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Comment by Causality1 | Hacker News Reader

Socialized healthcare works. Capitalistic healthcare works. This ungodly mess we've created in the US that combines the worst aspects of both doesn't work. When everything is secret and there's no actual competition between providers but also no regulatory controls to prevent abuse you get the worst possible results.

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The most frustrating thing about this is we're already paying for universal healthcare. You can't be denied care if you don't have the means to pay. We just somehow pay for it through the nose, and it's shitty beyond belief.

My wife traveled to Russia earlier this year and did a couple of MRI scans while there (neck and shoulder). Total cost for both was $100. This is all out of pocket and without insurance coverage. Here it'd be $2K+ _each_, _with_ insurance, _excluding_ the subsequent doctor visit to analyze the results. How the fuck does this happen? How is this justifiable? I don't know. The machine is the same. The doctor is far less expensive, sure, but it's not like the doctor is needed for more than 10 minutes to view the results and produce a diagnosis. Whoever untangles this multi-trillion ball of bullshit will forever be remembered as one of the greatest leaders this country ever had.

It's always surprising to me that I an age where it's incredibly easy to have friends in foreign countries, travel to foreign countries, and view media from outside the US people here still think it's normal for the worst thing about a broken leg to be the hospital bill.

Absolutely right. If we had transparent prices and the customer was also the payer and the drug companies weren't colluding then the invisible hand could work for healthcare.

How is this true? If a medical procedure is the only thing between you and death how could you possibly negotiate a fair rate in the free market, especially considering some treatments are monopolies if they have a patent on them. The free market cannot work in health care.

There should be an anti price gouging law which states that a doctor can only change their prices every month or something, and must publish them publicly. This could also include stats indicating with which percentage what procedures are done for a specific complaint. Ex, for a head injury, in 50% of cases an MRI was done at cost X.

Then we could all use our internet connected phones to find the price instantly. If we are unconscious or decapitated at the time, we could set up a set up a ranking system beforehand weighing price, distance to hospital, and quality of service ratings.

Even more minimally, just require them to publish their prices. If you change $10 fifteen time, $50 once, and $150 eight times for a procedure, publish all of that.

And all group buyers should have to publish what they paid for each procedure too, to be fair to the doctors.

The majority of medical procedures are neither unique nor proprietary, and the majority of medical procedures are not to save someone from imminent death.

In other words, most of the time people would have options and time to compare those options. Iff the conditions I described above obtained.

Unfortunately there's lots of money in convincing Americans to vote against their best interest. Expect to see lots of "socialism is bad/will destroy America" propaganda in the future. My guess is socialized medicine will be branded as some kind of evil force and demonized.

As someone who grew up in the USSR, I do agree that socialism would be extremely bad for America and I don't want it here. I believe it'd cause the eventual collapse of the country, much like we've seen with the USSR and for the same reasons. I do not believe that the state is any better at spending my money than I am myself.

The issue here is not capitalism per se, because US healthcare system is not capitalist in nature. Capitalism requires pricing mechanisms and competition in order to work. That's the part that's fundamentally screwed up in US healthcare: there isn't any downward pricing pressure until the prices get to truly baffling levels and there's no real competition. The Trump administration is beginning to work on creating it (https://www.nytimes.com/2019/07/05/upshot/trump-drug-prices-...), but so far without any visible result. While (if it works) this is a good start, I'd like to see some kind of downward pricing pressure on the services as well. E.g. I should not be required to pay 5x as much if I'm not covered and paying out of pocket. This disproportionately affects the poor, quite obviously: break a leg and you could end up paying $50K or more (whereas insurance would pay $5K, if that). Introduce a "favored nations" clause on that as well: if I'm paying out of pocket, I should be paying your lowest "insurance" negotiated rate.

> As someone who grew up in the USSR, I do agree that socialism would be extremely bad for America and I don't want it here. I believe it'd cause the eventual collapse of the country, much like we've seen with the USSR and for the same reasons.

Most of the world's most successful nations have socialized health care, and seem to be doing just fine.

God knows I don't want a Soviet system. But the term "socialism" seems to refer to any sort of universal health care or public safety net these days, so when pundits start claiming that those things are a slippery slone to Stalinism, it's a problem.

You don't need socialism to have universal healthcare. Above in the thread I said that we're already paying for universal healthcare right here in the US: you can't be denied care. It's just that the system grew a ton of perverse incentives and it's not in any way capitalist. Case in point: you can't even get the prices ahead of time for the most part, and doctors treat inquiries about pricing as a personal insult. Therefore there's no way to look for a lower price. That's the goddamn cornerstone of capitalism. So before we throw the baby out with the bathwater maybe we should try what this country is good at: capitalism and competition? Or would you rather give another few trillion dollars to dense government bureaucrats to piss away on whatever lobbyists tell them to piss it away on? People keep forgetting just how corrupt and inept the US government is and has always been.

> You don't need socialism to have universal healthcare.

What I'm saying is that many, many people on both sides of the issue use "socialism" to mean "any socialist policy regardless of the majority economic or governmental system." That's not what Marx intended, and it may not be what it means in the former USSR, but that's usually what it means in English. When someone says "we need more socialism" or mocks the idea that "socialism will destroy America", then barring additional context, it's not helpful to assume they want a full Soviet system.

What I'm saying is "what Marx intended" is utterly idiotic and destructive, and fundamentally at odds with human nature. It has failed every time it's been tried, it just took longer for it to fail in some cases than in others. Sooner or later you do run out of other people's money.

Indeed. I hope nothing I said implied that I disagreed with that.

Healthcare in the US has little that is really socialized, at least for the middle class. The ACA had NO public option, despite efforts to include it. So unless you're poor (Medicaid) or elderly (Medicare), you have no hope of anything "socialized".

Healthcare in the US is a racket -- pure and simple. It puts our health into the hands of middlemen, the insurance companies. And the funny thing is, they don't insure a damn thing. They make you pay thousands of dollars, typically, before even attempting to do their part, and even then, they will charge for preventive visits and other things that are supposed to be 100% covered irrespective of deductibles/etc. They rely on the bureaucracy of the system to force people into the path of least resistance which is to pay the bill.

The simple fact is insurance providers, hospitals, and now doctors, do not care at all about patients. They care only about money. Until we, as a people, take back control, nothing will change. I would ask doctors, what happened to "do no harm"? Financial harm is harm.

And I agree with you. It either MUST be fully capitalistic (get rid of the state boundary crap, make it easier to get affordable individual insurance, etc) or it MUST be fully socialized (single payer). There is no in between that will ever work for patients. And I'm skeptical of the fully capitalistic approach simply because it can still become a racket with price-fixing.

As an aside, part of the problem lands solely on the doctors. Far too often they roll people through like it's an assembly line. Far too often they don't even listen to the patients, especially women, and just think people are hypochondriacs. Far too often they prescribe needless medicine to treat symptoms and never try to find root cause and treat _just_ that. Of course, we have no choice but to "trust" doctors when the time comes, and that's what they and pharma banks on. The family doctor truly is a relic of the past.

EDIT> Bring on the downvotes, it's always a pleasure, Internet.

Medicaid + Medicare is bigger than all private insurance combined, so have huge effects on the market. Federal + State government account for 45% of all health care spending.

Sure its socialized. Insurance is socialism for profit.

Spread the cost across society but add a profit layer. A huge profit layer. Go check out what insurance employees make.

In which countries does capitalistic healthcare work well? Or do you mean just within your theory it works well and that there are none that actually do it?

Switzerland. Netherlands. In one ranking they are the best systems in Europe.

Do any of them not have price controls and a “public option” of some sort? And sometimes prohibition on for-profit insurance (Switzerland, for example, IIRC)?

No public option from what I know. Insurance is all private, Swiss require no profits while Netherlands allows for profit. Government subsidies and restrictions exist on the plans, similar to Obamacare.

Switzerland has compulsory healthcare, insurance subsidies for low-income people, extremely heavy regulation of health insurance companies, and many (mostly?) public hospitals.

Not exactly something I'd describe as "capitalistic health care".

40% of hospitals in Switzerland are private vs 69% in the US (21% for-profit). Most hospitals in Netherlands are private (non-profit). Both have all private insurance, although Switzerland requires it to be non-profit. Obamacare subsidizes and regulates insurance in the ways you stated, but could be made stronger. Perhaps not pure capitalistic healthcare, but a strong role for the private sector.

Netherlands has a mandate, universal healthcare, and free coverage for children up to 18, not capitalistic.

And:

>Affordability is guaranteed through a system of income-related allowances and individual and employer-paid income-related premiums.

https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands#...

Obamacare also provides subsidies. The point is that the provision and insurance in Netherlands is done with private organizations, not the government directly.

Switzerland and a few other countries have fully privatized medicine. You don't hear about them dying from preventable diseases.

Privatised medicine is not a free market, conflating them like this is disengenuous.

The system in India works for the middle-class and upper. They have fairly elastic supply of doctors so it balances out. Some of their surgical outcomes have higher performance than American surgeries, particularly some heart surgeries. Cheaper, faster, better.

Plastic surgery is capitalistic healthcare.

The incentives are very different. When the doctor says injections or implants will set you back $X it's not a matter of life and death. Or even health at all. You can choose to wait and save up. When the doctor says you need medical treatment that costs $X you're going to have to come up with a way to get the money even if you go broke trying. And that's assuming you're lucky/healthy enough to even be given a chance to price shop.

It's hard to go broke getting boob jobs. It's exceedingly easy (in US) to go broke getting even the most basic of health care.

Good points. When I was taken by ambulance to an out of network trauma center, I had no choice.

It worked well in the US until around 1990.

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