Comment by arrosenberg | Hacker News Reader

Comment by arrosenberg | Hacker News Reader

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Good list of objections I've heard. The people who say #1 will never get on board. The DMV is a state-level agency, and people have plenty of good (maybe not great) experiences with government agencies like Medicare, USPS or SSA. That's more of a talking point for opposition parties who oppose central government altogether.

#2 isn't a serious objection, because the math is pretty clear that almost everyone winds up spending less.

#4-6 are intractable and come down to the population having the will to overcome objections from capital and doctors. I do think that doctors and nurses are gettable if we bring down the costs of malpractice insurance and education so that overall take home doesn't suffer.

In my experience trying to sell the idea, the biggest impediment to real progress is #3, though I am certain I have a local bias. That's the issue that keeps the knowledge working class separate from the labor-working class. I haven't come up with a good answer other than accommodating them by allowing first-class treatment for those with money and second-class treatment for everyone else. Not the most altruistic answer, but probably the most achievable. No one with premium healthcare now is going to risk it, and that's an important political block.

2 is a serious objection because while a government administered program promises to be cheaper in aggregate, it will almost surely not be cheaper for every individual/household, especially if you intend for or expect people to supplement or replace the government insurance with private insurance on top of the public option to get back to the level of the insurance they have today.

You could argue that 4-6 aren’t real objections either because most people aren’t in those fields either.

In the US the cost of healthcare is so ridiculous that underwriting the system and bargaining as a unit for things like equipment, disposables, and pharmacy will save the entire system billions of dollars of overhead/profit/graft (depending on your viewpoint) that currently go mostly to insurance companies and private equity healthcare groups. At some point you will be right that the harm outweighs the good for a sizable group, but we aren't there today.

> You could argue that 4-6 aren’t real objections either because most people aren’t in those fields either.

Way more money and influence though.

> Way more money and influence though.

Bingo. 50 million poor people have less lobbying clout, ie dollars, than the medical or pharma industries.

It’s no coincidence that the ACA provided for money for insurance, without actually increasing the supply of actual medical care. Increasing insurance increases demand, provides a way for the existing industries to get paid, and overall raises the cost of care.

Now had they had a lick of sense and simply spent the same amount of money on setting up clinics (ie supply side), you’d see a drop in prices as existing providers would have to compete with a lower cost option.

regarding #2, the math isn't necessarily clear at all. I actually have no idea how much my health insurance costs. my employer isn't required to fill that box on my W-2, so they don't. I'm mostly convinced that the average cost would be lower, but governments in the US do seem to have an incredible ability to waste money.

In California it's about $500-600/mo for a "Gold" level PPO plan for a 20-30s individual through CalChoice Small Business pool. Bronze level plans are usually in the high 200s to low 400s. HMO plans are usually about $100-150 a month cheaper than PPO. Vision and dental are another $20-50/mo. Spouse roughly doubles the cost, and kids add more to it, but I don't remember the exact amounts.

Keep in mind that even with the Gold level plan you are still subject to network restrictions, paying copays, deductibles, and you have an OOP maximum of several thousand dollars.

Big companies can get better rates than individuals or smaller companies and businesses get to write off the expense, whereas individuals (mostly) can't. It's only the governments' fault insofar as they haven't done something about this already. The rules were written to enable corporate profits, not quality, cheap healthcare. Even as a small business owner, trying to offer healthcare was brutal just from the sheer expense of it. It's almost hard to justify unless you have kids or a chronic condition, but you never know when catastrophe will hit, so the market is fairly price-inelastic.

Well, my insurance for a family of four cost slightly more than 10,000 last year (both employer and employee sides). You could triple the amount I paid into Medicare in exchange for Medicare covering everyone and I and my company would come out ahead. There has never been a year where I have been paying for insurance that it has not grown faster than inflation.

You can estimate it from this table NJ publishes:

https://www.nj.gov/dobi/division_insurance/ihcseh/ihcrates20...

Add or subtract 10% based on your cost of living compared to NJ.

People with good salaries and benefits will presumably see their taxes increase by a couple orders of magnitude more than the peanuts we are currently paying for care. Our employers will save, but not necessarily share that with us. I still think it’s the right thing to do, but it’s obviously going to wreck me personally given my SWE salary.

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