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Comment by kensai | Hacker News Reader

Medicine is one of those few fields the "socialized" approach is actually the better one. Of course you would prefer a I-don't-want-to-pay-for-others* stance when you are young and healthy (ie provided you were not born with a genetic condition or something similar), but once you start aging and caring, you start appreciating why Medicine as practiced in Europe makes much more sense in the end.

*even Ayn Rand allegedly made use of the "social benefits" when the shit hit the fan and it's perfectly alright (https://www.quora.com/Did-Ayn-Rand-really-accept-Social-Secu...)

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Isn't insurance already paying for others, if nothing happens to you?

I-don't-want-to-pay-for-others != I will not insure my health.

US health system needs competition more than socialism [1].

[1] https://mises.org/blog/lack-epipen-competitors-fdas-fault

EDIT: A really good comment from link above.

Mark S - https://mises.org/blog/lack-epipen-competitors-fdas-fault#co...

The culprit in virtually all health care or drug price gouging outrages is insurance and "free" taxpayer money. Americans want someone else to pay for their health care -- the insurance pool, Medicare, Medicaid, the VA, the hospital (if they are indigent). Drug makers know that someone else (not the patient) is paying for the drug, that payee has no economic incentive to minimize costs, and so drug makers do not care or have an economic incentive to control their costs or limit their prices. Somebody else is paying, so who care what the drug costs. Insurance companies pass costs along in the form of escalating premiums, so they have no incentive to control costs (especially in the Obamacare environment where health insurance providers are exiting the market leaving the remaining firms with a monopoly); giverment health programs have virtually unlimited access to taxpayer money (and, in the end, money printed by the Fed), so they have no incentive to control costs; health care providers also know that the patient is not paying the bill, so they have no incentive to prescribe or investigate more afforadable alternatives.

People never ask "So, what does this drug/treatment cost?" but rather "Do you accept my insurance?"

Competition in a socialized system exists, it is just at the individual practitioner level, rather than at the administrative level. So, could you explain why administrative (e.g. hospital, insurance, physician network) competition is needed in this field? Historically, it's been more expensive this way, not less.

Normal, free market competition does not apply to healthcare because, unlike any other market segment, transactions between patient and doctor are never fully free (voluntary).

If you go to a mall to buy a TV and see two different models offered by two producers you have THREE choices: buy TV A, buy TV B, or buy none, if both are too expensive.. When you are sick and need to see a doctor the third option is not viable - you need to be treated otherwise your condition will get worse and you might even die.

That's why free market in healthcare causes high price inflation: you are not buying a product, you are buying your own life and well being.

Competition is not the issue, it's private healthcare itself. There is not a single country I know of where private healthcare works.

See my sister comment, see Switzerland.

I live in Thailand. Private healthcare is excellent here. In fact, hundreds of thousands of people from around the world come here every year to take advantage of it - Thailand is a huge medical tourism destination.

There is also a public healcare system here which is quite terrible.

Interestingly, some public hospitals offer "special clinic" hours where you can get treatment on a cash basis instead of using the public healthcare system. Since the "special clinics" are not so heavily oversubscribed the wait times are shorter and service is better. Not luxurious like the private hospitals (which are indeed luxurious) but solid care by excellent doctors. I had foot surgery at Siriraj Hospital (oldest and largest public hospital [0]) by an excellent specialist [1] who also practicies at Bumrungrad (pricey private hospital). Total cost of everything, including two nights in hospital, was USD700.

I guess that's a sort of hybrid of public and private and is an excellent value. But the private healthcare is outstanding and (again) luxurious, and while more expensive still only a fraction of western pricing. The thing is, the prices are known and even advertised in advance and you can just pay out of pocket. Wife had surgery at Bumrungrad to remove an ovarian cyst, three nights in hospital with pampered treatment, total cost a little over USD2,000.

[0] https://en.wikipedia.org/wiki/Siriraj_Hospital [1] https://www.bumrungrad.com/doctors/Bavornrit-Chuckpaiwong

I did not explain very well my thoughts on this. By "works", I mean healthcare as a commodity that everyone (including the poorest) can afford. In order to exist, the private system has to be better than the public one, which means better facilities, top doctors and therefore higher prices. The reason the public service is terrible is because the private system exists, top doctors are going private to get better salaries and the public one will never improve.

I'm pretty sure the private healthcare in Thailand is very good, but the only reason it's affordable for us is the difference of the cost of life, I doubt a farmer there can afford those services.

Seems strange to say the public healthcare is bad because of the existence of private healthcare. It's bad due to the fundamentals. Things like: - it is "free" so it is grossly oversubscribed (basic market forces at work) - it is taxpayer funded and government run (spending other people's money on other people, the worst way to get value) - there is no incentive to improve since there is no competition (nobody loses their job and the public system does not go bankrupt and disappear regardless of how much worse it is than the private system)

And those fundamentals are why the private system is so much better. It's not free and consumers are spending their own money on themselves so seek out the best value they can. And the competition between private hospitals is pretty fierce so they are contantly upgrading, innovating, and advertising (including their prices) to attract customers.

It is common here for many of the best doctors to practice in both private and public sectors. My anecdote mentioned the fact that the doctor who did my foot surgery does that.

As for cost, those private hospitals, and there are lots of them, cater primarily to Thais. So plenty of Thais can afford private care. It's not a huge unknown cost going in that is potentially ruinous like in the U.S.

Like you said, in order to exist the private system must be better than the public system. That is the wonderful effect of markets when they are allowed to operate.

IMO the US health system needs stricter regulation. Switzerland is doing fine with a system very similar to Obamacare, with one important difference: Item prices for health services and goods are regulated by the government. Yes I know, small rich country yada yada - but if you look at it a bit more closely, the average Swiss is not that different from the average American - GDP per capita, median income, most live in diverse but smallish cities, lots of cars, lots of guns, high (but still way lower) health spending, all quite comparable - except Swiss have one of the highest life expectancies and can expect treatment for everything treatable while for many Americans this seems to become some sort of raindance.

Have you ever been to Switzerland? I have and I find this comparison absurd. It is a very small, very wealthy country with almost none of the structural problems faced in the US.

The nominal GDP in Switzerland is actually much higher than in the US, it's just that the country is way more expensive to live in. Therefore, when adjusted for cost-of-living (PPP), the GDP are about equal.

Of course, the absolute amount of money per capita is still much higher, which lowers the relative cost of, say, medical equipment.

The private healthcare in Switzerland is also compulsory and insurers are forced to offer a basic, non-profit plan. Furthermore, individual payments may be subsidized by the government. It's therefore not that different from Obamacare, nor are private insurers left to the devices of the "free market".

Hmm. First you call my post absurd, then you basically repeat everything I've written. The only point really left is that medical equipment is cheaper for Swiss. I really don't think this makes much of a difference - the main difference cost wise is what we both wrote: Regulations such that health providers and insurers have strict boundaries. Btw. I'm Swiss, if it hasn't been obvious already.

I called your comparison of the two countries absurd. It's not obvious that you're Swiss, it's obvious that you're out of touch and it's common for Americans to make some simplistic argument, pointing at fringe countries like Norway or Switzerland as an example.

You point at some facts that happen to be similar (when adjusted) for the US and Switzerland, but it's rather arbitrary. What the hell does gun ownership have to do with healthcare? And of course, like most industrialized countries, there are "lots of cars"...

The absolute difference in wealth doesn't affect just medical equipment, it affects practically everything besides labor. One of the reasons why labor is so expensive is the high taxes (VAT etc). When the government subsidizes that expensive labor, it'll get a big part right back.

You also edited your post to agree more with mine (i.e. Obamacare), when the original point was more like "private insurance can work look at Switzerland!".

Yes, it can work, if you're wealthy Switzerland and you regulate the fuck out of everything. Touche...

btw. I never edited in Obamacare, it was in there from start. The US has enormous wealth, with a purchase power per capita almost as high as an average Swiss, times 300 million. I think Americans should stop making excuses. I don't see what's wrong with comparing anything internationally - you have 150 experiments with different parameters, there's no reason not to use that knowledge if you want to figure out on how to improve or what not to do.

switzerland is by far the most expensive health care system in the EU. Crucially it doesn't outperform by very much either.

It's certainly not the most effective, that would probably be Japan. My point was that Switzerland has probably one of the systems closest to the US, so it's the easiest to compare and would also be one of the easiest for the US to copy, were it not for all the pharmaceutical lobbying going on (maybe Trump will solve that?)

I just like to use it to point out how the common American argument against universal healthcare don't really apply.

"it's socialist!" - no, you can have a system where everyone pays in according to insurer determined risk factors, pay less overall and still be within what people at minimum wages can afford. Below that you subsidize with taxes, but that costs very little compared to total health spending.

>I-don't-want-to-pay-for-others != I will not insure my health.

But it is. Insurance works by pooling money from a group of people where only few are going to use it.

>People never ask "So, what does this drug/treatment cost?" but rather "Do you accept my insurance?"

Which makes sense, as survival and physical and mental well-being are humans primary needs.

> But it is. Insurance works by pooling money from a group of people where only few are going to use it.

Except not everyone paying the same amount. Most pay nothing. That is, in socialist health care system.

And I am not just refering to insurance but also investment toward better medical education. If there is medical advancement going on then we have to collectively make sure that we all get it at good price. I am advocating more proactiviness toward our own health rather than rely on government to do it. But sadly government interference make this very difficult.

> Except not everyone paying the same amount. Most pay nothing. That is, in socialist health care system.

Ehm, the national health care systems in Europe are paid by our taxes. The only persons who do not pay to them are those that are entitled NOT to pay (below poverty level, children, etc).

Here even folks below the poverty level pay a little bit on the VAT taxes and so on, as do children. (Even if the money they are spending originated with the taxpayers)

Health insurance is not really insurance, though. Not only "a few" are going to use it. If auto insurance worked in the same way people would expect it to pay for oil changes, new tires, and other car maintenance expenses.

Was wondering when someone would say this. It always boggles my mind reading the discussions about "insurance". It's what Americans have become used to calling insurance even though much of it isn't insurance at all.

I love how nobody calls military spending "socialized". Only health care and education, for some reason.

The US has a gigantic "socialized" spending on that compared to everyone else. It's just that it's rather focused on one single thing. You can even hear politicians promise to spend even more taxpayer money on it.

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