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Comment by avenius | Hacker News Reader

I've never quite understood how so many americans appear to oppose a communally paid healthcare system. It should be a win-win for everyone, right? Is it just a severe lack of empathy?

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Many Americans simply do not see fellow Americans as people deserving of compassion, much less resources.

Which is strange, right? Because America ranks number two in charitable giving [1].

So what makes people charitable when it comes to charitable giving, not so when it comes to single payer?

[1] http://www.marketwatch.com/amp/story/guid/6EF5920A-87B8-11E5...

Difference being charity is strictly voluntary and therefore people can give strictly to people they deem deserving.

I'd love to participate in a communal healthcare system, but I don't believe that I have the right to demand that others do the same.

How is it win-win for everyone when one person pays for another person's healthcare? There might be overall good effects, but it's clearly win-lose in its basic transaction.

In a public system the federal government would pay. Since federal government's ability to pay is only artificially restricted by Congress, there should be no problem affording it financially. In other words, it's not citizens paying out of their pockets for other people's care. It's fed paying. Worst problem would be potential inflation. Likely because system would be cheaper overall it would have immediate economic boost. Like putting extra 5k in everyone's pockets.

No, it's the lack of quality. I dare you to try to receive care in Canada for anything which isn't a visible emergency. Even if you could pay for it you still couldn't get it.

Socialized health coverage works better in some places outside North America because people have some sense of custodianship and duty. North America is full of irreverence, nobody gives a damn if they're doing what they ought to do as long as they're seen to do what they have to.

Ask yourself if you would like to do dermatology like the DMV; surgery like a typical post office.

This anti-government ideology is self-reinforcing. We underfund government programs, then hold them up as examples: "Look, government funding doesn't work. I told you so!"

In reality, the people doing the actual work of health care wouldn't change -- the money to pay them would just come from a different place. Do you really think the folks at insurance companies have more custodianship and duty than people working in the public sector?

I agree about the frequent use of the tactic of making government dysfunctional to persuade people that they don't want to pay the taxes necessary to expand government services, but that tactic probably isn't going away. You can thank people like Grover Norquist who really, really want taxes lowered.

Also, something to keep in mind with fully socialized medicine is it would almost certainly reduce doctor pay, because the government would have almost all the leverage in pricing. I know some doctors in France well, they're extremely poorly paid compared to doctors in the same practice in the US.

And if you squeeze doctor salaries too much, what fraction of would-be doctors are going to decide that they don't want to go through the hassle and expense of medical school?

> I know some doctors in France well, they're extremely poorly paid compared to doctors in the same practice in the US.

French doctors still in the top 5% of earners in France, even higher when it comes to revenue from work. And the schools have to reject like 80% of the students at the end of first year.

But France is not a country where medicine is the most "socialized". For instance, GPs are usually private doctors in France. Then the universal health insurance refunds 70% of the price usually (but it can be less, because doctors can choose their price - it's called "sector", and only ). Then, most French people have a complementary private insurance called "mutuelle" from their job that pays the remaining 30%. Only long-term illnesses such as cancer are fully reimbursed by the national health insurance.

And yes, even the least paid doctors in France earn much more than the median French salary. Also in France, medical school is not expensive ("socialized" education). It just takes time...

https://en.wikipedia.org/wiki/Health_care_in_France

Interesting, thanks for the additional info!

> We underfund government programs

Does Canada under-funds it's health program?

A point about under funding: the US government ( not including private insurance) pays more for health care than the UK government.

It's not particularly surprising that a country several times larger than another pays more money for health care. Are you saying the per capita cost is higher?

Per capita medical costs in the US are double that of most Western countries. Both private and public.

http://www.pbs.org/newshour/rundown/health-costs-how-the-us-...

This would seem a good statistic to cite when trying to show the comparative inefficiency of the American system.

While I agree that that's a pretty scary thought, it's a bit of a strawman, since you don't have to go full state run - you can give everyone a baseline and allow for private insurance on top for those that want the gold plated treatment.

And by the way, that is how it works even in places with socialised healthcare. It's not like anyone is going to prevent you to buy private insurance in the UK if you have the money.

By the way, that is not how it works in Canada. Seems it's not legal to pay for additional access. Private insurers are used for drugs, paramedic bills, and other things not covered by the province; but they can't pay for enhanced medical services, only coverage of out-of-pocket expenses.

Meanwhile in most of the developed world, US healthcare is held up as the ultimate horror, and most people are satisfied with socialised care even when additional private insurance is available.

> I dare you to try to receive care in Canada for anything which isn't a visible emergency

Please, please, please stop the hyperbole. It does not help rational discussion.

I, my friends and family have been treated many, many times in Canada for everything from broken bones to just walk into the ER and say I don't feel good.

I have never heard of anyone waiting more than 45 minutes.

Last time I was in there I walked in and said "I got hit by a car 2 weeks ago and my leg still feels funny". I waited 15 minutes before a doctor poked a prodded me and said "you'll be fine, seeya".

Free, of course.

While I agree that you definitely can get treated for anything, I find it very hard to believe that you've never had to wait more than 45 minutes to be seen by someone. The past few times I've had to go to emerge I had to wait around 5-6 hours each time.

That matches my experience in Canada too. Large hospital .. waited 4-6 hours in the ER (got triaged by a nurse the instant I entered). On the positive, they had a Tim Hortons in there.

GPs/specialists in the US see me instantly. In Canada, they would make me wait 45mins-hour. Waiting a bit isn't the end of the world IMO.

One time I had a pretty bad accident (in the US) .. I remember going home to pick up my damn insurance card before rushing to the ER in a cab. Of course ... despite the fact I was bleeding, the first thing the hospital attendant asked me for was my insurance.

I personally prefer the Canadian model over the US one.

Where are you?

I'm in Yukon, also family/friends in BC.

Maybe it's just different in the East? (like so much of Canada...)

Having unfortunately needed hospitals in Calgary, Vancouver, and Toronto; I can tell you that a 45 minute wait for anything (including scheduled appointments!) would be a near miracle. It's nice that 45 minutes is what you get in Yukon, glad it works there. :- )

I'm still waiting to be called by a specialist for something I ran out of my prescription for two months ago. They simply never scheduled what they said they would schedule. I had to call the ER one week after the fact to get them to actually fax the request to the specialist, because they neglected to; then I had to call the specialist to acknowledge the fax, and after all that I still haven't received a call from them. I ended up researching the condition and treating myself, but I could have been wrong and done more damage; pharmaceuticals could also have been a safer approach.

In Calgary waits were a bit better, only about 3 hours instead of 4-5; but I needed stitches both times I went to an ER there.

The condition of the healthcare system is not for lack of trying, my own mother worked at hospitals for most of my childhood, and I know plenty of people who work in medicine; they all seem to try their best, but the chronic lack of oversight/accountability and lack of competition means that things just continue to fester. It's frankly amazing that we've survived this long and this well without a private system.

Why does the United States have one of the largest maternal mortality then?

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