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Comment by arcticbull | Hacker News Reader

How about the state gets a bill for everyone and the risk is distributed over the population minimizing the cost and improving efficiency? This happens by maximizing the risk pool size and eliminating waste from marketing and executive compensation (and the claims denial department). This happens to also incentivize the state to ensure everyone gets the preventative care they need, and line up incentives re: legislation (for instance around cigarettes and alcohol). Then we can call it “what every other civilized country does.”

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How do you then provide higher-quality but more expensive healthcare to those who can afford it?

It's pretty simple: https://www.nuffieldhealth.com/ https://www.bupa.co.uk/

But then you can’t have “everyone is charged the same” which some posters were suggesting... basically all I’m saying is that “just public” is barely better than “just private” - ideally you’d have a reasonable mix (with, of course, full transparency of prices, ratings, quality control etc.)

How is it barely better than 'just private'? WHO rankings show that not to be true (the US is 36th at $7500 per capita spend, Canada's single-payer system is 30th at $3600 per capita spend, the UK's 'single-payer' system is 18th, Spain's single-payer system is 7th). The reality is that if you're attempting to minimize illness and suffering, doing that at a larger scale is always strictly better than restricting it to those who are lucky enough to be able to pay. You can of course optimize further but single payer is strictly better than private cover. Two-tier is another valid solution.

I don't know about Canada's and Spain's system, but UK's (where I live) definitely isn't "single-payer" - there does exist private insurance, it allows you to "skip the line", get better diagnosis and probably also better treatment.

The "just public" system doesn't work for similar reasons as communism doesn't work. (1) Lack of incentives and (2) corruption. A paid-for healthcare encourages innovation (you can sell expensive new treatment to rich people who want to live longer, when the technology is mature it is then distributed to the masses), and prevents corruption - e.g. in Slovenia, which is "almost public" (i.e. the private healthcare system is severely limited by the government), there is rampant corruption - if rich/powerful people can't "jump the lines" by paying more, they will (try to) jump the lines by utilizing other forms of power (threats, favors, gifts, ...).

It's easy to shit on US/Switzerland, but keep in mind that their "expensive" healthcare systems also fund a huge amount of farmacy research that then "trickles down" to other countries.

You provide the same high-quality healthcare to everyone because nobody is better than anyone else on account of wealth. Wealthy people don't suddenly need different healthcare when they make money.

Why not also provide the same high-quality cars, housing, jobs etc to everyone?

Hint: communism doesn't work.

Also, the reality is you have to prioritize. A public health-care system has a limited amount of money (by definition) and needs to spend it in a carefully balanced way. E.g. you'd rather operate/save a kid than a 90 year old person. Another example is, governments "advise" citizens to do preventative exams based on cost-efficiency, not on "best quality healthcare" - it's simply unrealistic to perform a mammography on 50% of the older than 25 population every year. But if someone wants to do that, and can pay for the costs themselves, why would I, you or the government limit their freedom?

The system described above, as applied specifically for healthcare, works wonderfully for most in countries that use it - significantly better than in US, anyway. That alone is already a reasonable answer to your "why?".

But also, there's no reason why you can't have private insurers providing better options on top of a public system. In fact, most countries do exactly that.

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