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Would healthcare overall in e.g New York be equivalent though? In Canada, we have "free" healthcare but literally have no other option so it's the Soviet style mess you'd expect a government monopoly to be. But would this bar paid healthcare? Couldn't people still have health insurance and get private care? Is there something preventing that?

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I’m a Canadian living and working in the US and I’d take the Canadian system any day of the week.

I think it’s crazy that your access to healthcare is dependent on your employment.

But it's also crazy that your access to healthcare is based on how the government prioritizes your need of it.

I agree with the idea of public healthcare, but not as a legislated monopoly. And that's true for government services generally. Monopolies don't benefit anyone except the monopolist, and competition makes everyone stronger. If the government wants to use it's buying and borrowing power (and maybe even taxation to the extent voters tolerate it) to provide a universal healthcare option, that's a big win. But if they want to push out other market participants in the name of some kind of fairness - well instead of having two-tier healthcare, everyone is on the bottom tier

> But it's also crazy that your access to healthcare is based on how the government prioritizes your need of it.

Triage is a pretty universal concept.

Healthcare has difficulty with competitive market effects because the amount anyone is willing to pay to live is essentially infinite.

>"... the amount anyone will pay to live is essentially infinite."

This has actually been studied, and is not true.

I suspect that there are people who would rather die than burden their families with crushing debt but that's a slightly different issue.

> But it's also crazy that your access to healthcare is based on how the government prioritizes your need of it.

So does every private insurer under the sun. You've never had insurance deny access to care? No insurer can afford to give an MRI to everyone a doctor wants.

> But it's also crazy that your access to healthcare is based on how the government prioritizes your need of it.

Doctor's prioritize need. More sicker, more quicker 'service' / treatment.

> I agree with the idea of public healthcare, but not as a legislated monopoly.

There is no monopoly on health care in Canada: if you want to cut a cheque you can get private care. What is legislated is that if you take provincial funding you cannot also take private funds. It's either-or.

At least in Vancouver there are private clinics[0] where you can get MRIs, CT scans, endoscopies, etc within the week if you are willing to pay.

[0] e.g. https://www.timelymedical.ca/

> Monopolies don't benefit anyone except the monopolist

For healthcare in Canada, the monopolist is the Canadian people.

Are you making that decision because the quality of care you've received is better in the Canadian system than the American system, or because you disagree with how the American system is structured?

> Are you making that decision because the quality of care you've received is better in the Canadian system than the American system

That would depend completely on their job in the US. If they're a line cook, care was better in Canada. If they're a software engineer, it's better in the US.

It's not though. We have have ACA plans you get independent of employment and Medicaid for the unemployed.

Costs $20k for a family.

Just interestingly - the average per capita cost of Canada’s system is $4,000.

Of course in the US, there are costs beyond just insurance, but if you had to pay for coverage out of pocket it would be $16,000/yr for a family of 4.

Well the point is that you don’t have to worry about coming up with 20k if you leave your job in Canada.

Of course, but it puts the cost in perspective a bit if you did have to pay it out of pocket.

My "ACA plan" (Individual, bronze) through my state's exchange costs $2770 in premiums, which seems relatively good until you add the $8250 deductible. Now we're up to $11,020 for one person. Plus we're not counting whatever portion of my taxes also goes to healthcare expenses for myself or others already.

You're not supposed to be able to get private healthcare in Canada, but actually there are plenty of fancy clinics that will fix you up on the spot if you have money. It's all hush-hush because those in power are the primary users of that parallel system. It's not a criminal underground but an unregulated mezzanine, yes?

Also, in my experience, public healthcare _can_ be quite good, but the quality of service varies a lot across regions and institutions.

> It's all hush-hush because those in power are the primary users of that parallel system

Any hint you can provide of how to look into this? I know there are private clinics for certain things, but I would be very interested to see what options there are for my family

That was the part that pissed me off in Poland. Long story short, country moved to a very weird spot healthcare-wise, where, in theory, 'money would follow the patient'. Doctors did well ( cuz they tend to be smart and are well organized ); patients.. not really. I was young and very, very naive at the time. I figured that if the guys, who are voting for this have to use it, it won't be so bad.

I did not anticipate that they would grant themselves special kind of access to healthcare. Like I said, very, very naive.

> You're not supposed to be able to get private healthcare in Canada […]

Sure you are. There is no government monopoly on health care in Canada: if you want to cut a cheque you can get private care. Nothing illegal about it.

All (family) doctors in Canada are private businesses. It's just that most of them hook into the provincial payment system. Similarly for hospitals: they are not government run, just funded through government. If you wish to set up a private clinic and/or hospital and not take government funding, there is no legal impediment to do so.

What is legislated is that if you take provincial funding you cannot also take private funds. It's either-or.

> It's all hush-hush because those in power are the primary users of that parallel system.

It's not hush-hush, it's just most of us plebes cannot afford fancy pants clinics.

This bill doesn't ban private insurance, it does however have this rule:

"Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents."

So in other words, private insurances can only be offered if they provide benefits that surpass whatever the public option has.

I imagine that private insurances will logically offer more benefits regardless, otherwise why would someone pay extra to use them over the public option?

that will mean, though, that it will be impossible to get insurance to actually cover the things that the public system "covers" if you wait 35,600 years for your turn

Why? Wouldn't a line skip be by definition something that the public system isn't offering?

I haven't read the full text of the bill, but presumably not. The intent will be to disallow private coverage for any service that the government would provide, specifically because they would want to make sure that people with money couldn't avoid the public system.

That's how it ends up working in many places with government care

I don't know of any healthcare system where what you're describing is the case outside of outliers like North Korea. Even in the UK with NHS, there's a whole system of private insurance and private hospitals too.

In Norway and UK there is public healthcare, but you can pay to skip the lines if you want to. I don't know why we would go full socialist in the US when living in a capitalist society. Should we only get cars allocated to us or something as well?

I am not hugely in favor or capitalism, but I can't see anything better or a way to replace it even though I am a social democrat. Let people with money spend them as long as we provide a decent floor for everyone.

I went to a clinic in Canada a few years ago to see a doctor. My provincial health card had expired and I didn't know. I was sick and wanted a consultation with the doctor. I said I would pay cash and was told that they are not allowed to charge people who are eligible for public healthcare. So I had to go and wait at our equivalent of the DMV (while sick and seeking medical attention) to get my health card renewed before I could see a doctor. I'm sure there are countless bureaucratic nightmare stories coming out of the US health insurance system, there will be countless more under a public system

Don't know why you were modded down (well I do but I don't want to start a fight), this is exactly how it works in Canada. I know people who have been told to wait years for tests or consultations. Those who can afford it go to the US.

Yes, it is very common, but HN is one of those places where one is required to have the community's approved opinions on things, and even the approved supposed-facts on things.

Of course many systems, including Canada's have this problem. The primary motivation for governments to prohibit private competition is specifically so that they can pretend that it can't be better elsewhere, to keep their system alive.

If people realized how likely they were to suffer for years utterly unnecessarily, they wouldn't be willing to put up with the government health systems they have. But because the government banned competition to keep them ignorant of the alternative, people remain peaceful while they wait in pain for years to get treatment that is utterly routine in America.

You realize the only reason rich Americans don’t wait for healthcare is because poor Americans aren’t getting much if any care.

This shows a serious misunderstanding of pretty much everything (I mean that).

It's not a zero sum game.

Where will the additional doctors and MRI machines come from if more folks had access to healthcare? If all the uninsured in my state suddenly had the same access to health care as I did, there would be 700,000 additional people who need primary care physicians, OBGYNs, psychiatrists, and so on. I think it would be a net good, but I would absolutely expect that the wait time for treatment would go up. You can't just snap doctors into existence. (I mean that)

Healthcare in the US isn't fair for anyone.

I don't know why the medicare for all plans need to ban private healthcare. Norway and UK has free healthcare for all, but still private options available for people that want to pay extra. That is also reducing the load on the public system so I can't really see why it is negative.

A lot of providers won't accept medicare because what they pay out is significantly lower compared to private insurance. That's why Obama's "If you like your doctor, you get to keep your doctor." promise was such a big deal.

As of 2020, only 1% of physicians opted out of Medicare[0]. That is an increase of only 0.3% since 2013. Furthermore, in my experience, physicians that opt out of Medicare refuse to accept any insurance, so the number of Medicare opt-outs is probably more of a proxy for opting out of insurance entirely. It is really not “a lot”.

[0] https://www.kff.org/medicare/issue-brief/how-many-physicians...

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