Comment by hitpointdrew | Hacker News Reader

Comment by hitpointdrew | Hacker News Reader

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> the fact that healthcare is already a consumer product in the US

I would strongly disagree with this. Healthcare in the US is currently a cartel system, not a consumer product/market system. If healthcare were a consumer product then:

  1. It wouldn't be tied to or dependent on my employment.
  2. Prices for medical treatment wouldn't be hidden/obfuscated by medical providers.
  3. Insurance providers wouldn't be restricted by arbitrary/geographical boundaries.

I think the debate over weather healthcare is a human right is an interesting one, and I personally haven't come to any conclusion on that yet.

If you think healthcare is a basic human right then a single-payer system is probably the most reasonable solution, although I don't think single payer isn't without it's share of problems.

If you think healthcare is not a basic human right then I think a real free-market solution is the most reasonable solution, again I don't think this is without problems either.

I don't believe there is a "perfect" solution. But I think either a true free-market system, or a single-payer system would both undoubtedly be 100x better than the current system in the US. I would be in favor of moving to either of these solutions as my political stance isn't D or R but "lets make improvements" regardless if those improvements are seen as left or right.

The Japanese system is not a single payer healthcare system and in terms of outcomes vs. cost is one of the best in the world, so I am not so sure that single-payer is the most reasonable solution. Particularly in the US where voters are averse to giving up their private insurance.

Japanese system does have a public option and much tighter price controls, which we are missing here.

What the US is missing to achieve that is japanese culture. It can't work the same or even similar.

I totally agree that culture is a big factor. I just think the conversation in the US around healthcare is kind of limited to pro or anti “Medicare for all” when there are actually many ways of doing things which do not require a single payer. Japan is just one example, Germany is another.

Obviously we shouldn’t just exactly copy the system of other countries, but it’s equally shortsighted to not learn take away anything from other existing systems. The possibility for universal coverage and higher cost efficiency without the need for single payer I think is a valid thing to take away from those examples.

I only put this out there because I feel it needs to be, but we can't just put all of health-care into a single basket. Emergency medicine should be separated out of these discussions as there is no "Free Market" option, just as there is no real free market option for police or fire services.

For optional surgery or cosmetic treatment, sure. You can argue a free market option, but that's why I always think there should be separate baskets, for lack of a better term.

Which I think and correct me if I am wrong, is currently the norm for most developed countries?

It is sort of strange it needs to be explicitly written out, at the same time for those of us not from US we just took it for granted and never think much about the system.

Preaching to the choir, but you might be surprised at how many of us in the US don't think these things through. Now, I do think a lot of this has to do with political marketing, so to speak. Let's not kid our selves, the health care industry makes fairly large corporate donations to both political parties and there is no real discussion to get rid of privatized, emergency medicine. Even our "radicals" like Bernie Sanders, who aren't even that far left, are loathe to bring that up in the US as the indoctrination has been dug so deep =[

This is very fair point and distinction.

It's not (just) about whether healthcare is a human right. E.g., interstate transportation on surface roads isn't a human right, but markets lost out to collective action. Why? Because building a well-functioning market for 8 lane interstates across an entire mostly-rural country was impossible in the 20th century (and probably still is).

So, the other important question to ask is the following: how feasible is it to create a well-functioning market for this product?

So far, we don't have an existence proof that such a well-functioning market is possible to construct in the healthcare space.

> E.g., interstate transportation on surface roads isn't a human right, but markets lost out to collective action. Why?

Because if there is a public option funded by taxation (whether you use it or not) and a comparable or even marginally superior private option which you have to pay use fees for (on top of the taxes), the public option will win every time. Simply put, do you want to pay once or twice for the same service? It's not like one car taking the toll road instead of the public road reduces that driver's tax burden by any noticeable degree. In antitrust terms, the government is using its monopoly in one area, "protection" (mostly from itself, as with any protection racket), as leverage to create a monopoly in another area, transportation. The surprising part is that there are some areas where the public roads are just so bad that you can actually run a profitable toll road alongside them. Level the playing field by requiring the government to fund the construction and maintenance of its interstate highways exclusively through use fees and I expect you'll see a very different result.

It's the same with any other bundled service. Having decided to subscribe to a certain service package one tends to stick with the included services, even if on an individual basis there are better services available at lower cost elsewhere. It only becomes viable to switch to the better service provider if you can replace all the bundled services. Except in this case that isn't even an option since there is no opting out of (paying for) the tax-funded package.

To add to the other comment about public-private competition (another example is schools - parents in private schools pay for both), the mostly-private industry managed to build inter-city railroads and local streetcars just fine. It is not obvious that it wouldn't eventually build highways if there was vision and/or existing demand.

Who knows, it might have even achieved a reasonable balance between the two, instead of forcing a car-centric environment everywhere like the public option? ;)

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