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Comment by forca | Hacker News Reader

Medical debt rankles me like nothing else. The US, supposedly the most advanced nation on Earth has the worst notion of all: health care for profit. Simply evil. Health care is a basic human right. Full stop. Health care should never be based on one's ability to pay. Never.

I pray I see socialised medicine in the US in my lifetime. If Hilary Clinton gets elected, the push for this will be stronger than the thin edge of a wedge President Obama has managed. We need a full single-payer tax-based system.

I pay the ridiculous sum of $700 US dollars a month for my family's health insurance. If we raise taxes by 10% for every American, we could have awesome health care. I'd gladly take the 10% tax over $8400 a year I pay now. Sick, capitalist theft. I feel I've been politely robbed every pay period.

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I agree, but I think there is too much at stake for too many high net-worth individuals and corporations for the US to make a change to the single-payer system.

A 10% rise in taxes? That's a heck of a lot of money. The majority of the rich won't buy into it, they'll fight it tooth and nail.

In my opinion, I think it depends on how well appeals for/against a single-payer system resonate with the middle class. Do they generally feel that they will be subsidized, or be subsidizing?

Heck, even some poor people (who would be net winners) won't even support it on principle.

>A 10% rise in taxes? That's a heck of a lot of money. The majority of the rich won't buy into it, they'll fight it tooth and nail.

But now they pay insurance anyway, aren't they?. With a single-payer system, their contribution would actually probably fall.

Right now, if high net worth individuals pay insurance at all (it's usually an employer provided benefit), it's pre-tax and even the best cadillac plans for the entire family are ~2k/mo. A 10 percent increase in income tax would rankle anybody making over ~150k/yr, and that's assuming the best whole family plans. Someone like myself who pays under 400/mo for really good insurance would get dinged on a 10 percent tax increase at only $50k/yr.

Single payer would have to come in at about a 5-7 percent tax increase for it to be even remotely palatable to me, and that's as someone who's all for it and think it's morally bankrupt that we don't have it.

The average person in the US is already paying ~200% as much as a citizen of your typical single-payer country for coverage. Not only are we paying twice as much for coverage, we don't even have universal coverage after paying twice as much.

http://healthcarereform.procon.org/view.resource.php?resourc...

The health care tax could be regressive, say 5-10% of your income below first $100-150k, and then 0% of the remainder. This way, even the richest would not be affected that much by that additional tax.

Actually, even without additional tax, if US government dropped Medicare, Medicaid and other state sponsored insurance systems in favor of universal coverage, it would have enough money to have world-class healthcare system without any additional taxes -- the US government _already_ spends as much on health care per capita as Germany, or France, and 30% more than UK.

The US government already pays more per capita for health care than Canada, despite not covering anywhere close to everybody. If one could wave a magic wand and transmute the US to the Canadian system, US government health care expenditures would actually fall, and taxed could be lowered.

I certainly don't disagree with you.

The fact of the matter is: If a goal involves raising taxes on the rich (or corporations) in the US, it will be pretty difficult to achieve.

I don't disagree with that either, I'm just pointing out that universal coverage, done well and efficiently (a massive qualifier, I know) wouldn't require any tax increases at all.

By definition there are that many rich people. If poor people were willing to pay 10% in taxes they would get back far, far more than they put in. But they aren't so they won't.

Would a tax that only applied to the first X dollars of income, like social security does, be feasible?

Evil! The hyperbole is overflowing!

It is true that socialized medicine puts an end to the financial hardship imposed on individuals, but it also brings other problems into the picture, namely rationed healthcare. I've experienced it myself. That's why you have so many Canadians coming to the US when they get really sick.

>That's why you have so many Canadians coming to the US when they get really sick.

Hardly any Canadians come to the US for medical care, it's a silly rumor that has no grounding in reality. The US has one of the most expensive health care systems in the world for people without insurance, but we're supposed to believe that all these Canadians are rushing over the border with tens or hundreds of thousands of dollars for marginally better care?

http://content.healthaffairs.org/content/21/3/19.full

"Results from these sources do not support the widespread perception that Canadian residents seek care extensively in the United States. Indeed, the numbers found are so small as to be barely detectable relative to the use of care by Canadians at home."

The study you reference seems a bit weak. They polled hospitals in Michigan, New York and other border states? The Canadians that I know who have got to the US for care go to places like the Mayo Clinic or Sloan-Kettering.

At any rate, rationing of healthcare is a reality in Canada. A few years back the Supreme Court of Canada stated that the ban on private health insurance violated Canadians' right to security as the waiting times for the public system were so high.

http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_Ge...

> They polled hospitals in Michigan, New York and other border states? The Canadians that I know who have got to the US for care go to places like the Mayo Clinic or Sloan-Kettering.

They also polled Canadians directly to approach the question from both sides.

> Several sources of evidence from Canada reinforce the notion that Canadians seeking care in the United States were relatively rare during the study period. Only 90 of 18,000 respondents to the 1996 Canadian NPHS indicated that they had received health care in the United States during the previous twelve months, and only twenty indicated that they had gone to the United States expressly for the purpose of getting that care.

whereas you provide no study whatsoever

"The Canadians that I know who have got to the US for care go to places like the Mayo Clinic or Sloan-Kettering."

So it's that they want to go to the pre-eminent institutions in the world, not "American healthcare (as a whole) is better than Canadian" - -your- inference is weak.

If that is the determining factor, I can guarantee that if those same Canadians had needed a heart transplant in the 80s, they would have flown to Sydney to go to St Vincent's and be operated on by Dr Victor Chang (http://en.wikipedia.org/wiki/Victor_Chang). I think your causality is broken.

Healthcare is already rationed in the U.S. It's rationed everywhere, by definition, because there isn't (to my knowledge, anyway) any country where the (price-agnostic) demand for resources isn't more than the supply.

It's just rationed in an inhumane, stupid way in the U.S.

No one from the industrialized world comes "to the U.S." because of a severe illness. Rather, people come to specific doctors for new procedures, or to have the one surgeon in the world who's done Risky Procedure X a hundred times instead of four. If that doctor's in Paris, they go to France. If he's at Mount Sinai, they go to New York. If he's at Hopkins, they go to Baltimore. But no one from the industrialized world comes to the US itself for its not-that-great-overall healthcare system, and no one has for over 30 years.

If the US is the country with the top notch doctors, then how to you separate "they are going to the best doctor" to "they are going to the country with the best doctor"?

The US isn't the country with top-notch doctors. There are some top-notch doctors in the US.

> The US, supposedly the most advanced nation on Earth has the worst notion of all: health care for profit.

I presume that in your socialist medical system doctors, nurses, drug chemists, medical feathers and so forth would still get paid, right? Guess what? That's profit.

There's plenty wrong with our health care system. Much of it is due to the insurance idea. Much of it is regulatory. Much of it is structural. Single payer wouldn't really address any of that (not even the insurance bit: it'd be insurance writ large). What we need is for everyone to pay for what he receives, with charity/welfare for the indigent. It works for food; it works for medicine.

No, it doesn't. That's been proven wrong by the entire developed world.

Easy. Set limits on salaries. All medical schools become government owned and run. Doctors graduate with no debt and they agree to serve the system for 10 years. If you bail before 10, you pay the debt of schooling you. Salaries would be reasonable and capped. You don't become a doctor to become wealthy -- you do so to serve.

Have for-profit clinics for stupid things like breast implants and other things that insurance should never be paying for -- like optional stuff.

Um, there are more not-for-profit hospitals than there are for-profit hospitals, which doesn't dramatically change the pricing equation.

http://www.aha.org/research/rc/stat-studies/fast-facts.shtml

One man's profit is another man's stash for bonuses and building a new wing of the hospital.

The goal is zero profit in health care.

Where does a dentist then raise money to buy a new XRay machine?

Where do you find money if your top doctor wants a raise or threatens to leave for a competitor?

Profit != revenue.

Ok, but zero profit = zero flexibility on meeting unplanned expenses.

Ridiculous, profit is what drives innovation. You think the billions of dollars a year that go into healthcare R&D comes from the goodness of people's hearts?

The hospitals aren't the problem, every hospital in the Boise, ID area is non-profit and frequently they work with those without coverage to significantly reduce or completely write off their medical expenses.

It's the insurance system that is the problem, since I have insurance the hospitals won't give me a dime off my bill, and my costs are heavily inflated because those of us WITH insurance are subsidizing those without.

Now, I'm a software engineer, I make a comfortable income and have a high deductible healthplan and a health savings account, I know I will be able to afford health expenses should they come up, at worst I can make payment arrangements because my annual out-of-pocket max is $5K/10K (individual/family).

But many families in my area are just scraping by on barely above minimum wage, and planning for health issues is not high on their priority list. If something happens to them, the $5K debt can be devastating, and it would take them YEARS to pay off what I can in months.

Just to clarify: a bunch of people pooling their resources together to negotiate a lower price are a problem, but provider charging high prices to those not able to negotiate a discount is not a problem?

Sorry, I may have mis-phrased this, I've edited my original comment. The problem is those pooling their resources into insurance companies are subsidizing those who are NOT. This is what the insurance mandate of the Affordable Care Act is trying to fix, we have yet to see if this will work or not.

Ultimately, the simplest solution to the resource pooling problem is to eliminate the insurance industry and go single-payer, then EVERYONE pays with their taxes. However, many insurance companies are for-profit and they'll keep fighting against single-payer until they go out of business.

Insurers almost always negotiate huge discounts with hospitals. So the bill you see is not the bill they pay, and what they pay is considered confidential.

I've never gotten a bill from a hospital that didn't include the adjusted amount from the insurance companies. The crazy original charges from the hospitals are usually as high as they are because the insurance companies ALWAYS negotiate them down, even with these discounts the bills are still crazy expensive, it ended up costing $2,500 for my wife to have a Cesarian when my daughter was born after insurance paid.

Unless the insurance falls through entirely or partially, and then the patient is stuck with some or all of the massively unreasonable bill.

That used to be the case, but ACA regulates maximum out-of-pocket costs now.

My "national insurance" is about that much, £400/mo, at current exchange rates. You would be no better off if the US had an NHS.

>Medical debt rankles me like nothing else. The US, supposedly the most advanced nation on Earth has the worst notion of all: health care for profit. Simply evil. Health care is a basic human right. Full stop. Health care should never be based on one's ability to pay. Never.

An injured person has no capitalistic value. They are injured, and can either work limitedly or not at all. Therefore, they are worth little to nothing.

Why would a capitalistic government like ours care about someone who will be a drain on the "system"? I's better to send them in the insurance mill or die in the ER.

yay usa.

You sound like a Nazi...

I pray you never experience a major medical issue whereby you are "useless" to society.

Actually, I'm much more a socialist. I believe that All people have a right to health. And I also think that introducing large swaths of cash like we do in the USA enables horrible perverse goals.

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