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Comment by Kalium | Hacker News Reader

It's also worth bearing in mind that the socialized healthcare system the US does have - the VA - does not have a uniformly good track record. This does a poor job of making the case for a larger socialized system all on its own.

Which is to say it's not just propaganda.

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Interesting you pick the unpopular one, whereas Medicare (62 million people covered) is widely liked and considered successful. In fact, satisfaction levels of Medicare are considerably higher than most private coverage.

The difference of course between Medicare and less popular plans like VA coverage and Medicaid is that people on Medicare have political power, veterans and the poor do not.

Nobody is arguing that you can run a healthcare system badly, but to only point out the worse case is not arguing in good faith.

I picked the VA because it's an attempt at a thoroughly integrated system in a way that Medicare and Medicaid are not.

It's not irrational for people to look at the risk of making a worse system and judge for themselves if they think it's a risk worth taking. Examining a worst case that's within the scope of possible outcomes is a reasonable part of a good-faith process.

But a thoroughly integrated system isn't necessary. One proposal is to simply allow every American to enroll in Medicare, keeping the remainder of the system the same. It's the most expensive option, but since people on Medicare like Medicare, it might be the best next step for user acceptance.

I agree!

That said, the person I responded to was to my reading optimizing for getting away from the private health care apparatus as much as possible. Medicare For All does not accomplish that.

Yes, the VA is more akin to the UK's NHS (socialized costs/medicine) than a single-payer system like Medicare (socialized insurance/private doctors).

The VA was under-budget even before the two wars started in 2002/2003.

Then the ruined bodies and psyches rolled in, and VA wasn't given additional funding to handle the aftermath.

It's pretty clear how that ends up. The wars above cost $Trillions but the aftermath costs a few more Trillions that VA and other agencies didn't have.

VA efficiency is driven way down by the fact that it is an integrated system that covers a very small, diffusely distributed segment of the population, which is the worst possible case for an integrated (in your sense of having dedicated staff and facilities) system.

> It's also worth bearing in mind that the socialized healthcare system the US does have - the VA

That I know of, the US has either 5 or 55, depending on how you count the Medicaid programs run by each state + DC in cooperation with the feds, socialized healthcare systems (Medicare, Medicaid (1 or 51), TriCare, VA, and the Puerto Rico public healthcare system.)

At 9 million covered beneficiaries, the VA system is smaller than Medicare, smaller than Medicaid, and even smaller than California's state Medicaid plan (Medi-Cal).

It’s kind of weird to pretend VA is the socialized healthcare system in the US. (Actually, you can argue that TriCare and VA aren't even true “socialized” systems but employment-based plans for current and former employees, for a subset of federal government employees.)

Within Medicaid are several programs targeting different populations, each of them rightfully a Medicaid program to itself.

Pregnant women, indigent, long term disability, orphaned children, and others are programs w/in the Texas Medicaid programs, for example.

The US has a massive socialized healthcare system much larger than the VA - Medicare. Roughly 18% of Americans are covered by Medicare, a socialized system.

One difference is that the VA is a complete system, with it's own hospitals and staff. Medicare is that half-way solution, a public insurance system which buys medical services for the members from the private sector.

As for the VA system's woes, I would say: yeah, it's definitely possible to build a system that doesn't work well. But that doesn't mean we shouldn't be trying.

Medicare isn't really a socialized healthcare system. Most of the providers aren't government employees, and some providers don't accept Medicare patients because the reimbursement rates are low. Many beneficiaries actually obtain their plans through private insurers with the Medicare Advantage program.

> It's also worth bearing in mind that the socialized healthcare system the US does have - the VA - does not have a uniformly good track record. This does a poor job of making the case for a larger socialized system all on its own.

> Which is to say it's not just propaganda.

No public or private system anywhere in the world has a uniformly good track record.

You are right. I think as long one doesn't run the risk of getting bankrupted by medical problems, it's already a "good enough" system.

I find that an extremely low bar since you mention nothing of quality of outcomes. In any case, I guess the US system wouldn’t be “good enough” by your measure.

I fully agree - it's an extremely low bar and yet the US doesn't reach it. Edit: I mean the system as a whole, with a few ups and many lows.

Yes, underfunded systems tend to perform poorly, especially when society doesn't integrate other necessary services such as housing or unemployment assistance very well.

Why not look at medicare's track record instead ? Its extremely popular with all its users

Popularity and efficacy are wildly different metrics. Further, Medicare is not a system that gets away from the private healthcare industry that parent was criticizing. The VA's integrated system largely does.

A whole lot of the universal healthcare systems elsewhere also does not "get away from the private healthcare industry". Many countries with universal cover have private hospitals providing the services or private insurers providing part of the insurance solutions, or both, without incurring the problems of the US model.

Here's a first step to solving the US problem: Remove the legal restrictions on Medicare preventing it from negotiating best possible prices, and reinvest whatever it manages to save on expanding coverage.

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