[hannasanarion]

Because for-profit healthcare is immoral, wasteful, and inevitably results in scenarios like the above.

A Bismarck system (nonprofit govt sponsored insurance companies that all charge the same and are taken by all doctors) would be fine too, but that's not on the table in the US

[flexblue]

> Because for-profit healthcare is immoral, wasteful, and inevitably results in scenarios like the above.

There's no such thing as a healthcare system where nobody profits in some way. Lots of people working in "non-profit" organizations are still lining their pockets.

> A Bismarck system (nonprofit govt sponsored insurance companies that all charge the same and are taken by all doctors) would be fine too, but that's not on the table in the US

You must be alluding to the German system. We actually have two-class healthcare: Private insurance for those who are self-employed or who earn well enough to afford it and public insurance for everyone else (15% of income).

Those with private insurance get preferred treatment at almost any level, because while price controls exist for both public and private treatment, the amount of money doctors get for public patients is a joke.

It doesn't stop there of course, salaries for all healthcare workers are extremely low, as is the budget for cleaning personnel. Pretty disgusting, but also dangerous. Our rates of MRSA are extremely high, for instance.

Lots of German healthcare workers are moving to Switzerland (private system, but compulsory), being replaced by Eastern-Europeans. That doesn't bother me per se, but if we didn't have that kind of cheap labor, the system would just collapse.

In effect, I can tell you how to get "affordable" healthcare, whether it is public or private: Just pay your healthcare workers dramatically less money. Instate price controls. You'll have a lot of frustrated workers in a system constantly working at the brink of collapse, but it does work.

[Nosewelder]

"Bismarck" is a class of healthcare systems, referring to employer/employee financed insurance-based healthcare. It is used in Germany, the Nederlands, and Switzerland I think. Other models are Beveridge (like the UK) and National Insurance like Canada.

The difference in payment between US and European health care workers isn't large enough to make much of a dent in US healthcare expenses. The big sources of costs is the US massive bureaucracy dealing with bills, insurance and negotiation, as well as the medical inefficiency and overprovision inherent in the system. Also high drug prices.

For example, a US medical doctor makes about 100 000 $ more than the European average, although a few countries pays doctors more. There are about 1 million doctors working in the US. So thats 100 billion. US overspending is about 1 500 - 1 800 billion.

[flexblue]

> It is used in Germany, the Nederlands, and Switzerland I think.

Germany today has a public/private mixture, Switzerland and Netherlands is fully private. I'm making this distinction because private profits do exist in these system, while the original comment I replied to lamented them.

> The difference in payment between US and European health care workers isn't large enough to make much of a dent in US healthcare expenses. The big sources of costs is the US massive bureaucracy dealing with bills, insurance and negotiation, as well as the medical inefficiency and overprovision inherent in the system. Also high drug prices.

Are you sure about this? Last time I looked it up, I came to a different conclusion: Administrative overhead (~8%) is neither a huge part of costs, nor is it massively different than in Europe. Drugs prices also only account for 10%.

Salaries for workers on the other hand are a significant chunk, and those are easily double than those in Germany in most cases. Note that I'm talking about all salaries, doctors, nurses, clerks, cleaners...

I agree with the overprovisioning being much costlier, but those are due to legal liabilities being more expensive in the US in general. In Germany, even if you win a malpractice suit, you get a pittance.

> There are about 1 million doctors working in the US. So thats 100 billion. US overspending is about 1 500 - 1 800 billion.

Again, this disregards the vast majority of worker salaries involved.

[mcv]

> "Switzerland and Netherlands is fully private."

Private insurance in those countries works because those markets are highly regulated, and they don't have a corporate culture of trying to rip off people as much as they can.

[dthul]

I guess the point is: No matter whether you are privately or publicly insured in Germany, a transport in an ambulance, an emergency helicopter ride, a long-winded illness like cancer, or any other medical treatment won't ruin you financially. The same goes for most (all?) of Europe.

[flexblue]

Doesn't insurance in the US cover these cases? I think it ultimately comes down to whether people can afford healthcare or not. For instance, healthcare costs are covered with unemployment benefits in Germany.

If you don't have insurance in Germany you'll have to pay for that yourself as well. That's rare, but it happens especially with the precariously self-employed.

The issue with the US system is that you can't have it be both non-compulsory but also that coverage must be offered to everyone, no matter their state of health. Then you'll have a few healthy people pay huge premiums to finance treatment for those who never bought insurance until they're sick.

It is my understanding that a compulsory purchase (as in Switzerland) would be unconstitutional, so I guess "Medicare for all" in the form of a tax would actually be the next best thing. Just keep in mind that with US levels of healthcare salaries, that wouldn't come cheap.

[Faark]

> If you don't have insurance in Germany you'll have to pay for that yourself as well. That's rare, but it happens especially with the precariously self-employed.

The difference is GKV being the default, and opting out of that kind of hard. You have to earn €5,062+ per month, for a start [0]. And the step is intentionally hard to reverse. I consider that a decent compromise. At that point people have to actively shoot them self in the foot, and I've little pity for those.

If you didn't opt out, thus are still under the GKV, the system will cover emergency services. Even if you haven't payed (yet).

[0] https://www.bundesaerztekammer.de/weitere-sprachen/english/h...

[flexblue]

> The difference is GKV being the default, and opting out of that kind of hard.

It's not hard at all, just go self-employed and you have the option.

> And the step is intentionally hard to reverse.

Yes, so that people towards the end of their lives don't profit from a system they never paid into. You're stuck with expensive private insurance for the rest of your life. In the US however, you would qualify for Medicaid.

> At that point people have to actively shoot them self in the foot, and I've little pity for those.

It's actually not that uncommon for people to fall into the trap of working self-employed for most of their lives, then retiring poor because they never paid into the pension system and their private insurance costs them over 500€/month.

[hannasanarion]

Compulsory purchases are constitutional, as long as Congress can reasonably invoke its taxation power in application of the penalty. Americans are already compelled to buy health insurance, but as of the 2017 Republican tax bill, the penalty for not doing so is $0.

[flexblue]

Then it's not a compulsory purchase, it's a tax. The money doesn't go to the insurer. Even before the penalty was $0, it was too low to be effective.

In Switzerland, it is compulsory to purchase insurance, there's a basic plan that all insurers must offer, and if cost exceeds a certain fraction of the income, the state chips in.

[xhgdvjky]

I mostly agree with what you're saying. however I am concerned that sudden and large changes to critical components of America will 1) be hard to do right and 2) create a lot of dissent from people who think differently.

remember healthcare.gov? we were pretty glad we had other redundancies from day 1! it takes time to build a system and in my (granted unrelated) experience, big changes are best done in small steps

[hannasanarion]

healthcare.gov had difficulty because it was so complicated, with layers of byzantine qualifications, exceptions, and requirements.

There is no healthcare system less complicated than "medicare pays for everything"

[User23]

There are arguments to be made for medicare-for-all, but that it is the absolute minimally complicated solution is observably incorrect. One counterexample suffices to dispel a claim of being the least member of a set.

For example, the healthcare system the USA had for well past the first half of the 20th century was "pay workers a middle class wage and control costs so the average family can afford housing and pay for medical care for their 5 kids. And then send them to college after." Nothing is simpler than to be told the price of the service ahead of time and then pay for it. I know this because my father lived through it. He was the child of dirt poor immigrants, only got a high school diploma thanks to being drafted out of college, and still managed to pay for medical care for a wife and six children. He told me about how insurance started as just catastrophe coverage, and then just grew and grew until the entire system became the morass of red tape, inefficiency, and rent-seeking it is today. Just like with student loans, having the monetary sovereign spend money into existence (directly or through high interest loan guarantees) will inevitably wildly inflate prices in the affected sector. To an extent it already has.

This isn't a simple static system. If it were, then sure "government pays for everything, good to go" would be correct. Unfortunately the reality is that it's a dynamic system, and providing a payment guarantee with politically determined pricing is "government pays for everything, so now every middle-man, lobbyist, special interest, rent-seeker, and every other assorted grifter is going to wet his beak". And that's just the beginning of the higher order consequences. Maybe medicare-for-all is a good choice, I just don't know. And I won't know until I see a cogent, rigorous, and complete analysis of the second order and higher effects of the policy change. I'm not aware of anyone offering that analysis.

[snagglegaggle]

Careful, "for-profit" healthcare has a lot of government controls on it. Single payer is only obvious after you add a lot of controls to the market.

See https://www.youtube.com/watch?v=8q71hrwUcu0 and the more complete https://www.youtube.com/watch?v=rWlk9HreE7U.

He explains how regulation eventually results in a centrally planned setup that is less efficient than what used to happen.

[kgantchev]

> Because for-profit healthcare is immoral

The [majority of hospitals in the US are non-for-profit](https://www.aha.org/statistics/fast-facts-us-hospitals). Needless to say, they are not able to provide a cheaper service than the for-profit hospitals. So there is some factor, unrelated to profit, which makes healthcare expensive.

If profit was causing healthcare expenses to rise, then non-for-profit hospitals should be be able to maintain lower prices than for-profit ones. They can't. So what's driving up the cost? The answer is pretty simple: government intervention.

[ceejayoz]

The "not for profit" thing is a bit of a fiddle.

Sure, there aren't shareholders getting dividends. There are plenty of other motives that push non-profit hospital systems to want to make money. New buildings, fancy robotic surgery machines, cushy patient amenities to compete with the other system in town, expensive administrators and staff...

[RHSeeger]

I think the point was that there are multiple different reforms that are important, and why health care over another. What if there is a candidate that is for health care reform, but against something else you consider important, but there's another candidate that's for the other reform, but against health care reform? Or there is a candidate that is for health care reform but also for other things your are strongly against?

[yladiz]

Politics is all about compromises, so the answer to all of those questions is, “it depends”.

[xhgdvjky]

It's easy to forget the importance of compromise during a primary. Sometimes it feels like a positive feedback loop.

[w1nst0nsm1th]

You speak, you debate, you argue and because of this, nothing gets done.

Even for the most urgent issues like universal healthcare that have been literaly implemented by all western countries a long time ago as well as in most developing countries, you say : "But me..."

Since you're not directly affected by the matter, you simply don't care. Even if you could be the next...

You're part of the problem and nothing will never get done in America because of people like you.

Selfishness will break America.

Before your country collapses under its own debt, America will be filled by slaves and a clique of companies and billionnaires owning them.

[RHSeeger]

I was merely debating the idea that "if you believe X is important, then you must vote for the person that supports X", because it's not as black and white as that. Like it or not, there are too many other factors that come into play. The only way "vote for X is you support X" is black and white is if each topic comes up for it's own vote. Even then, it's possible that the vote could be for a horrible way to support X.

> You're part of the problem and nothing will never get done in America because of people like you.

You don't know me and you don't know what I do / do not vote for. I recommend you keep your insults to yourself.

[kgantchev]

> Selfishness will break America.

Selfishness is healthy in moderation. It's what helps people come to the conclusion that they have a shared interest on which they can collaborate.

> Before your country collapses under its own debt, America will be filled by slaves and a clique of companies and billionnaires owning them.

So the answer is to bankrupt the billionaires so everybody is living a terrible life?