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I'm reading the comments, and surprised at what's missing. What happened to the business approach?

The US government is delivering a large number of products with wildly varying costs, efficiencies, and price points. e.g. unemployment, welfare, food stamps, etc. There is a proposal is to replace those products with only one.

The new product fills (mostly) the same need as the existing ones. It will do so at less cost, with more efficiency (less bureaucracy, administration, fraud, etc.). Previous market studies show that it works.

So... what's the problem?

As a non-US person, this looks a lot like previous discussions on health care. France pays about $10 per person per day for universal health care. The UK pays about $10. Japan pays about $10. Canada pays about $10.

The US (before Obomacare) ? About $20, for care that isn't universal.

You guys are getting ripped off. Yet the bulk of the population sticks their fingers in their ears, and complains about people who may not "deserve" it. Or they complain about fraud.

Who the hell cares about random welfare guy ripping off the system? If you're making over $40K per year, you're getting ripped of by the system. By your system, that you demand to keep in place.

You can get rid of the checks and balances, and just absorb the cost of fraud. And as a bonus, a simpler system is harder to game, which leads to more detectable fraud, and therefore less of it.

This won't happen in the US for a number of reasons. One of which is that the bureaucracy won't voluntarily reduce. Another (as seen here) an unwillingness to deal with these issues in a business-like manner.

Yes, I'm from a socialist country advocating for more capitalism. Not unfettered, but more.

> bureaucracy won't voluntarily reduce

I think that's one of the big ones. Bureaucracies tend to become living, breathing organisms who's sole purpose is to self-preserve and grow. A basic income in the US would threaten so many different agencies and organizations within (and without) the government, that the response would be fierce, assuming you could even get it anywhere near the government. With people's anti-communist attitude here, it's hard to get any ideas out there that don't fall in line with the current capitalist-imperialist system. Even if something isn't anywhere near communism, you get fox news calling it communism and in a few short minutes half the country hates it.

I think the only way this will ever happen in the US is if a bunch of other countries do it first, successfully. Then, after maybe 20 years, the US will implement a shittier, watered down version that accomplishes 1/10 of the original idea but with staggering overhead.

>>Who the hell cares about random welfare guy ripping off the system? If you're making over $40K per year, you're getting ripped of by the system. By your system, that you demand to keep in place.

The USA is a deeply individualistic society. For most people, the default mindset is "me vs. those other people," and your average American will do anything (including tolerating a grossly inefficient system) to make sure "those other people" don't steal from "me."

If anything many people are pushing harder in this direction. For instance, consider the push for mandatory drug testing for welfare recipients even though the places have tried it have discovered that:

1) Almost no one fails them 2) They cost more money than they save (in cancelled benefits)

Oddly, you've also just summed up the reasons behind many of our copyright and patent issues.

Let us not delude ourselves into thinking any healthcare system is self-contained and self-sustaining, equipped to deal with all the needs of its citizenry.

Most European nations ( and Canada, Australia & New Zealand ) are great at dispensing - what can be termed as - "subsistence medicine." Most ailments, procedures and surgeries are handled quite well, although - it has to be said - a tad frugally. ( It is not uncommon for the doctor to under-prescribe medications or opt for a less cost-prohibitive option over another even when the situation could be better dealt with, with a more exhaustive course of prophylaxis)

Plenty of Canadians including the Premier of New Foundland have opted and continue to opt for minimally invasive procedures ( as well as convoluted surgeries ) to be done in the United States, simply because the U.S. is better equipped with the resources and the doctors to deal with such cases.

  "This is my heart, it's my health, it's my choice."
  With these words, Newfoundland Premier Danny Williams
  defended his decision to hop the border and go under the 
  knife for heart surgery in Florida.
  The minimally invasive mitral valve surgery he needed is not 
  available in Newfoundland, he told his province's NTV News channel
  in the first part of an interview aired last night.[1]

  For instance, some Canadian patients who are tired of waiting 
  for procedures in their country's national health system come
  to Michigan hospitals. [2]
Even the richest of the rich pick the United States over say European destinations for their medical treatments.

  The king (Abdullah of Saudi Arabia), who is 86 years old, was in town
  for surgery at New York Presbyterian Hospital on Nov. 24.[3]
[1] http://www.theglobeandmail.com/news/politics/its-my-health-i...

[2] http://www.cbsnews.com/news/reverse-medical-tourism-points-u...

[3] http://www.nytimes.com/2010/12/14/business/14road.html?_r=0

Having the best hospitals in the world doesn't matter if only a tiny subset of your population can actually use them.

The wait times for life threatening issues in Canada really isn't that bad as someone who spent last year with my mother going through Cancer treatments and has a few friends here going through the same at the moment. Less urgent procedures due tend to take a long time though.

So while Canadians may wait up to 6 weeks for non-essential/urgent surgeries, 45,000 americans die each year because they lack the insurance to pay for their medical treatments.

I think you need to see what Dr. Danielle Martin[1] a Canadian doctor had to say when she testified to the U.S. Senate defending the Canadian system.

The reference was to Newfoundland Premier Danny Williams’ controversial 2010 decision to undergo heart surgery at a Miami hospital.

“It’s actually interesting,” replied Dr. Martin, “because in fact the people who are the pioneers of that particular surgery … are in Toronto, at the Peter Munk Cardiac Center, just down the street from where I work.”

She then hinted that Mr. Williams was of the mistaken belief that simply paying more for something “necessarily makes it better.”[2]

[1] http://youtu.be/iYOf6hXGx6M?t=1m22s

[2] http://news.nationalpost.com/2014/03/12/toronto-doctor-smack...

As a Canadian in the healthcare field perhaps I can chime in as well.

When you talk about Canadian healthcare, it is a provincially run program (not federal) so let's talk about it at the provincial level. As I am an Ontario resident I'll be discussing this from an Ontario perspective, talking about all of the provinces and their differences would entail several posts.

Ontaio is currently going to institute (or plans to at least) pay freezes on physicians due to the rising cost of healthcare in a non-booming economy. However it is currently one of the best provinces in wait times. The provincial median is 6.7 weeks to see a specialist after being referred and another 7.1 weeks to being treated. This has increased 3 years compared to last year and about doubled from 20 years ago. For some specialties like orthopaedics the total duration is ~40 weeks. This is in contrast to the US where ~90% see the specialist within 4 weeks. Internationally we are considered to be amongst the worst nations when it comes to wait times.

Another big problem with the Ontario system is unemployment. 1/3 specialists, especially surgeons, are unemployed due to a lack of operating rooms and jobs available - even in rural areas. There is a definite need but with the single payer system we have, the aging population pyramid, and increasing healthcare costs we have there is no money left to pay physicians - who make less on average (at least in the surgical specialties) than the US physicians. So we're graduating surgeons who can't work and are forced to go the US to find jobs.

To address one of Dr. Martin's comments btw, someone jwo develops a surgery/technique/game isn't always the best person at solving it. Developing a mitral valve replacement survey using MIS techniques doesn't mean you're the best person to technically achieve it (you could be, but it's not a given as she phrases it). The US has a system that rewards exceptionalism and excellence, the Canadian system generally rewards mediocrity (this is even evidence in other fields such as law and even academia). The US is famous for having premier surgeons and state of the art equipment. A prominent example I know is in the field of limb lengthening, where until very recently there was not a single surgeon in Canada who could do internal limb lengthening, they all used the external fixator pioneered in the USSR. Even in medical education you are seeing prominent US schools teaching the use of hand held ultrasound devices which are supposed to one day replace stethoscopes. The US also has far more specialized medical fellowships focused on advanced techniques and tools such as using tne da Vinci robot system.

I can provide references if necessary (I typed this up on my phone) but most of these facts are readily google-able.

TLDR: Our system isn't as perfect as you might think and is actually teetering on financial instability at the moment with up to 1/3 new physicians unable to find a job in the country due to funding issues.

>The US has a system that rewards exceptionalism and excellence, the Canadian system generally rewards mediocrity (this is even evidence in other fields such as law and even academia).

That sounds like a Polandball-grade national stereotype, and I'd really prefer to hear some justification.

Interesting, how she did not have numbers, when asked, for Canadian fatalaties owing to protracted wait times and instead slyly diverted the discussion to the wait times at the security line to enter the Senate building. She seemed a tad petulant and more than a tad eager to please Sen. Sanders and offer a markedly animated and rosy account of her country's system than the rest of the representatives from Taiwan, Denmark and France.

Anyway here are some unvarnished facts about the share of things that plague the Canadian system.

  "In 2011, a significant number of Canadians—an estimated 
  46,159—received treatment outside of the country."
  "At the same time, the national median wait time for 
  treatment after consultation with a specialist increased from 
  9.3 weeks in 2010 to 9.5 weeks in 2011. Among the provinces, 
  wait times from consultation with a specialist to treatment 
  decreased in six provinces, rising only in Manitoba, Ontario, 
  New Brunswick, and Nova Scotia." 
  "In some cases, these patients needed to leave Canada due to 
  a lack of available resources or a lack of appropriate 
  procedure/technology. In others, their departure will have 
  been driven by a desire to return more quickly to their lives,
  to seek out superior quality care, or perhaps to save their 
  own lives or avoid the risk of disability. Clearly, the 
  number of Canadians who ultimately receive their
  medical care in other countries is not insignificant."[1]

  "Wait times for health care in Canada have stalled at historically
  high levels, in spite of current government strategies aimed at 
  improved timeliness. Canadians wait longer than citizens of many 
  other OECD countries with universal access health care systems, 
  from emergency room visits to physician consultations to elective
   surgeries, despite Canada’s relatively large health expenditures."
  "Failing to fix wait times has affected the economic well-being of 
   Canadians in a number of important ways. One estimate, from the  
   Centre for Spatial Economics assessing just four procedures – 
   total joint replacement surgery, cataract surgery, coronary 
   artery bypass graft surgery, and MRI scans – found that excessive
   waits were costing Canadians $14.8 billion, plus another $4.4 billion
  ($19.2 billion,together) in lost government revenues from reduced 
   economic activity."[2]
I dislike offering anecdotal evidence because it appeals to emotion and not reason.

All I can say is I'm acutely familiar with the Canadian system on more than one level.

All of this is not to put too fine a point on how single payer systems are terrible in their own way.

It is to indicate that no matter which system we side with we are confronted with a more or less equally (depending on who you ask) dreadful trade-off of horrors.

I'm not going to dump links here to the scores of Daily Mail reports, to offer as proof of how "efficiently", the British system under the auspices of the NHS, works. You can Google it yourself "NHS site:dailymail.co.uk" )

The point is that vested interests on either side always make the other option look barbaric.

Some prefer a system where every manner of medical malady can be treated skillfully and expediently, right here within our shores without extended wait times, by distinguished medical experts with a tremendous case experience in a given line of treatment, be it Hodgkin lymphoma or Parkinson's or Multiple Sclerosis.

Some prefer that everyone last person in the country has an "on-paper" access to free and need-based healthcare.

Some like David Goldhill want to entirely scrap the insurance model in favor of a radical direct pay model - where everyone pays out of pocket for most common procedures and office visits and thereby largely expunging the role of insurance companies. In 2007, David Goldhill's father was admitted to a New York City hospital with pneumonia, and five weeks later he died there from multiple hospital-acquired infections. [3]

Your outlook is shaped by how healthy you are or how diseased you are. How your family coped with various medical hardships in the past or how everyone you know has always been blessed with bountiful health. How a certain system excludes things that you think should be offered by any self-respecting medical system, for the well-being of its public.

At the end of the day, most sensible people anywhere in the world would want to pay for a system that they see some utility out of, without adverse consequences.

A sick person's utility is different from a hale one's.

A salaryman's utility (with his cautious life choices and lifestyle) is structurally different from a freewheeling thrill seeker's.

After all how is it fair that you are admitted into a ward for a routine fracture and contract some deadly MRSA bacterium from a guy who just returned from a safari in Belize? (This is quite a charitable example and is intentional. There are much worse examples that I could use, that will immediately invite censure and rebuke. Funny how just earlier today I was reading one of the comments to PG's "What You Can't Say" piece - https://news.ycombinator.com/item?id=7443715 and how it strikes a resemblance to what I'm saying here.)

These are some - JUST A TINY TINY FRACTION - of the vast number of things that go UNSAID during a national debate concerning healthcare systems.

Because no politician, policy expert, insurance company executive, medical professional or even an electorate would want to be seen holding borderline prejudicial views, in this context.

Hence they find other ways to verbalize their opposition to a single-payer system, using societally acceptable narratives and scenarios.

[1] http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Conte...

[2] http://www.fraserinstitute.org/research-news/news/display.as...

[3] http://www.theatlantic.com/magazine/archive/2009/09/how-amer...

[4] http://en.wikipedia.org/wiki/Methicillin-resistant_Staphyloc...

"I'm not going to dump links here to the scores of Daily Mail reports, to offer as proof of how "efficiently""

Good, because the Daily Mail is laughed at in the UK as being gutter press. It is our version of what the Americans have in TMZ, basically.

So let's charge these rich people coming over here for premium care a bit extra and redistribute subsistence care to those traditionally not covered.

This is so appalling. If your wife is in labor and needs to rush to the hospital, the cab driver ought to charge you outrageously because you're richer than him?

The cab driver is a really bad example because the cab driver isn't providing a service that people argue is a human right. In terms of healthcare I think that it's reasonable that those who can should pay more to cover for those who can only afford to be grateful. That is usually how the cost of public services is distributed using taxes.

Ok, so make the example "your wife is bleeding out". Should the can driver charge you outrageously because you are richer than he is?

If you read my post again I am sure that you will understand that the predicament of my wife is irrelevant to my argument. Economically rationally the taxi driver will charge according to the perceived value of his service, which in terms of money means more to a rich person. Of course other factors weigh into this equation, especially competition and the fact that people aren't economically rational.

Should the can driver charge you outrageously because you are richer than he is?

Only if you are outrageously rich and the driver did an excellent job of emergency transportation and only by billing you after the fact. The first priority should be on saving lives, then sort the logistics out later.

It's worth noting that Ontario spent a lot of money to introduce photo health ID, because of the fraud under the old system (including people who would border-hop to take advantage of OHIP while living primarily in the US).

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