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Comment by Pet_Ant | Hacker News Reader

Man, it's almost like healthcare and human lives shouldn't be for profit...

You're welcome to come up with an alternative system of aligning interests, so far all of the other ones have failed horrifically.

I live in NL. I pay 130 euros a month for my health insurance, and a max of 375 yearly on deductibles should I accrue some costs. The only reason I pay 130 is because I earn above a certain number, otherwise it's discounted and even free at a certain level (and I opted into the more expensive tier to also have dental coverage). In my case, my employer even pays for my insurance so in reality I don't even pay anything monthly (that's rare here though).

I recently did an in-depth sleep study, got a CPAP machine prescribed to me, free replacement filters and replacement tubes + mask for it whenever I need them. I also got xrays and CT scans because of a foot injury around the same time. I also got comprehensive blood tests done.

None of it cost me a penny other than the ~100 euros a month, the doctors and GPs are paid well, the quality of care I received was exceptional, and in the worst case scenario possible I would've only paid 375 euros max.

My mother in law has osteoporosis and a number of other chronic illnesses, so she has to see specialists quite often. The quality of care she receives is similarly excellent to the one I received, and due to her disability her healthcare is partially covered as well.

It's not perfect of course, but it sure does beat all the horror stories you often hear coming from across the pond of people ending up in lifelong medical debt should, God forbid, something happen to them that they realistically have no control over. So I'm sorry, but I don't buy that the for-profit fucked up system you guys have going on over there is the best of the lot, especially if you're an average Joe and not someone from SV earning obscene amounts.

"Healthcare that isn't for profit" doesn't mean just a national health insurance. Just that as a random citizen you are shielded from seeing all the same issues underneath. The pharma companies, test providers, equipment makers and personnel are all making profits. I bet the total amount paid is higher that 130 euros a month. There's profit all through the system, so claims that healthcare should not be for profit are silly.

Now, what happens is that the profits have to be kept in check, either via price controls or sufficient competition. It's not hard to argue that the choices made in the US are quite suboptimal, but it's far more of a regulatory problem than purely a matter of people making money. If nobody makes money, there's no healthcare.

Not to mention EU pharma makes 50-70% [1] of their money from the US, an unregulated market. I'd challenge them to shut down that 800USD/shot revenue stream and still give subsidised insulin locally and remain profitable. Hint: they can't. Their shareholders would shut them down in a week. Good luck manufacturing the next new drug then.

[1] https://www.novonordisk.com/content/dam/nncorp/global/en/inv... https://www.marketscreener.com/quote/stock/GSK-PLC-9590199/f...

Edit: I too agree the US healthcare system is flawed, I'm just saying you cannot compare it against EU's results without considering the above fact.

Profit is what's left after everyone is paid for their work. No profit doesn't mean nobody gets paid - it means nobody's trying to simultaneously maximize revenue and minimize costs just so they can pay themselves the difference.

Speaking of tax-funded healthcare, did you know that US residents pay more tax towards healthcare than residents of any other country? And in return for that, they don't get any healthcare so they have to pay a second time to buy their healthcare.

> so far all of the other ones have failed horrifically.

Have they?

i live in neither country but i know i'd rather have cancer in the UK than the US.

That Breaking Bad meme about Walter getting lung cancer in the UK comes to mind.

The US has higher 5-year survival rates for most types of cancer than the UK. In general the US is the world leader in cancer care.

> so far all of the other ones have failed horrifically.

Uh, what? Other systems have their problems, but they're varying levels of functional, and the health and life expectancy of the populations in most other developed countries is higher than the US, all the while spending a fraction.

Most other developed countries have a mix of public and private insurance and/or delivery, with the better run systems being better rationalized in dealing with costs and having an actual market where it makes sense to form one (eg you can't practically shop around for ER care, but you can for elective or planable services). The French system is held in high regards in particular (though it isn't really replicatable due to their unique civil service setup).

how about copying the exact thing that works in literally almost every other country in the world

What do you mean failed horrifically? Yes, some countries have long queues. That's because there are actually people getting served. That's just the latency/throughput tradeoff being tilted farther towards throughput - which is what you want, and it's not like people who come in with heart attacks don't get to skip the queue. In America, people get heart attacks and just choose to die so their family won't get bankrupted by an ambulance ride.

Are you possibly getting this information (that healthcare is a horrific failure in every other country) from propaganda sources, instead of information sources?

"It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest."

Exactly. Glad you agree it shouldn't be for profit, either.

I have no problem with it being for profit. The issue is the alignment of interests and the thumb on the scales by government and vested interests. If health insurance worked like car insurance I think we'd be in a better state.

I wish health care worked like veterinary care. Except, now, veterinary care is becoming more like human health care, and it sucks.

Vets are really the most amazing doctors and I hate to see what is happening to their industry. Hopefully in exchange for dealing with the bullshit of human health care, at least maybe the money is getting a little better for them (a lot of them are just criminally underpaid).

> I have no problem with it being for profit.

That's not what your quote says. Quite the opposite.

> The issue is the alignment of interests

Exactly. Which is why I think we should be guided by the constitution and not greed.

Find some doctors, nurses, researchers, manufacturers etc etc who will work for no money and we can remove money from the problem.

> Find some doctors, nurses, researchers, manufacturers etc etc who will work for no money and we can remove money from the problem.

Not being for profit doesn't mean you don't pay people.

Further, I wonder how the Sixth Amendment works then? So many non-profit people working for... no money?

This "work for no money argument" is so incredibly weak, I had to make sure I quoted the argument so the person wouldn't change it.

Eventually everyone works for profit if they get paid. Spending time only is pure profit in money.

A reasonable wage or salary isn’t usually considered “profit” in a legal sense. This is why nonprofits can still pay employees. Any money that is left over after costs (including wages/salaries) needs to be reinvested, spent on the organizational mission, or held for future use, not distributed through dividends or other distributions as in a for-profit enterprise.

> reasonable wage or salary isn’t usually considered “profit” in a legal sense

This is a semantic punt to the word “reasonable.”

The IRS has some guidelines that they use to decide what is “reasonable” but they don’t give out whatever actual formula or process they use to determine this. It’s supposed to be based on industry averages (more or less) but in reality it’s hard to determine what exactly that means. Generally you are “safe” paying in an industry average range, but if outside that range you need legal and accounting support to back up your own assessment.

> you are “safe” paying in an industry average range, but if outside that range you need legal and accounting support to back up your own assessment

What? The IRS doesn’t regulate wages. They just care about getting their money. If I pay you $10bn a year to yell at my cat, the IRS is fine so long as I pay payroll and you income taxes.

Actually as a nonprofit you are required to pay at or below a reasonable wage/salary or you may face sanctions: https://www.nolo.com/legal-encyclopedia/how-determine-reason...

Similarly as an S Corp (maybe other corp types too) then officers must take at or above a reasonable wage/salary to limit the tax advantage: https://www.irs.gov/pub/irs-news/fs-08-25.pdf

This is intended to prevent people from, for instance, setting up a “nonprofit” where they just funnel all gains into their pocket while gaining all the other tax benefits of being a nonprofit. You can’t overpay people, you can’t engage in transactions where you intentionally overpay a supplier for materials/services and then they compensate you for the extra amount, etc.

Have you spent much time looking inside non profits? A lot of hospitals in the US are non profits. Some are part of non profit universities too. This in no way leads to superior cost controls, or those universities being cheap. What it does mean is that they get some significant tax advantages (for instance, no property taxes), and that there's fewer optimization incentives. When you limit yourself to the US definition of a non profit company, it doesn't make care better or cheaper.

Studies have shown both a decrease in care outcomes and higher costs for private hospitals: https://pmc.ncbi.nlm.nih.gov/articles/PMC419772/ https://www.buffalo.edu/news/releases/2002/05/5712.html

I'm not saying profit in that sense. I'm just saying that it's monetary profit all the way down when it comes to paid work. People work for profit. People invest for profit. People bet for profit.

The person you were replying to seemed to be discussing profit in the sense of tax law, not whether or not people should be paid at all. I don’t think anyone here is saying that doctors should not be paid.

Most people do not profit off their labor. 2/3rds of people are living paycheck to paycheck, which means that they are being paid approximately the same amount that their labor costs to produce. That makes their wages an exchange of equal value, and thus not profitable.

> which means that they are being paid approximately the same amount that their labor costs to produce

No, "living paycheck to paycheck" means you're spending everything you get each month. There can be all sorts of reasons for that.

> That makes their wages an exchange of equal value, and thus not profitable.

This is true for all profit. If you lend me money and profit off the interest, we've decided between us that the time value of that money is worth that interest, and so it's an exchange of equal value.

If a business makes $50,000 in revenue, and has $50,000 in costs, we don't say that business turned a profit. If a person makes $50,000 in revenue, but has $50,000 in costs, we tax them as if they profited $50,000.

I like how you ignored the entire point and lied about what I said.

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