[ericmay]

The US healthcare industry is easier to understand once you equate insurance companies with the government and realize that they are jobs programs.

But that also makes it easier to understand the need to get rid of them and have the government fund healthcare.

My mom passed away recently (Monday) and it would have been impossible for her (because it was impossible for me) to try and navigate insurance claims (and subsequent denials lol), hospital billing, Medicaid, Medicare, Ohio Medicaid, and other programs. It's just level after level of waste and all of this could be combined into just one god damn program that does the same work and we would save money. But jobs. Oh and also let's not forget the now 3-6 spam calls I get daily from official sounding scam artists who try to "help" with your medical problems (steal money) in your darkest hours and most vulnerable. Does nobody seriously care? Why does the United States of America allow its citizens to be robbed?

When we were clearing out her things we probably had an entire trash bag worth of prescription medication.- Waste Maybe you should be required to return the empty? All those pills had to be safely disposed of.

Equipment - thankfully we could donate this to a local charity but many hospitals and healthcare facilities won't accept things like wound bandages even if they are brand new and sealed in a box.

Transportation - It's unreliable. Companies like Caresource contract with the government to provide rides to get patients to appointments, but they then further subcontract these rides to the most obviously shitty companies imaginable and then those companies contract the rides out to random people who will go pick people up for money. It works sometimes, but ultimately things happen. We had multiple no-call, no-shows and my mom who needed lifesaving cancer treatment had a hard time getting to scheduled appointments. More waste.

I could go on and on.

The thing that pisses me off the most is that we're explicitly opting in to spend more money. It's just a tax that goes to the health insurance industry instead of the government. Health insurance companies are just parasitic entities and do not innovate or provide market efficiencies - they just work to find how they can deny claims and try to "innovate" on billing complication. Unlike pharmaceutical companies and healthcare equipment companies. There are still efficiencies to be had there with licensing, drug patents, trials, etc. but health insurance is a complete scam. If we just did single-payer then we could see some actual innovating on the insurance side from whatever business was remaining that the "wealthy" could afford - which I'm fine with.

I do dislike the usage of "free" to describe the NHS or any government run healthcare program since it's inaccurate (nothing is free) but as another user pointed out the US system is like double cost because you pay taxes, you don't get any of the benefit, and then you have to pay too. Philosophically I prefer people to say "hey we should fund this" versus "I need my free thing from the government" because the former is indicative of a society coming together to support itself and the other is indicative of social collapse. People don't call Social Security free very often, but instead support it because "I paid for it".

[springogeek]

The actual phrase for describing the NHS is meant to be "Free at the point of use", but people are likely shortening for convenience. People are paying for it, but not in a tangible way.

The main thing is knowing that if you need any procedures, services, an ambulance, critical or emergency care, etc, you'll not be asked up front to pay for it, you'll just be treated. Seeing that principle erode over time is heartbreaking and terrifying.

(rant) Healthcare as an industry doesn't function properly under a capitalist model, which expects that competition and consumer choice will encourage innovation and further competition, leading to a better outcome for the consumer. If you need healthcare, you don't really have a choice in it, or your choices are artificially restricted by circumstance, so you can't benefit from a competitive marketplace. It's a broken system, as far as I am concerned.

[ericmay]

I'd say the health insurance industry specifically doesn't function and that's because in the United States you will not be turned away from life saving treatment regardless of the cost [1]. Other aspects range from working very well to working marginally and could be improved. Public-private relationships generally seem to do well but we need to capture more of the profits when the funding is subsidized by the public, but that doesn't mean that private entities who do heavy lifting shouldn't also profit. It seems like we have some clear win-wins if we want to take them. On the whole the government is far better at cutting checks than it is at innovating.

I agree with your statement that "Free" is likely short-hand but I personally still don't like it because I prefer to think of items like that less so as entitlements because entitlements are easy to attack and dismantle. On the other hand when someone feels like they paid for something they are more likely to defend it. Social Security in the US is IMO a good example of this.

[1] Price discovery is impossible in a free market where you can't be denied service. Since society is (in my view correctly) not willing to let people die on the street if they can't pay for treatment the health insurance industry can't function except as a parasite with the aim to extract as much as it can and redistribute it to employees and shareholders. I do think healthcare costs would be cheaper under a "pure" free market where we let people die on the streets, though, but again I just don't find that acceptable.

[nradov]

Ambulance service might be free at point of use but that hardly matters if the ambulance never arrives.

https://www.bbc.com/news/health-64243044

[springogeek]

You're right, but it isn't a helpful comment for the discussion at hand. The story in that article, and many like it, are symptoms of a larger problem, but it's not because of public vs private healthcare.

The system works, assuming it's adequately funded, which it hasn't been for a while. Salaries aren't high enough to live on (thanks to the conservative government and creeping privatisation), and then brexit and other immigration policies have caused a shortage of trained professionals and no one willing to fill the vacancies.

There's a whole heap of issues (I've left out quite a few) stacked up against the NHS, and yet it powers on, doing its best.