Both in rich and poor countries, universal health care brings huge benefits

If a few motivated politicians can ruin the lives of millions those politicians shouldn't have that power in the first place.

While it's tempting to blame any failure of national healthcare on Republicans, this is simply not factually accurate.

It's been at least two generations since the VA was anything resembling a good model for healthcare, and it's not simply the Republicans to blame for that, nor is it merely a problem of funding.

IN most nations with a VA-style (Beveridge) setup, there is great media interest in the least failing or hint of scandal. And they mean politicians lose a lot of votes. The VA hasn't enjoyed that feedback system until recently.

Normal hospitals don't have multiple scandals of reusing insulin pens on different people, reusing colonoscopy bags, killing people, paralyzing people and periodically losing all of our records.

A lot of veterans who are covered by the VA are like me. Technically covered because of service connected disabilities, but I will never use it.

The VA is run in a federated fashion, so there is a massive variation in how well they operate.

The problem with the VA isn't that literally every hospital is terrible. The problem is that:

(1) a lot are bad

(2) the bad ones are really terrible

(3) the bad ones are consistently bad over time, with no success in improving them

Part (3) is the really damning one, because it's not like there haven't been efforts to fix the issues with the VA. But because the US is such a heterogeneous country, the successes of Portland don't translate well to Memphis.

If you want to convince people to support a single-payer system, this is quite possibly the worst argument you could use. Any veteran or anybody who has had any experience whatsoever with the VA will instantly assume you don't know what you're talking about.

The VA is, on the whole, atrocitous. There are a couple of regions which do relatively well, because the system is federated, but on the whole, it's almost universally considered to be a disaster, even by people who are supportive of the program's existence.

If you want to convince people that a single-payer system wouldn't end up like the VA, start by acknowledging the problems with the VA, not denying them.

edit, If this is a benefits/paperwork thing, then shouldn't that be separate from the care provider network?

Have other folks actually stepped inside a VA facility? Many of them are old/outdated/underfunded it's true. But some of them truly do offer superior care to a typical private hospital (in staff, facilities, and outcomes). The VA system could use significant improvement, absolutely. But if the fear-mongering 'worst case scenario' is that everyone gets VA levels of healthcare, that's still a huge win for all of America. That's a great baseline standard to start with, that no one should ever fear falling below.

If an uninsured American is critically injured, the options today are "A: Die" or "B: Bankruptcy". Having a new option "C: Universal VA-levels of healthcare" would be a win for literally every American, even for Americans who are lucky enough to already have great private insurance and who would never need/use this option themselves.

His first experiences weren't that great, but you could easily tell it was because they were understaffed and underfunded.

Once they got to the point where he could start seeing specialists and whatnot, everything since then was a breeze.

He had a surgery on his stomach. It wasn't life threatening, but he was in some pain. The VA was able to get him an appointment with a Dr. and schedule the surgery within a few days to a week or so.

He also needed eye surgery. This one he had to wait for his eye to get to a certain point before surgery. The VA was able to get him to see an eye Dr the same day he went in for something else. Then less than a month later he was going to go in for surgery but something came up so he had to have it rescheduled. They were able to reschedule the surgery for the following week.

I would consider this a success story. He was hesitant on getting the eye surgery because of costs that were told to him by the previous company, but the VA told him he would not be paying anything, and he didn't.

No, because it's free, but 1/3 of Medicare recipients opt to receive their coverage through private insurers that typically add on additional coverage, an indicator that Medicare alone is not enough for a large segment of the population, or that they prefer a private insurer even with government subsidization.

https://www.kff.org/medicare/fact-sheet/medicare-advantage/

Since you asked - yes, yes they do. Medicare patients can opt to receive their inpatient/outpatient benefits from a private insurer in lieu of traditional Medicare benefits, and an increasing number of people do so.

Privately managed Medicare plans, incidentally, outperform Medicare on the three key performance indicators: medical outcomes, cost, and patient satisfaction.

Yes, because it goes to treat chronic preventable (voluntary) conditions and to keep rich old people alive for a few hours or days longer. The way to handle those freeloading on the system is to abolish the system, not increase its scope.

The logical consequence of this is that any cost must be paid. And if the person cant pay it someone else does. So if someone gets a rare cancer whose treatment has 1% effectiveness and costs millions, it should be paid by someone else.

The principle is wishful thinking, not economics. We as people every day make trades of our life for money. We pick a means of transportation riskier than other to save some money, we choose to use a bike to be physically healthier in the long run but expose to short term risks. We eat those cheese french friends with a beer, or smoke. Etc etc.

We are no strangers to paying our pleasures with our life.

- It is the tendency of all men to magnify their own services and to disparage services rendered them, and private matters would be poorly regulated if there was not some standard of value. This guarantee we have not (or we hardly have it), in public affairs.

Americans often believe that universal healthcare is this pristine ideal that will solve everything, but thats because you haven't analyzed the consequences of it and its real life consequences.

The problem of healthcare in the us is not public-vs-private, its the extreme regulatory environment.

Not necessarily, although it does depend on the definition of "long-term":

* Reducing ER visits for preventable issues lowers hospital costs

* Higher demand for supplies should lower costs

* A larger market creates stronger incentives to research and address rarer diseases

* Eliminating individual medical debt reduces crime rates, increases education/competition

Sure, but it's not a dichotomy either. I suspect they both have better ROI than average for government spending.

If you want to attract, say, a young PhD with a spouse and kid, the guarantee of healthcare for the family - even if they change jobs - is a huge selling point. Anecdotally at least, I've known several international students who left the US after college for Canada, France, or England and cited this as a factor. (The ridiculous artificial barriers like "go home to file this form and come back" don't help either.) And with non-open immigration, e.g. the Canadian model, there's no special economic burden to this approach.

Maybe that's a good thing. Invite enough educated immigrants, and America will have more people saying "You know what, my country had a saner healthcare system thirty years ago when ordinary people couldn't afford air conditioners. What the hell is wrong with you America?"

(Yes, I'm speaking from my own experience.)

Sometimes one decides to leave the country because the misalignment of goals becomes intolerable. But there is no substitute for a properly functioning government. At least not at our current level of our collective psychology.

I would assume that if you live on someone’s land, you would agree that their property rights mean you must pay rent, otherwise you must move.

The government is sovereign over the the land of the nation. If you live there, you must pay “rent” in the form of taxes. You aren’t respecting the property rights of the nation otherwise. You can always move.

Quoting Wikipedia:

The European Health Insurance Card (or EHIC) is issued free of charge and allows anyone who is insured by or covered by a statutory social security scheme of the EEA countries and Switzerland to receive medical treatment in another member state free or at a reduced cost, if that treatment becomes necessary during their visit (for example, due to illness or an accident), or if they have a chronic pre-existing condition which requires care such as kidney dialysis. The term of validity of the card varies according to the issuing country.

The intention of the scheme is to allow people to continue their stay in a country without having to return home for medical care; as such, it does not cover people who have visited a country for the purpose of obtaining medical care, nor does it cover care, such as many types of dental treatment, which can be delayed until the individual returns to his or her home country. The costs not covered by self-liability fees are paid by the issuing country, which is usually the country of residence but may also be the country where one receives the most pension from.[1]

It only covers healthcare which is normally covered by a statutory health care system in the visited country, so it does not render travel insurance obsolete.

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

At this point in the world's history, we are not individuals who can wander off into the wilderness on our own, to live and die as God might have intended. We are members of a vast, global social fabric. We benefit from it. We pay into it. There's no way to avoid the coersion/evils or really deny the benefits/goods that this society provides. We can only discuss things relatively speaking, on a whole, in balance.

I think a productive use of our time is thinking about (and experimenting with) how information technology could better support our emerging social fabric so that we could make the best collective decisions: that is, enable even more personal freedom.

In many places in the real world, universal government insurance is already in place. This isn’t some hypothetical.

The ultimate market victory - completely avoiding the destroyed free market healthcare system and travel abroad to parasite on universal healthcare.

   The most economically efficient way to pay for B is to allow the free market to drive the cost of care so low that...

What you actually want from policy is something like a trajectory toward the best expected result in existing markets over reasonable times. This is much more practical than a provably optimal result in an oversimplified model. Models can be very useful, but the map is not the territory.

Sounds like Venezuela, which I would not hold up as a gleaming example of good governance.

I meant along the lines of: I can't see how allowing medicare to negotiate drug prices, letting nurses do more of what doctors do and publishing prices gets the US medical system anywhere close to a 50% reduction in per capita spend, or gets the US any closer to covering 100% of the population. The US should do each of these. Each would make a difference.

What the country needs, though, is real reform.

And also, yes, socialized medicine is dramatically more efficient. Medicare's overhead is only 2% whereas that of private insurance is 18%. Just knocking that off the top would bring the US per capita expenditure much more in line with the OECD.

[1] http://cepr.net/blogs/cepr-blog/overhead-costs-for-private-h...

Yes, that's exactly true. A lot of countries cover everyone, at a far lower cost per capita. Universal healthcare lowers costs. The evidence simply isn't on the side of the libertarian argument. Universal healthcare has been tried, in many, many countries, and it works just fine.

There isn't a single country you can point to, including and especially the United States, that has "free market" healthcare and gets better outcomes at lower cost than universal healthcare countries.

The US does spend a lot more, _because_ it doesn't cover everybody.

The use-value of private health care in the the US is:

- delta (getting treated, slow painful death and/or bankruptcy)

whereas most places it is more like:

- delta (private room in fancy building, non-private room in an oldish building)

If you were a salesman, and you sold the first product for less than 5x the price of the second, you would deserve to be sacked on the spot. How could a profit-seeking economic system be so inefficient that it would fail to extract a large portion of that value from the customer?

> he US needs to focus on lowering costs

Why would a profit-seeking system seek to lower costs when high costs led to higher prices that still get paid? Any CEO suggesting such a thing would be sacked by the board the same day.

Do the math; costs are about 3x what they should be, but 85% of the market still pays them. 3 * 0.85 > 1 * 1.0.

I'm definitely not saying that. What I am saying is that their talent had to be coupled with an immense amount of luck, being in the right place at the right time, and things falling in line just right for them.

> Again, I'm not wealthy, so these taxes would not affect me. But I'm not sure you're correctly modeling transmission vectors for communicable diseases.

They would absolutely affect you -- you'd get medical care. It's also not fair to say you don't pay taxes even if your marginal tax rate is 0% as your employer pays ~15% of your salary on top in payroll taxes, and your employer could also be taxed to provide healthcare as some countries do. Even San Francisco follows such a model with Healthy SF.

> You're saying rich people should pay really high taxes because poor people getting an education will cause the stock market to go up? Uh...not sure that's how it works.

A quick google search yielded all sorts of great reading material on how that could work [1], [2] and [3].

Of course correlation is not causation and if you reject that data, the reality is you participate in a society -- would you rather your peers be uneducated or educated? Healthy or sick? Terrible roads or good roads? Drinkable water? On fire? Ultimately those of the highest means have the highest responsibility to that society to give back.

[1] https://www.usnews.com/opinion/knowledge-bank/2015/08/12/edu...

[2] http://siteresources.worldbank.org/EDUCATION/Resources/27820...

[3] https://nces.ed.gov/programs/coe/indicator_cmd.asp

Its a fundamental different view of reality and especially society. We are animals, we have no rights and not duties. We do what we want. Things like ownership are derived not from some concept of rights, but from power. We combine our power through government, and in doing so grant the ability to own things. Theft is wrong, not for a moral reason, but because we decided to punish those who steal.

This view doesn't completely reject the notion of rights and duties, because we can still use the concept of such to determine how we run our combinations of power. But it does do away with the assumption they inherently exist. It becomes something of a more philosophical question, much like asking does math exist outside of humanity (or any other intelligence that is able to understand the concept of math).

I suppose the core issue is that there is trust that the public funds are used in proper way.

I don't understand the 'US is too large to X' arguments. I thought the states are sufficiently independent to handle most things distinctively from the federal level. But I don't know enough of how US works to discuss this beyond it looks odd. Couldn't e.g Oregon implement something, and if it works, then other states could just copy the model. From the outside the concept of distinct state level governments sound like they could provide great platform for innovation and experimentation. But maybe they are bogged down in federal legislation and partisan politics?

soru's comment on this thread provides one nice rational model that tries to explain why. But the much more important point is that our rationalizations are slaves to the empirical data. Not the other way around.

In one hundred years, society will be laughing at the current system that let's people die, or ruin their life financially because they got Crohns disease and aren't able to pay them or to be attended because they don't have the means to.

It is just that some societies are not as mature as others.

Given that places where government pays for everyone's healthcare, in the developed world, get compsrsvle outcomes at much lower per capita and per GDP cost than the US system, I don't see that an idea opposed to universal healthcare so much as a motivation for it.

http://cepr.net/blogs/cepr-blog/life-expectancy-and-u-s-heal...

https://www.pbs.org/newshour/health/health-costs-how-the-us-...

This is a violation of the most oft-ignored HN guideline: "Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize."

What the moral argument side is saying is that it is immoral for a country this rich to not provide socialized healthcare up to a certain level. What level, specifically? I don't know. I'm guessing it would probably include a diabetic's insulin, and would not include a smoker's lung transplant. The point is, (according to the argument you're disagreeing with) there is a level and it should be higher than it is now.

What you did with your straw-man quote - "everyone should be able to eat anywhere they want and not look at the tab" is set the level at infinity, so that the argument is trivially wrong and easy to defeat. You've done the same elsewhere: "The logical consequence of this is that any cost must be paid" and "If its rationed then some people are going to be left out, and the moral argument crumbles, as people that need it don't get it." This doesn't get us anywhere.

Try, before responding to an argument, paraphrasing it such that the person who you're arguing with would agree. If you can't do that - if you can't restate their position in a way that they would say, "Yeah, that is indeed my position" - then you don't understand it well enough to argue against it.

But what are they? What is the root cause resulting in the richest country in the world being so dysfunctional for so many of its own citizens?

There are alternatives that are picking up support, like Medicare for all, that are worth more time and energy discussing.

Private company with motive different than maximum profit. Motive: not to get subsumed and punished by the government allowing them to do this...then second motive is maximum profit. That primary motive one is an important one in all of these non-competitive industries, and can't even have a private vs public discussion without including it. Otherwise, it's just corruption/apathy and it's a different problem.

So yeah, fuck those 28 million, they're not rich, let them suffer if they get ill!

[0] https://www.cdc.gov/nchs/fastats/health-insurance.htm

  People go to "ER-or-equivalent".

  Immediately mentions a place that is not the same as ER that the US also has (clinics).

I've lived in the US and in more than one country with universal healthcare, and know quite a few people in similar situations. Some prefer living in the US, but I'm not familiar with a single person who, given a choice, would take the US model over the European model. Do you?

I wonder if "better cancer outcome in the US" is actually a result of selection bias, because the really poor people don't even get diagnosed, e.g. the money quote from [0]:

"""Danielle Scott, an employee at the store where Savastano bought the winning lottery ticket, told WABC that Savastano used the money for a visit to the doctor because he was uninsured. It was then he learned he had cancer, she said. """

[0] https://www.usatoday.com/story/news/nation/2018/02/02/lotter...

You can do that in countries with universal healthcare too.

Someone is paying for this in tax.

There's a huge US tax spend on a health care system that doesn't provide universal coverage and has worse outcomes across a range of measures.

[1] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

[2] http://thehill.com/policy/finance/238735-average-us-worker-p...

Before the ACA removed restrictions of pre-existing conditions, merely switching employers carried the risk of losing access to necessary healthcare.