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Comment by ds | Hacker News Reader

The reason is pretty simple to understand- Those who can afford health insurance dont want their standard of care reduced on a 'free for everyone' system. Looking at the existing bureaucratic issues the current 'free' health programs have ( VA, Medicare, Medicaid, etc.. ) seems to indicate their fears might be well placed. In the VA for instance, you can go months just to get a first visit.

Basically, people who have a job and get health insurance dont want to be lumped in with the commoners and get worse care/longer wait times/less options/etc... Its fucked up, but its not hard to understand the pushback. They dont want their health care experience to turn into a 6 hour trip to the DMV.

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That doesn't explain why people who can't afford health insurance are opposed to universal, government-funded healthcare, which is what the comment above you was about.

Meanwhile, I (SRE at a hedge fund) and all my liberal coastal elite friends can absolutely afford private doctors in an emergency without having to think about cost up front, and we do support universal healthcare—and we know it would be a larger tax bill for us.

(BTW, in practical terms, putting liberal elites in well-paying, politically-connected industries on your healthcare system is a great way to make sure it doesn't turn into the VA. America cares deeply about our happiness. It doesn't care about our veterans and sort of wishes they hadn't survive, so we could just remember their sacrifice instead of actually facing up to what we did to them.)

for a lot of deep-seated structural reasons, the US tends to be pretty bad at implementing most citizen-facing services. it doesn't seem unreasonable to think that we would also do much worse at universal healthcare than the europeans. for the services that the US does actually offer, we tend to spend more money and produce worse outcomes.

> (BTW, in practical terms, putting liberal elites in well-paying, politically-connected industries on your healthcare system is a great way to make sure it doesn't turn into the VA. America cares deeply about our happiness. It doesn't care about our veterans and sort of wishes they hadn't survive, so we could just remember their sacrifice instead of actually facing up to what we did to them.)

this is a pretty common talking point, but I don't really see this happening with the systems that already exist that wealthy people have to use. I, an upper-middle class white person, still have to take at least a half day of PTO any time I need to go to the DMV. my dad, wealthier than me, still had to spend a whole day at city hall disputing a $40,000 water bill (the city doesn't even have a functioning water meter on his property because DPW paved over the access; it's been "estimated" for twenty years).

>and we know it would be a larger tax bill for us.

It would quite possibly be a net saving. The UK, for example, spends less public money on healthcare than the US. There's no necessary reason why you should end up paying more in taxes for universal coverage than you pay currently for insurance.

convert your USD salary to pounds and then do a UK tax calculator. compare the UK NHS tax to your yearly premiums and copays plus the employer contribution (should be on your W-2). when I did this, I found that I would pay about $2k more for the UK tax than my total healthcare costs in the US (including the portion paid by my employer). I'm sure lots of people on this forum make even more than I do.

there are definitely some good arguments for universal healthcare, but software devs should not delude themselves that they will do any better than break even in most cases.

edit: probably not true, I didn't investigate the UK tax system enough.

What is the UK NHS tax? There is no such tax, as far as I'm aware. You may be thinking of "National Insurance", but that is not specific to the NHS (and nor do all NHS funds come from National Insurance).

I'm sorry, it's actually called national insurance. am I making an incorrect assumption? I'm just going off this tax calculator: https://www.moneysavingexpert.com/tax-calculator/

Yep, incorrect. National Insurance is not an NHS tax.

sorry to be obtuse, did I just call it the wrong name or is it completely different? I'm american and I just assumed that NHS is the government org that handles healthcare and a mandatory contribution is pretty similar to a tax.

See my comment above. Not all of National Insurance goes to the NHS, and not all NHS funds come from National Insurance. There exists no special tax whose revenue is earmarked for the NHS. Thus, there is no easy way to see how much of your pay you are contributing to the NHS. Similarly, someone in the US can’t easily see how much of their pay goes to the US military or to the National Science Foundation.

edit: On an individual level, a lot will depend on your income, and how expensive your US health insurance is. Here is an informative post:

https://www.quora.com/If-you-make-100-000-in-UK-what-percent...

That works out to about $560/month for someone with a salary of $100,000. If you take into account employer contributions, that's still less than a lot of Americans are paying. If you're on a lower income, you're likely to be paying significantly less in the UK for much better coverage.

And I almost forgot - copays! The amount you're paying in taxes in the UK really is paying for virtually the full cost of your treatment when you're sick.

understood, ty for the explanation.

>That doesn't explain why people who can't afford health insurance

It's because doctors et al don't want to work for less than $x/hr and there are people who don't produce enough to trade with doctors or prefer to spend their money on other things. There's no way to get a free lunch out of this.

Respectfully need to split a hair on the VA comment: once you're into the VA system, their access is incredible. If you can't get an appointment in less than 20 days, or if you need to drive more than 30 minutes, they'll pay for you to see a doc in your community. So you certainly do not need to wait months to get an appointment at the VA.

There are veterans who are still waiting to get paperwork processed to show a service connection for health issues -- they're still waiting to get into the VA system -- but that's a different bureaucracy. The wait time at most VAs once you're in the system is substantially less than through my employer-provided insurance.

Is 20 days period for seeing your family doctor or some kind of specialist?

I'll preface what I'm about to say by pointing out that I am all in favor of universal healthcare.

BUT.

I have a hard time thinking of getting a doctor's appointment in 20 days as "incredible access." If I need to see a doctor, I can get an appointment at the local clinic within a day or two. And my employer-provided health insurance is pretty crappy! If I tell the clinic I think it's important (like I'm in pain but it's not an emergency), they'll try to fit me in the same day if possible.

And that's not even considering the Urgent Care facilities 15 miles away..

> I have a hard time thinking of getting a doctor's appointment in 20 days as "incredible access."

According to kaitai, those "20 days" are the absolute upper boundary. As a German, I don't find that upper boundary particularly high. When I need to see a specialist about something that's not an emergency, a wait time of a few weeks is normal since there are only so many specialists per area.

But does it really reduce your standard in those systems? I know it's really hard to properly compare the costs of something like this between countries, but it would be interesting to know how much you need to spend on healthcare in the US to get similar benefits as in some European country purely with public healthcare. Since another benefit of public health care is that you can be reasonably sure people around you are healthy and not dragging themselves to work with god knows what since they can't afford treatment. Be it your colleague or the cashier at the store.

It's actually quite baffling how Americans generally seem much more generous, warm and helpful to their fellow human beings, but the idea of potentially paying for someone else's medical treatment seems absolutely outrageous to most.

> It's actually quite baffling how Americans generally seem much more generous, warm and helpful to their fellow human beings, but the idea of potentially paying for someone else's medical treatment seems absolutely outrageous to most.

this is just my personal take as an american. I think the disconnect has to do with locality/proximity. americans who have some surplus income (ie savings and not living paycheck-to-paycheck) are quite willing to help people they know with cash or free labor and will happily donate time or money to help people in their broader community. what americans hate is being forced by the government to help people far outside their circle. I think partially we are suspicious that the money doesn't get where it's supposed to go intact, but there's also an element of "fuck them, what do those people over there have to do with me?"

obviously this is suboptimal as entire communities can be disjoint and have serious imbalances in funds available. also it tends to leave a lot of efficiency from scale on the table. but perhaps this at least explains some of your bafflement.

This might be true but still sounds like the information given about public health systems is biased.

In Spain the public health system is still better than the private one and most of the long and most expensive treatments are done within the public circuit. You can wait months for "minor" issues and there is where a private insurance can help (actually I think is beneficial for the system that anyone being able to afford a complementary private insurance should pay for it)

Also, having experience in both systems I feel better when I am treated by someone with no economic interests.

It’s funny, I live in Japan where contrary to my experience in the states, I can go see a doctor any time - just walk in. No need for specialist referrals either. If doc says I need to see a specialist, I just walk in.

US politics, specifically from the right, lobbies pretty hard and uses fearmongering to the max. Lower standard of care? What’s that? Wait times? Sure, you may wait a bit longer that one day, but someone will see you. I remember when my wife needed to see a therapist for her depression, we had to wait 2 weeks to see someone “in network” in CA. This was with good insurance. Here, walk in, wait, see doc, walk out. My fellow Americans need to wake up to reality and try to understand that powerful interests are lobbying against you and using fear as primary means for arguing against “universal” healthcare. Let me be clear, I still pay a monthly premium and I still have co-payments, but one this is for sure - it’s practically impossible for me to go bankrupt due to a medical issue.

Which means there are more hospitals needed, more doctors and more nurses. So it may even create more jobs.

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