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Comment by monero-xmr | Hacker News Reader

The solution is to have universal catastrophic insurance for all citizens automatically, say $100k or some number. Combine that with tax-deductible health savings accounts and a competitive retail healthcare market, you find a sweet spot between universal and for-profit.

Anyone who thinks the universal model standard in Canada and the UK is actually working has a hole in their head. The solution is a combo.

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> a competitive retail healthcare market

What's a "competitive healthcare market" for diabetes? Or cancer? Or childbirth?

> Anyone who thinks the universal model standard in Canada and the UK is actually working has a hole in their head.

The UK has a population of 67 million. There are half a billion patient contacts in any given year. I've yet to hear stories like "I can't afford my insulin" or "we had a child, the bill was 200k and we were also charged for holding the baby"

The horror stories from the UK type system are more like "I had to wait 8 months for treatment" or "my medication wasn't available".

"I had to wait X times for treatment" is a very common complaint in the US on top of "I can't get treatment because my insurance doesn't cover it".

Same for "medication wasn't available": "my insurance doesn't cover the medication required".

The US literally has a video genre of "rationing of insulin to survive".

in uk, good thing is, if you do get to see the doctor, you don't have to pay anything but the tricky thing is "getting some one to see you".

on average, system is good for bottom half but system is pathetic in terms of services after paying such high taxes.

You can definitely have a competitive market for any procedure that can be scheduled. Amazon will often negotiate on behalf of their employees in order to shop around procedures (see Oklahoma Surgery Center).

The difficulty is for sudden situations like heart attacks. For these you need savings accounts and a baseline catastrophic plan.

> You can definitely have a competitive market for any procedure that can be scheduled.

You don't have unlimited fully equipped hospitals and operating rooms. You don't have unlimited heart surgeons. You don't have unlimited MRT scanners or labs doing blood tests.

In healthcare both the supply and the demand are inelastic. Market forces here work only for the most common and the most simple cases like nasal sprays and eye drops.

Hard disagree. The market exists for healthcare. The government may artificially restrict certain aspects of it but the market does respond to signals by building more facilities.

Furthermore a lot of innovation goes to increasing bandwidth of the existing doctors. See tele health.

I think you have a very limited view of what is possible.

I think you have a very rosy view of the market. And you also overestimate the supply and demand in healthcare.

One thing I've noticed about the UK is that I've had to stop reading every British author I've read in my life because they've all died young.

Some of them did manage to release statements about how much they support the NHS before dying. I'd be more impressed if they lived though.

    The United Nations World Population Prospects suggests current life expectancy in Australia in 2022 to be 83.79.

    In fact, Australia enjoys one of the highest life expectancies in the world, ranking 8th out of 60 developed countries. That’s higher than the UK (81.65) and the US (79.05).

[ quote source ] https://www.hcf.com.au/health-agenda/health-care/research-an...

[ raw data source ] https://population.un.org/wpp/

So it appears that both Australia and the UK with National Health services (named differently in AU) have greater life expectancies than the US.

Perhaps it's the authors you read?

Bertrand Russell was 97 when he died.

Medicare isn't the same type of system as the NHS. My understanding is the NHS is actually fairly rare among healthcare systems, but aside from that it has the bad luck to be run by UK politicians.

US's lifespan is not caused by lack of access to healthcare though, that is fentanyl.

> Medicare isn't the same type of system as the NHS.

True, however Australia has a tiered health care system with a very low gap to ensure that practically the entire population has access to healthcare that they can afford in addition to national bulk pharmacy deals to cap generics for the bulk of ailments that require prescription.

For all it's warts the Australian system delivers a kind of healthcare that the US system does not .. widely available affordable treatment for the bulk of medical issues.

US (general mean both sexes) life expectancy sharply dropped as COVID spread, the most that fentanyl can be accused of is the flattening of the general slow increase between 2012 and 2018 .. even that ended and was on the increase until the USofA foot gunned its handling of COVID.

[ Historic USofA ] https://population.un.org/wpp/Graphs/Probabilistic/EX/BothSe...

[ Historic Australia ] https://population.un.org/wpp/Graphs/Probabilistic/EX/BothSe...

> US's lifespan is not caused by lack of access to healthcare though, that is fentanyl.

How do people with substance use disorders stop using substances? They use healthcare, unless they're in the US where they'll using some quasi-religious abstinence-only residential programme.

Tolkien lived to 81. Agatha Christie 86. John La Carre 91. Jackie Collins 77. Ken Follet is 74 and still very active. Anthony Burgess 76. PD James 94.

If you're talking about Douglas Adams, he died of a massive heart attack...in California, where he'd lived for years.

So, in summary, uh wot mate?

Iain Banks (59), Pratchett (66), and I'm not letting them off for Douglas Adams yet.

Though everyone in my family in Glasgow seems to live well into their 90s.

Both Banks and Pratchett died from untreatable illnesses. Feels a bit unfair to blame the NHS.

This is a pretty hot take. The NHS has been run into the ground. That doesn't mean socialised healthcare is not possible. I don't look at broken old car and say "no cars work".

You mean above $100K they pay? Per year or what? Because a $99K/year bill for ongoing treatment is still going to bankrupt people.

Considering the average family cost for insurance is $22.5k

https://www.kff.org/report-section/ehbs-2022-section-1-cost-....

It is quite feasible that redirecting all of that to a tax-free savings account could pay for itself in no time.

That much? Makes the $2600/yr that I pay sound good. I have a high deductible though ($3K). I don't know if putting $23K aside each year and not having any insurance would work for everyone... I think we should just give that money to the gov't and they should cover pretty much everything. With a pool that big I think the economics would work.

It is not as easy as that because supply is heavily constrained. You need a lot more people able and willing to become doctors, nurses, people who change bedpans and clean hospital rooms, so on and so forth. Add in aging populations with fewer proportionate working age people, and the equation does not balance.

That is not something any policy change can fix until far in the future. In the short term, all that is possible is deciding who gets allocated the available healthcare.

> The solution is to have universal catastrophic insurance for all citizens automatically

> It is not as easy as that because supply is heavily constrained

I don't think this argument works when the data shows 90%+ of the population has health insurance.

My assumption is that the many people, if not the majority, still avoid seeking healthcare due to a doctor visit costing a minimum of $250+. You can give everyone the $100k deductible insurance, which is great, but the issue in this thread is that a regular consultation with a doctor costs so much, that a $29 telehealth option (probably with someone less qualified than a doctor) is better.

Nurse practitioners have been allowed by states to handle more and more services. Telehealth primary care has enabled more scaling - I know because I use such a service for my whole family. I’m much, much more confident in the US to handle an influx of immigrants and aging retirees than Canada or the UK with their rigid services.

Yes, one of the ways that the limited resource of doctor time will be allocated is to simply have increasing portions of the population see people less qualified than doctors (perhaps not bad from a systems point of view if it is diagnosing conjunctivitis, but from an individual point of view, you can see where this is going.). You pay more, you get people who have met a higher standard of education/experience, e.g. concierge care and direct primary care practices.

Yes the reality is harsh. But much better than waiting 12 months to get in cancer care and then dying while you wait.

Completely agree. I am fairly conservative in my thinking, and this is a strategy I could get behind.

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