[ok_dad]

Too bad America doesn’t have nationalized health insurance for everyone. The only argument against it that I can see is that people think standards of care will decrease. Decrease from what? From more people having insurance! They want some folks to be in dire straits so they can have cheaper health insurance, but any reasonable study shows that health care would cost less on single payer healthcare.

(I don’t care how unpopular this view is on hacker news, I stand by it. I’m ashamed sometimes that this forum is so harshly capitalist and thrives on grinding poor humans into proverbial paste, because otherwise everyone here is pretty kind and supportive of each other.)

[giantg2]

It's an incredibly complex topic and probably off-topic for this article. For example, you could in fact have lower revenues at a provider even if everyone has insurance, if that insurance pays less than today's private insurance. There certainly could be cost savings under a single payer plan, but to what degree is highly dependent on the proposed system. It's worth noting that one of the main points of contention is how to fund such a system (who to tax, from what source, how much, etc).

[ok_dad]

How is it off topic? This guy is surviving in the good graces of his former employer. Off they pulled the contract, he’d be pretty fucked. In America, this is because without a job you don’t have healthcare unless you pay out the ass for it. My comment was very on topic.

I agree it’s complex, too bad no one is smart enough to solve it.

[giantg2]

The article wasn't really covering any reforms. The article itself is probably off-topic for HN.

I think a lot of the negative response to your comment is how you framed it and the questionable content (having fewer insured people doesn't necessarily make care more affordable; in fact the point of the ACA was to increase affordability through increased coverage, although the effects on gross costs seem negligible).

Yes, things would not be as good if they pulled the contract. But Medicaid is an option, so it's not like he'd have no care at all and one doesn't need to "pay out the ass" for that.

[ok_dad]

That was my point, people think increased coverage will cost us more in aggregate, but most studies show that if everyone were covered under a large single payer or natural heath plan it would be cheaper overall!

I don’t really care about the downvotes, that’s what the button is for. I’m also neurodivergent and don’t really communicate my thoughts well so I’m used to it.

[rootusrootus]

> Too bad America doesn’t have nationalized health insurance for everyone.

What fraction of America has socialized health care already? Half, more or less? It doesn't seem like a big leap to go all-in.

[rootusrootus]

For anyone else reading, It's only about 36% or so that are covered by socialized health care. E.g. 85M in medicaid, 65M in medicare, 10M in tricare.

So we have a pretty good basis to figure what it would look like to make that number 100%.

[chankstein38]

Yeah I don't really get it either except that there's a whole basically half of the media that will do anything they can to demonize it. Our healthcare as it is now is atrocious. I wait a month for an appointment for a simple thing. I have a friend whose kid is special needs and he has been waiting for months for results of a genetics test that he's repeatedly been told they have but they keep rescheduling because "the results aren't ready yet."

It's costing him an arm a leg and his kid is not getting potentially important treatment because of it.

But I have heard endless talking points about how "You'll just wait until you die under a single payer" or that care will degrade. It's sad. I've had arguments with people about this and they can only repeat those talking points and pretend they have personal experience with people in other countries because some talking head on the radio told them "The Brits are always waiting for their healthcare some die before getting there"

I was part of these people a decade ago. I've grown a lot since then and the time there has become a huge learning experience because I now see how manipulated I was. I thought I was "informed" because I listened to these talking heads tell me what to think all day. Truth is, I feel more informed today. I learn from whatever comes up but everything comes through a lens of "This may be special interests manipulating me."

Anyway, yeah. Long story short, from my perspective at least, the people against it don't really know why they're against it. They've just been told to think that and they think that makes them informed. The reality is our healthcare system is trash and will bankrupt anyone but the richest people in the case of an emergency but a huge percentage of the US is against making it better because SOCIALISM.

[giantg2]

"huge percentage of the US is against making it better because SOCIALISM."

There are many people who oppose things they don't understand because they haven't looked. There are also people who oppose things temporarily because they looked but have unanswered questions or some of the details don't make sense. We'd probably make more headway working to convince the people who will listen than trying to convince people who are ideologically opposed.

[pyuser583]

Standards will almost certainly decrease, especially for people in top 60%. And possibly for everyone.

The argument in favor is financial. But anyone with halfway decent medical coverage - tech workers, government employees, retirees, union workers, etc, it’s almost certainly going to go down.

Part of the reason is that Americans do get pretty decent care when they can afford it.

I can tell you personal horror stories about my time in Europe and ex-Europe.

I’d say the real problem in America isn’t even payment - it’s how medical information is siloed and treated like proprietary data. Usually under the guise of patient privacy.

[mindslight]

Have you been to a US doctor for anything more than a check up? Ten minute appointments, most of which gets spent on mechanical questions and memorized explanations is not decent care. Being pushed out through gradual ramping up of social pressure after your "allowed" one or two questions, so the doctor can move onto the next semantic billing event, is not decent care. Continually hearing, in every single setting, that everything is someone else's responsibility is not decent care. If decent healthcare gets provided in the US, it's in spite of the system, and those individual doctors/nurses/etc going above and beyond inevitably end up burning out. Lather, rinse, repeat.

I'm not a proponent of single payer because I don't think it addresses the root problem of the absolutely broken anti-patient incentives of a system that has long ago been destroyed by bureaucracy. But I'm not an opponent of single payer either - I just don't think it's the panacea people think it is.

[pyuser583]

> I'm not a proponent of single payer because I don't think it addresses the root problem of the absolutely broken anti-patient incentives of a system that has long ago been destroyed by bureaucracy. But I'm not an opponent of single payer either - I just don't think it's the panacea people think it is.

I totally agree. Payment isn’t the problem.

But I’ve had similar experiences with doctors in European and ex-European nations.

If I could make one change to the healthcare system, it would be a universal healthcare records system.

It’s nuts this is treated like it’s proprietary data.

[mindslight]

I can't speak about Europe, but I don't think the healthcare records alone would actually help care in the US. Once again the problem is the base incentives - a doctor doesn't actually want to have access to your whole medical history, as it would mean they would have to spend time reading it or otherwise possibly be liable for some detail in it. My experience is that staying at the same practice, even one with its own EMR, they basically ask you to complete a new patient health questionnaire every single year and self-enumerate all of your health concerns. Presumably it's the same incentive of not wanting to have to read, understand, integrate, and synthesize everything from the past.

My problem with your previous comment is that you just baselessly asserted that healthcare standards would go down with single payer, which is a common political talking point that completely ignores how the industry has already been captured and destroyed by private corporate bureaucracy (ie we already have "death panels", only they each consist of a single malpracticing doctor with a computer algorithm and an autosigner). Payment isn't the underlying problem of why healthcare is so bad, but it's certainly another problem for many people who go receive (shoddy) healthcare, and then afterwards end up at the pointy end of fraudulent billing shakedowns.

[giantg2]

"Standards will almost certainly decrease, especially for people in top 60%."

Arguably, private insurance will still exist for the upper class. So the top 10% or so will likely be unaffected. It would just further increase any inequality that currently exists. (The current proposals are Medicare for all and not a state run facilities)

[pyuser583]

I said 60%, not 10% - which is a tougher problem to solve.

Medicare as it currently exists is not “free at point of service”, or even “affordable at point of service.” There’s the Medicare gap, etc.

Medicare isn’t really set up to be a universal program. It assumes that providers have non-Medicare patients, and regularly uses that fact to calibrate the program.

[alistairSH]

Couldn't we just allow private policies on top of the socialized/nationalized plan? I'm pretty sure one of my Scottish uncles has a concierge plan in addition to whatever NHS offered.

[pyuser583]

I mean concierge policies are fine, but for what?

Not for core health care competencies. That wouldn’t be universal coverage.

When I say “quality would go down” in talking about actual health care.

Having a system where you have to pay extra to have a good doctor sound suspiciously like the current system, except it’s usually your employer paying extra.

[alistairSH]

Define "worse", I guess. Health care outcomes in the US are demonstrably worse than our peer nations and at a much higher cost today.

Yes, as an upper-middle-class salaryman, my care is above average. If I don't like what Uncle Sam provides, I can buy additional coverage/care. No change for me.

For everybody with worse coverage and less income? They're already receiving worse care than most of Western Europe.

My personal point of reference: Scottish immigrant, with substatial family in Scotland, Ireland, and Australia. Both white collar and working class.

[rootusrootus]

Ha, do 60% of Americans even have private health insurance? Less than half get it through their employer, so that would mean more than 10% are just paying out of pocket through the exchanges?

[nickff]

This is extremely easy to look up, from a very reliable source:

>"In 2022, private health insurance coverage continued to be more prevalent than public coverage, at 65.6 percent and 36.1 percent, respectively."

https://www.census.gov/library/publications/2023/demo/p60-28...

[rootusrootus]

Thanks for that. 65% is more than I'd have expected. 48% get it through employer, so the number paying for it on the exchanges is around 17%. I would have guessed the employer number were higher than the out-of-pocket payers lower.

[choilive]

So how would that change with increased health care access for everyone? Anyone with the means could certainly get access to elite healthcare if they wanted to like they do today.