Comment by cvccvroomvroom | Hacker News Reader

Comment by cvccvroomvroom | Hacker News Reader

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It's a haphazard, inconsistent, bureaucratic, unkind, demeaning patchwork that isn't funded enough to meet the needs of people left-out in the actual cold. It's not meant to help people improve their situation because it treats people consistently like lazy criminals who don't want help and can't be helped.

- Section 8 housing takes forever.

- Work programs are for menial jobs that don't pay anywhere close to livable wages.

- Cash assistance amounts to $5 per day.

- Food assistance amounts to $7 per day (without a means of refrigeration).

- Medic-aid is barely accepted by any doctors except random ones. Medicare with SSDI takes years to get.

- Make just enough to try to get ahead, then you can't afford medications. Working severely penalizes the destitute into even more impossible situations.

- Everything takes longer and is more difficult and more expensive: laundry, showering, and transportation.

- Social workers don't go outdoors in most of America. They sit at desks, fill out paperwork, and randomly stop benefits based on errors, assumptions, and their lack of communication.

I read a statistic that the government spends $108k per homeless individual in San Francisco per annum. Reading this, it seems efficient for government to just hand that directly to the homeless..

That's the argument for UBI. Basically it's "no, we don't trust the government even to decide if somebody is in a precarious situation, much less to know how to help them".

It's probably more cynical than the reality warrants, but it's visibly closer to the truth than the current "let's poll the money and hire some people to help the ones in need".

> "no, we don't trust the government even to decide if somebody is in a precarious situation, much less to know how to help them"

UBI switches the question : "we think the people themselves would do a much better job if they just had the money". It's gonna be true in some cases. And completely wrong in many others.

1. I need to see the exact statistic, but IME statistics like that are flawed because they undercount the amount of people served (ie. housing assistance that keeps people housed would count towards the budget, but won't count toward the amount of "homeless individuals")

2. the other possibility is that for the very mentally ill, they actually do need 2x the median income to survive, eg. because of mental illness counseling costs.

If there was a no-strings attached $108K/y to be had somewhere, some conniving scum would find a way to get their hands on it before any single genuine homeless person in need.

Conniving scum skimming off the top is a large is part of the reason it costs $108k/y/pp in the first place. A simpler system is less prone to fraud and embezzlement.

> Medic-aid is barely accepted by any doctors except random ones

What makes you think any sort of government intervention will solve this? If you implement universal healthcare these doctors will still have revenue streams from rich people and won't need to take poor patients. You can't force doctors to treat people they don't want to.

An even more absurd form of this is happening in France.

There used to be some "abuse" (according to the national health insurance administration) where people would, supposedly, try to see specialists for no reason. So they figured that everyone should have a "family doctor" and, with a few exceptions (dentist, eyes, maybe others) you always have to go through this doctor first.

Now most of these doctors are "full" and won't take any new clients. You don't need to be poor, they don't even ask your situation. If you call them up, they'll ask you if the doc knows you. If not, they hang up. And even if they're your family doctor, you better hope your cough isn't anything too urgent, 'cause they're in no hurry to see you.

Of course, there are doctors who will see you, but usually they charge extra, so they're not fully covered by the "free" healthcare, if at all.

> So they figured that everyone should have a "family doctor" and, with a few exceptions (dentist, eyes, maybe others) you always have to go through this doctor first.

Every private insurer I've ever had in the US has the exact same requirement.

That’s mostly a problem in small towns, not that it makes the problem OK

From what I hear it's brutal in small towns. My post above came from my own experience, living in Paris proper.

I live in Paris, and finding a medecin traitant has been a pain.

Interesting, never had an issue in Lyon. Just use google maps, call the ones that are closer to you, sure some won't take you because they have too many patients but usually there are so many doctors that it's not a problem. I'm surprised that Paris would have this problem but not Lyon.

Univers healthcare almost always bans duplicate coverage. Without private insurance, a tiny fraction of people (<1%) can afford to bypass the public healthcare system. Therefore, it is not financially viable for all but a small number of doctors not to integrate into the public healthcare system.

The scenario you're described had the opportunity to be borne out in dozens of countries and generally didn't.

No. Most proposals for universal healthcare by the American left would ban private insurance.

Most actual universal healthcare does not ban private insurance.

>Basically, every single country with universal coverage also has private insurance,” says Gerard Anderson, a professor at Johns Hopkins University who studies international health systems. “I don’t think there is a model in the world that allows you to go without it.”

https://www.vox.com/health-care/2019/2/12/18215430/single-pa...

You're making the exact mistake I was anticipating when I talked about duplicate insurance. Sure, you can get private insurance, but it cannot legally cover anything that is covered by public insurance. This is the standard worldwide.

You're conflating private insurance and duplicate private insurance, and ending up on a very mistaken conclusion because of it.

Nope. There is no such "standard worldwide". Read the article I posted. In most countries private insurance either replaces public insurance (in countries whose system uses an individual mandate like the original ACA) or as the article puts it, "complements it", for "faster access to specialty doctors or elective procedures."

In the vast majority of countries it "complements" or "supplements" it. There are very few countries where private healthcare is allowed to replace public care. Israel, Slovenia, the Netherlands and few developing countries are the only cases.

There are other countries with a system between complementary and duplicate where private insurance may also pay for duplicate care, but you still aren't allowed to not subscribe to the public healthcare plan.

Duplicate healthcare insurance is deeply toxic and

> Duplicate healthcare insurance is deeply toxic

Wanting better coverage - lower wait times, higher quality doctors - is deeply toxic? Getting higher quality doctors who don't want to get paid pennies by the public system is toxic? (for example Medicare pays substantially less than most private insurance in the US today to care providers, which is one of the biggest reasons why many doctors don't take Medicare patients)

I don't see how being able to have a private plan isn't a win-win for doctors and patients. Doctors get paid more by private insurance, and patients get better care. If you want to use the public system you have the option of doing that.

What happens in the long run if you force doctors to exclusively get paid public system rates? Doctors make less and less smart people want to become doctors. Why do you think the federal government can't hire top tier software talent? It's because they pay pennies on the dollar compared to private companies. You can't regulate your way out of a market. The Soviet Union found that out the hard way.

> the only cases

You left out Germany and Switzerland, probably others. Hardly "developing countries".

So you agree that universal healthcare systems do not almost always ban duplicate coverage, and you agree that there is no "worldwide standard" of banning duplicate coverage though private insurance.

You're just in favor of banning private insurance and are willing to engage in sweeping hyperbole toward that end.

Other countries don't have Supreme Court rulings stating that banning campaign finance contributions was a violation of the 1st Amendment. Such a ban would absolutely be challenged and likely struck down in court in the US.

Meh. There are already Supreme Court rulings that state that insurance falls upon the Federal government as interstate commerce, and there is already precedent for banning certain categories of insurance.

The only way it would get struck down is if there were activist judges and if there was no political will to repair the Supreme Court. I would assume that in a world where the US political system manages to fix itself enough to pass universal healthcare that would be dealt with or fixable, because those are more urgent issues.

>manages to fix itself enough to pass universal healthcare

The Democrats could have done this of their own volition in Obama's first term, during periods where the Senate had a filibuster-proof majority. Instead, they came up with the ACA.

Thanks a lot Joe.

> Lieberman, 67, used his deciding vote in Congress to help strip out a provision for government-run medical insurance, intended to set up competition to the abuses of private companies, by threatening to filibuster the legislation.

> Senate leaders agreed to drop the public option for all in favour of allowing people over 55 to buy into an existing government-run scheme for the elderly. In September, Lieberman supported the measure, as he had when he was Al Gore's running mate. But just as it seemed that a deal was done, Lieberman scuppered it by announcing that he had changed his mind and would block any bill that expanded government insurance coverage. Obama gave way.

https://www.theguardian.com/world/2009/dec/16/joe-lieberman-...

> The Democrats could have done this of their own volition in Obama's first term, during periods where the Senate had a filibuster-proof majority. Instead, they came up with the ACA.

How much more than the ACA (a campaign promise) and stimulus did you expect them to get done in the 4 months of the first term that they had a filibuster-proof majority?

https://www.beaconjournal.com/story/news/2012/09/09/when-oba...

>How much more than the ACA

They could have done universal healthcare instead of ACA and with much simpler legislation and less regulatory authoring burden.

They never said that. All they did was describe why the current American system sucks.

Because we solved it entirely in Scandinavia and most of northern Europe.

- If you start to make a little legal money, your benefits get reduced by more than you earn.

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