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It seems we in the United States have traded inefficiencies. Though our payments are higher, from the (little bit of) evidence I could gather from other single payer systems our wait times are far lower. This CNN opinion piece offers supporting evidence: https://www.cnn.com/2017/09/25/opinions/single-payer-failure...

It's been my own experience as well. My dear friend in Australia who otherwise praises her system has had to wait over a year for some very important foot surgery. I was able to schedule a not-very-critical knee surgery in a matter of days, and I have the lowest-cost insurance plan my company offers.

Even while unemployed and on government insurance, my daughter was able to have open heart surgery when she was six months old. She waited a few weeks for an opening. I shudder to think how long she might have had to wait in Canada.

I can't see the article because my free views are up; Do they discuss what I view as the two most heavy flaws of United States healthcare? The increased regulations and the ability of doctors and hospitals to charge exorbitant prices due to insurance itself.

Regulations (in my observation) consistently bring heavy cost burdens to every industry they are applied to.

And insurance permits cost hiding: It doesn't trouble me terribly that a saline bag costs $70 if 3 million of those on my plan pay less than a penny each to pay for my saline. Doctors and hospitals have jacked prices sky high since insurance has become the norm. Whereas stories abound of cash payers getting their hospital bills slashed by significant margins. Only because they bypassed insurance.




My daughter was born a month premature, with her stomach outside of her belly still. She was in the ICU for a month in one of London's top hospital. There was no waiting (obviously), and this was all for free. I shudder to think of the costs that would have been in the US. I would say 100k easily and I would be bankrupt.

I've also lived in Australia and when I needed a eye operation, it wasn't even life threatening or dangerous (probably in 30 years it might have blinded me). I got surgery scheduled on the same day.

So really the wait all depends and of course it's on a triage system. I would say if your daughter needed her surgery in a socialised healthcare system it would have been triaged and made a priority.


This is my experience aswell. (in the dutch healthcare system).

i was also born prematurely, and as a result of that had to have some pretty major surgery done as a child. All of these surgeries where done rapidly aswell to keep the impact to a minimum.

Compared to a couple of months ago, where i needed to get some surgery done in my hand, in which i had to wait a couple of months. The issue with my hand was annoying and slightly painful at times, but nothing life threatening or "serious" compared to my premature birth surgeries.

Sure, the wait time sucks, but healthcare is (in my opinion) something collective that should be done by society as a group.

if i have to wait a couple of months to get my hand fixed. While at the same time it allows a premature child to get fixed up and get's a proper chance to live, so be it.


As much as I am opposed to the collectivist view points on society in the world, it seems this is one area where an individualist perspective doesn't work as well.

But the problem here, as you pointed out, is that to implement this idea in America, people would have be less selfish and more responsible for their own health. Neither of which is a core tenant of our modern society. 50-70 years ago is when we should have done this.


Sadly, I find $100k to be an extreme lowball for a month in an ICU. Here’s a story from last year, for example: http://www.philly.com/philly/news/alison-chandra-social-medi...

A related tweet from the woman in the article: https://twitter.com/aliranger29/status/878429522533777410?s=...

> I'll save you some math; without insurance we would owe $231,115 for 10 hours in the OR, 1 week in the CICU and 1 week on the cardiac floor.

Of course, I could be wrong too. I’ve been very lucky with my health. My grandfather spent four days in the hospital last year and it was $35,000...

I’m glad your daughter was able to get the care she needed.


Yeah to be honest I have no idea of the costs of healthcare in the US, just what my US friends say about copay and obamacare and stuff. And reading hackernews. 100k would be low and that's a scary though.


It's easier to have lower aggregate wait times when a large chunk of your population knows they won't (e.g. can't afford to) get health care unless it's a life-threating emergency. Did the study cited normalize for "discouraged" patients from rural and inner-cities?


The perverse thing is that those supposedly "discouraged" patients are not discouraged at all, since they won't pay for their healthcare costs themselves anyway. Virtually everywhere in the US has programs for free healtcare for those at some varying multiple of the poverty line.

The people that are fucked over are the working and lower-middle class people who make too much money for the free programs, and so have to purchase exorbitant, yet often very terrible, insurance plans, which typically have high deductibles, so that they pay thousands of dollars a year for their terrible coverage, plus $3k-$5k more if they are unlucky enough to actual need to use the insurance they're paying through the nose for.


wait time == infinity, if you can't get access to care you need at all!


There is certainly some long wait times for care here in Canada, but the moment it's life threatening those times vanish. The wait times we Canadians grumble about are for quality of life surgeries like hip replacements and emergency room wait times for non emergencies. Cancer diagnosis or heart surgery gets done right away. To provide excellent care for people who need it right away without spending US level dollars on healthcare requires something to give, and we have chosen wait times for stuff that won't kill people. I'm pretty happy with the setup since I know not just my family but all families get treatment when they need it, and we all suffer together in the waiting room when we stub our toes.

Some examples:

My mother cut her finger quite badly making dinner a few years ago. She wrapped it up in a towel, grabbed a book since she knew she was in for a wait and headed to the ER. Triage nurse confirmed she wasn't in danger of bleeding out and added her name to the list. My mom waited 3 or 4 hours and then someone stitched her up. Many people in much worse shape were wheeled through while she waited.

My father was peering out a window with security bars, slipped and caught his wedding ring on a bar which partially degloved his ring finger. We rushed him to the ER where the triage nurse raced him into an OR to have the ring removed (it was embedded) and his hand stitched up. He was home within an hour or so with his mangled wedding ring in a urine sample jar. Followup care recommended plastic surgery in combination with physiotherapy to restore finger movement. My Dad had to wait several months for a plastic surgery opening since it wasn't life threatening. Plus based on his telling the other people in the plastic surgery waiting room has crazy gruesome disfiguring traumas and he was happy to let them go first.

A friend got stung by a bee and thought nothing of it. The next day we were playing soccer and he got hit with the ball where the sting had been. He had a delayed allergic reaction of some kind since his leg swelled up to about triple size and turned a really crazy colour. We drove him to the ER and I've never seen a triage nurse move so fast in my life. My buddy was on an IV with doctors prodding him within 30 seconds of walking through the door. He needed to have a full IV bag of a concoction of drugs I couldn't pronounce twice a day for a week, but he was fine.


> I shudder to think how long she might have had to wait in Canada.

I have seen no evidence that in Canada it wouldn’t have been the same or faster than the USA. There is plenty of rightist propaganda in the USA that claims otherwise, but it has mostly been exposed as...propaganda.

Cash payers pay much more than those with insurance at American hospitals, mainly because the collection rates for cash payers are much lower so they are associated with more risk.


>>"There is plenty of rightist propaganda in the USA that claims otherwise"

There is, also, a more subtle game at play here. At the end of the day, if the public system is good or not is a political decision.

There is a strategy that is happening now in some (many?) places in Europe where the public health system is defunded and then there are public claims of how bad the system is.


> There is a strategy that is happening now in some (many?) places in Europe where the public health system is defunded and then there are public claims of how bad the system is.

Sure, because it is a very nice piece of cake for the private sector. What better business than something that people cannot live without?. There is a lot of money in play.


Yes, however even Theresa May can’t make the NHS look as bad as the American system.


Couldn't it just be that most people aren't getting the treatments they need? When I forgo medical procedures because of cost, I'm technically increasing 'efficiency' for everyone else - that's not a positive of our healthcare system though.


The wait time of someone without access to care is infinity. The average wait time for the overall population is not lower in the U.S. It is lower for those with access to the system.

All healthcare systems have to ration care. The U.S. rations care in an immoral way.


Yes, I don't like the fact that those who work hard and honestly cannot afford the necessary work. Another dear friend in Texas may need rotator cuff surgery. She and her hard-working husband have discussed the matter; they cannot afford it. It seems immoral that though she needs surgery she cannot afford it.

But there is more to the morality of it than what you state: Our system, for all its faults, naturally favors those who choose to excel in their field. By contrast, those who choose to steal from their neighbors by taking an easy route, whether by doing mediocre work, or by not studying, or by not working at all, will find themselves left out.

DON'T HEAR WHAT I'M NOT SAYING. I'm not saying everyone who is poor is lazy! My Texan friend is a hard worker. Where they might have gone wrong is the choice of career path and education. But many do indeed choose the easy route. Earlier this year I was seeking to help a poor family move, get a job, get education. I could see them consistently choosing the easy route, and they suffer because of it. Their daughter suffered most because of it.

My dear Texan friend likely could pay for her rotator cuff surgery if she or her husband had a startup in which they poured their lives and passions into. (I am hoping to help them do just that.) The United States is in the top 10 countries for ease of starting a business.[1] (To be fair, New Zealand is single payer and is first. I'm not saying the system is perfect.)

Rewarding career excellence it seems to me has a broader impact on the culture around. Better workers pay more into insurance to help others. And better workers improve the systems and products that they touch.

Don't hear me say however that I think the system is perfect. I am a Christian and my command from Jesus is to help the needy, and we don't do that as well as I'd like. That's why I am aiming to bring better healthcare and careers to people in the poorest of nations. I have a side project I'm working on for the people of Haiti, and I don't see any reason it would fail to help many dozens or thousands (or millions?) of needy.[2] I have high hopes that in 20 years many more people in Haiti will be able to afford health care, and not because their government made it much more affordable or available. There is little hope of that in a corrupt nation like Haiti.

So I'm hoping to take the skills I have excelled in to help others to help themselves to improve their own skills, so that they too may be able to enjoy the same benefits I have.

TL;DR: There is more to morality than helping those who cannot pay. Our system seems to be, whether knowingly or unknowingly, guided by the "if a man will not work, he shall not eat" principle, and the moral response for those living under such a system is to both work hard to better one's own life and the lives of everyone who uses the products of one's skills; and to lend a hand to one's neighbor on an individual level, to help them to help themselves.

We all are guided by some form of absolute morality; please ensure yours takes into account all factors.

[1] http://www.doingbusiness.org/rankings

[2] https://news.ycombinator.com/item?id=16402404


"I am a Christian"

Yeaaah, I remember you having very odd, non reality based objections to geology yesterday, too. Now I know why.

I would suggest that you re-evalute your ideas, they seem utterly crazy to me. We aren't all born with the same skills, even if we all work as hard and smart as we can we aren't all going to make six figure salaries so that we can afford medicine. Someone has to dig the ditches and take out the garbage, and you should not be using twisted religious logic to condemn your garbage man to death.


Straw man attack. I don't condemn garbage men, and I said so very clearly if you would go back and re-read. I want them to in their spare time pick up Lean Startup and learn what they need to start a business. You're on the YCombinator website. You of all people should agree.

I repeat: We are all guided by absolute morality.* Ensure yours takes into account ALL factors.

Now if you’ll excuse me, I’ve got to get my business off the ground. Can’t spend my whole day here chatting. People in Texas and in Haiti lack healthcare and I’m aiming to do something positive about that.

* Edited to add exhibit A, the statement above by yequalsx: "The U.S. rations care [does so] in an immoral way."[1] That is a statement of absolute morality on the part of yequalsx. I didn't bring up morality, they did. Their belief is absolute; it is not relative. They do not believe that what is good for them is only good for them, but that this morality must be obeyed by the entire world. That is an absolute standard.

The hole in this absolute moral standard is it seems to fail to take into account those who either steal or who miss out on opportunities due to a lack of awareness. See my carefully-worded comments above.[2]

[1] https://news.ycombinator.com/item?id=16583943

[2] https://news.ycombinator.com/item?id=16584193


If everyone followed your advice to start a startup, how would you find employees?


Our system, for all its faults, naturally favors those who choose to excel in their field. By contrast, those who choose to steal from their neighbors by taking an easy route, whether by doing mediocre work, or by not studying, or by not working at all, will find themselves left out.

According to your first paragraph you realize there is not a dichotomy. It is not the case that everyone falls into the "excels in their field" and "steal from their neighbors" camps. Indeed your example demonstrates this. So our system is immoral in how it rations care. That is all I said.

You said the phrase, "steals from their neighbors". I guess this refers to welfare recipients and some sort of belief that taxation used to help loafers is theft. This is most disturbing to me. The one you follow has it written in his book that the love of money is the root of all evil. He said with regard to taxes pay unto Caesar what is Caesar's. He said to his disciples that at judgment he will divide people into his left and right and say to the one group you fed me when I was hungry, clothed me when I was naked and that they did this when they fed and clothed the least of their brethren. He mentioned the parable of the Good Samaritan.

You mention a brief passage in 2 Thessalonians 3:10. A passage clearly taken out of context. Yes the phrase, "if a man will not work, he shall not eat" is in the Bible. You should realize though that it was said to believers in Thessalonica. Your usage of the phrase and it's use by right wing Christians in the U.S. is completely out of context.

Given what Jesus said with regard to helping others vs. a passage taken out of context written by Paul I think you have your priorities wrong. I will paraphrase what H.L. Mencken said. The modern right leaning version of Christianity as practiced in the U.S. can best be described as people who have the haunting fear that someone, somewhere is getting something they don't deserve. This is quite ironic since the whole premise of Christianity is that some will be saved even though none deserve it.

I choose not to focus on possibility that someone will get healthcare even though they don't deserve it. I choose to focus on the possibility that everyone has value and is worthy of being cared for. I choose to focus on this because in my view it is the moral thing to do. I'm not a Christian.


> I guess this refers to welfare recipients

No it doesn’t, as a more careful reading of my words would reveal. I’m not interested in discussing this with someone who won’t carefully read, so I wish you good day and God bless.


Hence my use of, "I guess...". I didn't know what exactly you were referring to with the phrase in question. However, the remainder of what I wrote remains on point and valid as that had to do with your selective reading of the Bible.


"Our system, for all its faults, naturally favors those who choose to excel in their field."

Choice of parents and zip code are the prime factors.


I have the lowest-cost insurance plan my company offers.

Yes your insurance plan may cost you a little but how much is your company paying on your behalf?

I had this same argument with some of my coworkers who didn't want to pay extra taxes for government healthcare. The company list how much they are paying on your behalf for insurance as part of the ACA it was $12000 a year for the family. Assuming a $120,000 developer salary (reasonable but low for a senior dev in our market). That's 10% of our total compensation. That money comes from somewhere.

They were paying the same $12,000 for the help desk support staff that was probably making $40K at the most - about 25% of their total compensation.


If you want quality, fast care, live closer to your providers.

This is a symptom of provisioning, not single payer vs profiteering.


wait times are only lower because you are not counting the infinite wait times of people who just don't go to the doctor because they can't afford to.




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