Hacker News Reader

Universal healthcare would be a great boon for employers, as then they would no longer have to worry about providing and paying for it as part of employee compensation.

I get that now. I didn’t understand it for a long time.

While a government-run universal care program doesn’t thrill me, I find the current employer-based system to be borderline immoral.

The more I deal with the system the more it strikes me as a corrupt, crony deal to make workers more dependent on their employer, depress wages, and drive up medical industry profits.

It will also benefit lower income employees and consumers who will see good wage/price changes relative to taxes.

Another possibility is a cap on drug profits declining with drug age. This will allow enough market to avoid having to guess production costs in advance and set them in stone. The drawback is incentives to efficiency. Perhaps a mixture of price cap and profit cap would hit the sweet spot.

“Borderline” immoral?

Unemployed people doing gofundme’s for insulin...

My partner and I have, for the last couple months, been going through the medical system hoops over a broken elbow and resulting surgery. We've fiiiiinally started getting the bills in, along with the 'Explanation of Benefits', and so far 100% of the bills have included a patient-oriented error. And then spent many many hours on the phone getting them corrected.

It's goddamn criminal.

[edit: it's also 'fun' to think how much harder it would have been to identify the bad charges prior to the ACA's explanation of benefits requirements.]

If universal healthcare were to be implemented, they'd probably copy what most other countries do: financing it through taxes paid by employers for each employee.

In France, if you want to spend 120k euros on an employee, you'd pay about 40k towards healthcare and the national retirement plan (and a few other things). The employee gets paid 80k, and then pays income tax on that. Income tax is quite lower than in the US though. All in all, my experience has been that the taxation levels in France are comparable to what you'd pay if you lived in New York City.

What is the income tax rate in france roughly?

In us, federal reaches to 36% or so on highest bracket, and about 10% on states like california. I dont know how much is average, however.

From years ago when I lived in CA, taxes for mid-range income were comparable with France (and Western Europe in general), just itemized differently. The main difference in my opinion was in the quality/quantity of public services one got.

I can give some information from Finland, which I imagine is relatively similar to France. For a hypothetical 100k EUR/year salary you'd pay total 40% income tax. I think the top bracket is somewhere north of 50%. To more accurately compare the taxation, I think it is prudent to mention that we pay usually 24% VAT for most goods we purchase, which iirc is bit higher than typical sales taxes in US.

Taxes on employers are taxes on employees. Employers have set compensations that include the payroll taxes and insurance plans and everything. Why have an extra layer of obscurity when you could just tax income directly? Unnecessary complication that makes doing business harder just so the taxes are hidden from the working class.

Probably because paying that tax is just extra paper work that doesn't have to be done by the employee. So let accounting of your employer figure it out.

Income tax on the other hand is something the employee will have to figure out himself, because he may have other income streams.

This keeps the work where there is expertise as much as possible.

I don't know the particular situation in Croatia when it comes to how it cross-finances private healthcare but I would assume that this patient was billed for everything they recieved accordingly and not directly subsidized.

Of course there are indirect/externalized cost like the the health worker education system, potentially having hospitals and their equippment set up not to maximize profit but for coverage in the population etc. which this patient now may be freeloading on.

There is another perspective though if you consider free movement of labor in the EU (and to some extent globally for highly educated individuals) and the comparatively low salaries for medical professionals in Croatia and other cost-saving medical travel destinations (Hungary, Poland, Thailand, Mexico and others). If the doctors in the country can make an attractive buck on the side doing private practice then this alleviates the pressure to some extent. Especially if it allows the more senior doctors to stay in country and thus continue to train the next generation in med schools and the facilities.

Now I don't have a source to back it up but my feeling tells me that it is a net-positive activity for the destination countries. Depending on the scale of business, the foreign money might buy a new machine that other patients can use as well or quality improvements via the international certifications and accreditations.

That is not guarantee against potentially canibalising the local social system and could in worst cases lead to a two-class system so i suppose an adequate system to regulate access and subsidize for social fairness is in place where private and public seem equally "healthy".

Full disclosure: I work in tech at https://www.medigo.com We help facilitate global medical travel and publish prices to bring the best of capitalism to work in an ethical manner. We also have our own critical illness insurance for global treatment available for employers.

The current American system is heavily regulated and nowhere close to a free market.

> Thus in an unregulated market, medical practitioners can very nearly charge whatever a patient is capable of paying, and in my experience that’s exactly what they do.

Emergency situations are exactly what insurance is for. Free market advocates don't expect patients to shop around in that kind of situation, but they do expect them to shop around for insurance, general practitioners, specialists for non-emergency treatments, etc.

Right now, none of those things are realistic for the vast majority of Americans because the government has incentivized and now mandates employers to provide comprehensive insurance, which introduces a layer of opacity between consumers and prices.

You make some okay suggestions but even more can be done without resorting to mandates:

1. Remove the requirements and incentives for employer-provided insurance, introduce a program for transitioning employer insurance into private individual/family coverage.

2. Reduce or eliminate medical patents. You suggest price controls, which are a bad idea, commonly leading to shortages. Pharmas can't charge such outrageous prices when faced with competition.

3. Reduce or eliminate minimum coverage requirements, introducing a new type of medical plan that covers only catastrophic unpreventable emergencies.

4. Reduce the onerous nature of the FDA to a level on par with such agencies in other countries. Make it cheaper to develop drugs. The FDA should have two branches: safety and efficacy, with separate certifications. A drug can be released whenever it is safe, but they can't directly advertise until it's proven effective.

If a doctor says the cost of your life, or your child’s life, is X... who is going to shrug that off and refuse to pay?

Of all healthcare dollars spent, what percentage are these kind? 20%?

Well, there is a reason why infant mortality is so low in western countries, so you can imagine pretty big.

Lowering of infant mortality was mostly driven by preventative measures.