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Comment by eaandkw | Hacker News Reader

I would argue that healthcare is not a right. But most of the comments here seems to leave only two choices: all or nothing. Just because someone is against socialized, universal, or free healthcare does not mean that they want people dying in the street. They just see the argument as a lot more complicated. As crazy as it sounds I think we should do away with health insurance in general. I think that would do more for cost control then any scheme the government could come up with.

I do believe that making hospitals publish their prices would be a good start. The first thing I think that would do is bring to light the difference in price between paying in cash versus using insurance. From there we could make arguments why the same service has a 10x to 100x difference in price depending on how or who pays for it.

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How would you then hedge against unexpected high-cost procedures? Your assumption is that ridding the world of insurance would magically, dramatically lower the cost of every drug and procedure on the market.

Not everyone gets cancer, the medical insurance profit model is predicated on a bet that most people won't. The more people in the coverage pool, the less likely you will be paying out for every single person.

Socialized care is just the expansion of that model to encompass the entire country's citizen population. What would have been privately-captured profit from people that were healthy members of the pool can instead be used to reduce the premiums paid by all members of the pool.

I am arguing from the point of view that at current prices very few if anyone would be able to afford a high-cost procedure. When that happens prices would come down. This is partly why a bottle of snake venom antidote in Mexico can cost $100 but in the U.S. costs $10,000.

Another example is eye surgery. Originally the procedure was expensive but now it is more affordable because it is not covered by insurance. Comparatively, plastic surgery is relatively affordable because it is not normally covered by insurance.

Reducing or eliminating health insurance would also eliminate a lot of the medical administrators that provide zero care but due incur a cost due to their salaries.

As far as getting rid of the profit motivation but capturing the profits and giving it to those without health insurance I believe that you would also eliminate any reason to innovate and create new drugs.

I will admit that if you got rid of health insurance tomorrow that there would be a lot of short term pain. But I also believe that in the long run people would be better off because they would be able to afford there healthcare.

Using a different example look at the cost of college. I believe that we could fix that problem one of two ways. The first way would be to get rid of government loans and grants. The other way would be to allow people to file bankrupcy for student loans. The first way would attack the problem by getting rid of easy money. Because easy money makes things expensive. The second way could work by shifting the risks of the loans from the student to the banks. The problem with this solution would probably make it harder to pay for degrees that don't pay well.

To summarize my arguments, cheap money makes things expensive and is destroying almost everything is this country.

Edit: added the college example.

It's not all or nothing though. Many countries have hybridized private/public healthcare. Examples:

- Compulsory basic insurance (private or public) (Switzerland)

- Private insurance + equalization pool (Netherlands)

- Compulsory HSA + government price fixing (Singapore)

- Socialized general coverage + private supplementary coverage (France)

I don't think it would really work. Each of those countries developed their versions of healthcare based on the needs of the country at that time. It isn't like those countries were identical in size, population, gdp, etc. and then choose their healthcare scheme on a whime. The U.S. would have to design a plan that would work for the U.S. We are so polarized as a society right now we couldn't plan our way out of a paper bag if we needed to without getting into a fight.

I will admit that I have not read up on those countries healthcare plan but I think it is a lot more complicated than saying lets copy X countries plan. If you made a big change there would be a lot of second and third order effects that we would have to deal with and we may not like those out comes.

Maybe it would make more sense for each state to come up with a plan for healthcare as each one would have different needs.

I think it would be better but it still doesn't address the problem of easy money making everything expensive. The other problem I think could come from making each state a "walled garden" so to speak that prevents non-residents from using those services. At least with the states deciding you can vote with your feet.

I could see California residents arguing why they should pay for the medical expenses of tourist.

Having some domain specific knowledge of the financial flow through the industry, I tend to favor a more federated administration model like you suggest. Skeptical of federal level ability and historical competency, I favor outsourcing the initial transition wrt implementation and administration to Switzerland, Netherlands, Singapore, France, etc.

Now that I have thought about it for a little while longer I think I would be fine with each state deciding which model they wanted to follow. I falls in line with states rights and the 50 individual experiments concept. Which I also believe in. If one of the models work then great. If not they can look to see what is working.

The polarization is not as significant as imagined. On issues such as healthcare there is overwhelming support for universal coverage or a single payer type system, by around a 2:1 or higher margin. The problem is that our mainstream political parties are broken.

I am skeptical about that. I think that it is closer to 1:1. I could make the argument that everyone that I know is against single payer and universal healthcare. But I know that I would be biased. I think that that is called Comfirmation Biased but don't quote me on that.

We could point finger all day long about who is responsible but at the end of the day nothing changes. I think politics at this point is more about entertainment then anything.

> but I think it is a lot more complicated than saying lets copy X countries plan

I don't think anyone in the discussion thread is advocating carbon copying another country's healthcare.

Perhaps, but then there is no reason to bring up what other countries are doing except to say that they are doing something. But again we are back to trying to figure out how to make healthcare more affordable.

I think that both we and everyone in this discussion can agree that what we are doing now is not working and is unsustainable. We are just arguing over the best way to fix it. I personally believe that easy (cheap) money makes things unaffordable where is seems everyone else wants to spend or devote more tax dollars to an already broken system. I would just like to fix the root problem and not the symptoms.

> there is no reason to bring up what other countries are doing except to say that they are doing something

Are you suggesting that healthcare legislation should be drawn up in a vacuum? It's important to compare and contrast the benefits and pitfalls of other countries' systems. It's really all we have to go off of evidence-wise. It's also good to look at them for inspiration. There are a lot of different ways the public and private sector are being combined to make far more cost-effective healthcare systems than in the US. You are correct that some might not work in the US; that sort of reasoning needs to be weighed into whatever overhaul happens.

> I would just like to fix the root problem and not the symptoms

What are you suggesting as the root issue?

I have no problem with looking for good ideas from other countries. I just want to use realistic figures and study what the second and third order effects would be.

The main point to my arguments is that cheap money makes things expensive. Meaning is the government or somebody else subsides healthcare it will get more expensive. Because why not. Hospitals are trying to compete with other hospitals so they want the biggest budgets for paying the best doctors and newest equipment and technology. So why not charge just a little more then you need to get that. Then the next year comes around and the hospitals need more money so they charge just a little be more this year and it goes on and on.

You could probably start to fix things by making everyone publish their prices and charging the same price for cash as they would to insurance. From there things would start to unwind.

> I would argue that healthcare is not a right.

I would argue that rights are things that we declare by agreement as a group, not physical objects or measurable qualities. Of course healthcare is not currently a right; we haven't made it one. The question is: "Should healthcare be a right?"

Now here would be good forum post. But is pretty philosophical. What is the source of rights. If we agree that rights come from the state then we can't really complain when other countries do horrific things to their citizens. We also can't complain if our elected leaders decide that free speech, privacy, or any other pet social issue is removed. I think that we had it mostly right at the founding of this country.

Too much could be written about this argument but to me a right can't be provided by someone else's labor.

Now that I think about it, a right is also something that can't be taken away. No one should be able to prevent your free speech (1st Amendment), defend yourself (2nd Amendment), or violate your privacy (4th Amendment) without due process.

In this case no one is preventing someone from being able to care for themselves. We are just arguing over who pays for it. It is probably a bad example but everyone has the right to use the roads for transportation. We just don't have the right to the car, insurance, and gas.

Edit: Added more comments

What you're getting at is the difference between Negative Rights and Positive Rights. Negative Rights guarantee inaction, e.g. the government can't suppress your speech or take away your ability to defend yourself. Positive Rights guarantee action, e.g. the government will force someone to provide you healthcare.

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

You're also touching on the difference between Natural and Legal Rights.

Rights are expectations that you have from a just society. There's no real division into positive and negative rights. Due process, for instance, could be phrased either way but it is the same right nonetheless. One phrasing would emphasize freedom from extralegal persecution, the other would emphasize that all sorts of people (e.g. lawyers, juries, judges) are compelled to provide you certain services.

You can't have rights without guaranteeing action. My right not to be tortured requires all sorts of individual and societal interventions in order to fulfill. There's no classification of rights into positive/negative and certainly no difference in validity between the two.

I could not have said it better myself. I actually thought of that a little while after I wrote that.

Healthcare isn't a right. But as a wealthy society we have a moral obligation to provide essential healthcare to everyone at a price they can afford.

Now I am not wealthy by any stretch of the imagination but I do not have a moral obligation to force anyone rich or poor to provide essential healthcare. I could morally encourage people to donate time and money to hospitals as a charity but to force them as part of a government mandate to me is morally wrong.

If you think that taxing the wealthy to provide essential services to the poor is immoral then you've totally lost me. That's not the type of society I want to live in. Relying on voluntary donations leaves too many people to fall through the cracks.

The problem with using words like wealthy are that it is a moving target. Generally when someone says wealthy they mean anyone making more money than them. In a small town in south east U.S. 150k would make someone very well off. One might even say wealthy. In San Francisco someone making that amount of money might be homeless. So should the person living in California pay more?

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