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Comment by consensus1 | Hacker News Reader

Nobody, including congress, gives a rat's ass about insurance companies and their profits. The truth is that someone has to approve or deny healthcare. Every universal system does it too, but by government policy instead of corporate decision. After the CEO of United Healthcare was gunned down in the streets for doing that thankless job do you think congress is saying to themselves "hey, maybe we should get into that business"?

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> thankless job

His annual compensation was over $10 million.

That's their point. Congress isn't going to get $10 million from providing universal healthcare (at least for any system that is any good), so they have no incentive to pass it. The year the ACA passed, Democrats suffered one of the worst legislative defeats in history. Nobody wants to be the person to tell millions of people that they can no longer see their chiropractor for free or that their healthcare is not longer paying thousands of dollars a month for weight loss medications.

https://en.wikipedia.org/wiki/2010_United_States_elections

There’s a disconnect between what people say they want, and what people actually want.

People say they don’t like the ACA. But if you try to revoke its grants, it’s political suicide. Which is why republicans don’t even try.

Bring back denying insurance for pre-existing conditions? Lower the age for parent-child plans? Can you even grasp just how wildly unpopular either of those would be? Or what about marketplace plans? Congratulations, you’ve just destroyed every small business and entrepreneur in the country. I’m sure that will go over well.

The ACA is universally loved. Yes, everyone likes it. They won’t say that because they don’t know exactly what it gave them, and they’ve taken it for granted. Many of you would be uninsurable without the ACA.

And that’s why, despite people complaining, the republicans do not dare repeal even parts of the ACA. It’s too popular, whether people know it or not.

I suspect a single payer system would be equivalent. It would be contested hard, but once it’s passed, it’s passed. It would become so unbelievably popular for a majority of the population that suggesting a repeal would immediately end your political career.

> someone has to approve or deny healthcare. Every universal system does it too, but by government policy instead of corporate decision

That's another lie you've been told and believed.

With Universal Healthcare the government just provides the funding. Medical decisions are made by Doctors.

Nonsense. In every nationalized healthcare system there is care rationing performed by government bureaucrats. Regardless of a doctor's opinion on medical necessity, some treatments involve long waiting lists or third-party reviews or are simply unavailable. That might be preferable to our current system in certain ways but let's not pretend that there are no trade-offs.

For example, let's say you're in England and your doctor decides you need Enhertu or proton beam therapy. That decision is meaningless because the NHS won't pay for them.

The lie you're believing is that the decision is made by government bureaucrats.

See my other reply in this thread.

I would love to know how universal healthcare works in your head

It's not how it works in my head: it's the reality of how it works here.

To quote from my other reply:

They don't fund everything. They don't fund anything in particular.

They provide the funding and the medical professionals decide how best to allocate that funding for the best results.

>With Universal Healthcare the government just provides the funding.

And what makes you think that they fund everything? I support universal healthcare as well (I'm literally Canadian), but I can accept that there are tradeoffs associated with it.

They don't fund everything. They don't fund anything in particular.

They provide the funding and the medical professionals decide how best to allocate that funding for the best results.

It's a bit different in Canada to my situation in Scotland since there is also the choice of private healthcare here if you want to pay more to skip queues etc.

Huh? NICE sets a cost-effectiveness threshold of about £20,000-30,000 per QALY gained from a drug[0]. There was even a controversy where a drug for pancreatic cancer was denied funding for this very reason[1].

[0]https://web.archive.org/web/20110925050527/http://www.nice.o...

[1]https://web.archive.org/web/20151225115559/http://www.pancre...

NICE is an independent body consisting mainly of medical professionals. It's not made up of MPs.

That's exactly my point. How on earth are you still missing this?

Man I wish I could downvote a comment. This is what you’d see on Reddit.

“Thankless job” is a crazy way to describe United Healthcare.

No one cares about insurance companies and their profits?? This doesn’t even make sense, so many people rely on insurance and many stakeholders profit off the American insurance system.

You would never see content like that on Reddit as it is far outside of the political valence there.

> "Man I wish I could downvote a comment"

I mean, you can do that here. The system just restricts what you can do until you've spent more time commenting.

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