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Everything I read about healthcare recently just reinforces the notion that we need public health care. Let's just model our system after say, Canada's, and cal

by kzahel 14y ago

Everything I read about healthcare recently just reinforces the notion that we need public health care. Let's just model our system after say, Canada's, and call it done.

eli 14y ago
Easier said than done. If you recall, the relatively modest improvements in the Affordable Care Act were narrowly approved by Congress and then narrowly avoided being struck down by the Supreme Court.
- natrius 14y ago
  Canada's system would be as constitutional as Medicare is. The Affordable Care Act introduced a novel (to U.S. case law) mechanism for getting everyone insured.
  - herge 14y ago
    Which was only done to get it narrowly passed by the U.S. Congress.
paulhauggis 14y ago
Issues I have with public health care: 1) The government hasn't been able to run anything efficiently as long as I've been alive. It's not like we can just go back if UHC doesn't work out. 2) The more the government runs our lives (especially something like health care), the more they will be able to dictate our choices (what we eat, risky behavior, etc). 3) I haven't seen one person that supports public health care tell me the downsides. I know they exist and we need to know the risks (and talk about them openly) before making such a huge change to our current system.
- rquantz 14y ago
  Do you have these issues with Medicare, Medicaid, and Veteran's healthcare?
- smokinjoe 14y ago
  1) Can this just stop until someone presents a direct (and accurate) comparison? You make it sound like it will be a fourth branch of Government. There are several Government Agencies that don't hemorrhage money and actually accomplish what they set out to do. Look at Medicaid - people were saying essentially the same exact things about it and now people probably couldn't imagine not having the program. 2) Please explain. 3) Probably because a wider availability to care and an overall increase in average quality of life is a good, if not great thing for a society.
- corry 14y ago
  Regarding (1): The question isn't whether gov can run it 'efficiently', but if gov can run it MORE efficiently than the current system. Based on the US's position as highest per-capita spender on healthcare + the underwhelming quality of care that $$$ gets you, more gov intervention seems like a pretty valid thing to look into.
- 3825 14y ago
  > 2) The more the government runs our lives (especially something like health care), the more they will be able to dictate our choices (what we eat, risky behavior, etc). I know I will be pushing for change towards less and not more freedom. It makes no sense that you have to pay for my reckless high-risk behavior such as jumping out of a second floor window "for shits and giggles". Another thing in particular that I want to call out attention to is food. If I retarded enough to eat nothing but McDonalds every day for a year, why should you just not let me die? Why should you pay for my surgery? If you are going to pay for it, over time you will gravitate towards a "high-risk fee" on activities that are just plain dumb. Let's increase taxes on cigarettes, alcohol, (and implement new ones on ecstacy, marijuana, and all drugs... I don't know how that's possible without legalization but there is no way I am paying for someone rehab for something that has not been taxed) The idea is that nobody should have to pay for someone else's high risk activities. Over time, the high risk activities will become expensive enough. Money will be a driving force that will drive people towards a better lifestyle. Think about it. Money will be a force for good for once. Just take McDonalds. People say McD is a cheaper to healthier food. If a McD meal is a dollar and causes a health maintenance fee of twenty dollars, what do we do? We tack that twenty dollars to the cost of the meal. Bam! The McDonalds meal is now $21. That $2.49 price tag on the celery at Aldi's is suddenly not so expensive by comparison. Yes, there are downsides but if enough people are annoyed you will get real reform. Please don't do anything stupid like the last time when conservatives tried to "starve the beast"[1]. We have solid evidence that starve the beast does not work. [1]: https://en.wikipedia.org/wiki/Starve_the_beast https://en.wikipedia.org/wiki/Starve_the_beast
  - oleganza 14y ago
    So certain people point guns at everybody else to extract money and pay for health care. It suddenly diminishes motivation to stay healthy and we need even more guns pointing to some other people so some third category of people would feel that motivation has been justly restored and everybody is moving towards brighter future. And please don't even start with an argument that "you can go away if you don't like it". It is you, not me, have to prove that some people have a right to point a gun at us while we cannot do the same towards them. Either that, or there is no difference between initiation of force and self-defense, but then it does not prove why somebody has an exclusive right to use guns. To those who are going to downvote me: are you able to come with a valid argument why it is me, not people with guns should prove a position before taking action?
- rprasad 14y ago
  Issues with private health care: 1) Private health insurers haven't been able to run anything efficiently as long as I've been alive. My premiums go up by double digit percentages every year because "costs" keep increasing, but at the same time, insurers' profits go up by double digit percentages every year. It seems like this is simply a money transfer to health care executives. 2) The more private companies run our lives (especially something like healthcare), the more they will be able to dictate our choices (what we eat, risky behavior etc). Oh wait... corporations already do dictate what we eat, what sort of medicine we use, where we work, how we communicate, how we move around, what we wear...The only difference between corporate control and government control is that we actually have some say in how the government controls us because at the end of the day we control the government. 3) I haven't seen on person that supports privated health care tell me the downside. I know they exist and we need to know the risks and talk about them openly before we stick with such a horrible system. But anyways, the downsides to public health care: cafeteria health care (i.e., standardized treatments) which is good for most patients but not for the few who have nonstandard variations of ailments; higher taxes; less personalized care as a consequence of standardized treatments; potentially reduced choice of health care provider(s) (but if the entire system is UHC this may not be the case); potentially longer waits for medical treatment that cannot be handled in a day (i.e., anything that cannot be handled outpatient or by nurses or nurse practitioners). And the downsides to private health care: all of the above, plus: risk of claim denial for valid claims (though admittedly less of a risk now as a consequence of numerous state and federal laws cracking down on claim denials); double-digit increases in premiums every year despite no corresponding increase in costs (this is actually happening, and has been happening, every year for the past decade); reduced choice of health care providers (which is actually the case now, i.e., in-network vs. out-of-network); ruinous medical bills; unnecessary tests and treatments; private health information being shared with "business partners"; inadequate medical facilities as a result of lack of capital investment due to premiums being redirected to marketing or executive retention. It turns out the downsides of a private health care system outweigh the downsides of a public health care system, since you have all of the same downsides but the additional downsides that come with a profit-seeking business. And as history has amptly demonstrated, cost-cutting is not one of the benefits of a private health care system (costs are cut in a way that benefits the insurer's profits, but in ways which are detrimental to the insured).
- mgkimsal 14y ago
  "The government hasn't been able to run anything efficiently as long as I've been alive." I'm not so sure private insurance companies and hospitals are all that "efficient" either, but define "efficient" first. Private insurance companies are motivated by making a profit, and the easiest way to do that is to take in money, but pay out as little as possible. There's very little competition in insurance, as 'the market' is primarily larger employers, so insurance companies by and large cater towards the needs of their biggest customers. We need to get rid of employer-provided health care benefits, and focus on getting people to buy it directly themselves. This will bring more market forces to bear, getting more companies to compete for our business, not the employers', and perhaps we can then talk about 'efficiency' and having that be something positive for end recipients of health care.
  - tdfx 14y ago
    > We need to get rid of employer-provided health care benefits, and focus on getting people to buy it directly themselves. This. People are given these ridiculously expansive health care plans and most of the premium is picked up by their company or is deducted before they ever notice it. If people have to buy it themselves, they're going to choose higher deductible plans to get lower premiums. With higher deductible plans, they will want to see what their money is paying for and demand price transparency (which is sorely lacking in the US health care market). Allow companies to operate without stifling state interference and this will be a whole new market, one that actually responds to the forces of supply and demand (as opposed to the clusterfuck we deal with now).
- astrodust 14y ago
  Medicare has been run for decades at a pay-out efficiency significantly higher than private insurance companies. There's a model that's in place and works even when loaded down with high-risk individuals. The government already "runs your life" by dictating speed limits, acceptable levels of toxins in your foods, safety standards for cars, etc. You're freaking out about things that don't matter. You know what the downsides to public health care are? Fewer jobs in the insurance industry. You also won't be able to expedite your care by paying a premium, everyone gets roughly the same treatment. For 99% of the people out there, this is a non-issue.
- anigbrowl 14y ago
  1. Oh please, this is just a truism expressing your general political views. Government does lots of things well. Every time there's a relevant accident, the NTSB is on the spot within 24 hours. The FAA does an amazing job. I could go on with many other examples; and where government is slow to respond, it's often because the rules require government to engage in a lengthy public consultation process or make it easy for third parties to litigate against the government (see: any case involving environmental review). It's not like waste, inefficiency, and so on are absent from the private sector. 2. The more your choices impact the lives of others (making yourself chronically ill and sucking up expensive medical resources, driving at 100mph in the rain), the more costs your bad choices impose on other people. Government is the agency we delegate some of our individual autonomy to in order to deal with such systemic problems. The alternative is everyone suing everyone else all the time. 3. I'll tell you the downsides: there are waiting lists for some procedures that are in high demand. There are about as many industrial disputes as before. Everybody blames the government for everything (like a tiny country hospital shutting down, nurses' pay, availability of some experimental treatment of unknown efficacy). A commonly-voiced fear is that if healthcare is cheap then everyone will crowd up doctor's waiting rooms all the time. This doesn't happen, because other than a tiny number of hypochondriacs nobody likes going to the doctor unnecessarily, for the same reason that most people don't engage in recreational dentistry. The fact is that healthcare can't clear like a normal market for three reasons: a) there are genetic factors that you have no ability to control or predict that can make you sick unexpectedly; b) you typically don't have a choice about when you get sick so you can't defer your healthcare spending accordingly; c) most participants in the market are woefully under-informed because they don't have any kind of medical degree, and price theory demands market transparency for all participants in order for equilibrium to emerge and vendors to be price takers. What we have instead is a monstrously inefficient and unresponsive form of monopolistic competition, in which part of your healthcare costs go towards billboards and TV commercials for goods and services whose efficacy you are incapable of judging properly, massive layers of incomprehensible administration, and heads-I-win-tails-you-lose pricing that royally shafts the individual consumer in insurance and care markets.
  - tptacek 14y ago
    It is especially amusing to see people suggest that the government can't competently administer health care given that Medicare customer satisfaction exceeds that of private health insurers. It's weird how easily people "forget" that the federal government is already an extremely accomplished health management administrator. But I take issue with your argument about the health market not clearing. In fact, consumers have important options for how they finance the cost of care. One obvious one: they can pay higher premiums for a low-deductible policy that gives them less control over their outlays but eliminates risks, or they can opt for nosebleed deductibles offset by rolling health savings accounts.
- grecy 14y ago
  1) Given that the health insurance companies in America make billions in profit every year, I'm confident the government can be more efficient than that. 2) This is a naive line of reasoning. The (socialist) FDA already stops you from buying food with lead in it. The (socialist) DMV forces you to wear a seat-belt and wear a motorbike helmet and the (socialist) Police stop you beating people up on the street whenever you want. You are basically saying you don't want "big government" to tell you want you can't do, even though those rules and limitations would make your society better for everyone overall. Everyone's happiness would go up. This is very selfish and shortsighted. 3) It's very simple. Everyone is equal. A billionaire is treated the same as a homeless person. A strongly classed society (like America) does not like this idea, because Americans define success as "better than other people". Public healthcare would take away this distinction.
  - baddox 14y ago
    > You are basically saying you don't want "big government" to tell you want you can't do, even though those rules and limitations would make your society better for everyone overall. You're demonstrating a very common misconception, which is that people who don't want the government to perform a function do not want that function to be performed, or that certain functions can only be performed by a government. > It's very simple. Everyone is equal. A billionaire is treated the same as a homeless person. A strongly classed society (like America) does not like this idea, because Americans define success as "better than other people". Public healthcare would take away this distinction. Is there a competition being held in this thread to see who can make the most ridiculous generalization? Seriously, at least put forth a bit of effort into making your argument seem remotely credible.
  - protomyth 14y ago
    "1) Given that the health insurance companies in America make billions in profit every year, I'm confident the government can be more efficient than that." Given this theory, explain Indian Health Service. Point 1 is bad reasoning and demonstrated to be false. On point 2, rules are not inherently socialist (Capitalism actually requires a strong rule of law).
- r0s 14y ago
  1) How efficient is Medicare now? Private healthcare will always be an option. The existing private system would still be very good, and very competitive. 2) You can say the same for private industry. 3) The downsides are taxes. Expand the existing government payer system with minimal logistic cost. Remove the tax burden from employees (or employers passing it on to same) and watch the economy flourish. The biggest risk is to private insurance, which will never fully recover. Some may opt for the nonprofit model.
- tptacek 14y ago
  1) You mean besides Medicare. 2) You mean besides whether you have to work for a BigCo to have health coverage. 3) You mean besides every discussion about public health care that has ever happened on Hacker News.
rayiner 14y ago
I don't even need public healthcare. I just want something that does away with the current employer-sponsored system. We should make it easier, not harder, for people to move between jobs, take gaps to start companies or get new training, etc. We shouldn't be discouraging younger workers from getting preventative care so they can stay healthy and keep contributing to the economy.
- yaks_hairbrush 14y ago
  Absolutely, yes! I was and still am upset with PPACA because it reinforces the horrid employer-provided care model.
  - tptacek 14y ago
    No it doesn't. It doesn't scrap employer-provided care, but it takes significant steps towards alternatives. The major reason employer-provided care is dominant is that employer care is guaranteed-issue and automatically deducted. Employees of large companies are not screened or given physicals before insurance is extended. Under PPACA, all health insurance is guaranteed issue. And while enrollment isn't automatic, it's enforced; you're fined if you don't get insurance.
    - jacoblyles 14y ago
      Employer provided care also comes out of pre-tax money. So employers get a big discount compared to what you would pay for the same plan.
- cma 14y ago
  The new plan does make it easier to move between jobs, take gaps etc.: pre-existing conditions no longer matter when getting insurance, and the employer tax break for providing insurance is now extended to individual health insurance as well (which used to only happen if medical expenses exceeded X% of your income).
- deleted 14y ago
  [deleted]
wheaties 14y ago
You do realize that this is a recipe for inordinate amounts of public debt that you and I will never have to pay but our children and grandchildren will. Much like Social Security, Cananda's unfunded liabilities are long term too great: http://www.reuters.com/article/2010/05/31/us-health-idUSTRE64U3XO20100531 http://www.reuters.com/article/2010/05/31/us-health-idUSTRE6...
- rayiner 14y ago
  Really, we have two separate problems that unfortunately get lumped together. First, is how to provide healthcare for the working age population and children. Nearly all the evidence points to public healthcare being better for this problem. Insurance discourages people from getting preventative care and ultimately costs more in the long run. Second, is how to provide healthcare for the boomer generation. I don't think there is a solution to this problem, that we can stomach, that doesn't ultimately involve working age people paying out the nose either in insurance premiums or taxes.
  - 3825 14y ago
    >Second, is how to provide healthcare for the boomer generation. There absolutely has to be a dollar cap on how much the government will spend on health care on an individual. Then, we must absolutely stick to it. If the limit is reached, then no more money for that person. I'd support such a limit on baby boomers only since those idiots are the ones who got us into this mess but I can't think of a way to implement that without a big discrimination lawsuit.
    - wheaties 14y ago
      The boomers are not the ones who got us into this mess. It was actually their parents. They paid for their parents and then expected their children (us) to likewise pay for them. In that time, the average life expectancy and cost to prolong life grew enormously. I do not have hate for the baby boomers. What I have hate for is solutions which foist upon OTHER generations costs and expenses associated with THIS generation. I see that public care is perfect in a perfect world. We are not living in such a dream. Policiticians are elected today. Tomorrow they retire. As such there is very little long term planning because the incentive structure is not there to promote long term thinking. Hence, the ability to actually have a limit or cap would never last. Just look at copyright to see the types of things that could happen.
eloisius 14y ago
I think bundling most healthcare under the idea of insurance is a big problem. Insurance works because there's profitability in calculated risk. Everyone doesn't get in a wreck every day, everyone's house doesn't burn down regularly. Dissimilarly, everyone gets old, everyone gets sick, everyone is going to need healthcare.
- jacoblyles 14y ago
  poppycock. Not everybody is going to need the same amount of healthcare. You can insure against the risk that something dire is going to strike you. Your argument may work for old-age care, where the cost of care for most people soars off the charts for last-ditch, cutting-edge efforts to stay alive. But there is no reason the insurance model can't work for most of the population.
  - 3825 14y ago
    I heard so much about death panels and blah blah blah but I absolutely want to sign a document that says that if keeping me alive is going to cost over x dollars, please pull the plug and save the money. The x will probably change as I make more money. Right now, two million dollars is probably where I'd balk. (Pretty sad I know but I think the government could put that two million dollars to better use than to keeping me alive.) I guess a death panel is inevitable. I am pretty sure I will change my mind and chicken out at the last minute and say "I want to live even if it costs ten million to keep me alive". Don't listen to the senile me! Let me die and use the money on what matters -- kids. I don't have kids and don't plan on having any anytime soon.
  - EvanAnderson 14y ago
    Agreed. Insuring against inevitability is silly, and health insurance shouldn't cover those events. A friend of mine uses the analogy of "food insurance" to describe the dysfunctional nature of attempts to insure against the inevitable.
    - dalore 14y ago
      So life/death insurance is silly? No, insuring against an inevitability isn't silly because there are other factors to consider. Like when the inevitable occurs. Insurers are taking a risk that you put more in before that happens.
jacoblyles 14y ago
I far prefer the Singapore model to Canada's. Have you informed yourself of the variety of different public healthcare models out there? UK and Canada seem to have issues with very long wait times and bad options for private care for niche conditions (private care was illegal in Canada not too long ago) Singapore has good health outcomes, low health expenditure, and a high quality of care. They use a forced-savings model with a public backstop, giving consumers market incentive to conserve healthcare and keep costs down (unlike the US all-you-can-eat model). It's very effective and not too far from our current system for political feasibility. There are economists who have been studying the problems and benefits of various universal public healthcare for years. Are you aware of their arguments?
grecy 14y ago
I don't suggest you model it after Canada's system. It's good, but it could be better. I moved to Canada from Australia, so I'll compare the two systems for you. Canada: "healthcare for all" provides basic coverage of everything you need. Works pretty well. Even homeless / out of work people are fully covered. Things like dental and chiropractor are not covered, so you pay for those. Employers give "health care" which really just means they will pay a percentage of your costs for things like dental, chiropractors, prescriptions, etc. The problem here is that if you want "better than basic" healthcare, it's tied to your employer, which has all the negative impacts of the US system of being stuck to your job. This sucks. Australia: Same as Canada in that basic coverage covers emergencies and what-not for everyone. Again dental, chiropractors are not covered. BUT if you want "better than basic" care, it's your choice if you want to go out (with your own cash) and buy "private health care" which again will pay a percentage of your out-of-pocket costs for those extras (dental, etc.). The massive, massive, massive advantage here is that your health is in not directly linked to your job. Your employer has no say or impact on your choice of healthcare provider, or if you even want to buy that extra coverage. As a single, healthy 30 year old, I've never seen the need to pay the extra, but in Canada I'm forced to because my employer says so. I've been in Canada 7 years, and I actually think I'll go back to Australia, primarily for exactly that reason. EDIT: OK, sure. In Canada you can also choose to buy your own "extra" health care from your own money. What I think is bad is how employers do it for you, without you having much say in the matter. In this way, Canadians feel their health is connected to their employer (a great example is when you interview for a job in Canada, people ask "what are the benefits like"? - In Australia, that is not a question.)
- astrodust 14y ago
  Here in Canada, if you want "better than basic" health-care you can pay for it yourself. The net cost is under $1,000 a year for a typical individual who wants the deluxe treatment.
  - prostoalex 14y ago
    Net cost of what? Pregnancy with complications, chemotherapy, spinal surgery or teeth cleaning is all <$1,000 with deluxe package?
EvanAnderson 14y ago
We need to get rid of the unregulated, manifest "socialist" medical system that the United States has today and replace it with something that is a known quantity. A public system is one option (and one that I'm in favor of), but there could be other solutions too. In general, the current system doesn't stop people who can't pay from receiving care. If we agree that allowing someone to die because they can't pay isn't acceptable then we need to have some kind of public system. Care is rationed by insurers and providers who make judgement calls that, largely, aren't subject to public scrutiny or regulation. (We have the "death panels" that those opposed to public healthcare railed against, but these "panels" are made up of insurers and providers working in a decentralizd, uncoordianted, and uncontrolled manner.) What we have is a "shadow socialist" system where those parties who can afford to pay have to carry the slack for everybody who can't. Individuals and employers end up paying higher premiums to insurers. Healthcare providers increase the cost of procedures to cover the write-offs for the uninsured. Insurers negotiate relationships that limit consumer choice or access to procedures that providers aren't willing or able to discount. It's like the entire mess is designed to be suboptimal for all parties involved. It's depressing that, as a country, we can't have reasonable discourse, agree to compromise, and come up with some kind of substantive strategy.
- tptacek 14y ago
  "Socialist" is a bad term for what we have. The insured do pay for the uninsured (mostly via taxes), but the uninsured don't get free rides: the system we have bankrupts them, often repeatedly, when they have health problems.
  - EvanAnderson 14y ago
    That's why I said "socialist" (in quotes) instead of socialist. It's not a true socialist system-- it's just a big ball of mud that's grown up over time rather than being something that is designed. Different interest groups have exerted influence over the years to shape that ball of mud in such a way that it benefits them, but it's still a ball of mud. It has the effect of spreading the cost to those who can pay (or who don't have the leverage to get discounts), much the same way that a socialist system would, but without the benefits of having a well thought-out socialist system that is subject to public scrutiny and regulation. I don't know what part of my taxes go to paying for the uninsured. I have anecdotal experience of seeing rather large hospital bills for emergency written-off because the person receiving care didn't have adequate insurance. I would agree that someone with health problems is likely to end up with no assets or credit, bankrupt, and receiving some kind of public assistance.
kjackson2012 14y ago
I have Canadian friends, and although they would do anything to preserve their health care, they complain about how long it takes them to make appointments for specialists, tests, etc. I live in the Bay Area, and I have Kaiser HMO, and I love them. They seem vastly superior to Canadian health care in every respect. Even in cost, my friends in Toronto have to pay $100/month each as a Health Tax. Case in point, I got an endoscopy scheduled in 9 days. My friend told me that the average wait time in Canada for an endoscopy is 9 months. I had an MRI scheduled within 1 day. My friend's wife, who was suffering from gallstones, waited 4 months for her MRI. I just made an appointment to see a GI specialist, and it took 1 day. My friend who is a pharmacist for Shoppers Drug Mart in Toronto told me she was amazed at how quick that was.
- tptacek 14y ago
  Kaiser is great unless/until they refuse to cover you because your medical history includes one of hundreds of disqualifying conditions, or they decide to renege on their coverage using contract fine print and creative (re)interpretation of your medical history. In other words, Kaiser is great if a big company that employs you is making sure you're covered. My point is that Kaiser vs. Health Canada isn't an apples/apples comparison.
  - OldSchool 14y ago
    Reminds me of the ONE truly profitable piece of legal advice I've ever received from a lawyer: Having an insurance policy really only guarantees you the right to sue your insurance company if they refuse to pay a claim. He said this as we walked outdoors in a large American city and then pointed out the tallest building on the skyline - an insurance company HQ. This wasn't health insurance but the point is the same.
    - jimbokun 14y ago
      Isn't that true of any contract?
      - 14y ago
DennisP 14y ago
A good book to continue your reading is The Healing of America by T.R. Reid. The author traveled to eight countries, checking out treatment options for his bum shoulder and learning about their healthcare systems. Canada was one and did have some advantages. He also went to the U.K. But the best systems were in France, Germany, and Japan. They all have private (but nonprofit) insurance, a mandate, and no exclusions for preexisting conditions. But they also have good electronic medical records systems, a government-controlled price list, and no claim denials allowed for anything on the list. Many German doctors don't even hire office staff. They swipe your card, your medical records pop up on screen, and whatever they do they're guaranteed to get paid in a week, no questions asked. (On the other hand, another good book is Best Care Anywhere, which advocates extending the V.A. model to everyone. A nice bit from that book is the VistA medical records system, which V.A. doctors and interns built and opensourced. It's been adopted by several national healthcare systems.)
- bitcartel 14y ago
  The UK should have outsourced to Germany: "£12.7bn computer scheme to create patient record system is to be scrapped after years of delays" http://www.guardian.co.uk/society/2011/sep/22/nhs-it-project-abandoned http://www.guardian.co.uk/society/2011/sep/22/nhs-it-project... Instead they outsourced to people who outsourced to people... "Accenture; Computer Sciences Corporation, or CSC; Fujitsu and BT. They were known as local service providers, or LSPs. BT and Fujitsu picked a US software firm, IDX, to work with, while Accenture and CSC both picked a British software company called iSoft. iSoft who offered a software system called Lorenzo, a program that had "achieved significant acclaim from healthcare providers”. "However, the program was not finished..." "CSC had to continue on its own, while the other two providers, BT and Fujitsu, were having their own problems. They were trying to implement American software, which is not such an easy thing to do in a British hospital, because American hospitals rely on billing for each and every activity and do not, conversely, expect to have to handle waiting lists." http://news.techeye.net/business/nhs-it-debacle-debated-in-parliament http://news.techeye.net/business/nhs-it-debacle-debated-in-p...
  - DennisP 14y ago
wissler 14y ago
The system has been screwed up to the point where it certainly appears as if we need it, as if that is the most just solution to the problems. However, that appearance is a mirage. Unfortunately, we are so far down the path of doing things the wrong way that stating the proper solution only leads to misunderstanding. Think of a complex software system that has hack piled upon hack, and where the only programmers left are those who've been the ones piling on the hacks. These are not the people who can understand that what they've been doing is wrong. Our system is the final consequence of people who, among other things, want safety guaranteed by the government. Unfortunately, there are no guarantees in life, so they are chasing a fantasy, and fantasies can become hideously expensive, as this one has. It is tragic that they do not comprehend what they are doing to themselves, but it is even more tragic that what they are doing isn't only to themselves, but to those of us who understand as well.
- jaaron 14y ago
  I'm likely going to regret getting into this conversation. > Our system is the final consequence of people who want safety guaranteed by the government. That's quite a statement and I expect you intended unjustifiable hyperbole. Yet, for a moment, let's jump down the rabbit hole of political philosophy debate. There are no guarantees in life (aside from death) and on this we agree. Accepting this fact does not require us to be a slave to it; however. As a parent, for example, I could tell my children, life isn't fair, go out and buy your own dinner, but I chose not to. I chose to create a household that in intentionally does not simulate the harsh realities of nature. Likewise, I decide to live in a community in which we reject the idea that we are all barbarian animals, fighting for scarce resources in a dog-eat-dog world. Instead, we chose to compromise, pool resources and worth together to create the living environment to which we aspire. This model extends naturally to government. Indeed it is the source from which government springs. Government is the cooperation of the community to reject the harsh world in which we live and try to create a better one. We often fall short. Yet in some ways, we achieve some victory over cruel nature. We establish security from enemies with our armies. We build and protect common goods such as roads and parks. Now at some point, we quickly start to diverge in what everyone in the community wants. Some of us believe its in our benefit to fund the education of all of our next generation. And some of us believe that it would be in the benefit of the community that all would have equal access to some form of medical care. We believe that we are a rich enough, prosperous enough community, that we can afford to ensure even the poorest among us need not worry whether or not they can afford medical care. We do not believe the government is required to coddle us. We do not believe the government will solve all our problems or eliminate all disease. Instead, we want to live in a society which cares enough for one another that we fund health care for all members. That's the philosophical difference. Not some delusional guarantee of safety or a misplaced sense of entitlement. It's an aspiration of a better world and a rejection of idea that we are enslaved into the brutal nature in which we find ourselves.
protomyth 14y ago
Since the US acts as a safety valve for Canada (look at the number of Canadians getting treatment in the US) and the USA's version of public health care for a small subset of the population is a disaster (google: don't get sick after june), I would much rather we pick some solutions other than public health care. I really wish the US had started with better Health Savings Accounts, Catastrophic Insurance[1], tort reform, and reforming how we pay doctors (Medicaid is having problems with new doctors not accepting it). Moving on from there would have been better. [1 - edit] 100% paid for a cost over some figure like $50,000 - cannot remember url of proposal
- colmvp 14y ago
  "Since the US acts as a safety valve for Canada (look at the number of Canadians getting treatment in the US)..." While I don't doubt that there ARE Canadians who travel to the United States for medical treatment, I'd be curious as to the percentage of the population. Growing up in both countries, I can say with certainty I had less hesitations in the Canadian system. In America, I worry all the time about switching jobs and figuring out healthplans. In Canada, I always assumed that I'd be covered in some form.
  - protomyth 14y ago
    The old joke in Grand Forks, ND was that "Friendly Manitoba" license plates outnumber ND license plates. It was a big enough issue that in 2009, Canadian health agencies were contracting with hospitals in border cities[1]. Plus, the US has a lower cancer mortality rate than Canada. One driving factor is waiting lists in Canada are much longer than in the US (well, except at IHS). This drives Canadians to seek treatment in the US. There are several studies done on this. The only real advantage to the Canadian system is that it isn't tied to your employer. In pretty much all other respects[2] it is not as good in either time taken or results. [1] http://www.freep.com/article/20090820/BUSINESS06/908200420/1319/ http://www.freep.com/article/20090820/BUSINESS06/908200420/1... [2] Costs are debatable, but do remember the government costs money and is not free
    - 14y ago
jbp 14y ago
I would prefer it to be modelled after Kaiser(non-profit) and add no exclusions for preexisting conditions.

by kzahel 14y ago

Everything I read about healthcare recently just reinforces the notion that we need public health care. Let's just model our system after say, Canada's, and call it done.

eli 14y ago

Easier said than done. If you recall, the relatively modest improvements in the Affordable Care Act were narrowly approved by Congress and then narrowly avoided being struck down by the Supreme Court.

natrius 14y ago
Canada's system would be as constitutional as Medicare is. The Affordable Care Act introduced a novel (to U.S. case law) mechanism for getting everyone insured.
- herge 14y ago
  Which was only done to get it narrowly passed by the U.S. Congress.

paulhauggis 14y ago

Issues I have with public health care: 1) The government hasn't been able to run anything efficiently as long as I've been alive. It's not like we can just go back if UHC doesn't work out. 2) The more the government runs our lives (especially something like health care), the more they will be able to dictate our choices (what we eat, risky behavior, etc). 3) I haven't seen one person that supports public health care tell me the downsides. I know they exist and we need to know the risks (and talk about them openly) before making such a huge change to our current system.

rquantz 14y ago
Do you have these issues with Medicare, Medicaid, and Veteran's healthcare?
smokinjoe 14y ago
1) Can this just stop until someone presents a direct (and accurate) comparison? You make it sound like it will be a fourth branch of Government. There are several Government Agencies that don't hemorrhage money and actually accomplish what they set out to do. Look at Medicaid - people were saying essentially the same exact things about it and now people probably couldn't imagine not having the program. 2) Please explain. 3) Probably because a wider availability to care and an overall increase in average quality of life is a good, if not great thing for a society.
corry 14y ago
Regarding (1): The question isn't whether gov can run it 'efficiently', but if gov can run it MORE efficiently than the current system. Based on the US's position as highest per-capita spender on healthcare + the underwhelming quality of care that $$$ gets you, more gov intervention seems like a pretty valid thing to look into.
3825 14y ago
> 2) The more the government runs our lives (especially something like health care), the more they will be able to dictate our choices (what we eat, risky behavior, etc). I know I will be pushing for change towards less and not more freedom. It makes no sense that you have to pay for my reckless high-risk behavior such as jumping out of a second floor window "for shits and giggles". Another thing in particular that I want to call out attention to is food. If I retarded enough to eat nothing but McDonalds every day for a year, why should you just not let me die? Why should you pay for my surgery? If you are going to pay for it, over time you will gravitate towards a "high-risk fee" on activities that are just plain dumb. Let's increase taxes on cigarettes, alcohol, (and implement new ones on ecstacy, marijuana, and all drugs... I don't know how that's possible without legalization but there is no way I am paying for someone rehab for something that has not been taxed) The idea is that nobody should have to pay for someone else's high risk activities. Over time, the high risk activities will become expensive enough. Money will be a driving force that will drive people towards a better lifestyle. Think about it. Money will be a force for good for once. Just take McDonalds. People say McD is a cheaper to healthier food. If a McD meal is a dollar and causes a health maintenance fee of twenty dollars, what do we do? We tack that twenty dollars to the cost of the meal. Bam! The McDonalds meal is now $21. That $2.49 price tag on the celery at Aldi's is suddenly not so expensive by comparison. Yes, there are downsides but if enough people are annoyed you will get real reform. Please don't do anything stupid like the last time when conservatives tried to "starve the beast"[1]. We have solid evidence that starve the beast does not work. [1]: https://en.wikipedia.org/wiki/Starve_the_beast https://en.wikipedia.org/wiki/Starve_the_beast
- oleganza 14y ago
  So certain people point guns at everybody else to extract money and pay for health care. It suddenly diminishes motivation to stay healthy and we need even more guns pointing to some other people so some third category of people would feel that motivation has been justly restored and everybody is moving towards brighter future. And please don't even start with an argument that "you can go away if you don't like it". It is you, not me, have to prove that some people have a right to point a gun at us while we cannot do the same towards them. Either that, or there is no difference between initiation of force and self-defense, but then it does not prove why somebody has an exclusive right to use guns. To those who are going to downvote me: are you able to come with a valid argument why it is me, not people with guns should prove a position before taking action?
rprasad 14y ago
Issues with private health care: 1) Private health insurers haven't been able to run anything efficiently as long as I've been alive. My premiums go up by double digit percentages every year because "costs" keep increasing, but at the same time, insurers' profits go up by double digit percentages every year. It seems like this is simply a money transfer to health care executives. 2) The more private companies run our lives (especially something like healthcare), the more they will be able to dictate our choices (what we eat, risky behavior etc). Oh wait... corporations already do dictate what we eat, what sort of medicine we use, where we work, how we communicate, how we move around, what we wear...The only difference between corporate control and government control is that we actually have some say in how the government controls us because at the end of the day we control the government. 3) I haven't seen on person that supports privated health care tell me the downside. I know they exist and we need to know the risks and talk about them openly before we stick with such a horrible system. But anyways, the downsides to public health care: cafeteria health care (i.e., standardized treatments) which is good for most patients but not for the few who have nonstandard variations of ailments; higher taxes; less personalized care as a consequence of standardized treatments; potentially reduced choice of health care provider(s) (but if the entire system is UHC this may not be the case); potentially longer waits for medical treatment that cannot be handled in a day (i.e., anything that cannot be handled outpatient or by nurses or nurse practitioners). And the downsides to private health care: all of the above, plus: risk of claim denial for valid claims (though admittedly less of a risk now as a consequence of numerous state and federal laws cracking down on claim denials); double-digit increases in premiums every year despite no corresponding increase in costs (this is actually happening, and has been happening, every year for the past decade); reduced choice of health care providers (which is actually the case now, i.e., in-network vs. out-of-network); ruinous medical bills; unnecessary tests and treatments; private health information being shared with "business partners"; inadequate medical facilities as a result of lack of capital investment due to premiums being redirected to marketing or executive retention. It turns out the downsides of a private health care system outweigh the downsides of a public health care system, since you have all of the same downsides but the additional downsides that come with a profit-seeking business. And as history has amptly demonstrated, cost-cutting is not one of the benefits of a private health care system (costs are cut in a way that benefits the insurer's profits, but in ways which are detrimental to the insured).
mgkimsal 14y ago
"The government hasn't been able to run anything efficiently as long as I've been alive." I'm not so sure private insurance companies and hospitals are all that "efficient" either, but define "efficient" first. Private insurance companies are motivated by making a profit, and the easiest way to do that is to take in money, but pay out as little as possible. There's very little competition in insurance, as 'the market' is primarily larger employers, so insurance companies by and large cater towards the needs of their biggest customers. We need to get rid of employer-provided health care benefits, and focus on getting people to buy it directly themselves. This will bring more market forces to bear, getting more companies to compete for our business, not the employers', and perhaps we can then talk about 'efficiency' and having that be something positive for end recipients of health care.
- tdfx 14y ago
  > We need to get rid of employer-provided health care benefits, and focus on getting people to buy it directly themselves. This. People are given these ridiculously expansive health care plans and most of the premium is picked up by their company or is deducted before they ever notice it. If people have to buy it themselves, they're going to choose higher deductible plans to get lower premiums. With higher deductible plans, they will want to see what their money is paying for and demand price transparency (which is sorely lacking in the US health care market). Allow companies to operate without stifling state interference and this will be a whole new market, one that actually responds to the forces of supply and demand (as opposed to the clusterfuck we deal with now).
astrodust 14y ago
Medicare has been run for decades at a pay-out efficiency significantly higher than private insurance companies. There's a model that's in place and works even when loaded down with high-risk individuals. The government already "runs your life" by dictating speed limits, acceptable levels of toxins in your foods, safety standards for cars, etc. You're freaking out about things that don't matter. You know what the downsides to public health care are? Fewer jobs in the insurance industry. You also won't be able to expedite your care by paying a premium, everyone gets roughly the same treatment. For 99% of the people out there, this is a non-issue.
anigbrowl 14y ago
1. Oh please, this is just a truism expressing your general political views. Government does lots of things well. Every time there's a relevant accident, the NTSB is on the spot within 24 hours. The FAA does an amazing job. I could go on with many other examples; and where government is slow to respond, it's often because the rules require government to engage in a lengthy public consultation process or make it easy for third parties to litigate against the government (see: any case involving environmental review). It's not like waste, inefficiency, and so on are absent from the private sector. 2. The more your choices impact the lives of others (making yourself chronically ill and sucking up expensive medical resources, driving at 100mph in the rain), the more costs your bad choices impose on other people. Government is the agency we delegate some of our individual autonomy to in order to deal with such systemic problems. The alternative is everyone suing everyone else all the time. 3. I'll tell you the downsides: there are waiting lists for some procedures that are in high demand. There are about as many industrial disputes as before. Everybody blames the government for everything (like a tiny country hospital shutting down, nurses' pay, availability of some experimental treatment of unknown efficacy). A commonly-voiced fear is that if healthcare is cheap then everyone will crowd up doctor's waiting rooms all the time. This doesn't happen, because other than a tiny number of hypochondriacs nobody likes going to the doctor unnecessarily, for the same reason that most people don't engage in recreational dentistry. The fact is that healthcare can't clear like a normal market for three reasons: a) there are genetic factors that you have no ability to control or predict that can make you sick unexpectedly; b) you typically don't have a choice about when you get sick so you can't defer your healthcare spending accordingly; c) most participants in the market are woefully under-informed because they don't have any kind of medical degree, and price theory demands market transparency for all participants in order for equilibrium to emerge and vendors to be price takers. What we have instead is a monstrously inefficient and unresponsive form of monopolistic competition, in which part of your healthcare costs go towards billboards and TV commercials for goods and services whose efficacy you are incapable of judging properly, massive layers of incomprehensible administration, and heads-I-win-tails-you-lose pricing that royally shafts the individual consumer in insurance and care markets.
- tptacek 14y ago
  It is especially amusing to see people suggest that the government can't competently administer health care given that Medicare customer satisfaction exceeds that of private health insurers. It's weird how easily people "forget" that the federal government is already an extremely accomplished health management administrator. But I take issue with your argument about the health market not clearing. In fact, consumers have important options for how they finance the cost of care. One obvious one: they can pay higher premiums for a low-deductible policy that gives them less control over their outlays but eliminates risks, or they can opt for nosebleed deductibles offset by rolling health savings accounts.
grecy 14y ago
1) Given that the health insurance companies in America make billions in profit every year, I'm confident the government can be more efficient than that. 2) This is a naive line of reasoning. The (socialist) FDA already stops you from buying food with lead in it. The (socialist) DMV forces you to wear a seat-belt and wear a motorbike helmet and the (socialist) Police stop you beating people up on the street whenever you want. You are basically saying you don't want "big government" to tell you want you can't do, even though those rules and limitations would make your society better for everyone overall. Everyone's happiness would go up. This is very selfish and shortsighted. 3) It's very simple. Everyone is equal. A billionaire is treated the same as a homeless person. A strongly classed society (like America) does not like this idea, because Americans define success as "better than other people". Public healthcare would take away this distinction.
- baddox 14y ago
  > You are basically saying you don't want "big government" to tell you want you can't do, even though those rules and limitations would make your society better for everyone overall. You're demonstrating a very common misconception, which is that people who don't want the government to perform a function do not want that function to be performed, or that certain functions can only be performed by a government. > It's very simple. Everyone is equal. A billionaire is treated the same as a homeless person. A strongly classed society (like America) does not like this idea, because Americans define success as "better than other people". Public healthcare would take away this distinction. Is there a competition being held in this thread to see who can make the most ridiculous generalization? Seriously, at least put forth a bit of effort into making your argument seem remotely credible.
- protomyth 14y ago
  "1) Given that the health insurance companies in America make billions in profit every year, I'm confident the government can be more efficient than that." Given this theory, explain Indian Health Service. Point 1 is bad reasoning and demonstrated to be false. On point 2, rules are not inherently socialist (Capitalism actually requires a strong rule of law).
r0s 14y ago
1) How efficient is Medicare now? Private healthcare will always be an option. The existing private system would still be very good, and very competitive. 2) You can say the same for private industry. 3) The downsides are taxes. Expand the existing government payer system with minimal logistic cost. Remove the tax burden from employees (or employers passing it on to same) and watch the economy flourish. The biggest risk is to private insurance, which will never fully recover. Some may opt for the nonprofit model.
tptacek 14y ago
1) You mean besides Medicare. 2) You mean besides whether you have to work for a BigCo to have health coverage. 3) You mean besides every discussion about public health care that has ever happened on Hacker News.

rayiner 14y ago

I don't even need public healthcare. I just want something that does away with the current employer-sponsored system. We should make it easier, not harder, for people to move between jobs, take gaps to start companies or get new training, etc. We shouldn't be discouraging younger workers from getting preventative care so they can stay healthy and keep contributing to the economy.

yaks_hairbrush 14y ago
Absolutely, yes! I was and still am upset with PPACA because it reinforces the horrid employer-provided care model.
- tptacek 14y ago
  No it doesn't. It doesn't scrap employer-provided care, but it takes significant steps towards alternatives. The major reason employer-provided care is dominant is that employer care is guaranteed-issue and automatically deducted. Employees of large companies are not screened or given physicals before insurance is extended. Under PPACA, all health insurance is guaranteed issue. And while enrollment isn't automatic, it's enforced; you're fined if you don't get insurance.
  - jacoblyles 14y ago
    Employer provided care also comes out of pre-tax money. So employers get a big discount compared to what you would pay for the same plan.
cma 14y ago
The new plan does make it easier to move between jobs, take gaps etc.: pre-existing conditions no longer matter when getting insurance, and the employer tax break for providing insurance is now extended to individual health insurance as well (which used to only happen if medical expenses exceeded X% of your income).
deleted 14y ago
[deleted]

wheaties 14y ago

You do realize that this is a recipe for inordinate amounts of public debt that you and I will never have to pay but our children and grandchildren will. Much like Social Security, Cananda's unfunded liabilities are long term too great: http://www.reuters.com/article/2010/05/31/us-health-idUSTRE64U3XO20100531 http://www.reuters.com/article/2010/05/31/us-health-idUSTRE6...

rayiner 14y ago
Really, we have two separate problems that unfortunately get lumped together. First, is how to provide healthcare for the working age population and children. Nearly all the evidence points to public healthcare being better for this problem. Insurance discourages people from getting preventative care and ultimately costs more in the long run. Second, is how to provide healthcare for the boomer generation. I don't think there is a solution to this problem, that we can stomach, that doesn't ultimately involve working age people paying out the nose either in insurance premiums or taxes.
- 3825 14y ago
  >Second, is how to provide healthcare for the boomer generation. There absolutely has to be a dollar cap on how much the government will spend on health care on an individual. Then, we must absolutely stick to it. If the limit is reached, then no more money for that person. I'd support such a limit on baby boomers only since those idiots are the ones who got us into this mess but I can't think of a way to implement that without a big discrimination lawsuit.
  - wheaties 14y ago
    The boomers are not the ones who got us into this mess. It was actually their parents. They paid for their parents and then expected their children (us) to likewise pay for them. In that time, the average life expectancy and cost to prolong life grew enormously. I do not have hate for the baby boomers. What I have hate for is solutions which foist upon OTHER generations costs and expenses associated with THIS generation. I see that public care is perfect in a perfect world. We are not living in such a dream. Policiticians are elected today. Tomorrow they retire. As such there is very little long term planning because the incentive structure is not there to promote long term thinking. Hence, the ability to actually have a limit or cap would never last. Just look at copyright to see the types of things that could happen.

eloisius 14y ago

I think bundling most healthcare under the idea of insurance is a big problem. Insurance works because there's profitability in calculated risk. Everyone doesn't get in a wreck every day, everyone's house doesn't burn down regularly. Dissimilarly, everyone gets old, everyone gets sick, everyone is going to need healthcare.

jacoblyles 14y ago
poppycock. Not everybody is going to need the same amount of healthcare. You can insure against the risk that something dire is going to strike you. Your argument may work for old-age care, where the cost of care for most people soars off the charts for last-ditch, cutting-edge efforts to stay alive. But there is no reason the insurance model can't work for most of the population.
- 3825 14y ago
  I heard so much about death panels and blah blah blah but I absolutely want to sign a document that says that if keeping me alive is going to cost over x dollars, please pull the plug and save the money. The x will probably change as I make more money. Right now, two million dollars is probably where I'd balk. (Pretty sad I know but I think the government could put that two million dollars to better use than to keeping me alive.) I guess a death panel is inevitable. I am pretty sure I will change my mind and chicken out at the last minute and say "I want to live even if it costs ten million to keep me alive". Don't listen to the senile me! Let me die and use the money on what matters -- kids. I don't have kids and don't plan on having any anytime soon.
- EvanAnderson 14y ago
  Agreed. Insuring against inevitability is silly, and health insurance shouldn't cover those events. A friend of mine uses the analogy of "food insurance" to describe the dysfunctional nature of attempts to insure against the inevitable.
  - dalore 14y ago
    So life/death insurance is silly? No, insuring against an inevitability isn't silly because there are other factors to consider. Like when the inevitable occurs. Insurers are taking a risk that you put more in before that happens.

jacoblyles 14y ago

I far prefer the Singapore model to Canada's. Have you informed yourself of the variety of different public healthcare models out there? UK and Canada seem to have issues with very long wait times and bad options for private care for niche conditions (private care was illegal in Canada not too long ago) Singapore has good health outcomes, low health expenditure, and a high quality of care. They use a forced-savings model with a public backstop, giving consumers market incentive to conserve healthcare and keep costs down (unlike the US all-you-can-eat model). It's very effective and not too far from our current system for political feasibility. There are economists who have been studying the problems and benefits of various universal public healthcare for years. Are you aware of their arguments?

grecy 14y ago

I don't suggest you model it after Canada's system. It's good, but it could be better. I moved to Canada from Australia, so I'll compare the two systems for you. Canada: "healthcare for all" provides basic coverage of everything you need. Works pretty well. Even homeless / out of work people are fully covered. Things like dental and chiropractor are not covered, so you pay for those. Employers give "health care" which really just means they will pay a percentage of your costs for things like dental, chiropractors, prescriptions, etc. The problem here is that if you want "better than basic" healthcare, it's tied to your employer, which has all the negative impacts of the US system of being stuck to your job. This sucks. Australia: Same as Canada in that basic coverage covers emergencies and what-not for everyone. Again dental, chiropractors are not covered. BUT if you want "better than basic" care, it's your choice if you want to go out (with your own cash) and buy "private health care" which again will pay a percentage of your out-of-pocket costs for those extras (dental, etc.). The massive, massive, massive advantage here is that your health is in not directly linked to your job. Your employer has no say or impact on your choice of healthcare provider, or if you even want to buy that extra coverage. As a single, healthy 30 year old, I've never seen the need to pay the extra, but in Canada I'm forced to because my employer says so. I've been in Canada 7 years, and I actually think I'll go back to Australia, primarily for exactly that reason. EDIT: OK, sure. In Canada you can also choose to buy your own "extra" health care from your own money. What I think is bad is how employers do it for you, without you having much say in the matter. In this way, Canadians feel their health is connected to their employer (a great example is when you interview for a job in Canada, people ask "what are the benefits like"? - In Australia, that is not a question.)

astrodust 14y ago
Here in Canada, if you want "better than basic" health-care you can pay for it yourself. The net cost is under $1,000 a year for a typical individual who wants the deluxe treatment.
- prostoalex 14y ago
  Net cost of what? Pregnancy with complications, chemotherapy, spinal surgery or teeth cleaning is all <$1,000 with deluxe package?

EvanAnderson 14y ago

We need to get rid of the unregulated, manifest "socialist" medical system that the United States has today and replace it with something that is a known quantity. A public system is one option (and one that I'm in favor of), but there could be other solutions too. In general, the current system doesn't stop people who can't pay from receiving care. If we agree that allowing someone to die because they can't pay isn't acceptable then we need to have some kind of public system. Care is rationed by insurers and providers who make judgement calls that, largely, aren't subject to public scrutiny or regulation. (We have the "death panels" that those opposed to public healthcare railed against, but these "panels" are made up of insurers and providers working in a decentralizd, uncoordianted, and uncontrolled manner.) What we have is a "shadow socialist" system where those parties who can afford to pay have to carry the slack for everybody who can't. Individuals and employers end up paying higher premiums to insurers. Healthcare providers increase the cost of procedures to cover the write-offs for the uninsured. Insurers negotiate relationships that limit consumer choice or access to procedures that providers aren't willing or able to discount. It's like the entire mess is designed to be suboptimal for all parties involved. It's depressing that, as a country, we can't have reasonable discourse, agree to compromise, and come up with some kind of substantive strategy.

tptacek 14y ago
"Socialist" is a bad term for what we have. The insured do pay for the uninsured (mostly via taxes), but the uninsured don't get free rides: the system we have bankrupts them, often repeatedly, when they have health problems.
- EvanAnderson 14y ago
  That's why I said "socialist" (in quotes) instead of socialist. It's not a true socialist system-- it's just a big ball of mud that's grown up over time rather than being something that is designed. Different interest groups have exerted influence over the years to shape that ball of mud in such a way that it benefits them, but it's still a ball of mud. It has the effect of spreading the cost to those who can pay (or who don't have the leverage to get discounts), much the same way that a socialist system would, but without the benefits of having a well thought-out socialist system that is subject to public scrutiny and regulation. I don't know what part of my taxes go to paying for the uninsured. I have anecdotal experience of seeing rather large hospital bills for emergency written-off because the person receiving care didn't have adequate insurance. I would agree that someone with health problems is likely to end up with no assets or credit, bankrupt, and receiving some kind of public assistance.

kjackson2012 14y ago

I have Canadian friends, and although they would do anything to preserve their health care, they complain about how long it takes them to make appointments for specialists, tests, etc. I live in the Bay Area, and I have Kaiser HMO, and I love them. They seem vastly superior to Canadian health care in every respect. Even in cost, my friends in Toronto have to pay $100/month each as a Health Tax. Case in point, I got an endoscopy scheduled in 9 days. My friend told me that the average wait time in Canada for an endoscopy is 9 months. I had an MRI scheduled within 1 day. My friend's wife, who was suffering from gallstones, waited 4 months for her MRI. I just made an appointment to see a GI specialist, and it took 1 day. My friend who is a pharmacist for Shoppers Drug Mart in Toronto told me she was amazed at how quick that was.

tptacek 14y ago
Kaiser is great unless/until they refuse to cover you because your medical history includes one of hundreds of disqualifying conditions, or they decide to renege on their coverage using contract fine print and creative (re)interpretation of your medical history. In other words, Kaiser is great if a big company that employs you is making sure you're covered. My point is that Kaiser vs. Health Canada isn't an apples/apples comparison.
- OldSchool 14y ago
  Reminds me of the ONE truly profitable piece of legal advice I've ever received from a lawyer: Having an insurance policy really only guarantees you the right to sue your insurance company if they refuse to pay a claim. He said this as we walked outdoors in a large American city and then pointed out the tallest building on the skyline - an insurance company HQ. This wasn't health insurance but the point is the same.
  - jimbokun 14y ago
    Isn't that true of any contract?
    - 14y ago

DennisP 14y ago

A good book to continue your reading is The Healing of America by T.R. Reid. The author traveled to eight countries, checking out treatment options for his bum shoulder and learning about their healthcare systems. Canada was one and did have some advantages. He also went to the U.K. But the best systems were in France, Germany, and Japan. They all have private (but nonprofit) insurance, a mandate, and no exclusions for preexisting conditions. But they also have good electronic medical records systems, a government-controlled price list, and no claim denials allowed for anything on the list. Many German doctors don't even hire office staff. They swipe your card, your medical records pop up on screen, and whatever they do they're guaranteed to get paid in a week, no questions asked. (On the other hand, another good book is Best Care Anywhere, which advocates extending the V.A. model to everyone. A nice bit from that book is the VistA medical records system, which V.A. doctors and interns built and opensourced. It's been adopted by several national healthcare systems.)

bitcartel 14y ago
The UK should have outsourced to Germany: "£12.7bn computer scheme to create patient record system is to be scrapped after years of delays" http://www.guardian.co.uk/society/2011/sep/22/nhs-it-project-abandoned http://www.guardian.co.uk/society/2011/sep/22/nhs-it-project... Instead they outsourced to people who outsourced to people... "Accenture; Computer Sciences Corporation, or CSC; Fujitsu and BT. They were known as local service providers, or LSPs. BT and Fujitsu picked a US software firm, IDX, to work with, while Accenture and CSC both picked a British software company called iSoft. iSoft who offered a software system called Lorenzo, a program that had "achieved significant acclaim from healthcare providers”. "However, the program was not finished..." "CSC had to continue on its own, while the other two providers, BT and Fujitsu, were having their own problems. They were trying to implement American software, which is not such an easy thing to do in a British hospital, because American hospitals rely on billing for each and every activity and do not, conversely, expect to have to handle waiting lists." http://news.techeye.net/business/nhs-it-debacle-debated-in-parliament http://news.techeye.net/business/nhs-it-debacle-debated-in-p...
- DennisP 14y ago

wissler 14y ago

The system has been screwed up to the point where it certainly appears as if we need it, as if that is the most just solution to the problems. However, that appearance is a mirage. Unfortunately, we are so far down the path of doing things the wrong way that stating the proper solution only leads to misunderstanding. Think of a complex software system that has hack piled upon hack, and where the only programmers left are those who've been the ones piling on the hacks. These are not the people who can understand that what they've been doing is wrong. Our system is the final consequence of people who, among other things, want safety guaranteed by the government. Unfortunately, there are no guarantees in life, so they are chasing a fantasy, and fantasies can become hideously expensive, as this one has. It is tragic that they do not comprehend what they are doing to themselves, but it is even more tragic that what they are doing isn't only to themselves, but to those of us who understand as well.

jaaron 14y ago
I'm likely going to regret getting into this conversation. > Our system is the final consequence of people who want safety guaranteed by the government. That's quite a statement and I expect you intended unjustifiable hyperbole. Yet, for a moment, let's jump down the rabbit hole of political philosophy debate. There are no guarantees in life (aside from death) and on this we agree. Accepting this fact does not require us to be a slave to it; however. As a parent, for example, I could tell my children, life isn't fair, go out and buy your own dinner, but I chose not to. I chose to create a household that in intentionally does not simulate the harsh realities of nature. Likewise, I decide to live in a community in which we reject the idea that we are all barbarian animals, fighting for scarce resources in a dog-eat-dog world. Instead, we chose to compromise, pool resources and worth together to create the living environment to which we aspire. This model extends naturally to government. Indeed it is the source from which government springs. Government is the cooperation of the community to reject the harsh world in which we live and try to create a better one. We often fall short. Yet in some ways, we achieve some victory over cruel nature. We establish security from enemies with our armies. We build and protect common goods such as roads and parks. Now at some point, we quickly start to diverge in what everyone in the community wants. Some of us believe its in our benefit to fund the education of all of our next generation. And some of us believe that it would be in the benefit of the community that all would have equal access to some form of medical care. We believe that we are a rich enough, prosperous enough community, that we can afford to ensure even the poorest among us need not worry whether or not they can afford medical care. We do not believe the government is required to coddle us. We do not believe the government will solve all our problems or eliminate all disease. Instead, we want to live in a society which cares enough for one another that we fund health care for all members. That's the philosophical difference. Not some delusional guarantee of safety or a misplaced sense of entitlement. It's an aspiration of a better world and a rejection of idea that we are enslaved into the brutal nature in which we find ourselves.

protomyth 14y ago

Since the US acts as a safety valve for Canada (look at the number of Canadians getting treatment in the US) and the USA's version of public health care for a small subset of the population is a disaster (google: don't get sick after june), I would much rather we pick some solutions other than public health care. I really wish the US had started with better Health Savings Accounts, Catastrophic Insurance[1], tort reform, and reforming how we pay doctors (Medicaid is having problems with new doctors not accepting it). Moving on from there would have been better. [1 - edit] 100% paid for a cost over some figure like $50,000 - cannot remember url of proposal

colmvp 14y ago
"Since the US acts as a safety valve for Canada (look at the number of Canadians getting treatment in the US)..." While I don't doubt that there ARE Canadians who travel to the United States for medical treatment, I'd be curious as to the percentage of the population. Growing up in both countries, I can say with certainty I had less hesitations in the Canadian system. In America, I worry all the time about switching jobs and figuring out healthplans. In Canada, I always assumed that I'd be covered in some form.
- protomyth 14y ago
  The old joke in Grand Forks, ND was that "Friendly Manitoba" license plates outnumber ND license plates. It was a big enough issue that in 2009, Canadian health agencies were contracting with hospitals in border cities[1]. Plus, the US has a lower cancer mortality rate than Canada. One driving factor is waiting lists in Canada are much longer than in the US (well, except at IHS). This drives Canadians to seek treatment in the US. There are several studies done on this. The only real advantage to the Canadian system is that it isn't tied to your employer. In pretty much all other respects[2] it is not as good in either time taken or results. [1] http://www.freep.com/article/20090820/BUSINESS06/908200420/1319/ http://www.freep.com/article/20090820/BUSINESS06/908200420/1... [2] Costs are debatable, but do remember the government costs money and is not free
  - 14y ago

jbp 14y ago

I would prefer it to be modelled after Kaiser(non-profit) and add no exclusions for preexisting conditions.