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Comment by glenra | Hacker News Reader

The fact that something might work in "numerous other countries" is of limited utility in determining whether it would work in the US.

Consider: If your kid is a bad student, pointing out that the neighbor's kids down the street are excellent students doesn't really help your kid pass math. Telling Microsoft or GM it should just "be more like Apple" doesn't mean they could succeed following Apple's strategies.

The US system has been very different from these other counties for quite a long time. We have different values, different skills, a different history, a different political process. It's quite possible that you simply can't get there from here. The transplant surgery necessary to put a european welfare system into an otherwise-American sociopolitical system could kill the patient. America is just NOT LIKE a tiny european country, and the ways IN WHICH they are different are relevant to what is politically and practically possible.

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I think the country most similar to the US is probably Canada. Canada has both significantly cheaper medical care (US$4360/person/year vs. $7960/person/year) and significantly higher life expectancy (80.7 vs. 78.2) than the US.

Another candidate would be Australia. Life expectancy 81.81 years, medical cost $3445/person/year.

Or maybe the UK. Life expectancy 80.05 years, medical cost $3487/person/year.

I think we can get there from here. We've had Medicare for over 40 years. It's just a matter of slowly lowering the eligibility age until everyone is covered. Of course it's not politically easy -- the healthcare industry makes a ton of money and owns a lot of politicians -- but it's possible.

Those are good countries to compare US to for public policy. I go nuts when people draw in Scandanavian examples for diverse anglo nations.

But that doesn't mean that the alternative of universal health as it's practiced in those other countries is a good alternative, just the obvious one.

The current US system is stupid: tying your healthcare to employment. It's no surprise that creating distance from the people who pay and the people who consume significantly increases costs.

In Australia you can opt for private health insurance, and get a rebate. Nothing like that in the UK. People in London who can afford it often pay for private service to avoid dealing with the state facilities. I'd be interested to know whether that was factored into the books for the figures you cite - I'd expect not.

The big issue is aged care. If the official system is so awful that you find ways to keep your parents at home longer - how does that get reflected in the numbers. Also quality of life issues - whether people in state aged care in country A are having a good time at greater expense, whereas those in country B are being dosed up with drugs to keep them quiet. What choice does the person and relatives have in that care? With universality - very little.

I can't see how universal care could deliver good outcomes for aged care. It has all the makings of a numbers game, an exercise in muddying the waters about who is responsible so they can ship a cheap one-size-fits-all model.

The US system already have 'universal health care'-ish systems. Medicaid and the VA health system. Both different models (government as insurer and government as hospital owner).

This is what more specifically would happen in the US: providers of drugs, medical equipment, etc. would lobby for government mandates and other support, essentially sucking unlimited amounts of public funding to cronies. This is more or less how defense procurement works.

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