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Comment by eyko | Hacker News Reader

I'm not sure how the USA is going to fund universal health (one that's actually unversal and free like we have here in Europe) care without first having a discussion on taxes. I can't say I'm qualified to have an opinion on it but regardless what the budget in the USA is, the cost of public healthcare all of a sudden could very well be unsustainable without having a federal level tax policy similar to other countries with public heatlh care. Furthermore, the USA as a whole does not have a very healthy population, which means free health care could cause a surge in appointments and treatments. I think it's something that they will have to do sooner or later but the first years (or decade?) would be a test to overcome, and cultural changes would need to kick in before it starts running smoothly.

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What I've ultimately discovered is that the only time people enter "Can we afford it?" into the discussion, it's because they're looking for an excuse for it not to happen.

Try taking a close look at how the US budget actually breaks down. It's quite a task since it's an enormous budget. But, if you boil it down to a pie chart, you'll find that we spend an absurd amount on "defense", most of which is wasted. You'll also find that Congress will routinely spend enormous sums of money - in the trillions - on things that aren't health care (e.g. wars & combat, economic bailouts, etc.), without ever asking how it can be afforded, and it doesn't cause the whole system to come crashing down.

It's about priorities, and finding legislators to elect who share the correct ones. I believe that we'll get there, slowly, one funeral at a time.

Currently there is a private tax that people and companies pay: the insurance premium. All Medicare for all proposals have funding plans that include higher taxes or new taxes that essentially pick up this premium in other areas. At least some require that this insurance premium is carried over into salaries ISTR since it’s currently a benefit and should go to your salary.

> Currently there is a private tax that people and companies pay: the insurance premium.

We do that in Germany too. On top of (much) higher income taxes, (much) higher sales tax and plenty of extra taxes on products. Health insurance is "free" as in "you pay ~7% of your income and your employer matches it".

There's no such thing as a free lunch or free healthcare.

And what are the deductibles and co-pays? What are the bankruptcy rates and how many of them are because of medical bills?

Plenty of Americans "have insurance", but if you go (or are taken via an ambulance) to the 'wrong hospital' you're not covered. Even if you go to the correct hospital, but are treated by the 'wrong doctor' you also may not be covered:

* https://www.usatoday.com/story/opinion/2019/09/23/out-of-net...

Do a search for "out of network hospital" or "out of network doctor". So yes, the health coverage in Germany is certainly not "free", but you're actually covered. Just because you pay your premiums in the US does not necessarily mean much.

> And what are the deductibles and co-pays? What are the bankruptcy rates and how many of them are because of medical bills?

Depends on your insurance, but obviously lower than in the US. I don't know what US-insurance companies usually cover, public health care in Germany is so-so, e.g. if you need glasses, they won't pay, so you've have to pay for those yourself.

The US system certainly has plenty of issues, and I'm not saying that European systems aren't superior, I'm just saying that we pay much more. This obviously has a smaller effect in low-income people as their healthcare, social benefits etc will be subsidized by others, but if you're working in a high-skill profession, you'll take home a lot less of your paycheck than in the US.

Unless the high earners in the US are fine with significantly reducing their net income, I don't think you'll find a lot of support.

> I'm not sure how the USA is going to fund universal health (one that's actually unversal and free like we have here in Europe) care without first having a discussion on taxes.

Americans are already paying for it: it's just that their premiums are going to private companies instead of a government agency. The money is coming out of your pocket either way so what difference does it make whether it is labelled as "tax" or "medical bill"? That's just a form of mental accounting.

Also: you can have universal healthcare without the government, single-payer or otherwise. Don't Germany and Switzerland both have universal coverage with private, non-profit health insurance companies?

> Don't Germany and Switzerland both have universal coverage with private, non-profit health insurance companies?

Germany has a dual-system. You get basic coverage with public healthcare, and you get premium coverage with private health insurance providers. Want eye glasses paid for? You need private insurance.

Doctors get a fixed rate for most things, and they exist mostly by treating private insurance patients, because they'll get 2.3-3.5x the rate from private insurance companies, while treating public insurance patients is close to being a net loss.

>the cost of public healthcare all of a sudden could very well be unsustainable

What about Space Force and the increasing military budget every year? How come there is magically money for that?

The USA as a whole does not have a very healthy population

Thing is, the relative health of citizens of the USA tends to vary wildly by region. For instance, people in Colorado are far more likely to be very fit, active, eat healthy, exercise daily, and engage in outdoor activities than residents of, say, Alabama.

That means that free or universal health care, if it comes to pass, will be very unevenly distributed in the USA.

Speaking of that, if free/universal health care does come to pass, is it more likely to be federally or state funded/organised? (I'm European, so please bear with me if that seems like a basic question)

It will be federally funded and state organized (over simplified but that the General idea)

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