Hacker News Reader

Comment by thefringthing | Hacker News Reader

Would you prefer the Singaporean norm (clearly posted prices) to the Canadian/European one (free at the point of use)?

There is no single "European" model.

Neither is it "free", at least not in Germany. It gets charged to your insurer.

True. In fact it is worth noting that a large portion of the ACA/Obamacare model was based upon Swiss healthcare (specifically the individual mandate in particular) due to its heavy private market presence.

First line in Wikipedia (https://en.wikipedia.org/wiki/Healthcare_in_Switzerland) There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country).

The difference being their version of the individual mandate was not struck down or watered down to becoming a 'penalty'. Instead it was like what we do with auto insurance.

Personally, yes. Like many posters here I am an Engineer not in the medical field, so take my opinion with a grain (read: mound) of salt.

Most "free" healthcare systems have either (1) horrible quality of service or (2) impossibly long waits unless your life is in danger or close to it. The latter is a systemic issue I've noticed in that healthcare, regardless of pricing or structure, does not aim to foster optimal health, but merely to prevent mortality - so if you go with a 'minor' issue such as recurring headaches or chronic fatigue, it will be dismissed entirely.

I don't have the right answer here and am all for people having affordable options from 'free, wait 3 months' to '20K, full service now', but once again, personally speaking, I'm not rich enough for 'free' things. I'd rather pay and know exactly what (and in this case, much more importantly, when) I'm getting. And from what I've noticed, my personal beliefs that people should strive for optimal health rather than mere preservation of life, is a popular opinion deemed 'unrealistic' by experts.

As a soon-to-be Canadian who has only experienced the US and Canadian systems, up here the quality of service isn't horrible and the waits for service tend to be shorter than they are in the US - but they are based on need rather than wealth. So someone in discomfort but no danger will end up waiting longer in Canada then if they were rich and lived in the US, but my relative with cancer was seen to promptly due to a high chance of complications if surgery had been delayed.

So I'm not sure what constitutes "most free healthcare systems" but Canada is apparently different from "most"

If you are rich and live in Canada, you can cross the border and pay out of pocket to receive treatment in the United States. I wouldn’t be surprised if Taiwan (the only other country with a Canada-style one-tier single-payer system) has a similar relationship with Singapore. Britain also has the ability to pay out of pocket for private practice care as an alternative to the NHS.

Re: quality vs wait period trade off.

We generally call this the 'Iron Triangle' in healthcare policy/management. You basically get a pick at most two out of (1) access, (2) quality, (3) cost.

As to your general sentiment healthcare is a bit 'one size fits all' when in terms of insurance/reimbursement solutions. Note that the needs of the aforementioned triangle are weighted differently based on acuity of care. More generalized simple/low acuity care we are happy to get low cost and ready access as our best solutions (e.g. minute clinics, online/virtual care/telemedicine for getting a vaccine or pinkeye/localized infection without complication).

Meanwhile ER representing the other spectrum we instead have greater need for higher quality and access. You must get to an ER ASAP and get stabilized.

Chronic care quality solutions with long term cost-effectiveness are what are needed. Access to a specialist for longer term condition management (or episode or care like a cancer diagnosis).

Similarly more procedures are becoming outpatient, or recovery at home, or at dialysis centers, or at skilled nursing facilities ... you get the point.

I argue the problem is that the insurers have not adequately fragmented the insurance market/reimbursement model. Healthcare is changing in how it is delivered and insurers are not keeping up with it when it comes to modeling their payouts. For example why does being in-network matter for low cost care at outpatient facilities? The added 'negotiation' of being in a specific network doesn't add much value. One size fits all doesn't work with the modern spectrum of care.

Reply on news.ycombinator.com