fraud on Medicare and other government run health programs especially in durable medical goods and fake billing. In fact one of sitting US senators medical care company was involved in the largest Medicare fraud fines in the US and he still holds his seat. https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386.htm https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386.... Infact fraud billing Medicare for services not rendered is so popular that even Insurance companies do it https://oig.hhs.gov/fraud/enforcement/united-states-intervenes-in-second-false-claims-act-lawsuit-alleging-that-unitedhealth-group-inc-mischarged-the-medicare-advantage-and-prescription-drug-programs/ https://oig.hhs.gov/fraud/enforcement/united-states-interven... Combine all the above factors and you will see why the US consumer gets so little while paying so much for his healthcare.
zzzeek 1y ago
not sure why you're getting downmodded. People will say M4A ("medicare for all") polls at super high levels, and they're right, it does. But poll those same people telling them "would you favor that your employer-based healthcare would be rescinded and you would instead get healthcare from a new government controlled plan, where there would be no other options", which is the assumption M4A's viability is based on, and that poll turns right upside down.
- Projectiboga 1y ago
  Every actuarial study about the switch projects total cost savings even during the first year. This scarsity of providers is artificial there haven't been enough medical student slots ever in America. American life expectancy isnt in the top 25 nations, while having the largest percapita GDP.
  - Aurornis 1y ago
    > Every actuarial study about the switch projects total cost savings even during the first year. This is missing the point about why people don't like the past M4A proposals: It's not about cost savings, it's about losing access to their existing health care with scarce details about what would change. The surprising reality about American health insurance is that many people's plans cover a lot of things, procedures, and medications that would be harder for them to obtain under Medicare or even in other socialized medicine systems like the NHS. If politicians would lay out a Medicare buy-in option and let everyone opt-in to it, it would be far more popular. The past proposals that involved shutting down the private insurance industry and handing it all over to the government is resoundingly unpopular.
- Aurornis 1y ago
  > "would you favor that your employer-based healthcare would be rescinded and you would instead get healthcare from a new government controlled plan, where there would be no other options", which is the assumption M4A's viability is based on No, that's just the condition for one proposal for Medicare For All. As much as Americans complain about healthcare in general, most people don't want to give up their own health insurance once they have it. This is a known political trap that the previous M4A proposals walked right into, before crashing and burning. When you say "Medicare for All" to people without details, they assume it means a Medicare option for all. When they start reading the details and realize they have to give up their current insurance, they don't like it.
ransom1538 1y ago
Medicare has a total enrollment of approximately 69 million people, while Medicaid has around 83 million people. That is 152 million people. We already have socialized medicine we just run it poorly and don't apply it to people that can pay. Moving our system to 340 million people + letting our corporations out of paying would put the US into an economic death spiral. US corporations would love this plan. But at 340 million... I don't see doctor visits but once every 2 years -- many would just die waiting for appointments.
- SV_BubbleTime 1y ago
  Is this a comment for or against socialized medicine?
- tptacek 1y ago
  Medicaid is apparently 77MM including CHIP. The underlying compromise in the system that you're describing is sane: people's health care costs rise dramatically and unpredictably at retirement age, just as their ability to pay plummets, so socializing health care at that point makes a lot of sense.
umvi 1y ago
> I have heard the US is a democracy It's not a simple democracy, no (i.e. "enact a national-level vote for every issue and majority vote wins"). It's a constitutional republic where basically you have 50 mini countries each with different weight in the house of representatives and in the electoral college and a bazillion checks and balances that make repealing existing laws and enacting new ones very difficult. I think the majority of Americans do not like the current healthcare status quo, but getting changes that everyone is on board with through the political machinery is very difficult and Americans are polarized and tend to distrust change plans proposed by the opposite party (since parties tend to propose legislation that favors their own first).
- LeoPanthera 1y ago
  > It's not a simple democracy, no (i.e. "enact a national-level vote for every issue and majority vote wins"). But it's worth remembering that, if it were, Trump would still have won. He won the popular vote. So, assuming that enough votes were legitimate, a majority of Americans actually do want the current health situation in the US, in fact arguably they want even less coverage.
  - ar_lan 1y ago
    We don't know if that's really accurate, because you're conveniently ignoring 2016. If Trump were never initially president, would he have ever become one? Maybe, maybe not. But 2024 surely would have looked very different.
    - LeoPanthera 1y ago
      This only serves to reenforce the fact that the US is not a functioning democracy, if the will of the voters is not reflected.
      - DaSHacka 1y ago
        Is it not? He did still win the popular vote.
georgeecollins 1y ago
I think the reason is that people know it is a problem but ideologically they really disagree about what to do about it. The impasse creates an opportunity for profit driven actors to fight reforms. Also, democracies do dumb things sometimes. See Brexit. But also, sometimes people from other countries-- I am thinking parts of Europe-- underestimate how well paid people in the US often are. They compare the averages, like the US only makes 20% more per household, why do they put up with this or that. But that comparison is for the whole country, so imagine if you were comparing all of Europe or China. I had a friend in Spain at a similar company as mine say, how can you put up with no safety net, etc. But I look at his company and every one at my company at any level gets paid 2-5x as much. So like these are less serious issues if you are paid an extra $1-200k/ year. It doesn't explain the inaction, but I believe it is why a lot of politically influential people don't care.
- nkmnz 1y ago
  > ideologically they really disagree about what to do about it I really don't understand this sentiment. It's not like the current state of the US insurance market were based on the principles of a free market. On the other hand, not coupling your health insurance to an employment contract that can be cancelled at will has nothing to do with socialism.
- banku_brougham 1y ago
  Wrong - sorry. The reason is that politically the US public is very skillfully managed from above via divide and conquer strategies and beaureaucratic techniques (i.e. identity politics, gerrymandering voting districts). The public polling is very clear about US citizen preferences, but US Govt policy is rarely aligned that way.
  - tptacek 1y ago
    No, it's not clear at all: it's been tested in actual referenda and failed. What's actually happening is people don't intuitively grok the distinction between opinion polling, where questions are asked in the abstract (and often in the best light preferred by the org sponsoring the poll) versus actual voting, where the questions are very specific and include details like "your taxes will increase by X%" or "you will lose access to your current insurance plan".
tptacek 1y ago
Scarcity is a fact of every country's health system and you'll quickly find stories with similar fact patterns with e.g. the NHS. There's not a lot to recommend the US system as implemented today, but the problem isn't "insurance-based health care"; lots of countries have insurance-based health care.
- tracker1 1y ago
  It's largely a side effect of a couple things... first the ACA (ObamaCare) limited the percentage of profit that insurance and medical providers can make... so they instead just grow the pie larger by inflating everything. Second is that they are allowed to have effectively vertical monopoly investments controlling multiple layers of healthcare as a whole from insurance, providers, pharma and pharmacies. Trust busting and multiple supply lines really need to be established in order to have a chance at restoring normalcy. Which is all but impossible as Pharma alone is the single biggest spender of advertising alone, let alone policy influence over politicians.
  - lotsofpulp 1y ago
    > so they instead just grow the pie larger by inflating everything So why would they deny coverage? All they have to do to earn more money is keep paying for more and more healthcare.
    - tracker1 1y ago
      Because they make more by not paying than by paying... When the payouts are larger, they raise premiums, make money on both sides. Not to mention, if they can delay payment for a month, that's a month worth of interest on the money in an interest bearing account.
      - tptacek 1y ago
        How exactly do they make more money by not paying? They're required to spend 80% of their funds on provider expenses. The only obvious way to sustain the narrative that insurers are distorting the system for profit is the preceding comment's hypo that they'd be over-paying (and then driving rates up as their expenses increased). You propose the opposite fact pattern here. (Net cost of health insurance, all expenses, is around 6.5% of total US spending, as against 51.5% of direct provider costs for doctors, nurses, and procedures, not counting prescriptions.)
LeoPanthera 1y ago
The US is only ostensibly a democracy. It's not a functioning one, due to widespread voter disenfranchisement. Voter ID laws, voter roll purges, registration barriers, polling place accessibility, early and mail-in voting restrictions, and perhaps most importantly gerrymandering, misinformation, and intimidation all serve to reduce the power of the ballot box. And that's before we even get to US citizens in Puerto Rico, Guam, the US Virgin Islands, and American Samoa being unable to vote in Presidential elections at all.
- nickff 1y ago
  Most other countries have voter ID, and the controversy surrounding it is puzzling to most foreigners. Additionally, parliamentary systems which result in majority governments are much more ‘dictatorship-like’ than the US system where individual representatives retain some autonomy.
  - hydrogen7800 1y ago
    A large number of Americans do not have ID's, which is strange to many people. If the need for voter ID and risk of fraud were so great, the efforts would be to make it trivial for these folks to get one, rather than preventing them from voting.
    - deleted 1y ago
      [deleted]
mothballed 1y ago
In part because hospital bills are monopoly money and most people just play a game of chicken with debt collectors, and the only actually sue a small fraction of the time and mostly either settle for a small fraction, give up besides annoying phone calls, or it gets discharged in bankruptcy. Almost no one gets a bill from the hospital and just pays it, and in most cases if you do it's totally financially illiterate.
dclowd9901 1y ago
No one is "putting up with it." We don't have a choice. The way our government is designed right now, the populace doesn't really have elected representatives. More accurately, they have a corporate bought-and-paid for stooge that managed to be more likeable in a political race than their opponent, so we don't actually have anyone representing our interests _as a country_ at the federal level.
_heimdall 1y ago
I don't think this has much to do with being a democracy. I, for one, wouldn't trust our federal government to competently run an efficient, most uncorrupted healthcare system for all. The incentive structures that have built up around US politicians simply doesn't leave any room for it to realistically happen. Until the incentives are changed I'd vote against nearly any major government program.
- wing-_-nuts 1y ago
  I hope you refuse Medicare at 65 under those same principles
  - _heimdall 1y ago
    That would entirely depend on the coverage I could get and how it compared to private. If Medicare is changed over the next few decades to look more like Medicare Advantage, aka Plan C, you couldn't pay me to deal with that. Edit: its worth noting that your question for whether I'd take medicare is a separate issue from my original point. If the existence of Medicare as it is today was on the ballot, I would vote to get rid or drastically change it. If the program exists regardless of my opinions of it, my choice to take benefits from it is entirely a question of means and comparative benefits of all the options.
    - wing-_-nuts 1y ago
      >If Medicare is changed over the next few decades to look more like Medicare Advantage, aka Plan C, you couldn't pay me to deal with that. Ironic, considering that MCA is the more 'free market' of the two. Almost as if medical care shouldn't be for profit.
tracker1 1y ago
Just Pharmaceuticals not even all medicine is literally over half of all advertising spend in the US. And that is just the tip of the iceberg and doesn't go into the incestuous and conflicting interest relationships between pharma, pharmacies, medical providers and insurance companies all inter-invested in each-other to simply grow the pie larger since ACA limited profit percentages. It's the single most powerful lobbying group as a whole, and nearly every politician is bought and paid for by them. Good luck getting a majority or super majority to work against them.
- nickff 1y ago
  Pharmaceuticals are only a (high) single-digit percentage of medical spending in the USA, and the (likely) reason for the ads is the highly competitive nature of the market. Most of healthcare spending is on labor, specifically doctors and nurses, who are protected by highly effective trade and lobby organizations.
  - tracker1 1y ago
    My point stands... as a whole, they (medical industry as a whole, including pharma) are the single largest lobbying group and nothing you've said refutes that. My use of pharma ad spend was an example of how much money they put out as an indication of how much lobbying power all of medicine as a whole has.
emeril 1y ago
-Democracy in name only -Currently a dictatorship -Historically more of plutocracy -Our history has effectively yielded the current healthcare situation especially since those who would be most vocal tend to have better coverage and thus are less invested especially since the high costs are largely obfuscated
willio58 1y ago
The United States is a democracy, but more specifically, a representative democracy. That means citizens don’t directly vote on most laws or policies—aside from certain state or local measures—but instead elect representatives to make those decisions on our behalf. The idea is that we trust them to act in our best interests. You can probably see where the problem comes in. Take, for example, a politician who campaigns on Medicare for All or universal healthcare. To win an election, they often need massive campaign funding—much of which comes from wealthy donors, including those in the medical or pharmaceutical industries. And once in office, they’re targeted by powerful lobbying efforts worth billions of dollars from those same industries. In the end, the issue is that politicians can legally receive millions in donations and support from industries whose interests might directly conflict with the needs of the people they’re supposed to represent. Ultimately though, it is known by most people irrespective of party affiliation that medical costs are out of control. One recent example of this collective understanding was when the united healthcare exec was killed. Before there was even a suspect, people generally knew why he was assassinated. Most people in the U.S. have either been directly affected by the insanity that is our healthcare system, or one of their loved ones has. Those that haven’t yet, it’s just a matter of time. It’s just so pervasive.
- supertrope 1y ago
  As Lawrence Lessig put it: before the general election and before the primary election, there is a "Lester" election where donors choose who is able to mount a campaign. Candidates are effectively pre-qualified by 0.0005% of Americans. It's probably an even smaller crowd than that as that includes Joe Nobody who gives $20. Those who "bundle" $1 million in donations or write a mega check themselves have exponentially more access.
- egorfine 1y ago
  Ah, so Americans are okay with that system as well. Got it.
  - quickthrowman 1y ago
    It might be worth mentioning that a massive propaganda campaign against universal healthcare has been conducted on the American public for decades by interests that benefit from privatized healthcare.
wrs 1y ago
Ideologically, just enough voters in the right places believe that unless you’re old, or a military veteran, in which case government healthcare is just fine, your sickness should not be their problem, even if it means they pay more for their own care. Also, if healthcare wasn’t tied to having a job, then the inherent laziness and moral degeneracy of people without jobs would be encouraged by letting them not be sick. (BTW, being self-employed does not count as “having a job” in this mindset.)
thesuitonym 1y ago
The US money machine has one of the most sophisticated propaganda networks in the history of the world working to make sure nothing ever gets better for working class people. In George Orwell's vision of a dystopian future, "The party told you to reject the evidence of your eyes and ears. It was their final, most essential command." In the US, the party didn't even have to issue the command, they just asked a few thousand talking heads to do it.
wafflebot 1y ago
To the extent that U.S. voters want to maintain the status quo, which many (though not most) voters do wish to do, it's largely driven by an individualist mindset in which the worst thing that can happen is somebody else getting something that they didn't "earn".
- bobro 1y ago
  I’d love to see a poll asking Americans: “Do you want to maintain the status quo?”
codegeek 1y ago
Great question. No one "wants" insurance. Everyone wants to be able to get covered for care. The problem is that Govt decided decades ago that Health Insurance is the only way to get care even for mundane things like a regular doctor visit. To make it worse, they tied it to Employers needing to provide insurance. Insurance companies love this bureaucracy and became too powerful over the last few decades. It is a sad state and I have almost given up on the hope that someday it will change. I m lucky enough to afford healthcare and feel for those who can't.
- egorfine 1y ago
  > I m lucky enough to afford healthcare Up to a point, I guess? Correct me if I'm wrong.
  - codegeek 1y ago
    Yes and it still sucks because I hate wasting my hard earned money because of a random number thrown at me for the so called "Claim". Fk the entire insurance industry especially health insurance mafia. And don't get me started on the inefficiencies and waste of time that you have to go through to fight a "claim" that is incorrect.
fukka42 1y ago
Yes, it is what they want. In the end there are more of them who want to "own the libs", or "not pay for freeloaders" than those who want to contribute to another's child surviving.
tpurves 1y ago
America is trapped in a cycle where political parties have discovered that fear and anger drives voters whereas contentment with status quo does not motivate turnout. This leads to a scenario where parties will actively sabotage the resolution of painpoint issues such as immigration, healthcare, gun control etc. so long as it continues to create anger and fear that they can successfully blame on the other party. This behavior extends to voting against their own proposed policies in the interest of seizing/maintaining power over problem solving. And now deliberately creating crises (both real and fictional ones) has become the game-theory dominant strategy in American politics.
- supertrope 1y ago
  Even for politicians who are not absorbed in wedge issues, meaningful reform is a long term task. It would require multiple elections in a row showing that there is a durable political coalition for universal healthcare.
- egorfine 1y ago
  So much this. Also, this works for every people, not just American.
elif 1y ago
We are a "binocracy", where our democratic function has been reduced to a binary choice, and unfortunately both choices have been fully captured by the healthcare industry.
ponector 1y ago
One can argue what people wants is to be ruled by old convicted felon dictator.
saghm 1y ago
Without making a claim about whether it's what most people actually want or not, there's not much that an individual can do about this by changing their voting preference. The US doesn't have proportional representation, and the overwhelming majority of elections are "first past the post" rather than one of the more "modern" alternatives like ranked choice votes, so in practice very few elections ever swing to anyone outside of the two major political parties (neither of which have a particularly large contingent of politicians who have come out in favor of something like single-payer healthcare). Even for a purely single-issue voter who only cares about this, from a game theoretic perspective you're likely to be essentially throwing your vote away if you vote for someone outside of those two major parties because it's unlikely enough others will. Presidential elections are even worse because they're determined by electoral college vote rather than popular vote. Even ignoring the potential for "faithless electors", all but two states allocate the entirety of their electoral votes to the candidate who wins the majority of their vote, which means that if you live in a state with a majority who reliably vote for a specific party's candidate every four years, your vote for president is effectively meaningless. The only obvious way to fix these issues with how elections work would be to elect people who make different decisions about how to run them, which is hard to do because of the issues themselves. The system is self-reinforcing in a way that makes it extremely difficult for the average person to do anything about it, and any desire to do so gets weighed against the concerns about the policies that you might actually get to influence by voting for one of the two candidates who might actually win. At the end of the day, people who are concerned with the fundamental systemic flaws in things like elections and healthcare still likely end up picking pragmatism over principle (with the expected value of a vote for a candidate who is almost guaranteed not to win being lower than one who is might be less desirable than a third-party one but still has an actually realistic chance of winning and is preferable to the other major party candidate) or just check out of the system entirely (with people not bothering to vote at all already being a fairly common phenomenon in the US).
throwforfeds 1y ago
> Though why do you Americans put up with all this? I have heard the US is a democracy. So then insurance-based healthcare is what American people truly want? It's because our politicians are largely owned by our corporations and spend a ridiculous amount of money protecting their interests [1]. We almost had a public option with the original "Obamacare", but it was forced out of the bill [2]. Also, just turn on Fox News for an evening and realize it's been the number one news channel in the US for 20-something years. They've been a right wing corporate propaganda machine for a long time, all while brilliantly portraying themselves as the "underdog" fighting the mainstream media. Americans aren't very educated and take pride in their ignorance, unfortunately. [3] [1] https://en.wikipedia.org/wiki/Citizens_United_v._FEC https://en.wikipedia.org/wiki/Citizens_United_v._FEC [2] https://en.wikipedia.org/wiki/Public_health_insurance_option https://en.wikipedia.org/wiki/Public_health_insurance_option [3] https://www.youtube.com/watch?v=QFgcqB8-AxE https://www.youtube.com/watch?v=QFgcqB8-AxE
- seanmcdirmid 1y ago
  FoxNews has only been the number one TV news channel for the last 20 something years because almost everyone under 40 doesn't watch TV anymore. Yes, there are a lot of conservatives in the US, but the demographics is really skewed if you just look at people who watch TV and have cable.
  - throwforfeds 1y ago
    Yes, but older people vote and young people don't. I haven't owned a TV my entire adult life (in my 40s now), so I agree with you, but it's hard to imagine Trump and the current Republican party without Fox News.
    - DaSHacka 1y ago
      > it's hard to imagine Trump and the current Republican party without Fox News. Not Twitter and the Internet? As a non-boomer that's been the majority of the activity I've seen from people around my age.
ajkjk 1y ago
We fucking hate it don't worry
goodluckchuck 1y ago
I think you’re just believing whatever the author says, and not considering the fact that reasonable people can disagree and be wrong and make mistakes. For all we know the procedure was entirely unnecessary and they agreed because he pushed for it. Also, what’s the alternative? The only system where you can go get procedures that authorities think unnecessary is a free market where you self-pay. A government-run system could equally decide that the procedure isn’t recommended.
blitz_skull 1y ago
This frame assumes several things: 1. Americans are not displeased with the situation. Ironically, I think this is one place most Americans agree there is a problem. The solution is the hard part because: 2. This presumes a drop-in solution where no one loses. This is where the fight is. 3. This presumes that democracies do what is logical or beneficial for the vast majority, which is a very naive view of democracy.
- queenkjuul 1y ago
  Just reminding you that American citizens continue to be detained https://www.techdirt.com/2025/10/22/more-than-170-u-s-citizens-have-been-held-by-immigration-agents-theyve-been-kicked-dragged-and-detained-for-days/ https://www.techdirt.com/2025/10/22/more-than-170-u-s-citize...
  - blitz_skull 1y ago
    What does this have to do with my comment?
    - queenkjuul 1y ago
      You told me no American citizens were being detained by ice. I'm reminding you your wrong.
      - blitz_skull 11mo ago
        lol, get a life dude.
- queenkjuul 1y ago
  Have some more https://www.cbc.ca/news/world/us-citizens-ice-arrests-detentions-9.6960504?cmp=rss https://www.cbc.ca/news/world/us-citizens-ice-arrests-detent...
robrenaud 1y ago
A lot of employed people like the status quo for the healthcare that they receive. "In contrast to their largely negative assessments of the quality and coverage of healthcare in the U.S., broad majorities of Americans continue to rate their own healthcare’s quality and coverage positively. Currently, 71% of U.S. adults consider the quality of healthcare they receive to be excellent or good, and 65% say the same of their own coverage. There has been little deviation in these readings since 2001. Compared with their counterparts, older adults and those with higher incomes register more positive ratings of the quality and coverage of their own healthcare." https://news.gallup.com/poll/654044/view-healthcare-quality-declines-year-low.aspx https://news.gallup.com/poll/654044/view-healthcare-quality-...
- egorfine 1y ago
  So basically they accept and approve of them being bankrupted by an unfortunate medical event no matter how top tier their health insurance package. Right?
  - knollimar 1y ago
    Are there not out of pocket maximums on most plans?
wouldbecouldbe 1y ago
Well there is lot of shit we Europeans put up with, for instance EU moving court every few weeks voor 200m per year. But systems are hard to change.

[flagged]

tboyd47 1y ago

It's not a democracy. You were told wrong, it's a republic.

galangalalgol 1y ago
Well it was a democratic republic. Now it is an electoral autocracy. He fixed it so good those christians will never have (or be able) to vote again. Just like he said he would. A Republic where the representatives are chosen by a popular vote are still democracies.
- tboyd47 1y ago
  The representatives are chosen by the Electoral College, not the popular vote. The U.S. is not a democracy.
  - galangalalgol 1y ago
    Representatives are chosen directly by the voters of their districts and senators directly by the voters of their state. Electors are selected however their state decides, so yeah, the president isn't necessarily democratically chosen. Neither are judges. In practice though the electors are chosen based on the state vote. Saying the us wasn't a democracy is narrowing the definition of democracy quite a bit.
    - tboyd47 1y ago
      It's a constitutional republic. Democracy is optional. We'll either discover it now or discover it later.

zarmsdos 1y ago

Decades of right-wing propaganda, unfortunately. They tend to have an emotional reaction against any sort of socialized anything, including healthcare.

gosub100 1y ago
Left wing won't solve it either. They profit from the crisis by promising each election and not delivering.
- zarmsdos 1y ago
  That's true. I wouldn't even call them left-wing, to be honest.

micromacrofoot 1y ago

It's precisely as many have said over decades at this point: the poor in our country hate themselves to the extent that they view being poor as a personal failing, and voting for free services for everyone is therefore dishonorable. I talk to people like this every day and it's frustrating.

ziofill 1y ago

Non-US person here too. From what I understand the majority of Americans want a single-payer healthcare system, but too many people in government are paid by insurance companies and affiliates to not change how things work.

dragonwriter 1y ago

> I have heard the US is a democracy. It is certainly not a direct democracy where each individual policy is resolved by separate independent voting, no. > So then insurance-based healthcare is what American people truly want? Pretty consistently, no, but there is not any single alternative that a majority of the American people prefer recently (for a while, as far back as the 1990s, there was a clear popular majority for universal single-payer), and more importantly, it is not the only issue that factors into people’s voting decisions.

baby 1y ago

As soon as someone introduce these ideas people think they're a communist. See Mamdani in NY right now.

nine_zeros 1y ago

[dead]

selfmodruntime 1y ago

The US is gigantic. Imagine if every EU member, however rich, poor, or corrupt from Bulgaria to Germany had to enact one healthcare system.

egorfine 1y ago
India is larger and yet.
- selfmodruntime 1y ago
  And yet even its major cities are filled with sewage, 400 million are without healthcare and less than 50% of its people have reliable access to clean drinking water?

andy99 1y ago

Edit: just saw an earlier better comment saying the same thing: https://news.ycombinator.com/item?id=45737190 https://news.ycombinator.com/item?id=45737190 Countries with “free” also healthcare ration it and don’t cover everything. Socialized insurance is still insurance, and at least in Canada it’s the only game in town, so if you have a procedure that is denied or not available your choice is basically to go to the US and pay for it and be in the same position as an uninsured American.

stronglikedan 1y ago

Yes, but we also want universal healthcare. What we don't want is only universal healthcare with death panels like the UK and Canada has. Give us universal health care where we can also get insurance if we want, and we'll vote it in. That's never what comes up though. I firmly believe we could gut medicare/medicaid and the savings from the bureaucratic administration costs alone could pay for universal healthcare.

polski-g 1y ago
UK/CA healthcare sounds like hell. Every doctor is under the government, so even if you have money for a procedure the government doesn't want to cover, you can't get it done. And of course because there is no rationing by price there is rationing by time, so you end up with 13mo waits for an MRI.
- dragonwriter 1y ago
  Leaving aside the subjective impressions, the objective parts of that description are only accurate for CA, not UK, healthcare; the UK has optional add-on private insurance and care on top of the universal public system.
trollbridge 1y ago
Note that Massachusetts and San Francisco have universal healthcare. Mass. is also home to one of the best healthcare systems and children’s hospital in the word.

somethingsome 1y ago

Hum.. At least where I live in europe, you still need to battle with insurances for any non trivial problem.. We get a health care coverage for the common stuff, but many things are not covered, or not covered enough.. Then you need insurances.. And it's always a battle.. Same for other kind of insurances such as issues with the house, etc..

FpUser 1y ago

Non US as well. Life saving saving surgeries get denied, delayed and otherwise screwed all the time. Not sure where exactly it is worse since absolutely atrocious cases can be found in every G7 country never mind the rest

frogperson 1y ago

The are advertised as a democracy, but ever since Citizens United was passed we became an Oligarchy. Money now takes the place of votes since the rich can donate unlimited funds to a candidate. Candidates have zero incentive to serve the public.

msla 1y ago

The same way European people put up with the insane NHS and its refusal to care for the people who support it financially and supposedly support it politically. https://edition.cnn.com/2024/03/13/uk/england-nhs-puberty-blockers-trans-children-intl-gbr https://edition.cnn.com/2024/03/13/uk/england-nhs-puberty-bl... The NHS and its bizarre political agenda is an example of what can happen when a government controls access to health care.

pjc50 1y ago
A good example that "public" campaigning can work, but not necessarily for the better - there's been a systematic campaign to delegitimize trans healthcare. There's comparable examples from other places; Ireland has come a long way in getting the church out of reproductive health, but there are still problems. And of course it doesn't matter whether it's public or private, abortion care is at risk in many US states. The UK does allow you to go private, remember.

qgin 1y ago

We have a lot of people being constantly brainwashed that we have the most amazing system in the world and that any attempt to change it is communism.

zulban 1y ago

You've implied the answer to your own question. The USA is not a democracy. The opinions of almost all Americans have no impact on policy. It's a well researched fact. Having an election day where people vote doesn't mean you live in a democracy.

bluesounddirect 1y ago

Then what sort of feel good stories about AI would we have . The US needs to adopt a single flat income / corp tax, government provided healthcare, and move on to the rest of life.

thatfrenchguy 1y ago

Add a French and American person, in the US you hear "insurance did not approve", in France it's more "you can't get an appointment / the surgery provider does not have any spots unless you go to their spots in their private hospital". The French system is more predictable (because any vaguely sane healthcare system has a price for a code instead of negotiated rates, negotiated rates is the most inefficient way to run this market) & you can get cost estimates though. And in both countries, if you live in a small town in both systems, the healthcare you will receive will suck.

knollimar 1y ago
Do negotiated rates not affect quality of care? I work in contracting and negotiated rates allow me to add quality, while systems like price codes incentivize minimum effort/outcomes. I know doctors probably take their jobs more seriously, but I'd be surprised if it doesn't bleed over into healthcare quality.
- thatfrenchguy 1y ago
  Negotiated rates are per code here though, and doctors generally aren’t the ones doing the actual coding for the visit in the US, they have folks going through your doctor’s notes and figuring out the codes. Another reason why the overhead of health care is so high in the US.

levocardia 1y ago

Why do you put up with long wait times and lower-quality care in your home country?

janalsncm 1y ago
It is very interesting that you do not where they are from but you assume longer wait times and lower quality of care. This suggests you believe the US has the shortest wait times and highest quality of care, which is objectively not true.

deleted 1y ago

[deleted]

lucasban 1y ago

One thing also to keep in mind, is that this experience is not uniform throughout the US. Many Americans like -their- employer based insurance, even if they don’t like the system. I personally pay nothing for visits and nominal fees ($1-10) for prescriptions. I have not been hospitalized while on this insurance, but my understanding is that it is relatively low cost. I also have no monthly premium. Meanwhile, my mother works at a small business, pays a significant percentage of her income for insurance from the ACA marketplaces (the public marketplaces created during the Obama administration) with the current subsidies, subsidies that are in question under the current administration. The American healthcare payment system is broken, but we aren’t all living through the worst case scenario experiences that get the attention. Add to that the amount of money and effort that went into turning healthcare reform into yet another partisan issue, and there’s a good recipe for maintaining a broken status quo for a while yet.

BobbyTables2 1y ago

Its too easy to convince enough of the population to actively vote against their own interests.

DaSHacka 1y ago
How right you are, and more than you know

fallingfrog 1y ago

No, we all hate it, but the number of senators and members of congress who would vote to replace it could be counted with one hand. The reason is simple: the insurance companies give those senators millions and millions of dollars and nobody has the cash to beat them. And we've given up at this point. As the song goes: "Everybody knows that the dice are loaded Everybody rolls with their fingers crossed Everybody knows the war is over Everybody knows the good guys lost Everybody knows the fight was fixed The poor stay poor, the rich get rich That's how it goes Everybody knows"

billy99k 1y ago

The alternative is no surgery and no choice, which is what happens with government-run healthcare.

Freedom2 1y ago
I doubt this comment is true, given that other countries with government run healthcare have surgeries and choice. Do you happen to have any evidence that every country with government run healthcare has no choice or surgeries at all? Your comment seems to imply as such.

bko 1y ago

US person here. I have insurance through my employer as do most Americans. And most are happy with their insurance. I can go to the doctor often same day, I can see a specialist and pay just a co-pay of between $25-50. I had some bills but my out of pocket max is something like $5k, which I have saved up. The benefits of living in the US is that the same kind of work (engineer) pays about 3x as much here and you pay a lot less taxes (save many multiples of my out of pocket max). So I prefer to live in a vibrant economy and take care of my own insurance.

BurningFrog 1y ago

In European countries the procedures that are denied or very expensive in the US are often simply not offered. There is a national health budget, and not everything fits in it. The doctors have to tell the patients that there is nothing they can do, and that's that. The patient ends up just as dead, but there is nothing to get furious about like when the doctors could fix it, but only if someone pays for it.

ab_testing 1y ago

I think the root cause of the problem is not insurance companies but they definitely do play a part. The real reasons are multiple but can be listed as below. 1 A very high cost of drugs due to no intervention by the government as part of free market philosophy. This means that the same insulin that costs $25 in Canada can be sold for up to $1000 per month. New introduced drugs for Alzheimer's or other diseases can cost up to 50k per year - again because no price controls. 2. Insanely high prices of services due to a captive market - example a ten minute ambulance ride can cost up from $1000 to $5000. The private ambulance companies know they can charge a high base rate because they are connected to a city or municipality via contracts. Bribes as campaign funds are popular here. E.g. a new York based ambulance operator paid 45k in campaign funds to NY's governor elect and got a contract worth one billion dollars https://www.wkbw.com/news/state-news/report-nysdoh-awards-multi-billion-dollar-contract-to-hochul-campaign-donor https://www.wkbw.com/news/state-news/report-nysdoh-awards-mu... 3. Overcharging by hospitals for medicines and services again due to a captive audience. The hospitals are free to maintain various price books and you are not told what each service will cost at the time of administration of service. lately the hospitals have been forced to open up their price books but they are so convoluted that no normal human can decipher those prices. Thus a ten cent aspirin would cost you $25 in the hospital and a MRI can run up to 15k. 4. Very high charges for doctors due to strict control on the number of MD positions and no increase in colleges or D seats over multiple years. https://www.aamc.org/news/press-releases/new-aamc-report-shows-continuing-projected-physician-shortage https://www.aamc.org/news/press-releases/new-aamc-report-sho... 5. Insurance companies have a for profit motive and need to extract their profits from premiums paid. Thus they fight tooth and nail to deny procedures and medications and set up convoluted processes for appeals. 6. Extensive fraud on Medicare and other government run health programs especially in durable medical goods and fake billing. In fact one of sitting US senators medical care company was involved in the largest Medicare fraud fines in the US and he still holds his seat. https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386.htm https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386.... Infact fraud billing Medicare for services not rendered is so popular that even Insurance companies do it https://oig.hhs.gov/fraud/enforcement/united-states-intervenes-in-second-false-claims-act-lawsuit-alleging-that-unitedhealth-group-inc-mischarged-the-medicare-advantage-and-prescription-drug-programs/ https://oig.hhs.gov/fraud/enforcement/united-states-interven... Combine all the above factors and you will see why the US consumer gets so little while paying so much for his healthcare.

zzzeek 1y ago

not sure why you're getting downmodded. People will say M4A ("medicare for all") polls at super high levels, and they're right, it does. But poll those same people telling them "would you favor that your employer-based healthcare would be rescinded and you would instead get healthcare from a new government controlled plan, where there would be no other options", which is the assumption M4A's viability is based on, and that poll turns right upside down.

Projectiboga 1y ago
Every actuarial study about the switch projects total cost savings even during the first year. This scarsity of providers is artificial there haven't been enough medical student slots ever in America. American life expectancy isnt in the top 25 nations, while having the largest percapita GDP.
- Aurornis 1y ago
  > Every actuarial study about the switch projects total cost savings even during the first year. This is missing the point about why people don't like the past M4A proposals: It's not about cost savings, it's about losing access to their existing health care with scarce details about what would change. The surprising reality about American health insurance is that many people's plans cover a lot of things, procedures, and medications that would be harder for them to obtain under Medicare or even in other socialized medicine systems like the NHS. If politicians would lay out a Medicare buy-in option and let everyone opt-in to it, it would be far more popular. The past proposals that involved shutting down the private insurance industry and handing it all over to the government is resoundingly unpopular.
Aurornis 1y ago
> "would you favor that your employer-based healthcare would be rescinded and you would instead get healthcare from a new government controlled plan, where there would be no other options", which is the assumption M4A's viability is based on No, that's just the condition for one proposal for Medicare For All. As much as Americans complain about healthcare in general, most people don't want to give up their own health insurance once they have it. This is a known political trap that the previous M4A proposals walked right into, before crashing and burning. When you say "Medicare for All" to people without details, they assume it means a Medicare option for all. When they start reading the details and realize they have to give up their current insurance, they don't like it.

ransom1538 1y ago

Medicare has a total enrollment of approximately 69 million people, while Medicaid has around 83 million people. That is 152 million people. We already have socialized medicine we just run it poorly and don't apply it to people that can pay. Moving our system to 340 million people + letting our corporations out of paying would put the US into an economic death spiral. US corporations would love this plan. But at 340 million... I don't see doctor visits but once every 2 years -- many would just die waiting for appointments.

SV_BubbleTime 1y ago
Is this a comment for or against socialized medicine?
tptacek 1y ago
Medicaid is apparently 77MM including CHIP. The underlying compromise in the system that you're describing is sane: people's health care costs rise dramatically and unpredictably at retirement age, just as their ability to pay plummets, so socializing health care at that point makes a lot of sense.

umvi 1y ago

> I have heard the US is a democracy It's not a simple democracy, no (i.e. "enact a national-level vote for every issue and majority vote wins"). It's a constitutional republic where basically you have 50 mini countries each with different weight in the house of representatives and in the electoral college and a bazillion checks and balances that make repealing existing laws and enacting new ones very difficult. I think the majority of Americans do not like the current healthcare status quo, but getting changes that everyone is on board with through the political machinery is very difficult and Americans are polarized and tend to distrust change plans proposed by the opposite party (since parties tend to propose legislation that favors their own first).

LeoPanthera 1y ago
> It's not a simple democracy, no (i.e. "enact a national-level vote for every issue and majority vote wins"). But it's worth remembering that, if it were, Trump would still have won. He won the popular vote. So, assuming that enough votes were legitimate, a majority of Americans actually do want the current health situation in the US, in fact arguably they want even less coverage.
- ar_lan 1y ago
  We don't know if that's really accurate, because you're conveniently ignoring 2016. If Trump were never initially president, would he have ever become one? Maybe, maybe not. But 2024 surely would have looked very different.
  - LeoPanthera 1y ago
    This only serves to reenforce the fact that the US is not a functioning democracy, if the will of the voters is not reflected.
    - DaSHacka 1y ago
      Is it not? He did still win the popular vote.

georgeecollins 1y ago

I think the reason is that people know it is a problem but ideologically they really disagree about what to do about it. The impasse creates an opportunity for profit driven actors to fight reforms. Also, democracies do dumb things sometimes. See Brexit. But also, sometimes people from other countries-- I am thinking parts of Europe-- underestimate how well paid people in the US often are. They compare the averages, like the US only makes 20% more per household, why do they put up with this or that. But that comparison is for the whole country, so imagine if you were comparing all of Europe or China. I had a friend in Spain at a similar company as mine say, how can you put up with no safety net, etc. But I look at his company and every one at my company at any level gets paid 2-5x as much. So like these are less serious issues if you are paid an extra $1-200k/ year. It doesn't explain the inaction, but I believe it is why a lot of politically influential people don't care.

nkmnz 1y ago
> ideologically they really disagree about what to do about it I really don't understand this sentiment. It's not like the current state of the US insurance market were based on the principles of a free market. On the other hand, not coupling your health insurance to an employment contract that can be cancelled at will has nothing to do with socialism.
banku_brougham 1y ago
Wrong - sorry. The reason is that politically the US public is very skillfully managed from above via divide and conquer strategies and beaureaucratic techniques (i.e. identity politics, gerrymandering voting districts). The public polling is very clear about US citizen preferences, but US Govt policy is rarely aligned that way.
- tptacek 1y ago
  No, it's not clear at all: it's been tested in actual referenda and failed. What's actually happening is people don't intuitively grok the distinction between opinion polling, where questions are asked in the abstract (and often in the best light preferred by the org sponsoring the poll) versus actual voting, where the questions are very specific and include details like "your taxes will increase by X%" or "you will lose access to your current insurance plan".

tptacek 1y ago

Scarcity is a fact of every country's health system and you'll quickly find stories with similar fact patterns with e.g. the NHS. There's not a lot to recommend the US system as implemented today, but the problem isn't "insurance-based health care"; lots of countries have insurance-based health care.

tracker1 1y ago
It's largely a side effect of a couple things... first the ACA (ObamaCare) limited the percentage of profit that insurance and medical providers can make... so they instead just grow the pie larger by inflating everything. Second is that they are allowed to have effectively vertical monopoly investments controlling multiple layers of healthcare as a whole from insurance, providers, pharma and pharmacies. Trust busting and multiple supply lines really need to be established in order to have a chance at restoring normalcy. Which is all but impossible as Pharma alone is the single biggest spender of advertising alone, let alone policy influence over politicians.
- lotsofpulp 1y ago
  > so they instead just grow the pie larger by inflating everything So why would they deny coverage? All they have to do to earn more money is keep paying for more and more healthcare.
  - tracker1 1y ago
    Because they make more by not paying than by paying... When the payouts are larger, they raise premiums, make money on both sides. Not to mention, if they can delay payment for a month, that's a month worth of interest on the money in an interest bearing account.
    - tptacek 1y ago
      How exactly do they make more money by not paying? They're required to spend 80% of their funds on provider expenses. The only obvious way to sustain the narrative that insurers are distorting the system for profit is the preceding comment's hypo that they'd be over-paying (and then driving rates up as their expenses increased). You propose the opposite fact pattern here. (Net cost of health insurance, all expenses, is around 6.5% of total US spending, as against 51.5% of direct provider costs for doctors, nurses, and procedures, not counting prescriptions.)

LeoPanthera 1y ago

The US is only ostensibly a democracy. It's not a functioning one, due to widespread voter disenfranchisement. Voter ID laws, voter roll purges, registration barriers, polling place accessibility, early and mail-in voting restrictions, and perhaps most importantly gerrymandering, misinformation, and intimidation all serve to reduce the power of the ballot box. And that's before we even get to US citizens in Puerto Rico, Guam, the US Virgin Islands, and American Samoa being unable to vote in Presidential elections at all.

nickff 1y ago
Most other countries have voter ID, and the controversy surrounding it is puzzling to most foreigners. Additionally, parliamentary systems which result in majority governments are much more ‘dictatorship-like’ than the US system where individual representatives retain some autonomy.
- hydrogen7800 1y ago
  A large number of Americans do not have ID's, which is strange to many people. If the need for voter ID and risk of fraud were so great, the efforts would be to make it trivial for these folks to get one, rather than preventing them from voting.
  - deleted 1y ago
    [deleted]

mothballed 1y ago

In part because hospital bills are monopoly money and most people just play a game of chicken with debt collectors, and the only actually sue a small fraction of the time and mostly either settle for a small fraction, give up besides annoying phone calls, or it gets discharged in bankruptcy. Almost no one gets a bill from the hospital and just pays it, and in most cases if you do it's totally financially illiterate.

dclowd9901 1y ago

No one is "putting up with it." We don't have a choice. The way our government is designed right now, the populace doesn't really have elected representatives. More accurately, they have a corporate bought-and-paid for stooge that managed to be more likeable in a political race than their opponent, so we don't actually have anyone representing our interests _as a country_ at the federal level.

_heimdall 1y ago

I don't think this has much to do with being a democracy. I, for one, wouldn't trust our federal government to competently run an efficient, most uncorrupted healthcare system for all. The incentive structures that have built up around US politicians simply doesn't leave any room for it to realistically happen. Until the incentives are changed I'd vote against nearly any major government program.

wing-_-nuts 1y ago
I hope you refuse Medicare at 65 under those same principles
- _heimdall 1y ago
  That would entirely depend on the coverage I could get and how it compared to private. If Medicare is changed over the next few decades to look more like Medicare Advantage, aka Plan C, you couldn't pay me to deal with that. Edit: its worth noting that your question for whether I'd take medicare is a separate issue from my original point. If the existence of Medicare as it is today was on the ballot, I would vote to get rid or drastically change it. If the program exists regardless of my opinions of it, my choice to take benefits from it is entirely a question of means and comparative benefits of all the options.
  - wing-_-nuts 1y ago
    >If Medicare is changed over the next few decades to look more like Medicare Advantage, aka Plan C, you couldn't pay me to deal with that. Ironic, considering that MCA is the more 'free market' of the two. Almost as if medical care shouldn't be for profit.

tracker1 1y ago

Just Pharmaceuticals not even all medicine is literally over half of all advertising spend in the US. And that is just the tip of the iceberg and doesn't go into the incestuous and conflicting interest relationships between pharma, pharmacies, medical providers and insurance companies all inter-invested in each-other to simply grow the pie larger since ACA limited profit percentages. It's the single most powerful lobbying group as a whole, and nearly every politician is bought and paid for by them. Good luck getting a majority or super majority to work against them.

nickff 1y ago
Pharmaceuticals are only a (high) single-digit percentage of medical spending in the USA, and the (likely) reason for the ads is the highly competitive nature of the market. Most of healthcare spending is on labor, specifically doctors and nurses, who are protected by highly effective trade and lobby organizations.
- tracker1 1y ago
  My point stands... as a whole, they (medical industry as a whole, including pharma) are the single largest lobbying group and nothing you've said refutes that. My use of pharma ad spend was an example of how much money they put out as an indication of how much lobbying power all of medicine as a whole has.

emeril 1y ago

-Democracy in name only -Currently a dictatorship -Historically more of plutocracy -Our history has effectively yielded the current healthcare situation especially since those who would be most vocal tend to have better coverage and thus are less invested especially since the high costs are largely obfuscated

willio58 1y ago

The United States is a democracy, but more specifically, a representative democracy. That means citizens don’t directly vote on most laws or policies—aside from certain state or local measures—but instead elect representatives to make those decisions on our behalf. The idea is that we trust them to act in our best interests. You can probably see where the problem comes in. Take, for example, a politician who campaigns on Medicare for All or universal healthcare. To win an election, they often need massive campaign funding—much of which comes from wealthy donors, including those in the medical or pharmaceutical industries. And once in office, they’re targeted by powerful lobbying efforts worth billions of dollars from those same industries. In the end, the issue is that politicians can legally receive millions in donations and support from industries whose interests might directly conflict with the needs of the people they’re supposed to represent. Ultimately though, it is known by most people irrespective of party affiliation that medical costs are out of control. One recent example of this collective understanding was when the united healthcare exec was killed. Before there was even a suspect, people generally knew why he was assassinated. Most people in the U.S. have either been directly affected by the insanity that is our healthcare system, or one of their loved ones has. Those that haven’t yet, it’s just a matter of time. It’s just so pervasive.

supertrope 1y ago
As Lawrence Lessig put it: before the general election and before the primary election, there is a "Lester" election where donors choose who is able to mount a campaign. Candidates are effectively pre-qualified by 0.0005% of Americans. It's probably an even smaller crowd than that as that includes Joe Nobody who gives $20. Those who "bundle" $1 million in donations or write a mega check themselves have exponentially more access.
egorfine 1y ago
Ah, so Americans are okay with that system as well. Got it.
- quickthrowman 1y ago
  It might be worth mentioning that a massive propaganda campaign against universal healthcare has been conducted on the American public for decades by interests that benefit from privatized healthcare.

wrs 1y ago

Ideologically, just enough voters in the right places believe that unless you’re old, or a military veteran, in which case government healthcare is just fine, your sickness should not be their problem, even if it means they pay more for their own care. Also, if healthcare wasn’t tied to having a job, then the inherent laziness and moral degeneracy of people without jobs would be encouraged by letting them not be sick. (BTW, being self-employed does not count as “having a job” in this mindset.)

thesuitonym 1y ago

The US money machine has one of the most sophisticated propaganda networks in the history of the world working to make sure nothing ever gets better for working class people. In George Orwell's vision of a dystopian future, "The party told you to reject the evidence of your eyes and ears. It was their final, most essential command." In the US, the party didn't even have to issue the command, they just asked a few thousand talking heads to do it.

wafflebot 1y ago

To the extent that U.S. voters want to maintain the status quo, which many (though not most) voters do wish to do, it's largely driven by an individualist mindset in which the worst thing that can happen is somebody else getting something that they didn't "earn".

bobro 1y ago
I’d love to see a poll asking Americans: “Do you want to maintain the status quo?”

codegeek 1y ago

Great question. No one "wants" insurance. Everyone wants to be able to get covered for care. The problem is that Govt decided decades ago that Health Insurance is the only way to get care even for mundane things like a regular doctor visit. To make it worse, they tied it to Employers needing to provide insurance. Insurance companies love this bureaucracy and became too powerful over the last few decades. It is a sad state and I have almost given up on the hope that someday it will change. I m lucky enough to afford healthcare and feel for those who can't.

egorfine 1y ago
> I m lucky enough to afford healthcare Up to a point, I guess? Correct me if I'm wrong.
- codegeek 1y ago
  Yes and it still sucks because I hate wasting my hard earned money because of a random number thrown at me for the so called "Claim". Fk the entire insurance industry especially health insurance mafia. And don't get me started on the inefficiencies and waste of time that you have to go through to fight a "claim" that is incorrect.

fukka42 1y ago

Yes, it is what they want. In the end there are more of them who want to "own the libs", or "not pay for freeloaders" than those who want to contribute to another's child surviving.

tpurves 1y ago

America is trapped in a cycle where political parties have discovered that fear and anger drives voters whereas contentment with status quo does not motivate turnout. This leads to a scenario where parties will actively sabotage the resolution of painpoint issues such as immigration, healthcare, gun control etc. so long as it continues to create anger and fear that they can successfully blame on the other party. This behavior extends to voting against their own proposed policies in the interest of seizing/maintaining power over problem solving. And now deliberately creating crises (both real and fictional ones) has become the game-theory dominant strategy in American politics.

supertrope 1y ago
Even for politicians who are not absorbed in wedge issues, meaningful reform is a long term task. It would require multiple elections in a row showing that there is a durable political coalition for universal healthcare.
egorfine 1y ago
So much this. Also, this works for every people, not just American.

elif 1y ago

We are a "binocracy", where our democratic function has been reduced to a binary choice, and unfortunately both choices have been fully captured by the healthcare industry.

ponector 1y ago

One can argue what people wants is to be ruled by old convicted felon dictator.

saghm 1y ago

Without making a claim about whether it's what most people actually want or not, there's not much that an individual can do about this by changing their voting preference. The US doesn't have proportional representation, and the overwhelming majority of elections are "first past the post" rather than one of the more "modern" alternatives like ranked choice votes, so in practice very few elections ever swing to anyone outside of the two major political parties (neither of which have a particularly large contingent of politicians who have come out in favor of something like single-payer healthcare). Even for a purely single-issue voter who only cares about this, from a game theoretic perspective you're likely to be essentially throwing your vote away if you vote for someone outside of those two major parties because it's unlikely enough others will. Presidential elections are even worse because they're determined by electoral college vote rather than popular vote. Even ignoring the potential for "faithless electors", all but two states allocate the entirety of their electoral votes to the candidate who wins the majority of their vote, which means that if you live in a state with a majority who reliably vote for a specific party's candidate every four years, your vote for president is effectively meaningless. The only obvious way to fix these issues with how elections work would be to elect people who make different decisions about how to run them, which is hard to do because of the issues themselves. The system is self-reinforcing in a way that makes it extremely difficult for the average person to do anything about it, and any desire to do so gets weighed against the concerns about the policies that you might actually get to influence by voting for one of the two candidates who might actually win. At the end of the day, people who are concerned with the fundamental systemic flaws in things like elections and healthcare still likely end up picking pragmatism over principle (with the expected value of a vote for a candidate who is almost guaranteed not to win being lower than one who is might be less desirable than a third-party one but still has an actually realistic chance of winning and is preferable to the other major party candidate) or just check out of the system entirely (with people not bothering to vote at all already being a fairly common phenomenon in the US).

throwforfeds 1y ago

> Though why do you Americans put up with all this? I have heard the US is a democracy. So then insurance-based healthcare is what American people truly want? It's because our politicians are largely owned by our corporations and spend a ridiculous amount of money protecting their interests [1]. We almost had a public option with the original "Obamacare", but it was forced out of the bill [2]. Also, just turn on Fox News for an evening and realize it's been the number one news channel in the US for 20-something years. They've been a right wing corporate propaganda machine for a long time, all while brilliantly portraying themselves as the "underdog" fighting the mainstream media. Americans aren't very educated and take pride in their ignorance, unfortunately. [3] [1] https://en.wikipedia.org/wiki/Citizens_United_v._FEC https://en.wikipedia.org/wiki/Citizens_United_v._FEC [2] https://en.wikipedia.org/wiki/Public_health_insurance_option https://en.wikipedia.org/wiki/Public_health_insurance_option [3] https://www.youtube.com/watch?v=QFgcqB8-AxE https://www.youtube.com/watch?v=QFgcqB8-AxE

seanmcdirmid 1y ago
FoxNews has only been the number one TV news channel for the last 20 something years because almost everyone under 40 doesn't watch TV anymore. Yes, there are a lot of conservatives in the US, but the demographics is really skewed if you just look at people who watch TV and have cable.
- throwforfeds 1y ago
  Yes, but older people vote and young people don't. I haven't owned a TV my entire adult life (in my 40s now), so I agree with you, but it's hard to imagine Trump and the current Republican party without Fox News.
  - DaSHacka 1y ago
    > it's hard to imagine Trump and the current Republican party without Fox News. Not Twitter and the Internet? As a non-boomer that's been the majority of the activity I've seen from people around my age.

ajkjk 1y ago

We fucking hate it don't worry

goodluckchuck 1y ago

I think you’re just believing whatever the author says, and not considering the fact that reasonable people can disagree and be wrong and make mistakes. For all we know the procedure was entirely unnecessary and they agreed because he pushed for it. Also, what’s the alternative? The only system where you can go get procedures that authorities think unnecessary is a free market where you self-pay. A government-run system could equally decide that the procedure isn’t recommended.

blitz_skull 1y ago

This frame assumes several things: 1. Americans are not displeased with the situation. Ironically, I think this is one place most Americans agree there is a problem. The solution is the hard part because: 2. This presumes a drop-in solution where no one loses. This is where the fight is. 3. This presumes that democracies do what is logical or beneficial for the vast majority, which is a very naive view of democracy.

queenkjuul 1y ago
Just reminding you that American citizens continue to be detained https://www.techdirt.com/2025/10/22/more-than-170-u-s-citizens-have-been-held-by-immigration-agents-theyve-been-kicked-dragged-and-detained-for-days/ https://www.techdirt.com/2025/10/22/more-than-170-u-s-citize...
- blitz_skull 1y ago
  What does this have to do with my comment?
  - queenkjuul 1y ago
    You told me no American citizens were being detained by ice. I'm reminding you your wrong.
    - blitz_skull 11mo ago
      lol, get a life dude.
queenkjuul 1y ago
Have some more https://www.cbc.ca/news/world/us-citizens-ice-arrests-detentions-9.6960504?cmp=rss https://www.cbc.ca/news/world/us-citizens-ice-arrests-detent...

robrenaud 1y ago

A lot of employed people like the status quo for the healthcare that they receive. "In contrast to their largely negative assessments of the quality and coverage of healthcare in the U.S., broad majorities of Americans continue to rate their own healthcare’s quality and coverage positively. Currently, 71% of U.S. adults consider the quality of healthcare they receive to be excellent or good, and 65% say the same of their own coverage. There has been little deviation in these readings since 2001. Compared with their counterparts, older adults and those with higher incomes register more positive ratings of the quality and coverage of their own healthcare." https://news.gallup.com/poll/654044/view-healthcare-quality-declines-year-low.aspx https://news.gallup.com/poll/654044/view-healthcare-quality-...

egorfine 1y ago
So basically they accept and approve of them being bankrupted by an unfortunate medical event no matter how top tier their health insurance package. Right?
- knollimar 1y ago
  Are there not out of pocket maximums on most plans?

wouldbecouldbe 1y ago

Well there is lot of shit we Europeans put up with, for instance EU moving court every few weeks voor 200m per year. But systems are hard to change.