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Comment by cpncrunch | Hacker News Reader

The insane part is that the hospital only receives a tiny fraction of the billed amount from the insurance company, yet uninsured people have to pay the full amount.

The US healthcare system is broken on many levels, and I don't think anyone has the balls to really fix it.

Some ideas:

[1] Free basic medicare for everyone, but allow people to pay for faster/better service. This is the way it works in the UK, and it works very well. The basic service is fine for most people, but if you want a room to yourself or you want to jump the queue, you can pay to get US-style service. Overall it works out much cheaper and fairer than the US system.

[2] Set up a system that allows uninsured people to get the same rates as the insurance company. It's a bit of a scam at the moment - basically the hospitals seem to be out to screw you if you're not insured.

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It's quite possible to get a lower rate than what's billed to the insurance company if you're uninsured. Maybe not at all hospitals, but at many.

Perhaps, but it seems to be down to your negotiating ability.

I had a major bike accident in 2006 and was taken to a hospital emergency room. The hospital told me they take my insurance. They really meant they'll bill my insurance.

My insurance company didn't have a negotiated rate with the hospital and the treatment was considered out of network. Instead of paying only the maximum out of pocket cost of $4,000 USD per year, insurance only offered 50% and I got hit with a bill for $50,000. It eventually got worked out months later after months of fighting the hospital, doctors, and insurance, but it sucked big time.

Health care but Financial death.

UK doesn't not work as described in [1], and I don't think any other country works like that.

In the UK, if you have a certain income (as low as £8,000), you must pay for national insurance, whether you like it or not, whether you're going to use it or not. If you want to use the faster/better service, that is private insurance, then you have to pay for your private insurance, as well as national insurance, both in full.

You are going to use it... it's just a question of when and how severely the need will be.

"whether you're going to use it or not"

Wat? This is the exact use case of insurance. It protects you should you need it, but ideally you won't.

The point is, you're forced to pay for the government "insurance" (which is actually called insurance, although it's not actually insurance), even if you have private insurance on the side that pays for most things the government insurance would, and more. Thus, "don't need it".

But NI covers other stuff such as unemployment. Also, I'm pretty sure it's still cheaper than US health insurance in total.

No, NI is just tax. It doesn't "cover" anything.

The point still stands: even if you have private health insurance, you still have to pay your share of the NHS, even if that share is not a line-item anywhere.

> It doesn't "cover" anything

Yes, it does "cover" other stuff, and gaps in your NI payments can leave you not getting that other stuff. That's why you're allowed to top up your NI payments.

EDIT: Also, while it's true about health insurance (if you go private you have to pay both) it's not true for pensions. You get a reduced rate of NI if you opt out of the national pension scheme and opt in to a recognised provider.

"Other stuff" is state pension. Which is an earned entitlement, not an insurance.

That's a little bit simplistic.

(https://www.gov.uk/national-insurance)

(https://www.gov.uk/working-tax-credit/overview)

You pay national insurance if you earn over £149 per week. (Which is less than your £8,000!!) You pay 12% on anything between £149 and £797, and then 2% on anything over £797.

That sounds like a lot. English NI isn't just for health care, it's for some benefits and pensions too.

And people are eligible for Working Tax credits, which cuts that number down a bit.

You get a reduction in national insurance if you opt out of the pension and opt in to a recognised scheme.

I understand how the UK works as I lived there - I was just simplifying it. However I don't believe it's a big issue that you pay twice. People in the USA still pay school taxes when they send their kids to private schools and nobody seems to be complaining. If it's a big deal then you could refund the school/health portion that people pay in taxes.

Straw man.

That's pretty close to how it works in Canada. The difference is the difference between "free" and $60/mo if your income is sufficiently high.

So, in addition to the nominal required subscription, we optionally pay for additional services at hospitals like private rooms, etc. We also pay for additional health insurance that covers prescriptions, full dental and some discretionary medical procedures that aren't, or are partially covered in the universal plan.

The efficacy of the system is manifest in one of it's largest problems: Large numbers of non-Canadians scamming the system with fake medical cards. In BC, we're currently rolling out a revised personal identification system, in large part, to address this.

In case a US cousin here on HN is tempted to make some hay with that "non-Canadian" thing, please, reconsider. :) Also note, the reason that we bother to harass you folks with how far from optimal you've strayed on this topic is that the wacky ideology 'free market blah blah', leaks into our countries and is a huge distraction from pushing our systems forward. We have to keep fighting these fights that, in all practical terms, are long dead. If you guys were to get a grip on your own setup, the rest of the world would heave a huge sigh.

I used to live in the UK, but now live in Canada. There are a few problems, but for the most part healthcare works very well in both countries and the vast majority of people are happy with it. You just get issues in fast-growing cities like Calgary, but those issues are being resolved. I agree that most of the objection to free healthcare in the US is wacky ideology. The ridiculous thing is that they have free education, but nobody is whining about having a commie education system :)

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