[zaroth]

There’s nothing wrong with the concept of an insurance premium or even a deductible.

The problem is the sheer magnitude of the cost. It’s an extraordinary sum of money to be paying out of pocket as an annual family expense for a non-discretionary basic living expense.

And more or less every single family in the US is doing the same? It’s totally untenable.

[ceejayoz]

My kids had about a million dollars in NICU costs from being three months early. I take a $18,800 shot every twelve weeks.

Now, I think a single-payer national health service would be better, but that $30k/year doesn’t surprise me at all. Our monthly premium is $2,700. It sucks, but this stuff is expensive.

[FireBeyond]

> My kids had about a million dollars in NICU costs from being three months early.

Except the true cost of that NICU stay was not a million dollars.

> I take a $18,800 shot every twelve weeks.

The true cost of that medication is not $80,000 a year, including R&D. Particularly for patients who needs meds like that indefinitely.

Pfizer claims that it effectively is profitable everywhere in the world but the US, its base: That of its nearly $40B profits last year, less than $5B was earned in the US, despite its US sales being nearly $50B of it's $100B global revenue (do that math, they say that selling $50B of drugs in the ROW earned them $40B in profit, yet the same sales in the US netted only $5B in profit...) - they're offshoring all their finances, basically.

Big Pharma likes to peddle the myth that all their R&D takes place in the US, hence the costs. That's all it is, a myth. They do significant R&D in the US, sure, and about the same elsewhere in the world. And most of their R&D isn't from first principles, but often leverages publicly funded research in universities and government/quasi-government orgs.

[haldujai]

> Now, I think a single-payer national health service would be better

This isn't the panacea it sounds like, single payer doesn't work that well in Canada. Having worked in both systems the quality of care and accessibility is far better in the US, assuming you have good insurance of course, but it's hard to get access to things in most of Canada until you're actively dying. Primary care is also challenging to access in most places not Toronto.

I've seen conflicting reports on the math of how this plays out while trying to maintain quality and options.

I fully realize I am saying this from a privileged position that an OOP max wouldn't be financially challenging but I would much rather get care in the US than Canada.

I'm not sure what the best system is. Perhaps a two tier system would work better and have a better safety net, although that's controversial as well. I do think single payer is overrated, of course the US might do it better (and obviously has more resources + economies of scale).

[ceejayoz]

> This isn't the panacea it sounds like, single payer doesn't work that well in Canada.

They pay about half as much per-capita with similar health outcomes.

> the quality of care and accessibility is far better in the US, assuming you have good insurance of course

Well, yes. Homelessness isn't a problem for people who own houses, either.

> Primary care is also challenging to access in most places not Toronto.

This is not unique to Canada.

https://www.health.harvard.edu/blog/why-is-it-so-challenging...

https://www.newyorker.com/science/medical-dispatch/americas-...

"Experts have long warned of a shortage of doctors providing foundational forms of outpatient care, especially in rural areas. Last year, the Kaiser Family Foundation estimated that more than fourteen thousand primary-care physicians were needed to eliminate existing shortages."

[haldujai]

You’re missing the point, I said it’s not a panacea.

I doubt adequately insured in the US (69%) would tolerate lower quality care and being prohibited from paying for better care like in a single payer system, both socially and legally although I am not a lawyer.

There is a growing movement towards privatization and two tiered systems in Canada. It’s already available in Quebec, British Columbia (illegally as recently determined by the Supreme Court) and Saskatchewan. It’s starting to happen in Ontario.

> They pay about half as much per-capita with similar health outcomes.

Health outcomes is very misleading as it’s confounded by baseline population characteristics, lifestyle, and non healthcare related morbidity. It isn’t very useful as a single measure to determine system efficiency. The simplest example is Americans have more chronic conditions than Canadians.

Paying more is only a problem if you get the same level of care, which you don’t.

As compared to the US more Canadians use the ER for primary care, are unable to get same-day or next-day appointments and wait longer for procedures.

https://www.cihi.ca/sites/default/files/document/how-canada-...

> Well, yes. Homelessness isn't a problem for people who own houses, either.

Uninsured rate is 9% acknowledging underinsured is 23%.

The main point here is in the Canadian single payer system quality of care for adequately insured declines relative to what the US has now.

Whether that sacrifice in single-payer (as opposed to two-tier or privatized) is worth it is a complicated political question depending on social values and the legal system.

Using your analogy, people don't want to and aren't giving up their luxury homes to fix homelessness.

> This is not unique to Canada.

No but it’s significantly worse in Canada than the US (see reference in point 1).