[cyberax]

> Why with single payer would there not still be instances of treatment being denied?

The most common failure mode for single-payer is scarcity. You won't be denied, but you'll have to wait many months for an appointment.

> Would this not be replaced with faceless automata in government?

They are controlled by politicians, who are directly responsible to their electorate. Brexit is a good example, using money sent to EU for NHS was one of the more influential ads. Of course, the outcome turned out to be... different.

With the current insurance system, you don't have ANY levers. You can't usually change your insurance company because it's provided by your employer. And even if you want to buy medical insurance yourself via the ACA, you can switch it only once a year. With no way to tell in advance if your new company is going to cover your treatment.

You also can't even sue your insurance company if it denies you the treatment because _all_ insurance companies require binding arbitration. And arbitrators basically always side with the insurance company, because your contract says that the insurance company is always right. That's how UnitedHealthcare can get away with just randomly denying treatment.

[colechristensen]

>They are controlled by politicians, who are directly responsible to their electorate. Brexit is a good example, using money sent to EU for NHS was one of the more influential ads. Of course, the outcome turned out to be... different.

Calling out Brexit is an... interesting way to argue here.

If you're proposing my options for heath care are going to be taken away and given to the single option controlled by the electorate who are liable to do things like Brexit... no thank you, I'll take marketplace competition where I can "vote out" the idiots by making a different choice for myself.

People here are like "isn't it awful that personal medical choices are being made by politicians and popular vote" with respect to abortion, gender-affirming care, etc... and those same folks are damn near excited to give away all of their health choices to a government entity.

Do you want your health care options to be dictated by an executive order the first day a new president enters office?

[cyberax]

> Calling out Brexit is an... interesting way to argue here.

Why? It's an example of directly affecting healthcare via political pressure.

> If you're proposing my options for heath care are going to be taken away and given to the single option controlled by the electorate who are liable to do things like Brexit... no thank you

That's the thing, it can also be fixed by the electorate.

> I'll take marketplace competition where I can "vote out" the idiots by making a different choice for myself.

Except you can't. Go on, read your insurance contract if you don't believe me. You're at the total whim of death panels, who can just tell you to go and die.

[AnthonyMouse]

> That's the thing, it can also be fixed by the electorate.

In theory it can but in practice it usually isn't, especially for things like this. It's all too easy for some bureaucratic rule to be killing people who have e.g. a particular type of cancer, which makes that 0.5% of people care about it very much, but it takes 51% of people caring about it to change the law.

Meanwhile some other rules are each killing some other 0.5% of people and when you add them all up it's a large-scale disaster but it's also many independent problems. The details matter but the electorate doesn't have the bandwidth to even understand, much less solve everybody's different problems.

You want as much as possible for people to be able to affect their own circumstances rather than relying on the bureaucracy to care about them.

[atombender]

Those rules are completely hypothetical and borderline reductio ad absurdum, since they have never been in place anywhere in the world, and you could make the same argument about anything the government does.

You seem to pretend that people in countries with universal healthcare don't have any agency, but of course they do. Public healthcare doesn't preclude private healthcare. We see this in Western countries that have high-quality universal healthcare, which have successfully managed to strike a balance.

There will of course always be gaps not adequately covered by the public option — new, unproven modalities that aren't offered, or unacceptably long wait lists, or a certain drug being denied that might help improve quality of life over a more conservative drug. In those situations you always have the option to seek alternative private healthcare at higher cost, and you always have the option to get private insurance. So many commenters on HN (presumably American) paint universal healthcare as some kind of draconian Big Brother regime where it's either all or nothing, and the public option will "take away my rights," when nobody has ever proposed such a thing.

In the US, you are under the thumb of private insurance companies whose profit motive is, indisputably, not aligned with patients' healthcare needs. Sure, you can shop around for insurance plans, but realistically, when faced with a health crisis, that's not an option. Which means you have to deal with a system that doesn't care about your health and tries to wriggle itself out of paying anything more than the minimum they're obligated to cover, and that minimum isn't known until the bill arrives. To my mind, having lived under both types of systems, the American scheme is much more restrictive.

Under a universal healthcare scheme, there's no profit motive to cloud the quality of care. There's a cost reduction motive that can affect quality of care, but as the other commenter points out, the democratic model helps balance that. The world over, in places like Scandinavia and the UK, funding of healthcare is a big concern that gathers a lot of public debate and figures heavily in election campaigns; it's not swept under the rug. It's not perfect, but it feels much more of a "we are all in the same boat" kind of environment than the American one where every day we have newspaper articles about huge hospital bills, health bankruptcies, drug epidemics caused by greedy pharma companies, and widening wealth inequality.