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Comment by colechristensen | Hacker News Reader

When people promote universal single payer healthcare in the US, this is the kind of thing I want them to know about. There are downsides.

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Actually no. Care is rationed according to need, not ability to pay. Unfortunately the UK has a government that wants a US style system, so they reduce funding as much as they think they can get away with.

The US system is worse on every single metric (unless you're rich of course - which is the point of it).

Rationing according to needs apparently scaled so that people with real but not severe beds needs get delayed for a long time.

Lack of mental health and illness services is due to a lack of supply i.e. not enough clinicians. How it is delivered (or not) is orthoganal. The lack of clinicians may be related to pay, working conditions, brexit. I mostly believe that in the UK, the idea of 'getting therapy' is not as culturally universally accepted as the US, so has largely not been considered neccesary by society (see 'keep a stiff upper lip'). That is changing, especially amongst the young, but it will take a while for people to want and move into those jobs.

Source: someone who is willing and able to pay for services, but cannot find them

Nothing is perfect. That said, overall the cost to the system in healthcare provision in the US is approximately DOUBLE that of the NHS per capita.

If you took half of that difference and applied it judicously, waiting lists would drop quite a bit.

Do the people on waiting lists care what it costs the government or what could be but isn’t?

Do they stay on waiting lists if they can afford to go private? No. They certainly care that their likely path to a fix is not going to bancrupt their family, if they elect to stay on the waiting list and when they get to the top, the surgeon who sees them is the same as the private one, and the anaesthatist, and the nurses, most times.

These kinds of wait times are not an inevitability for single-payer.

I have Medicaid in the US and I get seen within a week to a month (sometimes even same-day) in non-emergency situations, and 100% of my medical bills are covered by the government.

The worst part of it is that for certain specialties there just aren't many doctors who accept Medicaid, so I pretty much have to take what I can get... but this shouldn't be a problem if every doctor accepted a single-payer plan.

On the other hand, for things like mental health care there's a large amount of choice in my area. So overall I'm pretty pleased.

Sure, but this is partially enabled by the fact that often doctors lose money on Medicaid patients which is why they often don’t accept them.

The situation would not be the same if everyone was on the same payment plan.

What are the downsides? People in the UK can still have private insurance if they want, which actually tends to be much cheaper than in the US.

Well the alternative you’re working with there is only the wealthy are able to afford that healthcare. Poor people just can’t. How is that better?

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