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Comment by muttled | Hacker News Reader

Reading your comment, I had the thought "I wonder if California's done it?" Turns out they've tried it 10 times. I'd imagine there's a lot of money being thrown against the initiative by for-profit insurance companies, which is an industry with a lot of cash to buy laws.

https://stateofreform.com/featured/2023/05/california-seeks-...

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The problem with doing it at the state level is that then all the sick will move to that state. Which won’t work from a risk pool perspective

It would seem unlikely that all sick people would move just for one perk. Most people do not take moving as a light decision.

Also most people that actually do move would likely have jobs with taxable wages that helps to subsidize things.

The real risk population is maybe the homeless sick that migrate. But those tend to be in a different category entirely (e.g mental illness, addiction, trafficking etc.)

Well sharts, most people don’t take dying too lightly either. Free care for the gravely infirm would be, to a point, the only perk that mattered at the exclusion of all others. Likewise with the possibility of total bankruptcy.

This problems is mostly solved for in state vs out of state tuition. Just institute 12-15 month waiting period or 3 months waiting period with full time job.

That reads like they've tried to try it 9 or 10 times. They haven't even gotten to the point of finding out what all might turn out differently in a US state than in an EU country surrounded by other EU countries, all with roughly similar approaches to public health care.

I work in public health at a state government, in a western state. The biggest hurdle I see is that America has freedom of movement and residency. If my state creates truly affordable health care, we will of course have refugees from conservative states coming here for medical care.

We'll probably end up with a public option of some kind that will somewhat function like health insurance but who knows.

This is an interesting point. And perhaps worse yet, high quality doctors will have the freedom to move out of your state.

I'm an American living and Germany and sadly, my GP who is also a personal friend of mine, will be shutting down their practice at the end of the year because their small practice simply isn't financially sustainable. They will instead start treating the prison population, which apparently pays more / is more consistent.

So I can also imagine how doctors in your state would feel if suddenly their rates are dramatically capped by the state.

I'm not aware of any public health care systems where medical care services are as expensive as in the United States, but perhaps it's possible to maintain relatively similar doctor pay as currently exists AND provide socialized health care benefits. I really don't know enough about this topic and the financials of American (non-public) health insurance companies to comment accurately on whether that would be feasible.

There is no chance that the state would cap rates, I'm not sure they even could. The real pull would be trying to expand Medicaid, which is free,creating a single payer system and raising taxes, or creating public health insurance, or some combination of both.

The public option would be the best in a vacuum, but if its truly affordable, we will still attract uninsured and under-insured people who come here when they get sick.

Prices could probably drop if the market was saturated with doctors. And the best way to do that would be eliminating medical-school debt.

I thought the limited number of residencies was the real bottleneck?

Both

Both are important. The high cost of medical school means people are only going to try and go for the specialties that pay the most (surgery, oncology, radiology, etc) leaving a shortage of Drs in other specialties like primary care/family medicine.

Primary care reimbursement rates also need to be raised and we need more preventative treatments that insurance is required to pay for.

I'm comparing to the best public healthcare system I'm personally familiar with (Germany) and saying:

* Medical-school debt is not a thing here. * Prices are low. * I know doctors who can't make a sustainable income to keep their small practices open.

Somewhat puzzlingly, for a handful of services, there can a medium length delay in getting an appointment because of how busy the doctors are.

This is definitely all much better than the situation is in Canada, where the typical person struggled even to get a GP, and friends with cancer would be forced to wait a life-imperiling year to get a routine scan that be the difference between life and death.

This is a challenge. It would be unconstitutional to out right ban individuals from getting the benefits, but maybe a waiting period would be constitutional(i.e. must be a resident for 1 year to sign up).

They haven’t actually tried it. The last time it was yanked from being voted on because politicians make promises to get elected and are then told by their donors not to dip into their profit pools.

But in many ways California already has it if you qualify based on income (Medi-Cal / Medicaid).

It actually works well which is why it won’t be made available to everyone. Stock prices and profit margins would drop too much.

If you want consumers that spend more money on your products, you need consumers with more money. To some degree, an inefficient healthcare system stands in the way of every other industry's profits. A suitably ambitious middle manager at a large company could probably make a dent. A CEO of such a company might actually capture some of that inefficiency.

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