Hacker News Reader

Comment by Firebrand | Hacker News Reader

Medical care is a commodity, and aren’t we all often faced with commodities we cannot afford?

People who cannot afford medical care have no right to demand it from anyone. Maybe someone will be empathetic enough to offer charity; friends and family may choose to band together and fund a sick person’s medical care. But even a poor person’s necessity does not change the fact that healthcare is a service and a good provided by a third party.

No matter how much some starving kid needs food, he doesn’t have a right to steal someone’s wallet or hold up the local convenience store to obtain it. If I were in that position, maybe I’d end up choosing to steal since it’s the least immoral choice under the circumstances, but that does not make it a moral choice, or suggest that I have not violated someone‘s rights in pursuing my own needs.

View on HN

> Medical care is a commodity

No, it's a right.

> No matter how much some starving kid needs food, he doesn’t have a right to steal someone’s wallet or hold up the local convenience store to obtain it.

Everyone has the right to life. I cannot imagine how callous one must be to willingly deprive fellow human beings of that right, purely because it is not how the economic system works. If we have the resources to provide healthcare to everyone, then we should. No matter what the cost.

Repeat after me: Property is worth less than people.

""This means that nobody - including the government - can try to end your life. It also means the government should take appropriate measures to safeguard life by making laws to protect you and, in some circumstances, by taking steps to protect you if your life is at risk. Public authorities should also consider your right to life when making decisions that might put you in danger or that affect your life expectancy.""

In the UK, Sweden, Norway, and many other civilized countries, everyone pays into a public pot that is used to provide medical care. Because of this, our workers are much more healthy, and much more able to work without the stress of "what if I get injured during work". They do not have to die of preventable diseases like septicemia, from something silly like duct taping their glass cut because they cannot afford to be treated.

> Medical care is a commodity > No, it's a right.

You cannot have a right to healthcare without taking the right to not work for someone else. You have a right to access healthcare, you dont have a right to force someone to service your health.

And you shouldn't either.

> In the UK, Sweden, Norway, and many other civilized countries, everyone pays into a public pot that is used to provide medical care. Because of this, our workers are much more healthy, and much more able to work without the stress of "what if I get injured during work". They do not have to die of preventable diseases like septicemia, from something silly like duct taping their glass cut because they cannot afford to be treated.

This is medicare. Would you say medicare is economically successful?

> This is medicare. Would you say medicare is economically successful?

Good old late stage capitalism.

Because economic success is paramount to all things right? Certainly more important than increasing the quality of life of citizens.

How does bankrupting the system improve quality of life for all?

You assume that having a non profitable healthcare system means bankrupting the entire system. This is false. In France, where the healthcare system is arguably one of the best in the world, it has been losing money since as long as I can remember.

So what? The healthcare system looses money and the government injects money back, either directly from taxes or by some other means. I don't know a single french person that would want to get rid of this system even if that means paying less tax, because this very clearly improve the quality of life of everyone.

Its also important to see what cannot be seen.

Who bears the cost of the most expensive healthcare? And what is the effect of it?

> The healthcare system looses money and the government injects money back, either directly from taxes or by some other means.

The government doesnt have money. Its your money. There's no difference between the government paying it and you paying it, except the government takes a slice along the way. Government is seldom if ever efficient there.

I dont think french people were happy when retirement age was increased, which was to balance the budget. And the spending per capita is amongst the highest in europe. Its not a perfect system.

You are also making assumptions by result. You are saying france has great healthcare because its provided by the government, because it has great healthcare. There are no shortage of examples of countries with socialized medicine and disastrous results, so we must dig deeper to have a model we can compare.

> There's no difference between the government paying it and you paying it, except the government takes a slice along the way.

Ok, so why don't you pay for the roads in front of your house privately?

Because... guess what, with more money, you can achieve more.

> You are saying france has great healthcare because its provided by the government, because it has great healthcare. There are no shortage of examples of countries with socialized medicine and disastrous results, so we must dig deeper to have a model we can compare.

Yes, France has bad results, and it is still better than what is available in the US. The fact that you have to find a worse model to compare to your country just means that you're already failing.

> Because... guess what, with more money, you can achieve more.

Isn't the whole point here that healthcare in the US is spending a lot of money for the results it shows? If money is no problem then this is not a debate.

> Yes, France has bad results, and it is still better than what is available in the US. The fact that you have to find a worse model to compare to your country just means that you're already failing.

I dont think you got my point. The debate on socialized care in the U.S. has to compare what the U.S. would look like with it. If you compare current US with current socialized France, you will make the mistake of saying "socialized medicine is better" on that sample. Add argentina into that mix, and now socialized medicine doesn't work as well. So you need a different model to compare what is successful and what isnt on each instance.

Compare any country with socialized medicine and with a GDP per capita in the same order of magnitude as the US and it's always better. France is not an outlier.

I can compare US medicare, which is socialized health, with other gdp/per capita countries and say the same. Its still very expensive.

We are talking about an economic problem. And if you dont care about quality of life, why would you enter a debate about rising cost of healthcare?

> We are talking about an economic problem.

It is a societal problem. This system doesn't have to be economically succesful by itself, so it's not an economic problem first.

> And if you dont care about quality of life, why would you enter a debate about rising cost of healthcare?

Hmmm..What? You probably misunderstood me... I do care about quality of life, and that's why I am shocked by you putting economic success before anything else.

The equivalent of medicare in many european countries is not economically successful and loses money every year. But so what? You balance that from some other budgets, or raise more tax. the point of such a service is not to make money or to break even. The point is to substantially improve the quality of life of citizens by allowing them to seek the care they need.

> You balance that from some other budgets, or raise more tax.

Fun. So if costs are rising, just keep paying more and more, that will solve it!

Providing cost effective healthcare is the best way to treat more people. If you make it more expensive, people will get less service. This is basic microeconomics. As simple as that.

> Providing cost effective healthcare is the best way to treat more people.

*Providing free healthcare is the best way to treat more people.

> If you make it more expensive, people will get less service

All countries with free healthcare also have way tighter regulation on the pharma/medical industry than say, the US, so they can't just go and rise the price of medications whenever they want.

Just to be clear, I'm not saying we should throw money by the windows and not count what we are paying. We should definitely try to optimize the healthcare system so it costs as little as possible, but having a non-profitable healthcare system is not the end of the world, and is definitely better than what is currently in place in the US.

> Providing free healthcare is the best way to treat more people.

Outlandish claim. Venezuela has free healthcare. Argentina has free healthcare. Germany has free healthcare. And in each country, people go private when they can afford it.

> All countries with free healthcare also have way tighter regulation on the pharma/medical industry than say, the US, so they can't just go and rise the price of medications whenever they want.

You got cause and effect mixed up. It is regulation that makes pharma expensive in the us. It is the FDA that doesnt allow german pharma to flood the US, and that puts incredibly onerous costs to the R&D and manufacture of drugs. Thats why it is better for patients in the us to fly to other countries to buy their medication and fly back, in retail smuggling.

> Outlandish claim. Venezuela has free healthcare. Argentina has free healthcare. Germany has free healthcare. And in each country, people go private when they can afford it.

Sure private medicine is often still better than the public service, so what?

The point of free health care is to make sure that people with low income can get treated when they need it without getting crushed by debt.

If you are rich and can afford the best private clinic in town that's good for you. But you weren't the one this system is trying to help in the first place.

That tells you you should give money, not healthcare. Its a very different proposition!

Economic success is why you're not dying of some random disease in a cave and instead typing on a computer that is a part of a worldwide network.

Without economics you can't pay for all the fancy stuff!

You don't understand what I am saying.

In countries with free healthcare, if you only take the department of health budget in isolation it's of course not going to be an "economic success", and I'm just saying that's ok, we shouldn't expect it to be.

Should we expect our armies to be economically successful as well?

Working in healthcare, economic success is much broader than making a profit. Looking at long term cost effectiveness is very common, so I would argue you could say that health care is an economic success.

> You cannot have a right to healthcare without taking the right to not work for someone else. [...] you dont[sic] have a right to force someone to service your health.

Why is this "right not to work" not enforced across the board? People should be able to just slack off whenever, right?

As far as I can recall, capitalists view people striking as a bad thing, and they invoke private millitaries and various laws to force people to stop striking and work.

So regardless of that, this is a silly idea, what if the fire department decides not to help you? Do they have a right not to work? What about politicians? What would happen if every single politician decided to exercise this right at once?

What about in hospitals? If the only X specialist surgeon available in the world decides to not treat you? And by this I mean, they're willing to treat other people, just not you. What then?

The world that you would like to exist, is, quite frankly, insane. What sane person would decide to let other people die, just because they do not feel like working

> This is medicare. Would you say medicare is economically successful?

Do you think making the working class bankrupt is helping the economy? The very working class that you expect to buy commodities, the working class that, without disposable income to waste on commodities, our economy would crash.

> Why is this "right not to work" not enforced across the board? People should be able to just slack off whenever, right?

It is, and they are. You may end up living on the street if you don't work, but the choice is 100% yours.

> what if the fire department decides not to help you? Do they have a right not to work?

The fire department entered into a contract with their coverage area, bought and paid for in advance by the people they are covering.

> If the only X specialist surgeon available in the world decides to not treat you? And by this I mean, they're willing to treat other people, just not you. What then?

This frequently happens, especially with surgeons.

Your questions indicate to me you have not sincerely considered GP's argument. Your _choosing_ to work is very different from my (or the government) _forcing_ you to work.

> It is, and they are. You may end up living on the street if you don't work, but the choice is 100% yours.

"Be homeless or work" is not a choice. Just like "Give me the money or I'll shoot you" is not a choice.

> The fire department entered into a contract with their coverage area, bought and paid for in advance by the people they are covering.

Just like the surgeons, at the hospital. Now you're finally understanding it.

> This frequently happens, especially with surgeons.

Wow, really? I've never heard of it happening. At least, not within the civilized countries in the EU (As opposed to uncivilized America).

> "Be homeless or work" is not a choice. Just like "Give me the money or I'll shoot you" is not a choice.

Give me healthcare or I will imprison you is your actual proposition, once you shed the intermediary steps.

Freedom is freedom from men, not from nature. We all decay and are victims of our biology, as well as our desires. You are as subject to dying from starvation as of dying from lack of healthcare service if people denied you access to it. The question is not if you have a right to demand those goods, but why the people that are willing to serve you health care for cheap cant get to you.

> Give me healthcare or I will imprison you is your actual proposition

Uh, no? Private healthcare still exists in the UK, alongside the public healthcare industry. People have a choice of which to go into. You seem to have a complete misunderstanding of how this system works...

Why does someone that pay gor his own private care does not have the option to not pay public care. That is the "do it or prison" aspect.

For the same reason that you pay for train maintenance despite probably having a car (At least in places with nationalized trains).

Also are you comparing being homeless (and risking death from disease, and the winter months in the process) to the simple inconvenience of taxes? I'm sorry, I cannot discuss any longer with someone who is willing to consider things so loosely and callously.

> simple inconvenience of taxes

Okay. United Kingdom has 34.4% of tax to GDP ratio. That means that out of 5 working days, almost 2 days are given to the state. I would not consider working 2 days a week for the government a "simple inconvenience".

That analysis of “work days” assumes that 100% of GDP is retained by labor in the absence of taxes.

Its probably even worse if you take a marxist approach to labor.

> This is medicare. Would you say medicare is economically successful?

Please explain what you mean by economically successful.

Good value/cost in comparison to other developed nation's public healthcare solutions. Isnt that what the OP is comparing healthcare in the U.S. to?

Medicare is also very expensive, it spends less in administration but also has very high costs in regulation. Medicare has the size of public healthcare in other developed nations, and its still high cost in GDP/capita. So expanding medicare would not solve the cost issue, it will just swipe it under the rug.

Medicare spends less than private insurers; despite the bureaucracy and regulations it's far more efficient than private insurers. Something like 98-99% of every dollar spent on Medicare is spent on treatment vs 85% for private insurers.

One of the reasons that many doctors hate Medicare is the paperwork associated with patients. (This paperwork only exists because of the bad actors who bill Medicare for non-existent health services.) But they stick with it because unlike private insurers, Medicare will pay out for services legitimately performed, which is why nearly every doctor who drops Medicare patients ends up taking them back within 2 or 3 years.

Its still very high per patient, higher than developed countries. And medicare will not necessarily get more efficient as it grows, in fact, the opposite.

Should we remember what the healthcare.gov for obamacare turned out? Billions into a non functional website.

Its true medicare shows some good signs in comparison to private, but it shows some other terrible ones. Lets not forget that healthcare regulation is designed by the same people that run medicare, in a broad sense.

Medicare is phenomenally successful given its constraints. It insures more patients, for lower costs, and better care, than any comparably sized private insurer. As the standard for basic care, it can't be beat in the US. Indeed, one of the original Romneybamacare proposals was to make Medicare the baseline health insurer, covering emergencies and major health crises (like cancer), with additional or concierge treatment options to be offered by private insurers.

The only reason why Medicare works is because private insurance subsidizes it. Costs are lower because the federal gov't say "I will pay you $X, even if it costs you $X+$1,000".

Can you give me some more info on this? My understanding is that medicare does less administrative work, and that might have some other consequences like they always pay out or never negotiate down, but how is it subsidized?

Bear in mind the opposite is definitely true as well: older patients are way more expensive than young ones, so their actually healthcare spending per patient has to be higher.

When I say subsidized, I mean informally. Commercial insurance pays much more than the cost of procedures and that makes up for the fact that Medicare sometimes pays less than the cost of the procedure.

In other words, if you were a doctor and you only took Medicare patients, there is a chance that you'd actually be losing money year over year. Of course, it depends on exactly what the doctor is doing as Medicare is more generous with some procedures than others.

Do you have any source for this? I find it generally hard to believe, but i dont know that much about medicare.

But its worse than developed countries healthcare in terms of cost. That has to be an indicative that the private vs public debate is a red herring, something else is making it expensive.

>Everyone has the right to life. I cannot imagine how callous one must be to willingly deprive fellow human beings of that right, purely because it is not how the economic system works. If we have the resources to provide healthcare to everyone, then we should. No matter what the cost.

I disagree on so many levels. First its most of the time the right to comfort (not hurting, being sick 3 days and not a whole week, etc) or the right to live carelessly (thinking about tobacco, obesity and their consequences here), not the right to life. Many people accross the globe don't even have access to our level of care yet they still live. Not everyone is sick either.

I also don't think we should provide to everyone. I don't think that having sick people being able to lead a normal life only thanks to modern medicine, and thus having the possibility of spreading their bad genes, making their descendance dependant on modern medicine, is a very sound choice to make as a species.

As for the public pot, considering that europe's population's getting older, staying longer alive, not being especially healthy (obesity rises too), I don't think that the point where it's not sustainable enough for our societies is very far.

I'll reply rather than just downvoting.

There's no such thing as "stealing" or "property" as a natural phenomenon. It's a social construct. We have collectively decided that it's important that if people have things in their possession, they shouldn't have them taken away. We have made property into a real thing by constructing a judicial system.

We have also decided as a society (to a greater or lesser extent) that people have a right to some kind of food. We have made this right to food real by constructing a social security system.

If someone takes possession of your car do you have the right to demand it back? Society says you do, and you do it by asking the state to help and resolve the judicial issue.

If someone is going to starve to death, do they have the right to demand food? Society says you do, and you do it by asking the state to help with food / benefits.

What does social construct even mean?

I mean it appears everything outside of physics and chemistry is a social construct (in academia they argue those are SC too).

Biological gender? Social construct! How is having ovaries or testicles a social construct?

Hierarchy? Social construct! Hierarchy appears even in non-living things, never mind most biological systems!

Property? Social construct! Why? How? Why is a solitary apex-hunter delimiting territory "natural" but when bald monkey does it, it's a "social construct"

Finally this "decided as a society..." BS! That just revels your identify with the social class that gets to make the rules. But, unless (maybe) you're Swiss, you have no real political power. The vast majority of Americans despise Trump, didn't like Hillary, and don't want Bernie either. There are more independents than either party (almost than either combined).

But somehow this representative democracy makes decisions that respects with my agency? BS!

Get this even society is not a social construct. That's right! Society arises as soon as you have a handful of people (or agents) finding their place in their interrelationships. Hierarchy will naturally arise from this.

I'm not saying the OPs point are (or aren't) abhorrent. But this social construct and contract thing is getting out of hand.

Yes, lots of things are social constructs. We are social animals, we have created and evolved highly complicated structures. But very little is intrinsic.

The hierarchy in my filesystem has a similar structure to the one in my family tree / political system / place of work. But the fact that they form a shape that has an abstract representation doesn't mean that there's some law of physics that say that humans form hierarchies. Many people form monogamous relationships. You know what else does? Oxygen atoms! Maybe there's a link!

The difference between science and religion (which is in the same ballpark as society) is that if you started from scratch you'd eventually converge on the same observations and scientific theories. Society, on the other hand, could go a very different way.

Other societies decide different things, case in point, America.

I can't be bothered to argue sex vs gender. But if you really think everyone fits neatly into two buckets in a nice bimodal distribution, maybe you haven't met enough people. That's kind of the point - inferring some kind of law, and therefore "should" from "looks like", e.g. Natural Moral Law is flawed.

I understand it's very unsettling that there aren't many certainties in the world. We construct them to make ourselves feel safe. I'm very happy to inhabit that psychological world. But I'm not fooling myself that we're not alone in a cold universe.

> If someone is going to starve to death, do they have the right to demand food? Society says you do, and you do it by asking the state to help with food / benefits.

I dont think people can enter your property and take food from your fridge to satisfy their need. There is no right to food, lets not forget America also has a big issue in kids malnutrition. That is what it is today.

The problem you will always run into is that you cant use the state to give food to some without taking something else from someone else. And because the means are force, the results become quickly irrelevant. You cant get good results through bad means. If you force people to provide healthcare and not get reimbursed for it, they will not do it, or they will do as minimum as possible and litigate as much as possible. So then the state spends money fighting, and people spend money fighting the state. The state can be more efficient on many things, and its worth looking at it: but it is not efficient in healthcare, not particularly so. And it has created most of the cost drivers. That is a fact, not an opinion.

Force is not the way to get costs down, its the way to get something done at any cost.

Yes, social agreements of this type come down to the state monopoly on violence -- if I don't pay taxes I will be locked up, and if I struggle I will be assaulted by then police.

But this is a collective (if undemocratic) decision.

In my example you don't just go and take your property back, you ask the state. And the starving person doesn't steal food, they ask the state.

There's a theme of over-personalization in some narratives, and I've seen it a lot in the USA. Feeding this person means another gets less. It's just not true, unless you forget literally everything else that society does, like infrastructure, for example, ensuring property rights. If you're that precious about paying tax to live in a civilized society you can go and live in the woods, but no-one's going to help you when your stuff is stolen.

> Feeding this person means another gets less. It's just not true, unless you forget literally everything else that society does, like infrastructure, for example, ensuring property rights

It is literally true in the strict sense of the word: whoever provided the healthcare service to that person either was not paid, he worked for free. And if he was paid, then it was "kicking the can down the road".

In economical terms, what is most interesting about things like socialized solutions is that they very often have the opposite effect of their intention, even disregarding state-run efficiency. A(theoretical, dont have data for it) example of that with healthcare would be that wealthier people live longer and get more difficult diseases with age ,which in the end mean higher spending for them. As taxes are raised from everybody, it ends up being a wealth transfer from poor to rich. This is true with free college tuition for example: it is claimed it is for the poorer, but its actually used most by middle class. And roads help people with cars more than those that can't afford cars. Also we have to add the incredible ingenuity of people: you will quickly find ways people trade that socialized healthcare on all ends: from servicing it at benefit (turns out the new socialized top-notch hospital is close to politician's homes, and the crappy one are in the crappy neighborhoods, like what happens to schools).

Anyway, the amount of ways socialized solutions can go wrong is truly outstanding and where private markets fail, public works fail spectacularly. And they are impossible to turn around, because there is no more vested interest than state interest.

> If you're that precious about paying tax to live in a civilized society you can go and live in the woods, but no-one's going to help you when your stuff is stolen.

Right, and probably even worse, the moment you do it your very own former-country of residence might send the military to kill you and seize your claimed land immediately. Thats a real danger things like "self floating islands" and all that have to deal with.

On the other hand, submitting to that idea has no sense of proportion. There is no difference between north korea or the US: whatever the guy with the guns tells you you must abide, so it doesnt matter if 5% tax or 100% is reasonable. At least in practical terms that is not how we perceive it.

You can make that argument about other services the government provides. It's like saying "Security is a commodity. People who can't afford security guards and private investigators have no right to demand protection from criminals or investigations into their house being burglarized. A poor person's necessity does not change the fact that policing is a service and a good provided by a third party."

We are aware that the current healthcare system treats it as a commodity for those who can afford it. The argument being made is that this is a problem and that we would do better to treat it a public service provided for those who need it.

"No matter how much some starving kid needs food, he doesn’t have a right to steal someone’s wallet or hold up the local convenience store to obtain it."

There is something fundamentally wrong with a state that prioritizes punishing hungry people over not having hungry people in the first place.

Setting aside the fact that you're conflating voluntary theft with involuntary medical catastrophe, we're only as good as our weakest link. To your point, when people in society suffer, society as a whole suffers.

> If I were in that position, maybe I’d end up choosing to steal since it’s the least immoral choice under the circumstances, but that does not make it a moral choice,

Or you know, maybe the fact that you recognize that in this situation you would be left with only immoral choices, is a sign of broken system?

> No matter how much some starving kid needs food, he doesn’t have a right to steal someone’s wallet or hold up the local convenience store to obtain it

There is at least one Italian court that disagrees with you: http://www.bbc.com/news/world-europe-36190557

The article states that Italy's highest court of appeal has ruled that stealing small amounts of food to stave off hunger is not a crime.

The court says it's legal, or not a crime, but it didn't say it was right.

I think the issue is that basic medical care is enormously expensive in the US. Other countries will have similar outcomes for much less money.

This is an entirely separate point but your argument about stealing doesn't seem related to healthcare as I don't see anyone in this thread arguing for stealing healthcare

You are correct, but i feel a decent society cares about its citizens.

Personally, i'm very happy to live in a country where we care about our citizens, and where we have voted for supporting those in need of food or healthcare.

Consider the following: It might not be possible to create a consistent and complete set of logical rules to derive the best outcomes in human affairs.

Think of it as a type of 'incompleteness theorem.'

That would be true if those high prices were actual price of 'parts' and service fee. But if the same procedure is few times cheaper in EU...

if even medical care is a commodity, what's the point of paying taxes?

Reply on news.ycombinator.com