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Comment by toomanybeersies | Hacker News Reader

How can people read and hear about stories like this, and even possibly think it's OK or even normal?

How do lawmakers in the USA convince people that this is acceptable? I have never directly paid a single cent for healthcare, and neither has anyone I know. When I had to get 6 stitches in my forehead at 2 AM on a Sunday morning, it cost me nothing. When my friend needed to get the tip of his finger reattached, it cost us $5 for parking. When my brother spend almost a week in hospital after coming off his motorbike, requiring surgery on both his knees, it cost him a grand total of $0 out of pocket.

Are people just so blind to how extortionate healthcare is in the USA?

The argument that I pay for my healthcare in my taxes doesn't hold water either. I pay less tax in Australia than I would in California, and I get free hospital care as part of that. I don't have health insurance and see no reason why I would purchase it either.

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It's because most people in the US are brainwashed (note: I live in the US) into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario. Meanwhile they are still losing ~40% of their income to taxes if they own a small business with no insurance applied.

The messed up thing is, the US also offers "catastrophic" insurance for about $150 / month but they only allow people under the age of 30 to apply for it. But at the same time I'm pretty sure hospitals are forced by law to perform emergency surgery on you regardless of whether or not you have insurance (don't quote me on this).

In 2017 I had to spend thousands of dollars in tax penalties for not having insurance. Welcome to the US!

“Brainwashed” is a bit harsh. We put up with this because it’s necessary to work within the constraints of the system.

I grew up on the coasts and for a long time would have believed that. People might hate the system but they will comply and work within it.

Living in the midwest has changed my mind, here people need the system to be true because it is the basis for their entire way of seeing the world. They listen to Rush adn to Fox News...and they accept it at a philisophical level. They rely on being told it because otherwise they would have to confront a lot of realities all at once. I don't see brainwashed as a slight, I see it as said with compassion and sadness.

“It's because most people in the US are brainwashed (note: I live in the US) into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario.”

What are the other options? Most dont choose their health insurance based on belief in one system or another.

I agree there are plenty in the midwest, with conservative views, who believe in conservatism to unhealthy levels, no thanks to the crack pots they listen to on the radio.

The only person I’ve heard who felt the american healthcare system was the best in te world was in a speech by GW Bush. His speech was answered with silence because the audience was in such shock.

The hospital can’t turn you down if you walk in with a medical emergency but they will charge you for it and if you don’t pay they’ll only patch you up until you’re no longer an emergency.

That may be the case in an "emergency" that threatens your life. But if you come to the ER with something that doesn't fall into that category? Something life changing like a detached tendon in your hand that will* render your hand permanently useless for life if not fixed within a few days? No insurance? Fork over 50% of the cost of the surgery, upfront, before they'll do anything about it. (this happened to somebody I know)

At least they told you the cost beforehand, right (no pun intended)?

> they only allow people under the age of 30

People under 30 who have nothing (known) wrong with them. I was rejected for a condition which barely affects my life, at a time when I was a poorly-paid contractor with no insurance through work.

> into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario

It is, though. Insurance is expensive, but it's not a scam. That money tends to go mostly for care, overall. Someone has to pay it.

It's true that on the whole, the US tends to overpay for care and that other systems tend to get similar results for less cost. But that's a constant factor on the insurance payment.

Obviously many of us think making this an individual burden is a bad idea: obviously it's regressive and burdensome for the bottom of the income distribution, and more subtly it's a moral hazard for the healthy, who are tempted to forego insurance figuring that they don't need it and thus pushing the cost of providing care disproportionately onto the sick and the elderly.

But again, someone has to pay it. There's no magic wand here that makes health care cheap or free. Health care is expensive, someone's got to write that check.

> In 2017 I had to spend thousands of dollars in tax penalties for not having insurance. Welcome to the US!

Because someone has to pay it, and you didn't!

Health care has a cost, sure. But you haven't explained why that cost is so much higher in the US if outcomes aren't proportionally better.

I wonder if everyone wanting to sue in America and high malpractice insurance costs might be a reason we pay more with less quality of care in America? I mean sure if you get hurt, you want some sort of recourse but I wonder if that's why American medicine is so high.

A lot of the full time RV community parks and walks over to Los Algodones, Mexico for eye care/glasses, dental and some medicines that aren't a certain schedule they can get and are allowed to take back a certain amount. They pay cash directly, no insurance is needed.

I guess they don't drive because of needing a separate auto insurance policy for Mexico. I believe most US policies cover only Canada, but not Mexico for trips across the border. Plus it might be quicker to just walk back and forth for a day trip. There's a official border crossing back and forth on foot for pedestrians, compared to cars which has a lot longer line.

However I'm not too sure what kind of recourse you have if a dentist or some other doctor messes up. Haven't researched it too much personally. There's some YouTube videos about it though, they have like a entire block of just dental offices back to back. Kinda amazing, but it's a popular area for medical tourism. A lot of them even speak English in that town, accepts US dollars and everything. Some people just visit for lunch and check out the town.

When an OB doc pays 6 figures a year in malpractice insurance — that’s why.

The party on the left who complain the loudest about health cost are incidentally heavily supported by the plaintiffs lawyers. Look at who opposed tort reform in Texas — it wasn’t Republicans, they are the ones that proposed it; it was plaintiff lawyers and the candidates they purchase.

Literally billions a year is paid in malpractice claims and punitive damages in the 7 figures is common. Who pays those awards? We do. Try suing the NHS. Or in the case of Alfie, try even having someone else willing to pay to leave the hospital — not happening.

There is also cross-subsidation as well. When an uninsured “undocumented” person visits the ER for a sore throat — that money is almost never collected, hence the $100 bed pan. When services are effectively shoplifted, everyone else covers the loss. For data on this, look at the finances of south Texas hospitals compared to a hospital in Wyoming. Or better yet, go work in a hospital billing department. Those that disagree with this have never worked in an ER.

Ironically, in Mexico, if you need an emergency surgery, you better have proof of funds or they will literally let you die in the waiting room.

Even the “beloved” NHS will deny care to non-citizens: https://www.independent.co.uk/news/uk/home-news/pregnant-bri...

But the US? Pregnant woman walks in to any US hospital, they’ll be treated regardless of ability to pay or citizenship — which is a good thing, but then we can’t be surprised when we get to pay for that when we visit the ER.

> It is, though. Insurance is expensive, but it's not a scam. That money tends to go mostly for care, overall. Someone has to pay it.

Yes but the govt already takes a bit over 40% of my income (I run my own business). I'm certainly paying my share. It's not my fault that the govt would rather use those funds on non-healthcare related things.

I'm all for a true universal health care for everyone, but if you're already taxing me so hard, I shouldn't have even more taken away from me. That's unreasonable.

> Because someone has to pay it, and you didn't!

I would bet anything the amount I paid in penalties is more than what most people pay to be insured just going by the average income in the US compared to the "assisted pay" discount you get for having a certain bracket of income.

I don't even make that much either. I'm in the "typical software developer income" bracket, but I'm self employed so I have no help or matching from an employer. I'm essentially paying both halves with no benefits (health or retirement).

And to top it off, if I get into medical trouble I'm left hanging.

FYI, there's a loophole out of the penalty. Don't know anyone who's tried it, but if you get a disconnect notice from the utility you get three months I think, so just time your payments accordingly.

> I'm certainly paying my share.

That seems very hard to determine, especially as a business owner. What's the value to you of safe shipping lanes to get raw materials to you? What's the value of employees not worrying about being executed by warlords? What's the value of having US customers who can afford your products?

I don't think you can say what your "fair share" is as some limit for what you pay. Rather, the amount the businesses are taxed has to be a matter of pragmatism.

> I would bet anything the amount I paid in penalties is more than what most people pay to be insured

One would hope so. That is the point of penalties, after all.

> That seems very hard to determine, especially as a business owner. What's the value to you of safe shipping lanes to get raw materials to you? What's the value of employees not worrying about being executed by warlords? What's the value of having US customers who can afford your products?

I am a freelance web developer and online teacher. I have no employees or physical goods.

About half of my customers are from the US and I am in a hyper competitive world wide market.

The thing that also confuses me about your insurance is that it doesn't even seem to cover the whole amount? I mean what the fuck.

That's the contract you enter into.

You pay a premium for coverage of unexpected medical costs and you agree to pay a copay and pay up to a deductible amount.

If you don't like the contract, enter into a different contract with a different company, or start your own private insurance companyn or self insure.

I was actually doing something similar with my ISP.

Exactly. In a country where regulations allow you to start your own insurance company or your own ISP, it works well as an alternative.

With heavy regulation (Obamacare, net neutrality), it is much harder for the small time players to start their own businesses to address shortcomings of the existing companies.

I hate it all, and would rather pay much more taxes if we had universal healthcare.

That aside, I had a few different people give me the following reason why this is acceptable to them. "Why should we pay any of our hard earned money to the government so some drug addict can get their fix?" "Why should I pay for single mothers who made bad decisions?" It is almost always other people making poor decisions or getting into poor situations that justify their choices on this type of stuff.

When you ask about parents who's kids can't get surgery, they reply in a similar fashion, "there's government programs for them, so I don't need to pay anymore taxes." They have never had to use one of these "wonderful" government programs. That's key to their thinking.

Try to tell them that it could be their kids that need a surgery they can't afford and it'll go something like, "well that's why we pay for insurance out of our pocket." They never stop to think about people who are in a bad situation.

There is NO getting through to some of these people until they need the help they refuse to pay for. I have seen one couple change their minds once their insurance refused to cover something for their kid. Immediately they were "raising awareness" for this type of stuff... but whatever at least they eventually came to.

So to answer your question, they aren't blind per se, as they see how stupid it is. They are however selfish as shit and don't care about anyone outside of their initial friends and family.

In addition to being cruel, this kind of penny-pinching is often penny-wise and pound-foolish. It's easy to lose more money verifying that people are not shiftless than you save by denying them benefits.

For example:

https://www.nytimes.com/2012/04/18/us/no-savings-found-in-fl...

> Because the Florida law requires that applicants who pass the test be reimbursed for the cost, an average of $30, the cost to the state was $118,140. This is more than would have been paid out in benefits to the people who failed the test, Mr. Newton said. As a result, the testing cost the government an extra $45,780, he said.

A simple retort to that would be "Why should we pay any of our hard earned money to the government so it can send our children off to some fucking desert to fight in an unwinnable war that was started before they were even born?"

60% of the US budget is spent on the military. Reduce that to just 50 or 40% and suddenly, hundreds of billions would become available to spend on health care, education, infrastructure, etc.

Raising taxes is probably also something to do though, the US is racking up trillions in debts at the moment.

60% of the US budget is spent on the military.

No, it's 16%.[1]

[1]https://www.nationalpriorities.org/budget-basics/federal-bud...

53% of discretionary spending, though.

And the rest is non-discretionary, most of which is welfare: Medicare, Medicaid, social security.

> They are however selfish as shit and don't care about anyone outside of their initial friends and family.

evidently people in Canada, the UK, Japan, Sweden, Singapore and other places where there is a comprehensive, well-managed health care system are not "selfish as shit."

so, we should probably ask: "why? why are people selfish as shit in America?"

It seems pretty selfish to expect others to pay for your costs.

"Why should we pay any of our hard earned money to the government so some drug addict can get their fix?" "Why should I pay for single mothers who made bad decisions?"

furthermore, taxpayers already foot the bill for these cases anyway since the government reimburses the hospitals, at least partially, for treating the uninsured. What the govt doesn't reimburse, the hospitals pass on to the insured customers (at this point it is hard to call them patients) in the form of higher costs.

> There is NO getting through to some of these people until they need the help they refuse to pay for. I have seen one couple change their minds once their insurance refused to cover something for their kid. Immediately they were "raising awareness" for this type of stuff... but whatever at least they eventually came to.

There's a risk associated to the type of thinking that takes root before a breakthrough experience like this: it's the idea that if something bad like were to happen to them, it's because they are exception to the rule, where the rule is plugging your ears and repeating personal responsibility over and over again.

That's to say such a situation gets internalized as, "It's unfair that my treatment isn't covered because I pay for insurance coverage, so of course I expect to be covered when I'm sick. If you don't pay for insurance, you shouldn't expect anything."

Which is a close relative to, "It's okay that I'm benefiting from public assistance, because I'm actually suffering and I'm not cheating the system like everyone else."

We do it for the illusion of freedom which is used to trick unfortunately ignorant people out of services that would cost the wealthy a bigger percentage of their income.

"Choose what X is right for you and your family"

This allows the wealthy the chance to choose a better level of healthcare, schools, and basically everything else leaving the rest of the nation to choose only what they can afford (guess what, its not much). By patronizing the nation by saying "You're so smart, you know better what you need than a stupid Washington bureaucrat like me!", they stroke our ego's just enough to convince people that they are able to get a better deal (ie, beat the system).

It infuriates me that the people who ran for office and chose to "represent" us in a lot of cases completely abdicate their responsibility to do anything. Not to be partisan, but one party is a lot worse about this than another, to me if you go through all the trouble to put yourself in government and enrich yourself handsomely while you are there, at least fucking pretend you are going to try and solve something rather than this self-deprecation that comes out of the Republican party.

I've never met anyone (of either party) who thinks that stories like this are acceptable. The issue, as always, is how do we fix it? Pointing to European democracies merely shows that it can be done, it doesn't necessarily offer a blueprint for how to make it happen in a country with very different size and culture.

Bernie Sanders' "medicare for all" is the plan I've seen get the most support. If we got single payer healthcare, it would probably happen that way. It would cost $1.4 trillion per year[1], which is more than everything the government currently spends outside of entitlement programs. Adding this much spending without raising revenue would more than double the annual deficit.

"Tax the rich to pay for it," Bernie says! Okay, sounds good. His supporters will point to how the top marginal tax rate in the 1950s was 91%[2], and everything was great during that post-war boom. Here's the problem: regardless of the tax laws or rates, the US federal tax revenue has always been 15-20% of GDP[3] (we are currently at 17.3% of GDP). This figure has not changed since 1945, even as the tax law has been wildly changed many times over. That's not to say that nothing can ever change this figure -- it is different in other countries after all. But numerous attempts to change it by manipulating marginal tax rates have failed, and there's no reason to think that Bernie's tax-the-rich plan will do any better.

[1] http://money.cnn.com/2017/09/12/news/economy/sanders-medicar...

[2] http://www.politifact.com/truth-o-meter/statements/2015/nov/...

[3] https://en.wikipedia.org/wiki/Hauser%27s_law

... and it is easy to do gradually. i.e. Lower the age two years every year. In ten years people born in 1983 would be covered.

We are on pace to run a $1 trillion deficit this year thanks to the Republican tax cuts. Simply rescinding the cuts and putting things back they way they were in 2017 gets us about 2/3 of the way to paying the cost of Medicare for all.

It can be done, we the people need to stand up and demand it while voting in leaders who will make it happen.

In 2017, before the Republican tax cuts kick in, the treasury took in $3.3 trillion, or 17.3% of GDP. Projections are that, with tax cuts in full force in 2020, we will take in $3.6 trillion or 16.4% of GDP. You're right that annual deficits will reach $1 trillion by that point, up from $660 billion in 2017.

So let's say we want to add Bernie's $1.4 trillion Medicare-for-all to 2020's projected budget of $4.6 trillion -- we're now spending about $6 trillion total in 2020. To maintain the same annual deficit we have in 2017, we'd need tax receipts of $5.3 trillion, or 24% of the projected GDP. If we wanted to balance the budget, we'd need tax receipts of $6 trillion, or 27% of GDP. That is massively higher than the US has ever been able to get. Undoing the Republican tax cuts would barely put a dent in it.

Since raising revenue to 27% of GDP through aggressive taxation is unrealistic, let's say we could do 20% of GDP -- Bill Clinton and Jimmy Carter era policies were able to reach that level. That means we need to raise $6 trillion in 2020, and we need that to be 20% of GDP. So our GDP in 2020 would have to be $30 trillion. We would need to sustain 16% annual economic growth during a period of record taxation to get there. The growth has never been that high, not even during record booms, and we would need to reach it and sustain it for three years straight.

Bottom line, if you want Medicare-for-all, you're going to have to accept much higher annual deficits than this country has ever seen -- and that's after a major tax increase on the rich.

The data supporting this post is here: http://www.taxpolicycenter.org/statistics/federal-receipt-an...

We all know it's bad. We pay hundreds a month to insurance companies because it's a law that we have to, and our employers pay even more. The health care industry is massively profitable. There's simply nothing we can do about it, or many of the issues plaguing this country. Before anyone says so, the illusion that we can change it by voting is not helpful. We can all elect a representative who will say they are going to change it, and they don't have to do a damn thing we want them to. Our system of government is broken, not just our health care system.

The individual mandate was repealed.

With the explicit goal of causing the individual marketplaces to implode. In the meantime it's increased the cost to taxpayers of subsidizing marketplace plans!

The individual markets were already a mess.

That was the talking point, and may have been true in a couple of places (especially those states that refused to expand Medicaid or only did the minimum to comply with the law), but I'm aware of no evidence that was true overall.

Costs in Massachusetts did not go down when an analogous plan was enacted. Obamacare may have been better than nothing but it was not good.

They were briefly a mess, while insurers worked out the numbers - what to charge, how many young healthy folks would take the penalty, etc.

https://www.cnbc.com/2018/01/04/obamacare-health-insurers-se...

> That report instead finds that the Obamacare market has continued "stabilizing," and that insurers are "regaining profitability" despite continued political uncertainty over the health-care law.

For a bit of anecdotal data, my premiums went up 2% last year, after 17% the previous year. I also got a $500 refund as they'd exceeded the 20% non-medical costs cap.

That doesn't really excuse the political cowardice of undermining the system while leaving most of it in place.

I guess we are pretty screwed though, there's no willingness to prop up the buy side of the market and no willingness to make regulatory changes that would negatively impact incumbents on the sell side.

(the fair, "market based" approach to decreasing medical costs in the US is to dramatically increase the number of doctors and mid-level providers).

>How do lawmakers in the USA convince people that this is acceptable?

One side of government is intent on breaking government and then using that dysfunction as a justification to create more dysfunction. The American political environment relies entirely on fear and creating fear using misinformation.

"There's profit in confusion."

I agree completely, although I highly suspect we would refer to different "sides" as the ones intent on "breaking government".

I think one side has explicitly stated it as their goal, hasn't it?

No...this isn't a 'both sides' thing.

It is a defined political strategy that one side is committed to[0]. There is a difference between a group of people doing things that you think will break government and a group of people doing things with the intent of breaking government.

This type of 'counter argument' is a symptom of exactly what I'm talking about.

[0] https://en.wikipedia.org/wiki/Starve_the_beast

I've literally had someone on reddit tell me that (and I quote) "the only reason why you have free healthcare is that we[USA] subsidize it by protecting your country so that you are free to spend your budget on healthcare".

And I mean....maybe there is a little bit of truth to that, but what sort of attitude is this? It was almost pride as in "yeah we're paying through the nose so you don't have to"?

It's funny that guy would say that because, because of the wars the USA and its greatest ally begin, we have to deal with millions of economic immigrants now, which are seriously hamstringing our system. So I'd say it's kinda the opposite

Trump had made it pretty clear he was against the Iraq war, and plans on closing military bases overseas to reduce military costs.

Keeping our military in European bases certainly does cost the United States significant resources to counter the Russian threat to Europe. While NATO countries don't pay their fair share of costs of maintaining their security, the United States has to pay the balance.

If European countries actually spent what they ought to, they absolutely would have less money to spend on their welfare systems.

>>While NATO countries don't pay their fair share of costs of maintaining their security, the United States has to pay the balance.

The counterpoint here is that US keeps American bases in Europe because US wants to keep their bases here and it serves their interests first and foremost, any defensive goals are secondary, if not tertiary. All Nato nations could contribute exactly ZERO to the budget and US would still be getting the best deal out of everyone here.

Their interests are to prevent Russia from invading Europe. Clearly every non Russian European country has an interest in that as well.

The US could clearly exit NATO to save some (a lot) money.

How is paying for someone else's defense a good deal for America?

I mean, if US wants to tell itself that it's protecting Europe from Russia, then sure, whatever they need to sleep well at night. I, as a European citizen, don't believe that for one second.

>>How is paying for someone else's defense a good deal for America?

Just get rid of the notion that America is "paying for someone else's defense" and it should become clearer - US currently has a complete military hegemony worldwide, and you can't maintain it without having forward bases all over the globe - countries inr Europe provide space for these bases, sometimes willingly, mostly over promises of things that have never materialized. In a lot of cases I think it's clear that the presence and actions of American forces around those bases are antagonizing Russia - at which point I'm not asking myself "why is Russia upset" but "wtf are the Americans doing". I have zero faith that in case of any conflict with Russia, US would come to our help or even prioritise us on the list of locations to defend - I'd much rather rely on our neighbours for help than a country literally on the other side of the planet whose interests don't necessarily align with ours.

Why should stitches be free? Of course they arent, its being paid for under your country’s healthcare model. The cost is harder to see to the individual but its there. I’m all for universal healthcare but comparisons like this are deceiving.

The advantage of the single-payer model is this: if some clinic decides to mark-up one patient's treatment by 4,453%, the single payer can not only refuse to pay for that treatment, but also refuse to pay all other treatments performed at that clinic. This keeps the cost for treatment in a much more reasonable range, since the health care budget is debated and scrutinised as part of government spending.

The Australian model is that health care providers can charge what they like, but Medicare only pays a predetermined amount for every kind of treatment. Providers are free to charge more, but have to capture the difference as a 'copay' or by billing the patient's private health insurance.

That makes sense. Medicare works in a similar way in the US.

I disagree. It’s a universal form of insurance that everyone contributes too. It’s free in the same way a public library or road is free to use. It just becomes another societal cost which frankly, no one notices. It’s not perfect either, if you want something unusual or not common, it’s possible you’ll have to pay for it if it can’t be arranged at the right price. Certain vaccines for example. So there’s still a need for health benefits but without a system charging high prices by default, even those costs tend to be more reasonable.

Yes, the cost is there, but it's much lower per treatment. Mainly because the medical/insurance complex makes less money off healthcare.

I understand where you're coming from, I too live in a country where healthcare is free at the point of use, but your claim is ludicrous. If you've ever payed any taxes then you have payed for the services you've received.

In America you pay for health insurance and Medicaid and Medicare taxes. So we are already paying for universal healthcare we just don’t get it until we are 65 or poor or disabled.

Nobody thinks this is good, but half of our voters think government is the problem, and these problems would disappear if the government would stop messing everything up and let businesses provide health care how they want.

I'm pretty sure "how they want" looks exactly like it does right now, with the only change being the option to refuse treating uninsured emergency cases.

They also don't want to be "forced" to buy insurance.

You don’t have to convince me! I think socialized medicine is the way to go. But I see enough from the other side to have an idea of the thinking there.

Part of the reasoning is that prices are high because of excessive regulation, like that requirement to treat all emergency cases. Get rid of those and prices will become affordable, the theory goes. I don’t think that would help nearly enough to make it work, but others clearly disagree.

> The argument that I pay for my healthcare in my taxes doesn't hold water either

Indeed. Americans spend more per capita on healthcare than any country in the world, and needless to say, for all that spending we don't even cover everyone.

To put it another way, we _already_ spend enough on healthcare to cover everyone. That we don't cover everyone is a political problem (allowing for the existence of a for profit system with no public alternative), not a spending problem.

> How do lawmakers in the USA convince people that this is acceptable?

When comparing different health care systems there are dozens, probably even hundreds, of points they can be compared on.

If a US politician or party advocating universal, affordable, effective healthcare uses Australia, or Canada, or the UK, or Germany, or any other specific system as a model, or even just as an example to compare to, their opponents can find for that specific system something that it does not handle as well as the US currently does. They use those to convince their constituents that the current US system is better than the proposed replacement.

If the politician advocating change does not reference specific other systems, then their opponents say they are pushing for a government takeover of healthcare using an untried, untested system based just on theory and speculation.

Another thing they like to do is label every other system as "socialized medicine", and paint a picture of adopting such a system meaning we will have to go to government assigned doctors who work in government owned hospitals and deal with a giant, intrusive, inefficient bureaucracy for every medical thing we do no matter how minor.

its not about laws or health. it's the american dream.

hospitals and doctors are in it for the money. so anything that forces you to pay, they will make you pay, because they will get money and that's the American dream.

the incentives are all wrong. remember the news about a bank telling drug companies to straight out quit researching cures and only go for treatments because those generate more money? its all the same problem

> How do lawmakers in the USA convince people that this is acceptable?

They don't; it's a lot easier to channel blame for the problem in the wrong direction than to sell the system as acceptable, so that's what they do.

Yes, prices in the USA seem totally out of control.

I pay a significant amount in the UK in tax towards the NHS ( I think about £7500 a year of my tax goes towards it) but that's nothing like what I'd pay in the USA.

It's not just the system there that is poor, it's how expensive it is in addition.

> Are people just so blind to how extortionate healthcare is in the USA?

Yes, Americans are utterly blind to this. It's amazing. But it has taken no small amount of effort on the part of specially interested parties to create and maintain that blindness.

People who have insurance good enough for all the medical care they've ever had are afraid of being denied care, basically.

I don't understand the logic of "it will cost too much to save my ear so I'll get plastic surgery instead". That's fucking mad.

A plastic surgeon can do cosmetic surgery, but they aren't cosmetic surgeons: their specialty covers many less-well-known but far more important treatments.

A plastic surgeon specialises in repairing or reconstructing damaged body parts: in this case, the treatment is clearly reconstructive surgery on the patient's ear in the hospital. The patient was weighing the cost of that surgery against living with a damaged ear…

Plastic surgeons also do cosmetic alterations of body parts, such as removing moles, etc. Some platic surgeons work privately to only do these kinds of procedures for celebrities etc., so you may be more familiar with this minority & their work rather than their primary specialty.

The thing that is often hard to understand about the United States is that many Americans hate each other, and many hate the non-Americans that live here even more. We aren't so much a melting-pot, where a single culture emerges from disparate ones living together, as we are an arena with enclaves of very separate, very antagonistic cultures that happen to live in the same country.

It is often very difficult to convince these groups, especially the economically prosperous ones, to contribute to a system that helps the others, even to their own detriment. The rich don't want to pay for healthcare for the poor, the conservatives don't want to pay for healthcare for illegal immigrants, the mid-westerners don't want to capitulate to the coastal-elite agenda, progressives have zero respect for the values of conservatives and on and on. There are cultural lines drawn, and crossing those lines is nearly unthinkable to many Americans, even if it costs them their health.

American culture is broken and divided, most people can see that but they think that the other groups are the problem, and I'm not sure we will make much progress on our massive problems unless something changes with it.

Tens of millions of Americans thought it was smart to elect Donald Fucking Trump president. We're paying the price for decades of underfunding and ignoring our educational system with an astoundingly ignorant electorate.

Universal Health Care / Medicare For All --> "That will never happen." Candidate for President Hilary Clinton

Trump being elected is not actually germane to this discussion.

I will bring up one point. The wages medical practitioners make are generally higher in the US. So the cost of medical care is higher.

I live in Belgium, mostly good and free healthcare (barring payment of a few euros here and there). I have 3 cousins who are (or are studying to become) doctors and while specialised doctors can make decent money (€75 -> 450k), they don't come anywhere close to what a US based doctor might be making.

Someone making between $1 to 2m in the US (e.g. certain surgeons) might "only" be making $300 - 400k here. And the quality level is exactly the same.

That's a good point, but not the only reason. The insurance industry extracts a big profit margin by just moving money from one risk pool to another, and that profit has to come from somewhere, so, costs go up. It's inevitable.

U.S. health insurers have an average profit rate of 3.1%. Does that sound massive to you?

That's their profit. We are all paying for their operating costs as well.

The whole healthcare provider<->insurer interface is hugely expensive.

http://www.commonwealthfund.org/publications/in-the-literatu...

That's the same as Amazon's!

Should healthcare be a for-profit venture?

it has little to do with the pay of doctors and everything to do with health care administration costs, and insurance companies extracting as much profit as possible.

This is not the reason US healthcare is costly. Canadian doctors do very well - there isn't much incentive to work south of the border. The reason US healthcare is expensive is because you have multiple payors and a ridiculously complex web of rules for everyone to navigate.

Wages certainly are a contributing factor to the cost of US healthcare. Canadian physician salaries are high by any normal standard, but still much lower than US salaries, especially when you get into specialties.

If you were to break down the charges from a surgery, the portion that goes to the surgeons salary is rather small, and particularly the portion that might be the difference between EU and US salaries. I think differences in charges for things like prescription drugs make a much higher impact.

The other difference. Training in the US to become a doctor costs hundreds of thousands of dollars up to 1M. In your country it is free.

What about Alfie Evens? UK said he must die. Parents were prevented from taking him to another country for care.

This isn't at all accurate.

There was no treatment for his condition beyond palliative care. He was on life support for the rest of his life, no matter what anyone did.

His doctors, whose duty is to the patient, determined that it was more harmful to artificially keep him "alive" (he was in a semi-vegetative state due to serious brain damage) than to disconnect his life support and allow him to die.

The offer of "care" in another country (the Vatican) was simply palliative care: they intended to simply keep him alive on life support indefinitely. There was no treatment for his condition.

His doctors, quite rightly, concluded that transport to another country would do him no good and would instead cause more harm.

The court case was between his doctors and his parents. The UK government had absolutely nothing to do with it.

> The court case was between his doctors and his parents. The UK government had absolutely nothing to do with it.

Is there a difference in terminology here? The courts are part of the government in my mind. And they have the ability to overrule unjust law.

An independent judiciary is a foundation of all true democracies. The government may make the laws, but the judiciary are fully independent when making judgements about a case.

IANAL but I believe in this case, the point of law it came down to was largely about deciding what was best for the patient, not the parents.

From what I can tell, Americans seem to define "government" to include the courts as one of its branches, whereas Brits define it to only mean the legislative branch and maybe part of the executive in US terms. Which makes it interesting when British people accuse Americans of lying for claiming the government was responsible for this, especially since I'm sure some of those people know Americans mean something different by that word.

Aren't judges appointed by the president in the US? Reports of Supreme Court candidates every time the US elects a president appears to indicate a lack of judicial independence.

I'm not hugely well informed on US law so could be misunderstanding this process.

Edit: Wikipedia tells me Article 3 of the Constitution makes the federal courts part of federal government

> Aren't judges appointed by the president in the US?

Appointed by, but not accountable to once appointed, and the appointments are permanent. The President can't direct judges or fire them because he doesn't like how they do their job (Congress can “fire” them by impeachment, but that requires a supermajority in the Senate after charges by a majority of the House, which means it doesn't happen on a whim of the political majority.)

UK courts have had judicial independence since the Act of Settlement. Governments don't appoint judges - now via an independent panel since the Blair govt abolished the Lord Chancellor, but even then govts didn't have influence or appointing powers.

The courts quite often upset UK governments (of whichever party) when they strike down bad laws via judicial review, or by finding some aspect of government policy illegal.

In parliamentary systems, “the government” is often most frequently understood in a sense somewhst similar to the way “the administration” is used in the US, referring to basically the cabinet and their political subordinates who direct policy.

This is probably a bit confusing for Americans because in the UK big cabinet posts in that executive will be filled by people from the legislature. So all the senior jobs go to elected representatives - but the citizens who elected them don't get to pick who gets which job.

Imagine if Mitch McConnell runs the executive, he gets to pick Senators for important stuff like the Secretary of State, and lesser things like the top of the FCC go to Republicans in the House. They're still in Congress, they just are now also running an executive. Just as now all the real work is done by career civil servants, the politicians are there to set political direction.

The Palace where the UK's elected legislators meet is divided down the middle so that members of the political parties that aren't in Government are quite literally "the opposition" - they're facing the members from the governing party.

Because power might shift suddenly a serious opposition political party has to have "shadows" of every major executive role. A Shadow Environment Minister for example doesn't have a huge Department actually governing the environment like the "real" Environment Minister but they need to know what's going on in that department and be able to explain how their party would do it differently, because tomorrow they could be in power.

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