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Comment by Brendinooo | Hacker News Reader

First kid was no cost to us. My wife was on insurance with her employer. Long day, but no complications. I kept waiting for a bill that never came. Couldn't believe we didn't pay anything!

By the time the second kid came around, we were self-insured on the healthcare.gov marketplace. We ended up paying $5000 out of pocket - $2k for the prenatal care and doctors' services, $3k for the delivery and stay at the hospital.

We made a $1500 mistake. My wife had a really fast and normal delivery, but it was so fast that they didn't have time to administer an antibiotic that they otherwise would have. They wanted to monitor her for a day to look for an infection. We said okay, but if I had more closely read my policy I'd have learned that the policy had a $1500/day copay for labor and delivery. We'd have taken our chances and gone home had we known.

Kid three is coming! And this year's marketplace plan says that we're on our own up to the individual deductible of $6950. That's a bronze plan that carries a $950/month premium for 4 people; financial assistance from the government drops that down to $700/month. So we pay $8400/year for the privilege of not paying more than $7000 for an individual ($14,000 for the family) on our plan.

I don't think state-run healthcare is the only solution here (nor is it an inherently bad solution; I'm no libertarian), but I have to think that I'm living in the worst of all worlds here. I'm forced to buy an expensive product that I'm afraid to use, a product that costs more than the roof over my head per month but delivers a fraction of the value. It's expensive because it's violating basic principles of insurance, because the people who made the law are trying to implement universal healthcare in a system that's not built for that idea (at least not in the way it currently exists).

If I lived in a more market-based system there'd be price transparency, presumably a better way to monitor outcomes, and a lot more say in what kind of policy I could get to better accommodate the needs of my family.

Anyways, there are alternatives and means for assistance out there, and we're exploring them. But we like our doctors and our hospital; it's a shame that we have to look elsewhere. Not looking for sympathy, just adding a data point! My takeaway from that article was that maybe we should price out a trip to Spain sometime late in the third trimester :)

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> We said okay, but if I had more closely read my policy I'd have learned that the policy had a $1500/day copay for labor and delivery. We'd have taken our chances and gone home had we known.

What the bloody flying everliving fuck??

Does this not seem absolutely absurd to anybody else? You'd have risked a severe infection for the mother of your newborn child had you known there was a monetary cost attached to not risking it? This is patently ridiculous, and it is inhumane that people have to make such calculations.

You go to the place with the people in white robes when you're sick. No ifs, no buts, no strings attached. This is how you keep a healthy, productive populace.

No wonder the US, the largest economy in the world, ended up with a terrible infant mortality rate…

https://www.cnbc.com/2018/01/08/us-has-worst-rate-of-child-m...

EDIT: from the article:

> "Persistently high poverty rates, poor educational outcomes, and a relatively weak social safety net have made the US the most dangerous of wealthy nations for a child to be born into."

… yeah. As a young person who's planning on having a family: I will go work in the US exactly never.

Socialized medicine (e.g. one paid by state) also weights costs and risks. You just don't see it and don't have to make those decisions by yourself.

You don't know how much for them 1500 wad nor how high the risk nor whether coming back from home was that much dangerous in case that bacteria happened.

That's nonsense. You do know, statistically.

Parent I responded to does not know. He is just horrified that couple would save on healthcare. If you live in system with socialized healthcare, you don't have to make these decisions.

However, if you pay out of pocket then you do have to make those decisions personally. Else you will be taken for financial ride.

Funnily enough I agree with you but I have to disagree a little bit.

The truth is no one knows what the right level of care is even in many common situations.

Up front I'll say I'm a state and universal healthcare advocate.

But it comes with its own forms of waste.

Our first child had a borderline kidney tube measurement. We had 8 follow up scans costing the taxpayer $300 each.

Gradually I realised that the clinics had figured out a way to game the funding system, because at the level of deviation i saw I could find no research supporting the need for 8 extra ultrasound scans and in fact the only measurable risk was an increased risk of uti escalating to kidney infection which actually an ultrasound is not the best diagnostic tool for anyways.

In fact none of the doctors or technicians I talked to could coherently explain the level of risk or how the scans mitigated that risk.

What they did have was numeric guidelines and some measurement uncertainty. Plus a blank cheque to do more scans if they could justify it under current guidelines.

On the gripping hand they were $300 scans not $1200 scans like in insurance driven systems so...

I would really liked to know why is this downvoted. Do people think insurance dont make those decisions? Or that those decisions being made implies I think socialized medicine is bad?

Or they all know everything about that particular bacteria and assume everyone should?

>>Does this not seem absolutely absurd to anybody else?

It does, and it's shit like this that makes me absolutely convinced that US is a 3rd world country, where people have to weight their own health vs the financial cost. There's plenty of people saying they don't want to call an ambulance because they are worried what their bill would be. That people would risk their lives and that of their new born baby because there is a financial cost associated with staying at the hospital for another day is beyond absurd, it's like bad fiction about some distant society where things have gone horribly wrong, except that this is real and calls itself the greatest country in the world.

If individuals aren't free to make these financial decisions for themselves, then insurance companies or the government will. My mom had a severe infection while on chemo because the insurance company didn't want to pay for an injection that would've boosted her immune system. Having these decisions made at the population level, instead of the individual is far worse.

> individuals aren't free to make these financial decisions for themselves

An individual can only be free to make this kind of decision if they've got a spare $1500.

What do you mean individuals aren't free to make that decision? Even in a fully public healthcare system you can always opt to pay for treatment which is not covered(as rare as those are). How is that different than your insurer in US refusing to pay for treatment and you paying from your own pocket?

If the state was paying and your mother wanted to pay out of pocket nothing would stop her. Elective course of action is not banned in any single payer system that I know of.

Canada -- a Quebec ban on private health insurance was overturned in 2005, but there are still open court cases on whether that applies nationally and whether healthcare providers may charge privately for services.

I don't know about Canada obviously but in Poland hospitals are not allowed to charge for anything that is refunded by the national health service, but they are free to charge for anything else. So if a patient says they want an extra injection that is not funded and they will pay out of their own pocket for it, they absolutely can.

why not do some research online, buy the meds for a penny on the dollar via the darknet, and give them to your mom's nurse with a $100 note to seal the deal?

is it absurd that i have plans for these exact situations already worked out?

That’s a red herring though. Few countries have a system that forbids paying extra for extra care. The point is that in the U.S. system you can’t get basic care without paying extra, which is not the case in other countries.

I'm american. This time last year I had a minor bone break in my hand (not emergency, no severe pain).

I have a preferred doctor who doesnt have an xray machine. Obviously getting an xray image is the first step before even talking to the doctor. An xray of your hand is a _very_ basic procedure. My plan was to get my own image from a conveniently close facility of my choice and bring it to the doctor.

This is an open commercial market right? I decided to play a quick game with this and ask all my in-network local providers what their charge would be for just an x-ray of my left hand.

A car mechanic should be able to quickly give you an up-front estimate for common procedures, why not an imaging facility?

If youve read this far youre probably not surprised I called 4 different facilities, followed up with a series of requests over multiple days and failed to receive even one straight answer except "come in and we will see what we can do".

It makes me realize how soul-crushing the experience can be in this so-called "open market" to find the best possible treatment when you have a more complicated problem. The amount of leg-work, scheduling, waiting for doctors and getting opinions all while in pain would break the spirit of most anyone.

Is it really that much simpler in other countries to connect with the proper provider? I was under the impression countries like canada handle simple problems like mine much more gracefully but serious issues remain problematic.

My wife banged her foot about a year ago. We were pretty sure it wasn't broken, but we went to the hospital to get it checked out anyway. We never even considered which hospital we should go to - we basically expect them all to be decent, so why bother thinking about it? We had to wait in the emergency room for an hour or so, but then we were seen. My wife's foot was X-rayed 30 minutes later and it was confirmed that everything was fine.

>> Is it really that much simpler in other countries to connect with the proper provider? I was under the impression countries like canada handle simple problems like mine much more gracefully

In Canada and in Britain, you simply go to your local GP and get a referral, or go to A&E (Emergancy).

>> but serious issues remain problematic.

No, generally treatment in Canada and Britain for 'serious issues' is very good as well.

We all hear about the well publicised failures of the NHS and Canadian Healthcare, but by and large it works very well. I have seen close relatives and friends have cancer, septicemia, strokes, severe bone breaks, a life changing injury that made a friend a quadrapeligic, and more. For the most post part, the level of healthcare in Canada and Britain has been excellent.

My friend who had septicemia was in a very remote location, and once diagnosed was airlifted to a major hospital.

All of this is covered by public healthcare. It is amazing.

It is even more astounding that the USA still has this Byzantine 'private' system that tries to claim that it is an open market, but it is not.

From a macroeconomic point of view, the USA pays 18% or 19% of GDP for its healthcare system, where as Britain and Canada, and pretty much every other western country pay about 10%. (These are OECD figures) The American healthcare system is horribly inefficient, and puting in a public system ought to be every American's politicial priority.

Imagine that, a universal healthcare system is cheaper to operate than the private system?

The rhetoric and hyperbole that comes out of those who are vested in the status quo is outright criminal.

And I didn't think to include the time wasted by you 'shopping' around. That would be also be another drag on national productivity.

I agree, I have no real complaints about the Canadian system. ~14 years in Ontario versus ~29 years in US. Are there differences? Sure. Is there peace of mind knowing that I won't be uninsured or out of pocket for a relatively minor procedure that might cause me real financial hardship in the US. Goddamn right.

I live in Germany and I would probably just go to the next hospital, wait for a while, get x-rayed and see a doctor. In this situation I wouldn't even have to think about money and I don't have to search for the best provider because they are all good. Even if I wouldn't go to a hospital, every doctor who can treat you usually can do an x-ray at his practice. I cannot imagine how it must feel in such a system in urgent cases. (edit: "such a system" refers to the American system)

> Does this not seem absolutely absurd to anybody else?

It is obviously an insane way to run healthcare. But for the majority of US citizens, they've never experienced anything else. So this insanity is considered totally normal to them. Medical bankruptcy isn't just a thing, it's an expected outcome of any major illness -- medical bills are the most common reason for bankruptcy in the US.

If the US just switched to a proper universal national healthcare system (like say, a clone of UK's NHS), for even just one month, America would never go back to the way it is today. Not suggesting that UK's system is perfect, but it's so much objectively better than the US system that there would riots in the streets, if anyone suggested going back to today's US system.

Which is why we see so much lying about how terrible socialized medicine is, and so much money/time poured into preventing Americans from learning/experiencing it in any way.

Having a Baby in US. I will definitely give my insurance provider a call. They didn’t pay much for the OB and I work for a very solid tech company.

America’s healthcare is a f*ing joke. It’s riddles from the top to bottom with people who want to leech money at every step and provide the most minimal service.

I had a slight fracture in my scaphoid. I paid $2000 out of pocket and insurance paid half of that.

In Australia where I don’t need employer golden handcuffs for health insurance, it would be less than a third of that.

I was in the US once, and had developed a cyst on my finger that hurt (due to the pressure of the liquid inside -- could have been a ganglion cyst).

What you do with those, is you burst them open to relief the pressure, clear the liquid inside (white cells and such) and put some disinfectant. In my (Western European) country it's a trivial 10 seconds operation every pharmacy is authorized to do.

So I go asked at a pharmacy/drugstore for that (probably a Walgreens) -- and they said they weren't allowed to do it and that I should ask at a clinic. I asked how much it would cost for this, if I went at one, and they told me about $150.

Yeah, right.

I just went on and bought a regular clothespin from that pharmacy, burned it with a lighter to disinfect it, and burst the cyst myself...

(And it's not about government mandated insurance vs "really free market" and such. We have mandatory insurance were we are, and the prices for all kinds of operations, both with and without insurance coverage, are still way lower).

s/clothespin/safetypin/

>No wonder the US, the largest economy in the world, ended up with a terrible infant mortality rate…

That's largely a product of people trying a lot harder to with much earlier premature births than other countries, not a fault in care provided.

There's a lot of ways to frame how the US healthcare system fails people, this one's a canard.

And higher rates of teenage pregnancy, pregnancies by obese persons. Using the infant mortality rate as a proxy for US healthcare quality isn't reasonable, as you say.

On the flip side, one could argue that teen contraception and nutrition education are important parts of a properly functioning health system. To put it another way, who is to say high rates of teen and obese pregnancies are not caused, in part, by our health system?

> who is to say high rates of teen and obese pregnancies are not caused, in part, by our health system?

Sure, perhaps in part, just as any occurrence in other countries with any recordable teen or obese pregnancies. However, it would be inappropriately reductive to say the health system is the cause of these, and I'd argue it would be incorrect to say the health system is the primary cause. To do so would be to ignore the entrenched historical and cultural influences on the present state.

My wife is a resident physician. She also went through the same experience of delivering a kid.

Here's what I've learned:

* Pricing is not transparent. When the hospital tells you how much the procedure will cost, they are not telling you about the anesthesiologists portion, or the room fee, ect. There will be surprise bills. Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?

* Doctors are in short supply. This is because becoming a doctor is impossibly hard. Why can't undergraduates enter straight into a medical school program? Doctor's are in the 30's when they complete training and are already halfway toward the retirement age

* If things go badly during the delivery, you will be glad you are at a well equipped Hospital. A $5000 bill is a small price to pay to ensure the baby does not arrive brain damaged.

Why can't undergraduates enter straight into a medical school program?

That is a thing called a direct entry medical program. It gets you the the end of medical school in 6 years instead of 8 by dispensing with the undergraduate degree. The extra two years cover the sciences and how to learn at medical school speeds.

It shaves two years off, but at the cost of pinning the student into a rigid track. The number of high school seniors who think they want to be doctors and change their mind during an undergraduate is pretty high.

Is there evidence that this leads to worse outcomes in all the countries that have direct entry out of high school as the standard path for doctors?

"Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?"

that's the first thing that should happen. Especially the free market people should want it.

I believe in the UK, hospitals are by law required to give you the fully itemized bill. Knowing transaction price up-front seems to be an obvious part of market health.

There is no cost to the patient in the UK, nor is there any bill presented, so in that sense you're right.

Private health care exists in the UK. Some people chose it. If you do chose it the hospital must tell you the price up front.

https://www.legislation.gov.uk/uksi/2001/3968/regulation/7/m...

> Patients' guide

> 7.—(1) The registered person shall produce a written guide to the establishment or agency (in these Regulations referred to as “the patients' guide”) which shall consist of—

> (a)a summary of the statement of purpose;

> (b)the terms and conditions in respect of services to be provided for patients, including as to the amount and method of payment of charges for all aspects of their treatment;

> the baby does not arrive brain damaged.

Or the woman dies.

Or both....

Seriously though, listen to the advice of giving birth in a hospital setting. If they have a midwife center then take advantage of it, but I would highly caution against the trend of birth clinics and home birth unless you live very close to an emergency room. Things can wrong in an instant.

Source: Experience. First born was in NICU for 12 days and mother had bad complications. We had to be rushed in an ambulance from a natural birth center when things went south.

And yet 30% of Dutch women choose to give birth at home and it seems to work out. https://www.expatica.com/nl/healthcare/Why-the-Dutch-cherish...

Actually Dutch child mortality (birth mortality?) is high compared to surrounding countries, in part because of home birthing (the occurrence of which is trending downwards, btw)

https://www.google.nl/amp/s/www.volkskrant.nl/wetenschap/typ...

Can't find english source easily - tl dr 13% of births are at home vs 23% 10 years ago.

> Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?

Medicare would oppose this tooth and nail. The lack of pricing transparency enables them to keep reimbursing less than cost, because they can expect private insurers to be forced to pay the difference.

Got a source for that?

https://www.cms.gov/apps/physician-fee-schedule

I'm not sure what you're implying by posting that link. Medicare posts its fees and schedules, yes, but the point is about what private insurers reimburse.

> Doctors are in short supply

Yes, but also there is the fact that there is an artificial cap placed on total US residency class size, meaning there is a pretty effective bottleneck on actually becoming a medical doctor.

You realize millions of babies are born in countries with better healthcare than the US and $5k is literally about 1000 times what they pay.

This is an important point. I think I'd be ashamed if my kid grew up and found my archives here, lamenting a $5k bill. Bringing a human into the world is a big deal, and worth at least that much. And I'm not lamenting too much; we were blessed enough financially to be able to cover it without going into debt.

But if it's being done for less elsewhere, then I don't think it's wrong to let that influence your expectations.

Doctors are in short supply. This is because becoming a doctor is impossibly hard

That's an entirely artificial problem created by the AMA (or BMA in the UK) to keep wages high. What if everyone who had the academic ability could train, rather than having to compete for a restricted number of slots? It's how every other discipline does it (they defer competing for places until the job market).

I'm sorry, but if someone is going to be cutting into my body, I want them well trained and I want them to have dissected a human. I don't want someone who "moves fast and breaks things" puking on my exposed parts.

The parent isn't talking about reducing quality, but rather waiting to pick "winners and losers" so to speak until after training.

This is a huge problem. The limiting factor appears to be the number of residency spots, not the number of accepted medical school students. We should take some of the billions our Federal government spends and increase the number of residency spots and increase funding for tuition reimbursement for practicing in underserved areas.

I can't personally speak to the accuracy of the linked claim below, but it suggests that the coverage of residency spots is controlled by a physician led advisory board called RUC that intentionally limits the reimbursement so as to control wages.

http://www.motherjones.com/kevin-drum/2013/11/its-doctors-wh...

AMA also blocks nurse practitioners from being able to take on more duties. Need to protect that market share.

I can't imagine dealing with such bills for bringing a child into the world. I was a military wife when I had kids. It cost me a few dollars a day for a hospital stay. I think both births were around $20 out of pocket, give or take a few bucks. I was in the hospital three days the first time and two days the second and the price went up a bit in between the two births.

but I have to think that I'm living in the worst of all worlds here.

I worked in insurance for a time. I do think Obamacare is the worst of all worlds. Requiring universal insurance is a terrible way to try to arrange universal health coverage for the nation.

I was also active duty military when my wife had our first child so I know what you mean. It's been pricey having the other kids but at least I've had decent insurance to do it. My heart goes out to those with no insurance or crappy insurance.

Regarding universal healthcare, we have a unique viewpoint because we've actually lived universal healthcare in the military.

Long wait times for appointments, crappy doctors that you have no choice but to go see (or have fun paying out of pocket at a civilian doctor), an employer with 100% insight into your medical situation, the loving kindness of a DMV clerk surrounding you while going through the wonder of childbirth for the first time... Ah, those days don't come back.

What are your thoughts on universal (or single-payer) healthcare?

I think it would make more sense than what we are doing currently. Given the high percentage of US GDP and individual income going to healthcare, it would also make a lot more sense than all this talk of Basic Income.

When I was a military wife, I never had to wonder if my kid was sick enough to justify seeing a doctor. I never had to consider cost as a factor. I never had to save for retirement. If he made 20 years, we would have a retirement check. When I was in quarters, I didn't have to worry about rent going up or other related expenses.

That security and stability was incredibly valuable for my peace of mind. It made life simple. We just needed to stay out of trouble and make sure my husband was a good soldier and everything would be okay.

We had two special needs kids and I have serious health issues. I had a college class on homelessness while still married. These kinds of problems are a root cause of homelessness in the US. After the divorce, my adult sons and I spent nearly 6 years homeless.

I think universal basic healthcare and a solution for the affordable housing crisis in the US would drastically reduce homelessness and be a vastly better solution than Basic Income. These are proven solutions with many available models. Basic Income is an unknown that has a lot of potential problems.

If people think single payer medical us not politically viable in the US, what in earth makes them think Basic Income is more politically viable? And if they don't think it is politically viable and are touting it anyway, doesn't that mean they are just jerking our chain and hoping that talk if some feel good answer will keep the masses mollified and not rioting in the streets while we continue to be crapped all over?

Interesting, and sorry to hear about your bout with homelessness. I spent some time homeless as a teenager and it was awful. I can't imagine going through that with kids.

I've wondered quite a bit about the basic income idea. One of the issues that has me stumped is what to do when AI and automation are taking lots of jobs that people currently do (like truck driving, which is going to disappear fast). I'm not sure providing only health care and not basic necessities will be enough.

Maybe at first people can retrain into other career fields, but the AI revolution will come swiftly and leave much wreckage in its path. I tend to think this will eventually be a very good thing, but it will wreak havoc and cause a lot of short term pain like the industrial revolution did in the 19th century.

Definitely interesting stuff to think about. Thanks for sharing.

Machines previously were threatening to take jobs away. It ultimately led to many improvements for commoners, such as the 40 hour work week. We call it The Industrial Revolution.

But no need to learn from history. We can just pretend that restructuring work isn't possible and act like what we are currently facing is utterly unique and the world hasn't seen anything like it before.

(Not a swipe at you. I am just angry and frustrated about the entire world acting like only UBI can save us from the robot-job-pocalypse.)

Totally fair :-)

I have also wondered if that wouldn't be the case. As machines take over, we may see new jobs created that never existed before, just (as you rightly pointed out) happened in the industrial revolution. I really hope this is the case actually.

My certainty diminishes somewhat when listening to people like Ray Kurzweil talk about his Law of Accelerating returns (exponential growth)[1]. I wonder if things might be different this time around (change is too fast, too extreme/disruptive) due to things like the exponential growth curve. Of course we humans always like to think "this time is different" so who knows.

[1] http://www.businessinsider.com/ray-kurzweil-law-of-accelerat...

It definitely wasn't a seamless transition. I'm sure we will come out the other side but more than a few eggs will probably be broken along the way.

You're trivializing the turmoil of the Industrial Revolution. The 40 hour work week was only won after centuries of bloody labor revolts. https://futurism.com/what-the-industrial-revolution-really-t...

This time is fundamentally different because AI automates the human mind. Human input may always be needed, but fewer and fewer jobs are required to support the needs of the population. New quality jobs are not being created at a sufficient enough pace to be offset the loses.

I'm not trivializing anything. I spent 5.7 years homeless. I got off the street 4.5 months ago.

We have a ridiculous number of homeless in the US. Meanwhile, rich tech giants talk of giving UBI to everyone as their solution to so many jobs going away. The jobs that are going away pay about $20k-$50k. UBI is expected to be $10k or maybe $18k. Articles that talk about this then write warm little vignettes about how lovely it will be to have that supplemental income on top of your low paid job, utterly ignoring the actual scenario posited that this money is in place of a job in a climate where there is little or no hope of getting another job.

If you think the Industrial Revolution was bloody, you don't want to see what happens with millions of people getting just enough money to sleep in a tent and keep eating while the cops harass them and the system gives them no hope of getting back to a middle class lifestyle. They won't be actually starving. But they will be mad as hell and have nothing but time on their hands to plot a revolution and train for it.

With UBI, you have two important new options:

- You can move away from expensive locale to a cheapest one.

- You can find supplemental income: do something with your hands, provide services, etc. You have all day to do that. It shouldn't be that your time is worthless and nobody is willing to pay anything for it.

- You can pool with other people to form a community, save on bulk.

Three actually.

You can find supplemental income: do something with your hands, provide services, etc. You have all day to do that. It shouldn't be that your time is worthless and nobody is willing to pay anything for it.

People are positing that we need UBI because jobs are outright going away and there will be no paid work to be found. If it is possible to create earning opportunities in the post robo-job-pocalypse, then why can't we focus on restructuring work to begin with?

I wish people would pick one. Either it will be possible to keep earning money somehow, in which case we don't need UBI to replace jobs and we can, instead, focus on restructuring work to improve quality of life generally. Or it won't be possible to find earning opportunities, in which case UBI is all the money you will have.

I don't think it would be a kind of work that can earn a living in urban setting.

However, it's something that can be used to earn supplemental income in cheap locale.

Teach spoken English using Skype, for example. There's 2B potential customers. Or maybe 4B. All you have to be is native speaker.

If someone wants to do that, they are currently free to move someplace cheap and do that.

On the other hand, a lot of low cost areas, like rural parts of the US, don't have the high speed internet necessary to do something like that. It doesn't work unless you have both low cost of living and amenities like high speed internet. Right now, amenities like high speed internet and jobs are mostly concentrated in big cities. So just giving people a check (UBI) and telling them to work the rest out themselves while the world is actively against the idea of restructuring work simply doesn't work.

Either we can make a world that supports living someplace cheap and earning money online or we can't. Basic Income has no bearing on the logistics of making that work.

This world kind of exists already. A lot of people move to Southeast Asia (for cheap and comfortable living) and there travel between countries while making money remotely.

Then why do we need UBI?

I work remotely. I moved someplace cheap within the US. I am still struggling for various reasons, but I currently live like you describe.

So if it can be done without UBI, why do we need UBI?

Either we need UBI because you can't get paid work and you need to live off UBI, or you can get paid work, in which case we don't need UBI. Please pick one

You bring a strong point in that I'm not ready to challenge right now :)

>plot a revolution and train for it.

i suspect the wheels are already in motion.

Give me 10K a year, no strings attached and I can live comfortably without ever working again.

Move somewhere cheap or go in with some friends, you will be surprised what 10k a year can do.

I have a bit over $10k a year in alimony. To get off the street, I spent 2 years researching where in the western half of the US I could a) travel inexpensively without a car and b) afford to buy a house. I am in a cheap rental trying to figure out how to buy a house with no money down.

There are places in the US where you can rent for $500/mo or less, but they are pretty hard to find. If it is just you, you may be able to make it, especially if you are willing and able to get a roommate.

If you have dependents, high health costs or any complications whatsoever, it rapidly falls apart. If we don't give UBI from birth, poor families with children won't be lifted out of poverty like we imagine. If we do, you can guarantee that some women will crank out babies as a means to raise their income and be lousy, abusive mothers who don't actually care about the kids.

For the vast majority of people, cutting their income 50 to 80 percent in exchange for going jobless will be a hardship. Most lottery winners are bankrupt within 5 years. I suspect part of the reason for this is that most people divide their time between working to make money and consuming in their off hours. When you remove the job from the equation, they suddenly have about 50 hours more a week that they need to entertain themselves. If you are used to spending money in your leisure time, it can be incredibly hard to shift gears and find cheap or free means to do so.

It can be done. I have lived on damn little for a long time and I do a lot for free because my income supports three people, not one. So the budget is quite tight. But a lot of people fail at it.

Currently, people failing to make ends meet can turn to food stamps, section 8 housing, etc. Many people feel that the way to finance UBI is to eliminate all that stuff. So if you get UBI and fail to make it work, it is possible there won't be a safety net to catch you when you fall. It may be one huge fuck you.

UBI is supplemental income, you can still work. With a UBI, you wouldn't have to live in a tent because you could afford an apartment.

I find it strange that someone who was once homeless is opposed to a policy like UBI that would end or at least severely curtail homelessness.

So if not UBI, what's your solution?

You can't still work if all the big wigs with the power to create jobs are not bothering to make work available because you have your UBI.

I have already laid out my solution: accessible healthcare, affordable housing and restructuring work.

And the reason I hold the position I hold is because I was homeless. So I know what bs it is to say "You can just move someplace cheaper and supplement your income." I was both willing and able to do both of those things. It isn't the easy answer folks imagine.

I owe a bunch of money from making the move. People who, themselves, make money online mostly shat all over me and wouldn't help me figure out how to make money online while saying things to me like I was panhandling the internet for trying to figure out how to earn money online etc.

UBI will not give anyone the knowledge, skills and connections necessary to turn free time into income. What it will do is allow classist or sexist or racist assholes to be more comfortable with shutting out Those People from the paths to an earned income because, hey, you don't need me to give you an opportunity. You have your UBI.

If we don't fix the affordable housing mess, UBI fixes nothing. There are lots of places where $10k is basically just rent for the year, with no money leftover for anything else. And if you think people can just move to the cheap seats, it is hard to find a place for under $500/mo. That leaves less than $500/mo to cover all other living expenses.

I have lived on that kind of a budget. I have looked for housing on that kind of a budget. I know firsthand how hard it is to make that work. So when folks who likely have more income than me post imaginary stories about what a piece of cake life will be when there are no jobs but everyone has UBI, that really sticks in my craw.

You telling me that UBI is supplemental income tells me you don't get it. UBI is not supposed to be supplemental. It is supposed to make sure most people don't starve when there simply is no paid work to be found.

These kinds of comments are crazy making. If it is supplemental, we don't need it. If it isn't supplemental, it doesn't work without also fixing healthcare and housing.

I think we don't need it. We just need to fix healthcare and housing and restructure work. We need to do all that with or without UBI. I think without UBI, we will do a better job of fixing those things. With UBI, too many people think those problems don't really matter that much. Poor people can just move elsewhere or something.

I'm totally with you on fixing affordable housing and healthcare, and that a UBI can only do so much without fixing those problems.

I don't buy the idea that UBI will make it harder to solve those problems. I think UBI will make it easier to fix those problems because it would free up more peoples' time (especially the lower and middle class) to be politically active and fix these fundamental problems. Right now nothing is really improving because the wealthy who've bought out the politicians don't care, and the poor have no time or energy to protest because they're too busy working multiple jobs and worrying about whether or not they'll make rent next month.

> You can't still work if all the big wigs with the power to create jobs are not bothering to make work available because you have your UBI.

Jobs aren't some kind of charity case that companies offer to appease the financially desperate masses. Jobs are created when there's a need for labor, and they believe the revenue generated by the labor will offset the wages. UBI does not mean that companies go "well looks like the masses don't need our money anymore, we can finally take away these jobs". Businesses are there to maximize profit, and UBI doesn't change that.

UBI however would massively increase the bargaining power of laborers by giving them the option to walk away. Wages of jobs that nobody wants to do but are services that we need would rise. We'd probably see more people opting to work less hours. The whole dynamic of interviews would change in favor of the laborer (as opposed to right now where the employer has the upper hand). Overall, it'd be a massive boon to labor.

Currently, multiple tech giants are pro UBI. Sam Altman is constantly on the front page of HN talking about it. He is putting millions of his own money into UBI experiments.

I am not aware of him doing anything about healthcare or affordable housing. Since he became president of YC, he has used it as a platform to promote various social agendas he is interested in. YC fosters the development of businesses.

You cannot convince me that the focus of someone like that has no impact on the kind of world we are creating. I do not believe he in any way cares about the little people. I do not believe he has any interest in or willingness to open doors for poor people. His interest in UBI strikes me as a huge fuck you and quit your bitching to the little people.

You need to be very leery of the motives of the architects of such a system. Currently, American welfare does an excellent job of trapping people in poverty. I have no idea why you are so strongly convinced that some new welfare scheme with a shiny new name won't continue that pattern. I have seen zero evidence that it will.

Since healthcare and affordable housing both need to be fixed anyway, I would much prefer to see time and effort to into those things in the here and now rather than into all this talk of UBI. If both of those things get fixed first and people still think UBI is a good idea, I would be much more willing to support it at that point. But at this point in time, talk of UBI looks to me like a lazy concept if throwing money at the problems of poor people as if their problems are easily solved. This makes me extremely leery of both the idea itself and of the idea that people trying to spearhead the movement are at all qualified to do the heavy lifting involved in solving healthcare and affordable housing.

Most of those complaints seem to be specific to your individual situation, rather than features of universal health care systems. I would argue that experiencing universal healthcare isn't that unique (Most developed countries) - what's unique is the specific (US Military) system you've experienced.

Employer knowing your medical situation? State-run healthcare keeps your employer out of healthcare completely.

Crappy doctors? Outcomes vary across countries and by treatment, but I think it's hard to argue that US outcomes are in general better than the average socialised system.

Choice of doctor? There's no reason private insurance can't co-exist with socialised healthcare. We have private healthcare in the UK (which is, I believe, kept to a reasonable price / practice by having to compete with the NHS). Furthermore, you do have some choice of your doctor in the NHS. If I want to see a doctor, I can choose where I make the appointment. Nobody is compelling me to see a particular doctor. For more serious issues, requiring complex treatments the choices do narrow. But this seems right to me - If I'm seriously sick, I want to rely on the expertise of a specialist. Even then, nobody is compelling me to have any particular treatment and I always have pretty much the same choice a US patient does - to go private.

Long waiting times? Perhaps, but it's pretty horrific to argue that this is worth the pain and suffering caused by shutting a significant portion of society out of the healthcare system.

There are other countries that use the mandatory insurance model, and it works fine. Of course, they do it much better.

https://en.m.wikipedia.org/wiki/Health_insurance_mandate

I am not seeing anything described here remotely like Obamacare. It sounds like bald faced copying any of those systems to the best of our ability would be a vast improvement.

I was homeless when Obamacare passed, so I was exempt. I am no longer homeless. I worry how this will impact me and I wish Trump would actually fix it like he said he was going to do when he took office. If he fixed our completely broken health coverage system, I would be willing to largely overlook what an utter shit show of a politician the man has been.

The individual mandate was repealed in the recent tax bill.

(I'm assuming that's what you mean with exempt)

Thank you. I will need to look that up.

In Austria if you are self enployed there is a mandate for medical insurance and pension contributions. If you are employed there is a mandate which is shared with the employer.

What indication do you have that Trump will ever do the things he promises to do?

I see zero indication of this, but that doesn’t mean I can’t wish for it.

> Requiring universal insurance is a terrible way to try to arrange universal health coverage for the nation.

The country where Obamacare was copied from, Switzerland, also outlawed group insurance so (a) you didn't get health insurance from work and (b) EVERYONE was in the same risk pool.

The current situation, you have group policies that are actually affordable because...people with good jobs to provide it typically are lower health risks. Everyone else is stuck a shitty individual pool with lots of high risk individuals. As long as the group pools siphon off all of the low risk, Obamacare won't work.

Group policies are still very expensive by international standards.

The markets were broken before Obamacare, and are just getting worse. It's vile.

Swiss insurance policies cost around the same as group policies in the states if you are on COBRA.

Salaries are also higher in Swiss though.

Those figures are shocking. To pay $8400 a year for the NHS you'd need to pay $46,000 in tax, which would be two salaries of about $70k.

(Cost of bringing my children into the world was about £10 - the petrol, the parking, and I bought a chocolate bar and bottle of water at one point)

Why does America stand for it?

... and people are up in arms in the UK over the fact that hospital parking is not free. Go figure.

Inertia, probably. Any gradual change adds to the bloat; any radical change is rejected out of fear, or maybe ideological concerns.

Not picking a fight here, just curious: another person commented on my original post noting that when I said my first birth didn't cost us anything, that wasn't true - my wife's employer paid a fair amount for her insurance.

Are your taxes broken out in the UK? Do you know how much you pay a year for healthcare?

UK taxpayer here. We get sent an annual summary of the tax we paid and what it paid for. It looks like this: http://i.telegraph.co.uk/multimedia/archive/02871/taxtable1_...

For my family it's about £2800, or $3900. My wife doesn't pay tax, but I earn in the top decile. Probably a little more due to spending on vat and other indirect taxes (petrol tax etc), call it $4200.

However my parents, gran, and my mother in law combined pay under $1000 a year between them.

On the other hand a premiership footballer pays about $250,000 a year for health. Plus their own private health care costs of whatever. That's the price they pay for living in our society though, a society where people aren't afraid to go to the doctors to check out that mole, or rush to give birth because they can't afford an extra day in hospital.

Have you and your wife considered using a birth center for #3 if there are no complications or high risk factors? My wife and I had our son at a midwife center in the US, and our prenatal, delivery, and postnatal care combined ran about $3k (of which our insurance covered about 2/3). The midwives were great, and overall I think it was a less stressful experience than the hospital might have been.

The most SEO-friendly one in the area that I found will run me about $6000, and I'm assuming I'd be on the hook for all of it if I read my plan correctly. Still in the early stages of research though.

My wife is open to a birthing center, unlike my home-birth overtones which she summarily rejected :)

Tough call there. The antibiotics were likely for Group B Streptococcus, meaning during prenatal screening she tested positive. I work in the field and we see some terrible outcomes from GBS (and other bacterial) infections such as blood stream infections, neonatal infections to hysterectomies and death. I've seen cases where moms have symptoms at home but they simply chalk them up to "what happens after giving birth". So whatever choice you make, tell your wife to listen to her body.

I think you're right. I say "we would have gone home" pretty flippantly; I have the benefit of hindsight where everything was fine, and presumably if we said that in a hospital we'd have gotten someone give me a spiel similar to yours, then we would have had to sweat the decision at that time. Maybe we'd have stayed anyways.

> So whatever choice you make, tell your wife to listen to her body.

Thank you for this.

My first son was born 10 weeks too early, we lived in Denmark at the time, cost 0.

My second son was born in New York and we had good health care coverage costed us nothing.

Right now we are on Cobra and we are fine. But once thats up we will have to find something else and I worry about the cost of that plan.

One thing I have learned though is that it's normally possible to negotiate the price down quist substantially (more than 50% sometimes) especially because these days it's the hospitals themselves who need to do the collecting and they simply aren't prepared for that (patient cost sharing up 230% and deductibles up more that 60%) They just want some money.

To add, I have almost identical numbers across the board w/ a delivery in 2017. My bronze plan is up to $1100/mo though and I get no assistance.

> If I lived in a more market-based system [...]

Unfortunately you can be vilified for saying this stuff in public. If you believe others, you are helping subsidize the poor and those with preconditions. In a market-based system you end up paying for what you need which, while it seems rational, is often considered amoral.

I think that's one of the biggest disconnects when it comes time to purchase. I'm being asked to purchase a product, but that product is being used with other goals in mind.

In other words, I bought a bronze plan because it fit best with my family situation and my budget, but was I selfish doing so? Should I have purchased a gold plan and therefore put more money in the system which would hopefully help more people?

I think there are a lot of potential solutions to the healthcare issue; either market-based or single-payer, if well-implemented, would be better than what we're doing now.

Insurance through employer is not a “no cost to us”. Employer is taking a significant chunk out of your income and giving it to insurance company. Government has already made insurance “self-funded” through HSA as well. So first few thousands dollars are coming directly out of your pocket.

I understand that's objectively true. "There ain't no such thing as a free lunch", etc.

Practically, it's hard to think like that. I don't know what her employer was paying the insurance company for premium subsidies or the care we received.

Why Americans don't demand some sort of national health plan is beyond me. That's one of the key reasons I moved to Canada.

What sort of policy would you like to buy?

My question is specifically about the phrase and a lot more say in what kind of policy I could get to better accommodate the needs of my family.

I'm wondering where the other poster thinks they would save money vs insurance that covers things like child birth, hospitalization, emergency room visits, etc.

I was looking at a co-op alternative for 2018 - Our family premium would have been about $650/month unsubsidized, and our max out-of-pocket would have been $2500. Pregnancy is a pre-existing condition though, and co-ops are still allowed to exclude for that, so it wasn't a viable choice for this year.

Regardless, I was alluding to the fact that I have no control over my health insurance costs, unlike every other kind of insurance I purchase.

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