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Comment by Loughla | Hacker News Reader

Honest question. What chance do you think, or how would you propose we start this discussion with people who genuinely believe the market as it is now, with 'choice' is the best option for consumers?

I live in flyover country, and people legit believe that letting the market make choices is best, and single payer is a quick step to full on communism. I'm looking for positive arguments to counter that nonsense.

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Ask them how many insurers they got to choose from when they got their most recent job.

I would bet a truckload of money that it's between zero and one.

What kind of choice is that?

Wouldn't they then refute with: "My employer chose between the insurer competition, not I" implying that there's still competition?

(for the record I am pro single payer)

While they wouldn't be wrong, I think one of the huge distortions in the US health insurance market is that most of us get our health insurance through our companies. It distorts & hides costs, and it prevents employees from leaving for fear of health coverage uncertainty.

I agree. Employers don't pay for a number of other insurances, why should health be different?

Yes that would be the standard reply. But the point is to shift the terms of the discussion away from choice vs non-choice and towards the realization that you're not making a choice at all. Someone is making a choice for you.

That's the kind of choice left when "You like your Doctor/Plan, you can keep them" comes to fruition. It's also hard to afford better plans when the $2500 a year in savings turns into $2500 a year more in premiums... and then you have to pay thousands in deductibles before you can even "use" your insurance.

Oh yeah... the Government Option is a real winner.

Wait... I know... lets go to the VA model where people aren't dying... while on waiting lists... and the administration spends millions on Bonuses, Art Work and Vacations.

Lack of choice? That's from lack of ACTUAL 'free market competition'.

Taking away more choice and removing more competition isn't the way to solve the problem caused by removing choice and competition.

The worst thing you can hear? I'm from the Government and I'm here to help.

Do you want a choice of health insurance or a choice of health care? If you actually want choice in health care, then single payer makes the most sense since you can just go to whichever doctor you want (since they will all be part of the single payer system).

I want the government involved as little as possible. Two things don't happen with the government: Affordable and easy access.

"Free" might sound affordable... until you have to pay the taxes that drive "free".

And government run anything? Yeah... how about a big ole glass of no. With a double dose of hell no. Look at all the cost overruns, crappy care and red tape surrounding the VA, Medicare, Medicaid...

It seems like we need a state or two to become an experiment (in the same nature as pot).

However I fear that any attempt to will result in companies suing the state for unfair competition or the like.

How about an inter-state compact where states can willingly join a group and adopt common set of laws/regulations. If California, New York, Illinois and Massachusetts join this group, you already have 75-80M population with more liberal states to follow. This group can also be used to advance other liberal agenda on issues pertaining to energy, climate or agriculture.

Of course, conservative states can do the same to advance conservative agenda to bypass gridlock in DC. But nothing wrong with that either. We will have some sort of real world A/B testing between the two groups and see which policies work better for a given problem.

The advantage of a compact of states is that it enables significant weight behind a proposal, which would be hard to ignore for the companies (eg. fuel efficiency standards might be ignored for MA alone, but will be hard to ignore for market controlling 30-40% of the population).

I learned recently that this is similar to what happened in Canada - it started with one province (I can't remember which) and spread from there.

Saskatchewan. Good ol' Tommy Douglas.

For those curious:

https://en.wikipedia.org/wiki/Healthcare_in_Canada#The_begin...

It's likely that providers would flee any smaller state that attempted to do single payer.

Not universally of course, but enough to have a big impact on availability of services.

California might be able to try it.

> California might be able to try it.

This. California democrats recently achieved a supermajority[1] making such an experiment possible. If California cannot push state legislators hard enough to give it a shot, the idea that a fractured national Congress will is fatally flawed. Voters rejected the idea in Vermont[2] (Bernie country[3]) -- so, can California be different? Granted, a California experiment must balance the fact the CMS money originates from federal sources, but that should not completely inhibit an experiment.

[1] http://www.latimes.com/politics/essential/la-pol-ca-essentia... [2] http://www.politico.com/story/2014/12/single-payer-vermont-1... [3] https://en.wikipedia.org/wiki/Vermont_Democratic_primary,_20...

Put the Surgeon General in charge of it and conscript all healthcare professionals into a uniformed US Health Service. Uniforms would make the best political cover.

> I live in flyover country, and people legit believe that letting the market make choices is best

There is a large segment of the population that worships the free market. They believe it will fix anything. Any flaws are because it's not a truly free market, but we can fix that and make it free and then it will work properly.

"Healthcare is not a market."

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