[gregsq]

My mother lives in country australia and had pancreatitis it seemed. Hospital, cat and mri’s, spent a week in hospital, sent home, returned after pain returned. More tests, it was decided she should be sent to a larger regional hospital for biopsy. Flew by Lear jet, drove by road home I guess about three hundred miles. Advise was a Whipple procedure. I wasn’t inclined to agree for reasons I won’t go into. I declined before second opinion from brisbane world class surgeon. He agreed. Flown commercial to brisbane. More mri’s and cat scans. Acinar cell carcinoma suspected. No need for full duodenectomy. Hospital stay and operation. After care and so on. Total cost zero. I live in the US. Healthcare here is a grift. The wife did medical billing, mostly reconciling and working all the codes. It’s a complete mess

[Gatsky]

Yeah it’s pretty good. You can walk into any hospital in Australia and they’ll just look after you and try to do their best to help you. You won’t be asked to pay anything, except maybe some pharmacy fees. Novel concept. And there is also the private system if you want alternatives.

Problem is, I don’t think it’s going to last. The ageing population means health costs will spiral, and health budgets will consume an unsustainably large proportion of revenues.

[chris_wot]

It will last because any government who threatens it will be removed. We have watched what is happening in the U.S. and almost every Australia who is aware of the U.S. model is absolutely appalled.

Actually, the U.S.’s standing in Australia has totally dropped in the last four years, and was already gradually dropping before then.

[aantix]

“Total cost zero”.

The cost is never zero. Doctors, nurses, don’t work for free. Infrastructure isn’t maintained without money. It comes from somewhere.

[uoaei]

Paying for healthcare via taxes would look very, very similar to how it is now. Because that's how insurance works: you are paying into a pool now to get access to help later.

I can't tell if you're being sarcastically libertarian or deliberately antagonistic.

[__blockcipher__]

I’m surprised you couldn’t tell because my reading is their point was quite clearly genuine and not at all sarcastic.

They were just expressing the notion that while the acute personal cost is zero the actual cost is still borne. They didn’t make the point in a very nuanced way but any system that divorces the cost from the person receiving the treatment hides information by suppressing the natural price discovery mechanism.

Anyway, I agree that insurance has a similar problem, at least if policies like “no pre-existing conditions” are followed. However if such policies are not in place then premiums would go up and thus the information propagation of the price mechanism is (all else equal) restored.

I don’t have time to get into it but speaking from the US perspective I really wish we had a real free market system with no government revelation or licensure laws whatsoever. What we have now is criticized by the ignorant as a “failure of unbridled capitalism” but it is of course anything but. It is absolutely absurd that I can’t decide that I don’t want insurance and equally that I’m not told what a procedure or drug or item will cost beforehand. I’ve been to the ER several times and you’re always treated like a bag of meat to poke and prod and I have to be very diligent about constantly getting them to tell me what they’re actually doing. (And don’t even get me started on the chargemaster system where they initially charge you 10x more than what they expect to recoup purely for leverage to negotiate with insurance)

[redler]

Under such a system, if your choice is not to have insurance, what should happen if you step in a hole and shatter your ankle in a way that requires complex surgery to repair? And if the response is to simply pay the cost out of pocket, what if that "choice" not to have insurance was made because you're working at a minimum wage job?

[__blockcipher__]

> Under such a system, if your choice is not to have insurance, what should happen if you step in a hole and shatter your ankle in a way that requires complex surgery to repair?

In this hypothetical, I clearly wouldn't be able to afford the complex surgery, so either I would do without it or make use of any non-profit foundations/charities set up to give people in my position money.

It's worth noting that the cost, while still significant, would be FAR lower in a world with no regulation/licensure whatsoever. It's hard to understate how much cost (nominally expressed in dollars but the cost is so much more than that, to be clear) is introduced by all the layers of red tape.

And actually, now's a great time to mention that this problem occurs in our current US system, except it's way worse because (well, at least pre-Trump) you will get fined for not having insurance in addition to all the fun that comes with not having insurance. The obvious counterpoint here is to argue that if we had a single-payer system, where there's not actually private insurance companies at all (or at best they exist for people who aren't satisfied with single-payer and so those individuals both pay taxes for the single payer system and also pay for their own private insurance in parallel), that this problem wouldn't exist because it's impossible to not have insurance since the government already has it. That part is true, although you run into the classic problem that when everyone has government insurance, the client of a doctor/physician/etc is the state and not the individual, and therefore incentives are aligned against you right off the bat. Then factor in that you don't get to make decisions about your medical care - or rather, you can reject treatments but you can't decide to take a treatment that the government has decided you can't take, etc etc.

> And if the response is to simply pay the cost out of pocket, what if that "choice" not to have insurance was made because you're working at a minimum wage job?

I already implicitly answered this with my answer to the first question because I didn't shy away from saying that if you can't afford the surgery then you can't get the surgery without a benefactor. If I had tried to pretend that magically you would always be able to get the surgery then this would be more of a "gotcha" than it is.

While we're here though, this is a good time to mention that minimum wage shouldn't exist either. (Doesn't change your point, to be clear, but I can't help but mention that the whole concept of minimum wage is regressive policy masquerading as progressive policy)

--

So, to conclude: resource scarcity is a thing and always will be a thing, and the best way to address is that to utilize our resources as efficiently as possible and maximize innovation, both of which require regulations to not be a thing. Regulations are always sold as "this will make things more efficient/safe/etc because the market dynamics aren't properly addressing this", but the reality is that regardless of your philosophical views on regulations, the actual utilitarian result is to make things more expensive with no increase in safety. And it of course makes things more inefficient.

[jimbob45]

You’re paying into a pool for the neediest to use. The social contract being that you implicitly admit you will one day be needy, no matter how healthy you live your life. Thus, you willingly throw your money away when you’re young and healthy and you do it smiling.

[jjav]

> You’re paying into a pool for the neediest to use.

Yes, that's the definition of insurance. Insurance company takes money from everyone (say, for car insurance) but only pays out to a few (those who crash their car).

As any insurance broker will happily tell you, the smaller the pool of people you belong to, the higher the premiums because they can't spread the risk as wide. Thus, a 100K+ employee company can buy health insurance for their employees at a better rate than a 4 person startup.

The optimal group size for an insurance pool is: everyone in the whole country. Maximum pool size, risk is spread as widely as possible, cost is minimized.

[heavyset_go]

Nobody is under the impression that there aren't costs to care, so your response feels like you're addressing a strawman argument and isn't really insightful.

[aantix]

>Nobody is under the impression that there aren't costs to care

Someone is. "Total cost zero"

It's dishonest.

[MystK]

Not sure why you think that. There are definitely people who think universal healthcare will cost nothing.

[Cederfjard]

Like, small children? What adult doesn’t understand that there are costs in performing health care?

[MystK]

I mean links are everywhere if you search...

https://thehill.com/blogs/congress-blog/healthcare/484301-22...

https://www.ucsf.edu/news/2020/01/416416/single-payer-system...

https://www.courthousenews.com/study-universal-health-care-i...

https://pnhp.org/news/implementing-a-universal-healthcare-sy...

[DanBC]

None of these links say what you're claiming they say.

Your courthouse link:

> “For me, the important lesson is that single payer can re-direct huge resources – about $700 billion per year in the U.S. – from insurance paperwork and excessive drug prices to clinical care. In other words, with a simplified payment system, we can afford to insure everyone and with high quality insurance – broad benefits, minimal cost-sharing, choice of provider,” Kahn said in an email.

Your UCSF link:

> The U.S. spends more on healthcare than any other country, yet is one of only a few developed nations that does not provide universal coverage. Under proposed single payer bills, such as “Medicare for All,” a unified public financing system would replace private insurance, similar to the healthcare system in Canada and many other wealthy nations.

Your pnhp link:

> Honoring a rather unpleasant tradition, the September issue of Health Affairs published yet another peer-reviewed study confirming that administrative costs in the U.S. healthcare system are the highest in the world. These administrative costs do not improve patient care. They pay for more administrators.

> Each American physician requires 10 administrators to stay in business. Why does American healthcare require twice as many administrators as any other healthcare system?

None of these are saying single payer healthcare is free. They're saying the US system is fantastically expensive, and single payer would be cheaper and better.

[heavyset_go]

Again, sounds like a strawman argument to me. Have any examples of people who think that?

[MystK]

Sure it's written about all the time.

https://thehill.com/blogs/congress-blog/healthcare/484301-22...

https://www.ucsf.edu/news/2020/01/416416/single-payer-system...

https://www.courthousenews.com/study-universal-health-care-i...

https://pnhp.org/news/implementing-a-universal-healthcare-sy...

[heavyset_go]

> https://thehill.com/blogs/congress-blog/healthcare/484301-22...

I'm struggling to find where this author concludes that universal healthcare is free like free energy from a perpetual motion machine. Can't find it.

Could it be that you're misinterpreting the repetition of the fact that countries with universal healthcare have better health outcomes, and yet pay less than half of what we do for healthcare, with it somehow being completely free? The same fact that's repeated in the title "22 studies agree: 'Medicare for All' saves money"?

Which of those 22 studies claims that cheaper healthcare with better outcomes is the result of free labor?

Looking at the rest of links, it seems to me that you believe that anyone claiming, with evidence, that universal healthcare saves money somehow thinks that universal healthcare doesn't cost anything.

[toomuchtodo]

“Total out of pocket cost zero, with taxes funding a functioning care driven universal healthcare system.”

We’re not arguing that funding is required, simply how it flows and to whom.

Disclosure: I too have first hand experience with Australia’s healthcare system. It’s very good.

[xtian]

What is the cost of an unhealthy population that defers or forgoes medical treatment? Where is that price exacted? In a 2019 Gallup poll, 25% of US adults said they or a family member had delayed treatment for a serious medical condition that year for financial reasons.

[chadcmulligan]

Australian here - was listening to a local doctor who has a radio program. He travelled to the US for something and remarked on the number of people he saw squinting - apparently this is treated here by the appropriate glasses when young (for free) but not so over there.

[sumedh]

> The cost is never zero.

I dont understand this argument. You literally dont have to pay anything after you come out of the hospital so yes the cost is zero.

You do pay overall for the cost in taxes but so do Americans yet their hospital costs is non zero.

[puppable]

Thanks for pointing this out. I had thought the Lear jet was just made out of magic, until I saw your comment.

[hippira]

Obviously he and his mother has already paid for in taxes, zero cost here is in the sense that the cost is not going to eat into their current savings. While in the US you paid taxes and can still potentially go bankrupt if you have major diseases.

[aantix]

But their current savings is lower because of their higher taxes.

[redler]

Under the US system, everyone's savings is also lower -- because of extremely high insurance premiums, co-pays, coinsurance, deductibles, high out-of-pocket payment maximums, uncovered care, predatory billing complexity designed to minimize "medical loss", lesser job mobility due to linkage of employment with the ability to get medical care, far higher drug prices, and so forth. It's a system full of holes into which almost anyone without wealth can fall -- even people with good insurance.

If you simplify and subtract the need for intermediaries to extract profit from this kind of system, remove all risk of anyone in the country being personally financially destroyed by their health care needs, remove from US businesses the obligation to manage and pay for their share of their employee health benefits, and distribute the resulting costs across the entire population, would you argue that would somehow cost more? That the resulting "higher taxes" would exceed the lowering of all the systemic, business, and personal costs and risk above?

[heavyset_go]

I pay for health insurance on the individual market, without employer or government subsidies. It's a shitty plan that I pay over $9k in premiums for and have a $3k deductible with an $8k out of pocket maximum each year with co-pays, and that's without utilizing the plan at all.

If I wanted to buy the same plan I had from an employer, a family plan, it would cost over $30k in premiums, with an $8k deductible and a $17k out of pocket maximum each year with co-pays.

All of those costs and it is still routine for the insured in the US to find out that the care they received actually isn't covered by their insurance, as well, so they're on the hook for paying for some care completely out of pocket.

I would love to hear your explanation for how my savings is actually higher now while I'm being extorted each year with higher and higher premiums for less and less care.

[toomuchtodo]

50% of bankruptcies in the US are medical cost related, so the whole “you can save more in the US with lower taxes” argument is moot. You’re doing the same as driving without car insurance; it works right up until the crash site.

[chris_wot]

He meant the total cost to the patient is zero. We pay for this via a regular yearly Medicare levy (if you don’t have private health care) and via our taxes. As Australians, we are fine with this.

[gregsq]

Yes I should have said zero to her at the various points of delivery. There’s a different method of accounting at play. Till recently a volunteer firefighter in an environment somewhat like California’s. You might call it socialism light. The tangible benefits to the wider community, and there are many she and her ancestors have brought, are also accounted for. The working population agree to pay a fixed proportion of their taxes for this very purpose. A community based insurance. This is an approach proven to not be very appealing in the USA. I think mores the pity.