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Comment by doktrin | Hacker News Reader

> 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.

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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.

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.

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.

"...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-...

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".

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.

> 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.

> 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.

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