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Comment by rayiner | Hacker News Reader

Most Americans have health insurance. Of the ones that don’t:

1/3 are illegal immigrants. Those folks would be excluded from the universal healthcare system of nearly every EU country. France and Spain are the exceptions, but France is under a lot of pressure to scrap that.

1/3 are eligible for Medicaid but haven’t signed up.

1/3 can afford Obamacare premiums but choose not to buy insurance. The Obamacare premiums are capped at 9.5% of income. That’s about the same as the employee-side healthcare tax would be in France or other countries with universal healthcare.

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Migrants are not excluded from healthcare in most EU countries. They are on special schemes, A.M.E. in France. In fact, as an Australian resident I came back to a French hospital (after expiry of my SSN / a consultation is cheaper in France), and after seeing the doctor, they said they couldn’t establish the bill without current SSN and would have to... call me back. I’m the kind of guy who really wants to pay (It was just 120€, on an Australian salary), so I did give them my real name, email, phone, but the scene was surreal. “I want to pay you. Here is money to pay France, please take it.” —“No”

That country is going to end up in debt.

As I said, France and Spain are the two exceptions. In the U.K., for example, illegal immigrants can access the NHS only for urgent care, similar to the situation for hospitals in the US.

> 1/3 are eligible for Medicaid but haven’t signed up

Does that include all of the people who live in states that haven't expanded Medicare?

It seems like it logically couldn't, else why bother expanding Medicare in the first place?

"Have health insurance" is not comparable with "is covered by universal health care" without a lot of clarification.

1. It's dependent on employment.

2. It comes with various forms of limits, out of pocket payments, and other caveats.

3. It comes with a profit motive for the insurance company to decline coverage.

etc

So fundamentally, "Am I under the threat of financial ruin if I were to get ill?" is still very much alive even with health insurance.

All health care systems regardless of payer structure have a financial motive to decline coverage.

Yes, but vastly different. Universal health care certainly won't come with a dozen pages of fine-print. It doesn't have pricing levels either. You won't hear: "Oh, you should've chosen our premium plan for that!".

That's true. The tradeoffs are different. There will be procedures you can't readily get, and more complexity in getting others. Some of those are procedures you shouldn't be getting in the first place. You'll have far less control over your own care, but most people weren't taking advantage of that control in the first place.

"Far less control over your own care" implies a very small, and wealthy, subset of the population.

I don't think that's at all true. Wealthy health care consumers are generally not price conscious.

I guess I misunderstood you? Because that's what I'm saying. That it would require substantial wealth to be able to have significant control over your own care.

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