[LaEc]

Elimination of the price mechanism eliminates a key way to sort out who truly needs healthcare (or whatever service). Consider a safe elective knee surgery. If you knew it was paid for by the government, you would just sign yourself up for the surgery for even the slightest ache. If there was a copay, you might reconsider unless your pain was actually painful enough to warrant it. Ask any Brit about NHS waiting times and they would understand.

Is access to healthcare important? Yes, but universal healthcare eliminates market forces which makes things efficient. A better way would be a mixture of health saving accounts (and redistributive transfers to such accounts) and subsidizing hospitals (to reflect the fact that healthcare is typically underconsumed).

Further, the government lacks the necessary profit incentive to keep costs low or maintain high standards. Bureaucrats on fixed salaries have no incentive to try harder.

[scabbycakes]

I can agree on the points you made about the system not having any need to be efficient, a government ran system is just not able to be lean - but as far as people just getting whatever they can for the heck of it, that's probably not the case.

Just from personal experience, I don't have copays or much in the way of direct monetary costs (I'm not American) and it's not like I'm out there grabbing free drugs and surgeries. There's a cost other than money to everything, time and effort and rehabilitation and fear of the unknown and so on. As another example my retired parents have messed up knees and hips but they don't feel it warrants the hassle/risk even though it'd not cost them anything to have surgeries, there's more to it than just financial consideration.

Health savings accounts doesn't seem that great though - I don't know if I'll ever have health issues so if I'm socking away $x00/month I'm removing that from the economy betting against my health. Assuming a somewhat capable health care system I'd rather pay that amount to the government in taxes so they can leverage it now for someone else and if my time comes, then I don't have to worry about dollars and cents and what I can afford.

Also if the government had the money from everyone now in the form of taxes instead of individuals socking it away, it'd be more able to purchase equipment and hire doctors well in advance and the local hospital may have better capacity to cater to my needs.

Just my two cents.

[basch]

Expand the HSA to be a universal savings account, more like food stamps + social security.

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

https://news.ycombinator.com/item?id=23010921

[LaEc]

HSAs are just like bank accounts. It reflects a debt owed to you by the govt/bank. The govt/bank doesn’t actually store all the money it owes on hand, it lends it out, makes investments or spends it. That’s why bank panics and bank runs can occur when too many people withdraw their money at once.

[zozbot234]

> Health savings accounts doesn't seem that great though - I don't know if I'll ever have health issues so if I'm socking away $x00/month I'm removing that from the economy betting against my health.

A pretty safe bet, seeing as most people's health gets quite a bit worse over time.

[ardy42]

> Elimination of the price mechanism eliminates a key way to sort out who truly needs healthcare (or whatever service). Consider a safe elective knee surgery. If you knew it was paid for by the government, you would just sign yourself up for the surgery for even the slightest ache. If there was a copay, you might reconsider unless your pain was actually painful enough to warrant it.

Huh? Surgeries don't work like that, they all have significant risks of giving you worse problems than you already have. And even if successful, they're not going to leave you "good as new" or anything like that.

Also, the price mechanism doesn't actually do anything to sort out who "truly needs healthcare," all it does it make it so the wealthy can get whatever they want and the poor can't even get what they need. The actual mechanism for preventing unnecessarily and wasteful medical care is the professional ethics of doctors and the caution of patients.

[cbhl]

The problem with price as a mechanism to determine who truly needs a resource is that it excludes people who don't have money. For example, children who would greatly benefit from early therapeutic and/or psychiatric care.

[LaEc]

That's where the health savings accounts (HSA) and subsidization comes in. We want people to be able to afford healthcare but not abuse it. So what should we do?

First, require each person to set aside part of their income to a HSA.

Second, top up the values of those HSA's through government transfers for the poor and lower income.

Third, mandate that HSA's can only be used for real healthcare (and not alternative medicine). This way, individuals can afford healthcare but will still take responsibility to not deplete their accounts unnecessarily.

Fourth, (and in response to the NhanN's question) subsidize healthcare providers because healthcare tends to be underconsumed. Why is healthcare underconsumed? When we think about the importance of our own health, we only think of ourselves or our families. But we are valuable to our employer, to our friends. To correct for these positive externalities, some subsidization is essential to bring down those costs.

You are right in that my post didn't address the issues of childcare, let alone genetic diseases, long term conditions etc. where the price mechanism doesn't really make sense or fails. Any healthcare policy will have nuances that I cannot capture in a comment. But for the majority of healthcare consumption, we should really be trying to be as efficient as we can be precisely because of how costly it can be. Throwing away the price mechanism just because it fails for the edge cases is not ideal.

[peteski22]

Brit here...

I disagree.

You don’t sign yourself up for surgery at the first ache.

Health is a basic human right and if your country can support that I believe it has a duty to do so.

If the system was nationalised then it has massive negotiating power when buying equipment and supplies.

That’s what happens with what’s left of our NHS before greedy capitalists got hold of it.

[NhanH]

What does it means for healthcare to be underconsumed?