[jnardiello]

State-sponsored universal coverage: "that's for commies! Not acceptable!"

Silicon Valley VC-based universal coverage sponsored with crowdfunding: "wooooho that's super great! I love technology"

I would laugh if It wasn't for the milions not being able to afford basic healthcare.

[flexie]

Thank you. It beats me that Americans when looking for alternatives to their current system(s) or the lack of systems in third world countries overlook the European models where "socialized medicine" in various forms works well and has done so since around WW2 (different from country to country).

My experience in Europe is limited to living in Denmark, Spain and Bulgaria, and in each place health care could certainly be improved. But most citizens don't worry as much about health care as they did when I lived in the US.

Having seen hospitals in those European countries and what is supposedly a top class Manhattan hospital, I would not trade the European model for the American. Just the humiliation of asking a woman in severe pain for her insurance before treating her; it's undignified.

But whereas the European models could - and in my opinion should - inspire in the US, they are not easily transposed to third world countries where you lack a strong government without too much corruption to collect taxes. Here, a private model might work better.

Anyways, kudos to anyone trying to improve healthcare in the third world or ours.

[reducesuffering]

What are your thoughts on wait times? I was very ill in Barcelona and was told by relatives there wasn't a point in going to the hospital unless I wanted a 6 hour wait for ibuprofen.

[fearface]

Switzerland: if you're ill, you don't go to the hospital. You go the a doctor near you, that already knows your medical history (family doctor), or you call a free hotline (Sanatel), or you just go to a Pharmacy, as the personnel there has medical training and they can also find the nearest doctor and make an appointment for you. And then, bigger public transport stations and airports have doctor stations that are reasonably staffed where you can just walk in ~24hrs. Hospitals do have walk-in for illness as well, but in relation to other stuff going on in the hospital you don't have a high priority and wait times can be more than you'd expect.

[delegate]

That's if you go to the emergency room - they will keep you waiting (closer to 2 hours than 6), when you have no apparent life threatening condition.

If you have a serious issue, like a heart condition or a broken bone or vomiting etc, you will be processed much faster.

I know that because I've been in both situations - once with pain in my left ear (waited 2 hours, got a prescription to ibuprofen) and another was chest pain and high blood pressure - processed immediately, all blood work done in minutes, etc.

I guess a lot of people go to the emergency room because they just need a doctor to confirm that they're all right.

[tigroferoce]

Same here in Italy. I waited 8 hours to be visited at ER when I had a foot injury while climbing, but in the meanwhile I saw a lot of way more serious patients to go first.

My daughter broke her nose while playing and she had nose surgery and she had to stay a couple of nights in the hospital.

In both cases everything has been completely free (AKA paid by high taxes). Our current system has a lot of issues, but I wouldn't trade for a more private one. For sure I wouldn't trade it for the american system.

[Cthulhu_]

> I guess a lot of people go to the emergency room because they just need a doctor to confirm that they're all right.

This is correct and an issue all over the world; without a proper network of local doctors and whatnot (with reasonable waiting times), people will jump to the ER, which is 10x as expensive as a local doctor. But when people have a pressing need for care, they don't have much other options.

Healthcare is hard and expensive.

[arethuza]

Recent UK NHS Scotland experience - went to "Minor Injuries" unit with what I thought was a minor injury (infected cat bite). Was immediately taken to A&E and saw a doctor almost immediately (within 5 minutes) - got an X-ray (which took < 10 mins) and was admitted to a ward where I got multiple intravenous antibiotics. Responded very well so no need for surgery and I was out two days later.

Food was decent, care by staff was very good and WiFi was excellent!

Edit: Turns out that a deep cat bite can be very nasty!

Edit2: This was lunchtime on Wednesday - I know that if I had went at midnight on a Friday it wouldn't be quite so simple...

[pmiller2]

What makes you think it would be any better in a US hospital? Unless you're literally dying, emergency room treatment is not known for its short wait times.

Side note: does the concept of "urgent care" exist outside the US?

[fergie]

Yes of course 'urgent care' exists outside the US (assuming that you mean A&E).

One of the most baffling things about this whole debate is the assumption by some Americans that socialised medicine is somehow lacking. It really isn't. It's just better and cheaper.

[pmiller2]

No, I don't think A&E is the same. "Emergency care" in the US is what emergency departments are for. I think this is the equivalent of A&E: go here if you are literally dying. "Urgent care" is for severe cases that don't have risk of imminent death: broken arm would be a great example. An ER will treat your broken arm, just probably not quickly. An urgent care facility is not equipped to handle anything life-threatening.

I'm not saying that the fact these things are separate implies it's worse than the European system, just different.

[vidarh]

In the UK there is the distinction between 999 (emergency services) and 111 for "urgent but not life threatening". 111 is staffed by nurses trained to triage and will escalate if necessary and get you an ambulance.

Similarly there tends to be walkin clinics if you don't think you can wait for your GP, but don't think it's something you should go to A&E/ER for. Most of them will not be equipped to handle surgery of any kind, but whatever decisions they do as part of triage will certainly be passed on if they believe you need to be sent to hospital.

I think the big difference is that in most European countries the default is to triage everywhere, unless you pay extra to go private, while Americans seem to be more used to triage being somehow mostly restricted to emergencies.

Triage sucks when you have a minor problem and want quick attention without paying extra for private care, but it's quite great when you have an urgent problem and don't have to wait behind people with much less pressing needs.

[DanBC]

There's a clue in the name - accident and emergency - that these departments handle urgent but non life threatening care too.

Really, it's a fucking stupid question. Of course Europe's socialised medicine will treat broken arms.

If the question is about the time taken to treat these problems: England is going to through a bit of a scandal at the moment about missed waiting time limits in A&E departments.

The maximum time from arriving at A&E through to either being treated and discharged, or admitted into the hospital for further treatment, is 4 hours. And that time limit must happen for 95% of patients.

And we're currently worried because at the moment it's over 90% (but less than 95%) of patients get treated and discharged or admitted to hospital within 4 hours.

We have the advantage of free or low cost primary care, so most people don't need to leave minor problems to fester until it's turned into a severe problem.

[tryingagainbro]

I was very ill in Barcelona and was told by relatives there wasn't a point in going to the hospital unless I wanted a 6 hour wait for ibuprofen.

Same in USA, unless you still have a knife stuck in your chest. IN USA, that ibuprofen might cost you $250, along with the $XXXX for the doctor's visit. Maybe I'm exaggerating with $250, but having some outrageous bills, I wouldn't be surprised if they bill you separately for the pill AND for opening the bottle and getting one for you.

https://www.google.com/search?q=emergency+room+visit+cost

[travmatt]

Yea the situation in America is different - they'll charge you thousands of dollars for tissues after your hours long wait time.

[tryingagainbro]

https://www.vox.com/2016/5/13/11606760/emergency-facility-fe... "Colette turned out to be completely fine. A doctor ran her finger under the tap, stuck a Band-Aid on her pinky, and sent the family home.

A week later, something else showed up at home: a $629 hospital bill for the Band-Aid and its placement on Colette's finger."

[bluedino]

I'd charge someone the same if they required immediate service for something silly. People in the USA will go to the ER for the common cold

[tchaffee]

Having lived many years in the US and Europe, wait times in Europe are shorter. This includes emergency room visits, doctor office visits, and physical therapy. Just for example if I was more than 5m late for my physical therapy in the UK, they wouldn't see me. So zero wait time for that. At the doctor I would make a phone appt ahead of time and I usually had to wait 5 or 10m. Also no insurance forms to fill out or any of that annoying extra work.

[ikurei]

I live in Madrid and my experience hasn't been even near that bad.

I have only gone to emergency services once, luckily, and it was a very brief wait. For more routine procedures, waiting times are even shorter.

On the other hand. I have had some trouble when I've needed certain specialities which have less available staff. Some relatives of mine have had to wait months for surgeries (not too urgent ones, luckily).

It's an imperfect system. Some hospitals are in terrible shape or overwhelmed, and some services or specialties have long waiting times. Many doctors are overworked and underpaid. But still I think the experience for most people is very positive.

[pqs]

I live in Catalonia, the same region as Barcelona.

If you only need ibuprofen you should not go to the hospital, you must go to a CAP (Centre d'Atenció Primària, Primary Assistance Center). My experience, in a small catalan city, is that sometimes you wait ten minutes, sometimes a couple of hours.

Hospitals can be croweded in Barcelona during flu epidemics or similar, but it is not often the case.

[dmitrij]

Do you need a prescription for Ibuprofen in Spain? Strange. In Germany, go to the drugstore and buy it yourself. € 10 for 100 400mg pills. And if you are ill, usually you go to a doctor near you. Only in real emergencies, go to the hospital.

[michaelmior]

I assume the parent's point wasn't that you need a prescription, but that you're unlikely to receive anything more than ibuprofen.

[rangibaby]

In Japan a a normal person will pay a little bit over $100 per month for an insurance card that can be used at any clinic or hospital. People under a certain level of income don't have to pay.

Since a visit to the doctor and medicine is rarely over $10-20 it means basic healthcare is something people don't have to worry about, and keeps people out of the ER (since it costs the same anyway).

[furyg3]

Anecdata: Can be at least 15x faster in Europe (NL) than US.

I moved from the US to NL. I've had a (similar) knee operation in both places, on the same knee. Both times involved an ER visit, referral to specialist, planning an MRI, getting a diagnosis, consultation with specialists, surgery, and physical therapy. The Dutch system was approximately 15x faster than the US system (Kaiser): 10 days from ER to OR, vs 5 months in the US. My brother is currently going through a different problem which is following the same trajectory as my knee, when I ask my Dutch doctor friend he is astonished at the hoops my brother has to go through to get action taken.

US:

* ER - unable to straighten knee (incredible pain). Happened before but never for this long. After many hours and extreme pain, it finally clicked into place in the ER.

* Schedule GP visit for referral to specialist (can't go directly!) Took forever.

* Schedule Specialist visit. Took forever.

* Specialist said it happens sometimes, could be several things, best to wait and see.

* 2nd ER visit required. Scheduled a specialist (not available for 30+ days). Talked to a out-of-plan specialist, said the problem was clear: it's the meniscus, you need an MRI to confirm, and will probably need surgery to remove parts or stitch it in place.

* Specialist appointment. Still wanted to delay an MRI. Lots of foot-stomping, finally scheduled an MRI (30 days later).

* In the meantime, another ER visit.

* Quite some time between MRI and specialist consultation. Diagnosis was clear. Surgery scheduled for a month later.

* Operation. Gives me some crutches and tells me to schedule PT for 30 days from operation.

* PT can't be scheduled, 30 days haven't passed! Once 30 days passes, PT can be scheduled. First availability is 30 days in the future (AAAAAAH).

NL:

* ER visit (same issue again out of the blue).

* Specialist sees me the same day. MRI is busy with higher-priority issues, schedules me for 2 days later. No GP approval. Doesn't need or want my info from the US, doesn't want to 'wait and see', just get and MRI and we will probably see the problem clearly!

* MRI. I wait in the hospital, discuss the results with the specialist 2-3 hours later. Plans an operation less than a week away.

* Operation, immediately discusses PT. Two In-plan PT organizations that the surgeon recommends are not available (fully booked), so she schedules me with an (also recommended) out-of-plan PT, and writes a letter to my insurer. They cover it.

So yeah, socialized medicine rocks.

[dominotw]

> Schedule GP visit for referral to specialist (can't go directly!) Took forever.

I can go to a specialist without referral on my PPO.

> Specialist appointment. Still wanted to delay an MRI. Lots of foot-stomping, finally scheduled an MRI (30 days later).

I got my shoulder MRI within 2 days after doctor visit.

> PT can't be scheduled, 30 days haven't passed! Once 30 days passes, PT can be scheduled. First availability is 30 days in the future (AAAAAAH).

Not sure what this is, I had surgery for my shoulder and was doing PT after 4 days post op. why did you have 30 day restriction?

> doesn't want to 'wait and see', just get and MRI and we will probably see the problem clearly!

MRI's often have high false positives, in my case a torn labrum would be seen in > 70% adults over 45 with no symptoms or pain. Scheduling surgery within a week merely from MRI sounds scary and irresponsible. Why would you want to jump to surgery first when its always available as a last resort. Wouldn't you want to see if something else would do the trick without surgery.

Also, did you research how experienced the doctor is in doing this particular type of surgery, is he upto date with latest techniques, whats his malpractice rate ect. Jumping into surgery with some doctor that you just happen to meet is scary. A botched up surgery is something you have to live with for rest of your life, its irreversible decision.

[furyg3]

I'm not sure what the general point is you're trying to make. Mine was to answer, in my experience, whether or not wait times and general 'hassle' is higher in places with more socialized health care than the US. My (limited) experience in NL, and that of those I know here and in the US, is that wait times and hassle are much lower.

It could be that this is due to irresponsible MRI'ing and unneeded operations. If that were true it would be very interesting, since that's the opposite of what people assume when they think of socialized medicine.

I would also assume that it would be more expensive per capita, which it doesn't appear to be: https://data.worldbank.org/indicator/SH.XPD.PCAP?end=2014&lo...

It could be that all these super-fast decisions are more expensive, but kill a lot of people sooner, thus saving everyone on healthcare. This also doesn't appear to be the case (life expectancy at birth is higher). https://data.worldbank.org/indicator/SP.DYN.LE00.IN?location...

Anyway, to answer your specific points:

- PPO vs HMO: Nice that you have a PPO. That option wasn't available to me. In the Netherlands, I can pick my insurer freely, my employer has no say in the matter (costs are 100-150 euro a month). Some insurers have in-group agreements, some do not.

- On getting MRIs: I can't tell you when it's correct to order an MRI or not. All I can say is that both MRIs were hits for a torn meniscus, and both operations also bore out evidence of this. Both times it was also a textbook case of a torn meniscus based on my symptoms. Both

- Researching Surgeons: Yes, I researched both surgeons (and hospitals where the surgery was performed). In the US I had fewer options (Kaiser only), in the NL the specialist gave me a list of other specialists who I could get a second opinion from, should I want to.

[dominotw]

>I'm not sure what the general point is you're trying to make.

Point I was trying to make is that you are comparing HMO to NL insurance that allowed you to see specialist directly. I don't think thats a fair comparison unless NL requires all insurance to cover self referral to a specialist.

I know nothing about NL healthcare but according to their website

https://www.govt.nz/browse/health-system/gps-and-prescriptio...

" In most cases, you need to visit your General Practitioner (GP) first so they can refer you."

What kind of insurance did you have that allowed you to self refer ?

You seem to have compared apples and oranges and came to the conclusion that oranges rock.

[dominotw]

My girlfriend had an emergency while I was in UK and we had to wait around 5 hrs to see the doctor and had to go through series of rooms each getting progressively smaller than the pervious one. First room had hundereds of people. This was a smallish town near london.

[efdee]

Why would you go to the hospital to get an ibuprofen in the first place? Go to a doctor.

[sannee]

Why would you go to a doctor to get an ibuprofen in the first place? Go to a pharmacy.

Is ibuprofen actually not OTC in some countries? It's like one of the safest painkillers ever.

[efdee]

I think the heavier doses require a prescription, but you're right. You can just get it OTC at your pharmacy most of the time.

[danans]

Why would you go to a hospital for ibuprofen? Isn't it over the counter there? I've waited at the ER in the US for hours because there was limited staff and more serious cases were handled ahead of mine.

[andriesm]

Exactly. Most gov healthcare result in rationing an long wait times and sucks up massive amounts of resources.

We need better private solutions. We need yelp for medical comparative price shopping, with consumer and expert reviews.

Really well executed gov care can be OK but is rare and usually does nor stay good long term.

The current "free market" in healthcare is completely hamstrung by regulation and unspoken anti-competitve practices and broken intermediation via medical aid funds and gov medicare and other programs.

[vidarh]

> Most gov healthcare result in rationing an long wait times

Most private health care avoid visible rationing by letting people pay to skip ahead in the queue based on economic means instead of urgency and clinical need. That the rationing and queuing isn't visible doesn't mean it's not there. Only that in the US people sit at home wondering how to afford treatment instead of wait in line based on triage based on urgency.

So yes, the US system is superior if you're one of the lucky ones that can afford to pay your way past those who need treatment more than you.

> and sucks up massive amounts of resources.

US healthcare is vastly more expensive for the users than most socialised options..

[walterbell]

Why not allow queue jump payments in socialised care, to subsidise the rest of the queue?

[vidarh]

Effectively many countries do allow this to some extent.

E.g. a significant portion of private care in the UK is provided in NHS hospitals by NHS staff either outside of their normal shifts arranged by private companies who pay the NHS for access to operating theatres and the like, and by NHS trusts themselves who are allowed to provide private services on top of their socialised care.

A market exception is Norway, which as one of very few countries have very strict limitations on what private services can be provided at all on the basis of an argument that as long as healthcare resources are limited (e.g. there is a practical cap on number of doctors - train too many and they don't get enough experience on real cases to gain the necessary skills), it is seen as immoral to allow people to queue jump.

[barrkel]

All healthcare involves "rationing"; that's what we call scarce resources divided out along some kind of priority basis.

"Free market" healthcare is "rationed" on the basis of ability to pay.

[gambiting]

>> We need yelp for medical comparative price shopping, with consumer and expert reviews.

I'm sorry, this is the stupidest thing I've heard in a long time. What you need is being able to go to any doctor, any hospital, at any time, and knowing you won't pay for it at all, ever, as it is in many countries around the world. Not competitive comparative pricing. If you are in pain you don't want to be shopping around for a good price.

[gambiting]

I(as a European) think the difference is that at least in my country nearly all hospitals are public, there's very few private hospitals and they are not very good. So the government can afford to give everyone great healthcare because they are using their own hospitals to do it - they set the rates for operations and hospitals don't have billing departments because they don't need them - even if someone is technically not covered by our national health insurance(say, a non-EU visitor) they are usually treated for free anyway because finding out how to bill them is more hassle than it's worth, unless it's a major operation. If you just need an xray and a cast they will do it and send you home. In US almost all hospitals are privately run, so corporations dictate prices - even if the government wanted to pay for everyone's care it would end up paying a lot more than Europeans are paying, because once again, the money would go straight in corporations pockets.

I mean, I'd be more than happy to learn more if I'm wrong about this, but at least this is my impression.

[chimeracoder]

> In US almost all hospitals are privately run, so corporations dictate prices - even if the government wanted to pay for everyone's care it would end up paying a lot more than Europeans are paying, because once again, the money would go straight in corporations pockets.

This is not at all how medical billing works.

First of all, many hospitals are structured as nonprofits. Whether or not they are, most hospitals are also barely staying afloat - a hospital that's turning 2 1-2% profit these days is doing astoundingly well. Many are going under and getting bought out by larger chains or by insurance companies.

The reason that they are doing so badly financially is because, in general, they are legally forced to lose money on half of their patients. Medicare sets its reimbursement rates unilaterally, and it reimburses about 7% less than COGS. In other words, if a vaccine costs the hospital $100/unit to purchase wholesale in bulk, Medicare pays them $93 for it. That means they've already lost money, even before they have to pay their doctors and nurses and building maintenance, etc.

Providers make up for this by over-billing the private insurers. That's why you see these stories of people who go to the ER and got charged an absurd amount for something. The hospital was presenting them with the same price they charge to private insurers (by law, they have to, at least on the initial bill). They don't actually expect individuals to be able to pay that, and in fact, an uninsured person is almost always able to negotiate that bill down if they know to try.

In short, yes, medical billing is totally fucked up. But it's not fucked up because the money goes to line corporations' coffers - it's fucked up because Medicare abuses the system to effectively pad its own budget instead of going to Congress to increase their budget.

And that's why, ultimately, Medicare will fight tooth and nail to prevent single-payer healthcare or any meaningful reform whatsoever in the US - they're the ones who stand to lose the most from it.

[maxerickson]

The ACA ("Obamacare") did a lot to make the US system look more like Germany and Switzerland. Standardized, subsidized insurance with some mechanisms to increase subscription.

The problem is that it also mixed employer mandates and Medicaid with that stuff. In principle Medicaid is good, providing care to low income people, including millions of children. The problem is that it is a huge off the books tax scheme, mandating care that it doesn't fund. And with guaranteed issue individual insurance available, employer requirements should have been reduced, not increased.

[AsyncAwait]

> The ACA ("Obamacare") did a lot to make the US system look more like Germany and Switzerland.

It did not, because it still kept private insurance companies in control and still made it impossible to negotiate drug prices. It seems better than what came before it, but I'd argue it may have even done some damage, (in terms of the debate towards universal health care), since its failures are now ascribed to 'socialised healthcare' by its opponents and equated to a single payer system, whereas in reality it is in may ways the polar opposite.

[maxerickson]

Germany has private insurance companies and all US insurance companies negotiate drug prices. Even the specific drug prices that the talking point says Medicare should be able to negotiate are negotiated (by the private companies that administer that part of Medicare...).

Most Germans are covered by "sickness funds" but those with higher incomes have the option of buying private insurance. And the sickness funds aren't really single payer, spending is negotiated regionally, not at the national level.

[AsyncAwait]

> Germany has private insurance companies

Yeah, practically every country does, if you want it. The problem in the US is that it is practically the only option for many, not a choice.

> and all US insurance companies negotiate drug prices

But that's the problem, it should not be done by private companies, but by a state/national body with more power.

> Even the specific drug prices that the talking point says Medicare should be able to negotiate are negotiated (by the private companies that administer that part of Medicare...).

Yeah, private companies...

> Most Germans are covered by "sickness funds" but those with higher incomes have the option of buying private insurance.

I am not saying anything about the option of buying private insurance, I am saying it should not be a requirement for basic coverage.

> And the sickness funds aren't really single payer, spending is negotiated regionally, not at the national level.

That is semantics, the principle is the same.

[krrrh]

In Germany private insurance is the only option for self-employed. It is precisely a mandated requirement for basic coverage. The two "public options" are not available to freelancers, and anyway the public options are more akin to competing non-profit insurance companies than state-administered health care like in France, the U.K., or Canada.

Buying insurance is also a pain because unlike in the US under ACA, German insurance companies are able to charge higher premiums for pre-existing conditions up to a mandated Basispreis (approximately 3x a healthy person's rate - somewhere north of 600€ per month). Pre-existing conditions can include a hospital visit with a null diagnosis.

There's a lot more to it, but I get frustrated when people talk about European-style health care as if it means something concrete, when there are such a wide range of policies across Europe.

[maxerickson]

Abusive drug pricing would go away nearly instantly if the Medicaid formula considered the lowest effective price paid (by accounting for rebates when calculating Average Manufacturer Price).

It's really only patented drugs where it matters, most generics in the US are all but free (the exceptions to that pattern mostly have few users).

[ahupp]

The Swiss system has mandatory private insurance. It's very ACA-like.

Drug costs are 10% of health expenditures in the US. Not sure this is a critical issue for controlling costs.

[Chathamization]

> The ACA ("Obamacare") did a lot to make the US system look more like Germany and Switzerland.

In Germany you're automatically enrolled in public insurance unless you opt out and choose private insurance, no? That's completely different from the ACA, which has no automatic enrollments (if you're application gets stuck at the exchanges, good luck), no option to keep public insurance (if you're on Medicaid and you're income rises, you might have a month long gap between being kicked off Medicaid and getting a new health plan), pushes people into employer provided plans, and generally has a host of problems and complications that lead to 10.9% of Americans still be uninsured (and those who are insured still facing massive problems with healthcare costs).

[maxerickson]

I said "look more like". I even listed the things I thought were similar.

Automatic enrollment is rather obviously going to be more effective than a tax penalty, but the tax penalty is at least a mechanism designed to increase subscription.

There are a bunch of bad compromises in the ACA, but the comment I replied to was mystified that the US apparently isn't even trying things that have worked elsewhere, which is just wrong.

[Chathamization]

> There are a bunch of bad compromises in the ACA, but the comment I replied to was mystified that the US apparently isn't even trying things that have worked elsewhere, which is just wrong.

I'd say that they are right. The ACA is completely different from the German system. I mean, I could argue that the Republican healthcare plan is similar to the German healthcare system since it would have a public Government run system (Medicare and Medicaid) and subsidized private insurance (vouchers), but that's not a particularly compelling argument. When two systems are completely different, talking about a couple of ways they're slightly similar if you squint and don't look at the details doesn't seem particularly useful.

[maxerickson]

I guess I think that guaranteed issue of a plan with minimum standard coverage is a lot more important than the details of how payments flow through a system.

I'm certainly more concerned about the possible repeal of the federal insurance standards, the "essential health benefits" than I am eager for a public option to start competing with insurers (which I don't think insurers are doing a whole lot to either control or drive medical costs). I wouldn't mind a public option, I just don't expect it to matter much.

[Noos]

The ACA is a huge failure.

it massively increased everyone's premiums and deductible, and made it more or less impossible for many poor people to afford private insurance. If you ask many americans here how much they pay per month and how large their deductible is, you'll realize Obamacare actually wound up being absurdly expensive catastrophic insurance instead of universal coverage.

[avenius]

I've never quite understood how so many americans appear to oppose a communally paid healthcare system. It should be a win-win for everyone, right? Is it just a severe lack of empathy?

[travmatt]

Many Americans simply do not see fellow Americans as people deserving of compassion, much less resources.

[toomuchtodo]

Which is strange, right? Because America ranks number two in charitable giving [1].

So what makes people charitable when it comes to charitable giving, not so when it comes to single payer?

[1] http://www.marketwatch.com/amp/story/guid/6EF5920A-87B8-11E5...

[travmatt]

Difference being charity is strictly voluntary and therefore people can give strictly to people they deem deserving.

[ebfd]

I'd love to participate in a communal healthcare system, but I don't believe that I have the right to demand that others do the same.

[mynameishere]

How is it win-win for everyone when one person pays for another person's healthcare? There might be overall good effects, but it's clearly win-lose in its basic transaction.

[mempko]

In a public system the federal government would pay. Since federal government's ability to pay is only artificially restricted by Congress, there should be no problem affording it financially. In other words, it's not citizens paying out of their pockets for other people's care. It's fed paying. Worst problem would be potential inflation. Likely because system would be cheaper overall it would have immediate economic boost. Like putting extra 5k in everyone's pockets.

[microcolonel]

No, it's the lack of quality. I dare you to try to receive care in Canada for anything which isn't a visible emergency. Even if you could pay for it you still couldn't get it.

Socialized health coverage works better in some places outside North America because people have some sense of custodianship and duty. North America is full of irreverence, nobody gives a damn if they're doing what they ought to do as long as they're seen to do what they have to.

Ask yourself if you would like to do dermatology like the DMV; surgery like a typical post office.

[grecy]

> I dare you to try to receive care in Canada for anything which isn't a visible emergency

Please, please, please stop the hyperbole. It does not help rational discussion.

I, my friends and family have been treated many, many times in Canada for everything from broken bones to just walk into the ER and say I don't feel good.

I have never heard of anyone waiting more than 45 minutes.

Last time I was in there I walked in and said "I got hit by a car 2 weeks ago and my leg still feels funny". I waited 15 minutes before a doctor poked a prodded me and said "you'll be fine, seeya".

Free, of course.

[ctw]

While I agree that you definitely can get treated for anything, I find it very hard to believe that you've never had to wait more than 45 minutes to be seen by someone. The past few times I've had to go to emerge I had to wait around 5-6 hours each time.

[throwawaybbqed]

That matches my experience in Canada too. Large hospital .. waited 4-6 hours in the ER (got triaged by a nurse the instant I entered). On the positive, they had a Tim Hortons in there.

GPs/specialists in the US see me instantly. In Canada, they would make me wait 45mins-hour. Waiting a bit isn't the end of the world IMO.

One time I had a pretty bad accident (in the US) .. I remember going home to pick up my damn insurance card before rushing to the ER in a cab. Of course ... despite the fact I was bleeding, the first thing the hospital attendant asked me for was my insurance.

I personally prefer the Canadian model over the US one.

[grecy]

Where are you?

I'm in Yukon, also family/friends in BC.

Maybe it's just different in the East? (like so much of Canada...)

[microcolonel]

Having unfortunately needed hospitals in Calgary, Vancouver, and Toronto; I can tell you that a 45 minute wait for anything (including scheduled appointments!) would be a near miracle. It's nice that 45 minutes is what you get in Yukon, glad it works there. :- )

I'm still waiting to be called by a specialist for something I ran out of my prescription for two months ago. They simply never scheduled what they said they would schedule. I had to call the ER one week after the fact to get them to actually fax the request to the specialist, because they neglected to; then I had to call the specialist to acknowledge the fax, and after all that I still haven't received a call from them. I ended up researching the condition and treating myself, but I could have been wrong and done more damage; pharmaceuticals could also have been a safer approach.

In Calgary waits were a bit better, only about 3 hours instead of 4-5; but I needed stitches both times I went to an ER there.

The condition of the healthcare system is not for lack of trying, my own mother worked at hospitals for most of my childhood, and I know plenty of people who work in medicine; they all seem to try their best, but the chronic lack of oversight/accountability and lack of competition means that things just continue to fester. It's frankly amazing that we've survived this long and this well without a private system.

[panic]

This anti-government ideology is self-reinforcing. We underfund government programs, then hold them up as examples: "Look, government funding doesn't work. I told you so!"

In reality, the people doing the actual work of health care wouldn't change -- the money to pay them would just come from a different place. Do you really think the folks at insurance companies have more custodianship and duty than people working in the public sector?

[ericd]

I agree about the frequent use of the tactic of making government dysfunctional to persuade people that they don't want to pay the taxes necessary to expand government services, but that tactic probably isn't going away. You can thank people like Grover Norquist who really, really want taxes lowered.

Also, something to keep in mind with fully socialized medicine is it would almost certainly reduce doctor pay, because the government would have almost all the leverage in pricing. I know some doctors in France well, they're extremely poorly paid compared to doctors in the same practice in the US.

And if you squeeze doctor salaries too much, what fraction of would-be doctors are going to decide that they don't want to go through the hassle and expense of medical school?

[programLyrique]

But France is not a country where medicine is the most "socialized". For instance, GPs are usually private doctors in France. Then the universal health insurance refunds 70% of the price usually (but it can be less, because doctors can choose their price - it's called "sector", and only ). Then, most French people have a complementary private insurance called "mutuelle" from their job that pays the remaining 30%. Only long-term illnesses such as cancer are fully reimbursed by the national health insurance.

And yes, even the least paid doctors in France earn much more than the median French salary. Also in France, medical school is not expensive ("socialized" education). It just takes time...

https://en.wikipedia.org/wiki/Health_care_in_France

[ericd]

Interesting, thanks for the additional info!

[pyrale]

> I know some doctors in France well, they're extremely poorly paid compared to doctors in the same practice in the US.

French doctors still in the top 5% of earners in France, even higher when it comes to revenue from work. And the schools have to reject like 80% of the students at the end of first year.

[DanBC]

A point about under funding: the US government ( not including private insurance) pays more for health care than the UK government.

[travmatt]

It's not particularly surprising that a country several times larger than another pays more money for health care. Are you saying the per capita cost is higher?

[tchaffee]

Per capita medical costs in the US are double that of most Western countries. Both private and public.

http://www.pbs.org/newshour/rundown/health-costs-how-the-us-...

[jedmeyers]

> We underfund government programs

Does Canada under-funds it's health program?

[vidarh]

Meanwhile in most of the developed world, US healthcare is held up as the ultimate horror, and most people are satisfied with socialised care even when additional private insurance is available.

[ericd]

While I agree that that's a pretty scary thought, it's a bit of a strawman, since you don't have to go full state run - you can give everyone a baseline and allow for private insurance on top for those that want the gold plated treatment.

[AsyncAwait]

And by the way, that is how it works even in places with socialised healthcare. It's not like anyone is going to prevent you to buy private insurance in the UK if you have the money.

[microcolonel]

By the way, that is not how it works in Canada. Seems it's not legal to pay for additional access. Private insurers are used for drugs, paramedic bills, and other things not covered by the province; but they can't pay for enhanced medical services, only coverage of out-of-pocket expenses.

[baby]

Why does the United States have one of the largest maternal mortality then?

[snomad]

To be fair, have you read about the VA system? That is a system with limited scope, understood problems, strong bipartisan support, that can easily pull the public's hearts for budget. And it still falls way too short in its mission and regularly fails to provides adequate care.

[AsyncAwait]

As an outsider, if you're talking about care for veterans, it seems it is often used as a tool to play politics, rather than actually provide care.

[brucephillips]

I don't agree with it, be the counter-argument would be that state-sponsored coverage involves taking money from people without their consent (taxes), whereas charity doesn't. You should always address the strongest version of the argument you're refuting.

[simonh]

All laws are coercive. Why are you picking out specific ones, what are the criteria?

For example public parks have bipartisan support and are funded by taxes. So why will the US tax people to care for wildlife, but not its own citizens?

At one time the US instituted a military draft, requiring citizens to carry out military service. Citizens are required to obey the law, pay taxes and serve the interests of society, as determined by the government. I believe that this places a responsibility on that government to care for and protect citizens. It must offer them the protection of the law, defend them in times of war and, I believe, provide basic health care. It should do so not just for the benefit of the individual, but for the benefit of society.

There's no point drafting people into the military if the health of the population isnt up to it. This was a major issue for the UK in WWI and a key factor in getting cross-party support for a national health service, because a shocking number of young men were unfit for duty. Currently not being in a time of war doesn't change the relationship though. The duties and responsibilities are still there.

[mempko]

At the federal level, taxes don't fund anything. Federal government spends first and the collects taxes. This is a common misconception about how government financing works. You don't to raise taxes to fund any program. Taxes one serve to bring legitimacy and demand for US dollar. They don't pay for anything.

[simonh]

If they don't pay for anything where does the money go? Where does the money the US Govt does pay to it's employees, contractors, suppliers and in benefits come from? This really is nonsense on stilts.

I know governments are in a unique position to be able to print money, but that is not how the US government routinely funds it's budget, and certainly not how it mainly or exclusively does so or inflation would skyrocket.

[mempko]

When federal government wants to pay for something, it tells the federal reserve to credit a bank account. The federal reserve then goes through the banking system and credits the account. The money comes from a key stroke. When the government collects taxes, the money is destroyed. It's just accounting. Inflation happens when government prints money beyond capacity of economy to produce. Too many dollars to too few resources.

The government can increase deficit to put more money into private sector, which boosts profits and savings, it can choose to take money out by taxing more or spending less. Which creates fewer savings and smaller profits, and more private debt.

[simonh]

You could just as well say that when I pay a bill the money is 'destroyed' in my bank account and 'created' in theirs, it's just accounting.

[bduerst]

>All laws are coercive

Locke would disagree with your premise. You're an individual with the freedom to move to any society that you agree with the most. Unless your freedom has been alienated, you are tacitly consenting to a government's laws by remaining where you are.

[soVeryTired]

So why does the typical American live within 18 miles of home? [0]

Do they just happen to agree with the society they're born into, or is it possible there are stronger forces than political preference that constrain their movement?

[0] https://www.nytimes.com/interactive/2015/12/24/upshot/24up-f...

[bduerst]

Choosing to live close to family isn't alienation of freedom. Those are economic choices, not coercive constraints.

[soVeryTired]

Sure, but I don't think that amounts to a tacit agreement with a government's laws. Sometimes people are just stuck where they are.

[simonh]

It depends what you mean by constrain. What constraints are they under that are not voluntary?

[soVeryTired]

Family ties? Caring obligations?

These are extremely powerful forces, despite the fact that they don't fit into the economics-101 thinking that libertarians are so fond of.

[raesene6]

I'd suggest that the reality for most people is that they're not "free to move to any society that you agree with most".

Many countries have strict immigration and citizenship requirements, many of which revolved around wealth.

So whilst it may be true that very rich people have complete freedom to choose their favourite society, that's not the reality for the majority of people.

[simonh]

That's entirely fair enough, but that's not the point we're arguing on. Objecting to a specific law on the basis that you are being coerced into following it is not a basis for picking and choosing which laws you're prepared to accept, because that is a general feature of laws.

[objclxt]

But I don't think that is the strongest version of the argument: it's based on the rather weak premise that taxes are inherently unconscionable. Imagine we were talking about the army, instead of healthcare. The argument would start with the question "is the state obliged to protect its citizens?", not "my taxes shouldn't pay for it".

The counter-argument here is not one around taxes, but around the obligations of the state. If you don't believe in universal healthcare then you ipso facto believe the state has no obligation to provide it, and that's where the counter-argument needs to come from.

[lancewiggs]

>Imagine we were talking about the army

Police yes, army no.

In Costa Rica the answer to whether government have an army is no. In many other countries the answer is "not really" or "not required"

The USA stands alone when it comes to the amount of money spent on military. It is somewhat absurd.

[negamax]

US pretty much guarantee current world order and international treaties. I know there had been many scandalous allegations against overspending. And conspiracy theories for overreach. But with weak US, world will pretty much go on a war the next day

[enraged_camel]

>>But with weak US, world will pretty much go on a war the next day

What makes you say that?

You might see more territorial wars, such as with Russia invading former USSR states and China making stronger claims over the islands in the South China Sea, but there is no indication that other countries would not pick up the slack and fill in the gaps created by reduced American military presence.

[ux-app]

pax americana. like it or not the Team America World Police is a real thing. For all their many faults, I'll take American Imperialism over something else like the Ruskies calling the shots, and yes if(when) the US stops providing world security some other state will step in. We might miss the days of USA calling the shots then.

[travmatt]

Just wait till China steps up and the world can get a taste of their style of economic warfare.

[briandear]

Actually on US military spending by percentage of GDP, the US spends less than Singapore and as much as Morocco.

The amount the US spends isn’t absurd on a percentage of GDP or even a per capita basis. It could be “absurd” when looking at it in raw dollar amounts, but you could say that American expenditures for movie tickets are absurd — Americans spend more money on movie tickets than the entire GDP of 65 different countries.

The US stands alone on the amount spent on the military, but it also stands alone for the amounts spent on everything: it’s the world’s largest economy and it would seem rather prudent to be able to defend that economy — and it does, at a reasonable level of military spending as a percentage of that economy.

A bank that protects $50 might not need a guard. A bank that protects $50,000 might need one guard. A bank that protects $5 trillion might need a few more guards.

Comparing Costa Rica to the United States is pretty ridiculous in terms of national defense. It’s rather naïve to suggest that militaries are not required. It’s never required, until it is.

If someone were to invade Costa Rica, who do you think would come to the rescue when asked? Costa Rican security is benefiting from the military of the United States. The Rio treaty gives Costa Rica the luxury of not having to worry about invasion since the US military is standing by to help.

Denmark doesn’t need much of a military because it’s part of NATO.. a risk to Danish national security wouldn’t last very long when you have the most advanced military in the world as your ally and treaty-bound to protect you.

These treaties and arrangements make it easier for countries to reduce their military since they are allied with the United States.

My point is that making comparisons isn’t very accurate without considering defense treaties that might exist and thus incentivize smaller military expenditures.

https://data.worldbank.org/indicator/MS.MIL.XPND.GD.ZS?year_...

[jeswin]

Not an American. But truth be told, more authoritarian countries and their armies will have a field day if the US military is weaker than it is. Europe is not going to stand up to Putin. And forget about Taiwan, South Korea, Syria etc.

The only thing holding them back is massive American firepower. In its absence every midsize Asian country is going to acquire nuclear weapons.

[brucephillips]

It's not based on that premise, no. A person can think that the country should tax its citizens to protect them, while simultaneously think that the country should not tax its citizens to redistribute wealth.

[pgeorgi]

> the country should not tax its citizens to redistribute wealth.

The army is also a huge wealth distribution machine: Raytheon or Boeing are businesses, and army personnel presumably is paid, too.

> tax its citizens to protect them

For example, from life threatening conditions.

Same statements, different cherry picking -> entirely different results.

[pjc50]

> A person can think that the country should tax its citizens to protect them

Ah, so you are in favour of universal socialised health care!

(/joking, mostly. But I feel that protecting citizens only from other humans but not from the far more deadly problems of disease and ill-health is a very limited view. If the US really believed in the inherent superiority of the private model, it would use it for its troops. No medevac if you've not paid your premiums!)

[AsyncAwait]

So protecting its citizens using military force is fine, not wealth redistribution, but taking care of its sick citizens, (arguably the ones needing the most protection), is somehow questionable?

[pnathan]

> involves taking money from people without their consent (taxes), whereas charity doesn't

This argument seems to be novel from the late 1800s. Before then, it seems to have been understood that the political system ran on taxes. It beggars the imagination that modern Americans seem to believe the old anarchist saw that cooperation and working with society via the ancient tradition of taxation is theft.

[brucephillips]

I'm not sure what you mean by "understood". Everyone has always understood that the government works on taxes. But if you mean "agreed with", that's certainly not the case. The line between taxes and theft in the middle ages, for instance, was extremely blurry.

[lmm]

> This argument seems to be novel from the late 1800s. Before then, it seems to have been understood that the political system ran on taxes.

Before then the political system openly ran on violent coercion.

[microcolonel]

It was also "understood" not long ago that the women of the villages you ransacked would become your property, that the king could do approximately whatever he wanted, that approximately all your kids would die seemingly out of nowhere before the age of five.

That tyranny has been "understood" is not a justification for the deliberate resurgence of tyranny. That you could take even more money from the public to fund your pet project is of no importance to the question of whether it is right or wrong to do so.

> This argument seems to be novel from the late 1800s.

Have you heard of the USA? It's been constituted since 1788, and it was more or less understood that the government wouldn't be getting involved in this sort of thing. If I'm not mistaken, 1788 is before the late 1800s.

[fsloth]

"it was more or less understood that the government wouldn't be getting involved in this sort of thing."

I propose you use some other rethorical device to back your argument. it was also understood back then that government would not ban slavery and that only people with property and penises could vote.

[angersock]

> involves taking money from people without their consent (taxes)

And yet you enjoy GPS, roads, running water, bridges, numerous standards, air quality and pollution reduction by regulators, defense of property, fire departments...

This particular line of argument is tiresome unless you're willing to forgo all of the amenities others have paid (and sometimes died) for.

If you're not willing to give them up, adding healthcare to the tab is hardly a step too far.

[brucephillips]

Most libertarians would give those up, in favor of private solutions.

Again, I don't believe this argument, but this is the argument.

[angersock]

I mean, that's the thing, right? You can't just give them up, short of moving away to the Libertarian paradise of Mogadishu or whatever.

Like, it's easy to say "well if somehow all of the public goods I enjoy were taken over by private companies then I'd be happy to pay them instead of taxes", but such a changeover doesn't really happen--you end up "freeloading" on the public dole until this future comes to pass.

And again, I know you aren't making this argument. It's just really annoying to have to hear it from otherwise intelligent friends when it comes up.

(Also, why the heck anybody would want to live in a world without a guarantee of basic services and rights is beyond me.)

[briandear]

Most libertarians aren’t opposed to government. For expample, most libertarians would agree that government is necessary as a means to enforce contracts. Somalia has no civil justice system of note, so Mogadishu is hardly a libertarian paradise.

Libertarianism is about the rights of an individual to engage in transactions they find beneficial. However, libertarianism is not about the right to infringe on others’ rights to do the same.

Libertarians support individual rights at a vastly greater level than anyone else. In collectivism, there are no individual rights or at least they are secondary to collective rights.

[tacomonstrous]

I really don't understand how libertarianism doesn't collapse at first contact with actual human beings.

>Libertarianism is about the rights of an individual to engage in transactions they find beneficial.

>Libertarians support individual rights at a vastly greater level than anyone else

And who protects these rights? Who defines them? Is it really possible for everybody's rights to be protected simultaneously (whatever those rights may be)? Who decides ownership? Who guarantees the avenues for beneficial trade?

The rule of law cannot be enforced without an element of coercion. The best we can hope to do is to make it as enlightened as we can.

[vidarh]

Most right libertarians would. Left wing libertarianism (what libertarianism started out as in the 1850's) started from the socialist and anarchist premise that de jure rights without the access to resources to enjoy them are not real rights - for rights to have meaning, people need to be able to take advantage of them.

Specifically, Joseph Dejacques polemic against Proudhon [1] where the term libertarian was coined focused on the latter's willingness to talk loftily of liberty on one hand, but the next moment limiting to liberty related to capital rather than the emancipation of all, specifically throwing women under the bus because Proudhon did not see them as equals:

> Moderate anarchist, liberal, but not libertarian, you want free exchange of cotton and candles and you seek to protect man against woman in the exchange of affectional human passion. You cry against the great barons of capital, and you would rebuild a proud barony of man on vassal-woman.

Dejacques makes an impassioned (and poetic -- the letter is well worth a read even if you disagree with every word) argument both for anarchy, and against the monopoly on resources, and the turns Proudhon's own word against him in arguing that for men to monopolise power is the same thing - talk of liberty becomes meaningless when we allow there to be arbitrary limits on who are afforded said liberty based on ideas of who are worthy:

> Attribute not to him a stock of intelligence which belongs to him only by right of conquest, by the commerce of love, by usury on the capital that comes entirely from woman and is the product of the soul within her. Dare not to attribute to him that which he has derived from another or I will answer you in your own words: “Property is robbery!”

> Raise your voice, on the contrary, against the exploitation of woman by man.

Dejacques set the term "libertarian" up as a step beyond "moderate anarchists" (!) and "liberals" such as Mr "property is robbery" Proudhon:

The emancipation of human beings, according to Dejacques, comes from taking the ideas that Proudhon happily promoted in economy - to limit power, be it over persons or property - to the full conclusion with a focus on the emancipation of all humanity.

Mere de jure emancipation will not do, then, if people can not take advantage of it. Maximising liberty to Dejacques meant being uncompromisingly willing to take that which is being hoarded and share it, be it money or power, or authority.

As such, the idea of maximising liberty from a left libertarian viewpoint does not see property as the holy cow that right libertarianism does, but in fact has from the outset seen strict property-rights as a direct threat to liberty, rising to outright aggression (e.g. if you try to use force to prevent someone who is starving from eating to maintain life you are putting their life at risk).

Right-libertarianism makes a mockery of libertarianism by sacrificing the principle of maximising liberty in order to provide an ideological veneer for the protection of wealth and privilege.

[1] https://theanarchistlibrary.org/library/joseph-dejacque-on-t...

[willvarfar]

This is the "What have the Romans done for us?!" argument :)

https://www.youtube.com/watch?v=Qc7HmhrgTuQ

[flexie]

Money is taken from citizens against their consent to pay for

- military

- roads

- primary education

- secondary education

- criminal justice system

- research

Each and every one of those could in theory run entirely on a voluntary basis and has through history been doing so here and there from time to time.

[wavefunction]

>Each and every one of those could in theory

I prefer to stick with what works in practice, even if it's imperfect.

[AsyncAwait]

Agreed and it seems to me that "free-market healthcare" doesn't work well in practice.

[orf]

It's rather ridiculous to argue that point. None of those could or should be ran on a 'voluntry' basis in today's society.

Consider more rural areas, where there are less people to make these donations, and more roads are needed. Is it ok to say "pay for your own roads" when it unfairly shoulders them with the largest burden? It will end up with lower income rural areas having crappy or no roads. Same for all the others you listed, bar military. Also, who pays for the highways?

Having a justice system depend on donations from the populace is kind of a huge issue with impartiality.

Fyi, England used to effectively do what you suggest pre ~1700. It didn't work out well from a justice, education or infrastructure angle until the state got involved.

[flexie]

I don't suggest that. I think it would be silly not to cover those items through taxes. My post is an answer to the guy above who suggests that healthcare shouldn't be paid by taxes because that's not voluntary. Then I point out that with the same reasoning you could argue that primary education or secondary education shouldn't be paid through taxes.

I think it works very well to pay all those things through taxes.

[pgeorgi]

> Fyi, England used to effectively do what you suggest pre ~1700. It didn't work out well from a justice, education or infrastructure angle until the state got involved.

Same can be said about health care, at least in countries that (unlike Post-Thatcher UK) don't actively try to ruin their public health system.

[AsyncAwait]

> the counter-argument would be that state-sponsored coverage involves taking money from people without their consent (taxes)

I hate this argument, taxes are a fact of life in society, you're going to pay them and the only question is where are they being spent. If instead of spending so much on the military, some of that budget was spent on healthcare, than maybe there wouldn't even be a need for higher taxes.

But instead of lobbying for their taxes being spent appropriately at home, many in the US seem happy with going to sovereign countries instead of taking care of their own citizens.

There never seems to be a concern if you have money for the next invasion, but when it comes to healthcare or education, where's the money going to come from? (To be fair, it's not just the US that has this problem, but it is certainly one of the worst examples.)

[MindOfAllDogs]

The problem with charity is that no one will think they need to give money to it if no one else gives it money. Also, people don't necessarily feel an obligation to pay anything whereas taxes are enforced by a government and regardless at this point pretty much anything is more efficient than US healthcare

[mempko]

This is plain wrong. At the federal level I in the USA, taxes are not used to pay for anything. Federal government spends first and then collects taxes. If you haven't noticed, the government ran a deficit for the good part of the last 150 years with no issue. In fact the government MUST run a deficit if we want our economy to grow, or even stay out of recession/depression.

[forapurpose]

I fully consent to paying my taxes, even when the money goes to things that I don't want my government to do. Everyone consents to the rules of democracy: Debate it, take a vote, majority wins. Sometimes I'll win, sometimes I'll lose, but I fully support the outcome every time (even if when I'm trying to change it for next time).

[pitaj]

Not everybody consents to those rules. The founding fathers thought those rules were fundamentally broken which is why they encoded a stringent restrictive constitution including checks and balances and the bill of rights.

[simonh]

The founding fathers thought the rules of democracy were fundamentally broken? Isn't the Constitution and Bill of Rights precisely a set of rules for democracy?

[pitaj]

Yes, they did. Based on what happened in Greece, Rome, etc.

[wildrhythms]

In what way do you think the Bill of Rights is restrictive?

[pitaj]

It restricts the power of the government to do things it otherwise would have the power to do.

[beefield]

There is also this thing called game theory and prisoner's dilemma which pretty much guarantees that the silicon valley version is limited to "make me feel good doing my part" instead of being an actual solution to universal health care.

My initial thought was that someone had tried to reinvent insurance, but this is not even that. Just charity destined to fail being a proper solution.

[michaelmior]

Could you explain more why you think the probability of failure is so high?

[beefield]

First we have to define the problem we want to solve before we can discuss whether a potential solution to the problem is likely to succeed or not.

If our problem is "I want to feel good by helping someone to cover their health care costs", Watsi and other charity solutions obviously are viable solutions. (Note that state sponsored health care is also a good solution for this problem, with the downside that somebody else tells you how much you need to pay). So Watsi is a better solution to this problem than state sponsored health care only in the limited case where you have no interest on the outcome of the health care, but only your own feelgood and want to have precise control how much you want to spend to feel good. (If someone senses contempt here to charity givers, the sense is not unfounded)

Second potential problem we are discussing here would be "I want some more people get health care." Of course, here as well, Watsi and other charity programs obviously are a solution to the problem in question.

Third problem might be something in the lines of "I want every member of the society to have access to decent health care so that first, when I drive past hospital, I do not have to look beggars begging money to get their health problems addressed and second, when I get sick, I do not need to worry whether there was some small print in my insurance contract I did not understand"

The third problem is the one where charity based solutions are doomed to failure. There is simply no scenario where I am motivated to pay. One scenario is where there are enough people to pay to solve this without me, so so I can save my money to more important things and enjoy health care benefits. Other scenario is that there are not enough people to pay the beggars out of the street, and my money is not going to change that, so again, I am better spending my money somewhere else. Only path out is that all of us that want to solve the problem and get benefit from the problem [1] solving somehow coerce each other to pay for the solution. I.e. state sponsored health care. Or individual mandate & community rating & subsidies (obamacare).

[1] Note here that everyone gets benefit so everyone must be coerced. If you let people out who claim they enjoy looking beggars, the system collapses again, because obviously I say that I enjoy immensely looking beggars and actually you should pay me if you deprive my enjoyment of looking beggars if you otherwise get the system working without my money. And the ones who actually do enjoy looking beggars, let's just say I am a bad person and more than happy coercing them paying real money to get rid of beggars.

[michaelmior]

You seem to be implying that people are only motivated to help because they don't want the guilt of seeing people in need. While this may be true for some, it's awfully pessimistic.

[beefield]

I did also imply that people are willing to help because they want to feel themselves good about helping.

Yes, I am a cynical bastard. But I think i is safer to design important institutions in society assuming bad about people instead of assuming good about them.

[michaelmior]

While I don't share your cynicism (acknowledging that naivete can be an equal or greater problem) I think it's true that ideally we should design systems that don't rely on altruistic behaviour.

[oskarth]

I'm not arguing for either being better or worse [1], but do you honestly not see the difference in it being voluntary or forced? You as an individual don't have to have anything to do with Watsi if you disagree with their implementation. This type of argument seems like a very dishonest strawman to me.

1: I'm from Sweden so I'm obviously appalled at the state of healthcare and health insurance in US, but that's beside the point.

[privateprofile]

The day I saw this post get buried under the traditional sheep-y "tap in the back" posts like 'This makes my heart happy to hear!' was the day I was finally convinced of how biased (censored?) HN really is...

[afsina]

State sponsored health care is very inefficient, coercive, unfair and open to abuse no matter the good intentions. I salute Watsi and YCombinator for making this without direct state support.

[matthewmacleod]

That’s a gross generalisation. The NHS in the UK for example - while far from perfect - is none of those things.

[lucaspiller]

Just for clarification, the NHS budget in the UK for 2016/17 was £120 billion[0], which works out to be about £1800 per person. Seems like a pretty good deal, given that in the US, health insurance for an individual would be around double that [1].

[0] https://www.gov.uk/government/statistics/public-expenditure-...

[1] https://resources.ehealthinsurance.com/affordable-care-act/m...

[maxerickson]

$3500 a year in premiums. But that leaves out the ~$7000 deductible those plans come with.

[afsina]

IMO, That's too high for a family with kids.

[DanBC]

There are large amounts of coercion in care for people with mental illness or people with learning disabilities.

Things like community treatment orders are based on coercion.

This only applies to quite small numbers of people, but we can't say they don't happen.

[notahacker]

There's also a large amount of coercion in keeping mentally ill people locked up in a prison because the government won't pay for them to receive treatment in the community, of course...

[matthewmacleod]

You're right that we can't say "no coercion happens in the NHS", but we can reasonably say "any coercion that happens in the NHS is orthogonal to its single-payer nature". CTOs are definitely in the grey area between the legal and healthcare systems.

[pandaman]

One thing people miss about government provided healthcare is that it's easy to be made mandatory. If government provides your health care it's only natural if it directs you to a healthier life to save people's money. I, for one, don't want "doctor's orders" to become actual orders enforced by police.

[alkonaut]

> If government provides your health care it's only natural if it directs you to a healthier life to save people's money.

Yes. And conversely, if you provide MY healthcare (by your taxes) I'm very much concerned about YOUR ability to work and pay taxes, which is effectively the same thing.

This is exactly why we have seatbelt laws. Your seatbelt just makes you less of a dead person so you can pay for your healthcare (and mine). And when/if you have an accident it makes you a person with two broken wrists that costs my taxes less than if you were a person with critical injuries - so I'd rather pay for your damages if you wear a seatbelt.

See this is also an important point: a high-tax society also requires a sense that tax money is well spent. This means that it can't feel like the money is spent "on someone else", you can't have a feeling among the population that tax money is often wasted, or that it's spent on wars (for example). If money was spent on healthcare for people who didn't want to use seatbelts - I'd be less willing to pay taxes. So my high taxes require these kinds of laws. Still, people are free to eat pizza and beer 24/7 and I still pay for their healthcare - because the alternative would be a too big government involvement in peoples lives. All they can do is tax beer higher, not much more.

Now, of course all of these limitations of your freedoms has to be weighed against the value they provide. The cost of people driving around without seatbelts is huge to socitey. The cost for an individual to wear as seatbelt is tiny. So it's a no brainer even in the most liberal societies.

[pandaman]

Kinda like that. Except, while you can still refuse to wear seatbelt (pay fine or don't ride in cars or trucks at all) you won't be able to refuse mandatory health care. US already has a history of this https://en.wikipedia.org/wiki/Eugenics_in_the_United_States#...

[alkonaut]

> you won't be able to refuse mandatory health care.

You mean you won't be able to refuse paying for it (that might be the case) or not able to refuse actually receiving the care (no one will force you)

The only exception is vaccination possibly, which should be legally required.

[pandaman]

You won't be able to refuse receiving it. Did you read the link? People had been forcefully sterilized in the US all the way till 1970s, even without public healthcare.

[notahacker]

The US government carrying out forcible sterilizations of course points to the well-understood fact that universal healthcare is neither necessary nor sufficient for forced medical procedures, and this objection to state-funding healthcare is an entirely bogus one.

[alkonaut]

> You won't be able to refuse receiving it. Did you read the link? People had been forcefully sterilized in the US all the way till 1970s, even without public healthcare

I saw the link but didn't see the connection between "public universal healthcare" and "forced healthcare practiced on people". Can you elaborate on that connection?

publicly funded universal healthcare is about how healthcare is funded. How it's performed is a separate matter.

[nothrabannosir]

Yes, these kind of theoretical arguments are so important and constructive when scores of people are actually in serious trouble today, in the real world.

"The police enforcing doctor's orders." Give me a break. I'm all for healthy debate but come on. This is the most inane argument I've ever heard about universal health care, and I've heard quite a few.

Sorry for not being more constructive, I just can't see this line of reasoning go anywhere useful.

[pandaman]

Theoretical? I've been living in the USSR. It's been very practical there.

[gattilorenz]

Maybe the fact that it was a dictatorship, not public healthcare, has something to do with that?

[pandaman]

I assure you, there was public healthcare in the USSR and I don't see how it's being a dictatorship has anything to do with the healthcare enforcement? You think people won't vote a representative who will want to establish mandatory rehab for drug users in the USA, for example?

[alkonaut]

> You think people won't vote a representative who will want to establish mandatory rehab for drug users in the USA, for example?

I don't think people think of that as healthcare but as a sentence for doing something criminal. Just like we lock insane murderers up and force them to undergo psychologicalt treatment (instead of sending them to prison which is often legally dubious if someone is clinically insane) that kind of rehab is basically treatment forced on someone for committing a crime, not some part of a public/universal healthcare program. Separate topic.

[pjc50]

Already happens. https://www.theguardian.com/commentisfree/2014/oct/27/mandat...

So the US manages to have mandatory rehab without public healthcare. The two are really not related.

[AsyncAwait]

Ugh, that doesn't normally happen in Western Europe, but if your argument is that you'd rather see thousands of people not receiving healthcare than an odd incident where someone was forced, then I am not sure you have your priorities straight.

[colde]

And perhaps that viewpoint has skewed your outlook somewhat. I haven't seen anything close to that nightmare scenario in Denmark, and indeed the rest of Scandinavia. What comes closest is taxing unhealthy food, which i tend to agree with.

[crummy]

Do the police enforce doctor's orders in the USSR?

[vidarh]

Are there any examples of countries where anything remotely like that exists, despite socialised care?