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Comment by LarryDarrell | Hacker News Reader

My premiums and deductible are north of 10k. This is why I laugh when some one tries to scare me with the old "with Medicare for all, your taxes will go up!" I'd gladly and enthusiastically pay more in taxes to rid myself of the current system.

I used to think employers would love to have to be able to stop offering insurance. But then I realized for the most part, employers love the current situation. Offering health insurance keeps employees chained to their desks. They'll moan every now and then about costs going up, but the current system ultimately serves them well.

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What if someone suggests your taxes would rise by 10k? Are you concerned because that much money is an expenditure you can’t afford, or is it just behavioral and you’d rather prepay in the expense in your taxes than choose to spend it?

If you get access to the same level of health care even during periods of unemployment - meaning, you might be paying no taxes at all - I wouldn't mind a bit.

For that service you need to pay more than the 10k, as you need the wones working paying for the ones that don't.

You cant make a pizza larger by cutting it in different ways.

Healthcare is not pizza.

The top level comment gave a perfect example why. Preventative care is cheaper than emergency care. When everyone (including the unemployed) can get preventative care, total costs go down.

That unemployed person with no insurance still gets emergency care. The hospital doesn't turn them away to die in the street. They don't pay the bill. They go into bankruptcy instead. The hospital makes it up on all the paying customers (the insured). Your $10k is already paying for the ones who don't have insurance. Medicine is already socialized!

Now, if we can acknowledge that, can we do the fiscally responsible thing and make sure everyone can get preventative medicine?

> Preventative care is cheaper than emergency care

A trope without rigour. The health community is even putting into question the value of yearly checkups (i.e. https://www.health.harvard.edu/blog/a-checkup-for-the-checku...).

It's not "flipping a switch".

> When everyone (including the unemployed) can get preventative care, total costs go down.

This is one side of the coin: when everyone goes to the doctor on a cold, total costs go way up. Its an economic problem, it requires economic solutions. Private insurance, for all its bad rep, has very strong incentives to have proper utilization. More so than government: when a patient gets hospitalized, insurance loses money. Govt never loses money!

> Your $10k is already paying for the ones who don't have insurance. Medicine is already socialized!

No need to change it then...

>Private insurance, for all its bad rep, has very strong incentives to have proper utilization. More so than government: when a patient gets hospitalized, insurance loses money.

"when a patient gets hospitalized, insurance loses money...." and the patient gets the treatment they need. you seem to have forgotten that part.

"Proper utilization", in a private sense, is the same as "maximize shareholder value". Anything that damages shareholder value is not "proper".

Sick people have very strong incentive to want treatment. HEALTHY people have very strong incentive to want treatment for sick people. Private insurance has very strong incentive to take in as much money and pay out as little as possible.

> and the patient gets the treatment they need. you seem to have forgotten that part. > "Proper utilization", in a private sense, is the same as "maximize shareholder value".

Access - Quality - Cost. Somebody has to make a choice. If what you care about is unabated and unrestricted access, get ready to pay more than what you pay today.

> For that service you need to pay more than the 10k

Not necessarily, you may just need to ensure that insurance companies put the needs of their patients before the need of the shareholders.

Insurances don't provide medical care: they don't have patients, they have clients that wish to not pay doctors directly and be protected from the risk of sudden high costs.

Don't complain to your car insurance company that cars are expensive!

Plus your family and friends who may not be as well off as you ALSO get health care. That's valuable.

Socialized programs ask you to pay according to your means, so if this person can afford 10K, they'll pay 10K, and if they can't they won't.

What if there were other ways besides raising taxes to fix the problems with our current system? How would you feel about that?

As long as the other ways require less effort for the patient/care receiver to worry about where to find quality health care, I'm game.

If I have to shop in a market full of confusing terms, exceptions, reams of paperwork (I am not a medical expert) the solution is already crap. When it comes to health care, the a provider should not have an opportunity to gain advantage by segmenting the market into different groups or risk pools, or hiding behind long and complex policies that require a subject matter expert to understand.

Before the ACA, a colleague with a small consultancy (IIRC ~10 people) discussed how ridiculous the term “market” was: none of the companies would even tell him the coverage details for the plan (“each member will get a booklet”) so the idea of shopping around was positively Kafkaesque, lacking basic information and having substantial time and cost penalties if you realized you made a mistake and wanted to switch.

You've been pushing this reply around to various comments without actually mentioning any of these other ways. What are you proposing?

I'm proposing we don't accept higher taxes and/or universal health care as foregone conclusions. I think we can do better than just sitting here on hacker news and smugly mocking those who "don't get it."

If you take away my 20k health insurance premiums (many commenters are not counting employer contributions), tax me an extra 20k, and now I have no deductible and can switch jobs fearlessly, how am I not better off?

Maybe you should make some specific proposals. Otherwise your statement is totally empty.

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