Comment by lotsofpulp | Hacker News Reader

Comment by lotsofpulp | Hacker News Reader

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Because the real role of managed care organizations (MCOs, health insurance companies) is to take the heat for government leaders for having a tiered healthcare system where individuals get access to healthcare based on their socioeconomic position.

If you are a government leader and you offer healthcare to everyone, you are now clearly responsible for any failures. But with an MCO in the middle, fingers can be pointed all over the place.

Different formularies and prior authorization rules can be set for different populations. For example, reimbursement can be lower for Medicaid patients (poorer/younger people), so they end up with less access to doctors, and higher for Medicare (older, likelier to vote), so more doctors are available there. Senators can get their own plan, and the military another, and the tech company employees yet another, and fast food employees, and so on and so forth.

This system benefits all the leaders, so it is not going anywhere. In fact, I would bet UK and Canada move towards this.

And yet many countries have successful universal healthcare.

I imagine those are dependent on population pyramids not turning upside down. But they seem to be at least flattening, if not turning upside down in all developed countries, hence my prediction of why there would be a change.

I keep reading about NHS in the UK having issues holding it together.

There's a PA at my general practitioner's office who's got to be about 80; it seems like a lot of healthcare jobs can be done into old age. I think about going the PA route after my next layoff actually because it seems like a job that could be a better fit for me.

The population pyramid is in better shape than many other countries with universal healthcare. Instead of imagining or searching for plausible sounding excuses study the issue a bit. A government run healthcare system can do much better than our current system and in a much more moral way.

The NHS (and many other UK institutions) has been starved of cash for fifteen years by the Tories led by increasingly incompetent PMs (I mean, seriously, if the best PM in the last fifteen years is David Cameron; frankly, a head of lettuce would have done better than most of the Tory caucus).

>>I keep reading about NHS in the UK having issues holding it together

I'm in the UK and yep, the system is on the verge of collapse, but it feels like it's entirely by design so it can be finally privatised and killed off once and for all - it feels inevitable at this point.

Basically right now it works for:

- maternity

- anything child related

- emergency services(to an extent, unless you are literally dying you will still wait hours for an ambulance).

Everything else is so massively underfunded it's a miracle it exists at all.

A friend was referred to see a psychiatrist on the NHS recently - you know what the wait time is to see a psychiatrist on the NHS in our region? 210 weeks. About 4 years.

> yet many countries have successful universal healthcare

Few which provide the level of care the upper middle class and above have come to expect in America. If you make more than $100 yo 167k (85th and 95th percentiles [1]), a good fraction of HN readers, you should be able to virtually walk into any medical establishment and get not only seen within a few days, but also tested and imaged by the latest technology, and consulted on by some of the best doctors in the world. You will do this without worrying about costs, because your employer has chosen an insurer who pitched on experience in addition to cost, because you have the market power to change jobs (or be heard by management) if your healthcare sucks.

Universal healthcare means everyone on a PPO falls to the middle class’s HMO-esque standards. For us privileged few, that’s a tough pill to swallow. That is the fundamental injustice and tradeoff that locks us into the status quo, not some paranoia about socialism.

[1] https://en.m.wikipedia.org/wiki/Affluence_in_the_United_Stat...

This is entirely wrong. My household income exceeds $300,000. My wife is a physician. It takes months to get an appointment with an ENT or dermatologist. In Germany, despite not being a citizen or having travel insurance I got an appointment with a dermatologist in 1 day. The cost was around 40 euros. These are anecdotes but they are just as valid as, “you should be able to virtually walk into..” statements.

It was fear of socialism that caused the outrage at Clinton’s healthcare proposals. The fear and outrage was so great that for the first time in decades Republicans took control of the House of Representatives in 1994. Look up the number of times things being labeled communism and socialism has been used to try to halt legislation.

> It takes months to get an appointment with an ENT or dermatologist

Out of curiosity, where are you? (I should have geographically qualified my statement.) In New York, the Bay Area and even western Wyoming (in a wealthy enclave), I have never waited more than a week for an appointment.

> fear and outrage was so great that for the first time in decades Republicans took control of the House of Representatives in 1992

Fair enough, will further qualify by last decades.

The bracket I’m speaking of knows European healthcare. They understand it is generally high quality and much cheaper. But being able to demand an MRI or the surgeon of your choice when something goes wrong is a real perk, and the one politicians are talking about when they reference public medicine.

What you said in the previous comment might be why those in power wish to keep the status quo in terms of healthcare but I don’t think it’s why middle and lower class voters vote against universal healthcare. I believe regulatory capture is why we haven’t done away with health insurance companies in their current incarnation. I believe but don’t know that upper class Europeans can pay for private care. I think Canada was the only country to banned privately paying for healthcare but they have relaxed this in recent years.

> Out of curiosity, where are you?

Not the parent, but in Seattle-Tacoma area, I have waited 10 weeks for an ENT, and 12 weeks for PT availability following a car accident (in which case I ended up doing my own PT and bought bands and tools to do so until then).

I wonder if there is a resource that tabulates wait times somewhere.

Anecdotally those wait times seem crazy. The PT one especially. I have 5 different pt choices in walking distance to me that can typically get you in next day or worst case a week lead time if you want a time block that is contended (right before/after normal business hours).

> in Seattle-Tacoma area, I have waited 10 weeks for an ENT, and 12 weeks for PT availability following a car accident

Have you checked if this varies with insurance provider?

Take the money being extracted out of the system in the form of executive pay, umpteen layers of administration and terrible software -> put it towards increasing the actual work of care.

> Few which provide the level of care the upper middle class and above have come to expect in America

This opinion is the opposite of what I’ve heard from people from peer countries who’ve experienced both, not to mention even countries we tend to look down on (there’s an entire industry around even pretty affluent Americans going to Mexico to save money for equivalent treatment). I’d believe it for the 98+th percentile crowd, but I’ve also known people considering going back to Europe because the lower salary is better than all of the out of pocket costs, stress, and risk.

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