Comment by rada | Hacker News Reader

Comment by rada | Hacker News Reader

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I have several friends in the UK and Canada and they tell me that universal coverage is more comparable to the US situation than everyone thinks, for several reasons.

If you are healthy, it's a wash because, well, you are healthy and it makes no sense for you to have health insurance at all, just pay out of pocket for what little you need. If you are sick, it's a wash because there are waiting lists and eligibility requirements, so they (my friends) all choose to carry extra insurance, for which they pay out of pocket, just in case by the time they are able to get that fancy heart surgery, they may no longer be alive.

What is your take on that?

Edit: Curious that all the responses so far are all about money. Surely going bankrupt beats dying because you never got that life-saving surgery on time?

A less dramatic example: I just had a wrist fracture. According to google, if I were a Canadian or a Brit, I would have had to walk around with a broken wrist for roughly 2.5 months (official average wait times).

I am not saying the US healthcare system is not broken. Of course it is. I am just saying universal coverage is not all it's made out to be either. At the end of the day, if you want good healthcare, you have to pay.

If you are healthy and rich, it makes no difference.

I've known quite a few freelancers and unemployed people in the US who had no insurance because they couldn't afford it (and, in the pre-obamacare days - because no insurer will take them).

The big difference becomes visible when something in your condition changes. Lost your job? in the US, you lost your coverage (COBRA[1] is only partially a solution). Found a new job, but had a pre-existing condition? too bad, you didn't get into the new healthcare plan. (Obamacare is solving that now, after a few decades)

Part time employee in a low wage job? You're unlikely to have had health insurance until recently.

Switched jobs? You're likely to have to switch your doctor, because your old doctor / hospital is not on your new network.

I've heard people in the US complain about pains and then say "but it's not horrible enough for me to go to the doctor - I can't spend the $150 right now". That's unthinkable in universal healthcare systems.

The difference is that there aren't 1 out 6 people (50 million) without health insurance in the UK and Canada. Another difference is that no one in the UK or Canada would ever have to go bankrupt trying to get that "fancy heart surgery" or "fancy cancer treatment" or "fancy kidney transplant".

"just in case by the time they are able to get that fancy heart surgery"

And, the 50 Million people who could never, ever hope to get that fancy heart surgery because they can't afford the surgery or the insurance (or don't qualify)? What of them?

Saying they are comparable in any way except "doctors perform treatment on patients in a licensed and regulated manner" is reaching.

1-in-6/50MM without health insurance is not as straightforward a fact as it seems. Not saying there isn't a problem, just pointing out a few considerations:

1. Insurance is not the same as coverage. Plenty of Americans who do not have health insurance are covered through various programs for children, the elderly, veterans, etc.

2. Insurance is voluntary, and many people who can in fact afford it, simply choose to spend money on "stuff", including that sacred cow of american life, home ownership.

3. The statistics for the uninsured (like your 1-in-6 number) include the elderly, the illegal immigrants, those who are uninsured only part of the year, and other groups that skew the results.

4. If 50MM (although I dispute that number as per above) cannot get the heart surgery because they don't have any coverage but the other 250MM can, it's better than, say, 200MM not being able to get the surgery because of waiting times or ineligibility. Of course, those are totally made up numbers, I am just making a point.

>it's a wash because there are waiting lists and eligibility requirements

It's not quite a wash, because you don't lose your home and your kids don't have to drop out of college if you can't afford insurance and you get sick.

For people who want private rooms and immediate service, added insurance seems perfectly reasonable.

>by the time they are able to get that fancy heart surgery, they may no longer be alive.

This will always be the case, no matter how much insurance you buy. There's no plan yet that brings the dead back to life.

The state of US healthcare is certainly detriment to meaningful debate of reform.

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