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Comment by dsfyu404ed | Hacker News Reader

What you consider helpful to the common person is not what they consider helpful to the common person is not what someone else considers helpful to the common person.

Adding variables like time-frame, varying definitions of "common person" only make it more complicated.

People have beliefs about what is good for society at scale that no not align with yours. The current administration thinks that deregulation of industries and trade policies that protect domestic industry are the right thing to do. That belief may be misguided but it's what they believe.

Whether they're right or not is still to be determined. You never really get a good picture of that until the next administration takes office anyway.

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http://thehill.com/homenews/administration/352597-us-wont-wa...

> Whether they're right or not is still to be determined.

In what possible way? The free market has utterly failed healthcare. Costs are higher than ever, insurance is more expensive and covers less than ever, the #1 route to bankruptcy is a medical emergency, our doctors are offing themselves at record rates, and we have boatloads of people addicted to painkillers. Exactly what way has the market done anyone any good, other than the people on the top?

But if you're rich you have low wait times, so it's all good.

Frankly, Obamacare is a bit of a failure for some - I have friends who have "insurance plans" that don't actually cover anything without a deductible that they can't afford. Care for ongoing conditions is essentially not covered as a result.

The thing is... they'd have no healthcare at all under the previous system either, so going back to that isn't a solution for them.

The only real solution is single-payer healthcare paid out of taxes - unless you believe that somebody's right to live depends on how much money they make.

You can dictate prices and have a private service model.

See Medicare Advantage for a US based example of this that is fairly popular with consumers.

> You can dictate prices and have a private service model. See Medicare Advantage for a US based example of this that is fairly popular with consumers.

Medicare Advantage doesn't dictate prices. And indirectly, this is the entire reason that it it's popular (the service is substantially better).

For additional services, but what about Part A and Part B? Seems that Advantage plans get similar pricing to traditional:

http://content.healthaffairs.org/content/34/8/1289.abstract

> For additional services, but what about Part A and Part B? Seems that Advantage plans get similar pricing to traditional:

Parts A and B are Original Medicare. If you're on Medicare Advantage, it replaces Part A/B coverage.

(It's also a bit more complicated than that, because Medicare Advantage plans are provided by the same private insurers who cover non-Medicare patients, and they'll structure their agreements in such a way that the extra payments are hidden. For example, "for every Medicare Advantage patient of ours you see, we'll reimburse an additional X% for non-Medicare patient" - it's not literally like that or that explicit, but that's the shape of how it shakes out).

> You can dictate prices and have a private service model.

Perhaps, but at that point, you usually have a system where providers see their only way of making a profit as cutting costs - except those cuts are never passed onto the taxpayer. It's the worst of both worlds. NHS England has been forced into selling off parts of its operation in a similar manner to what you're suggesting for ideological reasons, and it's only cost us more money for worse service.

Perhaps it works where there's actually competition - e.g. where there's a choice of half a dozen providers owned by entirely separate entities that you could reasonably go to, which might be the case in some cities - but it doesn't work where there's few options for service users.

The ACA is far from perfect, though it doesn't help that the more aggressive components were kneecapped by Republicans so Republicans could bitch about the weak points for the next 7 years or so.

I'm a big believer in Single Payer, I mean come on, we have huge rolls of the public already on Medicare for a variety of reasons. Why not just put everyone on it and be done already?

> I mean come on, we have huge rolls of the public already on Medicare for a variety of reasons. Why not just put everyone on it and be done already?

1) Medicare isn't single-payer; it's a multipayer system

2) The government-run portion of Medicare underperforms the private payers in cost, medical outcomes, and patient satisfaction (the three primary axes on which success is measured).

If you want to point to data that suggests that a single-payer system would be successful in the US, Medicare is the last example you want to pick, because it suggests the exact opposite.

> The government-run portion of Medicare underperforms the private payers in cost, medical outcomes, and patient satisfaction (the three primary axes on which success is measured).

Would you be willing to cede that this is likely because their patient base grows constantly and yet their funding is cut at every turn? I'm not saying it's their only issue, but constantly being drained of resources while getting additional work to do makes it somewhat incredible that they operate as well as they do.

> Would you be willing to cede that this is likely because their patient base grows constantly and yet their funding is cut at every turn?

Medicare Advantage is growing faster than Medicare and operates on the same budget, so no, that's not an explanation for Original Medicare's shortcomings.

>free market

When was there a free market? Colonial times?

And taking the thing down for 12 hours, 1/4 of every weekend could possibly be good in what way? Take it down on Tuesdays from 10pm to 10am Wednesday.

Are you thinking in context or just being contrary?

>And taking the thing down for 12 hours, 1/4 of every weekend could possibly be good in what way?

Some stakeholder somewhere probably refuses to go down during the business week for whatever reason. Maybe that stakeholder isn't even in government. Stuff like this is not uncommon in the world of enterprise.

I am usually the first to quote Hanlon's razor and attribute something like this to incompetence, but in this case it really hard not to see the malice in the actions taken.

And why was this new weekly downtime not present during previous years?

When you combine this with calls by Trump to refuse to pay insurance companies (see https://www.reuters.com/article/us-usa-healthcare-trump/trum...), it sure looks malicious.

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