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Comment by hello_friendos | Hacker News Reader

Why do Americans continue to accept this terribly flawed systems for their 'healthcare'.

Would you please not post unsubstantive comments on divisive topics? That's flamebait, and you predictably generated a flamewar. These are tedious, low-quality discussions and we don't want them here.

https://news.ycombinator.com/newsguidelines.html

Edit: this account unfortunately has quite a history of posting like this—and we've warned you before—so I've banned it until we get some indication that you intend to follow the site guidelines in the future. We're happy to unban anyone who gives us reason to believe that they want to use HN as intended: for thoughtful, curious conversation, not political or ideological or national battle. If you'd like to commit to that, you're welcome to let us know at hn@ycombinator.com.

None of the responses to your question seem to hit at what I believe the source: racism. Single payer has met resistance from the right because people have this misguided notion that they will have to pay for "other peoples mistakes", which is just dogwhistle.

There's also the fact that while it's going swimmingly (job, healthy, etc), it doesn't seem so bad, so there's little incentive to change it... until it goes wrong, at which point you're too preoccupied to change anything.

At least that's how it seems to me, and why for some people on the left, healthcare isn't the most important issue to tackle. Having humans die in agony or poverty is terrible, but having it happen to your fellow countrymen is unforgivable.

It seems pretty bad while it's going swimmingly too, since people pay through the nose (in both insurance and taxes) to be covered: https://www.healthsystemtracker.org/chart-collection/health-...

It's not racism, it's classism.

I think this is correct. If we accept that stress causes or exacerbates mental health issues, and if we accept that money can reduce stress to a degree, then it makes sense that the poor will have more mental health issues, and it's one more thing that the wealthy can see that appears to be fundamentally different in outlook or resilience between themselves and the poor, confirming the narrative that it's really their exceptionalism that is responsible for their current situation, and not luck or inherited wealth.[1] Yet another differentiator that prevents empathy.

1: That's not to say there aren't exceptional people that are wealthy, just that being exceptional is not a prerequisite to being wealthy, or even becoming wealthy (but I'm sure it helps in that case).

So how does that explain the poor people on the right who don't want to change the situation in the way the left wants are what?

Because among people's worst traits is the pleasure in knowing someone is worse off than you, especially if they are from an identifiable group you already dislike.

Your life might be miserable due to poverty, but you might still view that as a preferable situation compared to another even poorer group getting the same universal benefit as you, even if that universal benefit would make both of you better off.

This is also the strategy that white former slave owners used to disrupt a more equitable reconstruction in the South after the civil war. They took all the poor white folks who were feeling a certain class alliance with the former slaves and said, "look, we know you're dirt poor, but at least you're not like those people." And created the race divide that's still, of course, prevalent in the US.

Sure the wealthy fostered those feelings but I think the fact that a war was just waged on their land and lead to their economy being upended and blacks were the only ones who seemed to benefit probably had something to do with it. White southerners weren't going to instantly give up all the beliefs that they used to justify slavery just because they lost a war.

For anyone who'd like to read more, W.E.B. DuBois was the first person to write about it, and this is a nice little jumping-off point:

https://psmag.com/social-justice/taking-freedom-capitalism-d...

It's useful for a politician working for wealthy interests to have the lower class population fragmented and a portion actively voting against their own shared economic interests, rather than a united and motivated voting block. The only war is the class war, and racism is the tool politicians use to mask that fact from the masses. Sadly all to many people on the right buy into racist rhetoric as the substance and fail to see it as the facade that it is.

Race and class in most of America is deeply intertwined.

And it really shouldn't be. A poor white supremacist and a poor minority have a lot more in common than they would like to admit, and the rampant political rhetoric surrounding race is designed to keep the lower classes in constant conflict, fragmented, and in the case of poor republicans, reliably voting against their own economic interests.

There are plenty of reasonable "mistakes" people make; smoking, diet, exercise, alcohol, idiocy, stunts, etc, without having play the racist card.

Lots of people don't want to pay for problems they don't have control or influence over. You don't have to be racist, just a bit myopic.

Insurance premiums rise to incorporate the costs of these mistakes. We're already paying for other peoples mistakes, plus a healthy profit for a private corporation.

>diet

Segregation and redlining have led to people of color living in marginalized communities in "food deserts" where there are few to no fresh food options, so people that live there (who are too money-poor or time-poor to travel for groceries) have to rely on processed and shelf stable food, leading to a very poor diet and the health problems associated with it.

Just because the immediate observation isn't related to racism doesn't mean the root problem isn't racism.

The whole insurance system is that your monthly premium is paying for someone else's treatment. Universal healthcare is just a larger insurance pool that brings costs down for everyone in it.

Oh, I agree 100%.

I just get tired of bad faith racism interpretations.

A lot of people are making a lot of money. Either through positions that shouldn't exist or taking advantage of inflated prices.

Plus we have had decades of propaganda about public sector waste, that doesn't care about or ignores private sector waste.

> A lot of people are making a lot of money. Either through positions that shouldn't exist or taking advantage of inflated prices.

Yep. Just look at health care and related salaries in other countries. There are many fewer people in pharmaceutical sales in the EU or in Asia. Likewise, while being a doctor is a comfortable career in EU countries, no doctor earns $400k+ per year, like some surgeons/specialists in the US do. The problems aren't unique to any specific role in the US system, they are ubiquitous.

I am generally opposed to any major health care reform that the AMA, the AHA, PhRMA, or AHIP is in favor of.

There are plenty of consultant surgeons and specialists practicing on Harley St in London who make way more than USD400K/annum.

Interesting. And they are making that money via just NHS, or is there additional private insurance involved? (I'm in the US, so I'm learning here)

They work in both systems, but make the big money in private practice, which is often paid by insurers, but sometimes as cash. For instance Google Cyrus Abbasian; he works in both systems and I recently paid cash for a consultation with my son.

Thanks for quoting 'healthcare'. I make it a point to refer to it only as 'health insurance' because that it what it is.

I think rebranding it as 'care' was a real slick move by some marketeers and absorbed by the media. Every time i see the word repeated i feel like they won their little subliminal game. Recently i read someone using the words "climate disruption" instead of "climate change" which i rather liked.

This is a loaded question with many different factors. One factor is privatized insurance is only concerned about turning quarterly profits over providing care. Additionally they are not held accountable for unethical practices as they continue to break the law without any ramification.

We don't, but Americans have different answers for how to fix it. Some want to liberalize and deregulate healthcare, allowing the market to actually serve consumers. Some want to make it single-payer or nationalize it, which given the track record of the federal government doesn't sound like a good idea to many.

> given the track record of the federal government doesn't sound like a good idea

For the vast majority of Americans, their only interactions with the federal government are through social security and through medicare--two of the most widely popular functions of government. Government has plenty of failures, but that's the nature of enterprise writ large.

Obamacare was a massive failure for most Americans, and the VA is filled with horror stories. A large portion of young people don't think Social Security and Medicare will be around when they're older. And the financial stability of those systems doesn't look very good.

Government can with the stroke of a pen decide to fully fund any program. Even in the case of social security it's just an accounting mechanism. Anyone who says that social security and medicare depend directly on a larger taxable population today is lying. Young people being told that today are being lied to.

> Government can with the stroke of a pen decide to fully fund any program.

This is largely true.

Notice how easily our government, "with the stroke of a pen", can fully fund state-sanctioned violence and institutions of violence.

And we the people have no problem with this; some of us even cheer it on; some encourage their sons and daughters to join up to these institutions of violence. Others shake the hands of those who already are a part of it, and say "thank you for your service" - in almost reverent fashion.

I'm not saying we don't need these people or those institutions - they do serve a needed purpose - but let's not pretend that need is anything but ultimately for terrible violence.

Yet - we and our government somehow has a problem fully funding things like healthcare, education, infrastructure, and a whole host of other programs, which again could be easily done, "with the stroke of a pen". But we'll hem and haw on that all day long...

...our teachers will never be thanked "for their service" in reverent fashion.

Unless of course they were veterans of those institutions of violence.

What indication, given the current healthcare environment, makes you believe that any health insurance company is ever going to prioritize people and their health over profits?

It's easy to say "it's too hard, and the government will futz it up," but "the free market" produces predatory companies pursuing profit.

The free market, where competition is involved, produces companies that serve the interests of consumers in the most efficient way.

The current healthcare environment is not a free market, government is involved heavily at every level. Which is the main reason it sucks.

This is an oft-repeated sentiment, which I've never seen actually happen. The free market pursues profit. Not customer needs. The most "efficient" thing to do is fleece customers when they're at their most needy: when it's either pay up or die.

How do you explain all of the successful socialized medicine in other countries, if government involvement = healthcare sucks?

See Lyotard and his notion of Grand Narratives. The uniquely American Self Made Man conveniently overlooks wealth accumulated by men vis a vis free labour. To constrict these men, to suggest their wealth wasn’t “earned”, is to deny the other men of lesser social position of the “opportunity” to do so themselves.

That is, the myth perpetuates the energy that permits the men running these insurance companies to make billions. All reinforced by the whimsical meth-addled pipe dream that “I could be king too, one day” of the legion of white men of lesser caste.

"John Steinbeck once said that socialism never took root in America because the poor see themselves not as an exploited proletariat but as temporarily embarrassed millionaires. This helps explain why American culture is so hostile to the idea of limits, why voters during the last energy shortage rejected the sweater-wearing Jimmy Carter and elected Ronald Reagan who told them it was still 'morning in America.' Nowhere does the myth of progress have more fervent believers."

—Ronald Wright

Precisely.

Reinforced yearly, daily, and minutely by the constructs of media.

US conservatives. Most attempts to fix this system are stonewalled, blockaded, or hit with waves of propaganda against fixes. Some people are making good money compared to something like single payer. And profit is always more important than people.

I don't think there is a obvious answer to the question of what the health care system of the future should look like.

In South Africa, public hospitals are terrible and private hospitals are generally good and operated as far as I understand in a similar fashion to the US counterparts.

This may suggest that our future should look like the US's present. But it is a complicated subject. To start off with, many of the doctors at public hospitals are good doctors, paid well and respected. However, by a combination of being a new nation, having diverse cultures, having a high Gini coefficient (or <insert here coefficient>), having terrible rural schools (and excellent middle and upper class schools), etcetera, our public health care is frankly terrible. The hospitals are not well stocked, you'll wait for hours, they'll amputate your leg unnecessarily.

In our scenario we have both the European "socialist" model, which worked well during South Africa's past. However, once the hospitals had to cater (and rightly so) for the full population, including poor and formerly disadvantaged, the system could not cope. So now we also have the American "money driven" model, but of course it is expensive and you have to have a medical fund or you are out.

I don't think it is a question of idealogy. It's a simple premise. There is the world of sick people (which you are lucky if you join only a few times a year). And there is the world of healthy people. The premise is that sick people need to be treated. However you get there is perhaps politics, but I see it simply as a resource and logistic problem that need to be approached with commitment and expertise.

This simple premise: to heal the sick, is how I see the early doctors that came to Africa [1].

Of course OPs topic is more complex, mental health, but my point is that idealogy is often lost on people (including myself) that have more obvious challenges in their midst. And mental health in South Africa is an even more pressing issue. [2]

[1] See for example: https://en.wikipedia.org/wiki/Albert_Schweitzer

[2] Not going to share a link since they all seem written according to rather Trumpian standards. But about 90 mental health patients died in SA in one incident in 2017 due to what can maybe be termed "bureaucratic incompetence".

Apparently a growing number of us aren't.

What alternative do I have as an American citizen?

Cold war Era propaganda that has many people still believing that "socialism is when the government does stuff" plus a pretty frightening lack of critical thinking skills among many Americans

american exceptionalism

<sarcasm> Because they do not like it when Goverment Regulations work in their favour. They love their right to have freedom to choose guns, big corporate bailouts,poor healthcare. </sarcasm>

On a seriously everything including regulations have a place in civil society.

Because powerful moneyed interests have convinced many of them that we have the best healthcare system in the world and any change would make it worse.

True, but though this may sound arrogant, this reinforces my belief that people are generally too stupid to think about cause and effect rationally. Nearly every time I or my family have to deal with the US healthcare system I end up lamenting it's insanity, from lack of transparent pricing, lack of care follow-through when my elderly relatives are treated, the super high expense for simple visits or procedures, etc. And I'm someone with good health insurance.

To go through this system and think "well it couldn't possibly get any better than this" makes me think one's capacity for either self delusion or idiocy knows no bounds.

A big problem is that healthcare isn't often truly debated rationally.

When the ACA was going through Congress, there were accusations of "death camps" flying around that the new healthcare system was going to round up and exterminate old people. These rumors were sometimes pushed by congressional candidates and high-level party officials.

Fast-forward to today, and you see opponents of the ACA claiming that they're trying to protect preexisting conditions coverage too, when they're absolutely not.

Our political system rewards lies and disinformation, and when a significant portion of the population believes these lies without any skepticism, then we're no longer debting rationally.

> Our political system rewards lies and disinformation, and when a significant portion of the population believes these lies without any skepticism, then we're no longer debting rationally.

I know it's the topic under discussion, but today your statement applies to virtually everything under debate. We are in a very bad situation, that only seems to be spiralling downward, to what end is anyone's guess.

Not to devolve the conversation into a partisan debate, but when you have the former speaker of the house telling a reporter that how people feel is as logically true as hard data, we have a problem. And it's not going away any time soon.

https://youtu.be/LrerNmwpzHY?t=59

> one's capacity for either self delusion or idiocy knows no bounds.

The fact that it's the 21st Century, and despite all the progress of science that religion still exists, should give you pause.

We reject the taxation of the common man that socialized healthcare at the rates many of the example countries have. It's less about our healthcare, than it is about the manner in which we pay for it.

Don't get me wrong, it's a young man's system. You pay in when you are young, so you can have it when you are old. This is clearly the UK model after WWII and why its so popular here as an idea as our sister-mother country.

Flawed? Maybe ... terrible? no.

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