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Comment by cortesoft | Hacker News Reader

> Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce

Would this go away, though? Instead of fighting with insurers they would be fighting with the government insurer?

I am very pro universal healthcare, I just don’t want to pretend there aren’t still going to be fights over what should be paid for.

No matter what, there are going to be disagreements on what medical procedures should be paid for and who needs them, as well as how much they should be billed for.

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The way a lot of other countries deal with this is that the government calculates out a benefit vs cost assessment for every new treatment and only covers ones that come out ahead. But, that ends up with things like new targeted chemotherapies being unavailable for years after their initial release, vs in the US where they are available to much of the population once the right prior auth is filed. There is also more top down management of costs, such as long term life support for people in vegetative states.

All of this was branded as "death boards" in the American healthcare debate.

People hate it when faceless bureaucrats decide that some health care expense is too expensive for the large faceless bureaucracy to cover, when they have a medical issue that they would like the large faceless bureaucracy to spend money on. Perhaps in that world, some insane guy with a back injury who's unhappy about the quality of his care assassinates the Secretary of Health and Human Services, rather than the CEO of a medical insurance corporation (and hey, a lot of people hate RFK Jr. anyway, so maybe that assassin still becomes a folk hero for doing it).

This is already how Medicare works and it covers 70 million Americans. I’m not aware of any of these hypothetical violent outcomes being a huge problem for the program.

The HHS secretary during that time wasn't RFK, it was Xavier Becerra.

> Instead of fighting with insurers they would be fighting with the government insurer?

1. I'd rather fight the non profit-motivated entity 2. We can probably compare to VA and Medicare and even other countries to see what the fight will be like. I'm willing to bet it will be a big improvement.

> No matter what, there are going to be disagreements on what medical procedures should be paid for and who needs them, as well as how much they should be billed for.

Government insurance has a service motive. Private insurance has a profit motive.

Government has a cost motive. Lower taxes. There is no such thing as non-profit, cost drives all organizations.

And government can just lower the definition of acceptable service rather than provide any accountability for not providing it.

> And government can just lower the definition of acceptable service rather than provide any accountability for not providing it.

but why would they? OTOH for-profit companies do this all the time.

To lower spending. People always complain about taxes.

you know who else lowers spending (at the expense of service)? For profit corps. You’re ignoring that part.

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