Comment by Aunche | Hacker News Reader

Comment by Aunche | Hacker News Reader

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People talk about policies like they're something like can be picked up off the shelf at supermarket. If you could take the policies and Sweden copy-paste them to the US, then sure, we could save $1T and a hundred thousand lives. This would be a very difficult thing to replicate if you're a country without any existing healthcare system. It is impossible in a country with an extremely mature healthcare system, which accounts for nearly 20% of GDP.

No politician is going to want to deal with the fallout of massive layoffs or millions of people having their coverage changed (e.g. no free chiropractor appointments or GLP-1s for weight loss), especially since the Democrats suffered one of the worst Congressional losses in US history the year the ACA was passed. There are ways to make this transition less painful, but the only people interested in health policy are those who make money from healthcare, so you generally only see solutions that involve throwing money at the problem. We need regular people to develop an understanding of health policy or else we'll end up with a policy that merges the worst parts of a planned economy and capitalism even more than today.

The US already has a national health insurance network that pays the vast majority of all providers, and as far as I know it is widely popular and covers everyone legally present in the US for a portion of their life, Medicare. Old people experience just about every ailment young people do, we can just get rid of the age restriction on Medicare, it's already fully integrated with our medical system. No need to copy-paste from Sweden.

Medicare also isn't something that you can copy paste from covering only old people to everyone. For one, margins from Medicare patients are much lower and often negative for hospitals, and that money has to come from somewhere. Medicare doesn't cover a lot of drugs that people are already used to their private insurance covering like GLP1s for weight loss. Of course, a transition from point a to point B is possible, but there will inevitably be a lot of kinks and bugs to work out, which MFA proponents seem to be unaware of.

Lots of studies have shown that the US spends a much larger portion of our GDP on healthcare than other countries, there is plenty of money to solve this problem already allocated to healthcare. I am aware that Medicare does aggressively negotiate prices, and our current system is a complex mess of different parts of the system subsidizing other parts to keep hospitals somewhat solvent, but this is largely just to enable all of the useless insurance middlemen to take big chunks of the money for no good reason (and its not all yacht money, its also just bullshit jobs that accomplish nothing productive but are sufficiently complex to require expertise, training and pay decent wages in many cases).

And I do know that you mentioned a real material reason why this isn't pushed harder by either political party despite the nearly inevitable massive savings if we pull it off. Causing an upheaval in the job market by removing a bunch of unnecessary admin work has real short-term impacts that will be hard for any US political party to weather well. That being said, I do think there are very real paths to achieving this and rhetoric about needing to copy-paste big parts from other countries distracts from how achievable it is. 90% of the work is already there with Medicare, and expanding the list of covered drugs and having a price negotiation with hospitals to make Medicare a good customer rather than a burden in some cases is definitely possible with some political will. A public option if it had been included in the ACA would have likely moved us a lot closer to universal coverage, especially if the mandate was still enforced, and likely would have spurred some of these necessary discussions.

> rhetoric about needing to copy-paste big parts from other countries distracts from how achievable it is

When have you ever heard "rhetoric" that actually brings up the details of how universal healthcare would actually implemented in practice? If you have an idea at work and a coworker brings up a caveat that you missed, do you dismiss it as rhetoric? If you are to be worried about rhetoric, it should be about how the general public talks about policy like it's sports whereas corporations talk about policy like it's work.

It would fine if it were just internet comments. However, this article is talking about a paper from one of the most prestigious university in the world and yet it's devoid of meaningful analysis. It literally does the "copy-pasting" that I'm talking about.

> Hospital and clinical fees are paid at Medicare reimbursement rates, which are below the rates paid by commercial insurers and above those paid by Medicaid.

https://www.medrxiv.org/content/10.64898/2026.07.22.26358689...

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