Hacker News Reader

> I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap

I hear this a lot, but that doesn't really seem to be what the data says? There have been a good number of studies comparing American healthcare to more socialized systems, and the outcomes are generally comparable or better in the socialized systems. That doesn't imply that if we just changed to a universal system tomorrow that we would have the same outcomes, every country is different, and it's not necessarily guaranteed that copying Sweden's system would automatically work here.

But I do think that it's also not implied that it would lead to the bureaucratic chop-shop that people are afraid of.

It always comes down to who you compare. Most of the cited information on outcomes look at averages. US healthcare outcomes are bimodal. It is easy to sell the idea to people with poor coverage distribution. The harder sell is the people in the better distribution worried about taking a step down while carrying the cost for other people.

Yeah, that's kind of why I hedged what I said a bit, because I know things can get a lot more complicated than just looking at averages.

I do think it'd be better if everyone had healthcare and it sucked a little vs "some people have good healthcare while others have none", but of course that's a much harder sell.

A good universal healthcare system wouldn't have these issues but, much with a nod to the ACA, would we manage to accomplish a good system or would that system still be riddled with rent-seeking opportunities to protect the employment and profits that the current players extract?

The US seems to have real problems with regulatory capture (especially with recent political happenings where we're seeing tariffs implemented that specifically hurt competitors to those with influence in government) so I think it's important to not fall into a trap of believing you'd walk away with a wonderful healthcare system even if something like medicare for all happened. The entrenched interests would continue to exact their pounds of flesh unless a real sea change was seen away from the current status quo.

I do hope it happens though, I'm a Canadian and my employment is dependent on your system continuing as an entangled morass but I'd happily be out of a job if it meant more equitable access to care.

> I am scared that universal healthcare would introduce so much bureaucracy...

I use the NHS in the UK and it isn't especially bureaucratic, much less so that the US system. It does have its failings though like wait times to get stuff done, poor communication and the like.

The bureaucracy of dealing with a patchwork of health-insurances plans, their different payment structures, what care is/isn't covered, in-network or out-of-network etc, etc is a HUGE bureaucratic burdern. Doctors already do what you describe, or are at least pressured to do so. Doubly-so as places are being bought out by health insurance companies (like all those "Optum" clinics, which are owned by United Health Group).

A universal health care insurance plan, like "Medicare For All," would simplify bureaucracy. How many times can you honestly say that a government run program would simplify bureacracy?! Not often! But if we could just start over, a single health insurance plan that works the same for everybody in the country would be a huge burden lifted.

A bureaucracy results in controlling the payout of money. Once people's paychecks are tied to running or working in a bureaucratic system, it's hard to get rid of them. Mostly because they can show how many requests for cash were denied and the savings they achieved which were passed on to the taxpayer or to the stockholders.

A Fortune 500 company will find it easier to negotiate a good plan with easier money for it's employees typically, but a mom and pop shop doesn't have the negotiation power to make the insurance companies pay out.

And just because it's a benefit today, doesn't mean DOGE (or whoever next in power) will enshittify it.

That is the problem with good things. They sometimes are ruined. Best stick to the bad things, then!

> I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap, check off their forms and then shuffle you off.

That wouldn't be a change.

> Every time I think about quitting it gives me pause knowing it means a few risky months until I can get a new job and have coverage again.

There's COBRA for that! If you quit your job, you can continue your previous employer's coverage for up to 18 months, but you'll have to pay the premiums yourself.

And it's typically cheaper than what is available on exchanges. You can also get a subsidy for COBRA if you can't pay premiums, but only if you were fired.

> I am scared that universal healthcare would introduce so much bureaucracy that doctors will just process you asap, check off their forms and then shuffle you off.

We have universal healthcare: Medicare and Medicaid.

> If you quit your job, you can continue your previous employer's coverage for up to 18 months, but you'll have to pay the premiums yourself.

With what money?

> We have universal healthcare: Medicare and Medicaid.

Do you know what "universal" means? Both of those programs have significant restrictions on who can access them.

> There's COBRA for that! If you quit your job, you can continue your previous employer's coverage for up to 18 months, but you'll have to pay the premiums yourself.

That's not really a consolation if the premiums are really expensive.

> And it's typically cheaper than what is available on exchanges. You can also get a subsidy for COBRA if you can't pay premiums, but only if you were fired.

"Typically" yes, but not always. I mentioned in a sibling thread that when I was fired from a job and was on COBRA, the premiums were almost 4 grand a month.

It was so expensive that I actually started calling up different insurance companies in the NYC area, because the premiums were slightly lower even just paying out of pocket, and luckily I narrowly qualified for a medicaid thing, and it ended up being free through the MetroPlus network [1], so it all worked out, but my point is that COBRA isn't always cheap.

> We have universal healthcare: Medicare and Medicaid.

Medicare and Medicaid are great programs, I'm very glad they exist, I think it would be horrible if they were taken away. That said, they're not "universal" healthcare. It's pretty easy to fall through the gaps where you're "too rich for Medicaid" but "too young for Medicare".

Anecdata, but my brother in law does work for a living, as does his wife, and together they end up making somewhere around $75,000/year in Texas. Not a terrible wage, people have certainly lived on a lot less, but neither of their jobs have health insurance, and they make too much together to get it for free from the state.

[1] If you ever get fired in NYC, I'm sorry to hear that, but do not hesitate to call MetroPlus. The agents there was extremely nice, helpful, and without an ounce of sarcasm I think that their existence makes the world a better place.

The right way to think about Medicare and Medicaid is on a bathtub shaped graph, where everyone who is young is covered, everyone old is covered, and everyone poor is covered.

It's just "above income threshold between ages of 18 to 65" that isn't covered.

We just need to get the social/political will to fill the bathtub.

> "Typically" yes, but not always. I mentioned in a sibling thread that when I was fired from a job and was on COBRA, the premiums were almost 4 grand a month.

That sounds illegal. They have to charge the same premiums that the employer pays. Unless you had a really expensive coverage.

> It's pretty easy to fall through the gaps where you're "too rich for Medicaid" but "too young for Medicare".

I'm sorry, I meant that they are examples of universal healthcare that exists in the US, with some conditions.

I think my coverage was expensive.

Also, and I don’t know how the legality of this, it got progressively more expensive each month. The first month was around $1800, the next $2500, the next $3100, etc.

$4,000/month sounds about right for some plans. When I quit a job my COBRA premiums were like $2500/month which I did not want to pay since my new employer was providing me a stipend for an exchange plan in my area. My SO had a UHC plan through an employer that was like $1200/month via COBRA. I know that because we paid it so they could continue some treatment.

COBRA is not cheaper than exchange plans. Medicaid is not universal; in many places - Florida for ex - it isn't available to most men, to other-than-the-elderly, and other-than-children.

What's this about getting a COBRA subsidy if you're fired? Where did you hear that?