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Comment by sytelus | Hacker News Reader

This is interesting because there is so much conflicting information. On one hand several people mention they received timely inexpensive care in single-payer system and on other hand there are example of people who were told to wait in line for weeks or get denied of their desired treatment option. It appears that Taiwan's system is certainly getting stretched now and they have been putting up new constraints and caps. My main worry is that in single-payer you have zero options. If your "payer" decides to put a new rule (for example, only cover treatment X because Y is too expensive), it applies to you whether you like it or not and there is nothing you can do about it. Further, in single-payer there are virtually no incentives or restrictions on what they would and can do because its a virtual monopoly. For example, government can decide to reduce budget on health care because they must spend more money on defense due to some foreign threat.

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Well its not the government who decides what is covered or not. Most countries have special boards with doctors who decide what is covered by the basic mandatory health care insurance plan.

But at the end of the day society has to decide whether or not healthcare for everyone is something worth spending money on. And that's were the US fails imo: no sense of a shared community.

While that's probably true, it's difficult to have a comprehensive individual patient cost comparison because medical issues are so diverse, and some people do indeed consider some issues to not require immediate attention. But I imagine only a financially unhealthy government would strip the health care system's funding for all things that the general population considers a basic requirement. And if your government has financial straits that dire, you're going to have so many problems in all aspects of life, not just health care. What's the point of being healthy if everything else is a living hell? Not saying this is a good argument for or against single payer. I am saying that whether or not single payer should be the system is probably an unimportant question for an insolvent government's populace.

> on other hand there are example of people who were told to wait in line for weeks or get denied of their desired treatment option.

These seems to most often crop up around non-critical issues like joint paints etc.

And i have yet to find a single payer system that do not let you go abroad for elective care, if you can find the funding. They will however not fund your trip unless there is a strong case made for there being no viable alternatives back home.

With most US based insurance being employer based I don't see how the "we only cover x because of y" really is a discriminating function between single payer vs multiple. My ability to choose an employer based on their health care plan is challenging at best. I may be missing something however as I mostly know the US system

If you have good top tier employer, chances are that you have pretty good insurance. Medical insurance is actually a criteria for lot of people for which employers to work for. This however probably applies to more skilled workers who have such choices. In single-payer, your employer no longer provides insurance. So everyone gets same plan and you are stuck with it.

Yup, the idea for for profit driven healthcare sounds bad until you consider the alternative which is cost minimization driven, the easiest way to cut costs is to not provide service

It’s the same doctors regardless... insurance companies are cost minimizers as well.

Indeed. My understanding is that US hospitals will inflate their bills because they know the insurance companies will turn over every stone to find ways to drive the bill down.

This in turn bites those that try to pay directly, as they end up with sticker shock.

A top tier employer in Europe may still offer private health care insurance.

When my father had cancer treatment, he sometimes asked for the public hospital (shared ward, less lonely when he was feeling OK but had to spend days in a bed) and other times the private hospital (doctors and nurses had more time, but the treatment was the same and he had a private room).

Cultural difference. In my country everyone gets the same standard of healthcare. If you think you think you deserve special treatment just because you're rich you can fly to the US or Singapore. Strangely enough most rich people don't.

There is private health care in the UK and Germany. Presumably others, but not all EU countries.

Isn't some form of supplemental private health insurance available in most single payer countries?

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