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Comment by colechristensen | Hacker News Reader

I don't particularly see this as being a strong problem with American healthcare. You can buy health insurance to pay for any and all medical expenses. The healthcare system is broken if you do an honest day's work and can't afford insurance, but that's not what we're talking about here. There is a reason that most of the best hospitals in the world are American, and the way we fund our healthcare is that reason. Yes there are plenty of efficiencies to be improved, and much in the way of helping everyone access affordable care. However, you're never going to have Americans shifting away from exchanging dollars for doctors.

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> The healthcare system is broken if you do an honest day's work and can't afford insurance, but that's not what we're talking about here.

Isn't it, though? If you replace "insurance" with "appropriate medical care" that does in fact sound like what we're talking about.

This individual was a programmer, who based on his blog only quit his job once he was physically unable to perform the duties required - and yet, is clearly unable to cover all his medical expenses.

The system is broken. Anyone who says different is either delusional or selling something.

You can buy insurance which covers home health care and doesn't cost a cent after a deductible of a few thousand dollars. You can buy insurance which provides income if you can't work because of an illness... there are also several government programs that help the disabled.

You can also save money for emergencies and not live in debt beyond your means your whole life as too many Americans do. Sometimes bad luck strikes and you'll need to ask for help from friends, family, and the community and there's no shame in that.

If you get sick and can't work, is the health care system supposed to pay your mortgage too?

The American system is based on choice, and Americans will not give up that choice no matter how many discussions are had calling the system broken. It is not a broken system in which a person with appropriate means choses risk over safety.

If we were talking about people without the means to pay for insurance then this would be an entirely different discussion.

> If you get sick and can't work, is the health care system supposed to pay your mortgage too?

In lots of countries, if you get too sick to work, the government will assist you in paying for housing. In lots of countries, they'll do it if you're just unemployed, too.

There's no righteousness to the fend-for-yourself ideals of the USA. It doesn't have to work that way. You can choose, as a society, to sacrifice extreme wealth for greater equality. It doesn't make those countries better, but nor does it make them worse.

The widespread and persistent belief in the USA that whatever the USA does is the best way, and all other countries are dumber and weaker, is one of the most distasteful things about living here as an immigrant. It doesn't have to work this way. The American way is not automatically the best one.

The problem with your Rand-esque proposal that if we all saved and lived below our means would be rolling in it, is that we don't all have the privilege of living in state or region that provides reasonable healthcare.

Any guesses what a family policy with a $10,000 (?!) deductible goes for in Maine? $1,400. Say what? That's if you don't get insurance through your employer, which is becoming more rare everyday as insurance negotiations for employers gets stupid expensive everyday too. That's approaching 30% of my annual salary, and we'd have to pay up to $10,000 before anything kicks in.

Oh, and routine medical visits aren't covered either, so that just encourages you to not see a doctor unless you really need to. Who honestly wants to drop $200 annually to have someone with 5 years of med school tell you you're fine, but could lose a little weight.

The system is broken. If you're covered by insurance you have no right to speak to any of this. If you live in a state where individual policy pools are cost effective, you have no right to speak to any of this.

The state of the matter is that the rest of the world has figured this out. And while there will always be challenges figuring out when $84,000 for open heart surgery on a 90 year old man is warranted, we can do better than right now.

TLDR; Health care that's twice as expensive and general health that's not even in the top 25 in the world anymore. And no, people go to Thailand for really expensive experimental surgeries (done by American doctors, granted), these days.

The Affordable Care Act requires routine medical visits to be covered by your insurance provider without a copay. If you aren't seeing a doctor every year, you're throwing away money.

http://www.webmd.com/health-insurance/insurance-plans/health...

That's new in the past 45 days. For what it's worth, under the ADA the insurance subsidy I get from taxes is enough that I actually am insured, but it doesn't bring the monthly cost of an insurance plan down any ... just pushes the cost off to taxpayers.

The miserable irony of this is that then the government winds up making a deal with FOR PROFIT insurance companies. Companies which would be failing their investors if they weren't wringing every cent out of the policy holders to pad their own pockets and generate wealth off the suffering of others.

My personal opinion is that the ACA is a stepping stone to a single payer or something close to it in the USA. Meanwhile it is absolutely the worst of both government spending and private corporations. Now we just have to wait a whole other oscillation of the liberal-conservative pendulum, which tends to take 10-20 years.

Insurance companies generally have to spend 80% of premiums on medical expenses[1]. The profit and marketing expenses aren't that much of your premiums. What you seem to be asking for is price fixing the way much of the rest of the world handles healthcare, which will reduce the incentives to advance medicine. I prefer our current approach, where those who can afford to pay are left to pay as much as they're willing to, which increases the number of smart people who are willing to solve everyone's medical problems.

I grew up in Houston, where people from around the world go when they want to be treated for cancer at M.D. Anderson Cancer Center. It's not cheap, but the best doctors in the world head there because they can make the most money.

Single-payer healthcare is worse than the Affordable Care Act.

[1] https://www.healthcare.gov/how-does-the-health-care-law-prot...

But 90% of the world doesn't die from exotic cancers, at least not below the age of 50 (or 60 ... keeps creeping up). The idea that advanced medicine is an justification for for-profit medicine is a straw man argument.

The reality is that there are many more nuanced single-payer healthcare systems in the world than the one where the government tells you who gets to live and who gets to die. In the U.K. for example, there are still for-profit health care insurers and if you're wealthy enough you can buy their policy and have quadruple by-pass surgery when your 75.

I'm not going to pretend we don't live in a capitalist world and that at some point rich people are going to live better than poor people. That would a fool's dream. But to argue pure Smith-style market economics will help keep people healthy is a joke.

Even worse than that, while you laud the MDA Cancer Center in Houston now, wait 20 years and the cost of operating it will have sent it out of the country. In a globalized world you are competing with everyone, and while the USA has been sleeping the rest of the world has been getting very good at what we believe makes us special.

I don't fear the rest of the world getting better than us at medicine. Money motivates most people. The best doctors will go where they can get the most money. That is here.

If I had to pick between the UK's system, where price controls help pay for healthcare for those who can't afford it, and the Affordable Care Act, where wealthy people pay for healthcare for those who can't afford it, I'd choose the Affordable Care Act.

Price controls have such a terrible track record that we should prove why healthcare is different from the failures we've seen in housing, food and gas before trying again. Price controls give us less of what we desired so much in the first place.

"...the UK's system, where price controls help pay for healthcare for those who can't afford it..."

I'm not sure how much you know about the UK system, but it doesn't use "price controls". Its funded by National Insurance Contributions [1], which are a form of payroll tax. The more you earn, the more you pay. People on low incomes pay nothing but still receive health care.

[1] http://en.wikipedia.org/wiki/National_Insurance

The vast majority of the UK's health expenses flow through the NHS. This gives NHS the power to demand prices that are lower than they would be if there were many competing insurers. That is effectively a price control. If you don't agree to accept the NHS's price, you're left with few, if any customers.

> Money motivates most people. The best doctors will go where they can get the most money.

Except that most doctors already make plenty and that most doctors are in fact also strongly motivated by the desire to help and treat people. That's why they became doctors, and the latter desire helps them achieve becoming better doctors much more than a desire for money.

I'm not saying they're not motivated by money. Just that "the best doctors" are probably driven by a couple of other motivations too.

An interesting thing I learned when my uncle had cancer was that "the best doctors" would often only treat cases with at least a moderate chance of survival since they didn't want to ruin their stats.

No, but if your theory of healthcare is that private healthcare produces the best, most advanced treatments, then by all rights you should fear the world getting better than us at medicine. Healthcare is by it's nature a social issue as well as an economic issue. And a draining of doctors in the USA would have a devastating effect on general health.

Even more important is pointing out that medicine is already not a perfect capitalist economy. Insurance companies negotiate crazy deals with hospitals and doctors to avoid paying out, and the hospitals and docs are driven to post prices as high as humanly possible because the insurers are so ruthless in undercutting every single expense. What would Ayn Rand have made of a world where generic Advil in a hospital setting cost 1000% of what the drug store is charging? That's not a Smith economy. That's a gross perversion of free economics.

That's the snake eating it's tail on the other end of price control. $25 per pill for pain killers [1]? It's a joke.

[1] http://www.healthcarefinancenews.com/blog/why-aspirin-taken-...

There is a private health care sector in the UK - doctors can choose to work there exclusively or share their time with the NHS. You aren't forced to use or work for the NHS - although everyone does have to pay for it.

Why do you think the reality is completely contrary to what you explain? Care in the UK is just as good, and costs less overall.

> the best doctors in the world head there because they can make the most money.

To "make the most money" is not necessarily a motivation for "the best doctors in the world".

It doesn't even necessarily get you "the best doctors money can buy".

> If you get sick and can't work, is the health care system supposed to pay your mortgage too?

Where I'm from, if you get sick and can't work, we won't let people waste away on the streets, yes.

I don't know you, but I'd wager that in order to be able to say things like this, you're very privileged. And it's leading you to say extremely ignorant things.

The healthcare system is broken if you do an honest day's work and can't afford insurance...

A large segment of the United States falls in this category. In 2012, over 47 million non-elderly Americans were underinsured for health care: http://kff.org/uninsured/fact-sheet/key-facts-about-the-unin...

Also in the report: "The majority of the uninsured are in low-income working families. Reflecting the more limited availability of public coverage, adults are more likely to be uninsured than children. People of color are at higher risk of being uninsured than non-Hispanic Whites."

There is a reason that most of the best hospitals in the world are American

Uh, do you have anything to back that up, apart from the standard assumption that "US is #1 at everything!"?

And even if you had 10/10 top hospitals globally, overall average quality is a better metric than handpicked best-of-class examples.

If you have an especially difficult medical problem or you have the money and want the best possible care, your hospital of best choice is probably American.

If you're talking about average medical conditions and the average outcomes... maybe not, but those statistics are usually about the medical systems as a whole which is much more difficult to compare in a country without universal health care.

If you have an especially difficult medical problem or you have the money and want the best possible care, your hospital of best choice is probably American.

Again, do you have anything to back this up? My question isn't about there not being good hospitals in the US, but rather the assumption that the best ones in the world must be American.

Also, I think you definitely mean "and" rather than "or" in that sentence. If you have a difficult medical problem and no money, then your best hospital is going to be one that will treat you rather than turn you away for having no money.

Sounds like you might want to apply for your passport for the first time. Don't worry, it's common, lots of people in your country haven't been outside it.

> The healthcare system isn't broken if you do an honest day's work...

And how about all those people that can't work, because they're sick, or disabled, or mentally ill, or too young, or too old, or they just need 3 months think time to get their head in the right place.

Too bad for those people, they're going to die.

"The healthcare system is broken if you do an honest day's work and can't afford insurance, but that's not what we're talking about here."

But that IS what we are talking about here. Millions of americans do a hard days work and can't afford insurance. You know where they get their care now? At the country (public) hospital emergency room. Don't believe me? Go and have a look. Most of the people waiting in the waiting room are not emergencies. Their waiting for standard care. And they got no place else to go.

And this impacts us all. As in property taxes going up to pay for the public hospitals. Oh wait.. don't tell me - we don't need public hospitals either right? I mean you got yours... fuck the rest right? Until you get sick and facing cymo treatments that cost $75,000 a pop. And your insurance company only covers 75% of the bill.

Then you're complaining "where's my medicare disability?"

> most of the best hospitals in the world are American

Are they really? Citation?

It saddens me that some people look at travesties like this and think "fuck him, the system is great, three cheers for the status quo."

This despite the fact that any honest reading of our medical outcomes shows that America gets very average medical care, and that we pay about twice per capita what the best care in the world costs.

I mean, I know there's a lot of propaganda out there, and I know there are a lot of sociopaths who are eager to believe it... but I'd think you'd keep your dishonest pro-status-quo, anti-efficiency nonsense out of a thread like this one. Especially since your post implies an utterly nonsensical (and clearly grossly uninformed) dichotomy that the only options are pure state control or the status quo, when any informed survey of developed nations would show many other models, some of which would work well in the US.

Sadly, progress is stalled and we all suffer because there are obstructionist assholes like you, willing to ignorantly pretend that the status quo is the best in the world.

The top can get the best care for the right price, the bottom has been inadequately supported though much progress has been made with ACA, and lots of people in the middle are inadequately prepared, because given the choice, they choose a higher standard of living instead of more safety for the future. To be given that choice is engrained in a lot of American culture.

You won't find much sympathy for the middle class who choose a nicer house in a more expensive city, a newer car, or a bigger family instead of safety and security for the future.

Sure especially bad circumstances happen, and then you have the government, friends, and family to fall back on... and maybe some of these public services could be improved, but a significant positive change certainly has happened with the ACA.

Progress isn't necessarily taking choice away from the population, because ultimately health care will cost the same whether you can choose your coverage or the government chooses it for you... if there are inefficiencies and cost problems, don't think that forcing everyone to have the same health coverage will fix them... there are plenty of other problems.

"You won't find much sympathy for the middle class who choose a nicer house in a more expensive city, a newer car, or a bigger family instead of safety and security for the future."

The average cymo treatment is about $75,000 a hit. So, you know anyone who is prepared for that? The top 1% are, of course. But the rest of us? Those who don't have insurance are fucked. Those that do are ok until they get a bill for services not covered by their insurance. And god help you if you want a non-standard treatment. Then it's ALL on you. And then the house is up for sale. Then the cars. Then you are applying for medicare disability. Only to be dined because you made too much money last year.

This happens all the time. My hope is that Obamacare deals this. But I have my doubts.

Tell you what.. get cancer then come back and comment. I bet you change your mind. ;) No offense of course. Just don't come to my county hospital for care.. my property taxes are high enough. ;)

The thing that seems to be missing from most people's argument is that the cost doesn't go away if you move to a single-payer healthcare system. You still pay for that $75k in the form of higher taxes and higher prices... it doesn't get erased. Wanting a non-standard treatment and not being approved won't change with single-payer... you'll still have to sell everything you own to pay for it.

Saying the cost doesn't 'go away' is deflecting from the fact that it does reduce overall, because of a number of reasons. Administrative costs are vastly reduced. Employers no longer have to negotiate individual contracts with insurers. Hospitals don't need huge administrative staff for deals with different insurers and paperwork for each one. On the whole, the cost savings from moving to single-payer take a huge bite out of the increased taxes.

http://www.pnhp.org/facts/what-is-single-payer

Under plans like H-R 676, 95% of people are expected to pay less overall for healthcare. So, no, you are not paying for 'that $75k', you are paying for much less.

" Administrative costs "

They are HUGE. I work in the field (writing software). Every insurance company has it's own forms and payments requirements. So do governments, local, state and federal. Not to mention reporting requirements. Throw in other insurances such as schools, the VA (and TriCare), Medicare, Medicare Disability (they are different by the way) and Medicaid - and the hundreds of other sources I've missed. This all equals to a administrative nightmare. A cluster-fuck. A huge expense the hospitals and doctors have to deal with. And you'd think moving to electronic medical systems would fix this.

And this is one of the big reasons healtcare.gov failed the first time out.

My god you're a privileged, elitist, self centred... calm, be calm. The fact that you keep posting this crap on a thread about some I look up to who is DYING OF BRAIN CANCER is really upsetting. So please stop.

If you don't like discussing the costs and methods of delivering health care, downvote the parent comment which mentioned it initially, not a person whom you disagree with.

If you can't handle an opposing viewpoint without becoming extremely upset and resorting to petty insults, you are part of the broken political system that has led to many of the problems we face, not me.

I don't even live in the US, so nice try -- I'm telling you to pull your head out and show some respect for the fact that someone who is one of us is dying.

But hey, as far as you're concerned, that's okay; he should've lived out of his car or something to be able to afford it.

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