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Comment by vladvasiliu | Hacker News Reader

> The more I witness this the more I realize that having a single payer is necessary to actually break up enough of the monopoly to get some traction on this problem. Until then there are too many middle men and bureaucrats blocking this change.

By "single payer" do you mean the European model of "socialized" healthcare? That may be necessary (I don't know) but it's clearly not enough.

I'm in France, and I hear the exact same complaints from physicians here [0], and the hospitals seem to be in terrible shape. People quitting or being on leave, hence understaffing, so more people quitting because of burnout, etc.

[0] Basically, the gist is that for some time, hospitals have been run "like an enterprise", seeking (cash) efficiency above all. There was absolutely no slack in the system, so when COVID hit, medical professionals ended up in a terrible situation. This situation has not subsided even after the epidemic became less of an issue.

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I'd like to see a different take on single payer. First, allow anyone to buy into medicare for their insurance provider (at a market reasonable price for younger people, subsidized like it is now for seniors). This could act as a nation-wide insurer without any "funny business" such as getting charged thousands because an assistant that wasn't in-network showed up the day of your surgery.

Second, if an employee isn't covered by employer healthcare, the employer side of FICA should be increased to provide for employee coverage. That way if someone is working 40 hours a week, but for multiple part-time employers, they still get the same medical coverage as a full-time employee.

Third, when I go in for a procedure, I want all bills to go to the insurance provider, they pay everything. Then the insurance sends me a bill for my co-pay. Make that a law. That way I'm not stuck with getting dozens of separate bills up to years after a procedure, with no way of really knowing what should have been covered by insurance or not.

This is essentially what the “public option” in the original Obamacare proposal was — an opt-in publicly owned insurance company, which would compete with all the other insurers, but not have the overhead of their business models. Unfortunately, it was axed alone with much of the other important aspects of that bill.

The great irony is that the initial Obamacare proposal was a Republican policy — originally proposed in the mid-‘90s as an alternative to the proposal from the Clinton White House, and implemented in Massachusetts by Mitt Romney when he was the governor. The Republican congress and conservative media machine were so invested in seeing Obama fail that they instead branded it socialism and fought it tooth and nail. It would’ve been a fantastic opportunity for a resurgence in bipartisanship in government, and could potentially have averted the subsequent 14 years of animosity and bitter obstructionism. Ah well, so it goes.

> By "single payer" do you mean the European model of "socialized" healthcare?

Its socialized healthcare. You dont have to put in quotes. It was first advocated by socialists in the First Socialist International at the end of 19th century. It constitutes part of the social democratic program.

The reason I put it in quotes is that at least in France, healthcare is not completely free, and somewhat resembles the US model. Sure, everyone has to pay and gets "free" healthcare, but that's the basic level, barely above "none".

If you need dental work, glasses, etc, you better have either cash or a "mutuelle", which is usually tied to your employer (though you can purchase your own above that if you like). Lower-level jobs don't always have one (or it doesn't cover much).

However, procedure prices might be lower than in the US, though (I don't actually know) which is a big part of the issue with access to healthcare.

Procedure cost is a huge factor: AFAICT, it's generally cheaper everywhere than the US, frequently dramatically cheaper, for the same procedure, for out-of-pocket (non-insurance) cost.

Here in Japan, everyone has insurance, either private through their company, or public through the government, and the insurance pays a flat 70% of the cost, and the patient pays the other 30%. But the procedure costs are generally not that high to begin with, so the 30% copay ends up being pretty cheap usually.

> in France, healthcare is not completely free, and somewhat resembles the US model

That's the result of the privatization that has been pushed by the Anglosaxon business lobbies to Europe and everywhere else since Reagan/Thatcher period. They forced privatization of whatever they could get away with. Its still a socialized system with some forced privatization being pushed through. France is not the only country - all US satellites have been pushed to do some degree of privatization.

Single payer is certainly socialized public healthcare, but not all socialized public healthcare is single payer. I think Americans are predisposed to treat it as an either-or because Canada, which is used most often for comparisons by virtue of being the country with which relatively more Americans are familiar, is single payer. However, many European countries aren't, and there's no discernible pattern for countries with single payer being better than other forms of public healthcare.

I think pushing for single payer specifically is one of the biggest mistakes of the American left, because it's that much harder to sell in US due to more restrictions - and that's inherent in the model. If we took something like the German model instead, I think we'd be way ahead by now.

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