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Comment by georgemcbay | Hacker News Reader

> The United States has both market forces and massive access problems.

It boggles my mind when I still occasionally hear people speaking out against all forms of single payer healthcare in the US saying they don't want to have to wait weeks/months to see a doctor like they do in Canada/UK/wherever.

If I give them the benefit of the doubt of not being paid lobbyists for the medical insurance industry, I can only surmise these people haven't been to a non-emergency doctor since prior to 2020.

Because even here in the US if you aren't fabulously wealthy with concierge medical you'll be waiting weeks/months to see a 'doctor'. And you'll almost certainly never actually see a doctor, you're going to see an overworked NP (no shade on NPs here, most of whom are great, just establishing how our medical system actually works in 2026).

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> Because even here in the US if you aren't fabulously wealthy with concierge medical you'll be waiting weeks/months to see a 'doctor'. And you'll almost certainly never actually see a doctor, you're going to see an overworked NP (no shade on NPs here, most of whom are great, just establishing how our medical system actually works in 2026).

But it's simply not true. my mom broke her back last year and before we realized that her back was broken, we saw an urgent care doctor, same day, within 30mins (I don't recall the exact timescale now, but it was pretty much instant). Who promptly gave my mom an Rx and told us to go to the ER. Personally, urgent care appointments have always been available within 2hrs, and even stuff like an xray (usually in a centralized office, so some travel required) is possible same day. This isn't special treatment.

If someone is waiting long for care, it isn't a problem with the system - and the alternative you speak of isn't going to solve the "I'm not a medical doctor" problem either, which is the main objection to the long wait-times. Minor hypochondriac-ness notwithstanding - nothing will be able to solve that completely - money is the back-pressure mechanism to avoid waste of limited resources. Whether anybody likes it or not, doctors/xray-machines/etc are not infinite (for now heh).

For-profit health-care insurance companies should burn in hell, though.

I can do anecdotes too.

My father had his heart in afib for over 3 months straight as US hospitals and doctors jerked him around and set appointments weeks out before they finally removed his thyroid, despite a family history of thyroid problems and having multiple previous hospital trips for suspected heart attacks, which by itself should give the obvious conclusion that his thyroid needed to be removed.

Being in afib just for a few days can cause permanent heart damage, heart attack, and death. And even once they decided it should be done, it was another 2.5 weeks before they scheduled the surgery. I don't see how anyone can think the US medical system is any good for anybody but the obscenely wealthy.

No doctor in existence would consider that an acceptable scenario, but the profit driven investors seemingly had no problem with him dieing when they had more profitable patients to serve first.

> But it's simply not true. my mom broke her back last year and before we realized that her back was broken, we saw an urgent care doctor, same day, within 30mins (I don't recall the exact timescale now, but it was pretty much instant). Who promptly gave my mom an Rx and told us to go to the ER.

Ok.

But in the reply you are responding to I specifically carved out an exception for emergency situations:

> I can only surmise these people haven't been to a non-emergency doctor since prior to 2020.

Your mom's situation was certainly an emergency.

I'm glad she was seen promptly, but her situation is very different than someone who needs to see a specialist for something that is not immediately life threatening (even if waiting could have serious long term health consequences).

If you break your back in a place like Canada or the UK you are also going to be seen quickly.

Both systems triage. The wait for non urgent needs in the US system is still weeks to months

Urgent care is not a replacement for a family doctor or internist who can track your health across long periods of time. That's like comparing a substitute teacher to a tutor; a sub might be able to answer your questions, but they cannot track your academic progress over time and help you tackle an extended course.

Exactly. Last time I moved to a new area, out of about 5 local family doctors, the shortest wait time for a New Patient Appointment was eight months. In the good ol' non-socialized-medicine USA. So for eight months, we had to rely on urgent care for every medical need.

Urgent care would not be urgent if you had to wait months. Hang out with a few elderly people who actually need to see specialists more than people like me. Over the years, I've heard plenty of stories from people I know waiting multiple months to see specialists.

Yeah, and specialists are "usually" not available via urgent care. If not for the like of urgent care, specialties would be worse. The fact that it takes so long for such access is still a demand and supply problem at the end of the day, no way around the knowledge bottleneck - fixing that means shifting demand to different, more plentiful, supply (doing that soundly is not trivial, but likely easier than attempting to multiply the specialists, depending on the specialist). ERs are expensive because they have to have certain specialties "on tap" 24/7, among other reasons. This is not a unique problem of any single health-care system.

30 years ago, you’d just call your GPs office and they would have told you to go to the ER. Instead your moms insurer paid $150 for an interaction that likely funneled you their medical networks local hospital and added low value.

Urgent care is a grift to replace a relationship with a doctor or practice with a lower paid, lower skilled NP. It’s more a sales funnel that anything.

> relationship with a doctor or practice

What if I don't care about this whatsoever?

Go to a doc in the box and be happy.

I don’t remember the last time I had to wait more than a few days to see a GP or more than a week for a specialist on an employer’s PPO insurance plan. I’ve had them at several employers ranging from university to FAANG so it’s not exactly something only fabulously wealthy people have access to.

The problem is there is a huge bathtub curve in insurance quality between employers and the public market. It’s a rude awakening when you can’t afford COBRA rates and have to fall back to a “bronze plan” or whatever is available on the exchanges.

FAANG employee health insurance? Something like 1% of American workers get that, if even that many. Then throw in my oil company friends here in Houston and a few other industries which give premium benefits and you still have a tiny subset of the American workforce getting exceptionally strong benefits. Not at all indicative of the experience of most Americans.

The universities I worked for (both public and private) provided the same level of PPO insurance, as did a random fitness startup, a clinical diagnostics company, and a construction company. I invite you to reread the part where I said “several employers [plural] ranging from university to FAANG”.

Here in Houston, my friend who works at UH has excellent insurance. A quick search online confirms that it is much better than average. Different structure for employees at Rice, my alma mater, but still excellent. Gemini describes these employees being in a kind of "benefits bubble" here in Texas, and they're getting something way better from what most Texans get.

You said FAANG, so perhaps you're in California, a state that has laws regulating health insurance to an extent that make it unique in the USA?

> You said FAANG, so perhaps you're in California, a state that has laws regulating health insurance to an extent that make it unique in the USA

That is definitely a confounding factor, although I’m curious how much of that is the urban vs rural split in other states. (The construction company was not in California but oil boom-town adjacent in Texas)

On the other hand, most states with significant tech workforces have Medicaid which most people will qualify for if they're laid off (I did!) and these are excellent. People pay for cobra despite a public option being available.

That’s not necessarily an insurance issue.

Part of ACA was the creation of regional health cartels. If you’re in a region with shitty networks, care may be hard to get. Where I live there’s a teaching hospital with a doctor focused medical network and a big Catholic hospital chain.

In my scenario, There is a good market for cardiac, OB, and some other specialties in each network. The rest is a monopoly— the catholic network doesn’t staff neuro for example, they just have consultants.

> It boggles my mind when I still occasionally hear people speaking out against all forms of single payer healthcare in the US saying they don't want to have to wait weeks/months to see a doctor like they do in Canada/UK/wherever.

Conversely, people consistently put forth single-payer as a panacea without considering what other differences exist between the systems.

For example, in the US a medical residency is required by law but the number of residency slots is constrained because the AMA wants to reduce supply/competition. Change who pays the premiums and that's still just as much of a problem, and it might even make it worse to give the lobbyists an even deeper pocket to siphon money from.

Another significant source of costs in the US system is that doctors can prescribe much more expensive patented drugs or devices and no part of the system is given the incentive to say no to something which is only slightly or negligibly better but dramatically more expensive. Likewise, many of these patents are obvious (e.g. extended release version of existing drug or combination of two common existing drugs) and shouldn't be granted, but nevertheless are. But if those patents are issued and the system is required to pay for a drug when a doctor prescribes it, the seller has a monopoly for the patent term and can charge the monopoly price. The normal way to solve that is for "customers" to be more exposed to cost differences between treatment options, so that things that are only marginally better can only charge marginally higher prices, which is the opposite of how single-payer works.

"Single payer" is essentially replacing insurance companies with the government, but that doesn't solve any of the problems that exist in the parts of the system that aren't the insurance companies.

It's not worth it to solve any of the problems, let alone the biggest problem, if we can't solve all of the problems immediately, after all.

You're still assuming that the insurance companies are the biggest problem, and on top of that that single-payer is the best way to improve even that part of the system.

For example, why do we have insurance companies "negotiating" with providers and having "in-network" nonsense instead of requiring universal price transparency? Instead of the insurance company setting the price, have them set how much they cover, e.g. they pay 90% of the second lowest price that service is available for within 100 miles of the patient. Then the patient chooses where to go and pays whatever the insurance doesn't cover. Meanwhile the providers are all required to publish transparent pricing so there is a public database of everyone who can perform a service and how much they charge.

Then a patient receiving non-emergency care (which is the large majority of medical expenses) can decide whether they want to travel 50 minutes to get the lowest price, or pay a little more of their own money because another provider is closer or provides optional amenities. Which in turn makes the providers actually compete with each other, which is the thing single-payer doesn't get you.

>You're still assuming that the insurance companies are the biggest problem, and on top of that that single-payer is the best way to improve even that part of the system.

They are, and it is. And I'm not assuming; it's been proven empirically. Chasing "choice" is a distraction; the goal is access, which choice comes alongside.

I'm in the US, and I see my GP every two weeks + can arrange for an appointment within about a day or over the phone whenever I need it.

If I need to be referred to a specialist though, I could be waiting months just for the initial consultation, and then months again before anything happens. Also, there just aren't specialists in my area for some things. Been trying to get a consult about dissociative disorder for years now.

My GP is great though, he constantly tells me about exciting new papers he's been reading and he loves to share science and research level stuff. It's clear that he loves his job, it makes me super happy.

(He's an MD, not NP, and he takes Medicaid)

This is not my family's experience on distinctly not-concierge-medicine Kaiser Permanente in the Bay Area. Always meet with doctors (and NPs), have gotten in quickly when necessary, etc.

California is the only state that regulates wait times for specialists. When you uttered the words "Bay Area" it signaled that you enjoy better service than most Americans. I know people in states very close to yours (as well as my own) who have had extensive wait times.

> California is the only state that regulates wait times for specialists

Really?

I have never waited more than a day to see a doctor and hardly more than a week to see a specialist. I'm on a ppo plan so I just make an appt. If someone doesn't have an appointment I find someone else.

The main issue I've had is finding a gp in Portland Oregon. I want a male who is accepting new patients which is seemingly impossible to find.

> you'll be waiting weeks/months to see a 'doctor'

I live in the US, and this is false, with Zocdoc I can see even specialists within 24-72 hours. All I have is my wife's United plan, nothing fancy,

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