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Comment by chooseaname | Hacker News Reader

> I have yet to meet a single person who hasn't enthusiastically agreed that we should separate healthcare from employment. The reluctance comes when nobody has any idea what we're going to replace it with.

Sadly, I have, and it is invariably from people who basically say those who don't work don't deserve healthcare. It is disturbing to hear people say this. They don't want to "pay" for someone else's healthcare. They don't get that they already are.

> We're at an unusual social state in this country where nobody trusts the government and nobody trusts big business. What does that leave?

Where did we go so wrong? Is it because we treat government like football games? One side has to dominate the other; all or nothing? What happened to compromise for the greater good?

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Despite all our democratic and republican[0] efforts, we still wound up with a ruling class. Ruling classes aren't necessarily bad, but in order for that to work, the ruling class need to care about the welfare of the people they rule. That is not the case in the US right now. Our ruling class has turned parasitic and doesn't care that they are killing their constituents. The opioid crisis proves that.

[0]: the political systems, not the political parties

It seems like "healthcare linked to employment" is a nutty system even if you don't want healthcare for people who can't pay, though.

Even among people who work and have a lot of money, having healthcare based on employer causes all kinds of headaches. It makes a brief lapse between switching jobs unreasonably risky, especially before pre-existing conditions were covered. It punishes self-employment by denying people the major discounts big employers can negotiate. It punishes part-time work, because one 40 hour/week job with insurance might "pay" better than two equal-wage 30 hour/week jobs. And it makes long vacations or early retirement far less accessible; if you make in 6 months what someone else does in 12, you're not free to take those 6 months off without paying a steep premium on insurance.

And none of that is news, but it's always confused me that there's so little drive to delink healthcare from "being actively employed". Even for someone who wants to shut down Medicaid, the current system is bizarrely hostile to all kinds of high-earning people who could pay their own healthcare costs, but get punished for looking anywhere except full-time work at a big company.

Realistically, I think it's just ignored because the larger debates over cost and government care overshadow everything else. But in my more cynical moments, I can't help noticing that while the current system doesn't serve workers or entrepreneurs well, it's great at driving them to become a predictable labor supply.

"They don't want to "pay" for someone else's healthcare. They don't get that they already are."

Curiosity, because you seem to have first hand experience and I do not- what happens when you present that they already are paying for peoples' healthcare?

They state that they shouldn't be, and that the sooner the "government" stops that, the better off they think they'll be, like they imagine that their paycheck will rise directly and imminently as a result.

Would the free healthcare include only US citizens, all people who live in US, or everyone who comes to US on holiday?

If you want more affordable healthcare, you should make it cheaper, not force other people to pay overpriced bills for random strangers.

Naturally, it would include US citizens and permanent residents, and not holidaymakers. They already need travel insurance. By the way, those plans are more expensive with US coverage than without.

Other countries have already figured this out. And no one ever calls it “free healthcare” except for a few naive American libertarians. They don’t provide free healthcare, and if you aren’t in the system (and paying via taxes or otherwise covered via tax revenue redistribution), you’ll get a bill one way or the other (unless there is an agreement between two socialized health systems).

> Other countries have already figured this out.

None of those countries are the size of the US. Just like in Physics, you can't expect a 1/10th scale model to behave the same as the life sized version.

Japan has what...126 million people? So according to your math, America must have 1.26 billion people? Australia is as big as the US if you meant by area, plenty of other countries approach 100+ million besides Japan.

The EU has 511 million people. Sure it is multiple systems, but they all work much better than ours does.

Japan is a totally different culture than America, and their health care system is similar to ours in that it is employer paid. Also, you have no medical privacy rights, your employer gets a copy of every medical bill you incur.

Source, lived there six years and spouse was in that system for over 25 years.

Our healthcare system isn’t employer paid, it also has a large individual market (or those who can’t get access at all).

Japan, unlike the USA, has a health insurance plan for those who can’t get it through their employers (NHI, hence their system is considered universal).

I'm not sure what you mean by "our", that's ambiguous in this context. If you mean US, we don't have a "healthcare system", most health insurance is partially employer paid. My comment was not as clear as I meant it -- I meant that Japan's healthcare system is employer paid, which is similar to how most people in the US are insured. Maybe that's more clear.

Japan does also have NHI, but most are insured through their employers, as nearly everyone in Japan either works or is insured by someone in their family who works.

Are you implying that unit cost would increase at larger scale?

Everyone should be covered for emergency care. Beyond that citizens and permanent residents should receive unlimited care and anyone with a student or work visa should also be covered for the term of their visa.

>> We're at an unusual social state in this country where nobody trusts the government and nobody trusts big business. What does that leave?

> Where did we go so wrong?

False premise. Merchants and governments have been widely distrusted as far back as records exist. Merchants in particular are commonly the subject of some kind of official orthodoxy noting how evil they are.

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