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Comment by GuB-42 | Hacker News Reader

The median pay in the US is also half or more of the median pay in countries with much more generous healthcare.

I live in France, which is known for its good health coverage. However, I know a few people who worked both in France and in the US, and they made more there in terms of purchasing power, even after paying all the insurance required to get at least the same level of protection we get "for free" in France.

I suppose that the situation can be different depending on your occupation. But what I am saying is that it is just a different system. Healthcare is expensive by nature: highly trained personnel, state of the art research, unforgiving safety requirements, etc... and has to be paid for in some way, be it by taxes or by private insurance companies.

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Healthcare isn't "just" expensive. The system in the US is uniquely dysfunctional:

https://www.healthsystemtracker.org/chart-collection/health-...

"While the U.S. has similar public spending, its private sector spending is triple that of comparable countries".

> "While the U.S. has similar public spending, its private sector spending is triple that of comparable countries".

Healthcare in the US is corporate welfare for insurance companies.

Healthcare in the US is taxpayer welfare for big US companies that can afford to pay employees via pre-tax healthcare (insurance).

Arguably, it's both. A win-win.

I basically agree that the quoted statement supports the idea of a dysfunctional system, the system is crazy. But it should also be acknowledged that it’s pretty rational for a country to spend more on health care as it becomes wealthier. Beyond basic health needs you notice all sorts of expensive marginal conveniences that get bundled into healthcare costs. One example is the ubiquity of motorized wheelchairs in the US. It’s really hard to go a day without seeing at least one in any US city, while I don’t recall ever seeing one in Berlin over a couple of years. People who couldn’t walk either used cheap old-fashioned wheelchairs, crutches, or presumably stayed indoors. I’m not really making a judgement on which approach leads to better health because I don’t have that data, but one costs thousands more. Comprehensive health insurance in the US may also cover modifications to a vehicle or hole to accommodate a motorized wheelchair, again thousands of dollars.

Another example: someone who has trouble concentrating at work in the US might spend (out of pocket, or through insurance) $1000 a year on an Adderall prescription Where in Germany it’s quite unusual to get an adult ADHD diagnosis, and even harder to get medication. People are more likely to just live with their genetics on this issue, or make non-medical accommodations, and their problems holding down a job or a relationship never become a medical cost on any spreadsheet. Again, I’m not saying one is better than the other, but culturally speaking, a larger number of personal problems faced by Americans are medicalized than in other countries.

On the motorized chair, specifically, it turned out to be an epic scam where all the wrong incentives were in place to get people who had no need for them to get one through their insurance. If only increased spending could be less wastefully applied... https://www.washingtonpost.com/sf/national/2014/08/16/a-medi...

Wow, that’s quite the story. I’d also add that I see them frequently in Canada where presumably the same scam didn’t happen, or at least to such a great extent. I still think there’s a cultural piece to it.

This also really shows how #medicareforall wouldn’t automatically solve every problem.

The taxes in France presumably pay for everybody, while the US premiums only pay for similar healthy working people.

Healthcare is expensive. The US government started providing healthcare to old people, rather than letting them die on the street outside the hospital.

But rather than the government paying the full cost of this program (ala food subsidies), the government dictated that providers give them special lower prices. The hospitals want to make up for that money some how, and so attempt to pass on extra costs to others. The next target (private health "insurance") doesn't want to subsidize that cost either, so they negotiate lower rates. The hospitals are still optimistic that they can still fool someone, and so attempt to take it out of helpless patients.

The entire system is essentially musical chairs. This is why after you receive medical services, the hospital will send you a fraudulent bill with a fictitious inflated price list rather than waiting for your "insurance" to cover their part first - they're hoping to luck into a sucker who will mindlessly pay the sticker price rather than the back room reduced rates.

I can foresee a trend of people setting up trust funds for themselves, to reduce the chance of losing their assets to the healthcare reverse lottery. That's really the point we're at - the last attempt at healthcare reform was basically jiujitsued by the health "insurance" industry into making patronizing their cartel mandatory!

Many hospitals survive solely on Medicare revenue.

I didn't mean to make it out like Medicare was the sole cause (eg how health "insurance" got started by being excepted from the wage restrictions of the time, and how it continues to be exempt from income tax). But I think the analogy of musical chairs describes the present constructive behavior of the system quite well.

A no brainer step to reforming the health care market is to force all providers to publish a price schedule, uniform across any payer. We wouldn't accept grocery stores forgoing price tags and instead trying to gouge each person for as much as they can, and any free market rhetoric needs to incorporate that fact.

(Note this is orthogonal to what level of care should be guaranteed by the government)

> Healthcare is expensive.

When you tally up both government and personal expenditure the US is far more expensive for no valid reason.

Even government spending alone the US system is a bizarre outlier against OECD countries who all have universal healthcare as a core part of their system. When you include personal spending it's plain and clear that vested interests have corrupted your healthcare system.

https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?year_...

> it is just a different system

Different in the same way that Windows 3.1 is "just a different system" than MacOS X 10.14. The U.S. pays 2-3 times as much, and does not provide healthcare to vast numbers of people. Many who do receive health care go bankrupt paying for it; many who think they have insurance find that they are denied it by insurance companies.

That works precisely up until you get sick or a close relative gets sick, and then even with insurance you can be staring at medical bankruptcy. It works up until you lose your job and get sick while unemployed.

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