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Comment by jmpman | Hacker News Reader

I’m concerned with anyone proposing “Medicare for all” in America, because they all state - for doctors who want to stay out of the system, they can be paid directly… that immediately causes a slightly different 2 tier system. Right now our 2 tier system is the 90% with health insurance and the 10% without health insurance. In the new Medicare for all, it will be the 99.9% on government insurance, and the 0.1% - the ultra wealthy - who dominate tax policy and are heavily financially incentivized to reduce their tax contributions to the public system. They will influence politicians to spend less on healthcare, with no impact to their health outcomes. The only system which will work in the US is one in which the ultra wealthy have an incentive to provide funding to the public system, and that seems like you’d need to force them to be on the public system too.

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> The only system which will work in the US is one in which the ultra wealthy have an incentive to provide funding to the public system, and that seems like you’d need to force them to be on the public system too.

In my state, I pay $15k/year in school taxes, yet I have no children. I pay $1000/year in property taxes to support my city's library, yet I don't have a library card. People are taxed for lots of things they don't actually benefit from. I don't think we would need to force rich people to use the plans. If they want to buy medical services from private doctors, sure we can let them.

The issue then becomes more about allocation of resources (how many doctors are available to be seen on the public system vs. only available to self-pay customers) rather than the issue being about how to collect taxes.

you can either build good schools or good jails, so contributing to your schools is contributing to your town infrastructure.

There are no good jails.

School is jail

So is some healthcare.

This may be small potatoes, but I've heard it said that people like you benefit "by not living in a state full of dumbasses." There's definitely an indirect benefit from these payments.

Exactly, same with health insurance! I'm less likely to get sick if everyone around me has access to doctors when they get sick.

(I personally don't mind subsidizing my library + local school district... good schools and libraries are good for the community)

> (I personally don't mind subsidizing my library + local school district... good schools and libraries are good for the community)

Just sharing random coffee break thoughts... it always blows my mind is how many people _don't_ think like this. When base conditions improve for society, the conditions improve for _everyone_ regardless if they directly benefit you.

I'm also in the boat where I don't have kids, but I'd also like to live in a place that has educated people - so schools make perfect sense to me. Heck, even if I didn't benefit from it, providing children education is just the gosh-darn right thing to do.

> how many people _don't_ think like this

It's just lack of trust. It's not that people want a worse community, it's that they have a hard time believing that taking extra money from their paycheck will create a better community.

Part of it is real; seeing massive amounts of state/local government waste and corruption makes it feel safer to keep your extra dollars instead of giving them away.

Part of it is difficulty evaluating timelines; more tax dollars for a better elementary school to be built in 3 years and to yield higher educated people 18 years from now it a lot to bet on.

IMO it's because there's both benefit and waste/corruption in these kinds of social benefit structures. some people choose to only see one or the other:

"these benefit everyone including those who don't use them directly! how could you be against it?"

"this money that I'm having to pay is either overpaid to corrupt vendors, or just straight wasted, why would we ever want to increase how much we're paying into this system?"

in reality you can't have one without the other. it's up to each person to decide whether they can take the bad with the good

Yes, universal health will start saving money even during the first transition year. We spend almost 1/3 or more of those total health dollars on billing administration. That amount surpasses the uninsured number. And the reality is if we can get medical care during the daytime, eventually emergency rooms might get less hectic. My hope is that more days than not ER personell have to pass the time like at a Firehouse.

Not only are you less likely to get sick,

You're less likely to see sick people.

Healthy people are more productive (you'll have better businesses)

Healthy people are nicer (especially if we consider mental health, and then violence)

Healthy people use the ER less.

Be careful what you wish for. Having health insurance doesn't equate to having access to care. Especially in the mental health space, fewer and fewer providers will even accept new patients on government-sponsored health plans due to low rates.

https://www.wsj.com/health/healthcare/medicaid-insurers-doct...

That would require that the more tax money the school system gets the smarter the students will be. Every time I see a bill for increasing school taxes their justification is not for improving education quality, but for some other pet project they want to do.

In my state, the politicians attempt to fund the schools the least amount possible. Healthcare will fare no better.

Every western country that has a single payer system as far as I know allows for private clinics, doctors and labs.

I spent 18 years in Canada. The healthcare I got was as good as anything I received in America (in both cases it depends on where you live, unfortunately) and looking ahead to 2026 was cheaper (comparing my tax burden in Ontario to the terrible insurance I can afford for 2026 in America).

Healthcare quality and access varies widely between Canadian provinces. It's common for affluent Canadians to come to the USA as medical tourists and pay out of pocket for elective procedures like MRI scans or joint replacement surgeries due to excessive waiting times at home. There are advantages to the Canadian system but some clear downsides as well.

The point is that saying you have no "choice" in these systems is a lie.

You're never going to make a system that prevents the ultra-wealthy from augmenting it with private services. You might, however, reduce the power of the ultra-wealthy.

Not after citizens united.

This is precisely what allows for the NHS to be cannibalized. They underfunded one of the best systems of healthcare and replaced it with private care for ultra wealthy while reducing quality of care for vast majority of people.

Private care has been available in Britain throughout the history of the NHS and is available to people far below the 'ultra wealthy' strata. Don't ruin a valid point with hyperbole.

> is the 90% with health insurance and the 10% without health insurance

it's even more complicated, because you can have insurance fully accepted at one clinic and "not contracted" with a different clinic. it's a total mess.

All of that applies to military spending, highways, schools, etc.

Does that mean we can’t have these things unless the wealthy want them?

The wealthy benefit from military spending as it keeps their resources secure. The ultra wealthy are also business owners who benefit from increased commerce made possible from the highways. They don’t benefit from paying for my father’s cancer treatment.

That's the same as most countries then.

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