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Comment by Mirioron | Hacker News Reader

But a lot of countries dubbed as having "universal healthcare" don't actually have universal healthcare. A lot of them only cover some services and still require you to pay into the system to receive care.

It's not sunshine and rainbows in many European countries either. Maybe it is that way in the rich ones, but not all of them.

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You are right, but it still makes sense to compare. I am from Bulgaria, the poorest country in the EU and I have been living in the US for a while with an ok salary for a scientist. I keep an average (for the country) health insurance in both countries. I feel more secure when I am in Bulgarian health jurisdiction price-wise and emergency-wise (simple things like knowing no one will try to trick me into paying for an ambulance ride, that there are no gotchas about which provider I need to see, that my insurance will never be prohibitively expensive to keep, etc).

I completely agree with that last part. That's one of the biggest arguments to move towards a more universal healthcare system.

As a Dane living in Bulgaria, and who lived for a while in America, I too agree that I feel more secure with the Bulgarian health care system than the US one

It might not be sunshine and rainbows, but when i read about Americans taking an Uber to the hospital because they can't or don't want to afford an ambulance i can only shake my head in disbelief.

Yeah, ambulances should absolutely be covered through taxes. At least the ambulances people can call through 911/112.

I once ran into a woman with stage IV cancer and a nasal medication infusion pump who was on her way to a bankruptcy hearing to justify keeping her clothes and living arrangements while the hospitals, doctors and insurance companies vampiricly liquidated her life and all of her possessions. That's where America is right now. If you're sick, you'll likely go bankrupt (it's the leading cause) and you still won't necessarily be able to afford proper treatment.. and then if you die, your family will be most likely be destitute.

PS: "rugged individualism" based on "pulling oneself up by their bootstraps" was taken from a children's fairytale about an impossible task.

Sounds like you may not be from Europe. In Europe nothing is perfect but man, reading how the system works in the US is very depressing compared to how it works here.

I am from Europe. I'm speaking from experience here - I've had years with no access to healthcare. It just meant that I didn't go to a doctor when I was sick and I just ignored my chronic conditions (asthma with no inhaler during allergy season is not fun).

Usually European healthcare is a patchwork that looks confusing but at the end everybody gets the healthcare and you don't go broke even if you have to pay something. For example, you may have to pay up to some sum per year or percentage of your income. If you have income you don't have to pay.

>but at the end everybody gets the healthcare

I'm saying that this is not true. Estonia requires you to contribute (pay for it through taxes), or be registered as a student, retired or be a recipient of unemployment benefits to have healthcare. If you're unemployed, but don't receive unemployment benefits (eg you don't qualify) then you don't get healthcare.

Poland is the same. In such case, you explicitly need to self-insure with the state, and pay about $100 per month. I believe it was done to move people out of the grey economy - now, even if they don't pay taxes, they still need to pay the insurance (whilst if you pay taxes, most of the insurance premium is deduced from the taxes you pay, i.e. "free").

That sounds a bit different from the gov / non-private system we have in Germany. Sure, no doctor will make an appointment with you for anything not life-threatening unless you have a valid insurance chip card. But you do have emergency services available and coverage is continuous.

A family member didn't pay for a while. He had to pay up for the entire duration eventually, even if he had switched providers. So I'd expect that insurance would have gotten the bill in case emergency aid would have become necessary. That's very different from the US, where you would have to pay the bill yourself (from my understanding).

>He had to pay up for the entire duration eventually, even if he had switched providers.

What happens if he can't afford that? Will they garnish his wages?

It's a form of mandate, so yeah, probably. But no idea why they didn't try that in the first place. Probably didn't had enough to make it worthwhile. You can negotiate a payment plan and I'm sure there are gov support programs, but I'm not familiar with those and that stuff is for sure quite complicated, just like every other system that tries to be fair.

> So I'd expect that insurance would have gotten the bill in case emergency aid would have become necessary.

In Poland, if you don't pay, then in theory the hospital bill comes to you (as otherwise, there would be no penalty for not paying). In reality, 99.9% is insured one way or another and it's really hard to find someone who actually did not pay the insurance and needed serious/expensive medical help to see what actually happened in his/her case - I've never heard of anyone like that. Also, our consitution says that "the authorities provide equal access to publicly funded medical care, regardless of one's financial situation". Which IMO makes the whole system unconstitutional, but no one bothered to challenge it yet.

There is an enormous amount of rhetoric about how terrible the US system is, but the differences seem very nuanced every time the details are discussed.

In the US, hospitals are required to provide emergency treatment. When I was uninsured and needed emergency treatment about 14 years ago (before the ACA/Obamacare), the hospital made an attempt to help me apply for public assistance (Medicaid), because they assumed I would not be able to pay. I ultimately paid the bill in full, out of a (perhaps misguided) sense that I should because I could, but I was told at some point that they normally wrote off half of any bill not covered by insurance.

The not-very-nuanced difference is the frequency with which people find themselves without affordable access to healthcare, and the scale of magnitude of the price tag when they have to pay anything.

It seems like you are making an effort to describe the situation in a manner that connotes authority and facts, but it would be more constructive if you used terms with clear definitions and provided the numbers that you are describing.

I don’t know the healthcare situation in all European countries, and it’s inevitable that some countries will have less coverage than others.

But when one uses a country with a population of a bit more than 1 million as an example of how it’s not all sunshine in a continent of over 300 million, then I’m not really impressed with the argument.

You may indeed be correct in your opinion, but I don't see any point in declaring that facts don't affect your beliefs.

"It's not sunshine and rainbows" is not a legitimate argument against taking a step in a better direction.

Every system has its flaws. Some have many more than others.

I'm not arguing against universal healthcare. I'm saying that the claim that Europe has this is untrue. Europe (as a whole) is not an example of it. Maybe some individual country in it is.

Don't let "perfect" get in the way of achieving "good enough".

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