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Comment by creaghpatr | Hacker News Reader

>The bill embraces the principle of a single standard of care for all Americans. It will not allow participating institutions and providers to offer private care for covered services to the rich. Allowing the wealthy to "buy out" of the system has led to the erosion of care for everyone else in countries, such as Australia, who have experimented with it. The new House bill will also include substantial new language to begin to remedy healthcare disparities and expand service to underserved communities.

Mother, should I trust the government?

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So, if the government denies a treatment that could save my life due to some cost / benefit calculation, I can't get access to that treatment, even if I manged to raise funds for it on my own?

Come to think of it, if this passes, I'm going to lose access to a medication that I'm taking right now. Insurance denied coverage for it because they want me to try a half dozen others first, even though all of them have significantly worse side effects. I'm only able to get what I'm currently taking because the manufacturer covers the cost through their charitable foundation for anyone who can't get insurance / insurance approval.

If "medicare" for all banishes not only private coverage but all private care, and that extends to coverage for drugs, I'm f*cked. Death Panels indeed :(

Your government-enforced death will enable millions more to have basic coverage so don't feel bad.

Granted, it's a condition that practically guarantees that my lifespan will be shorter than if I didn't have it. On the other hand:

1) We already have medicaid programs for the poor 2) We already have medicare programs for those not in the workforce (age, disability, etc) 3) We already offer subsidies for those who cannot afford traditional plans but don't qualify for a medicaid or medicare program 4) Medicare still costs money. It's a public insurance plan, not "free for all". So no, it won't give millions basic coverage that they couldn't already get.

I'd prefer my death to be a bit more meaningful than fulfilling getting some politician political points, because that's pretty much all it would do under such a system. The above points don't add up to a perfect society; maybe we could work on improving those instead.

Edit: For those not in the know, elderly pay for medicare out of their Social Security income. Anyone who reads "Medicare for all" as "Free healthcare for all" is either misinterpreting what's being offered, or what's being offered is a lie.

There will still be private providers.

Edit: read my response below before downvoting. There will be non-participating private providers.

> The bill ... will not allow participating institutions and providers to offer private care for covered services

Right.

So there will be private providers that do not participate.

The same thing happens in the UK - you could visit a private hospital if you want to (and many people do) but if the institution is a public-funded one then they don’t get to offer different levels of care for different people.

You can absolutely have a private, non-participating hospital or practice under the proposed plan.

My situation is one of medication payment, not in-patient treatments You can bet that one of the worlds' largest drug manufacturers, and the pharmacies that provide their medications, aren't going to opt out of participating. If the bill truly makes participation all-or-nothing, I'm SOL. (US health insurance covers both treatment and medication; I'm assuming that the participation rule in this bill applies to both).

> but if the institution is a public-funded one then they don’t get to offer different levels of care for different people.

This is incorrect. Many NHS hospitals have private wings, and since Lansley there's no laws or regulations to stop hospital trusts providing basic service for all and better service for paying customers.

Not all institutions and providers would choose to participate.

Maybe, maybe not.

Yes is a real possibility. I was born in a country where government is largely trusted and live in another. It's a mixed story depending on branch, but by and large people trust the government no less than they trust the average bigco, and partly more.

But you're in the US, which seems different, so maybe not. And I've always wondered: Why is that? You Americans seem to distrust your government so much. Why do you vote as you vote and get a result you don't like?

If you look at the success rate for US public schools, you may want better odds under a healthcare system. The VA is a good example of government run healthcare that continues to fail its members to an astonishing degree.

A major part of the reason the VA fails is that it is legally bound to provide coverage for people all over the country, with a center within X miles of every person that needs it, while only getting funding to cover roughly one percent of the population.

Singler payer healthcare works a lot better if everyone is covered because then resources can be allocated more efficiently.

Serious question: Do you trust the government to "efficiently allocate resources"?

I think that single payer will more efficiently allocate resources than the current system. I think this based on the fact that the countries that have single payer healthcare manage to produce the same or better health outcomes for a fraction of the cost of the us.

Part if the issue is that the incentives in the US today encourage the poorest people to get health care at the most expensive places (emergency rooms), as well as the insane amount of wasted effort coordinating insurance providers, billing people, verifying copay amounts etc.

>I think that single payer will more efficiently allocate resources than the current system.

I do agree with this.

How do you know that this is not due to government interface, I read somewhere that the non-subsided plastic surgery industry saw less increase in prices for consumers. Bear in mind that waiting times in socialist countries are way longer and also if you don't agree with the treatment that has been decided for there is nowhere to go. If you are looking towards the Swedish model for an example keep in mind that the direction there has been increased privatization.

>Serious question: Do you trust the government to "efficiently allocate resources"?

Not really. But I trust them to fuck it up in a way that sucks less than the status quo and when they fuck it up we have more recourse than we do with the status quo.

It's the classic choice between the devil you know an the devil you don't except that most other countries have chosen a different devil than we have and are doing better for it so I think it's worth a shot.

Yes.

I trust the government more than I trust insurance companies.

Depends, are we electing Republicans?

The VA business is interesting, because the right clearly does support the spending of almost unlimited amounts of money on defence, where presumably this is "efficient", but not on healthcare for the troops. I'm surprised nobody's suggested that soldiers should have to buy their own battlefield health insurance and choose from a selection of medevac providers yet.

Shhh... Don't make suggestions.

For the most part, people trust their state and local governments, but distrust the federal government; state politicians are commonly re-elected until they choose to retire. I think it's because the country is so large and diverse that what's good for one state may not be good for another. We've got cities and states with a higher population and more economic power than some of the EU members, but a huge geographic divide in the middle of the country. Culturally, people on the west and east coasts seem to be different enough that they don't agree with the politicians that are elected, then you have smaller states that feel bullied by the bigger states like New York and California. Eventually it starts to feel like the only people you can trust to look out for your interests are state and local politicians.

I've seen a similar sentiment from citizens of smaller EU members who feel that Germany and France are willing to push for changes that benefit themselves and the EU as a whole, even if the changes are detrimental to the smaller states.

Depends on what you're trusting them to do.

Here's my personal ranking:

When it comes to "I trust the government not to send a bunch of thugs to kick down my door and shoot my dog for no good reason" I personally rank them local > state > federal

For "I trust the government to spend my money wisely" it goes state > federal > local

For "I trust the government not to pass legislation that makes my life worse" it goes federal > local > state.

My local government is inept, corrupt and burns money like a German housewife in 1923 (A 100ft ladder truck when the tallest building is 3-stories, a boondoggle of a new highschool, a town run pet cemetery for Christ sake!!!) but mostly harmless.

My state government is hell bent on screwing over certain classes of people and passing laws that annoy everyone for political virtue points (and it is a 1-party state so there's no stopping them) but they mostly spend their money wisely.

The feds wrongly harm a lot of people (some violently, some not so violently) and aren't all that great with money but they're too gridlocked to enshrine any real stupidity in law.

Without knowing which state you live in I can tell this is so true. So much so that it make me wonder if there is a structural reason for this?

You know how some countries feel the need to prefix their name with the word "Democratic" and it's basically a guarantee that not much democracy is happening there. I feel the same way about the word "Commonwealth" when applied to US states. It's basically a dead giveaway that the government prioritizes itself above the common interest. I live in one of those states.

One of our two major parties has built its entire brand around mistrusting the government.

Speaking as an outsider - Did you see what their choice was last time around? I'm far from pro-Trump but it seems Hillary would have come with a whole different set of issues. Unfortunately it's the whole 2-party system that's broken.

I'm speaking as someone from a country with pretty much the same system (the UK). Voting for anyone other than the candidate you dislike the least is essentially a wasted vote. I and plenty of others in my country really wish we knew the answer (and so do many Americans, from what I've seen).

I'd be interested to hear where you are from. From what I know about Japan I gather that people are generally satisfied with their leadership. Maybe New Zealand as well?

Scotland (still part of the uk for now) has proportional representation rather than first past the post. This can help avoid the wasted vote idea.

Feels like a bad idea to me. Why not just tax the hell out of the private treatment to make sure the public treatments stay funded?

I guess the concern is similar to the public vs private school situation, where some areas have bad public schools because everyone with any money chooses a private school and has no incentive to fund the public system.

Still I find the idea of government-only medicine to be scary. In the past we've had politicians who have decided that things like abortion, stem-cell therapy, and medical marijuana were all moral evils. I am glad people had private options to get those things.

This is not proposing abolishing the private option. It is just establishing a distinction between private and public providers, so you don't constantly get pestered for topup fees.

Using the school analogy, imagine if schools had a private component and a public component. All kids got an education there, but there would be an incentive to charge more for a better education. And an incentive to blur the lines between what's a required fee and what is nickel and diming the parent.

> It will not allow participating institutions and providers to offer private care for covered services to the rich

I feel this is going to be a major talking point... Canada's system kinda works like this. Basic coverage with additional coverage you can purchase.

That's true, but not quite the same. There is one system and one payer for emergency care, as an example. You can't pay for additional or better care. However, eye glasses aren't covered by the public system. Additional coverage would help here.

That’s also how the uk works. Even there, it’s still possible to go to a completely private hospital for most things but generally not for true emergencies.

This bill is less about what it gives and more about what it takes away. Can they convince 155 million people to give up their employer-sponsored insurance for a government option?

I would in a heartbeat if it means more take-home pay and/or never having to think about which providers are "in network" again.

The chance that this will end up giving you the same level of care for less money is practically zero.

It depends.

Insurance companies are able to negotiate better rates as they get larger.

See pjc50's parallel comment to your own. You may still have to think about which providers are in the government plan.

That's not what's happening though; it's the providers who have to pick one or the other, not the public. Again, this sounds a lot like the UK system, where employer insurance exists but is genuinely a perk rather than something you need to survive.

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