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Comment by lolinder | Hacker News Reader

I take it you haven't ever interacted with the IRS beyond filing the standard deduction? Or interacted with Medicare/Medicaid?

The only issue raised by OP that would go away if it were managed by a US government bureaucracy instead of a private company would be people running out of coverage, and that only if healthcare were subsidized universally.

And to preempt the comments saying it doesn't have to be this way: it doesn't matter what if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are, and the idea that this case would be the exception is just wishful thinking.

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The IRS and the USGOV in general is much more lax on preventing citizens from having free money. I get tax return refunds I shouldn't, plenty of people cheat the system and get away with it. For profit insurance companies are harder to cheat. If an insurance company refuses a claim, what are you going to do? go to another insurance company that will do the same thing? If the government refuses a claim, you can vote for the other guy. The government is comprised of "we the people", so it is in the best interest of the people for it to take place of insurance companies, which are certainly not comprised of "we the people".

You should also understand that I am not suggesting that insurance companies should be banned. If you don't like the USGOV subsidy, you or your employer can still subsidize private insurance for you. But now, insurance companies have to compete with the government!

I had Medicaid when I was an adult student. Worth pointing out that it was administered by the state of Colorado and not the feds, and was post ACÁ.

It was, by far, the best insurance I have ever had in the US. It was effectively a gold insurance plan with no deductible, a $2 copay, drug and dental coverage.

It was very easy to sign up for, and the paperwork was literally the exact same as buying marketplace insurance.

I found it to be a better experience, and better administered than any other American health insurance I ever had.

If I could have paid money to stay on it when I got a job I would have.

My brief insurance experience with Medicaid was the best I ever had. It was through State of NY. I happened to break my wrist during that time. It was easy to find a doctor, low/no copays or deductible, and they were comparatively easy to contact.

Every other insurance company I've dealt with has actively cost me money, time and unnecessary pain through ineptitude or beurocracy. My FAANG healthcare was good, but had relatively fewer health issues

Government support should start a few steps before payment and filing taxes. The solutions that would fix this problem are analogous with having free education instead of student loans

Now we've moved on from talking about direct government subsidy to talking about completely government-operated medicine.

And for that, I'd like you to point me to a state with government-operated medicine that doesn't have a therapist shortage. Because I'm hearing from several people in this thread that their countries have the same problems.

No we haven't- these problems aren't only reducible to a few categories (i.e., free market vs government operated). The shortage of therapists indicates at least an awareness of discontent among many people, and a desire for help (whether just listening, coaching, or deeper interventions). Those relationships used to involve family and friends, but we understand that a therapist is better suited because of better training and less conflict of interest. We don't need trained psychologists for all of those relationships, and much of it could be solved through other relationships that provide comraderie and fraternity- even in a racquet club, finding other people to help you understand the world and support you. That provides an alternative role for government to intervene, instead of the government-operated medicine boogieman. In this case, the government insuring that more people have leisure time to join clubs, go hiking, spend less pressured time with family and friends, would go a long way to improve the problem. That is a different approach from the financialization of cultural life that pervades most government approaches, but it would be much less costly and reap greater rewards

Next time, for comparison, choose a country where half of the political spectrum does not deliberately gimp goverment's ability to do things just to prove government can't do things.

We're commenting on an article from a US news outlet about the situation in the US. I wasn't going to start talking about a random other unrelated country when people are proposing solutions for this one.

Also, I attempted to preempt these comments. They're not clever or new or even particularly accurate:

> And to preempt the comments saying it doesn't have to be this way: it doesn't matter if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are

> I take it you haven't ever interacted with the IRS beyond filing the standard deduction? Or interacted with Medicare/Medicaid?

raises hand

I have! I've actually worked a shocking amount with the IRS, not because I'm a criminal but because I'm working class and wasn't educated on how to file taxes more complicated than a 1040-EZ, presumably because it was never expected I would make that much money or own my own business.

Strictly my experience, I would much, much rather deal with the IRS than my insurance company. Yes, they're intimidating at first, but ultimately every person I've worked with both at the IRS and my state agency has been calm, professional, and frankly to a degree I found surprising, extremely understanding about how badly I fucked up my taxes on a number of occasions. I was never treated like a criminal; they explained what I did wrong, how they found out, what I owed, and how to prevent those issues in the future. And I was given interest-free payment plans with a one-time administrative cost to setup, that I now pay monthly. I'll be fully 0'd out in about 2 years.

This contrasts sharply with my experience with my insurance company! My insurance company tries to get out of paying for every last thing they can manage. My dental insurance has a maximum pay out of a measly $5,000 per year, which seems completely backwards to every other insurance I have ever had, but what do I know. You know how fast you can crush 5 grand in dental work? And paradoxically it still has co-pays, so apparently I'm paying so they will cover most of some bills, up to a predetermined maximum. Additionally, since I own my own business, I do have the luxury of choosing my own insurance, which most people can't, and for that luxury I pay simply princely sums each month to insure both myself and my spouse. I've picked the best for my area (at time of comment) and have to spend many many days of unpaid labor every year re-evaluating that choice, both because circumstances and networks change coverages, and because every single year my insurance goes up despite both of us, by and large, being quite healthy, and I get fucking annoyed about it and want to see if I'm getting my money's worth. I wouldn't say I am by a long shot, but the alternatives cover less, and cost more, so I'm still paying.

Frankly, and I don't mean this as a personal attack against you, but I have to assume people who talk like you have never interacted directly with the IRS, and are instead absorbing that opinion through the same cultural osmosis I did, because I too was initially terrified to the bone when I got my first letter from them several years after starting my company, and honestly, they are incredibly over-hyped. The only way to truly get the IRS to take you to to task is to, for years on end, purposely try and weasel out of paying taxes.

I would LOVE, absolutely LOVE, the ability to get my healthcare funded via an organization templated off the IRS.

It's also country specific. HMRC in the UK are pieces of shit I wouldn't scrape off my shoe

To be clear, I'm not talking about the cultural fear of the IRS, I'm specifically referring to the idea that patterning insurance after the IRS would solve most of the issues that OP brought up:

> - Have to deal with filing claims, which ultimately becomes an additional expense, since chances are you have to pay someone to do this for you.

> - Get your money later instead of now.

> - Have to keep meticulous notes in case you ever get audited by the insurance companies, who can refuse to issue payments if your notes don't meet their standards.

This description could be lifted up and dropped in to be describing my tax situation each year. Meanwhile, I've never interacted with the kind of nightmarish insurance companies that some people have, so I'm strictly comparing two relatively painful bureaucracies, not nightmare stories about either one.

>I'm specifically referring to the idea that patterning insurance after the IRS

Maybe I'm missing something, but I don't see anyone who brought up the IRS as a model example except for you. It seems like people are just talking more generally about steamlined than the current status quo experience, and there are so many ways to steelman that which have nothing to do with analogies to the IRS.

To your credit you did note that you wanted people to take you up on your suggestion of using only bad examples, but I don't think your insistence on that front holds water because this is the type of thing where the difference that makes the difference is going to be the very details you are asking everyone to gloss over.

I was responding to GP, who definitely did say they would love to use the IRS as a positive example:

> I would LOVE, absolutely LOVE, the ability to get my healthcare funded via an organization templated off the IRS.

I'm not at all sure what you're getting at with the rest of your comment, because it doesn't seem to relate to anything I actually said. I'm insistent that we be realistic about what a US bureaucracy will inevitably look like and not expect it to produce less red tape than is already present. I said nothing about glossing over anything.

I fucked up my taxes one year. I filled out the form letting them know I had made a mistake and paying the amount and that was the end of that.

I messed up an insurance deadline one year. I called in and they sorted it out.

I didn't say the IRS was worse, I just said it wasn't any better.

Right but I think the point is that it is better at the end of the day. Since we're all sharing our anecdotes, I am familiar with someone who works in a municipality where their entire job revolves around billing and claims for EMS.

The amount of extreme cases of stonewalling, long holds, call transfers, inconsistent interpretations of policy, requests for faxes that get lost, requests for new paperwork, and general lack of urgency, across numerous companies in numerous states, is mind boggling, and easily an order of magnitude more extreme the IRS experiences I've seen shared here.

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