Comment by codegeek | Hacker News Reader

Comment by codegeek | Hacker News Reader

Something has to be done as status quo is not working. The idea that one could go bankrupt if they don't have health insurance or god forbid are hit with an illness such as Cancer is ridiculous.

Is single payer the answer ? Frankly I don't know. But as Americans, we live in fear when it comes to healthcare. If you have a job where your employer provides great coverage, then you are ok for the time being. But what if you lose that job ? What if you want to start your own business ? What if you want to be self employed ? What if...there are more like this.

Ok lets pay out of pocket then. Fine. If you have a family of 4 or more, be ready to shell out anywhere from $1500-$2000/Month (yes per month) to get a decent enough plan that doesn't have crazy deductibles and out of pocket limits. Can't afford this ? Oops sorry, you are on your own (some exceptions if you can prove you are extremely poor and get medicaid etc)

Fear. That is the issue I have. I don't want to be scared and I am not a dramatic person. But it is scary. Just the thought of getting sick and not having insurance.

Not to mention too many cooks. Don't believe me ? See below:

1. The Patient (so far so good)

2. The doctor/hospital (still good)

3. Insurance Company (things start to get worse. Too much power)

4. Doc's/Hospital Billing Company and their own process (now this is really idiotic). I once ran for a month to get billing errors corrected (not kidding).

Ideally, a system should only have the top 2 mentioned above. Single payer can certainly replace #3 with Govt. but that part is the tricky one. Part 4 should not even exist. But hey, medical billing/coding is an entire Business in the US.

Well, you could always adopt the European model and go free universal healthcare paid through taxes.

E.g. in Norway, people mostly pay around 30% in tax, and 8.2 percentage points out of those 30 go towards free universal healthcare.

The Norwegian state's annual healthcare expenditure per capita is below $8000, for one of the highest quality systems in the world.

Before something like this happens we need to address the costs. There are ridiculous situations where you can pay $X in cash but when using insurance the charge against the policy will be $X*4 or higher.

Or the fact that ~half of what your provider charges goes towards their own insurance they have to keep to cover lawsuits against them etc.

Also, not sure what the breakdown is outside of the US - here about 50% of the population (the "bottom 50%") effectively don't pay any taxes so the burden on the rest of the population can be significant if there's any movement towards using taxation to pay for universal healthcare.

Before, or while. If the health agency is the final player stuck with the bill, you can bet there will be a strong push and leverage) to contain costs.

CMS already applies downward pressure for many things; drugs are the one area where they can't because someone thought it was a good idea to pass a law forbidding them to negociate drug prices.

... because someone thought it was a good idea to pass a law forbidding them to negociate drug prices.

Good post. Just want to highlight that it's not so much that someone thought it was a good idea as someone lobbied so that they/their company would make more money.

> Before, or while. If the health agency is the final player stuck with the bill, you can bet there will be a strong push and leverage) to contain costs.

Not really - in fact, the current pricing situation is exacerbated by Medicare, not alleviated by it.

Medicare sets its reimbursement rates at whatever level it decides to pay (there isn't really any "negotiation" that happens), and providers are required, by law, to charge insurers and uninsured patients more than what Medicare pays. Unsurprisingly, this results in Medicare paying rates that are below COGS (and therefore literally unsustainable), and private insurers and uninsured patients make up for the difference.

The situation is so bad that Medicare has not one but two special programs to compensate providers who mostly or exclusively treat Medicare patients, because otherwise they would literally go out of business because they couldn't pay for their supplies, let alone rent and staff wages.

Everyone already pays into Medicare, it isn't part of the income tax brackets. Not nearly enough to cover their own health care costs, but let's not conflate no federal income taxes with no taxes.

> Medicare is funded primarily from three sources: general revenues (45 percent), payroll taxes (36 percent), and beneficiary premiums (13 percent)

http://www.kff.org/medicare/issue-brief/the-facts-on-medicar...

My experience is the opposite. Cash payer gets list price, insurance gets a much lower negotiated price. I always thought an 'insurance plan' with zero actual coverage but the negotiated prices could be ideal for self employed (with separate catastrophic policy)

That's effectively what a high deductible plan is. The ACA bronze plans are essentially high deductible catastrophic plans with some bundled services (but those services represent a small fraction of the plan cost).

The bills for simple services can still be pretty large.

Not to mention those $35 bags of saline...

And the ironic thing is, the fear and anxiety caused by healthcare costs (along with the many other things that everyone middleclass and down is anxious over) makes us less healthy.

This is one reason that I am glad to have my own policy (although if the ACA gets repealed, there is no guarantee that I won't get kicked off of it eventually) since my company is too small to have a group plan. I have private health insurance (with a stipend from my employer) and private disability insurance as well. I pay significantly more than I would for a group plan, but I also have some peace of mind knowing that losing my job doesn't directly put that in jeopardy (assuming I can still make my payments that is).

>Is single payer the answer ? Frankly I don't know

I think so, it works for European countries, and Canada, which are comparable in wealth to the US. I don’t see why not.

Most European countries don't have single payer. They just have better regulation.

Care to give some examples?

Typical features for non-single-payer and non-nationalized European healthcare systems include: insurance mandate, "public option", price lists/controls, insurers must be non-profit, insurance must not suck (see: many expensive plans in the US that are, nonetheless, terrible, even post-Obamacare). IIRC Switzerland and Germany's systems both have some or all of those features.

Germany has 200 private insurance companies. They cover the state mandated minimum. You can get better coverage over the base price if you want. Many Scandinavian countries have cohorts or risk pools that are not the whole country. You pay into those pools. You get care anywhere. Kinda like a coop system. True single payer like Medicare or the British system are actually rare.

All European countries have universal healthcare, but not necessarily single payer. Germany(https://en.wikipedia.org/wiki/Healthcare_in_Germany) has a multiplayer system that allows self-employed and high income people to have private insurance, though all others must take public insurance.

And this varies, but a lot of countries have some form of public + private option, though it's usually universal.

Look at Germany and Switzerland. They are quite similar to Obamacare in a sense: Mandatory insurance, multiple insurances, private providers.

If there is no political will to resist there is a good chance the US medical industry would mess up single payer in the same way they messed up the current system .

Germany. There are several public insurance... companies? with only minor differences. There is also private health insurance that some well-off people choose. Private is cheaper only when you are young and healthy but you have to stay private forever, and it provides "better" (usually just more luxurious, not substantially better) service.

by well off you mean 11% of the population? https://de.wikipedia.org/wiki/Private_Krankenversicherung

You can choose to take private insurance if you make more than 60kEUR ;)

German public health insurances are often "Körperschaften des öffentlichen Rechts".

While this means that they're "entities under public law", they're typically running on their own, as a type of non-profit company, with board of directors, annual reports, ...

Probably the closest US organization type would be a non-profit under 501(c)4.

"comparable in wealth to the US"

What is your point?

Qatar - $127,523 GDP (PPP) per capita

Is my point.

They're not, however, comparable in obesity rates.

I'd be happy to see a single-payer healthcare system in the United States with strict denial of coverage for smoking-linked lung cancer, type 2 diabetes, and any other medical problems caused by the choices of the patient.

They aren't, but you're looking at this the wrong way around. You want all levels of government working together to create a healthy society - If your urban planners just defer health costs to private health insurance, what incentive do they have to create spaces that are healthy and productive? Are there measures schools can take to lower mental health incident rates, etc.

Health outcomes aren't determined solely by visits to doctors and the availability of pills.

What about sports-related injuries? Serious question.

Should a marathon runner in this scenario get treatment for knee damage or amateur / recreational boxer - for head trauma?

I didn't say no treatment, just no coverage. If you choose to engage in risky behaviors/activities, then you are more than welcome to buy supplemental insurance as one of the costs of your lifestyle. It would likely be fairly cheap for boxers and runners. Possibly even offset entirely by their associated healthy lifestyles, and therefore eligible for default coverage on a net cost basis.

If anyone has to pay full medical out of pocket, then all medical expenses should be tax deductible. Period.

True, but most Americans don't pay enough in taxes to cover even 1 single significant medical issue per year. A few doctors visits maybe, but any kind of major injury or illness and you will likely blow your taxes out of the water.

Most people in America do not have enough money in savings to pay for a single ER visit.

Which is why companies like our health care system. It keeps us beholden to them and wages suppressed.

> Something has to be done as status quo is not working [for everyone].

FTFY.

It's working for me in a way that only one other healthcare system would be able to help me (and even that healthcare system can only help me because the US healthcare system developed the medical advances I benefit from). If I moved abroad, I would have to keep a US health insurance plan and return to the US regularly to get the treatment I need here that isn't available in the rest of the World.

I'm still waiting for proponents of single-payer healthcare to take the effort to find out what works about the current system and who it works for. If they don't figure that out, they won't propose a solution that maintains the benefits of the current system.

The single-payer system being proposed will almost certainly reduce efforts to improve medicine that would improve my health issues in the future.

what medical treatments are available to you in the US that aren't available in other developed countries?

Other developed countries are often more conservative when it comes to covering experimental treatments.

Since many of these countries are in Europe and Europe in general has an attitude of "prove that it's harmless before you go to market" (over the American "you can always sue for punitive damages when things go wrong"), that's probably less a property of the health insurance system than of society as a whole.

My treatment for cataplexy/narcolepsy. Only available in the US and Canada. It's also available in Italy, but not approved for cataplexy/narcolepsy.

Without the US, it wouldn't exist as a treatment option in Canada.

https://www.quora.com/Which-country-develops-the-most-effect...

This callow fuck-you-gots-mine attitude is appalling.

"find out what works about the current system and who it works for"

For the most part, the issue is not the quality but the underlying costs and power that insurance companies and drug companies have. So you personally may be getting a treatment that only US provides and I am happy for you but the discussion still remains about the fact that if you don't have insurance, you could end up getting a ridiculous bill for the simplest of procedures. You have no control over that. That is the issue. I hope you can understand that.

And let me reaffirm that the system primarily works for the profit making insurance companies and drug companies. Yes, the drug companies do R&D but what do Insurance companies do really ? Nothing except squeezing every bit of profit they can. The point is that we don't need insurance companies to cover EVERY little procedure because then they get too much power.

The insurance company have a contract that typically requires them to provide whatever treatments are available for a medical problem and are not experimental.

It's competition in the insurance space that creates such a large market for pharma and other medical companies to bring products to market.

If you had a monopsony (single-payer healthcare), where the only buyer is the US government, then the only treatments available are those it has approved via bureaucratic process. Nothing about single-payer healthcare prevents private options from existing per se, but so many people will go without private insurance, greatly reducing the market for medical innovations and shrinking the size of the R&D market.

Take a look at these graphs: https://www.quora.com/Which-country-develops-the-most-effect...

Single payer healthcare will dramatically shrink the US contribution to medical innovations.

In a way, the US healthcare system is socialized medicine that benefits the other 7.2 billion people on this planet at the expense of the 40 million uninsured people in the US. This is a trolley problem.

The WHO publishes a list of essential medicines. http://www.who.int/medicines/services/essmedicines_def/en/

96 new pharmaceuticals were developed since the list was first published in 1977. There are 306 today, so 31 percent of essential medicines have been developed in just the past 40 years. How many of those 96 were developed in the US? How many fewer would we have developed under single-payer healthcare?

It's possible that we still develop as many medicines under single payer healthcare, but simple economics suggest that's unlikely enough that we really want to be sure it won't decimate the R&D market for new drugs because that is what is at risk here, if we are wrong. Are you willing to take the gamble of depriving your future self and the other 7.5 billion people on the planet of the medical innovations we'll lose without the US system. Once you hand people single-payer healthcare, there is no way politically to go back.

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