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Comment by penagwin | Hacker News Reader

I never understood why people are against some form of universal healthcare. The idea of "socialism" or "communism" scare many conservatives, but it just doesn't make sense here.

How universal healthcare sorta works - we all put money in a pot, and use it to pay for healthcare.

How health insurance works - we put money into a company, who uses it to pay for healthcare, while taking a significant cut as it's a private entity.

With the correct organization (which the government is notoriously terrible at) it would seem to me that it could only be cheaper to have taxpaid healthcare?

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Someone else beat me to it, but being Canadian who moved to the US, I can kind of see where some people are coming from.

If you're young healthy, have a good job and are a bit short sighted, you're way better off in the US (with little to no insurance or a crappy high deductible plan) in term of take home pay.

Even if you're not healthy, if you have a lot of money, you're also way better off since wait times in affluent cities are way, WAAAAAY, _WAAAAAY_ better.

When I lived up north, getting an apointment with my family doctor was a 3+ month deal, most people didn't even have a family doctor because almost none took new patients, wait times for surgeries were so high my grandma almost died while waiting for hers (and did end up dying because of lack of care in the end). And i think in some places they're talking about no longer covering some services like regular check ups?

I had a bunch of lingering non-critical conditions I never got checked until I moved to the US, because it just wasn't worth the trouble, and was able to get everything squared away in record time since I did.

Something that isn't always brought up too is things like dental, which wasn't covered up there so you needed private insurance anyway, and very few of my employers offered compared to my US employers.

It's completely messed up and only benefit people who don't think far enough or have money up the wazoo, but for those, the socialized system would be worse.

>Something that isn't always brought up too is things like dental, which wasn't covered up there so you needed private insurance anyway, and very few of my employers offered compared to my US employers.

Most employer provided dental plans have a $1,000 or $2,000 cap.

Be careful when telling anecdotes, the implementation of health care is a provincial matter.

I can see my family doctor within zero to two days, assuming I don't use the practice's walk-in clinic first.

Fair point. That is from good old Quebec, and friends from Ontario do tell me it's better over there. My anecdotes do match with numbers and stats I've seen at the time (but it's been a while since I've lived up north).

To provide a contrasting experience, in Canada I had a family doctor who would see me with a couple day's notice, and 99% of people in the community had a family doctor. However, it was a relatively affluent suburb, which means a lot of doctors lived there.

Dental coverage is a valid point, I was surprised at how many things weren't covered under my company plan.

If you drop those who start costing too much, private insurance could totally be cheaper. :)

Or you could socialize the costs, cut out the massive waste involved by the private system and realize a healthcare cost that nears that paid by similar first world countries.

Plus I think(/hope) that people in the US have fully embraced their hatred of pre-existing condition exclusion in health care that came through with the ACA. The GOP keeps saying they'll drop it and they keep shying away due to the popularity.

Agree :)

The Nazis had that realization :-)

Not sure what the down voting is for. While I don't condone anything the Nazis did, it is true that eliminating "expensive sick people" would lower the cost of care. Whether that's something we would want to do and were you draw the line is a different story.

Trusting in a private company that must react to market changes is different than trusting in a government that doesn't listen to you anyway.

What is the market, here? What good or service do you get from insurance?

For their real value prop (covering the unlikely need for catastrophic healthcare), you 1. most likely won't ever use it. 2. have no idea how good their service is until you have no other option but to exercise your coverage.

Market-based capitalism works best when consumers can shop around, and take their money elsewhere when the good or service is not a good value. This is absolutely not the case with health insurance.

Meanwhile, medicare is pretty beloved in this country. And the public options in other industrialized nations outperforms US healthcare in most respects for significantly less money.

If it's employer-chosen, you're not the customer and they're not listening to you either.

Why do you stop there? The chain goes on. Employer will have to listen to the employees or they will be on a lookout for better place to work. It's not uncommon at all for employers to tout benefits as a way to attract new hires.

That only works if you’re in high demand, and your health problems don’t preclude getting a new job. Very few workers can rely on that being true at any point in their lives, much less all the way until retirement.

That is only true for an employee's market.

Your health insurance company listens to you? Mine just constantly tries to wriggle out of paying.

I cannot pick my own health insurance company. My choices are:

- Whatever my employer wants

- Something on the exchange for quadruple the price (particularly without my employer's share of premiums)

How does the market decide when it isn't a competitive market? Why are employers allowed to pick their employee's health insurance? Why are employed people at large companies paying less than employed people at startups?

I grew up in Canada so I totally understand why people are against universal health care... Check out the wait times for MRI scans that are published by the various Canadian provinces. 90 days' wait is not uncommon.

Meanwhile in the US it can be had in 3 days or so in every decent sized suburb or city.

An MRI that you can book in 3 days, if you have the money. I know people with health care insurance that had to postpone imaging for months in order to be able to afford the cost.

If waiting a little longer doesn't reduce the quality of care (research from 2007: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801918/), then it doesn't really matter how long you wait.

As someone who grew up in Canada and actually paid attention, this common line is mostly BS.

If you have an emergency, you essentially have no wait time for an MRI. If you have a condition that can wait, you go into the line and potentially wait for a long time. When the wait times become too long, it becomes a scandal and then improves. Every scandal then gets reported in the USA as stories about how horrible Canadian healthcare is.

Yes, this is the same as in NZ - the thing is if there are not queues for expensive resources (be they surgeons, MRIs etc) then there must be expensive resources sitting idle.

Queues are a good thing in that regard, they indicate efficiency of use, what we mostly argue about in countries with socialised medicine is "how long the queues should be?".

Ideally they are on average just long enough so that they never become empty when the usual various peaks/troughs of demand occur, plus have the capacity to handle all the life threatening cases on an urgent basis

I find it ironic that you stated the answer to your own question and didn't notice.

That is, how notoriously terrible the government is at organization is a major reason for why people are against universal healthcare. Whether their concerns are overblown or not I leave to opinion. But that is a major fear for many.

Medicare seems to work just fine.

> how notoriously terrible the government is at organization is a major reason

A major propaganda point, not a reason based on data. It’s really hard to find a first-world country which has a medical system which doesn’t compare favorably with American insurance companies on either cost or quality — the baked-in conflicts of interest are too powerful.

Insurance companies are also not exactly....paragons of good customer service themselves. I was camping with a friend when he managed to slice off the tip of his finger. The insurance company fought him tooth and..err...nail to avoid paying out for not having the ER visit “pre-approved”

That was my point: I’ve known a fair number of people from other countries and I’ve never heard any reaction other than stunned disbelief when they experienced the American private insurance system — up to and including giving up jobs here just to avoid the stress of not knowing whether you really will get treated or not.

I can sort of understand someone thinking that the government is bad at organizing large projects. What I don’t get is how so many people think that while simultaneously thinking that the government is the right tool for carrying out gigantic projects like completely reimagining the government of a foreign country that doesn’t want it.

I've always found it slightly amusing that the mostly unchallenged conventional wisdom is that private enterprise is more efficient and better organized that the government. Sometimes I wonder if the people who really believe that have ever worked for a large corporation.

I also think people forget that, in any case, the gov't is not a private enterprise and efficiency is actually not their first mandate, it's effectiveness.

You might find a more sophisticated version of that conventional wisdom to be less amusing and more worthy of food for thought.

It comes from Ronald Coase's theory about the natural size of companies. Companies exist at the tradeoff where the costs of transactions between multiple companies equal the internal inefficiency of a large organization. The larger the organization, the more it tends towards inefficiency. Anything that decreases transaction costs, decreases the size of organizations. And vice versa.

From that you expect large organizations of all kinds to be inefficient. Which fits your observation. Now note that government organizations tend to be are large organizations with a tendency towards complexity and no incentives for efficiency. How do you predict that will work out?

Again, whether or not this is a compelling argument is a matter of opinion. But if you want to understand the views of those who don't like government healthcare, this is a key point to keep in mind.

Are corporations really that much better though when it comes to organization?

We've just offloaded all of the terrible organization to large corporations like ISPs or health insurers, which don't actually have the consumers best interests in mind. I've worked for a government contractor in the past and I can tell you that private companies will do everything they can to drag their feet or siphon money while creating bureaucracy on the level of any government agency.

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