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Comment by franciscop | Hacker News Reader

Interestingly enough, 5-10 years ago in Spain you could hear some proponents of private healthcare to compare it with the US. Now I think there's enough understanding that the US model doesn't work that the proponents instead talk about Singapore or other private models, no one compares them to the US anymore.

Some arguments against universal health care I have heard in Spain: • Not enough choice, since you cannot e.g. pay more to get better treatment. • It's more expensive, since there's no free market to move prices down. • It's more efficient, since people are not paid to do nothing and impossible to fire (common complain about gvmt jobs here).

No beef here, just relaying what I've commonly heard

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My impression is, if you compare health care costs across various wealthy countries, it's pretty clear that socialised health care is cheaper than privatised health care. Netherland has universal but privatised healthcare, and has one of the most expensive health care systems in Europe, costing more than half that of the American health care system. And it's not particularly better than the more socialised healthcare systems of the surrounding countries, as far as I can tell.

And the only place in health care where you can have a free market at all, is in elective treatments. Treatments that you can choose not to use when they are too expensive. For everything else, it's your health and possibly your life at stake; you can't really say no to treatment, so you pay whatever it takes, and that's a situation that's easily abused by profit-seeking companies.

> it's pretty clear that socialised health care is cheaper than privatised health care

Causation goes the other way. If your healthcare is cheap, you might as well socialize it, and it will mostly be OKish; if it's too expensive (as in the U.S.) you have no chance of running a satisfactory socialized system. Switzerland has largely private healthcare and mandatory ("universal") health insurance, but its costs are not too high despite it being a comparatively small country with inherently higher costs of providing such services.

> For everything else, it's your health and possibly your life at stake; you can't really say no to treatment, so you pay whatever it takes

This is not really true. There is such a thing as pointless overtreatment, and the right balance of benefits vs. costs can only be reached with increased price transparency on the part of providers.

The mistake we all make is thinking the market includes us, the patients. If there is anything resembling a 'normal' (price discovery) market, it's between hospitals and other care providers and the government. The entity with the funds can foster healthy competition between the entities with the product/service. If you need medical attention, you need medical attention. A treated patient is not the customer, they are the output.

> "Causation goes the other way. If your healthcare is cheap, you might as well socialize it, and it will mostly be OKish; if it's too expensive (as in the U.S.) you have no chance of running a satisfactory socialized system."

I see no reason why it would work that way.

I mean, switching the US to a completely socialised system is certainly going to be a hell of a task, and even Medicare is way more expensive than it should be, but that's also because it's required by law to be expensive; Medicare is not allowed to negotiate lower prices, which throws away the primary advantage of a socialised system. But from what I understand, Medicare is still generally cheaper than privatised healthcare for the same treatment (though more expensive per patient because it insures only older people).

"Switzerland has largely private healthcare and mandatory ("universal") health insurance, but its costs are not too high despite it being a comparatively small country with inherently higher costs of providing such services."

The only graph I could find showed Swiss healthcare being even more expensive per capita than Dutch healthcare. This seems to confirm my suspicion that a privatised is generally more expensive.

Aneurin Bevan, The Minister of Health under which the NHS was created, said that to win support of the doctors, "I stuffed their mouths with gold".

While I agree with your point generally, it can still be useful to have competition between hospitals.

The NHS in the UK had great results with publishing clinical outcome statistics making people shun places with bad practices. This lead to a decline in deaths and complications.

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