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Comment by RyanMcGreal | Hacker News Reader

It doesn't matter how often I come across it or from which direction: I'm just flabbergasted that the USA doesn't have universal health care.

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Agreed.

Even the ex-"Evil Empire" managed to provide decent basic health care for its citizens.

Yeah, they couldn't graft a human ear onto a mouse (http://en.wikipedia.org/wiki/Vacanti_mouse), but at least when I broke my arm or busted my teeth on a bike they never asked my mom how she is going to pay for it, or some insurance company did have to decide to only replace 2 out of 4 of my teeth, because the other 2 would be considered "cosmetic surgergy" or "experimental procedure".

I think it's been an issue, but not that big of an issue (in voter's minds) until recently.

Many of the voting blocks are already covered. Low income people have medicaid, seniors have medicare. Many people working a full time job have employer sponsored health plans.

Health insurance costs are rising. It's harder to find a cheap plan. Pre-existing conditions really screw you as far as decent coverage.

I'm not sure what the answer is at this point. The US is almost broke, we might not have a choice. http://esr.ibiblio.org/?p=3035

Yeah, and it's brilliant, because the gov't is on the hook for poor people and old people, aka unprofitable insurance subjects, while the private industry scoops up profits on the rest. And before some conservative comes in telling me that insurance profits aren't that high as a % of revenue, % profits on a pass-thru payment system are not the same thing as % profits on actually building something.

I saw a statistic (can't place it now and don't feel like googling, so grain of salt) that we actually have comparable government spending per capita on healthcare to some western european countries, and that's just for medicare/medicaid, without even covering everyone. No generic drugs + byzantine public/private payment systems + highest-risk populations = lots of money.

% profits on a pass-thru payment system are not the same thing as % profits on actually building something.

Could you explain this claim?

In one sentence, IMO of course, passing something through should be much cheaper than actually building something or adding value unless you're bilking people. In another sentence, insurance companies don't administer care, they just move money around.

Compare to the overhead as a % of revenue for the social security administration, for example. They're a simpler passthru so it's not a completely fair comparison but insurance is closer to SS than it is to manufacturing.

passing something through should be much cheaper than actually building something or adding value unless you're bilking people.

The amount someone gets paid for doing something depends on how much value they capture, not how much they add. In most cases where all parties contract freely, you can't capture more than you add, but anyway

_Value added and paid are often wildly out of whack_

"Bilked" is a moral judgement. If you're saying you think insurance is unjustly fair then since that's a fact about you not about insurance, sure it can be true. But it's like "profiteering", a moral/political statement, with no economic content.

Adam Smith would differ with you, in the ideal case.

Value capture and rent seeking aren't how capitalism are supposed to work. Heck, if that was the best capitalism could do, I'd be inclined to try communism.

Military spending.

I'm flabbergasted that Europeans won't admit that it's a failing system. Both France and Sweden need to scale back their systems because it's just not efficient or cost effective.

I know it's just anecdotal evidence, but everyone I know from Canada that has had to get any major surgery has come over to the US. The reason? the waiting list is too long (in the years). Most universal health care advocates will deny this, but I just can't ignore it when I've seen it happen so many times.

I would rather have a system with no insurance companies that we paid for ourselves. This way, Doctors would be forced to charge affordable rates.

> Both France and Sweden need to scale back their systems > because it's just not efficient or cost effective.

What? Both countries have amazingly cost effective health care systems!

And now that both sides have made mutually contradictory and equally unsupported statements, I believe the first round is a draw. Galactus will have the honors in the second round. Proceed, gentlemen.

It's fairly easy to find supporting information for the galactus view e.g.:

http://ucatlas.ucsc.edu/spend.php

And frankly, it should be common knowledge that western europe has better/equivalent outcomes at less than half of our cost (very round figures to sidestep the nitpicking), meaning, at minimum, they're getting at least twice the value per cost that we are, and that's rounding every number in the direction that's unfavorable to europe. I could argue that let's just copy the system within europe that works best and we can go for 3x.

Unfortunately, doing things that have been empirically borne out to work doesn't seem to be on the agenda these days.

Great point. Right now, doctor's have to charge twice what they expect to be reimbursed by insurance companies. So, an individual who chooses to buy health care without a health insurance provider has to pay twice what doctor's even expect to get. I don't even think doctors get any reduction in transaction costs when dealing with large insurance companies over individual patients. In a lot of ways, it seems like doctors have to deal with the large insurance company and the individual patient.

Health insurance in the US is more like a payment plan to join a health-care purchasing group than health insurance. What's worse is that your purchasing group choice is chosen by your employer.

I think there's a serious reduction in job mobility because the US has chosen to provide tax incentives when health insurance is provided by the employer, but not when an individual purchases those.

Right now, doctor's have to charge twice what they expect to be reimbursed by insurance companies. So, an individual who chooses to buy health care without a health insurance provider has to pay twice what doctor's even expect to get.

The second does not follow from the first. What usually happens is doctors try to rip off the insurance companies as best they can (and the insurance company does the same to them), but prices magically become reasonable when you mention you don't have insurance.

Doctor bill: $100 splint (her finger taped to a piece of wood), total bill $350.

My uninsured mom: "This is ridiculous. You can keep it, I'll just have my son duct tape me to a dowel."

Billing girl: "Oh, you don't have insurance? I'm so sorry, my mistake. It'll be $75, let me print you a correct bill."

(I don't recall exact numbers, but that was the rough flavor of the interaction.)

your biased assumption is that under the $350 bill that the middle party that has to bill the insurer does not get paid..

Part of the bill inflation is the multiple payor billing system costs itself..non-insurance bills do not have that costs.

What would bring it down instead of universal insurance universal payor billing..it was one of Mrs Clinton's HealthCare reform bullet points..form years ago..

Talk with some private practice doctors some time. They often spend about as much time dealing with patents as they do with the insurance company. As to the initial bill, they need to inflate it because the insurance company will always try and drop the price on something. It's the same game purchasing departments at large company's play where it's easier to buy something for 75$ after the 25% discount than 500$ without a discount.

Ops, 750$

It's not "ancedotal evidence", it's just an ancedote. Every Canadian I know prefers their healthcare to the US one. Now that you and I have equally canceling ancedotes, look at some evidence.

http://theincidentaleconomist.com/wordpress/how-do-we-rate-t...

I'm flabbergasted you're still peddling the ridiclous notion that the single payer health care system that is working for every other nation in the Western World is broken.

The reason is race: http://www.kff.org/healthreform/upload/7871.pdf and many others. Search for "Truman health care reform". As in many other democracies, America's right wing party is a coalition of the military, established business, the religiously observant, and what you might call resentful rural folks (who unlike the other factions exist in enough numbers to make an electoral difference). But uniquely among rich democracies, apartheid is a living memory here and still a core political differentiator. That means that anytime established business opposing something, they can get traction by implying that it's a plot to help "them". Those who mocked the grandfather who demanded that his Congressman "keep your government hands off my Medicare" for ignorance miss the point. He meant "keep Obama's black hands off my Medicare."

I'm curious: you are aware that a universal health care law passed in the U.S. last year, right? Its goal was to make this statement no longer true in the U.S.:

>If you have the wrong medical profile, you could be simply uninsurable. That’s how a free market works.

by January 1, 2014.

Given that health insurance systems similar to the one the Affordable Care Act sets up do provide universal insurance in other countries, it seems that the ACA has a good chance of doing what it's promised to (though I'm sure it will require tweaks and adjustments in the years to come).

But regardless, a conversation about health care in the U.S. that doesn't even mention the ACA seems to be rather pointless.

Basic racial politics. Welfare queens and all that jazz.

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