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This is what frustrates me about many of our non-USA HN'ers here: every time the state sponsored health care issue comes up, the non-USA folks can't wait to tal

This is what frustrates me about many of our non-USA HN'ers here: every time the state sponsored health care issue comes up, the non-USA folks can't wait to talk about how their country has it, or how it costs this little to get coverage for this or that problem in their country, and then they wonder why "you Americans" put up with the system you have currently in place (self-insured, no state plans - pre-Obamacare). I've read my share of comments (often from European HN'ers) that mock USA citizens' mentality with regard to state sponsored health care here. Well here you go - this is the perfect example to share with you as to why most Americans didn't/don't want "Obamacare". We, the voters, have no confidence that the current system+administration+Congress (or previous 10 of each!) could've created a system for "health insurance for all" that worked and was efficient. It's not anything against Obama - it's that we've seen administration after administration try to implement some big, sweeping group/plan for 20+ years and every one of them has turned into an inefficient holy hell of a mess. The most recent example of a major #$%&-up is Homeland Security (which I think is the last major agency created). If the American public believed that the current government was capable of delivering state sponsored health care in an efficient way, every Democrat and Republican in this country would've voted for it. So don't think of "those who are against Obamacare" as anti-Obama, but rather anti-inefficiency (or anti-bigger government).

jmadsen 13y ago
Right - because inefficiency in government programs is a purely American thing. We have affordable, universal health care because we've eliminated all forms of waste & corruption from our governments, and are left with a stream-lined, Indy 500 car pit type system. I don't think so. Get off it already - America doesn't have a decent health care system because insurance companies pay off corrupt congressmen to make sure you don't have one.
- raldi 13y ago
  I'm not sure you're disagreeing with him. His point is that the US government has a history of creating huge expensive projects riddled with inefficiencies and which, quite often, yield a disappointing final product. Saying that one of the causes of that is corruption is not exactly refuting the claim.
  - andrew_gardener 13y ago
    I believe his main point is that its not just the States that has a corrupt/ineffective government. Other places with there own government problems have managed to gain some form of public free/cheap healthcare.
brown9-2 13y ago
If the argument though is "we can't have nice things because we screw it up", perhaps we need to look more at why America tends to screw these things up instead of taking away the lesson that we shouldn't try to have nice things.
- hga 13y ago
  While many of us would argue with the "nice things" concept (ScottWhigham grossly overestimates the nation's enthusiasm for socialism at the beginning of this thread), it doesn't take away from his point that it's stupid to try such grand projects while we have a demonstrated inability to do them. I mean, the government is taking control of 1/6 of the nation's economy, why ever did the Obamacare enthusiasts think this would work even vaguely well???
  - brown9-2 13y ago
    To be fair, the government isn't "taking control" of healthcare - they haven't assumed control over every private health insurance company.
    - hga 13y ago
      And how many of those "private" insurance companies can still write "major medical" high deductible catastrophic coverage polices that so many of us have used in time past as ... gasp, insurance, as opposed to a tax advantaged benefit + originally a way to get around WWII wage controls? Etc. etc. In a system that's structurally rather close to Original Formula Italian fascism, how "private" nominally non-government companies are when so much of what they can and cannot do is highly debatable, to the point where I think your quibble is very very minor.
- ScottWhigham 13y ago
  The "why" is easy enough to figure out. The "problem" with a democracy (or rather America's in particular) is two-fold: 1) when you say "we need to look more at why", the answer is "Because you keep voting this or that yahoo into office and he/she is a career politician whose sole interest is in continuing to please the various lobbyists, PACs, and special interest groups that offer the most perks." You can then say, "Okay, Scott - how do we solve that then?" I think the logical/easy answer is "Put term limits on Congress". Force the lobbyists/etc to make new relationships every four years. Take things out of the back room and make Congress be part of someone's CV, not their entire CV. 2) Those same "career politicians" are the ones who have sole vote on whether to reform any change in term limits. Term limits have been tried before but failed to get anywhere.[0] Until you change something with the career politicians of this country, we can't have nice new things. [0] http://en.wikipedia.org/wiki/Term_limits_in_the_United_States#Congress http://en.wikipedia.org/wiki/Term_limits_in_the_United_State...
RockyMcNuts 13y ago
Medicare is more efficient than private insurers. of course it helps that it just says, F u, we're paying X, instead of making everyone jump through hoops and hoping they screw up and provide an excuse for denial, and Medicare doesn't need to market or grow profits. http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/ http://healthaffairs.org/blog/2011/09/20/medicare-is-more-ef... sounds like this project is a colossal clusterf*k. Innovation and customer service are not in the government's wheelhouse, and I would certainly rather have market-based systems anywhere they work. It just hasn't worked for health care. And governments provide roads, schools, water etc. And the private sector has its share of disastrous projects, Webvan and Boo.com and Pets.com burning through hundreds of millions and going nowhere. I sort of wish Google or Elon Musk or somebody would step up and volunteer to fix it, instead of saying, government sucks, people have to keep getting crappy/no health care.
- hga 13y ago
  I think only the weakest level of "market-based" can apply here. The government has grossly intervened in the health care market since the WWII wage and price controls implicitly created the business model of employers playing for health care as non-controlled additional compensation, to the explicit post-WWII requirement for emergency rooms to treat everyone who entered. Now Medicare shifts quite a bit of additional costs onto others, you need federal government approval for every new hospital bed, I remember reading some time ago that one state's hospitals were screwed because the state and the federal government had incompatible requirements for hot water temperature, etc. The FDA has massive and politicized control over many system inputs such as drugs and devices, the government has failed to intervene when almost every other country insisted companies sell drugs at near cost (our market supports way more than half the cost of new drug development), etc. etc. etc. And just before Obamacare was passed the government (mostly Federal with states "partnering" Medicaid) was paying for almost half the nation's healthcare. A market that was thoroughly intertwingled with governments doesn't really seem up to allowing statements like "It just hasn't worked for health care."
  - RockyMcNuts 13y ago
h4rrison 13y ago
As a non-USA HN'er, I'm not sure I agree with this as a perfect example of the case against a national health insurance system. I'm not sure any democratic country with a population of over 300 million people could smoothly implement such an enormous project without some teething problems. And 20 years from now, when your grandkids don't have to worry about health insurance, the world isn't laughing at your health system, and everyone has forgotten how some menus didn't work on a website that went over budget, I bet you'll be thankful someone finally did try to implement something big.
lukeschlather 13y ago
This is a really good talking point, but the fact is the existing (mostly private) healthcare system is huge, expansive, riddled with inefficiencies, and is a disappointing product. Saying that the new government healthcare system is inefficient and disappointing is not enough to malign it - it has to be equally or more inefficient and ineffective than the system it's replacing.
- ctdonath 13y ago
  No, we're saying that due to extensive prior experience we expect the new government healthcare system will be more inefficient and more disappointing than the existing (mostly private) healthcare system - and that's taking into account that the latter is huge, expansive, riddled with inefficiencies, and is a disappointing product. Just because option A sucks doesn't mean we should prefer option B which we justifiably expect will be (and is rapidly proving to be) much worse. Oh, BTW: my nontrivial experience with the existing (mostly private) healthcare system is that it works very well, thank you very much, now please keep your hands & laws off it.
- hga 13y ago
  Except it wasn't even vaguely "mostly private", I touch on that in some detail elsewhere in this sub-thread: https://news.ycombinator.com/item?id=6528332 https://news.ycombinator.com/item?id=6528332
JPKab 13y ago
As if Obamacare is state-sponsored. Its a government program that helps people buy private health insurance. At no point is somebody's doctor taking orders from the government. Naturally the Republicans messaging on Obamacare resulted in Americans being against it, yet simultaneously being in favor of every actual aspect of the law provided it didn't include President Blackenstein's name with it. After all, our seniors have been enlightened with Fox News, and in their all-knowing wisdom seek to protect us from being a vassal state led by a rogue Kenyan. The vastly more efficient thing to do would be to expand our current socialist single-payer medical system (Medicare) to cover all. However, we live in a country where large financial interests our capable of preserving themselves, irrespective of the value they provide. The health insurance companies ensured that any solution to universal coverage included them, which is an automatically bad thing. They financed ad campaigns to scare the senior citizens into thinking that any expansion of Medicare would mean less care for them. Health insurance companies (in their current role of acting as payment middle men as opposed to a necessary role of covering catastrophic costs) provide no value. They interfere with the free market, and are less efficient than a Canadian style single payer/private provider model. Anyone who thinks the current system is acceptable has never experienced the current system: they likely are covered by a large company's health insurance company, and haven't had to watch a family member try to buy themselves insurance.
- hga 13y ago
  "Anyone who thinks the current system is acceptable has never experienced the current system: they likely are covered by a large company's health insurance company, and haven't had to watch a family member try to buy themselves insurance." Strange, a large number of us can remember buying individual "major medical" high deductible catastrophic coverage policies for quite reasonable sums of money, since they're true insurance ... policies which are now illegal. And a lot of self-insured people/families are finding their policies canceled or unaffordable, along with what they can in theory buy on the exchanges. Seeing as how Obamacare mandates 10? or so generally? new and expensive things, like coverage of your children till age 26. Or explicitly makes healthcare more expensive, like the 2.3% excise tax on medical devices: http://www.irs.gov/uac/Medical-Device-Excise-Tax:-Frequently-Asked-Questions http://www.irs.gov/uac/Medical-Device-Excise-Tax:-Frequently... As for "somebody's doctor taking orders from the government" ... well, what if they want to get reimbursed? Not quite the same thing, but just about the same effect. As for Medicare ... well, seeing as how much it shifts costs to other customers, just how do you propose to pay for it as more and more people got moved to it? Being disabled, I'm on it, and track what my doctors get paid. Sometimes its reasonable, frequently its not, and I haven't needed anything really expensive yet.... And I do believe your race card has been maxed out: http://www.thedailyshow.com/watch/thu-august-5-2010/race-card-is-maxed-out http://www.thedailyshow.com/watch/thu-august-5-2010/race-car... ; why do you think we've opposed this since Truman made the first attempt? Was Clinton truly our "First Black President" as way too many said before Obama, back when Hillarycare crashed and burned?
deleted 13y ago
[deleted]

jmadsen 13y ago

Right - because inefficiency in government programs is a purely American thing. We have affordable, universal health care because we've eliminated all forms of waste & corruption from our governments, and are left with a stream-lined, Indy 500 car pit type system. I don't think so. Get off it already - America doesn't have a decent health care system because insurance companies pay off corrupt congressmen to make sure you don't have one.

raldi 13y ago
I'm not sure you're disagreeing with him. His point is that the US government has a history of creating huge expensive projects riddled with inefficiencies and which, quite often, yield a disappointing final product. Saying that one of the causes of that is corruption is not exactly refuting the claim.
- andrew_gardener 13y ago
  I believe his main point is that its not just the States that has a corrupt/ineffective government. Other places with there own government problems have managed to gain some form of public free/cheap healthcare.

brown9-2 13y ago

If the argument though is "we can't have nice things because we screw it up", perhaps we need to look more at why America tends to screw these things up instead of taking away the lesson that we shouldn't try to have nice things.

hga 13y ago
While many of us would argue with the "nice things" concept (ScottWhigham grossly overestimates the nation's enthusiasm for socialism at the beginning of this thread), it doesn't take away from his point that it's stupid to try such grand projects while we have a demonstrated inability to do them. I mean, the government is taking control of 1/6 of the nation's economy, why ever did the Obamacare enthusiasts think this would work even vaguely well???
- brown9-2 13y ago
  To be fair, the government isn't "taking control" of healthcare - they haven't assumed control over every private health insurance company.
  - hga 13y ago
    And how many of those "private" insurance companies can still write "major medical" high deductible catastrophic coverage polices that so many of us have used in time past as ... gasp, insurance, as opposed to a tax advantaged benefit + originally a way to get around WWII wage controls? Etc. etc. In a system that's structurally rather close to Original Formula Italian fascism, how "private" nominally non-government companies are when so much of what they can and cannot do is highly debatable, to the point where I think your quibble is very very minor.
ScottWhigham 13y ago
The "why" is easy enough to figure out. The "problem" with a democracy (or rather America's in particular) is two-fold: 1) when you say "we need to look more at why", the answer is "Because you keep voting this or that yahoo into office and he/she is a career politician whose sole interest is in continuing to please the various lobbyists, PACs, and special interest groups that offer the most perks." You can then say, "Okay, Scott - how do we solve that then?" I think the logical/easy answer is "Put term limits on Congress". Force the lobbyists/etc to make new relationships every four years. Take things out of the back room and make Congress be part of someone's CV, not their entire CV. 2) Those same "career politicians" are the ones who have sole vote on whether to reform any change in term limits. Term limits have been tried before but failed to get anywhere.[0] Until you change something with the career politicians of this country, we can't have nice new things. [0] http://en.wikipedia.org/wiki/Term_limits_in_the_United_States#Congress http://en.wikipedia.org/wiki/Term_limits_in_the_United_State...

RockyMcNuts 13y ago

Medicare is more efficient than private insurers. of course it helps that it just says, F u, we're paying X, instead of making everyone jump through hoops and hoping they screw up and provide an excuse for denial, and Medicare doesn't need to market or grow profits. http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/ http://healthaffairs.org/blog/2011/09/20/medicare-is-more-ef... sounds like this project is a colossal clusterf*k. Innovation and customer service are not in the government's wheelhouse, and I would certainly rather have market-based systems anywhere they work. It just hasn't worked for health care. And governments provide roads, schools, water etc. And the private sector has its share of disastrous projects, Webvan and Boo.com and Pets.com burning through hundreds of millions and going nowhere. I sort of wish Google or Elon Musk or somebody would step up and volunteer to fix it, instead of saying, government sucks, people have to keep getting crappy/no health care.

hga 13y ago
I think only the weakest level of "market-based" can apply here. The government has grossly intervened in the health care market since the WWII wage and price controls implicitly created the business model of employers playing for health care as non-controlled additional compensation, to the explicit post-WWII requirement for emergency rooms to treat everyone who entered. Now Medicare shifts quite a bit of additional costs onto others, you need federal government approval for every new hospital bed, I remember reading some time ago that one state's hospitals were screwed because the state and the federal government had incompatible requirements for hot water temperature, etc. The FDA has massive and politicized control over many system inputs such as drugs and devices, the government has failed to intervene when almost every other country insisted companies sell drugs at near cost (our market supports way more than half the cost of new drug development), etc. etc. etc. And just before Obamacare was passed the government (mostly Federal with states "partnering" Medicaid) was paying for almost half the nation's healthcare. A market that was thoroughly intertwingled with governments doesn't really seem up to allowing statements like "It just hasn't worked for health care."
- RockyMcNuts 13y ago

h4rrison 13y ago

As a non-USA HN'er, I'm not sure I agree with this as a perfect example of the case against a national health insurance system. I'm not sure any democratic country with a population of over 300 million people could smoothly implement such an enormous project without some teething problems. And 20 years from now, when your grandkids don't have to worry about health insurance, the world isn't laughing at your health system, and everyone has forgotten how some menus didn't work on a website that went over budget, I bet you'll be thankful someone finally did try to implement something big.

lukeschlather 13y ago

This is a really good talking point, but the fact is the existing (mostly private) healthcare system is huge, expansive, riddled with inefficiencies, and is a disappointing product. Saying that the new government healthcare system is inefficient and disappointing is not enough to malign it - it has to be equally or more inefficient and ineffective than the system it's replacing.

ctdonath 13y ago
No, we're saying that due to extensive prior experience we expect the new government healthcare system will be more inefficient and more disappointing than the existing (mostly private) healthcare system - and that's taking into account that the latter is huge, expansive, riddled with inefficiencies, and is a disappointing product. Just because option A sucks doesn't mean we should prefer option B which we justifiably expect will be (and is rapidly proving to be) much worse. Oh, BTW: my nontrivial experience with the existing (mostly private) healthcare system is that it works very well, thank you very much, now please keep your hands & laws off it.
hga 13y ago
Except it wasn't even vaguely "mostly private", I touch on that in some detail elsewhere in this sub-thread: https://news.ycombinator.com/item?id=6528332 https://news.ycombinator.com/item?id=6528332

JPKab 13y ago

As if Obamacare is state-sponsored. Its a government program that helps people buy private health insurance. At no point is somebody's doctor taking orders from the government. Naturally the Republicans messaging on Obamacare resulted in Americans being against it, yet simultaneously being in favor of every actual aspect of the law provided it didn't include President Blackenstein's name with it. After all, our seniors have been enlightened with Fox News, and in their all-knowing wisdom seek to protect us from being a vassal state led by a rogue Kenyan. The vastly more efficient thing to do would be to expand our current socialist single-payer medical system (Medicare) to cover all. However, we live in a country where large financial interests our capable of preserving themselves, irrespective of the value they provide. The health insurance companies ensured that any solution to universal coverage included them, which is an automatically bad thing. They financed ad campaigns to scare the senior citizens into thinking that any expansion of Medicare would mean less care for them. Health insurance companies (in their current role of acting as payment middle men as opposed to a necessary role of covering catastrophic costs) provide no value. They interfere with the free market, and are less efficient than a Canadian style single payer/private provider model. Anyone who thinks the current system is acceptable has never experienced the current system: they likely are covered by a large company's health insurance company, and haven't had to watch a family member try to buy themselves insurance.

hga 13y ago
"Anyone who thinks the current system is acceptable has never experienced the current system: they likely are covered by a large company's health insurance company, and haven't had to watch a family member try to buy themselves insurance." Strange, a large number of us can remember buying individual "major medical" high deductible catastrophic coverage policies for quite reasonable sums of money, since they're true insurance ... policies which are now illegal. And a lot of self-insured people/families are finding their policies canceled or unaffordable, along with what they can in theory buy on the exchanges. Seeing as how Obamacare mandates 10? or so generally? new and expensive things, like coverage of your children till age 26. Or explicitly makes healthcare more expensive, like the 2.3% excise tax on medical devices: http://www.irs.gov/uac/Medical-Device-Excise-Tax:-Frequently-Asked-Questions http://www.irs.gov/uac/Medical-Device-Excise-Tax:-Frequently... As for "somebody's doctor taking orders from the government" ... well, what if they want to get reimbursed? Not quite the same thing, but just about the same effect. As for Medicare ... well, seeing as how much it shifts costs to other customers, just how do you propose to pay for it as more and more people got moved to it? Being disabled, I'm on it, and track what my doctors get paid. Sometimes its reasonable, frequently its not, and I haven't needed anything really expensive yet.... And I do believe your race card has been maxed out: http://www.thedailyshow.com/watch/thu-august-5-2010/race-card-is-maxed-out http://www.thedailyshow.com/watch/thu-august-5-2010/race-car... ; why do you think we've opposed this since Truman made the first attempt? Was Clinton truly our "First Black President" as way too many said before Obama, back when Hillarycare crashed and burned?

deleted 13y ago

[deleted]