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Comment by eli | Hacker News Reader

You don’t need to change or limit Medicaid payments to make this work. Just give it to everyone. Yes, the wealthy will have a benefit that they “don’t need” but that’s not actually a problem. A simpler program is more efficient and easier to administer. And if the wealthy have even a small stake in how the program is run they may hesitate to make cuts to it.

It is entirely possible to pay for health care for everyone with modest tax increases - taxes that will be instead of insurance premiums for most people.

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And if the wealthy have a benefit they don't need, we take it back with taxes. Maybe it really is that simple.

For me, cheaper premiums are not even the selling points of universal healthcare. It's selfish hedonism:

It's emergencies - No tax will exceed 100% of my annual salary, so why should a surprise medical bill I couldn't possibly avoid (T-boned when I had the right-of-way and thought I looked for cross traffic?) bankrupt me?

It's uncertainty - Sure I'm middle-class now, but what if software really is in a bubble, and I'm broke in 15 years? Voting for my own interests has to include voting for things that _could_ plausibly happen in my future, not just what's happening to me this week.

And it's the social graph of private charity. If my friend is a little worse-off than me, should I be guilted into donating money to their medical costs? I'm nowhere near the philanthropist class. Why should it fall on me? Not having a safety net punishes middle-class people who care about their not-middle-class friends and family.

Paying with taxes is much fairer - No surprises, no desperate clinging to my job, and no guilt.

Another way of looking at it is, because the average person cannot afford both (1) catastrophes like being hit in a car and becoming disabled, (2) accidentally disabling someone with their car, the underlying problem is still income inequality.

That problem in particular is completely solvable by insurance.

No, it isn't. Insurance companies have lawyers and will fight for every nickle in court.

They can't hire a lawyer for a nickel, so your claim is clearly false because that wouldn't be cost effective.

They contest large claims that aren't covered by your policy because that's what everybody does. You don't think Medicare refuses to cover certain things? They have to, because you can't spend a trillion dollars to save one life.

And for that single payer is even worse, because whenever they refuse to cover something, the provider goes out of business because the refusal applies to 100% of their customer base. Then what happens when something isn't covered isn't that you get a bill for $50,000 and file bankruptcy, it's that the provider who could have saved your life is out of business and you die.

Having been on multiple juries involving suits between insurance companies and the people they were supposed to be covering, I know for a fact that you have no idea what you're talking about.

You shouldn't have been on multiple juries where the insurance company didn't have at least a colorable claim, or the judge should have disposed of the case before it ever went before a jury. And if that's what happened your complaint is with the court system.

This may come as a shock to you, but insurance companies have a lot more money than most individuals who are harmed on the job and will spend some of it if it will ultimately save them money. Employers are in on the act because they don't want increased premiums.

Plaintiff: "any plain reading of the agreement stipulates that I am to be compensated X if I am injured on the job in a manner that results in me being unable to continue my job"

Insurance company: "Clearly this video of this man washing his car over a 4 hour period, cleverly edited to pretend that he is taking just 15 minutes to wash the entire thing, is indication that he is capable of climbing a 100 foot ladder while hauling 60 pounds of equipment, even though he has four fractured vertebrae, had a surgically reattached lower extremity, doesn't have the core muscle strength to balance on a ladder, and can't lift 15 pounds without extreme pain"

You're just beclowning yourself at this point. This is an every day occurrence in court systems around the country, but do continue to tell me how I don't know what I'm talking about because the system is virtuous.

Lemme put it another way for you. Because the average parent isn't rich enough to give their kids 13 years of school, but also the average parent isn't rich enough such that school doesn't matter, the underlying problem is income inequality.

> No tax will exceed 100% of my annual salary, so why should a surprise medical bill I couldn't possibly avoid (T-boned when I had the right-of-way and thought I looked for cross traffic?) bankrupt me?

It's amusing/pathetic that medical insurance was supposed to mitigate this risk, but we've gotten to the point where things are so fucked up that even "good" insurers try really hard to deny claims, especially the outrageously expensive ones that are likely to bankrupt people.

> we've gotten to the point where things are so fucked up that even "good" insurers try really hard to deny claims, especially the outrageously expensive ones that are likely to bankrupt people

What I find interesting is good, well meaning people defend the insurance companies’ tactics as it prevents premiums from skyrocketing but then they hear about “death panels” and immediately denounce single payer.

I had insurance from the marketplace a few years back and I distinctly remember the call center representative laughing when I asked why my premium was up year over year when clearly the only thing I had used the year before was a flu shot. She apologized for laughing when she realized my puzzlement was genuine and explained that it wasn’t about what I used but what the group used. Just sounds like a tax with extra steps, I thought.

In the discussion on another article also on the front page, people are wondering if we are ever capable of meaningfully doing an about face on issues (interestingly also about medicine: placebo surgeries).

That's an interesting way to look at it. Yes it adds a 1% inefficiency because it pays out to wealthy people (that's what "the 1%" means, right?) that don't need it, but I can easily imagine that simpler rules would yield back 5-10% just due to reduced administrative overhead, let alone the cost of everyones lives debating this stupid topic endlessly and the economic opportunity cost with everyone spending their time trying to game the unnecessarily complex rules.

I can't agree with the "they may hesitate" claim enough. We already see it in practice. Welfare and Medicaid are a political football, but Social Security and Medicare are untouchable because you risk angering the ENTIRE over-65 demographic, regardless of state, income level, or political affiliation.

We seem to throw out all our carefully honed consumer math understanding when the word "tax" appears. The same people that can intuitively understand that $1.49 Miracle Whip is cheaper than $2.99 mayo seem incapable of grasping that paying $1,500 in taxes to bankroll a NHS is cheaper than sending Blue Cross $3,000 per year.

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