Mexico's President Sheinbaum Decrees Universal Healthcare for 120M | Hacker News Reader

Mexico's President Sheinbaum Decrees Universal Healthcare for 120M

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Mexico already has “universal healthcare.” The public hospitals are so bad and chaotic that most people who can afford to pay private insurance so they can go to private hospitals.

The article doesn't state explicitly, but I guess this new decree changes the qualifying rules. For example, that even if you have private insurance, you can still access public healthcare facilities.

I don't see how this is going to work unless they also improve the resources to the public facilities.

Without knowing much this seems kind of reasonable? Some baseline of care but not enough that most people will opt it.

If I could make universal healthcare in the US it would be something like: - free generic meds where there are at least 3 independent low cost providers. - free ai diagnostic tools - tax breaks on healthcare spending - catastrophic insurance @ fixed prices for various diseases (eg if you get colon cancer you get $30,000 for treatments. Basically whatever the low end of reasonable is, to invent you to price shop etc.). These numbers should keep being adjusted down over time as people get more efficient at treating. - maybe up to $400 per year on various preventative tests.

And remove most other regulations on healthcare (including banning employer insurance).

If the government provided this, the cost for private healthcare would plummet. People would have free access to diagnostic and drugs better than anything you had 20 years ago (2006). Which is pretty incredible!

Why not just do Medicare For All?

> Medicare For All

Nobody who relies on Medicare would say that. The people who say it want a fantasy Medicare that doesn't exist.

https://www.medicare.gov/providers-services/original-medicar...

Some of the items and services Medicare doesn’t cover include:

    Eye exams (for prescription eyeglasses)
    Long-term care
    Cosmetic surgery  
    Massage therapy
    Routine physical exams
    Hearing aids and exams for fitting them
    Most dental care: In most cases, Original Medicare doesn't cover dental services like routine cleanings, filings, tooth extractions, or items like dentures.

Just as a data point, depending on a country of course, the European public healthcare systems don't cover some/most/any of these either.

For example the eye exams for glasses are usually done at the store where you buy the glasses and included in the price, dental might be covered only for children, routine physical exams may not exist as a concept, etc.

I rely on Medicare as a disabled person. I love it. The reduction in stress I experienced when I got to transition from my former employer plan to Medicare is pretty indescribable. I want every American to have at least this as a baseline.

Most of the complaints around Medicare come from those who get sold (conned) on takin Medicare “Advantage”, which is a privatized option for Medicare that denies a lot of coverage.

IIUC, the difference (for USG) of Medicare vs Medicare Advantage is that Medicare subsidizes the cost of a procedure done by a provider while Medicare Advantage (MA) pays a fixed rate per treatment to an insurer.

So if the MA rate is less than the provider changes then the insurer is highly incentivized to deny you coverage. While for Medicare you'd have a higher co-pay.

This also leads to scenarios where MA insurers upcode patients so that the treatment is at a higher rate [1]. (ex. Marking patients as recovering drug addicts when prescribing opioids to get both money from both counseling and the opioid treatment).

[1]: https://www.healthcaredive.com/news/unitedhealth-grassley-me...

My bad. I used that as a stand in for a single payer system like Medicare. Good idea, yes? Or do you object to that?

BTW There can still be a for-profit, premium health insurance market alongside. if you’re rich spend as much as you want on healthcare.

> My bad. I used that as a stand in for a single payer system like Medicare. Good idea, yes? Or do you object to that?

My objection to that is putting too much power over healthcare in the hands of the Federal government ends badly when someone like RFK Jr is in power in the Federal government.

My ideal is closer to the German system, with state-level public options which preserve private insurance.

But it covers everything that isn't those things? For free? Still sounds pretty good.

> if you get colon cancer you get $30,000 for treatments

And… what if its not enough?

But yeah, extreme inefficiency and inflated costs due to poor regulation seems like the main issue in the US.

It’s not however obvious that less regulation would solve that, i.e. you have countries like Switzerland or the Netherlands with entirely privatised healthcare (more so than in the US) yet they have quite strict regulation and price controls and are doing just fine.

It's not really entirely privatized if there are price controls. And at least in Switzerland, healthcare price inflation is a big topic like everywhere.

https://www.swissinfo.ch/eng/health-systems/expert-warns-swi...

https://www.swiss-medtech.ch/en/news/cost-control-initiative

But Swiss pharma price controls are not very populist. We basically use the communist approach of stealing prices from less regulated markets. The FOPH looks at international prices in "comparable markets" to help decide what the Swiss prices should be. Not sure which markets are comparable but surely the US is one. So if prices go up in less regulated markets, they go up here too.

There is still a lot of waste and healthcare costs too much. It is high quality but I am often impressed by how much low hanging fruit there is to save money apparently without harming the quality of care delivered.

It's culture. In the Netherlands a trauma heli will come for a homeless person or even a drunk British tourist.

America can afford healthcare it simply chooses not to.

It's a lot easier to cover a country the size of Norway with heli trauma than the United States. So let's not pretend that is even an Apples to Apples comparison.

Also, culture and health makes a big difference. Also, the number of people living off the government fully vs. taxpayers makes a difference.

The US is vastly richer than Norway, and benefits from economies of scale.

You’re right it’s not apples to apples at all.

The us chooses not to because the ruling class are barbaric and would make less money.

Well Norway was massively richer per capita than the US until quite recently and still currently is by a slight margin.

While I appreciate the excuse making, the fact is the US is by far and away the richest country to have ever existed, and the average citizen has a much lower quality of life than those in much poorer countries.

It’s a disgrace. Anything else you say is a weak excuse.

Are you not confusing per capita wealth/income with something else?

Russia is also technically 5x richer than Norway in that sense. Of course they have 25x more people..

They’ll need that wall for all the Americans heading to Mexico for healthcare.

It's for Mexican citizens only.

And, of course, they will prove it using their digital IDs.

Two decades ago the running joke was that if the border ever opened you’d have to hold onto a palm tree because of all the Americans stampeding south.

That joke was told by the many tens of thousands of US expats living in Mexico, and those coming down for dental, doctors and prescriptions

and where is this money going to come from?

This will reduce the healthcare expenditure, per capita.

A great counterexample would be the USA — which despite the highest global expenditure, per citizien, has among the lowest life expectancies / healthcare outcomes.

The US does not have "among the lowest" life expectancy. We're just out of the top quartile. And that has less to do with the quality of American health care and more to do with obesity and sedentary lifestyles. I expect with the more widespread introduction of GLP-1 receptor agonists you're going to see a jump in American longevity.

The US has a lower life expectancy than Cuba (!).

Despite decades of illegal blockade, despite economic warfare.

The Cubans are quite a bit thinner than Americans.

American healthcare is fantastic — best in the world – IF you can afford it.

Certainly there are multiple factors at play (for longevity) [0].

I know nothing — dropped out of medical school almost twenty years ago. Won't participate in private health insurances (Dr. ER).

[0] USA #55 (2023) <https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...>

Everyone in the US has access to healthcare. We have programs that cost little or nothing, depending on your income. Beyond that, we have EMTALA, which means the ER can't turn you away even if you never bothered to sign up.

>Everyone in the US has access to healthcare.

Also you/me:

>the ER can't turn you away.

----

Native white forty-something dude. Plan isn't planned.

are you saying they don’t have a budget plan for this? what is your budgetary concern exactly?

Mexico have almost three times GDP per capita of Indonesia, who have a decent universal healthcare scheme. Indonesian implementation isn't perfect, but it's still far better than some countries that don't even bother to try.

mexico is building free healthcare and america is going to pay for it

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