Hacker News Reader

Comment by southphillyman | Hacker News Reader

A handful of politicians have been trying to decouple health insurance from employment the last two election cycles but for whatever reason a significant portion of the country "likes their health insurance", whatever that means. Personally I've never loved any of my health plans and dread the yearly increases and frequent provider changes as I either jump between jobs or my job eliminates or adds new plans due to rising cost. As long as I can register with a competent physician and dentist and keep the cost low I could care less who administers my plan. It truly is a mystery but I suspect resistance is tied to a belief that a government implementation would some how be more inefficient than what we have and the general disdain people in the U.S have against taking "freebies" or public assistance due to the history of social/racial stratification in the country.

View on HN

It's laughable, the UK spends half as much (as a % of GDP) and has similar outcomes (and far better outcomes in areas like maternal death).

It seems the default assumption is that the US government could never run something efficiently, but this is said in the same breath as claiming the US as the greatest country on earth. One of those things must therefore not be true. For a country with the resources and know-how of the USA to not be able to run a health service is not in doubt, what is in doubt is whether bad actors will deliberately underfund it and try to point to it as being badly run as a result.

Notably the UK spends a smaller amount per person of tax money than the US. Because of how poorly the US healthcare system is regulated, Medicare and Medicaid - which only covers a small proportion of the population - costs more per taxpayer than universal healthcare costs UK taxpayers.

Americans pay twice: Once over the tax bill for a system that aims to provide some coverage, and then again for private insurance.

If the US regulated healthcare properly, they could extend Medicare and Medicaid to most of the population without increasing taxes as a starting point.

Part of the problem is absolutely ludicrous limitations such as actively restricting Medicare from using its market power to negotiate drug prices the way the NHS does, for example.

It's massive corporate welfare.

EDIT: Here's a factcheck on a claim relating to prohibition for government to negotiate for a small part of Medicare as an illustration of the kind of messed up policies that drive up these costs: https://www.politifact.com/factchecks/2017/jan/17/tammy-bald...

The kind of pretzels people will tie their brains into results in this kind of outcome. It's the view (reinforced by corporate media) that a) US corporations are the greatest force in the world and b) US Government is trying to restrain them because it's evil/incompetent.

Easy to give an (incorrect) answer if you have an entire propaganda arm willing to support you.

right now I'm getting a high deductible plan with the premiums fully paid by my employer. for a young healthy person, it's hard to complain about that. if you decoupled insurance from my employer and made them add their contribution to my salary but changed nothing else, I would be strictly worse off. the premiums would go up because it's no longer a group policy, and I would have to pay for it with post-tax income.

at least in principle, I am convinced by the argument that single-payer healthcare is cheaper on average. I do have my doubts that partisan politics in the US would actually realize that potential for efficiency, given the usual sabotage of public services in this country. I also doubt that my income bracket would end up saving much even in an optimal implementation.

so at the end of the day, I don't oppose some sort of national healthcare, but I don't really see any personal incentive to rock the boat. possible outcomes for me range from "about the same" to "a lot worse".

>the premiums would go up because it's no longer a group policy, and I would have to pay for it with post-tax income.

But there would be no premiums.

maybe I'm arguing against a strawman, but the first paragraph is addressing the situation where insurance is decoupled from my employer, but nothing else changes (ie, I select and pay for a private insurance policy). all this does is delete a tax exemption and group bargaining leverage. maybe I was supposed to understand from context that this isn't what "decoupling" means?

Someone has to pay for it.

>so at the end of the day, I don't oppose some sort of national healthcare, but I don't really see any personal incentive to rock the boat. possible outcomes for me range from "about the same" to "a lot worse".

This answers southphillyman’s question about why people like their employer health plans. Because they don’t want to help pay for other people’s healthcare, especially the sicker population that isn’t condoned off into white collar employer health plans.

The tax advantage is also a handout to big businesses, that people who are lucky enough to be employed by them get to enjoy and support, at the expense of the rest of the country.

So summary of US healthcare political situation is everyone is all talk, but when it comes time to vote, nobody wants to pay more in taxes in case someone else gets to benefit more from it than they do.

What about all the things that aren't covered by insurance. I hear lots of nightmarish stories about things like "out of network costs", or paying for ambulances or childbirth.

I'm not sure you understand the peace of mind that comes from being able to go to hospital or use other healthcare facilities without even having to think about the cost, because there won't be one.

tbh, I just don't worry about this very much. if I did, I could pay $100-200 a month for the PPO plan.

I'm not arguing against national insurance, just trying to explain that the personal incentive isn't really there for a lot of professionals. I wouldn't vote against a candidate just because this was part of their platform, but it also isn't enough to make me overlook parts of their platform that I actually oppose.

I've seen the odd post from people along the lines of "why should my taxes pay for someone else's healthcare? No thanks, I'll stick with insurance" and the inevitable "you do understand how insurance works, right?" responses. Always fun.

As usual, this seems to be partisan politics at work. Though I don't really understand why the right portrays universal healthcare as socialism when it's so clearly more "free".

What they seem to not realise is that they already pay more for other peoples healthcare than people in places like the UK - Medicare and Medicaid costs more per tax payer than the NHS does in the UK despite covering a small proportion of the population...

What the right really does in the US is protect massive wealth transfers from tax payers to corporations by restricting Medicare and Medicaid in ways that makes it impossible to make them cost effective.

Reply on news.ycombinator.com