[SideburnsOfDoom]

If you want to talk about extreme capitalism (US healthcare) vs. GDR Stazi communism, only, then sure the conclusion that you are lead to is obvious.

And yet there better models than both, once you get past the emotional appeal to this false dichotomy. Any well-off European country with universal healthcare (usually socialised), well-regulated free markets in most other sectors, and relatively low income inequality will do.

That's leaving aside the models that are currently "science fiction".

[toolcombinator]

Nope.

First of all, healthcare in many European countries is often insurance based.

Yes, in some cases it’s socialized. And in those places the healthcare system is rapidly falling apart/getting worse, and everyone who can afford it goes private.

Just look at the boom in private doctors/insurance in countries like the UK and Denmark.

And of course you also ignore the price paid in the form of taxes, VAT, etc. (Nope, not corporate taxes, which in Europe tend to be lower than in the US.)

If you wanted to nationalize healthcare in the US, you’re basically talking about adding trillions to an already bloated Federal budget.

For some reason, I’ve yet to see a solution to that problem that wasn’t some kind of immature, unproductive slogan throwing like “tax the rich!”

[SideburnsOfDoom]

Nope.

The only reason why the UK NHS is "rapidly falling apart" is the ideology of the Conservative party that's been in power for a decade now. They don't want to have it, but can't say that outright as it would be electoral suicide. So it's the good old Chomskyan Privatisation technique: "defund, make sure things don’t work, people get angry, you hand it over to private capital." i.e. "everyone who can afford it goes private" is not the market triumph that you might think.

Those people who have gone private, _still_ maintain a NHS GP with access to affordable drugs, etc. It's quite unlike private US healthcare.

> If you wanted to nationalize healthcare in the US, you’re basically talking about adding trillions to an already bloated Federal budget.

Nope.

Where did I say that I wanted to do exactly that to the US? Funny thing to exclude "European insurance-based" systems explicitly now, when explicitly including them earlier. I observed that there are better models, which there is empirical evidence for (1), nothing beyond that.

Any change to USA healthcare would be about _moving_ money not _adding_, would impact an "already bloated" and grossly poor value-for-money private extractive healthcare system: The USA currently spends more and gets less (1). So "adding" is deceptive, and "bloated" is a emotional-noise word in this context.

1) Spot the outlier in Figure 1 https://www.oecd.org/economy/growth/46508904.pdf

[toolcombinator]

Yeah, the US has a problem with spending more on healthcare than any other country, but it isn’t a “profit” or “administrative overhead” problem.

(Insurance companies have legally limited profit margins on health insurance.)

Does multiple private insurances add a little administrative overhead? Sure, but nowhere near as much as you see in the OECD figures.

There are many reasons why US healthcare is so expensive.

Some of them have to do with litigation: Skyhigh insurance premiums and a medical “Cover your ass”-culture with unneeded tests and MRIs done on a regular basis.

(In Canada, there is a legal ceiling on how much in damages you can sue a doctor/hospital for. This would be a good idea to implement in the US.)

Another added expense is free riders: All the people that show up in the ER, whether because of the flu or a gunshot, get treated/operated on, and never pay their bill.

Another issue is that the US has some of the best doctors in the world, and new, prohibitively expensive treatments are often introduced here first.

Many, very expensive treatments simply aren’t done (or done very rarely) in countries where the public (fully or in part) pay for treatments.

Waiting lists are another way of limiting costs in European countries. (Waiting lists that can be over a year long, but their healthcare systems are arguably cheaper to run.)

I could bring up some new medicines that in the US cost thousands of dollars per week (Crohns medication for example.) In European countries those medications simply aren’t available, or are only available on an exemption: Meaning that your doctor need to apply to have the cost covered, and is usually turned down.

Another example would be something like SRS surgeries.

These can be extremely expensive, and are covered by insurance, which of course increases the costs of coverage for everyone.

In European countries you’d either face a very long waiting list to get the operation covered, or you wouldn’t be eligible for it. Or only eligible after jumping through extensive hoops.

[unionpivo]

As someone who lived both in USA and am from EU (can only speak about Slovenian and German system) and I have preexisting condition (asthma and ankylosing spondylitis )

Sure you can find problems in any healthcare system. Because there is no upper limit on spending. There is always something more that you can do.

If you are proper rich* (dozens of millions or more) USA has the best health care system.

Fore everyone else, EU health care is better.

For instance right now I was at my pulmonologist and he wants me to take CT of my chest. As it is not emergency I could wait for a week (and it will be free), or I can have it today in private clinic, where I copaid 40 EUR*. If it were serious I would have it done for free today.

I got yearly prescription for Berudual, fosters, spiriva and Singular for free.

Bottom line is yes, sometime there is waiting time, but outside few pathological cases they are quite reasonable.

In USA I had more than double of my current pay, but with rent and my preexisting condition the way that they are, I am actually left with slightly more each month.

And there is another big difference between our system and US. Everyone is insured (weather it's public or private). So there is no fear of ever going to the doctors or calling ambulances.

Private clinics are getting paid by my insurance (I could get free CT at the same clinic a week later), 40EUR fee is just convenience (I don't want to wait) fee. And normally It wouldn't take a week, but with covid and flu season in full swing it takes a bit.

[SideburnsOfDoom]

> or I can have it today in private clinic, where I copaid 40 EUR

it seems to me that this is how public healthcare keeps private healthcare honest, by existing.

i.e. you have, and I have also, paid a double-digit sum for the privilege of being seen _today_. But that is not the same as paying for the privilege of being seen _at all_.

The BATNA is very different for the patient. A private doctor can get away with charging a fee for the convenience only, but since it's not the only game in town, they cant gouge to extremes, and charge a huge fee when you need to be seen by a doctor at all costs.

[DanBC]

> And of course you also ignore the price paid in the form of taxes, VAT, etc. (Nope, not corporate taxes, which in Europe tend to be lower than in the US.)

The US government pays more for healthcare than the UK government does, and the UK gets universal coverage.

This is fundamentally dishonest of US campaigners against universal coverage: they imply it's going to increase costs and decrease quality, when all the evidence is that it would decrease cost and increase both length and quality of life.