Why Can't America Handle the Coronavirus Crisis? | Hacker News Reader

Why Can't America Handle the Coronavirus Crisis?

mattstoller.substack.com

45 pointscjbest36 comments

The elephant in the room (re: the pandemic response) is the privatized health care system. With costs so high, people will avoid treatment, and with few security nets, people will go to work sick. How exactly do you prevent a rapid spread in that situation?

The SARS-CoV-2 test is or was $2000 without insurance. And now the private test clinics have it and get to charge whatever they want. In the past, such tests would be provided to the public for free. Instead, the poor and working-poor do without, have to go to work sick because they don't have sick days, and infect more people because they don't have a choice unless they want to lose their jobs, their housing, and become homeless.

> have to go to work sick because they don't have sick days

Personally, I think sick people who don't have paid sick leave should be paid to cough on people who oppose requirements for paid sick leave.

I have worked a lot of jobs before I got into sent where that was the expectation. Being sick was a matter of “pushing through” and “not being a burden”

I don't know why you're being downvoted, you make a valid point.

Also the 50-51 weeks/year of work culture that doesn't give days off during the year.

and the lack of paid sick leave

People seem to hold the Dutch healthcare system in high regard, and it's private.

The British NHS is private at the primary care level. Every GP is a private business contracted by the government to provide local health services.

It’s the elimination of the uninsured risk (aka will I get paid for treating this individual) that is the difference. Not whether the healthcare provider is employed directly by the state.

There's more.

I've lived in two different countries which have competently managed and effective health care systems. They're different from each other and it's noticeable, but so are various traits they share. They both try to learn from what other countries are doing better, they both keep costs down, they both are competently managed and essentially socialist (that is, they work for the entire population).

Here's a trio of predictions: At least one of the competent European health systems will mishandle the Corona crisis and a lot more people will die than in the neighbouring countries. The American fanbois will use that as a solid proof that anything and everything that country's health system is wrong, including the things its neighbours also do. Noone in the American health system will try to learn from the more successful handling in some European countries, and definitely not from any country like South Korea or Taiwan, outside the Indoeuropean language zone.

According to the German Wikipedia article every Dutch person is required by law to have a "legally defined" healthcare contract. Sounds quite different to the US system.

It sounds quite similar to the Obamacare individual mandate. Of course that's gone now...

private health insurance in the US is (even under Obamacare) expensive, and the deductibles are high if you're on those cheap plans.

Under an Obamacare cheapest possible insurance option you're not going to be bankrupted by (for example) a heart attack, but you'll still be paying the bill for a long time. That ignores hospitals like SF general that charge you directly (and are out of network) so you can still be trivially bankrupted.

At face value, this is almost exactly what Obama did. It killed most of the cheap options for people who just want emergency coverage and was essentially a tax in disguise which many Americans objected to.

This is false. "Catastrophic coverage" was ended because of the sheer wealth of data that these insurance policies did not in fact provide their customers with what the customers were expecting. That is: a person with such a policy who unfortunately suffered a major accident or severe illness would find the insurance company wriggling out of any financial responsibility.

The rules were tightened up, and without any explict legal language banning them, insurance companies dropped such policies because they knew they could not satisfy the new rules requiring actual coverage.

They seem to only partly be private (like the US).

> Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from earmarked taxation under the provisions of the Algemene Wet Bijzondere Ziektekosten, which came into effect in 1968.

The costs aren't high because it's private - they're high because the heavily regulated government system has broken the market.

In fact the only completely private parts have reasonable prices.

Ah imagination, what a wonderful world you weave.

What country has a working completely private healthcare system?

> What country has a working completely private healthcare system?

Switzerland [1]. And the Netherlands has a mostly-private system [2].

[1] https://en.m.wikipedia.org/wiki/Healthcare_in_Switzerland

[2] https://en.m.wikipedia.org/wiki/Healthcare_in_the_Netherland...

In Switzerland, health insurance may be private, but is mandatory and there is a large catalog that even the cheapest insurance must cover.

On the other hand, the state (each canton) pours large amounts of money into hospitals and research. There are laws and regulations at various levels (edit: eg how many doctors may open a new cabinet), and in these days we are reminded that doctors can be mandated to work when a crisis requires it.

Calling this a "completely private healthcare system" is a bit misleading.

> Calling this a "completely private healthcare system" is a bit misleading

The assets are privately owned. That’s completely private.

It’s not laissez faire. But those are different things. Subsidies and buying mandates are compatible with total privatisation, something often lost in this debate.

Privitisation of some of the profits, but not of the state-mandated signup scheme or the payments:

> The insured person pays the insurance premium for the basic plan up to 8% of their personal income.

So some huge portion is state-subsidized for lower incomes.

Medicare advantage in the US has similar privitisation aspects as well.

The climb acronym from the article, it is same reason we can’t build nuclear plants on time or or budget anymore.

The simplified answer: the US is a late-stage civilization in gradual decline since either post-WW2 or about 1960.

The "frog" has been "boiling" slowly for a long time and is almost cooked.