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Comment by jacquesm | Hacker News Reader

Good point. I'm not too worried about France, they seem to have their priorities straight there, other countries are less stable. Especially in former Eastern European countries there are disasters happening right now, and many Western countries will have to come to terms with the cost of health care and attempting to take commerce out of it.

NL had a very good system which got replaced by something much less efficient, ostensibly because the 'market' would have been better at making things efficient where the only real change is that healthcare is now much more expensive and options are as limited as they were before.

Personally I feel a good society should take care of its sick, poor, elderly and inmates even if it costs but that's an opinion that seems to be out of fashion.

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My personal suggestion for a good balanced system is that most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg but that society pays for more serious and longer term situations like cancer, heart surgeries where you are supposed to stay at the hospital for a longer time.

I.e. no one should be bankrupted because they get a serious illness.

With regards to France healthcare system here is an article who seems to think it wont survive though.

https://www.bloomberg.com/news/articles/2013-01-03/frances-h...

Yes, those poor people with recreational broken legs really should pay for their own work. That's only about 25K or so in a bad case without further complications... /s

Please read what I actually wrote instead of just knee-jerk reacting to your own prejudice.

I said MOST people should pay MOST of the bill. Do you really think I am talking about those with least amount of money.

You wrote:

> most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg

Most people are poor. Wealthy people are the exception and most people would not be able to pay for even the simplest procedures.

They typically can't pay for a new washing machine if their current one breaks down.

Most people in the west aren't poor just like most people aren't wealthy. Most people are in the middle.

There is a large number of people who can't afford to buy a washing machine but it's not most people.

> Most people in the west aren't poor just like most people aren't wealthy. Most people are in the middle.

Wrong, income distribution isn't normal, it's bottom-heavy, and most people are well below the mean.

https://www.ssa.gov/cgi-bin/netcomp.cgi?year=2015

Exactly. In 2015, most (50.08666%) wage earners earned less that $30,000/year.

While it isn't a majority, the fact that 3-in-10 (29.72726%) earn less than $15,000/year is a travesty.

Most people are in the middle

Of the income or wealth distribution - not a hope, it's Pareto all the way. You've got a really warped view of the world there.

This is why I liked the health care system in Belgium, where my wife and I lived for almost eight years.

In Belgium, you are charged based on your income, and they don't ask you how much you can pay when you get admitted.

As US ex-pats, we made enough money that we were in the top payment bracket.

Yet, for a significant surgery that kept my wife in the hospital in a private room for two weeks, we still paid less for the whole surgery plus hospital room WITHOUT insurance, than we would have paid in the US but with insurance.

That kind of social medicine does actually work, and work pretty well.

Belgium is pretty fair. NL requires you to pay between 100 and 150 euros per month or so (kids are free) and that covers everything, the rest is paid from the tax base so you already pay the income dependent part. The only bit that's nasty about it is the deductible, they really screw the poor people on that because of course only the cheap plans have high deductibles so those that can afford the least will end up with the highest costs when something does go wrong.

The problem is that people then tend to forgo preventive care & routine checkups if they don't have to (especially poor people), and in the long term end up costing a lot more when they do get treatment once their situation is far worse.

No thats actually not true which Denmark has lots of data to show.

It's 100% free to go to the doctor yet a lot of people don't go for checkups it's not a common thing to do.

Furthermore the situation is even worse for men over 50.

So access to healthcare has very little to do with that.

Earlier you write:

  > Its important to remember that in a state economy where
  > healthcare is free or semi free it's operated as a cost
  > center and thus has budgets that are politically mandated
  > not determined by market demand at least not directly.

and later write:

  > My personal suggestion for a good balanced system is that
  > most people pay most of the cost for normal healthcare costs
  > like going to the doctor for a checkup, most of the cost for
  > one of things like a broken leg but that society pays for
  > more serious and longer term situations like cancer, heart
  > surgeries where you are supposed to stay at the hospital for
  > a longer time.

But here

  > It's 100% free to go to the doctor yet a lot of people don't go for checkups it's not a common thing to do.

you allude to Danish data that show prospective patients do not take advantage of healthcare even if that cost is 100% subsidized.

So which is it? Does healthcare that is 100% subsidized distort demand so that people seek unnecessary care, or is demand so inelastic that people and populations who would benefit from it decline to use it?

EDIT: add third in situ quotation. Add comma in last sentence/question. Change pronoun to conjunction in last sentence; pluralize noun.

The ranking member of US Senate intelligence committee said

"1000 paid Russian trolls are spreading disinformation on US social media"

And recently said

>Be careful what you read on the internet because paid trolls are influencing what is discussed.

Perhaps parent poster is getting his info from disinformation sources like RT, Breitbart, Fox News, IJR, Limbaugh etc.

Not sure exactly what you are confused about.

I was responding to a post who claimed that if there isn't free checkup for all then people wouldn't go to get checked.

I simply pointed out that even in a country like Denmark which is 100% free people thats not the case.

So you would have to show causation between general checkups and cost of healthcare I don't think you will be able to find that.

My confusion comes because in my first two citations you suggest requiring patients to pay for most of their basic/non-life-threatening healthcare. You say this, if I'm not mistaken, because "free or semi free" healthcare is "operated as a cost center". That is, by requiring patients to pay for most of their basic healthcare, that cost center will be reduced because patients will be discouraged from seeking "unnecessary" healthcare.

On the other hand, in Denmark where basic healthcare is free, the data you allude to (but do not present) show that even then "a lot of people don't go for checkups [because] it's not a common thing to do." Additionally, you write "Furthermore the situation is even worse for men over 50."

So my confusion comes from your contradictory assertions about the effects of fully subsidized basic healthcare. Either free healthcare generates cost overruns because people seek out unnecessary treatment, or free healthcare does not generate cost overruns because people do not seek out even necessary treatment.

Your assertions about the effect of free healthcare are paradoxical, hence my confusion.

EDIT: fix typo, recast first sentence of penultimate paragraph. Remove redundant prepositional phrase from last sentence.

I am saying that because then they start paying for when they go to get treated or for checkups which allow for more money being possible to use on more serious situations.

I am not sure where you get that I want less people to go to the doctor. I just want to be able to pay for the situations you can't afford by asking for money in situations where most people can. And yes if you don't have any money then you should get help, but for people who make enough it should cost something.

So there is nothing paradoxial going on here. You just assumed I wanted fewer people to go to the doctor which I never said anything about.

That makes better sense, but covering costs of extraordinary care isn't an issue in state-provided health insurance (single payer), nor is it an issue with private healthcare insurance.

With single payer, taxes cover the cost of care for everyone. With private insurance, the costs for more expensive care is covered by the premiums of healthier individuals, which is sort of like what you suggest but does not financially punish people who get sick.

What you propose may not be workable (or humane, for that matter) because it distributes the costs of extraordinary care to people who already have more-than-routine care. Presumably these people already have paid their premiums and now would shoulder most of the cost for maladies such as broken bones.

EDIT: add missing word "workable".

It actually is an issue in both systems which is why in state-provided systems there are limits to what kind of treatments at what stages etc and in privet insurance systems there are limits to coverage.

The main premise of this discussion is that it's not possible to pay enough for healthcare. I.e. even if you taxed people 100% there still would be things they couldn't get because it has to be available to everyone and there are always new treatments being developed, new machines, new drugs.

Whether you find it humane or not is based on what you consider the end-game of healthcare.

That article is from 2013 and predicts crisis in as little as 3 years. It's 2017.

Be careful with articles about single payer healthcare systems in the US. Most similar countries to the US have functional single payer plans. It's a false talking point pushed by conservative media that those systems don't work well. Conservative media pushes those falsehoods because the media is funded by the very wealthy and those who want to cut taxes to line their own pockets at the expense of most Americans.

And the french started cutting benefits already in 2014 to make sure that didn't happen.

Right. So you're saying the French single payer system works, with political modification as needed over time.

The issue that might make single payer difficult in America is we don't trust our political system to manage good programs, because the GOP is committed to destroying government (to benefit the super rich) rather than trying to get things done.

No I am saying what I said originally that there are issues with the single payer system as it's based on tax money and thus can't make it's own money.

I'm not so sure about "have their priorities straight there". Using the state to manage healthcare brings up strange priorities: "Should we cover kidney transplants or should our soldiers have real bullets in their guns this year?", "Should we build the new transit line or increase coverage to include penile transplants?", etc.

I don't want people voting based on their appendix, their bad knee surgery, or a skin rash. Involving government in healthcare inevitably leads to possible futures wherein a country is brought to it's knees by colonoscopies. One's enemies can only laugh.

You say it's inevitable. Surely, then, you have some evidence of this trend actively weakening countries?

It's easy to sketch convincing strawmen. But if you could actually point to somewhere that is choosing between kidney transplants and bullets, I'd eat my hat.

No single payer system spend all the money they could on their healthcare system. I think this is what most people are missing. You could tax people 100% and you still wouldn't have enough to make your system as good as it can be.

Plenty of single payer systems decides how long they are going to keep someone on treatment, what kind of products they allow them to be treated with etc.

A single payer system is based on a budget which means that budgets size is based on how it's prioritized.

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