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Comment by dzink | Hacker News Reader

Imagine any single one of those companies being the single payer insurance you are forced into. They (government included) become far worse. Rationing care, deciding who lives or does, underpaying doctors and nurses till the best ones quit and the remaining have any care burned out of them. That’s what’s happened in other countries and regions and every time there is a surge or a more complicated care you and loved ones are left to die or deprived of care options.

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Yet we have examples of nationalized health care across the world that isn't this system you are describing. The US stands alone in it's terrible health care (and the price we pay for it).

We already ration care, it's based on what you can afford. We already underpay doctors and nurses like crazy, just go talk to one. We already drive them to burn out, because the current health care system is prioritizing admin pay over quality care.

The hellscape you imagine is the american system. It literally could not be done worse if we tried.

Average nurse salary in the US: $82,750

Average nurse salary in California (where ~10% of US population lives): $124,000

Average nurse salary in Spain: €29,277

My sources are probably junk, but even with insurance companies out of the picture what is the math that would make the US healthcare cheaper?

This is without tackling the earning rates for specialty MDs, like vascular surgeons, who are not that numerous to begin with.

Compare the cost of living of Spain to the US (food, rent, public transit) my friend. What makes the cost of CARE cheaper is less administrative agents/overhead.

Hypothetically then places with high concentration of beneficiaries covered by a single-payer system (Medicare) should have markedly cheaper medical care, lower overhead costs and all.

Yet https://www.wfla.com/community/health/coronavirus/florida-ha...

I suspect demographics are part of why Florida hospital costs are so high. The youngest state in the USA is Utah. The state has a median age of just 31. They have some of the least expensive hospitals in the country.

1. Medicare only covers the most expensive in terms of health care costs demographic. Knowing nothing else I’d expect having more people on Medicare to correspond with higher costs per capita. We make 25 year old men who statistically have nearly no healthcare costs buy insurance while providing it to their 90 year old grand parent.

2. Medicare was not allowed to negotiate drug prices until this year. Drug comonies basically got to wr8te themselves checks. In some ways the Us taxpayer subsidizes drug development for the whole world.

Now normalize those numbers by cost of living.

And type of nurse. Big difference in pay between an rn, Lpn, msn, crnp, but one might colloquially refer to all as a “nurse” (except maybe the crnp). Position matters too. A travel er nurse is going to make significantly more than an outpatient primary care office nurse

Exactly why the entire system should be nationalized instead of outsourced. Further, nationalized healthcare promotes political engagement on a basis of material necessities that politicians must be accountable for.

I’m not sure about that any more either. Read about the NHS in the UK - sounds like it is a dumpster fire and people are dying.

The dumpster fire is happening because the conservative government there is running it into the ground by cutting funding at every turn possible and closing down hospitals.

And even then, I've experienced NHS care and it's 1000% better than the experience I've had with american care. It's not perfect by any means, but it's insane how much better it is than what we have here.

I've heard this narrative over and over again yet every time I look at it the NHS budget has been consistently increasing year over year for a long time.

And proportionally even more of that budget goes to the pockets of politicians' donors who own the companies that displace the nationalized NHS. Again, the argument is for nationalization, which is the opposite of the direction the NHS has been heading in.

Real term cuts & ageing populace

They aren't necessarily cutting funding. They are cutting the amount of funding for nationalized services while increasing the amount of funding for outsourcing contracts.

It is. NHS is more of a de facto state religion than it is a decent healthcare system.

My argument is for nationalized healthcare. The NHS is increasingly not nationalized, so you're only proving my point if anything. Outsourcing the NHS has ruined it.

Before Brexit, NHS had better outcomes at 1/2 the cost of the US system.

Calling it a dumpster fire when the US system exists is laughable at best.

That's a pretty good description of the American system as well.

>Rationing care, deciding who lives or dies, underpaying doctors and nurses till the best ones quit and the remaining have any care burned out of them

This is literally happening under the current system now. My cancer treatment plan, should I ever get it while I'm living in America, is to blow all my cash and buy an exit bag on credit.

What scares some people is not that rationing care may already exist but that there may not be any fast-track line you can buy your way into.

A lot of countries have both nationalized care and the fast track. Many people buy private insurance to cover what the national system does not.

Maybe it's not the best of both worlds, but it's at least a far better safety net than the US provides, and that's the most critical piece. Both for the most affected individuals, and society as a whole (even in terms of cost! An ounce of prevention is worth a pound of cure, and all that.)

There are medical company systems in the US that operate similarly to a nationalized system (insurer and provider bundled, I’m not mentioning the name) and have similar downsides - cancer care or any advanced care is sub-par and mental health is hard to impossible to get. The funding to physicians within is distributed on political instead of performance grounds so best ones leave. I’ve lost several friends who used that insurance.

In Bulgaria where I have many friends and family, the system has always been nationalized, barely funded by the government. I don’t know a single Cancer survivor there.

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