[gambiting]

>>Would you go to work without being paid? I wouldn't.

Do you think doctors and nurses work for free in countries with socialized healthcare?

They do get paid. A lot if you're a specialist too - it's a very lucrative field to be in. Admittedly, not for everyone - nurses and junior doctors usually don't get paid very well, but it's my understanding that in US it's not like these professions make bank either.

>>if there was a ton of people who wanted to found, fund, and work at nonprofit health insurance companies.

That's the whole point that Americans are missing - you don't need the insurance companies in the first place, if the entire system is owned by the public. You go to a hospital, you get an operation done and that's it, at no point is there anyone sitting there are processing your "claim" - if the operation is one allowed by the system(and it almost certainly is) then it's just done and the system pays for it from general taxation budget. No one negotiates rates with the hospital, argues about your excess or premiums or in or out of network coverage. Health insurance is something you get for travelling abroad, like if you have an accident while skiing and need a helicopter to get you out, not for visiting a doctor or a hospital.

[s1artibartfast]

Im responding to a comment that thinks the following is crazy and wrong.

>When you remove profit from the equation, you also remove the incentive to increase supply.

Yes, socialized system countries have doctors because they pay doctors, ensuring supply. This proves the point above.

If you pay people to do something, you get more of it.

Health insurance companies dont provide healthcare. They dont stich you up or manufacture pills. They are in the business of vetting and denying claims to ration healthcare provided by others.

>No one negotiates rates with the hospital, argues about your excess or premiums or in or out of network coverage. Health insurance is something you get for travelling abroad, like if you have an accident while skiing and need a helicopter to get you out, not for visiting a doctor or a hospital.

It works different in various socialized systems, but there is always someone negotiating with the hospital, the workers, and the manufacturers. Sometimes this is the government, sometimes it is private insurance.

I dont know which country you are talking about, but almost every country has some sort of Health Insurance. What differs is the level of involvement by the citizens in selecting it.

A classic example would be Germany, which is a multiple payer system with both government and private insurance. 85% percent of people have the government health insurance, which is paid by employers and employees and mandatory. the government manages and negotiates rates for this plan. You can opt out and get private insurance instead, and those insurers have sperate negotiations and offer different services. There is also supplemental insurance, also private, also negotiated separate.

[gambiting]

From my understanding Germany is an outlier among countries with socialized healthcare because their system is either straight up reliant on insurance or is modelled after insurance-like systems. My experience is based on Poland and UK. And sure in the UK you pay for "national insurance" which partially funds the NHS, but the point is that it's almost irrelevant to your coverage - as long as you live in the UK legally you are entitled to treatment, whether you pay NI or not. Again, the difference(imho) is that if you go to a hospital and a doctor there decides you need an operation done, it only goes through a cursory check to make sure the operation is covered and then it's carried out. It doesn't go to some central office where someone checks if you as a person X are entitled to have this done or not, it's not a "claim" like a one you would make with an actual insurance company.

And yes, of course you can supplement that with private insurance if you wish, but vast majority of people don't.

And yes, of course the government negotiates with providers - but when you get treated that's not something that affects you. You don't get a bill that says "your treatment was £10k, but the goverment will only pay £5k, cough up the rest". In fact no one(patients) gets any bills ever.

[s1artibartfast]

I'm pretty sure that UK is the outlier, where healthcare providers are state employees. Wikipedia says the NHS is the largest employer in Europe with 1.4 million employees.

I think the vast majority of countries have some sort of a situation with the government as at least one of the payers, and Private health care providers.

I completely agree that the US is an outlier in how involved the patient is in the payment of their healthcare, and the fact that they can be left with the bill instead of the provider if the insurance is denied.

On a psychological level, I think people are more frustrated by being offered care that they can't afford and dealing with uncertain coverage then not being offered the care at all.

I'm a huge proponent of healthcare reform in the US. That's sad, I think one of the biggest problems with getting it past is unreal expectations. Americans have a caricature of European healthcare in their mind that is totally inaccurate.

[thegrimmest]

It’s still an insurance system though, whether it’s publicly owned or privately. There are still bureaucrats who decide what is covered and what is not, and they make that decision for the entire population. Things like cutting edge cancer treatments (often developed in the US) are many years late arriving to public healthcare systems. And many expensive treatments are simply not covered, or covered as second or third line (eg. immune therapy), when patients in the US with appropriately good insurance receive them as first line with far better outcomes.

> No one negotiates rates with the hospital

No one negotiates period. Coverage decisions are made unilaterally by government officials, and services that those officials deem too expensive are simply not offered. The same issue exists with medical equipment. The wait time for an MRI is absurd in eg. Canada because government only funded so many machines. In the states there are simply more machines, because supply was more elastic, and more freely able to meet demand.

[gambiting]

Sure. Don't get me wrong, I'm sure American healthcare system can be amazing in certain cases, and like you said, in specific instances the "market demand" is able to solve issues that socialized systems struggle with. But the same is true in the opposite direction - plenty of stories of people being denied lifesaving care because insurance companies decide it's not worth it. People who have their cancer treatment stopped because their employer changed the insurer and the new insurer has to do a full re-evaluation before they approve the treatment to continue, so in the meantime you get no cancer drugs for months while they do their process. And so on and so on. We could both do this I'm sure.

>>when patients in the US with appropriately good insurance receive them as first line with far better outcomes.

The problem I have with that is basically you're saying the quality of the treatment depends on what insurance you have. In socialized healthcare everyone gets the same treatment.

And in fact this is reflected in the average quality of care received on average, with outcomes in US being much worse than elsewhere. US has mortality from "preventable causes" twice as bad as Australia, Japan or France(paragraph 5). So in US few people get amazing care better than anywhere else. And most people get worse care than anywhere else.

https://www.kingsfund.org.uk/insight-and-analysis/blogs/comp...

>>Things like cutting edge cancer treatments (often developed in the US) are many years late arriving to public healthcare systems.

Obviously it's hard to make a general statement on this because every country has varied policies around this. But to share an anecdote - my own dad was enrolled into an experimental programme at a leading oncology hospital in Poland because he had a very rare and ultra aggressive cancer which had no known treatment other than a brand new(then) Glivec, which wasn't even approved for that cancer yet, but he had the whole course of his treatment fully funded under our socialized healthcare. In those very very rare cases where regular treatment is not available there are avenues to explore experimental treatments, and they then serve to direct general treatment plans for the rest of the population. Again, this is a specific example from one country.

[thegrimmest]

You would concede that, as a consequence of imposing involuntary obligations on their citizens, socialized systems are less free? And you would also concede that reasonable people can disagree about the priorities of their values, and that valuing personal autonomy over collective well-being is a reasonable position?

> people being denied lifesaving care because insurance companies decide it's not worth it

You get what you sign up for. Like in any business transaction, doing your due diligence and understanding the details of both parties obligation is table stakes. We also have courts precisely for cases when such disputes become intractable.

> so in the meantime you get no cancer drugs for months while they do their process.

No one is stopping you from paying for the drugs yourself. Insurance will reimburse you once they validate your claim. Bureaucracy takes time.

> the average quality of care received on average

And the quality of care on the upper end is markedly worse in many ways. Wealthy people from all over the world travel to the US for their medical procedures for a reason. You're effectively arguing that net-contributors to society (people who pay a lot of taxes) should accept an increase in their tax burden for the privilege of a degradation in their personal access to and quality of care, in order to bring up the average. I hope you appreciate just how directly this opposes the interests of this class.

> From each according to his ability, to each according to his needs

You can't have a system like this in a free country. I want the freedom to associate (in an insurance pool) alongside other people with a similar risk profile to myself (eg. no drinking/drugs/smoking, daily exercise, good sleep, healthy body composition) to the exclusion of others. I want my insurance company to carefully scrutinize its applicants and claimants, on my behalf, to ensure that my interests are being well-represented. Insurance does not mean absolution from personal responsibility.

[gambiting]

Well, needless to say, I disagree with every single sentence of your post. I don't think there's a reason to continue - we'll just not agree here.

[s1artibartfast]

The government still negotiates. Refusing to buy a product/service at X rate is a negotiation, and there is a back and forth with providers/manufacturers.

Same for state employed healthcare professionals, which have salary set by the state.