
Both in rich and poor countries, universal health care brings huge benefits - nopinsight
https://www.economist.com/news/special-report/21740873-argument-universal-health-care-clear-getting-there-difficult-says-john
======
sykh
When a person gets a life threatening disease they ought not worry about
whether or not their treatment will leave their family in penury. This is
especially so in a nation as wealthy as the U.S. The American healthcare
system is immoral and I hope it drastically changes.

Americans need to change their underlying notions of what it means to be a
society. An author was once made fun of for suggesting that it takes a village
to raise a child. When it comes to public funding for public goods we tend to
worry about some poor person getting something they don’t deserve. The go it
alone I’ve got mine, fuck you attitude is unhealthy.

Until we change our collective view in what the purpose of a government and
society is things won’t change significantly. Even so called champions of
progressivism in the U.S. Senate voted against allowing the importation of
medicine from Canada. It seems the public interest is subordinate to private
interests and often times with immoral consequences.

~~~
merpnderp
If you think the private healthcare system is immoral, you should take a look
at the 100% government ran healthcare system that is the VA. You literally
couldn't make up worse things than their administration has been caught doing
with little or to consequence.

If the VA is the best the US government can do, with some of the most
sympathetic citizens, then it is incapable of doing better than our private
system.

~~~
monocasa
The VA was a good system not too long ago, but the past couple decades has
seen it get extremely underfunded in a starve the beast strategy. It used to
be a black eye in the Republican's view of healthcare, but they sure fixed
that.

~~~
rukittenme
What makes you think universal healthcare would be any different? If you
recognize the VA's failings, and you blame Republicans for it, what's to stop
them from doing it to every "good" idea you have?

If a few motivated politicians can ruin the lives of millions those
politicians _shouldn 't have that power_ in the first place.

~~~
Sangermaine
>What makes you think universal healthcare would be any different?

Because America isn't the entire world and there are many places where
socialized healthcare of various forms have been very successfully implemented
for a long time. The idea peddled by conservatives in America that the only
options for socialized healthcare are inevitable failure or tyranny is simply,
demonstrably nonsense.

It's exactly this kind of parochial, limited mindset that needs to change.

~~~
rukittenme
Oh yes. Everyone who disagrees with me has a limited mindset. You could have
used your open mind to read about a European (within this comment thread) who
is having trouble with "the right" in his country:

> This is a principal reason why the US was crossed off my list of countries
> where I would work and live. I fight against the privatization that is
> occurring within healthcare in my native country, Iceland. We used to have
> the Scandinavian model but decades of attacks from the right-wing
> Independence Party has broken our healthcare system. The next phase
> described by Chomsky is handing it over to private capital since people are
> outraged that it doesn't work anymore. I'm sickened by the development and
> feel a little like an old man screaming at the desert wind.

It's exactly _your kind_ of Utopian mindset that needs to change. Please read
the news of countries other than the US. You might be surprised at the amount
of controversy that surrounds universal healthcare systems.

~~~
jdub
The controversy that surrounds universal healthcare systems goes something
like this:

"I am disappointed by my treatment in the system!"

"Do you want to privatise it?"

"Absolutely not."

~~~
Clubber
In the US, the first sentence holds true, it just costs a lot more.

------
fbunau
In my country we do have single payer health care, but I wouldn't step foot
into a state hospital unless I would have a terminal disease.

The infrastructure is old and crumbling, people get infections during
operations and walk out more sick than they entered.

Sometimes you are asked to bring your own medicine, and basic medical supplies
because hospitals don't provide you with anything. The system is overcrowded
and no one gives a shit about you unless you bribe them.

I think the key-word is functioning universal health care.

While I do support paying for universal health care and think it is a basic
necessity of a civilized country, you need a good culture and competent people
to make it work.

I think a good culture makes shit work, not the process itself. (just like
applying Scrum / Agile won't make you solve anything without the right people)

~~~
Frondo
What country is that?

~~~
kalleboo
Presumably not one that spends twice the world average per capita on
healthcare like the US.

~~~
mullen
> Sometimes you are asked to bring your own medicine, and basic medical
> supplies because hospitals don't provide you with anything. The system is
> overcrowded and no one gives a shit about you unless you bribe them.

Sounds like Venezuela, which I would not hold up as a gleaming example of good
governance.

------
ordinaryperson
Universal health care is a euphemism for the poor and sick getting their
medical care subsidized by the wealthy and healthy.

Morally, caring for the sick seems like the right thing to do, but it's like
when I hear Bernie Sanders call for "free college education": he doesn't mean
free, he means the wealthy subsidizing it for others.

Universal health care implies just distributed costs, but the focus should be
on bringing down costs so the payments don't have to be so astronomical.

For example:

-Nurses could do a lot of things doctors do now, and for a lot less money, but MDs refuse to cede any authority.

-Medicare should be allowed to negotiate drug prices.

-Hospitals should pre-publish costs upfront before you accept care rather than saddle you with 100K in bills later on.

All of these things would help bring down cost but for political reasons we
don't do them. Instead it's just about making wealthy people (which, for the
record, I am not) pay more to cover for it.

Even if caring for the sick is just it shouldn't be accomplished just by a
wealth transfer (to be fair, the ACA had some provisions to bring down the
cost of care, but not nearly enough).

~~~
arcticbull
There's some serious mental gymnastics going on here to justify that the US
spends 2x the next country per capita on health care expenditure and still
doesn't manage to pay for all its citizens. Especially when the federal
government has already taken all its worst customers (the old) and thrown them
into a socialized pool (medicare) without anyone to balance out the risk.

Wasn't there a writeup recently that wealth distribution isn't materially
distinguishable from luck? [1] Your argument that the healthy/rich subsidize
the poor/sick is tantamount to saying the unlucky should fend for themselves.
That's an easy argument to make if you're lucky. Your luck may turn at any
moment, and then if it does, you're SOL.

Further, if the moral argument falls flat for you, the self-centered argument
is that if someone is too poor to get their horrifyingly contagious disease
treated until its too late and it spreads to you, you're still sick, and you
may still die, cover or no cover. It's why the fire department is socialized
-- if the fire spreads to your house, it still burns does it not?

Especially as you argue you're not particularly well off necessary, you should
be the strongest advocate for yourself, and therefore, for socialized
medicine.

The world is moving there -- at least towards a two-tier system -- and this
argument is on the wrong side of history.

[1] [https://www.technologyreview.com/s/610395/if-youre-so-
smart-...](https://www.technologyreview.com/s/610395/if-youre-so-smart-why-
arent-you-rich-turns-out-its-just-chance/)

[EDIT] I also wanted to throw in there the self-centered argument for
socialized higher education. If you believe in the value of a college
education, then you believe it will increase the productivity of that
individual. A more productive individual makes your country more competitive,
boosts GDP, moves the markets higher relative to that of other countries. This
in turn benefits the wealthy who likely hold equities. Speculative, of course,
but the argument seems consistent to me.

~~~
edanm
> There's some serious mental gymnastics going on here to justify that the US
> spends 2x the next country per capita on health care expenditure and still
> doesn't manage to pay for all its citizens.

I'm not exactly sure what you mean by this.

The US _does_ spend a lot more, and _doesn 't_ cover everyone. If I understood
the parent post, (part of what) it's saying that the US needs to focus on
lowering costs, because otherwise, the fact that there is so much spending
even now, is going to cause trouble. And more trouble than comparable
countries, because the price in the US is so much higher.

I'm not sure if you're disagreeing with this, or what? Do you assume that if
the US covered everyone, it would be cheaper? Would be great if you could
clarify :)

~~~
arcticbull
Sure, my bad, in re-reading I can see how this wasn't clear.

I meant along the lines of: I can't see how allowing medicare to negotiate
drug prices, letting nurses do more of what doctors do and publishing prices
gets the US medical system anywhere close to a 50% reduction in per capita
spend, or gets the US any closer to covering 100% of the population. The US
should do each of these. Each would make a difference.

What the country needs, though, is real reform.

And also, yes, socialized medicine is dramatically more efficient. Medicare's
overhead is only 2% whereas that of private insurance is 18%. Just knocking
that off the top would bring the US per capita expenditure much more in line
with the OECD.

[1] [http://cepr.net/blogs/cepr-blog/overhead-costs-for-
private-h...](http://cepr.net/blogs/cepr-blog/overhead-costs-for-private-
health-insurance-keep-rising-even-as-costs-fall-for-other-types-of-insurance)

~~~
fastball
Centralized systems are more efficient when they're smaller. The bigger a
centralized system becomes, the more you need to spend on intermediary layers
of bureaucracy that don't actually help achieve whatever goal it is you're
going for (in this case, medical care).

The US has ~330 million people. The US has ~13 million undocumented
immigrants. The US is the size of Europe. You're not going to magically get
the efficiency of European countries 1/10 the size by having single-
payer/universal health care.

Imagine trying to have a single health care system for all of Europe. It would
not be nearly as efficient as you think it would be.

Does that mean we can't significantly bring down the cost of care in the US?
No, we absolutely can. But a national system in the US is never going to be as
efficient as _any_ European country's national system. It's impossible to
maintain the same level of efficiency when the scale increases exponentially.

~~~
aninhumer
If only the United States had some kind of system of geographic administrative
divisions similar to the countries that make up Europe...

~~~
fastball
Right, and states are free to enact single-payer/universal health care for
their residents if they so wish. In fact, you might want to look at the
Massachusetts health care system.

But implementation at a state level is obviously not what this thread is
about.

For a US-wide health care system you need US-wide infrastructure/bureaucracy.
This decreases efficiency.

~~~
arcticbull
I'm down with this -- this is how Canada's system is run. Each province
provides insurance for its residents meeting the requirement to provide a
socalized system as defined in the Canada Health Act. States should provide
the socialized system, the federal government should mandate a public option
exists (either single payer or two-tier) and the basic rules that govern one.

------
austincheney
When the issue of universal health care comes up with regards to US policy I
often see those emotional arguments pulling on the heart strings.
Unfortunately, this is a distraction.

I know this sounds cold, but it comes down to money. Healthcare in America is
expensive. The problems appear to be commonly identified by various forms of
research and including things like pricing inefficiencies of drugs,
malpractice insurance, and administrative inefficiencies.

The problem isn't as simple as blaming medical insurance providers, pricing,
or fees. The problems appeared be directly associated to the processes in
place, or in the case of drug prices missing pricing regulation. Drug pricing
regulation does exist for the VA which has a set pricing schedule, but
everybody else gets to pay more.

In order for universal healthcare to come into fruition in the US these cost
inefficiencies have to be addressed. If universal healthcare is important for
you then these financial and administrative problems are what you should solve
for.

~~~
Pharylon
I don't think emotional arguments are a distraction, they're the whole point.
This is a moral issue. Other countries manage to have universal healthcare and
it doesn't break the bank. In fact, they spend less per person. The fiscal
argument is the distraction.

~~~
conanbatt
> I don't think emotional arguments are a distraction, they're the whole
> point. This is a moral issue.

I find the moral argument to be disingenuous. It is immoral to make poor
people pay a tax that cure the diseases of rich people.

"Nobody should go hungry, so everyone should be able to eat anywhere they want
and not look at the tab".

~~~
Pharylon
Disingenuous? You think people arguing that it's immoral for someone to die
because they were born poor are not actually sincere in their argument? Tell
me, what is my evil ulterior motive? Do I actually just want to increase taxes
for the hell of it?

~~~
conanbatt
Of course its not a sincere argument: I believe that you can believe it, but
its insincere at least to yourself to say that the reason healthcare should be
universally provided through government is for the poor. If you cared for the
poor the argument is to make food stamps for healthcare services, not
universal. Universal is also for yourself. So yes, it is disingenuous to say
that which is best for your is also best for the poor.

Reminds me to the typical argument that college should be free so poor people
can go, but ultimately, middle class and up go. Healthcare is similar: the
richer live longer, which means they live more of the most expensive
healthcare years.

~~~
mattmanser
Your argument makes no sense.

It's like garbage collection, it's just something the government provides as a
service to all citizens.

Whether it's regressive or progressive entirely depends on the tax used to pay
for it. If everyone has to pay exactly the same, it's regressive, as poor
people are impacted much more than rich people. If it's a proportion of
income, it's progressive.

In the UK our national insurance, which pays for our universal healthcare,
social welfare and pensions, is actually a regressive tax, it's 12% on the
first £46k you earn, then 2% after that (something like your first £6k is
actually tax free). I don't know why people don't make a bigger deal out of
this given that the NHS is suffering at the moment.

~~~
conanbatt
> In the UK our national insurance, which pays for our universal healthcare,
> social welfare and pensions, is actually a regressive tax, it's 12% on the
> first £46k you earn, then 2% after that (something like your first £6k is
> actually tax free). I don't know why people don't make a bigger deal out of
> this given that the NHS is suffering at the moment.

Are you arguing that NHS is not a benefit to the poor? Because its a
regressive tax? So eliminating NHS is actually in benefit of the poorer
classes.

~~~
mattmanser
No, I replied and rapidly edited out a few words of my original reply to try
and make it clearer, but seem to have done the opposite. The last sentence
initially started with "Interestingly". My original meaning of the last
paragraph was "here is an interesting, related, factoid. The UK happens to
have a regressive tax to pay for the NHS".

My main point is that governments are free to provide the same service to rich
and poor without that being regressive or disproportionately favouring the
rich. For example, bin collection, policing, national defence, fire safety,
etc.

A universal health service can simply be another collective service. If you
want more because you're rich, in the UK we also have private healthcare
services you can pay for, much like you can pay for a cleaner in addition to
your bin collections or a body guard in addition to the police or national
defence or pay to install fire suppression in addition to the national fire
service.

What makes it regressive or not is how it is taxed for.

------
announcerman
Universal healthcare is not a silver bullet, in certain Eastern European
Countries we pay a large amount of our salary in taxes so that we have
universal healthcare and yet you still have to give "gifts" to every nurse and
doctor that treats you unless you want the bare minimum treatment and care.
Doctors can also intentionally botch surgeries if you fail to pay up. Not so
much that it can be called malpraxis though.

~~~
delinka
How can a surgery be "botched" but not be malpractice?

~~~
shawabawa3
Simple, there were "complications" caused by "x, y, z". which is all totally
legit, except it's all made up and unverified due to rampant corruption

------
patrickmay
Universal health care doesn't require government coercion. Many more people in
the US would have access to health care, including insurance for catastrophic
events, if the state and federal governments stopped interfering in the supply
side. The same groups that use force to prevent new hospitals being built,
restrict the number of doctors, prevent nurses and nurse practitioners from
treating many problems they're more than qualified to address, and disallow
insurance being sold across state lines say that the solution to the problems
they created is more government. It's almost like they have an ulterior
motive.

Big government programs raise taxes and decrease liberty. To quote Penn
Jillette, "Why not err on the side of a little more freedom?"

~~~
mikeash
Many people would also lose access to health care. Remember when a pre-
existing condition meant you were fucked for life? It wasn’t that long ago.

Fully privatized, deregulated systems can work out great for people who are
lucky enough to avoid financial hardships, bad planning, or being born into
bad circumstances. I’d rather not just screw everybody else.

~~~
pitaj
You're operating under the assumption that insurance companies would continue
acting as they do now, even if there is much more competition.

Insurance companies shouldn't want to deny you coverage just because you have
a pre-existing condition. They most likely would just charge you more, because
you're at a higher risk of costing them money.

~~~
mikeash
Of course they’ll just charge you more. That’s how it was before, too. But
when the premiums are so high that you can’t possibly pay them, there’s no
real difference between that and being denied.

------
adaml_623
Just going to throw this out there. Non universal health care is analogous to
half the roads in a city being toll roads. Society can still function and you
can mostly get to where you're going but it's not close to efficient.

~~~
merpnderp
Why are toll roads not close to efficient? In my state the toll roads are by
far the nicest best maintained roads and the tolls are extremely reasonable
and collected without having to slow down or stop at a booth.

~~~
AstralStorm
Who collects the tolls? Is it a private company or a government body with
motive different than maximum profit?

For example in Poland we got the most expensive toll motorways in Europe
because a private company owns them and continues to demands exorbitant prices
for passage with nobody to stop it.

~~~
kodablah
> Who collects the tolls? Is it a private company or a government body with
> motive different than maximum profit?

Private company with motive different than maximum profit. Motive: not to get
subsumed and punished by the government allowing them to do this...then second
motive is maximum profit. That primary motive one is an important one in all
of these non-competitive industries, and can't even have a private vs public
discussion without including it. Otherwise, it's just corruption/apathy and
it's a different problem.

------
patrickg_zill
Skeptic's questions:

1\. How many are aware that Britain's NHS, if run as well as Spain's
healthcare system, would kill 10,000 fewer patients each year due to better
treatment? [https://www.independent.co.uk/news/health/nhs-world-
ranking-...](https://www.independent.co.uk/news/health/nhs-world-ranking-uk-
healthcare-worse-ireland-spain-slovenia-30th-lancet-a7744131.html) and
[http://www.cityam.com/270171/nhs-world-class-if-you-
ignore-i...](http://www.cityam.com/270171/nhs-world-class-if-you-ignore-its-
woeful-outcomes) (3rd to last paragraph)

2\. I can get an MRI in the USA within 3-5 days (sometimes next day),
virtually anywhere in the country.

Canada (universal health care) wait times to receive MRI(self-reported by the
government): over 90 days in some cases. In the richest and most populous
province of Ontario, only 41% of patients got scanned within the targeted
time: [http://www.hqontario.ca/System-Performance/Wait-Times-for-
Di...](http://www.hqontario.ca/System-Performance/Wait-Times-for-Diagnostic-
Imaging?utm_source=Ontario.ca&utm_medium=Referral&utm_campaign=WT%20Referral)
(you might have to select Adult MRI instead of the default Adult CT)

If you were diagnosed with a possible brain tumor/cancer requiring an MRI to
confirm, would the 50 to 90-day difference in MRI and diagnosis result in a
measurable difference in outcome, if you did in fact have a tumor?

~~~
guitarbill
> 2\. I can get an MRI in the USA within 3-5 days (sometimes next day),
> virtually anywhere in the country.

Not if you don't have insurance, like a few million Americans. But fuck those
guys, right? At least _my_ MRI is fast!

~~~
lainga
You have a few percent of the overall American population waiting vs. 41% of
Ontario.

~~~
guitarbill
No, 41% of patients of Ontario who needed an MRI, which is a small subset of
the population. Meanwhile in 2016 you had 28 million Americans under 65,
that's 10.4% uninsured [0]. I'm sure 10% less people would cut the waiting
lines in Ontario a bit.

So yeah, fuck those 28 million, they're not rich, let them suffer if they get
ill!

[0] [https://www.cdc.gov/nchs/fastats/health-
insurance.htm](https://www.cdc.gov/nchs/fastats/health-insurance.htm)

------
walrus01
$5700 ER bill for an ice pack and refusal of treatment:
[https://www.vox.com/2018/5/1/17261488/er-expensive-
medical-b...](https://www.vox.com/2018/5/1/17261488/er-expensive-medical-bill)

this is what's broken in America today.

~~~
fastball
Maybe part of the problem is the mindset "banged my head on a table, time for
the ER"

???

If you're young and healthy and you lightly bang your head on a table, you
don't need the ER! It sounds like she wasn't even concussed! Sure, get checked
out by a doctor, but this isn't a life or death situation, so don't clog up ER
triage with your BS.

That's like breaking your toe and calling an ambulance.

~~~
beagle3
Maybe. But possible one in a hundred times, the "banged head on table" could
lead to complications. I'm familiar with such a case.

Somehow, everywhere in the developed world except the US, people can go to the
ER-or-equivalent (many places have 24-hour clinics/triage centers that would
send you to an ER only if needed) after they've banged their heads, and 99% of
the time be told "go home, it's fine" without being bankrupt. I would say the
problem is with how the US healthcare system is run.

~~~
fastball

      People go to "ER-or-equivalent".
    
      Immediately mentions a place that is not the same as ER that the US also has (clinics).
    

As I said -- she was wrong to go to the ER. She lives in NJ. I know for a fact
there are loads of clinics she could've gone to and been sent home with a
clean bill of health for $50 copay.

~~~
beagle3
I left NYC 5 years ago. But at the time I was living there, there was
essentially no option other than an ER after 3pm (and very few before).

And my point is that the European system does not require you to make
decisions in such a case. You just go and get checked without going bankrupt.

Where I live now I have 3 hospitals within 20 minute drive, one of which is
walking distance, and 20 triage/clinic locations. I can go to any; I prefer
the triage because they are quicker and nicer.

~~~
fastball
Really? I live in NYC and can't agree[1].

Yes, you are correct -- with a socialized system, you don't need to worry
about "triaging yourself". _But that is not a good thing_. You don't want
patients to mis-utilise the services available to them, just because they are
free and therefore they don't need to worry about the associated costs.

Ambulances / ERs / MRI / etc -- these things are EXPENSIVE to operate. It's
too bad, but it's the truth. Just because you _can_ use them in the UK or
wherever doesn't mean you should, and there is nothing to disincentivise
people from this because they're not footing the bill (directly, that is). I
literally wrote my undergraduate dissertation on various ways the cost of MRI
could be brought down, and it's not an easy problem, regardless of who is
paying for it. Getting medical care that you don't need is no small thing in
the scheme of things.

1:
[https://www.google.com/search?q=urgent+care+center+nyc](https://www.google.com/search?q=urgent+care+center+nyc)

~~~
beagle3
At the time I lived in NYC (2007-2013), Me and family had needed urgent care
services 3 times. In all three times, we called insurer (Aetna once, United
twice), and they told us to go to ER because there is no better option.

Things may be different now, last time I visited manhattan a few months ago
indeed there were several walk-in clinics between 8th street and 23th that
weren't there 5 years ago, but (at least from the sign on the window), not all
accepted all insurances, and none had a chargemaster listed outside, which
means there's a nontrivial possibility one would go bankrupt going into them.

> Just because you can use them in the UK or wherever doesn't mean you should,
> and there is nothing to disincentivise people from this because they're not
> footing the bill (directly, that is).

That's true. And if people did misuse them significantly, I'm sure the
(dis)incentive structure would be put in place. But it turns out that most
people in the UK and EU and other places are not jerks, and do not call an
ambulance needlessly.

It is a mathematical certainty that there is always a false-positive / false-
negative tradeoff; The US system (and your recommendation) prefers false
negatives, the EU system and other single payer systems prefer false
positives. And .. what do you know? Bang for buck, single payer systems
triumph greatly, have lower infant death, and higher life expectancy.

------
nisa
There are lots of problems you can avoid when you are able to regularly get a
checkup from your doctor.

Also not everything is only a cold and having someone who can check early for
complications might save a lot of lives or prevent people from far worse
conditions.

Last but not least: Access to mental health services like cognitive behavior
therapy that replace or supplement only eating pills might help a lot of folks
with addiction and raises productivity.

~~~
Consultant32452
What are your thoughts on this Oregon study which showed no significant effect
on health outcomes for people who were given Medicaid vs the uninsured?

[https://www.forbes.com/sites/theapothecary/2013/05/02/oregon...](https://www.forbes.com/sites/theapothecary/2013/05/02/oregon-
study-medicaid-had-no-significant-effect-on-health-outcomes-vs-being-
uninsured/#71a919d60430)

~~~
nisa
That's wrong - here is the study:
[https://www.nejm.org/doi/full/10.1056/NEJMsa1212321#t=articl...](https://www.nejm.org/doi/full/10.1056/NEJMsa1212321#t=articleTop)

We found that insurance led to increased access to and utilization of health
care, substantial improvements in mental health, and reductions in financial
strain, but we did not observe reductions in measured blood-pressure,
cholesterol, or glycated hemoglobin levels.

------
Kequc
I've lived in countries that have socialized medicine and ones without and my
experience was dramatically different. I was always taught that socialized
medicine was better. However I never got half decent care until I bought
private health insurance.

My whole life I've been on government healthcare plans, across various
countries. Imagine my shock when the first time I called my private health
insurance provider at 34, it worked well. They chose the clinic I would go to,
when I arrived to my appointment I was immediately ushered in to meet a
physician. The physician was able to diagnose many problems within a couple of
minutes, and I was asked to call my insurance company back so they could
approve a series of tests and treatments.

I waited half an hour for approval and I then immediately saw two different
doctors and had an x-ray all before leaving the building.

The clinic is interested in actually treating me and giving me the best care
possible so that I don't come back. This ensures they get repeat business from
my insurance company. Socialized medicine never gave me that kind of care or
expediency in my life. The problems were all fixed.

One of the problems I've had for 10 years. Doctors were never able to diagnose
it properly or it was "come back in 2 weeks, try this medicine, try that,
etc." They were not interested in treating me they were interested in seeing
me again and again because they were getting paid by the state.

I'm sure there are anecdotes to the contrary but I am completely sold on
private healthcare. It's also fantastically cheaper. In Germany for example I
was paying 800/month for healthcare, half "paid by my employer", which would
really be my money. My current private healthcare costs about 380/year.

Diagnosed immediately, immediate care. I can buy as much or as little as I
want and don't have to subsidize others. I'm encouraged to stay in shape and
healthy.

~~~
AstralStorm
You will quickly find the limits of private healthcare once a surgery or
advanced treatment is necessary. Usually that it is not covered in your plan.
Heck, even relatively simple specialist interventions will go beyond coverage.

In many countries they are great at routine care, no doubt, as they're just
not overcrowded and that is the main reason for problems in public systems. If
you shift all the crowd there... well... they degrade much quicker and worse
than public.

So, apples to apples. Fully public vs fully private systems.

You could say compare German system with US system which are almost completely
mirror images except German one is many times cheaper.

~~~
Kequc
Not true. For the small amount I am paying I am covered for one major surgery
in a hospital per year. Hopefully I never have to use it. If I need two major
surgeries in one year well then I'll pay for it. Sounds like I've got bigger
issues.

More than one surgery per year I'm covered for surgery in the medical vehicle.
So if I'm going beyond that, I think I'll take the extra 9220 that I'm saving
every year and risk it! Call me crazy I think most of that money is going
toward treating fat people and drug users.

------
tomasien
We should think of healthcare (not insurance, care) as our #1 national defense
priority.

~~~
dhimes
I get your sentiment, but I personally feel that education should be our #1
defense priority.

~~~
kingkawn
No need to fight over which one gets to be called number 1. Both are
components of a whole vision; a healthy, thriving populace, building off the
successes of one another to create a better experience for everyone, rich and
poor alike.

~~~
ubi_now
You don't need government programs to do that.

~~~
creep
It's important to have a central, regulated allocation of _some_ resources for
a society as large as America-- and for that matter, any society. The point of
group living (where any society is group living) is that everyone has a safe
place to return to and can count on at least most of the other members of the
group to help them out when they need it. The point of universal healthcare is
that you pool your money with everyone else so that when you get sick, you get
care, and when your neighbor gets sick, he doesn't spread his infectious
disease to you, and when someone else in your work place gets sick, you spend
less time making up for their missing days.

------
chiefalchemist
Yes, health care is important, if not morally necessary in the 21st century.

That said, it's also (imo) a proxy. The more accurate metrics are things like
infant mortality rate (IMR), longevity, etc. KPIs that measure actual health
and health outcomes. Access isn't necessarily the key.

Take for __example__ the USA. We now have the vast majority of the population
covered. We spend more and more (and more)on healthcare. Yet, IMR is climbing.
It's predicted that the current generation(s) will die younger. And finally,
obesity is so widespread it's been mentioned as a threat to nation security.

Point being, (as stated) healthcare is a proxy (even for the countries that
have it). I would imagine there are 5 to 10 KPI's that measure __health and
wellness__ that would be more accurate (and likely paint a different
impression).

Healthcare isn't a panacea. Yes, it's necessary. But benefits come from health
(and wellness / prevention) and not just care.

Editorial: Discussing health care without also discussing (personal) health is
a fool's errand. Championing healthcare is great for buying votes, but it's
only part of the picture.

------
narrator
The big riddle is how do you get the health care costs in the U.S back in line
with the rest of the world, which doesn't necessarily have single payer. I'm a
big fan of Singapore's public/private hybrid which delivers excellent results
for a very low percent of GDP. We spend double as a percent of our GDP on
health care vs all other developed nations.

~~~
speby
Me too. Then of course you get into the nitty-gritty
([https://www.vox.com/policy-and-
politics/2017/4/25/15356118/s...](https://www.vox.com/policy-and-
politics/2017/4/25/15356118/singapore-health-care-system-explained)):

"More than 80 percent of the hospital beds in Singapore are in public
hospitals, and those hospitals are cut into different “wards” with different
levels of amenities: A-class wards provide unsubsidized care but have single
rooms and air conditioning, while C-class wards are overwhelmingly subsidized
but are set up like shared dormitories with common toilets. There are a number
of ward levels in between, too, all with a sliding scale of comfort and
subsidization. So both A-ward patients and C-ward patients are paying for
their own care, but the prices they’re paying are very, very different,
because the government is absorbing the direct cost of care in the C-wards."

Not saying common toilets are unacceptable but it's things like that which
would be a big adjustment/shock to the American system of being used to mostly
individual rooms with meal service, etc.

------
majidazimi
Isn't it better to design health care system based on some form of score, very
much like credit score in financial systems? The healthier you live, the less
you pay.

Obviously someone who drinks alcohol regularly, smokes regularly, is
overweight, ... would be a burden on health care system (in long run) compared
to someone who lives with a healthy life style. Why would they both pay the
same amount? In a credit-based system the former pays more.

Making some exceptions in such a system is just fine. Not everyone has cancer.
Insurance company can easily pay the full amount for these people. It is not
the major cost for system.

~~~
throwawayjava
How do you know how often someone smokes or drinks? How do you determine what
level of smoking/drinking is harmful enough to merit higher premiums? How do
you dispute the insurance provider's claim that your cancer is really your
fault because you chose to live in a city with bad air?

Enforcement requires a beneficient panopticon.

------
commenter1
I'd much rather pay for healthcare, infra or basically what ever benefits us,
the society, than for the war industry.

~~~
conanbatt
As an average american citizen, you already pay for healthcare. You are not
getting the bang for your buck, thats the problem.

------
willvarfar
In these kinds of discussions I like to promote this interesting TEDx talk:
[https://www.youtube.com/watch?v=A9UmdY0E8hU](https://www.youtube.com/watch?v=A9UmdY0E8hU)
"Where in the world is it easiest to get rich?"

Spoiler: the talk shows that statistically the Nordic countries lead the world
in millionaires and billionaires / capita, and in rags-to-riches. The talker
offers the opinion that this is because its of the strong social safety net,
education and healthcare.

Living in Scandinavia of course I like to hear this ;)

~~~
fastball
Or maybe it's the very high resource/population ratio?

The petroleum sector accounts for 40% of Norway's exports.

Fishing is 10% (!) of Norwegian exports.

Both of these things have an incredibly high extraction efficiency in the
modern era. It would be nice to believe it's the social safety net, but I
don't think that hypothesis is backed up with much evidence. The much more
obvious reason is staring Scandinavia in the face. I'm intrigued to see how
Norway does when the rest of the world stops using petroleum and goes vegan.

~~~
willvarfar
Sweden, without oil and without much fishing, is also doing really well per-
capita etc.

On the ground, the welfare state approach seems the plausible explanation.

And how will Norway do post-oil? Really rather well, it seems, because of its
sovereign wealth approach which contrasts strongly with eg the Texas approach.

------
wjnc
A dissenting opinion: in The Netherlands, with pretty awesome universal
healthcare, >50% of healthcare costs are made for 600k 65+ yr olds. That in a
country of 17 million. It's 28 B€ for this small group in 42B€ total cost.

The social value of catastrophic health insurance is huge. The cost of
universal cradle to grave care is catastrophic and untenable within 20 yrs.

Source (in Dutch, from a government regulatory agency), looking across
healthcare categories:

[https://www.nza.nl/actueel/nieuws/2018/04/20/zorg-voor-
ouder...](https://www.nza.nl/actueel/nieuws/2018/04/20/zorg-voor-ouderen-in-
beeld-overgrote-deel-ouderen-woont-thuis)

------
programmarchy
If you get cancer, would you rather be treated in the US or Europe? Survival
rates are significantly higher in the US, so I know what I'd choose. And yeah,
I'll pay more, too, because I want high quality doctors.

~~~
rflrob
If you don’t get cancer, where would you rather live? Life expectancy is
significantly higher in Europe for lower average cost of medical care. There’s
not necessarily a conflict between checkups and chemo, and surely some of the
difference is due to population-level differences in poverty, diet, and
lifestyle. But it’s worth remembering that it can be rational to trade
slightly worse specialty care for better general care.

Also, fwiw, what I’m reading (e.g.
[https://www.npr.org/sections/goatsandsoda/2018/01/30/5819148...](https://www.npr.org/sections/goatsandsoda/2018/01/30/581914807/whats-
the-5-year-survival-rate-for-cancer-patients-around-the-world)) suggests that
US cancer survival is better than the rest of the developed world, but not
significantly so.

~~~
fortythirteen
> Lower average cost of medical care

All derived from figures that don't account for how much more you pay in taxes
for that "free or cheap" healthcare.

~~~
AstralStorm
Actually it is a perfectly visible item in budget. We pay less for whole of
medical care than total US budget for just VA.

 _Someone_ is paying for this in tax.

~~~
fortythirteen
I think you misunderstand the statement. I wasn't referencing the comparison
of the tax costs of different public healthcare systems. But while we're on
that subject, I'm willing to bet that your VA comparison isn't per capita, or
placed against GDP, rendering it useless.

What I was referencing was the per capita or per household _total cost of
healthcare_. The comparisons that say western countries with universal
healthcare have "lower costs" generally omit the increased tax burden.

If I make $100k a year, for example, and pay ~30% in taxes, but also pay ~$15k
a year for total family medical expenses, including premiums, I'm still making
out better than if I pay ~60% in taxes, but get "free" healthcare.

~~~
DanBC
The US government pays a huge amount on healthcare. This is whether you do it
by total; by GDP; per capita.

[https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...](https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcompareinternationally/2016-11-01)

If you include private insurance:

> As a percentage of GDP, the UK spent less on healthcare than USA, Japan,
> France and Germany and a similar percentage to Canada. The USA spent the
> most on healthcare as a percentage of GDP at 16.6%.

If you exclude private insurance the US still pays a lot, at about 8.2%

The US has by far the largest spend per capita, yet has average life
expectancy.

~~~
fortythirteen
You misinterpret or spin the data from your link. Look again and you'll see
that, as far as compulsory spending goes the US and UK spend roughly the same
percentage of GDP on "healthcare". What is "healthcare" as defined in this PR
piece from the UK government? Where do factors like average wait time to see a
specialist or have surgery weigh in?

I could take those same numbers and say, "The United States does a better job
of assisting it's poorer citizens into the highest quality healthcare in the
world, all while allowing all its people the complete freedom to control their
own health outcomes."

For the record, I'm not a health libertarian, but I'd sure as hell take it
over health authoritarianism, and the UK government proved that's what they
have last week.

~~~
DanBC
> Look again and you'll see that, as far as compulsory spending goes the US
> and UK spend roughly the same percentage of GDP on "healthcare"

Yes, that's the point. The US government spends more on healthcare, but that
huge spend doesn't cover the whole population.

> "The United States does a better job of assisting it's poorer citizens into
> the highest quality healthcare in the world,

Why does the US have such poor mortality figures if health care is so good and
if everyone can access it?

> but I'd sure as hell take it over health authoritarianism, and the UK
> government proved that's what they have last week.

In the US cases of medical futility the doctors announce their plan to remove
life support and if the parents disagree they have to go to court to stop it
happening.

In the UK the doctors need to get the agreement of the parents, and if the
parents don't agree the doctors have to go to court. In that court process the
family can get legal aid (if they meet the financial test) - Alfie Evan's
parents went through 7 legal firms, and they had expert counsel of a well
respected silk and two juniors. But also Alfie had his own legal
representation.

Alfie Evans had 16 months of excellent health care, followed by robust legal
protection to make sure his best interests were looked after. His family are
poor. He wouldn't have got anything like this in the US.

~~~
fortythirteen
> But also Alfie had his own legal representation.

What?! How does an infant/toddler receive legal representation arguing for the
plug to be pulled, outside of the wishes of his parents?! That is the very
definition of authoritarianism.

> He wouldn't have got anything like this in the US.

Absolute nonsense spread by someone who has no knowledge of the American
system. A child like Alfie is given free medical care from one of many charity
hospitals with some of the best doctors in the world, and other charities
house the family, for no cost, during treatment. You know, like the Vatican
offered, and the parents accepted, but apparently you're government decided it
was time for Alfie to die.

~~~
DanBC
> How does an infant/toddler receive legal representation arguing for the plug
> to be pulled, outside of the wishes of his parents?!

The child is not property. The child is a human, and has human rights. Those
rights are protected. The child has his own independent legal representation
to look after its best interests.

This system has been tested by international courts -in Europe- and they've
found it works to protect the rights of the child.

> You know, like the Vatican offered,

No. The vatican offered the same end of life care he was getting, with the
additional burden of a long difficult journey.

> A child like Alfie is given free medical care from one of many charity
> hospitals

I've already linked a page in this thread that shows this to be false.

You keep saying "government", but the UK government wasn't involved in any of
the cases (apart from the EU ones).

~~~
fortythirteen
> The child is not property. The child is a human, and has human rights. Those
> rights are protected. The child has his own independent legal representation
> to look after its best interests.

How humane of your government to decide that a toddler must starve to death.

~~~
DanBC
Have you ever had a naso-gastric tube fitted? It's not pleasant. Doing this in
order to prolong life when the case is medically futile is cruel.

Also, it's far better that the hospital has to go to the courts to get
permission to do this than the situation in the US: the doctors announce their
plan and the parents then have to go to court to stop it happening.

------
loxs
It has the benefit of being supported by the state, yet nowhere has it
obsoleted private healthcare (except for places where the government outright
criminalizes private healthcare). There is something rotten in Denmark.

------
Tomminn
Ah yet another time to remind US citizens they are needlessly dying at worst
or massively overpaying for health at best.

The health care of system of the US is insane and has malignant cost disease.
If they scrapped everything and adopted a universal health care system where
the government simply pays for health care of everyone up to a standard of
care above which there is quickly diminishing returns, they could do so
without increasing current federal levels of health spending, since US
government health spending is already large by the standards of other
countries that take the single payer approach. If you want more health care
than this, you can buy private insurance, except now because all consumers are
weighing up whether it's actually worth it given they have most of their
health care covered by the government, the insurance/health system has much
less cost disease.

This is how health care works in sane countries. Countries where rational
policy discussions cannot get totally derailed by the magical word
"socialism".

------
letsgetphysITal
It's almost as though sick people are less productive or something.

Did we _really_ need someone to tell us this?

~~~
matthewmacleod
_Did we really need someone to tell us this?_

Well, yes. Otherwise, we'd expect there to be universal healthcare!

~~~
cmrdporcupine
What makes you think most people in power really care about productivity of
the domestic population at this point? High productivity is something that is
purchased from abroad these days.

------
cderfvbgt
my father always said: "those who have will even take from those who don't
have". this seems to be the crux of the issue

------
wl78393
Tell that to little Alfie.

When you have an unconditional "right" to consume someone else's labor, the
inevitable result is tyranny, rationing and the force of government
determining outcomes.

~~~
shawabawa3
I see this argument a lot, but in no country with socialised medicine is any
doctor ever "forced" to treat someone.

Doctors can choose employers, work in private practises, and quit at any time.

Much like many employees, when they're employed they may have to perform
duties relevant to their position such as treating sick people

------
khawkins
From the Hackernews guidelines:

"Off-Topic: Most stories about politics, or crime, or sports, unless they're
evidence of some interesting new phenomenon."

This post is clearly political and calls for universal health care have been
around for decades.

~~~
ape4
Universal health care helps startups.

~~~
MrBuddyCasino
This is not certain. There is evidence that the safer people feel, the less
willing they are to take risks. This is only paradoxical at first glance.

~~~
amclennon
On the other hand, taking potential health concerns out of the equation makes
working for a startup inherently less risky.

Before the ACA removed restrictions of pre-existing conditions, merely
switching employers carried the risk of losing access to necessary healthcare.

------
fortythirteen
This article conflates public "essential health" services with universal,
state-run healthcare. It also uses nondescript graphs, in image form and with
no link to source data, to make sweeping, "correlation equals causation"
points about universal health care and life expectancy.

This is an article trying to make an ideological case rather than to discern
truth.

~~~
fsloth
"This is an article trying to make an ideological case rather than to discern
truth."

Generally Economist is unashamedly political. That's what makes it so good -
they don't try to hide the fact that they take a stand. They give you the
facts and their arguments, and then it's up to the reader to digest it.

If you disagree with some of the points, I suggest you send them a letter. The
letters section of Economist is one of the high points of the magazine as well
- they publish rebuttals and corrections no matter how far they stray from the
magazines core claim as long as the letter is well written and sanely
argumentative.

~~~
fortythirteen
> Generally Economist is unashamedly political.

I have no problem with unashamedly political. I do have a problem with willful
disingenuousness to promote ideological dogma.

