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Comment by kendallpark | Hacker News Reader

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kendallpark

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)

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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.

> 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.

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.

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