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Comment by Dove | Hacker News Reader

anti-health-care people have no such reasons

If you think it's that one-sided, you need to spend more time listening to the opposition. Here are some good reasons to oppose public health care:

- It will be more expensive due to government inefficiency

- There will be no incentive to innovate

- Health care run by government bureaucrats will be uncompassionate, due to distance from the community, and may not appropriately value human life and suffering

- A government that owns your health care can deny it to you

- Public health care options compete unfairly with private ones

You may not think these are good reasons, but a person doesn't have to be badly misinformed, stupid, or spiteful to find them persuasive.

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> You may not think these are good reasons, but a person doesn't have to be badly misinformed, stupid, or spiteful to find them persuasive.

Actually, a person has to be willingly uninformed to find them persuasive. Because there are actually case studies to be made, rather than evaluate ideas in vacuum:

- more expensive: It costs much less in every other country that has a single payer system, despite government inefficiency (including the Swiss and German system, where everything is private even though it's single payer, and the UK, France and Israel where it is public or private, and in Canada where it is completely public). And yet, those countries enjoy better health in every possible measurement.

- innovation: Those places all comparable innovation to the US (especially if normalized to "average entrepreneurship level" of the country - e.g. there's much less of that in Germany and France in general, but actually much more in Israel)

- uncompassionate: That is demonstrably not true in the above countries. Furthermore, the private system in the US is already demonstrably not compassionate in any way.

- government can deny health care: Government can do anything it pleases, like jail you, or confiscate all money not on your person at a press of a button (and if you're going through texas, all money on your person as well. Oops, can't pay for healthcare! private healthcare denied for you!) - that's a strawman. If you look at Switzerland, Japan, UK, France, Canada, ..., people who get on the wrong side of the government get better healthcare than people on the right side of the government in the US. No one is denied healthcare! The Israelis even treat the Gazans they bombarded the day before.

- Unfair competition: That's your only statement that is not demonstrably false using a counterexample. In fact, it's true. That's because it makes healthcare into a utility, much like schooling and water supply.

So, one reason that is not based on demonstrably false assumptions. That one is debatable; some people think healthcare should be available like schools, others do not. That should be what is being discussed, not the other reasons.

I actually listened to the other side, and heard one other good reason to avoid public health care:

- There is no reason people who care about their health should subsidize people who don't take care of their health (w.r.t exercise, nutrition, alcohol and drug consumption, regular medical attention, etc) as the latter consume much more healthcare services.

Which is again debatable: The same is true for basically every other shared cost facility (including utilities, fire services, police forces, road use, ...)

If the debate was around that, I would be happy. But somehow, in American politics, it has always been improper to bring up facts and case studies. And recently, it is becoming bad form to use logic.

>The Israelis even treat the Gazans they bombarded the day before.

They also treat the Gazans who bombed Israelis a day before: http://www.nytimes.com/2002/06/08/world/in-israeli-bed-faile...

I'll only nit-pick on your comment "And yet, those countries enjoy better health in every possible measurement."

Yes, they enjoy better health if you measure using blunt tools like "life expectancy". Of course, life expectancy is impacted by many more factors other than health care.

If you measure by things like "access to the latest technology/drugs" and "overall survival from first diagnosis of cancer" the US comes out on top in many, many areas despite the lack of uniform coverage.

Again, using blunt tools like life expectancy, one would argue that the UK has a better healthcare system. Of course, if you're a cystic fibrosis patient and can't afford the $300K/yr for the drug Kalydeco because the NHS doesn't cover it (although nearly every insurance company in the US covers), it doesn't quite seem that great.

I am curious to know if you or some relative actually has CF or if you are merely talking out your ass? I have CF and so does my oldest son. There are countries in Europe with better life expectancy, quality of life, etc for CF than the US has. And that is just the tip of the iceberg for the criticisms I have for your ridiculous statement. So just wondering here if you are merely pulling out inflamatory bs just cuz or if you or some relative happen to be in the 5% of CF patients who have the right alleles to potentially benefit from this specific drug.

I'm not sure where the hostility is coming from.

Although Kalydeco has been approved, it is unavailable in the UK to most of the patients who qualify for it as it is undergoing a "pricing assessment".

My argument is two fold: 1) Measure such as "life expectancy" are a poor indicator of the quality of health care one receives. 2) Although the US healthcare system has many problems, it covers many, many drugs, often used to treat serious illnesses such as CF and cancer that aren't covered by countries that have single payer systems.

So I take it you disagree?

You are the second person on HN to describe me as hostile. I am not. Feverish and crabby perhaps, but not aimed at you. Sorry.

I have gotten off 8 or 9 prescription drugs. I strongly disagree with measuring quality of life by how doped to the gills you can get on someone else's dime. And the measure you dismiss as "blunt" -- longevity -- has its good points as a rule of thumb measure. Stuff that kills usually isn't exactly good for your quality of life prior to killing you.

The drug in question is designed to help a tiny portion of the CF population which is an "orphan disease" to begin with. It is deadly and involves a lot of suffering, so it is a "dread disease". I think using a new drug that has the potential to help a mere 1500 Americans as your example because of the strong emotions associated with "saving" someone from something so awful amounts to a bullshit example.

Also, I worked for an American insurance company for five years. My diagnosis automatically disqualified me from some of their policies. So I suspect the reason American companies claim to cover this drug is because American rules are designed such that people with CF have trouble getting coverage at all. I was an industry insider for five years. I know how they make their money. Spending jillions on a small number of very needy people is not how they line their shareholder's pockets.

Most likely, they won't pay for it in England in part because that would involve actually paying that ridiculously high annual bill because I believe they have some form of national coverage. The American companies may list it as a covered medication, then do everything in their power to not cover any of the mere 1500 Americans with the alleles it is supposed to help. Plus the initial reports were spindoctored to boost company stock. There is a certain amount of hype surrounding this drug. It is generally a bad example to give as some kind of "proof" that Americans have it better.

I also have multiple relatives who have or have had cancer. For brevity's sake, suffice it to say I am not as impressed as you are with the American approach to treating it.

> things like "access to the latest technology/drugs"

That's not actually a valid measure. It is based on the assumption that newer=better. Because of how the US drug market works, as soon as a patent expires, the companies will work hard to discredit older treatments and find new patentable ones, including statistically invalid manipulation of the research data.

> "overall survival from first diagnosis of cancer" the US comes out on top in many, many areas despite the lack of uniform coverage.

While that is true (as far as I know), it comes out on top but not by a significant margin; and the base cancer and diabetes rates are much higher. This may or may not be attributable to the US health system, but I'm sure it does have a part (In the US, you get a pill for everything. In most single payer health systems, you get dietary and exercise advice before you get a pill for something chronic).

> if you're a cystic fibrosis patient and can't afford the $300K/yr for the drug Kalydeco because the NHS doesn't cover it (although nearly every insurance company in the US covers),

Well, Mz just commented about this specific example. I'm somewhat familiar with the Israeli single payer system (I have relatives that unfortunately had to use it extensively) - and it covers every single proven life saving treatment (life extending treatments are covered depending on a cost/benefit model). I don't know what their exact definition for proven is - but the Doc I talked to said it was reasonable (FDA approved, at least 1 year on the market since approval, and a few other similar requirements).

And the most important thing? With the exception of Canada, I think every single payer country lets you have supplemental private insurance if you want, for those live extending treatments, and e.g. if you want to be treated in a private/hotel hospital, or in a different country of your choice.

The dichotomy of "single payer vs. private" is a false one, just like public schools don't eliminate private schools - it just establishes a baseline that everyone has access to, and requires the private industry to deliver significantly more value.

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