Comment by phpisthebest | Hacker News Reader

Comment by phpisthebest | Hacker News Reader

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>>"leaves millions without insurance and since they're usually low-income and therefore cash-poor

This is still false, infact the most impacted group by medical costs is the Middle Class not the poor. People too "rich" to be on public assistance programs like Medicade but too poor to afford a medical emergency and work for employers that either do not offer insurance, or have poor coverage.

>>the words "bankruptcy can be a good thing" is going to be bouncing around my head for a while.

I have known more than a few people that have gone through bankruptcy and it was the best thing they could have ever done. One mistake people often make is waiting tooo long to declare bankruptcy. Bankrupcy is a legal tool designed to provide aid to people who find themselves in too much debt, there are all kinds of things built into that system to assit people. It really is not a punishment. For example most people do not realize that they can Keep their primary residence and primary transportation even after declared Bankrupcy. People have this vision that is you file for Bankrupcy *protection* the police are going to come take all your things and put you on the street.

>>I'm a little bit horrified thinking what kind of creative solutions these providers would come up with ...

One thing that is prevented by Regulation is Medical Coop's several have been tried but they can not navigate the regulations to make them workable. Non-profit Member owned Coops would be a great thing for medicine, just has it did for Utilities in many regions of the US.

When even companies like Walmart can not make low cost medical services work directly as a result of regulation you know there is an issue.

You're dancing around the issue: you shouldn't need to have that debt, regardless of how spiritually cleansing you think the bankruptcy process might be. If you'd asked the people who went through it whether they'd rather a national insurer handle , I am sure they would have far preferred that. I'm quite shocked you know multiple people have had this kind of medical debt and can still come back with the bankruptcy-is-good-actually line.

I kind of feel like you're trolling me a bit, if I'm honest.

Perhaps we should check our premises.

Would you agree that subsidies and regulations increase prices?

Not necessarily

>>you shouldn't need to have that debt,

Why?

Or I guess I should ask what other requirements of life should be completely under the governments control? Should Government run farms and give you food for free? Should government build homes and issue them to people?

I have never been clear why healthcare is uniquely something that must be provided by government but other things are not.

If you think the government should provide everything you need to live like they were a parent or nanny well then we have completely and incompatible views as to what a government should be

> Should Government run farms and give you food for free?

The government do provide assistance for food for those in need, and they are right to.

> Should government build homes and issue them to people?

Local governments in most developed countries build homes and issue them to the needy. And I believe this is correct.

You've obviously deployed exaggeration to try to make these things sound ridiculous ("...completely under the governments control..." and "...live like they were a parent or nanny...") but really none of this is controversial, they're pretty common, mainstream beliefs.

I believe that a government should work to better the lives of the citizens it governs. This includes things like providing education, healthcare, road and rail infrastructure among other things you probably wouldn't like. I am quite sure we have incompatible views as to what government should be and that we both believe the other's vision of an "ideal" country would actually be a dystopia. However some of the happiest, healthiest and best-educated countries operate pretty close to my ideal.

>>The government do provide assistance for food for those in need, and they are right to.

This is always the comeback to that question. The US provides food assitance and Medical Care Assitance to low income people via many many many government programs, very expensive government programs

That is NOT the same thing as NHS, which completely takes over and provides the care. Food Assistance gives people with out income money to go buy the resources on the open market. Medicade gives people with out income money to go by resorces on the very regulated US health system

This is not an analog to NHS or other government run single payer health systems

So again I ask, not about providing social safety net, but should the government completely take over farming and housing like the NHS and other government provided programs do for health services

>>This includes things like providing education, healthcare, road and rail infrastructure among other things you probably wouldn't like

Correct, Government is incompetence personified. The incentives for government programs do not include providing quality services at the most value. Driving on my roads, going to the government schools I went to, and seeing first hand what "government housing" is has cemented the fact that government provides poor quality services at extremely high costs

>>However some of the happiest, healthiest and best-educated countries operate pretty close to my ideal.

That is very debatable, and not really supported by hard data

Ok fine I didn't realise you were trying to lay a couple of little heffalump traps, so instead I just answered what I thought made sense. The given analogies are clumsy and don't really fit ("run farms" is silly - the NHS doesn't produce all of the things involved in the provision of healthcare - medicines and such) but I will humour you and answer in the context of the UK:

> Should Government run farms and give you food for free?

Probably not, the existing system works ok enough. They can maybe help the poor a bit more so they're not dependent on food banks (free school lunches was a recent controversy that shouldn't have been)

> Should government build homes and issue them to people?

I answered and you didn't like this but - yes and they should build more. I'll give you a little bonus and answer what you wanted to ask - "Should the government be the sole central authority providing housing?". Probably not, the housing market works ok enough in general. However they can maybe help the poor a bit more by building more council housing, not doing so is has directly contributed to making housing unaffordable for many.

And to bring us back to the original topic:

> Should the government have setup a national healthcare system back in 1948?

Yes - in the wake of WW2 there was no existing, competitive alternative that served the needs of providing quality, affordable healthcare to the populace. The NHS went on to deliver and then some. Plus with ~70 years of hindsight we see that in spite of a decade+ of brutal austerity, the NHS still costs less and delivers better outcomes than privatised systems like the USA has. It was the right thing to do, it is the right thing to do.

Also you seem to think they’ve shut out private providers altogether. This isn’t true, private healthcare exists if you want quicker access to some elective or non-urgent procedures or treatments.

Re your final point - this is very interesting. I'd like to know what countries you think I'm talking about, and if your libertarian (I think I'm right in saying this?), small government setup is anywhere close to implemented somewher right now or if it's purely theoretical/fantasy.

> That is NOT the same thing as NHS, which completely takes over and provides the care.

There's loads of reasons to dislike NHS care and it's genuinely weird that people who are so against the NHS never manage to hit on something real, and instead resort to stuff that's simply fiction.

NHS England spends billions commissioning care from private providers. That's why we have Priory Group, Cygnet, Operose, etc etc all providing care. (And in the case of cygnet and priory, often poor quality care).

And patients have a right to chose where to get their care - that's what chose and book is.

People who don't understand the NHS think it's a single organisation -which is what you've done here- and that's not correct. Patients have a choice of where they get elective care. NHS England commissions specialist services, and 42 ICSs commission the bulk of regular services. They're not allowed by law to have a preference for NHS providers, so if a private provider can do it for the money they should put a bid in. That commissioned care is provided by about 200 - 220 NHS trusts. NHS Trusts include ambo services, acute hospitals, community hospitals, mental health care, and community care. These NHS trusts are independent organisations that have their own boards of directors and their own accounts and they can compete against each other to provide services to particular regions. This does not include primary care which is provided by GP surgeries.

> This does not include primary care which is provided by GP surgeries.

Which are and have always been private businesses operating as NHS contractors - this was actually the concession the post-war government had to make in order to get the British Medical Association onboard with the NHS. And recent surveys indicate GPs are against any change to their private status.

So the criticism here is when talking about "The NHS" as a free-at-the-point-of-use system, I didn't also go into variety of contractors that are now involved and specifically the NHS Trusts that exist in NHS England which I have never encountered having spent 25 years of my life in Scotland so I can't really talk about personally?

And how exactly would that have improved this discussion with "phpisthebest" who seems to be against the very idea of insurance altogether, given that they have the means to take care of all their healthcare needs in cash (for now), and who thinks that everyone else should really see bankruptcy as a sort of spiritually cleansing and enriching experience?

> If you think the government should provide everything you need to live

If you're going to argue against fundamental human rights like "right to life" then you're going to have to do better than the arguments you're using here.

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