[tptacek]

You have a young family of four, and can barely afford insurance premiums. Basically, without insurance, every single year you're hitting on a blackjack 17 against bankruptcy. You see the ACA penalty, and you see the insurance premium cost, but you're not factoring in the 5-digit cost of virtually any significant medical expense.

Rising insurance premiums aren't good for anyone. The ACA set out to fix the problem of rising insurance premiums and (I think) pretty much failed. But it didn't create that problem; 5-digit annual premiums for a family of four were a reality prior to the ACA --- or, at least, they were in Chicago on the small group market.

The subtext to these discussions though is whether we'd be better off without the ACA. No, we would not be. We would lose guaranteed-issue insurance, so a sizable fraction of families wouldn't be able to get insurance at all, and, from the available evidence, we would at least have the same rate problems we have now, and (according to some studies) have worse rates. Obviously, this subtext is about the GOP's health care rhetoric, and I'm not wild about opening up a political salient in this thread, but let's at least be clear: the idea that you can repeal the ACA, do nothing else, and get lower health insurance premiums for real coverage is sleight of hand.

[x0x0]

For another example: my broken ankle: tib+fib fracture, 2 severed ligaments, partially torn syndesmotic ligament, gave myself plantar fasciitis during recovery. Two surgeries, a bunch of ortho visits, a bunch more PT, 10 months on crutches.

The net bill was over $110k if I hadn't had insurance and wanted to go to one of two ankle specialists in the city I live in. With insurance, $5k-ish.

[sjg007]

"the idea that you can repeal the ACA, do nothing else, and get lower health insurance premiums for real coverage is sleight of hand." --> it's a lie actually.

[whatshisface]

If enough people didn't have access to insurance, then there would be pressure on hospitals to find ways to reduce prices (so that their volume could go up). As it stands the medical industry is allowed to hold the poor for ransom ("accept our increased costs or they won't get treated") against the US's deep but finite pockets.

Before, we had the (very poor) demand elasticity of people paying everything they had and then maxing out every credit source, and predictably prices rose to around that point. Now, we have no demand elasticity at all, and prices can be expected to rise well above the average person's net worth + credit access.

If you look at any microeconomic equilibrium chart, you'll see that the price is held in a balance between people buying and people holding off due to price. When the good is healthcare, the human cost of "holding off" is very high, and usually involves inability to pay. Unfortunately our economic system tends to fly off the rails if this balance is disrupted, no matter how noble or urgent the cause.

[komali2]

>pressure on hospitals to reduce prices

Elsewhere it has been said: choosing between bankruptcy for your family or cancer care for your child isn't an actual choice, it's two loaded guns pointed at your skull. One held by the hospital, the other by the insurance company.

The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop. It is not an economic issue. If you want to get economic about it though you'll lose because as it turns out a healthy educated populace is more productive than one that loses productive families here and there to lances of bankruptcy from the unpredictable nest of human disease.

[whatshisface]

I also feel the moral imperative that you're describing. Nobody should have to tell their child that they're too expensive - to be honest, I can't imagine anything worse.

We were literally using lives as an economic mechanism, but now that we're not doing that we need to use something else in their place. The price of healthcare will continue to skyrocket unless we find something a little less horrifying than other people's lives to use as a balancing weight; although I won't claim to know whether it would be more possible to design a working market system or socialize it successfully.

Priority 1, stop making Soylent Green out of people. Priority 2, re-establish the food supply in a better way, because we need to eat.

[shard972]

> The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop.

I'm sure they said that in soviet Russia too. It's all good to say X,Y or Z is a right until you actually cash in on that right.

I mean you don't even have to look to the soviet union, what is goinig on with the VA? Obama was working to fix that smaller universal healthcare system from actually just waiting years for people to die but I haven't heard any good news comming out of there recently.

The rest of your claims are just nonsensical in this context since your just assuming universal healthcare works because the government decrees it to be universal.

[komali2]

On Reddit, to responses like this ("America is incapable of universal healthcare because... Reasons") I like to link to the Wikipedia pages of the multitude of other countries with far lower GDPs solving the problem.

I can probably predict the response but on the chance I'll be surprised - why can't America solve the problem when Taiwan, Switzerland, Sweden, France, Germany, the UK, Canada, Finland, Norway, etc etc etc have or nearly have?

(I have received healthcare in several of these countries and an readily prepared with counterpoints to the inaccurate "healthcare isn't good / lines are long in those countries" arguments, fair warning)

[cmurf]

Americans pay double in health care costs per capital than any industrialized nation. And we don't have better outcomes. All of those countries have universal healthcare. Citation, OECD.

[AFNobody]

I'm not sure its fair to argue that universal healthcare is a human right despite the fact it makes economic sense.

Humanity survived just fine without real healthcare and healthcare is not essential to a fair balance of power b/t the government and its citizenry.

Universal healthcare needs to be argued on the economics of the issue because that is the only practical way to make it sustainable. The "feel good" stuff about it being a human right will fail when stress is applied to America and stress is coming. The US, frankly, has peaked and it is all downhill from here.

[intended]

Healthcare is not hard. American healthcare is.

Frankly a single payer system is simpler and faster. But this is an area where American politics and market rhetoric just lead to terrible outcomes.

[candiodari]

In law school we were always taught that there are no rights. Rights, in practice are nothing but duties, and should be looked at like that.

You have no right to "life, liberty and the pursuit of happiness", you have a duty to not interfere with other people's life, liberty or their pursuit of their happiness. But even that is a negative duty. Positive duties, like paying tax, are more like the right to healthcare.

So this should be looked on in similar fashion. Do you have a right to healthcare ? Well, answer the question : do you have the duty to take care of others' health problems, completely irrespective of how it affects you personally (for instance, what if it takes up 90% of your time, while still not doing much more than slightly prolonging a miserable short life for them ?).

These questions are not so simple and knee-jerk statements like "right to healthcare, period" are not helpful and will do nothing but get us into a lot of trouble.

No country has "right to healthcare, period". That does not exist. For the obvious reason that it simply isn't feasible. Providing a named (but finite) list of treatments and medicine free of charge if diagnosed by a licensed physician is the furthest any country goes. In some cases that list is pretty short.

[hestefisk]

http://jeffsachs.org/2017/06/jeffrey-sachs-america-can-save-...

[whatshisface]

You also have to watch out that asserting positive rights that are sometimes impossible to provide (like healthcare) will confuse people when governments attempt to claim that other, deeper rights are "impossible to give." (For example, they might try to argue that they can't afford to not torture, comparing it to how their impoverished country can't give everyone free internet.)

[komali2]

Why is that? If a country tries to claim it cannot afford not to torture, can't we simply point to all the countries that manage without it, as I do for the healthcare debate?

[dragonwriter]

As anyone who lived through the more recent Bush Administration witnessed nearly daily, people claim “not torturing” is an impossible right to give while denying all positive rights—and acted on that argument—so I fail to see the relationship.

[whatshisface]

Denying every right is the last step of the manuver I'm describing, the first step is to re-define right to mean comfort. Bush-era politics just went straight to step 2 and it didn't work on us.

I suspect that the current UN rights council may be an example of this in action. See: the track record of the members on negative rights, the number of positive rights on their list of rights.

[dragonwriter]

> I'm not sure its fair to argue that universal healthcare is a human right despite the fact it makes economic sense.

“Universal right” is simply that which people feel all people ought to have.

> Humanity survived just fine without real healthcare and healthcare

“Universal healthcare” as a right is simply the right to a certain minimal level which is dependent on technology and resources. The fact that their have in the course of human history been times when no real healthcare by the standards of the early 21st century isn't material to that one way or the other.

> healthcare is not essential to a fair balance of power b/t the government and its citizenry.

That's quite arguably not the case; “government” is an a abstraction than the ultimately boils down to the subset of the citizenry with the most power in allocating resources, and it's quite arguable that that floors for allocation of resources in several domains, including healthcare, are essential for fair balance of power between that subset and the rest of the body of the citizenry.

Further, your implicit argument that a “universal human right” must either be something that prehistoric humans could not survive without or relate to balance of power between people and government is simply a statement of your political values, not a boundary on the what “makes sense” as a universal right.

> Universal healthcare needs to be argued on the economics of the issue because that is the only practical way to make it sustainable.

The actual concrete floor at any given time must be, but then again since every OECD country which guarantees universal healthcare, regardlesa of the details of the system, does it for less total (measured by absolute expenditures, per capita, or per GDP) than the US does spends on healthcare (and some don it for less by all three measures than the US spends in the. smaller public portion of its system alone, let alone the private expenditures), the economics aren't really an issue when you are talking about the US system.

[crzwdjk]

> pressure on hospitals to find ways to reduce prices

This might be the case if hospitals had to actually show their prices rather than sending bills after the fact for a price you aren't allowed to know when you consent to treatment. It might also help if competition were allowed, but for hospitals it is pretty much not in a lot of states. To open a new hospital in many states, you need a "certificate of need", which is basically a document demonstrating that you won't be competing with the existing hospitals. So much for "free market health care".

[intended]

How can you knowingly discuss demand elasticity and then apply to healthcare?

Healthcare is a non typical market and the cost of a persons health is irrationally high to that person.

[whatshisface]

Think about this:

Everyone on a boat has twenty dollars and absolutely needs an EpiPen to live. You have a supply of EpiPens and want to get as much of their money as possible. There's zero elasticity between 0 and 20 dollars, but you better not charge $21!

Now, imagine that there was only one person who needed an EpiPen, but everyone else was willing to pitch in as much as it took to help them out. If the supplier of the medicine was perfectly evil, the price would be $20 times the number of people.

Perfect self-interest is a pretty good model of any industry, including pharma, so I think this is a good picture of the situation. The ACA was careful to keep something like a market system in place, which is why we're faced with a problem that can be understood with microeconomics.

[intended]

Insurance markets are really really old concepts.

Healthcare is known to be a market which has non standard policy imperatives

The cheapest, simplest and most effective system is single payer with everyone in a single pool.

Every major first world power achieves better outcomes for lower costs than America.

Your theoretical premise would have merit if this was only theoretical, and we had no real world evidence that this was a bad idea.

[whatshisface]

I'm describing market actors with phrases like "perfectly evil," so I hope my comments aren't coming across as policy proposals. All I was arguing is that uninsured people running out of money was a pressure that used to be restraining the price increases but now isn't.

I really feel like this discussion is suffering from false-dichotomy-itis: I've actually been very careful to avoid saying anything beyond my point, about (say) whether or not single payer is a good idea for the US.

[sjg007]

Medicaid and medicare are what keep hospitals open. Most of the volume comes from those patient populations.