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Comment by runako | Hacker News Reader

Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.)

Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter.

One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely.

Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US.

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Don’t forget the repeal of the ACA healthcare mandate: “The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019.”

https://pmc.ncbi.nlm.nih.gov/articles/PMC8886708/

Aka Republicans being pissy about the ACA (despite having come up with no feasible alternative plan at the time and unanimously voting against it even after it incorporated Republican characteristics) and choosing to try to intentionally financially torpedo it so they could campaign on its failure.

I'm pretty centrist, but the sheer evil of fucking over a country's access to health services for political points is appalling.

Especially since, you know, coming up with an alternative plan was eminently doable -- just not a priority for Republican leadership (then or "we have an idea of a plan" now).

Quick note that for people aged 65 and over the US does have a healthcare system somewhat like other developed nations.

Given that older people tend to be some of the main cost drivers in healthcare, it's sort of silly that we cover them and then refuse to allow younger (cheaper) people to opt in to the same system & perhaps defray costs that way.

You're missing a key piece. Medicare only sort of works because the larger healthcare system has a hidden cross subsidy where commercial health plans reimburse providers at much higher rates. In some cases providers are actually losing money caring for Medicare beneficiaries. We already have a problem with doctors refusing to accept new Medicare patients, and if we moved more patients from commercial insurance to Medicare then that provider shortage would only get worse.

Medicare Advantage?

https://m.youtube.com/watch?v=Ejoi9yfLVCc

Health care is fine here if you have a decent job. Health care is not that great in public systems and you still pay for it with higher taxes

And naturally you make this absolute claim because you've undoubtably lived in more countries than just the United States, right?

As point of reference, I lived in Taiwan for years - they have a national health insurance system, and taxes are comparable if not lower in some situations to the United States.

I have lived in 3 countries with socialized health care system and the public systems were just average to poor, and costing me a lot.

In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people.

In this day and age public healthcare system are not efficient and bill the wrong people.

They are mostly payed by young population, between 18 and 65 years old. Specially the highest earners.

However most of the usage comes from 65+ citizens, which are starting to become majority. And also tend to be the ones concentrating the wealth of the country.

These public systems work great when most of the population is young and is paying into the system. But modern western societies are not like that anymore. Wealth is not owned mostly by older people while they barely pay into the system.

Private systems work better because each citizen pays into his old age health coverage during his young years.

> In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people.

The solution here is to get rid of private insurance in Germany and only have public. It creates a two class system and private is a terrible choice once you are older, as costs will skyrocket.

Actually the solution is to go full private.

Costs when you get older skyrocket, but not your monthly contribution.

You subsidize your own elderly costs by paying slightly more during your younger years. That slightly more is part of the insurance companies Float, which gets invested and is used 30-40 years later to cover your extra costs in old age.

In a public system there’s no float. Everyone pays to cover the costs of the healthcare for that budget year. Which has the consequence that whenever there are population age shifts, the system becomes not sustainable, which is our current situation in Germany.

If everyone (except unemployed) had private health insurance, population age would be non-problem.

So your complaint is that the young subsidize the old in a public system, and your solution is a private system that somehow doesn't raise rates on high risk (older people) and to use the young...to pay for the old?

You also ignore that you can't switch and magically have 30-40 years of float for old people currently receive healthcare, so you have to keep the same system in place until they are gone because insurance companies would instantly go bankrupt under your plan (since they have yet to build a float but have payouts instantly), so now young people subsidize old and have to pay for their non-subsidized future so they will basically have to pay double. Or do you plan just leave old people out of the public system? Pretty nice demographic to just ignore in your plan.

> Health care is fine here if you have a decent job

This statement is at odds with itself.

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