[__realtime]

> as a Californian...I'd rather that people like me...

There is crux of the issue: not everyone shares the same opinion and belief, so should the government force those people to spend their earned income on healthcare for others? Personally I think it won't end up how you anticipate but that's just me. Right now the working people of America are already subsidizing healthcare for the masses and all I ever hear is people complaining about it.

[hprotagonist]

>not everyone shares the same opinion and belief, so should the government force those people to spend their earned income on healthcare for others?

Yes. Ideally, that's what governments should do: require citizens to act in our collective and long-term best interests, not only their own.

In the case of healthcare: a healthy population is a productive, happy, and peaceful population. All of those things are good for the economy, not to mention any one particular person's soul -- you can make a completely utilitarian argument for it and largely sidestep thorny issues of morality.

[mcbruiser]

most likely what will happen is people will just leave CA, leaving a shortage and it will fail

[bsder]

> most likely what will happen is people will just leave CA

Could you please inform our population here about that?

Republicans keep promising that people will flee the Blue states due to various policies; somehow it never seems to happen.

Could you let us know what we're doing wrong? We'd really like to send some of these folks to Red states to help balance out the voting.

Thanks bunches.

[jeffbax]

http://www.sacbee.com/news/state/california/article136478098...

"Every year from 2000 through 2015, more people left California than moved in from other states. This migration was not spread evenly across all income groups, a Sacramento Bee review of U.S. Census Bureau data found. The people leaving tend to be relatively poor, and many lack college degrees. Move higher up the income spectrum, and slightly more people are coming than going.

About 2.5 million people living close to the official poverty line left California for other states from 2005 through 2015, while 1.7 million people at that income level moved in from other states – for a net loss of 800,000. During the same period, the state experienced a net gain of about 20,000 residents earning at least five times the poverty rate – or $100,000 for a family of three."

Life in California is becoming a luxury good, largely due to its own policies, and that is not a state in the right direction.

[astrange]

Do people migrate out of EU states with universal health care? They have free movement and everything.

I think this would actually be another great lock-in feature, on top of rent control and Prop 13 making it so nobody would ever want to sell their house.

[piedpiper_]

> Yes. Ideally, that's what governments should do: require citizens to act in our collective and long-term best interests, not only their own.

That's starting to sound a lot like Marxism where the value of the individual is less so than that of the collective (Government / State).

I'm sorry but no thanks. Who determines what our best interest is? The only person on this planet that can determine my best interest is me. If I'm incapable of doing so for myself then that is too bad.

[seanmcdirmid]

It's starting to sound like civilization. When we live together, I don't want to subsidize your poor decisions.

If you want to live your life alone in a forest somewhere, you can pay no tax and make all your own decisions.

[piedpiper_]

What does this have to do with healthcare? Is it a right or a privilege? Your answer to that question makes it clear why we likely disagree.

Healthcare is a SERVICE that someone PROVIDES to you for MONEY. It has a tangible COST. It is not a RIGHT which is something that WE as a COLLECTIVE have determined WE individually possess (liberty, right to bare arms, freedom of press, right to assemble, etc)

That is the bedrock issue behind all the arguments on this topic and why (despite idealistically admirable), universal healthcare will likely never happen...

To make it clear, personally I am not opposed to doing everything we can as a society to bring the cost of healthcare down and make it available and affordable to as many people as possible. But to guarantee blanket coverage for ~325M people is not realistic.

[sobani]

To add on to the comment of seanmcdirmid

Adding up the population[1] (in millions, rounded down) of all countries in Europe with universal healthcare[2], except the 144 million from Russia, which is mostly asia anyway, I get to 484 million people covered by universal healthcare.

This includes countries like Germany (81M), France (66M), the UK (65M), Italy (60M) and Spain (46M), which should alleviate the fear of 'small European countries can do that, but not a state as big as California'.

[1] https://en.wikipedia.org/wiki/List_of_European_countries_by_... [2] https://en.wikipedia.org/wiki/List_of_countries_with_univers...

[seanmcdirmid]

But there are more than 325 million people covered by socialized medicine in the EU. Why is that unrealistic?

Heck, it could even help our economy, because you probably don't buy your own health insurance anyways, but get it from work. Take away that burden from the companies, and it could actually make them more competitive.

[tempestn]

It seems like most of the complaints about healthcare now relate to unpredictable costs and complexity though. I'm not sure the simplicity and stress-reduction of a single-payer system really are appreciated. I'm Canadian, and our system is fair from perfect. That said, it's hard for me to comprehend the stories I regularly read about people's experiences in the American system, trying to decide on plans, sacrificing care due to cost, even just having to figure out what hospital they can go to when they need one. All this hassle has an effect that's significant but difficult to quantify.

I even have one personal anecdote - on a recent trip to Disneyland with some friends, a friend of mine got sick and needed to see a doctor. He had purchased travel insurance, so called the insurance company to figure out where to go. It turned out that the only walk-in clinics covered were halfway across LA. There were other clinics within blocks of our hotel, but they weren't covered. So, he basically wasted an entire day. Now, compared to serious healthcare issues, obviously this isn't a big deal. But still, the experience was just alien to us. Here, if you need to see a doctor, you either book an appointment with your family doctor, or if you need to see someone sooner or it's more convenient or whatever, you just go to a clinic. Any clinic doctor will see you, and will bill MSP (the provincial health plan).

Again, our system isn't perfect. Compared to someone with good coverage in the US, our wait lists for major procedures are generally longer. It's occasionally debated whether private clinics should be allowed to perform these procedures, allowing people who can afford it to jump the queue. The theory is that this leaves more public resources for everyone else, so it's win-win. However, generally politicians steer clear of anything that sounds like private health care, because in general people fear any erosion of the public system. (For example by having good doctors go to private clinics.)

Anyway, that was a bit of a tangent. The point is, there are intangible benefits to single payer healthcare that I don't see often discussed in the US.

[refurb]

As a Canadian as well, I appreciate you being up front about the drawbacks of our system as well. I've heard so many American's say "oh, the Canadian system is so much better". Is it better in coverage? Obviously!

However, when I ask if they'd be ok waiting over a year for joint replacement surgery, they get a weird look on their face. Or, if they have cancer, they aren't going to get to go to the best cancer center in Canada, you go to your local hospital. And if you want the latest and greatest cancer treatment? Well, you'll need to pay for that yourself since the gov't hasn't yet approved it for reimbursement.

There are benefits to both systems, but it's disingenuous to say that a single payer system solves all problems.

[hackuser]

These situations are common in the U.S., unless you are well-connected and can pull strings.

> waiting over a year for joint replacement surgery

1) Remember that many Americans have no access to healthcare outside of emergency rooms; they wait forever. I know plenty, including connected people, who wait months for simple appointments. A year before surgery wouldn't surprise me at all.

> if they have cancer, they aren't going to get to go to the best cancer center in Canada, you go to your local hospital.

2) Again, many Americans wait forever. Few others go to the best treatment centers in the nation - how much capacity do those places have, and who is filling up the local facilities?

> if you want the latest and greatest cancer treatment? Well, you'll need to pay for that yourself since the gov't hasn't yet approved it for reimbursement.

3) Again, some Americans get no funding. Most others are limited to what their insurance companies cover and often have the same problems.

[refurb]

I'm not arguing that many people would be better off. I'm arguing that many people would have to lower their expectations around healthcare.

There is a very big chunk of the US that has very expensive (that they can afford) and very good healthcare.

[hackuser]

Couldn't they still pay extra and get it? Can't you do that in Canada?

[refurb]

Nope! Physicians either have to be a part of the public system 100% or 0%. No doing both.

As a result, there are very few private options for healthcare in Canada.

[sdenton4]

And yet. We have a system where the rich are OK and the poor can be destroyed by an encounter with the health care system.

A system where almost everyone is OK and the rich can pay for the best care available is far, far preferable.

[nickv]

How many Americans do you think get to go and get their cancer treated at Memorial Sloan Kettering?

The US private health care system doesn't mean everyone who gets cancer goes to MD Anderson. And, you'd still be very hard pressed to have many private insurance plans cover truly experimental treatments. If I had to choose who gets advanced treatments between those who can pay the most vs those who need it the most I'd go with the latter.

It's funny, many of my Canadian friends talk about the "you can't get the best treatment in the world" problem with their system which, to me, shows how they really don't understand the dire nature of US health care. Wait a year for a surgery? Millions of Americans can only go to emergency rooms.

[refurb]

I'm not arguing that people in the US don't get care, I'm arguing that if you want to cut healthcare spending in the US (to match other countries) people will have to get used to a lower level of healthcare.

[nickv]

I don't understand what you mean there. I think you underestimate the administrative costs alone of the US' hodgepodge system (an entire floor at UCSF is devoted to insurance processing, how many floors does UBC have for billing?)

The US health care system even for the middle class is a disaster. Deductibles are often nearly 8k or higher alone! And nearly ALL plans have "networks" so you can't go to whatever doctor you want anyway. (One of my canadian friends doesnt even know what a deductible is!)

You realize there are nearly as many Americans without any insurance as there are people in Canada (27M vs 34M)? And this was AFTER the ACA expansion.

I get trying to post an alternative view, but it's so out of wack. Have you experienced the US health care system for an extended period of time personally? It sounds like you haven't.

[refurb]

I lived in the US for almost a decade, so I've experienced both systems.

My point is that the US system has problems and the Canadian system has problems. Hell, the Canadian Supreme Court ruled that healthcare wait times combined with a ban on private care violated the Canadian Charter of Rights and Freedoms[1].

There are numerous examples of Canadians either suffering in pain or heading to the US for surgery due to wait times.[2]

Bennett was referred for surgery on her right hip in November of 2013 and said she’s been told she won’t get in until early in 2016. She said her joint has deteriorated so much she is unable to work or even function without strong narcotic painkillers.

[1]https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG) [2]http://www.cbc.ca/news/canada/british-columbia/patients-live...

[ktRolster]

I like to remind myself of the complexity of the situation by remembering:

Sometimes Americans go to Canada for medical treatment, and sometimes Canadians come to America for treatment. It's not a simple better/worse situation.

[weaksauce]

so I recall back in the day when I was in highschool watching a guy on tv blow his brains out on an overpass with a shotgun because apparently his hmo(managed care insurance with a bunch of bullshit rules) screwed him and he couldn't find any recourse other than that.

Just having decent health care is a struggle in america. if you don't have a job and you are not independently wealthy you are basically screwed pre-ACA.

Not having a single payer healthcare in america also changes the risk calculus of starting up your own business.

[quietmonkey]

Yeah, that's pretty much what taxes are for. Funding the government which is what keeps us in line and keeps us from acting like the apes that we are. Part of not being apes is supporting people who won the life-disaster-lottery (which, if you think about it, could be you in 1 year).

[alexqgb]

The problem with this frame is that it assumes costs under a more socialized system wouldn't budge, making a single-payer system nothing more that simple wealth-transfer.

The thing to recognize is that the every-person-for-themselves approach leads to outcomes that drive costs up extraordinarily. Avoiding the US model is why every other OECD country offers universal coverage and boasts longer lifespans, even though health care costs them one half to two thirds less a portion of their GDP.

For all its bleeding-heart, hippy commie values, the major advantage of single-payer is massively reducing the costs of health care, and making life very hard for anyone not directly creating value. This is bad news for rent-seeking holders of pharma patents and CEOs of private insurance companies making $20 million per year, good news for just about everyone else.

It comes down to this: will you accept that some forms of socialism work in return for getting a better deal on health care and the indirect benefits of living in a society where access is a given? Or are you so ideologically committed to free-market fundamentalism that you would rather waste more of your own money and live in a more unstable society because hey, that's how John Wayne did it.

[refurb]

the major advantage of single-payer is massively reducing the costs of health care

It's cheaper because less is offered. Of course one can argue the extra you get under the US system doesn't really add value.

Keep in mind that single payer systems are struggling with costs as well. It's just easier for them to say "no one gets this new treatment".

[alexqgb]

No, this is demonstrably wrong. Cutting $87,000 in markups from the price of $1,700 off-patent drugs does not mean "less is offered". To the contrary, far more people get access to the drug in question. It may mean that the system as a whole offers far less opportunity to predatory rent-seekers, but that's a feature, not a bug.

And yes, you can very easily argue that many other costs don't add value. That's why pointing to the superior overall life-expectancy in other countries is such an important part of the argument. On balance, every other system in the developed world does more, for more, with less. Our system offers bottom-of-the-pile rankings by every major measure.

Finally, "struggling with costs" is a non-starter as far as arguments against single-payer go since what things cost and how you come up with the money are clearly two different things. Saying "country X is having a hard time funding their health care system at 10% of GDP" in no way undermines the case for dumping a system here in the US that costs us closer to 18% of ours.

Seriously, we could make massive improvements to ours simply by picking the name of any other OECD country from a hat, and just implementing their system. Literally anything is better than what we've got here, and it's not even close.

[refurb]

To the contrary, far more people get access to the drug in question.

There are plenty of drugs you can get in the US that single payers systems simply won't cover. The Cancer Fund in the UK is a great example. NHS said "nope too expensive" to several drugs so unless the Cancer Fund pays for it, you're SOL. That's how single payer systems save money.

That's why pointing to the superior overall life-expectancy in other countries is part of the argument.

Life expectancy is a very blunt tool when you're looking at level of healthcare. There is too much intra-country variability.

[alexqgb]

Part of the reason those drugs exist in the first place is that they've been engineered to extract the maximum amount of cash possible from our nightmare of a system. Yes, you may blow through your lifetime cap on one ailment, but the incentives are in place for pharma makers to see that as much of your cap ends up in their pockets, rather than the competitions. Treatments for Hepatitis-C are one of the more notorious examples of drugs being developed to maximally exploit our system.

The point of controlling costs is to provide incentives for developing drugs that not only work, but that do so at non-ruinous prices.

[refurb]

I guess we'll agree to disagree then. I would argue paying tens of thousands of dollars for a cure is a pretty good deal considering the alternatives.

And also, the cost of those HCV therapies is actually cheaper in the US than in the EU.[1]

[1]https://www.forbes.com/sites/johnlamattina/2015/12/04/for-he...

[woofyman]

You're just one serious illness or layoff from being one of "those people"

[FullMtlAlcoholc]

> Right now the working people of America are already subsidizing healthcare for the masses and all I ever hear is people complaining about it.

We do pay for the roads in Los Angeles and EVERYONE complains about the traffic. People bitch about everything

[hackuser]

Another new account making a trolling comment which adds no knowledge to the conversation.

> all I ever hear is people complaining about it

Government funded healthcare is widely supported in the U.S., including Medicare, Medicaid, and the Affordable Care Act.

[belovedeagle]

Let's not do the thing where everyone you disagree with is a troll, mmkay?