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This is one of the key factors: access. We can cut costs but that generally means removing access for a lot of people. There is a cost for having an UrgentCare and a CVS on every corner. This also means driving larger distances to get care which Europe doesn't have at the same scale given their density.Removing all that cost also means removing 100Ks of jobs (some direct, some indirect because even grocery stores make a killing on prescriptions). No one is going to vote for that. Instead we'll keep doing what we do with everything else, raise taxes on the middle class to pay for everyone else.

We also need a better way to separate emergency healthcare insurance (which is what we have for cars) from regular routine things that should maybe be paid out of pocket or socialized. We also need to cut down on the abuse and that is what you are talking about. No ER for a cold and less unnecessary tests and cut back on cancer treatments for people over 80 (most everyone is at risk for cancer eventually, this is just a result of aging, not an unfortunate event for a 20 year old).

I've heard that men who live to 100 have a 100% chance of prostate cancer. They just leave it untreated because we're cured when we die.

I would be ecstatic for an option for emergency healthcare insurance, because that's all my family needs. I could cost effectively purchase all other services necessary as needed, and save an enormous amount of money. But like I said, these companies need my money to shoulder the financial burden, so I'm not holding my breath. I just know I could learn to be okay with being forced to pay for other people if they managed it better.

High-deductible plans exist.

Right, I think the high deductible plans could work IF we also add national HSA that everyone is eligible for to pay for routine health care costs pre tax.

How is "a slight cough" an emergency room issue? I just call my regular physician (is that "general practitioner" or "family doctor" in English?) and her assistant gives me some advice.

I have no idea what would happen if people were to start abusing emergency rooms and ambulances for regular care, but I think it would make a lot of sense for emergency rooms to just direct people to their regular physician.

someone i once knew used to call the ambulance so that they could get into the emergency room at Kaiser and therefore get some treatment. otherwise, it took forever to get in and be seen by a doctor.

My wife was a teacher for middle school youth who were in state custody (or had other behavioral issues), and all of her students were raised with the exact same approach to healthcare as your co-worker. "Why pay for anything when you don't have to?"

When my wife was about to deliver our first child, she mentioned to her students how the hospital bills can be expensive. Her students were absolutely dumbfounded that anyone would actually pay out-of-pocket (with or without insurance) for a baby delivery. They almost couldn't comprehend the idea that anyone other than the government actually pays for this stuff. Many of those same students came from large families where a single mother literally chose to have many children (with random fathers) in order to qualify for more state-funded entitlements, and unfortunately, that whole mindset evidently perpetuates itself through the generations as kids grow up and expect to repeat the process.

And of course, their votes count the same as my vote.

I know exactly what you're talking about. When I went to setup a payment arrangement for my son's delivery, the hospital acted like they didn't know what to do with me. I had to call and explain what I was even doing every time I tried to make a payment. Eventually I got with a representative who helped me figure it out, but I was left with the distinct impression that I was the only idiot in my county who pays for that.

In the midst of all this partisan debate about what will work best, I keep feeling like nothing can sustain a system that allows so much abuse.

I'm a bit confused by the context. There's nothing wrong with the mindset of expecting free healthcare, but I think it's how you get there that is problematic.

In western countries, those things are "free" because we collectively pay for them. I can't imagine having to pay for child birth. It's just something we are collectively responsible for, because we try to provide basic human rights to everyone.

Same for daycare. As a parent, finding a daycare centre that met basic health standards was one of the most stressful parts of becoming a parent. When the government started subsidizing non-profit daycare, it solved so many problems and made me much more productive at work.

> In western countries, those things are "free" because we collectively pay for them.

Are you implying that somewhere else, these things are free without someone paying for them?

> I can't imagine having to pay for child birth.

Really? Should raising a child be free then too? Should everything be "free"? How does that work?

Except for rare circumstances, when someone gets pregnant, they choose to get pregnant. It may not be the desired outcome, but if you choose to play with fire, you're just ignorant if you think you can't get burned. It's a proactive choice. So if you don't have the means to deliver the baby (and subsequently raise the child in a positive environment), why did you choose to get pregnant and have the child? Why should everyone else be on the hook for your mistake? Regardless of who pays, children are expensive. Should we really reward people (and yes, that's what the system currently does) who want to make irresponsible decisions and have children they can't afford (in both time and money)?

Perhaps you're really pushing for full socialism? Sounds great! How's that working out in Venezuela?

> If I have to fight all the time for basic things, then yes, I'll start cheating the system

Are you "fighting" to pay your taxes? Are you "fighting" to pay your insurance premiums? We're not talking about a struggle to find the best daycare for your kid; we're talking about paying into a system (whether through the government or an insurance provider) that redistributes wealth from those that can pay to those who "can't", but it only works when people don't abuse the system. And if you have the ability to work, you should be contributing rather than "cheating the system". Otherwise, you're just trying to justify getting something for nothing.

> Are you implying that somewhere else, these things are free without someone paying for them?

Free, no, but the rest of the developed world has universal coverage and healthcare that costs half what it does in the US per capita, with similar outcomes.

Someone has to pay, yes. The US's way of paying is just horrendously complex, expensive, and inefficient.

>the rest of the developed world has universal coverage and healthcare

Why should every country have the same solution to healthcare? The US was formed as a democracy when 'the rest of the world' was run by monarchs. Healthcare is still a rivalrous good, and if we don't limit it by who can afford it, we will limit by some other ambiguous term like 'need.' My friend's grandma (80 yrs old) just had to fly to the US from Paris to have a surgery for which the French system deemed her ineligible (she was too old).

> Why should every country have the same solution to healthcare?

Single-payer systems have a variety of implementations - Australia has a vibrant private insurance industry alongside their public system, whereas Canada forbids it.

It's quite clear that the US healthcare variant simply isn't working and isn't sustainable. I pay more for my family's health insurance ($2,000/month) than I pay for my mortgage, and it goes up 10-20% every year (both pre-ACA and post-ACA).

We're well past the point of saying "well, that experiment didn't work, what's everyone else doing that works?"

We were past that point when Clinton raised the issue in the 90's (or even Bob Dole). I just don't think a federalized system with central control/power is the prudent path to pursue until we get price transparency for healthcare costs.

We already have price transparency for our single-payer system. Medicare pays a specific amount for specific procedures - you can get a full list (https://www.cms.gov/medicare/medicare-fee-for-service-paymen...).

Our current path is demonstrably not prudent, with a good dozen or more examples of what appear to be prudent approaches to draw from.

> Should everything be "free"?

No, but I know people who pay for insurance and still have a $4k co-pay for childbirth.

> but it only works when people don't abuse the system.

It used to be that we paid insurance, and were covered. Now it's we pay insurance, and also pay a larger portion of care than we are used to.

And why do you think we're paying so much? Either (a) the insurance companies and health care providers are just price gouging[1], or (b) the people who do pay are having to cover the costs for all those non-payers.

In this case, both problems are essentially the fault of the government. Choice (a) only happens in a system (like we currently have in the US) where the government imposes artificial limits on competition in the healthcare industry. Choice (b) currently happens because the government mandates that healthcare providers give care to non-paying patients, in addition to the government-sponsored entitlement programs (which often pay providers far less than the actual costs require).

[1] If it's just price gouging, then (in a free market) there would be a huge incentive for someone else to enter the market with lower prices; they'd be able to sweep the market overnight - at least until someone else came along to undercut their prices, and we'd all benefit from paying something closer to actual costs. But in the artificially regulated healthcare system of the US, unfortunately this doesn't happen.

Most other countries do a pretty good job controlling health care prices. The situation in the United-States is appalling. Deregulation sometimes works, but here it clearly fails.

> Deregulation sometimes works, but here it clearly fails

We haven't had a deregulated healthcare industry/market in the United States for a very long time (in fact, "healthcare" as we know it never existed in the US without massive regulation). I'm not sure anyone can make that claim based on real evidence, at least not in the US.

In most western countries, you don't negotiate a hospital bill. Usually you don't get a bill at all. In most Canadian provinces, governments set prices and their only "client" is the provincial government.

I think you meant "free market", not "deregulated"? and where supporters of free markets will always push for more deregulation because they'll blame whatever little regulation is in place in order to support their utopia. Heard that before.. all watched over by machines of loving grace.

> And of course, their votes count the same as my vote.

But your political influence is much greater with money

The popular vote is for welfare clones

Please stop violating the guidelines.

https://news.ycombinator.com/newsguidelines.html

I didn't violate any comment guidelines, which one did I violate?

I think I added to the conversation and this is a also a reality I live in. Kickback and relax, emphasis on kickback, is way more effective in creating favorable political situations for me and everyone I know, than a popular vote. Some jurisdictions formalize it with synonyms, others don't. Do I have to write massive disclaimers and sources for accepted reality just to avoid being shadowbanned?

But you didn't say that. Your comment was unsubstantive (like many of your previous ones) and inflammatory. I don't know exactly what you meant by "welfare clones" but it does give the suspicion of incivility.