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> I don't think you can argue effectively that granting the same medical care to all as a matter of law will fly. People will always find a way to get better care if they can afford it.

I’m not sure anyone is arguing that. In almost any country with single payer health care you’ll also find a thriving market in private health care, but they’re typically competing on things like providing private rooms and maybe a shorter waiting list rather than whether you get to live or die.

It's not live or die in America, in the worst possible scenario you may go into a deep debt, but they won't kick you to the curb if you're dying.

Nope, it's definitely life-or-death.

According to a 2009 study, 45000 people die annually due to lack of health insurance in the US[1]. Due to the ACA there are now more people who are insured but it's still a massive segment of the US population (not to mention that healthcare plans have been covering less and less over time).

The number of people who die due to lack of healthcare is ZERO for countries that have universal healthcare.

Fourty. Five. Thousand. Every. Year.

[1]: https://news.harvard.edu/gazette/story/2009/09/new-study-fin...

My point was that the hospitals don't turn you away if you are in need of urgent care. That statistic is looking at patients who avoided regular healthcare due to lack of insurance. Which is a problem.

And if we're looking at that, you have to look at the other side of the coin. Socialized healthcare systems have much larger wait times and you can find deaths attributed to those, so it's disingenuous to say ZERO people died in countries that have universal healthcare.

More research needs to be done before enforcing such a system on a wide scale in America. There has been data suggesting deaths and suffering related from long wait times in Canada. Then you have the increase of Canadians coming to America to escape the wait times. As well what we've seen with VA and ObamaCare wait times.

> 25,456 and 63,090 Canadian women may have died as a result of increased wait times between 1993 and 2009

https://www.huffingtonpost.ca/bacchus-barua-/wait-times-cana...

Basically you trade the fear of going into debt and not getting healthcare vs wanting to get healthcare and not being allowed to for an arbitrary amount of time. There are more pros and cons to each system, but my point is that socialized healthcare systems has it's fault and certainly does cause deaths in some instances.

> 19.8 weeks between referral from a general practitioner and receipt of treatment

> across the 10 provinces, the total number of procedures for which people are waiting in 2018 is 1,082,541

https://www.fraserinstitute.org/studies/waiting-your-turn-wa...

> Socialized healthcare systems have much larger wait times.

That's because in the US, a very large proportion of people go to the ER instead of the normal in-patient process that universal healthcare countries use for non-emergency problems. US hospitals have very long waiting times for ER for this reason. Here in Australia, I've needed to go to the ER before and there wasn't a waiting time (though obviously this depends on the time of day and what hospital you go to).

This is all due to lack of funding and staffing for hospitals, not for any other reason.

> More research needs to be done before enforcing such a system on a wide scale in America.

I'm pretty sure the existence of this system across the developed world is sufficient research to show that it works. Even with these worries you have, the healthcare system would be orders of magnitude better than what you have now.

>The number of people who die due to lack of healthcare is ZERO for countries that have universal healthcare.

The design of any health care system needs to acknowledge the fact that people are going to get sick and die even with an unlimited budget, and there is not an unlimited budget.

We can't all get billionaire treatment for our ailments, no matter what system we have in place. We should be adults and accept that

In universal healthcare systems, the government negotiates prices of treatments and drugs -- so there are very few treatments that cost so much that you can't be covered by public (or private) insurance.

Obviously people will still get sick and die, that's unfortunately part of the human condition. But I reject the argument that life-saving treatments being impossible to afford by ordinary people is something we should accept.

I didn't mean to make the case that we should forget about the whole thing because we're all going to die anyways.

It's just that in this whole debate it seems we never have the honest discussion about how to deploy limited resources - i.e. how to ration care under a socialized system, or how to subsidize care under a free market system.

I believe that if we discussed it from this perspective perhaps the two sides of this debate could find some common ground.

That is a conversation worth having, though I hasten to note that the "limited resources" discussion (assuming you're talking about money) only ever turns up when talking about progressive policies such as universal healthcare or free college.

It's curious that nobody ever complains about limited resources when discussing increasing the military budget or "corporate welfare" through tax breaks and bank bail-outs. It leads me to wonder whether it's actually a significant problem in the first place or if it's just another talking point (there is quite a bit of evidence that deficit-spending is not necessarily a bad thing in-of-itself, what matters is what that money is being spent on).

Or you put off getting care because you don't want to spend a four-figure sum only to find out it's a problem that will resolve itself. I know people, with insurance and without, that have done just that.

It's definitely live or die in America. If you need a stem cell transplant to avoid dying from leukemia, they won't do it unless you can afford the medications you will need after the transplant, which almost no one can afford without insurance.

Agreed. I guess my point, more succinctly is that this will always be the case, regardless of from whom folks obtain their insurance. A better question might be "does employment-based insurance make medical care MORE or VERY inefficient / unfair".

The fact that the rest of the developed world has universal healthcare (in one form or another) and most have better health outcomes and overall public health than the US tells me that your theory is flawed.

It should be noted that the Bernie Sanders proposal actually does allow for supplemental private insurance (for elective surgeries, or shorter waiting times). Most countries with universal healthcare have a private insurance industry, it's just that you get a basic level of care from government-provided free insurance.

My theory is that no matter what there will be things that are unfair or inequal in healthcare any time folks have more resources than others to apply to treatment. I agree with you that based on overall spending and outcomes something needs to change a great deal. I admit that even after reading the original article I don't really understand why employer-provided care is creating these asymmetries except to say that typically employer provided care is more reasonably priced to the employee than comparable coverages to a private citizen, because of course it is. It's an incentive.

>The best way to ensure fairness and efficiency is to get the data out there and available, and make healthcare more like a market instead of a black box.

Markets without perfect information are neither efficient or fair; I think it's reasonable to say that no healthcare market can have anything approximately resembling perfect information.

Also the idea of efficiency in healthcare is problematic. Does efficient healthcare means refusing care to old people and to people who need heroic interventions and instead focusing care only on interventions that provide a high return of healthy productive years per $?

I would like a clear articulation of efficient and fair in this context.

If I could choose which hospital to go to based on available data, pricing, luxury levels, outcomes, etc so that I understood the costs I would incur (at a high level) to get that care, and then get quotes from different places, I think that would go a long way to ensuring at a minimum that folks understood what they were getting, rather than being forced toward outcomes due to lack of information.

As for "efficient" and "fair" I would also be interested in a better definition there, one the article didn't quite provide to my satisfaction based on its question.

No market has perfect information, but many still work pretty well. Just knowing what a healthcare service would cost before you get it would be a huge improvement in the US. And how about requiring providers to charge everyone the same price for the same service, instead of radically higher prices for the uninsured.