[amatecha]

Rhetorical question, but why is there even a hospital bill for being hospitalized? Keeping your people healthy should just be a given. How many hundreds of years will it take before universal healthcare is finally accepted as the basic standard of a humane civilization?

[yarg]

It's not really rhetorical.

People absolutely should not be subjected to bankruptcy in order to get adequate health care, but there's an aspect of personal responsibility that needs to be considered.

In NZ we have ACC, ACC is a universal insurance plan that covers injuries only (we don't have universal healthcare) so some dickhead can shatter his knees jumping of the roof of a three story building and be fully covered, but my little cousin with a disintegrating hipbone got no help from the state.

I think we should expand to universal healthcare (no chance), and failing that ACC should not be abolished (no need to throw ambulance chasers and insurance fraud into the mix) but I do think that the state should have the power to recoup the costs in the case of grossly negligent behaviour that leads to predictable outcomes.

Beyond momentary acts of idiocy, there are also lifestyle choices that have a significant impact on the health - for example, my morbidly obese aunty has had damned near every one of her non essential organs removed - I firmly believe that tax payers should not be on the hook for her (or anyone else's) wilful self-neglect.

[candiodari]

I wonder where you get the idea that psychiatric detention is adequate health care, or that it helps patients. Regularly studies pop up pointing out that involuntary treatment in general does not lower the odds of suicide.

https://www.madinamerica.com/2019/06/involuntary-hospitaliza...

And before you ask, doing nothing does work, or at least it beats this option. Yes there are yet better options, actual interested attention from an actual human being, but literally leaving the person on the street works better than any mandatory treatment, and is a lot better than involuntary detention.

https://pubmed.ncbi.nlm.nih.gov/1023455/

And frankly, find a local Psychiatrist and ask them this question "Who is best of: a person committing suicide, or a person in involuntary detention NOT committing suicide for 6 months". They will illuminate what causes this problem.

So why are we doing this? Well, this gets done to those people to give Police an option to deal with people who've done nothing wrong but are judged to be "at risk" and generally being a nuisance, or the police judges they're "at risk" of doing serious damage by killing themselves, slowly getting worse but not actually having done anything wrong.

Lastly, some people are doing this because they see it as a form of euthanasia. They are ill, or have destroyed their lives (for example with medical bills) beyond repair and they just want out. It takes a long time for them to actually do something about this. Needless to say, any form of "treatment" for this will only (sometimes rapidly) make things worse. In fact most old people die not from old age but from starving or dehydrating themselves to death (this gets a lot easier once you're past 70 or so. Energy/calorie shortage causes cascading organ failure, which ironically feels good, and you fall asleep as your blood poisons itself. Obviously doctors do not make a habit out of telling next-of-kin this is what happened, nor do they try to prevent this by for example force-feeding them). But, there is sadly no age limit on this. For example, in one famous case a 15 year old kid relapsed into Cancer after a very intense and destructive cancer. She'd had chemo from 5 to 9 years old, which handicapped her phsysically and mentally, permanently. She caused a lot of damage killing herself by putting a certain person in a position where the police could indict her for murder, a hospital was involved, psychiatrists, she got people to cover up her earlier attempts at suicide, psychiatrists lied to her parents, her parents got divorced and partially remarried, youth services got involved because the parents did not agree on what to do ...

Note that this is independent of the actual health care system. The same problems manifest in Europe with public systems. The problem is that psychiatric help ... well, somewhere between doesn't help and actually destroys people.

Who pays for this is beside the point because mostly, of course, these people are homeless, very ill and/or (ex-)criminals. You can charge them all you want, but as the expression goes "you can't get blood from a stone".

The sad part is that parents and children can be held liable if a suicide (attempt) does damage, which then causes more problems. This is done to "protect" society against psychiatric patients and to redirect as much of the cost of totally rejecting people to those people and their families as possible.

[yarg]

I was replying to a comment pertaining to the cost of health care, not specifically regarding the parent topic of psychiatric care.

Comment threads often branch down different rabbit holes - the issue of how health care is paid for is generally orthogonal to the question of the nature of the care (although industrial lobbying makes this far less true than it should be).

You don't really have to convince me of anything regarding the utterly useless nature of western models of mental health - I've been depressed for over 20 years.

The first thing they did "for" me was put my on SSRIs - which turned me into an asexual robot (fuck you pfizer) the effects only reversed in the last couple of years due to this bad boy - https://en.wikipedia.org/wiki/Bupropion (thanks GSK).

I've gotten more help from fists full of illegal mushrooms than I ever have from the system (but at least they stopped drilling holes in people's heads).

[tivert]

> why is there even a hospital bill for being hospitalized?

Because hospitalization takes a lot of expensive resources. The bill has to go somewhere.

> Keeping your people healthy should just be a given.

For the entirety of human history, up to and including this point, it hasn't been.

> How many hundreds of years will it take before universal healthcare is finally accepted as the basic standard of a humane civilization?

Realistically? When they have AI doctors that can treat the plebs for very little cost.

Until then, we're talking about at least 10-15% of GDP of a rich country, which is a massive amount of money. Even places with "universal healthcare" make tradeoffs (e.g. IIRC, healthcare waiting lists for many things are absurdly long in Canada compared to the US).

[lifeonlars]

The figure 10-15% of GDP of a rich country seems to be concealing something important: in the US, it's nearly 20%. In Western Europe, it's generally around 10%, for the same, slightly better, or in some cases much better health outcomes.

The UK has a famously stingy system which costs 7.5% of GDP, however the UK has better infant mortality than the state with the best infant mortality, Massachusetts. The worst states have infant mortality 2-3 times that of the UK. (Note that the poorest states in the US, LA and AL, still have GDP higher than the UK. So the 7.5% is of a much lower per capita GDP.)

The average EU country spends a little more than the UK, as a % of GDP. But has health outcomes well ahead of the UK, and considerably far ahead of the best-performing US states.

It seems kind of distorted not to point out that around half of the US spend goes either on luxury healthcare for the rich, or emergency healthcare to those who can't afford proper healthcare, or simple rent-seeking by entrenched players (pharma, doctors, insurance companies) and that none of these improves health outcomes by very much.

[tetromino_]

> the UK has better infant mortality than the state with the best infant mortality, Massachusetts

The US uses a different definition for infant mortality than the UK or any other European country. (One major difference is whether a borderline-nonviable birth gets counted in the infant mortality or stillbirth column.) The raw numbers are not directly comparable. Correcting for the expected effect of difference in definitions, the UK still has lower infant mortality than the US overall, but by a far smaller factor.

[lifeonlars]

You are talking about a difference which would reduce recorded US infant mortality by around 15%, when it's nearly double that of Western European countries, and infant mortality in poor regions and for ethnic minorities is far more than that.

[aaomidi]

For the majority of human history, health care was done by village shamans etc (that did actually treat most ailments they could) for free.

It was part of living in that village.

So no, under modern less-personal systems this hasn’t been the case.

[tivert]

>>> Keeping your people healthy should just be a given.

>> For the entirety of human history, up to and including this point, it hasn't been.

> For the majority of human history, health care was done by village shamans etc (that did actually treat most ailments they could) for free.

Would you be OK with universal shamanistic healthcare? Because I don't think that would count as succeeding at "keeping your people healthy" by any reasonable definition. My strong hunch is that village shamans could successfully treat far, far fewer aliments than you could with OTC medications and first aid supplies.

Things start getting expensive once you try to be more effective than that.

And the shamans almost certainly weren't doing it "for free," but a village like that almost certainly is primarily a non-market economy, so their compensation could be obscure to modern eyes (e.g. for a more modern example and easy-to-understand example, Jewish priests were compensated by being entitled to a portion of religious sacrifices).

[aaomidi]

I expect that healthcare to be given with the standards of the day universally.

If we have resource constraints (not enough doctors, hospitals, medications) then one of our top priorities should be to solve the shortages.

[blowski]

Rhetorical and unfortunately polarising, with a lot of detailed and well-written responses from all perspectives.

[hackernewds]

They are in countries that also have high taxation. The US chooses to remain one of the lowest taxed countries in the developed world. The gap could be used to fund private insurance costs, would you rather have that as an option or be mandatory remit to the state?

[maerqin]

That is not exactly true. If you factor in state, county and property taxes, the taxes in the US are similar or sometimes even higher than other western European countries (It depends on the income and living situation, you could maybe approximate the average by looking at the state budget per capita (https://en.m.wikipedia.org/wiki/List_of_countries_by_governm...), but calculating it is far more complicated).

If you factor in insurance, Americans pay more as their percentage of income. In the US there is more private and public bureaucracy in the healthcare system, higher wages for doctors (because they often have to repay their student debt and prices are on average higher in the US) and overall higher prices for equipment and drugs (often due to (often lobbied) laws that favor some US businesses). In Europe health care is treated more as a public service (although there is also for profit health care there). The high profits for US companies in the medical sector have to come from somewhere and they often come from the pacients and the taxpayer, because the US also subsidizes their health care system by taxes. In fact the US government spends more per capita than other governments in the world on health care. https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...

Besides that the taxes in the US are more inefficiently spend than in many western European countries. I could write a long essay about that, but this is just a comment to a hn comment and I already spent to much time on writing it.

[drekk]

I would rather the state be able to collectively bargain on behalf of 330+ million individuals, personally. It would dramatically reduce costs. I never understand this argument because the average American pays more in insurance premiums, deductibles, and out-of-pocket expenses than what the tax would be. Unless you're a (temporarily embarrassed) millionaire I don't get it. As a nation we spend 2x as much per capita on healthcare costs than any other developed nation, and for some of the worst outcomes! Cuba, a tiny island nation-state suffering from 60 years of embargo has lower child mortality rates (under 5 years, infants, and neonatal) compared to the US. How can that be justified?

Life, liberty, and the pursuit of happiness—so long as you have a premium healthcare plan brought to you by Blue Aetna Cigna Humana Kaiser(tm)!

https://www.propublica.org/article/cigna-pxdx-medical-health...

[lifeonlars]

You're actually asking, would you rather be forced to have all your health needs taken care of, or have the freedom to choose inadequate healthcare in order to save money?

[LadyCailin]

So long as insurance providers are obligated to cover individuals that can’t afford the premiums, then sure, why not. But if you’re going to do that, you might as well cut out the rent seeking, handle it at a government level, and make it cheaper overall.

[nullsense]

I dunno. I'll take my high tax rate and universal healthcare any day.

[junon]

My taxes as a US citizen were higher than here in Germany. And I still have to pay taxes to the US even though I don't live there. One of two countries that enforces this. YMMV.

[runsWphotons]

Money really doesn't seem to be a problem for the US government at all. I really don't think it is the taxation, but how they decide to spend all the money they have.

[lynx23]

You named it, humane civilization, which probably also excluded the death penalty. The USA still has quite a way to go. Racist police violence, death penalty, universal healthcare, did I miss something?

[LudwigNagasena]

Who are “your people”?

[amatecha]

The term I used was intentionally vague, referring broadly to the people who make up a given community, society or civilization. Everyone living in a given country, for example. Everyone within a respective health authority's region of responsibility. The people who make up the society in which we live, and with whom we share some degree of dependence and implicit/explicit responsibility to help ensure the survival of.

[LudwigNagasena]

Do you think a civilization where healthcare is provided by mandatory extraction of wealth under a threat of violence is more humane compared to the one where people take care only of their close relatives without being compelled by any force?

[yarg]

Clearly he's referring to the citizens of a nation.

[LudwigNagasena]

Should every person consider people with the same citizenship as “their people” and treat them better than others? Is it really uncivilized and inhumane to not follow that norm?

[yarg]

I think you're reading tribalism into an issue of logistics.

[LudwigNagasena]

There are no logistics issues with residents and tourists.

[yarg]

Bloody hell man, you really do like to read between imaginary lines.

[drekk]

Presumably the voting-age population in the US that allows people to die untreated (or buried in medical debt)