Comment by bargl | Hacker News Reader

Comment by bargl | Hacker News Reader

Parent Full thread

You say that it isn't logical, but logic isn't your argument it's an argument of basic human rights (which I tend to agree with you on).

To play the devils advocate, linking health care to your job means that productive citizens are being taken care of. This fosters a "survival of the fittest" situation.

That isn't really how it plays out, but I think that's the allure to many of us Americans. I've spoken with others who who believe that you must work to earn certain things, such as health care. It is often toted that people who are obese, smoke, do drugs, and participate in other health risks are more likely to be on government aid than those who "earn" it. They use this fear of being taken advantage of to fuel a desire a knee-jerk reaction to health care.

Yet there are valid concerns. Especially with the migration of such an entrenched system.

If the US government is going to take on Health Care that money needs to come from funds already in the budget. The US government is poised on the edge of failure, the only thing keeping us going is a mass faith in the ability of the government to pay back it's loans, and thus receive more.

Also this points to a bigger break in the system. US Agencies (I can't speak to foreign agencies) incentivise the spending of your whole budget. If you don't spend it all then obviously you don't need it all. This creates a mad spending rush at the end of the fiscal year and an atmosphere where you have not only the right but the obligation to spend your budget.

I think a lot of people are intimidated by the concept of introducing another burden to the US budget when we are already incentivising the wrong thing.

I think if we could cut back the budget in other areas, this would make it possible to introduce a true health program.

I'm only touching on a few reasons why this isn't being done immediately. I do think that our defense budget is outlandish and could be put directly towards health care, but that is a huge transition in the work force. That is soldiers to medicare specialists. That sort of transition will take time.

You make some great arguments, even as devil's advocate, so I feel the need to offer as much of a rebuttal as I can.

linking health care to your job means that productive citizens are being taken care of

Assuming productivity is related to the selling of your time to another actor is outdated 20th century thinking. People can and are becoming increasingly productive without having "jobs" that fit a definition. Entrepreneurs, contractors, part-time workers, stay at home parents, students... all of these people are outside of the employer/employee equation and thus don't have access to health care because of it.

Tell me, who's more valuable to society, employee #992232 of big corp the next Richard Branson? Tying health care to employment ensures the former, not the latter is given incentive. This is precisely what we don't want.

If the US government is going to take on Health Care that money needs to come from funds already in the budget.

This is a much more practical argument and it is difficult to rebut directly. Essentially though, you are correct: something else would need to be sacrificed. There is, of course, an obvious target: http://armscontrolcenter.org/issues/securityspending/article...

In addition to that though, spending on Medicaid and Medicare within the current system is hugely inflated, from what I can see. US per capita administrative costs are triple that of Canada: http://pweb1.rwjf.org/reports/grr/036617.htm

So, even without a military cut back, the money is already being spent, just on HMO's instead of actual health care.

To me, as a European, your summary of the US-perspective on health care explains a lot. Over here, universal health care is supported by public opinion, mostly because it is seen as a question of ethics (with a healthy dose of "it could happen to me" hedging).

The consensus here is that society has to take care of the sick, independently of the circumstances of their life. It is important to note that I wrote society, not state. The state is seen as the agent through which society effects this, not the principal actor. The fact that it is seen as a question of ethics and a part of "we the society" probably also explains the rather vitriolic contributions that some of my European compatriots provide in discussions on the US health care situation (even though it is probably none of our business).

But health care is linked to employment in most parts of Europe as well. Unemployment benefits allow you to pay for it but if you those run out or you don't take benefit of them for some reason (say you live on the street) you're out of luck.

Hell, even if you have a job you might have to pay for health care yourself due to certain circumstances and if you're in monetary trouble you might not be able to do so.

Not to forget that freelancing or self-employment might bring you to the point were beeing unemployed is more beneficial to you because you have to pay for everything yourself with much higher rates.

Many details of the implementation are different in the individual states of the EU, since the health sector has so far not been harmonized. My experience is from Germany, where there exists a mixed system in which you are not allowed to have no health insurance. If you are self-employed or earn enough, you can switch to a private insurance company.

You brought up one very important thing when you wrote about monetary trouble and self-employment. Because even a mandatory insurance scheme as the one in Germany has holes in it. I recently learned that, if you are self-employed, have private health care and run into financial trouble, you can end up in a state of "inactive health insurance", where you still have basic health insurance, but you always have to go to the emergency ward at the hospital. So far, a few ten thousand people are affected by this (out of 80 Million), but it is a de facto hole in the system.

However, when I point this latter situation out to people around here they usually become quite enraged. In a way, this reinforces my point about the perception of health care as an ethics issue.

> where there exists a mixed system in which you are not allowed to have no health insurance

True. If you don't have one you have to pay a fine. Which is troubling if you couldn't pay for it in the first place. I have that problem at the moment. I guess it's mostly my fault for not taking every help I could get. So far I haven't gotten any troubling mail, but I'm sure I'll be in trouble once I have to get back into it.

Everyone around me feels uneasy about this. I didn't have the need to go to the doctor in a very long time, but I can relate.

Reply on news.ycombinator.com