Comment by chmod775 | Hacker News Reader

Comment by chmod775 | Hacker News Reader

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European view here. We're pretty much all left-leaning from an US-perspective.

> Housing - build more and higher density.

Zoning is an incredibly hard science. Hardly any country on earth manages to get this right. Solutions are often also highly specific to local parameters. Though admittedly, the US has glaring issues with some housing areas being super spread out and low density outside of city centers.

> Healthcare - price transparency and make it easier to shop around. Incentivize frugality.

The problem of making healthcare universal and affordable has been solved plenty of times around the globe already. Obama's administration made a huge leap in the right direction, but there's more track to cover and issues to fix before the US's healthcare system becomes comparable to a say, European, equivalent. They never got the chance to finish this though.

> Education - stop letting 18 year olds take out $200k in loans for poetry degrees.

Generally having education governed by free market forces, thus giving the best education to the highest bidder, kind of goes against the US's slogan of (equal) opportunity. Not to mention all the other issues with that idea. Again, just copy any of the plenty of countries with a better system.

And don't give me any of that "But the US is a larger country and thus those solutions wouldn't work". What happened to divide and conquer? Just have administration sit at state level and you get to pretend the US is really 50 smaller countries - divide further as needed (some countries like Germany use this strategy to divide administration of their education system as well). Also there's plenty of countries with a number citizens in a comparable order of magnitude with working systems.

> European view here. We're pretty much all left-leaning from an US-perspective.

I don’t think that’s actually true. Western Europe is often more social democratic in principles, but often quite conservative in implementation. For example, Europe relies heavily in VAT, which has theoretical benefits but is regressive. Healthcare in Germany is paid for by an insurance contribution that is much higher for the individual, but phases out on income above about $60,000 per year. Meanwhile, in the US you pay Medicare contributions on all income, and the left is pushing to make Social Security contributions the same way.

Likewise with college. Germany would pay a lot more to offer free education if it didn’t aggressively control the pipeline of students into colleges. That idea would be alien to the left in the US, where the belief is that everyone should go to college.

> Healthcare in Germany is paid for by an insurance contribution that is much higher for the individual, but phases out on income above about $60,000 per year. Meanwhile, in the US you pay Medicare contributions on all income, and the left is pushing to make Social Security contributions the same way.

Yeah, but in Germany most things are actually covered by the insurance, whereas in the US even people with really good insurance can face huge bills for things like being in the wrong hospital or being treated by the wrong doctor, which sounds utterly bizarre from a European perspective.

> Likewise with college. Germany would pay a lot more to offer free education if it didn’t aggressively control the pipeline of students into colleges. That idea would be alien to the left in the US, where the belief is that everyone should go to college.

To phrase that another way, in the US you believe that anyone with the money should be able to go to university.

Also, a key difference: taxation for public services is pretty universally supported in Europe. Even by the right wing.

With respect to out-of-network coverage: Germany also has a quarter of the population of the US and an land area smaller than several US states. Which is just to say, it's probably easier to provision a reliably coherent network of health care providers in Germany than it would be to do that across all 50 states.

> [...] it's probably easier to provision a [...] network of health care providers [among Germany's 16 Bundeslaender] than [...] across all 50 states.

Maybe. Slightly. Not really a challenge in the computer age.

Also the last paragraph of my comment above still applies.

> Obama's administration made a huge leap in the right direction, but there's more track to cover and issues to fix before the US's healthcare system becomes comparable to a say, European, equivalent.

I don't see how you can say this. My premiums literally doubled under Obamacare and now I have a new thing called "co-insurance" meaning that I pay 20% of all bills, period.

Edit: why would I be downvoted for relating my experience?

I didn't downvote you, but I'd like to reply to why this might be a leap in the right direction.

1) Universal insurance increases the fluidity in the labor market because people are no longer forced to stay in a job to have health insurance. This can be the difference between someone starting their own small business and sticking with a large corporation for the benefits.

2) Providing access to health care for the (currently) uninsured means they can manage their conditions and prevent them from deteriorating, instead of going through a costly cycle of ER visit -> stabilization -> ER visit. Because hospitals are obligated to stabilize anyone who goes to the ER, these procedures increase hospital operating expenses which is passed on either to (1) the tax payer or (2) insured patients. The best care both health and fiscal-wise is preventative care.

3) Obamacare was a leap in the right direction, but definitely did not go all the way. A portion of that may be that it simply takes time to adjust to a new system, but as parts of the old system are rolled back, it becomes increasingly less effective. For example, universal coverage without the individual mandate is costly for insurance companies, resulting in higher premiums.

4) People make poor decisions and forgo medical insurance only to have a medical disaster happen and land them in considerable debt. The affects of this debt continue to plague them for years after. Carrying crippling debt affects not only these people but any of their dependents, so the effects compound. The usual response is that the responsible shouldn't have to pay for the irresponsibles' poor choices, but you'll pay for them either way, just in one case it's easy to quantify the effect and in the other case the effect is nebulous are hard to pin down exactly. For example, studies have shown that acute poverty has an effect on intelligence. The more people that run around stressed by their debt, the less likely they're going to make smart choices going forward with respect to their finances, politics, etc.

Assuming you believe that Obamacare was a leap in the right direction, you have to recognize that it did not go far enough or reach a stable enough point to where the benefits may have been fully realized. Even if you agree that a single payer system or a European style system is better, you are still forced to tackle the transition period during which responsibilities and policies have to reshuffle between hospitals, the government, and insurance companies. That is going to be messy any which way you cut it, but the current system is clearly broken, so it might be better to rip the bandaid off. Aside from that, the benefits wouldn't primarily be in the amount your premiums are, but in the indirect benefits of having accessible health care for all.

> Aside from that, the benefits wouldn't primarily be in the amount your premiums are, but in the indirect benefits of having accessible health care for all.

Yes, it didn't benefit me at all. Now I pay much more money. I think that's going to have to be addressed if you want to get people on board.

"It's great for other people, but sucks for you" isn't going to convert people. Also when someone says Obamacare was a disaster for them, they're probably telling the truth. It was no small amount of money, it significantly impacted my monthly run rate and I'm sure it hurt people who don't make as much money even more.

I suspect you're being downvoted because you assume that your experience is universal, or that because you saw an increase in costs under the ACA that inherently means that it was bad.

Many people saw reductions in costs under the ACA. Many people who were not insured before are insured now because of it. It sucks that you ended up paying more, but that doesn't justify "I don't know how you can say [it was a huge leap in the right direction]."

Fair enough, thanks for the reply.

I guess I should say, it was really bad for me so I don't support it. The same could be said in the other direction though, if it was really bad for me I'm sure it was really bad for others. So maybe it wasn't universally a step in the right direction or a step in the wrong direction.

I suspect it was bad for people who were healthy and earn enough money to be disqualified from any sort of tax break or assistance.

For what it's worth: Education in Switzerland is mostly managed on communal level. Cantons have a certain administrative influence, but only really run the gymnasiums (higher secondary school, prep for uni) and interestingly enough cantons run the universities.

The only federal institutions of higher learning are the ETH / EPFL and their offshoots.

It seems to work pretty well.

> kind of goes against the US's slogan of (equal) opportunity.

No more than the government not providing access to private yachts to all citizens. Equal opportunity doesn’t mean equal buying ability.

Wow. This is incredibly disingenuous.

You don't need a yacht to compete with others.

You do need education though.

You may need education, but certainly not school.

Your notion of equal opportunity has an analog with respect to being equal under the law: the rich and poor alike are not permitted to sleep under bridges, etc.

Life, Liberty, and the Pursuit Of Happiness*

*As long as you can afford it.

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