[paulhauggis]

Issues I have with public health care:

1) The government hasn't been able to run anything efficiently as long as I've been alive. It's not like we can just go back if UHC doesn't work out.

2) The more the government runs our lives (especially something like health care), the more they will be able to dictate our choices (what we eat, risky behavior, etc).

3) I haven't seen one person that supports public health care tell me the downsides. I know they exist and we need to know the risks (and talk about them openly) before making such a huge change to our current system.

[anigbrowl]

1. Oh please, this is just a truism expressing your general political views. Government does lots of things well. Every time there's a relevant accident, the NTSB is on the spot within 24 hours. The FAA does an amazing job. I could go on with many other examples; and where government is slow to respond, it's often because the rules require government to engage in a lengthy public consultation process or make it easy for third parties to litigate against the government (see: any case involving environmental review). It's not like waste, inefficiency, and so on are absent from the private sector.

2. The more your choices impact the lives of others (making yourself chronically ill and sucking up expensive medical resources, driving at 100mph in the rain), the more costs your bad choices impose on other people. Government is the agency we delegate some of our individual autonomy to in order to deal with such systemic problems. The alternative is everyone suing everyone else all the time.

3. I'll tell you the downsides: there are waiting lists for some procedures that are in high demand. There are about as many industrial disputes as before. Everybody blames the government for everything (like a tiny country hospital shutting down, nurses' pay, availability of some experimental treatment of unknown efficacy). A commonly-voiced fear is that if healthcare is cheap then everyone will crowd up doctor's waiting rooms all the time. This doesn't happen, because other than a tiny number of hypochondriacs nobody likes going to the doctor unnecessarily, for the same reason that most people don't engage in recreational dentistry.

The fact is that healthcare can't clear like a normal market for three reasons: a) there are genetic factors that you have no ability to control or predict that can make you sick unexpectedly; b) you typically don't have a choice about when you get sick so you can't defer your healthcare spending accordingly; c) most participants in the market are woefully under-informed because they don't have any kind of medical degree, and price theory demands market transparency for all participants in order for equilibrium to emerge and vendors to be price takers. What we have instead is a monstrously inefficient and unresponsive form of monopolistic competition, in which part of your healthcare costs go towards billboards and TV commercials for goods and services whose efficacy you are incapable of judging properly, massive layers of incomprehensible administration, and heads-I-win-tails-you-lose pricing that royally shafts the individual consumer in insurance and care markets.

[tptacek]

It is especially amusing to see people suggest that the government can't competently administer health care given that Medicare customer satisfaction exceeds that of private health insurers. It's weird how easily people "forget" that the federal government is already an extremely accomplished health management administrator.

But I take issue with your argument about the health market not clearing. In fact, consumers have important options for how they finance the cost of care. One obvious one: they can pay higher premiums for a low-deductible policy that gives them less control over their outlays but eliminates risks, or they can opt for nosebleed deductibles offset by rolling health savings accounts.

[anigbrowl]

I see your point, but I think it's very hard to gauge what the appropriate level of insurance is, because the risk factors are opaque and the likely cost of treatment unpredictable.

The other reason I'm strongly in favor of socialized healthcare is because of the insane administrative burdens it imposes on patients, whether or not they have insurance. Every medical decision a person makes about their own health in the US suddenly takes on administrative and financial dimensions that are quite poorly correlated with the clinical considerations.

[jbooth]

Don't forget the VA, too.

Our government only insures the absolute worst customers (old people, poor people, veterans), and STILL does it cheaper than the vaunted private sector. It's absolutely mind blowing how bad a job the insurance system does.

[astrodust]

Medicare has been run for decades at a pay-out efficiency significantly higher than private insurance companies. There's a model that's in place and works even when loaded down with high-risk individuals.

The government already "runs your life" by dictating speed limits, acceptable levels of toxins in your foods, safety standards for cars, etc. You're freaking out about things that don't matter.

You know what the downsides to public health care are? Fewer jobs in the insurance industry. You also won't be able to expedite your care by paying a premium, everyone gets roughly the same treatment. For 99% of the people out there, this is a non-issue.

[grecy]

1) Given that the health insurance companies in America make billions in profit every year, I'm confident the government can be more efficient than that.

2) This is a naive line of reasoning. The (socialist) FDA already stops you from buying food with lead in it. The (socialist) DMV forces you to wear a seat-belt and wear a motorbike helmet and the (socialist) Police stop you beating people up on the street whenever you want.

You are basically saying you don't want "big government" to tell you want you can't do, even though those rules and limitations would make your society better for everyone overall. Everyone's happiness would go up. This is very selfish and shortsighted.

3) It's very simple. Everyone is equal. A billionaire is treated the same as a homeless person. A strongly classed society (like America) does not like this idea, because Americans define success as "better than other people". Public healthcare would take away this distinction.

[baddox]

> You are basically saying you don't want "big government" to tell you want you can't do, even though those rules and limitations would make your society better for everyone overall.

You're demonstrating a very common misconception, which is that people who don't want the government to perform a function do not want that function to be performed, or that certain functions can only be performed by a government.

> It's very simple. Everyone is equal. A billionaire is treated the same as a homeless person. A strongly classed society (like America) does not like this idea, because Americans define success as "better than other people". Public healthcare would take away this distinction.

Is there a competition being held in this thread to see who can make the most ridiculous generalization? Seriously, at least put forth a bit of effort into making your argument seem remotely credible.

[protomyth]

"1) Given that the health insurance companies in America make billions in profit every year, I'm confident the government can be more efficient than that."

Given this theory, explain Indian Health Service.

Point 1 is bad reasoning and demonstrated to be false. On point 2, rules are not inherently socialist (Capitalism actually requires a strong rule of law).

[grecy]

I have no idea what Indian Health Service is.

I know rules are not inherently socialist, what I was saying is you already live with a ton of them, and thinking that adding a few more will drastically decrease your "freedoms" is delusional at best.

[protomyth]

Indian Health Service is the currently running, government health care for a small fraction of the population. If they cannot get that right, they cannot get it right for the rest.

Adding a few more rules is the dictionary definition of loosing freedom. Adding the wrong rules will.

[mgkimsal]

"The government hasn't been able to run anything efficiently as long as I've been alive."

I'm not so sure private insurance companies and hospitals are all that "efficient" either, but define "efficient" first. Private insurance companies are motivated by making a profit, and the easiest way to do that is to take in money, but pay out as little as possible.

There's very little competition in insurance, as 'the market' is primarily larger employers, so insurance companies by and large cater towards the needs of their biggest customers.

We need to get rid of employer-provided health care benefits, and focus on getting people to buy it directly themselves. This will bring more market forces to bear, getting more companies to compete for our business, not the employers', and perhaps we can then talk about 'efficiency' and having that be something positive for end recipients of health care.

[tdfx]

> We need to get rid of employer-provided health care benefits, and focus on getting people to buy it directly themselves.

This. People are given these ridiculously expansive health care plans and most of the premium is picked up by their company or is deducted before they ever notice it. If people have to buy it themselves, they're going to choose higher deductible plans to get lower premiums. With higher deductible plans, they will want to see what their money is paying for and demand price transparency (which is sorely lacking in the US health care market). Allow companies to operate without stifling state interference and this will be a whole new market, one that actually responds to the forces of supply and demand (as opposed to the clusterfuck we deal with now).

[3825]

> 2) The more the government runs our lives (especially something like health care), the more they will be able to dictate our choices (what we eat, risky behavior, etc).

I know I will be pushing for change towards less and not more freedom. It makes no sense that you have to pay for my reckless high-risk behavior such as jumping out of a second floor window "for shits and giggles".

Another thing in particular that I want to call out attention to is food. If I retarded enough to eat nothing but McDonalds every day for a year, why should you just not let me die? Why should you pay for my surgery? If you are going to pay for it, over time you will gravitate towards a "high-risk fee" on activities that are just plain dumb.

Let's increase taxes on cigarettes, alcohol, (and implement new ones on ecstacy, marijuana, and all drugs... I don't know how that's possible without legalization but there is no way I am paying for someone rehab for something that has not been taxed)

The idea is that nobody should have to pay for someone else's high risk activities. Over time, the high risk activities will become expensive enough. Money will be a driving force that will drive people towards a better lifestyle. Think about it. Money will be a force for good for once.

Just take McDonalds. People say McD is a cheaper to healthier food. If a McD meal is a dollar and causes a health maintenance fee of twenty dollars, what do we do? We tack that twenty dollars to the cost of the meal. Bam! The McDonalds meal is now $21. That $2.49 price tag on the celery at Aldi's is suddenly not so expensive by comparison.

Yes, there are downsides but if enough people are annoyed you will get real reform. Please don't do anything stupid like the last time when conservatives tried to "starve the beast"[1]. We have solid evidence that starve the beast does not work.

[1]: https://en.wikipedia.org/wiki/Starve_the_beast

[oleganza]

So certain people point guns at everybody else to extract money and pay for health care. It suddenly diminishes motivation to stay healthy and we need even more guns pointing to some other people so some third category of people would feel that motivation has been justly restored and everybody is moving towards brighter future.

And please don't even start with an argument that "you can go away if you don't like it". It is you, not me, have to prove that some people have a right to point a gun at us while we cannot do the same towards them. Either that, or there is no difference between initiation of force and self-defense, but then it does not prove why somebody has an exclusive right to use guns.

To those who are going to downvote me: are you able to come with a valid argument why it is me, not people with guns should prove a position before taking action?

[corry]

Regarding (1): The question isn't whether gov can run it 'efficiently', but if gov can run it MORE efficiently than the current system.

Based on the US's position as highest per-capita spender on healthcare + the underwhelming quality of care that $$$ gets you, more gov intervention seems like a pretty valid thing to look into.

[smokinjoe]

1) Can this just stop until someone presents a direct (and accurate) comparison? You make it sound like it will be a fourth branch of Government. There are several Government Agencies that don't hemorrhage money and actually accomplish what they set out to do. Look at Medicaid - people were saying essentially the same exact things about it and now people probably couldn't imagine not having the program.

2) Please explain.

3) Probably because a wider availability to care and an overall increase in average quality of life is a good, if not great thing for a society.

[tptacek]

1) You mean besides Medicare.

2) You mean besides whether you have to work for a BigCo to have health coverage.

3) You mean besides every discussion about public health care that has ever happened on Hacker News.

[rquantz]

Do you have these issues with Medicare, Medicaid, and Veteran's healthcare?

[r0s]

1) How efficient is Medicare now? Private healthcare will always be an option. The existing private system would still be very good, and very competitive.

2) You can say the same for private industry.

3) The downsides are taxes. Expand the existing government payer system with minimal logistic cost. Remove the tax burden from employees (or employers passing it on to same) and watch the economy flourish. The biggest risk is to private insurance, which will never fully recover. Some may opt for the nonprofit model.

[rprasad]

Issues with private health care:

1) Private health insurers haven't been able to run anything efficiently as long as I've been alive. My premiums go up by double digit percentages every year because "costs" keep increasing, but at the same time, insurers' profits go up by double digit percentages every year. It seems like this is simply a money transfer to health care executives.

2) The more private companies run our lives (especially something like healthcare), the more they will be able to dictate our choices (what we eat, risky behavior etc). Oh wait... corporations already do dictate what we eat, what sort of medicine we use, where we work, how we communicate, how we move around, what we wear...The only difference between corporate control and government control is that we actually have some say in how the government controls us because at the end of the day we control the government.

3) I haven't seen on person that supports privated health care tell me the downside. I know they exist and we need to know the risks and talk about them openly before we stick with such a horrible system.

But anyways, the downsides to public health care: cafeteria health care (i.e., standardized treatments) which is good for most patients but not for the few who have nonstandard variations of ailments; higher taxes; less personalized care as a consequence of standardized treatments; potentially reduced choice of health care provider(s) (but if the entire system is UHC this may not be the case); potentially longer waits for medical treatment that cannot be handled in a day (i.e., anything that cannot be handled outpatient or by nurses or nurse practitioners).

And the downsides to private health care: all of the above, plus: risk of claim denial for valid claims (though admittedly less of a risk now as a consequence of numerous state and federal laws cracking down on claim denials); double-digit increases in premiums every year despite no corresponding increase in costs (this is actually happening, and has been happening, every year for the past decade); reduced choice of health care providers (which is actually the case now, i.e., in-network vs. out-of-network); ruinous medical bills; unnecessary tests and treatments; private health information being shared with "business partners"; inadequate medical facilities as a result of lack of capital investment due to premiums being redirected to marketing or executive retention.

It turns out the downsides of a private health care system outweigh the downsides of a public health care system, since you have all of the same downsides but the additional downsides that come with a profit-seeking business. And as history has amptly demonstrated, cost-cutting is not one of the benefits of a private health care system (costs are cut in a way that benefits the insurer's profits, but in ways which are detrimental to the insured).

[baddox]

> My premiums go up by double digit percentages every year because "costs" keep increasing

Because of government regulation.

> The more private companies run our lives (especially something like healthcare), the more they will be able to dictate our choices (what we eat, risky behavior etc).

Not violently, under the threat of fees or imprisonment.

> The only difference between corporate control and government control is that we actually have some say in how the government controls us because at the end of the day we control the government.

That's not true. The principal difference is that government uses violence to maintain control, while companies almost universally do not (except when they do so by lobbying government). Businesses go out of business all the time, which is a prime example of society exercising control over unpopular businesses, but unpopular governments very rarely cease to exist. I'm not sure how you can justify the claim that society has more control over government, with its vast military and police system and its nationwide campaign of mandatory taxation, than over businesses, which (with very few counterexamples, most of which involve employing government violence) only make money through voluntary transactions where both parties believe they are benefiting.

When you list the downsides of public and private health care, you leave out the primary distinction, which is that with private health care each person gets to choose which (if any) provider and plan to pay for, while with public health care there is no (or less) individual choice.

Now, I won't deny that a "perfect public health care system" sounds ideal, but the problem is that the definition of "perfect" varies from individual to individual. This is not a particularly profound or original idea: any dictatorial control is great for the people who enjoy the choices the dictatorship makes. You can easily apply this to some industry that is mostly privatized, like automobiles. If the perfect vehicle for Bob is a 4 door sedan with great gas mileage because Bob commutes and drives his family around a lot, then a "perfect" system for Bob would probably be one where 4 door sedans were the only automobile produced, and every household paid a set fee and was issued one of these sedans. Bob's costs would almost certainly go down, both from the economy of scale from only manufacturing a single type of car, and from the distributed fees. But that system is really bad for Joe, a farmer who really needs a large pickup truck and will probably have to buy one himself while his government-issued sedan goes to waste. Joe could argue (and I would agree) that even though switching to a privatized automobile industry might cause higher prices for a lot of people (like Bob), the individual choice is the important factor.

[paulhauggis]

"Private health insurers haven't been able to run anything efficiently as long as I've been alive. My premiums go up by double digit percentages every year because "costs" keep increasing, but at the same time, insurers' profits go up by double digit percentages every year. It seems like this is simply a money transfer to health care executives."

If they could compete across state lines, this would be different. You also seem to leave out the government regulations in place, which many times hurts the consumer rather than helps (see: Obama care).

"The more private companies run our lives (especially something like healthcare), the more they will be able to dictate our choices (what we eat, risky behavior etc). Oh wait... corporations already do dictate what we eat, what sort of medicine we use, where we work, how we communicate, how we move around, what we wear...The only difference between corporate control and government control is that we actually have some say in how the government controls us because at the end of the day we control the government."

So you are saying because all of the people here on HN and in the US that want MJ legalized, it's magically legalized? That's not how the government works.

What about the TSA and all of the control they have over us? We have a say..right?..right??

"The only difference between corporate control and government control is that we actually have some say in how the government controls us because at the end of the day we control the government."

The government can send you to prison for not doing what your are told. A corporation can do no such thing. If you don't agree with what a corporation is doing..you can just stop giving them money. Is there an opt-out with taxes? or following the law?

"And the downsides to private health care: all of the above"

With private health care, you have no choice. Yes, there may be private care, but it's so expensive..only the truly wealth can afford it (see: the UK). I still want a choice.

[Dylan16807]

> My premiums go up by double digit percentages every year because "costs" keep increasing, but at the same time, insurers' profits go up by double digit percentages every year.

The raw profit values in dollars? If the costs go up 20%, the premiums go up 20%, and the profits go up 20% all together I'm not going to cry foul. The problem is the fact that costs are going up because of bad management.

> at the end of the day we control the government

You also control which insurance company you use. You have even more power; think about how hard it is to switch countries.

> downsides of a private health care system outweigh the downsides of a public health care system

I agree there, at least when it comes to basic care.

[IanDrake]

Total BS.

Have any figures to support your first point? Here's CIGNA: http://yhoo.it/TLkvyd increase in Net Income: 2010 - 3.3%, 2011 - (1.3%)

>the more they will be able to dictate our choices

Private companies can't force you do to anything, only government can do that. http://bit.ly/Q4lj1s http://nbcnews.to/rK90ox

>government control is that we actually have some say in how the government controls us because at the end of the day we control the government.

That was a joke right?

As it is there is a shortage of nurses and doctors. Partly because it costs a lot of money and effort to enter that profession. How many people will be motivated to go that direction if they'll be slaves to government decree? It will take some time, but the effect of government controlled healthcare will be a race to the bottom.

Also, the profit motive is what keeps costs down and service levels high. The less regulated an industry is, the better the service and products are available to consumers who now have choice.

[beagle3]

> As it is there is a shortage of nurses and doctors. Partly because it costs a lot of money and effort to enter that profession.

In the not-so-distant-past (less than 10 years ago!) mostly because the AMA tightly controls the influx of new people to the field, in an attempt to make sure that the salaries remain high: http://skeptics.stackexchange.com/questions/4561/does-the-am...

(Although now they are trying, so far unsuccessfully, to reverse it)

> How many people will be motivated to go that direction if they'll be slaves to government decree?

Instead of philosophizing in the void, why don't you look at other countries where, gasp, that is the case? Look at Canada, France, the UK, Israel, Hungary, and any other single payer country. Medical schools still have a 1:10 acceptance ratio, and are usually the hardest or 2nd hardest to get into. There is no "race to the bottom" in countries that had this system for over 50 years.

> Also, the profit motive is what keeps costs down and service levels high.

And yet, the US system is the most expensive system for what it gives (compared to single payer), and what it gives isn't better when you measure e.g. life expectancy. I would say you never actually looked at data if you can say that with a straight face.

> The less regulated an industry is, the better the service and products are available to consumers who now have choice.

I agree about that, but the US healthcare industry is extremely regulated in all the wrong ways. For example, they are exempt from any claim of anticompetitive or antitrust. How do you think that affects choice?

[IanDrake]

>And yet, the US system is the most expensive system for what it gives...

I was making a generalized comment. As you said, the US healthcare industry is extremely regulated, which is what I believe is the root of the problem we face.

People who want a the government to control health care are pointing at a system with a ton of government interference and saying "Look that isn't working well, we must need more government."

>How do you think that affects choice? Poorly. But they're exempt because they're also force to take all comers. It's a water fall of faulty logic and regulation.

I'm not defending the current system. I'm advocating a free market system, which isn't anything like what we have right now.

[beagle3]

> People who want a the government to control health care

No one wants the government to control healthcare. Many people want the government to run healthcare, and accept that as a result it will be government controlled . You might consider this a distinction without difference, but it paints supporters of public health care in a light they do not deserve. An analogy:

You seem to want my health care to be controlled by people whose own profit is their motive -- in fact, by corporations who are required by law to maximize shareholder profit at the expense of my health.

> "Look that isn't working well, we must need more government."

Most are saying "look, that isn't working well. But e.g. NHS in England is working extremely well. Let's copy that". And after looking at the NHS, it turns out that you need more (and especially, a very different kind) of government involvement.

Can you point to a working example of a system that you believe in? Because if you can't, I think the NHS and government involvement carry a LOT more weight as arguments.

[te_chris]

You say that as if socialised medicine is somehow novel and untested? Look at most of the Commonwealth countries, there are no shortage of students applying to study medicine and they still get paid well. Take your blinkers off - or leave them on to be honest, I'm super happy with my socialist healthcare (which I supplement with cheap private cover for faster elective procedures).

[IanDrake]

Look at most of the Commonwealth countries. Which one specifically?

>I'm super happy with my socialist healthcare

Net consumers are typically very happy in socialist environments, no shock there.

[beagle3]

> Net consumers are typically very happy in socialist environments, no shock there.

99.9% are net consumers when it comes to healthcare. So you're saying we shouldn't do something that makes everyone happy?

The 0.1% providers should be made happy. Apparently, despite the claims laid by many Americans who argue this, almost every other western country has managed to make those providers happy enough to not all quite en masse and leave everyone without access to healthcare.