Comment by VeejayRampay | Hacker News Reader

Comment by VeejayRampay | Hacker News Reader

As a French citizen who's enjoyed the goodness that is subsidized health care, it needs to be stressed that all this has a cost for the country.

The vision that taxpayers support a system where everyone is granted access to next-to-free / affordable health care has a natural cost in certain areas.

Sure it's great when you're both poor and sick cause you get to be treated like everyone else, you get the day care for your kids, you get the MRI's, the cancer treatment, you're being taken care of at the ER etc.

But at the same time, everyone has to realize that this has a cost in terms of taxes. Taxes for companies, home buyers, CEOs, businesses, cigarettes and alcohol, gas, etc.

It's the old chasm between putting the emphasis on the individual or on the nation/country as a whole. America has traditionally favoured private/capital-oriented solutions so far for most of its services (postal services, health care, public transportation, part of its schools, water, electricity, Internet infrastructure, etc.) and was thus able to keep the burden of taxes lower for individuals.

If it were to move to a system where everyone pitches in for cheap state-driven services, the money would have to come from somewhere and it would be sure to somehow stifle economic growth in certain areas (see the economic situation of France or other countries where the involvement of the state is still strong).

TL;DR: The idea of cheap MRI is nice on paper (and I believe it to be awesome in practice), but there's no magic wand to make that happen, the money has to come from somewhere and it requires that a whole country accepts paying more to the state to get more at the other end, a paradigm shift that will be tough to swallow for the USA given its economic culture.

You overlook that US Americans still pay a lot more per capita (or as a fraction of GDP) than citizens/residents of other countries: http://en.wikipedia.org/wiki/List_of_countries_by_total_heal...

While you may be paying more in taxes, the average American will in the end pay more for healthcare (as a combination of insurance and out of pocket expenses). That this goes to healthcare providers and private insurance companies does not matter much; it comes out of your paycheck either way. If you're really uncomfortable with paying taxes to the government, you can pick the German system (where public health insurance is handled by non-profit sickness funds) or the Swiss system (where health insurers are private companies, but get told by the government what they have to offer and how much they can charge for it; they make money from providing non-essential addon insurance). In the end, though, either is still equivalent to a single-payer system in practice.

A major reason for the higher efficiency is that a single-payer system (economically, a monopsomy) can negotiate much better prices; prices also tend to be much more transparent, whereas in the US American system, the actual costs are often obscured. This is because normal market forces tend to work poorly in an unregulated or loosely regulated healthcare and health insurance market (e.g., ask yourself how much are you willing to shop around or bargain with a doctor when your health or even life is on the line).

Health care costs in the US can have the same effect on the population as a tax even though it does not get go through the government. The goal should be to lower the healthcare cost per person, not squabble about who is paying.

That's the kind of reasonable debate about values and priorities that would exist in a sane system.

But the US has a certifiably insane system. The government spends more on healthcare per capita here than the government does in France. To be clear: that's excluding private spending.

Some of that is certainly driven by a higher GDP per capita, but it's still ridiculous even when accounting for that.

We might not need the government to fully subsidize healthcare to improve things though. Prices are set so high that hospitals - even nonprofit ones - have huge profit margins (this is better stated in the original [now-paywalled] TIME cover story: http://www.time.com/time/magazine/article/0,9171,2136864,00....). So even without the government paying for everything, there could be regulation to control prices set by healthcare providers.

Health care taxes on cigarettes... morbidly hilarious.

Do people think health care taxes on cigarettes is a bad idea? As a smoker who pays extremely high taxes on cigarettes here in the UK I have no problem with them.

It makes total sense to tax the hell out of it, because it causes a very real health care burden. Doesn't change the dark humor of it though :)

The problem with taxes on cigarettes (as I see it) is that most of the time it's not proportional to one's income. A tax that is not progressive is inherently unfair IMHO, as it places a heavier burden on the less fortunate. EDIT: Someone mentioned that cigarettes are a life choice but I personally believe that to be more of a nice theory than a fact. In reality smoking is huge among people with lower income, due to lack of education about the risks, cultural factors, advertising, etc. (see http://www.gallup.com/poll/105550/among-americans-smoking-de...). As a result, a higher burden is put on people who tend to smoke more on average, which are apparently the very same people who don't have too much money to begin with. Still their mistake to be spending the little money they have on a drug, but it's one of those "easier said than done" things in my opinion.

You don't have to buy cigarettes though. They are a life choice.

Smoking is a choice that makes someone more likely to have health problems later. Under nationalized health care, taxing cigarettes is just aligning incentives.

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