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The U.S. insurance system is not semi-socialized on that part, it is a result of collusion between hospital administration and insurance companies to maximize profits instead of health of the nation. Corporatism keeps laws on the books that reduce competition and take the decisions out of the hands of patients and doctors and puts it into bureaucrats.

Medicaid and Obamacare are the socialization aspects, which try to work within the Corporatist solution... we should have and should just tear the whole system apart.

Too many good minds work in billing and adminstrative research and development, not in medical development.

Disclaimer: I make medical billing and administrative software. I have a job because of a broken system... I'd sacrifice my comfort for a better system.

> we should have and should just tear the whole system apart.

And replace it with what? I left Canada because of the abuse of their healthcare system, so please, share with me a model that isn't like Canada's that you'd want to move to?

The US insurance system is heavily tuned to make some people pay for others. Employer sponsored insurance, together with accompanying regulations about individual costs, is tuned to make sure the smoker and the healthy person pay the same price. See also community rating in the private market. On top of that, the US government pays more for it's own socialized medical programs than most other nations do.

And this isn't even getting into all the ways regulations micromanage doctors and other parts of the system. Not to mention micromanage financial services - India actually has innovation in that space.

Any theories which claim that for-profit systems are horrible need to be tested against the Indian system. It's mostly for-profit, free market, etc - all the incorrect claims people make about the US are pretty much true there.

There's this story about health care that goes like this:

1. There are two kinds of health care systems in the world.

2. The first kind is private-run, profit-driven and super-expensive, the second kind is government-run and much cheaper.

3. America has the first kind. Every other country has the second kind.

You can see that story being repeated all over this page.

You forgot to mention that that story is a fiction, albeit a popular one.

That's true

Employer sponsored insurance, together with accompanying regulations about individual costs, is tuned to make sure the smoker and the healthy person pay the same price.

That is kind of what insurance is for though - to level out the cost for everyone.

It's a common misconception that smokers cost society. The truth is, smokers die earlier and cost tax payers less in insurance benefits and health care than non-smokers. [1] We should be encouraging people to smoke if we want to save money. (I'm joking!)

[1] http://www.plosmedicine.org/article/info:doi/10.1371/journal...

That is kind of what insurance is for though - to level out the cost for everyone.

No, the point of insurance is to reduce the variance of an individual's future cost. Due to the law of large numbers, averaging across independent identically distributed people is equivalent to averaging over the future, but that's a side effect.

Averaging over independent non-identically distributed people is NOT part of insurance at all - that's what I'm describing as "the socialist part".

An example illustrating the difference - say you have 10 dice, and if a die rolls a 6 it costs $1,000. You also have 10 coins, and if the coin comes up heads, it costs $1,000. Insurance is when you charge the dice $166 and the coins $500. Socialism is when you charge everyone $333 - that's redistribution from the dice to the coins.

The link about smoking costs is interesting, however that applies at the level of government paying for lifetime costs. Annual costs are higher. So insurance for this year should cost the smoker more than the healthy person.

I agree with everything but the "not semi-socialized" statement. It is half socialized, half corporatism with the worst of both worlds. You even refer to the socialized aspects which it wouldn't have were it not semi-socialized.

I agree with almost everything you have written. But I'll add that it can be quite a bit more complicated than "ask the price, pay it". You're right about the financial aspect. But the technical aspect can be quite muddled.

Many doctors tend to show off expertise that they do not really have. I have a dead family member to show for as an instance of doctors who are too too stupid to understand what the reports were screaming at them. My family member did get top-quality care after an emergency incident put them under the purview of a different department: the department that the initial report had already made blatantly clear. And this was at one of the best hospitals in Bangalore. I have chronic health issues, myself. I had to "shop around" until I found a doctor who was (1) aware of the current recommended treatment procedures and (2) not making grandiose claims about the success of my treatment options.

And yes, medicine here is quite wonderfully capitalistic. Most drugs are very cheap, and the penurious get "BPL cards". That's enough for most people. However, things aren't all that rosy for people with weird chronic diseases, or diseases that need the latest in therapy... like cancers, etc.

> I think you mean how evil semi-socialized, heavily regulated medicine really is. India's medical system is as close to free market health care as I've ever encountered.

> You walk into a hospital, ask the price, pay it. If you don't like the price, you can go to a different hospital and ask them. If you have insurance, you send them the bill afterwards.

Yeah, it looks great from the perspective of rich people like yourself. It's not so great from the perspective of many of India's poor people, especially in rural areas, who cannot afford the market rate.

I'm aware that most people in India can't afford even a small portion of the things Americans take for granted. Forget medicine - what about a flush toilet or clean drinking water (let alone expensive things like cars or even two wheelers).

Poverty is an orthogonal problem.

> who cannot afford the market rate.

Any sources for that? As far as I have seen, admittedly, a fraction of the massive population, cost of healthcare is not the issue. Some of my doctors charged me rather high amounts and explained that they use it to offset the cost of treating poor people for free. Drugs are extremely cheap, and many docs give it away to the poor. India has problems with access, sanitation, hygiene, and education. As far as I have seen, "cannot afford the market rate" is not a common issue.

You would think Indians are lucky in this regard. It's actually the opposite, despite being a software developer who earned reasonably well (compared to the norm) I dread the thought of going to a good hospital. I just don't have the sort of money they ask for. I cannot even imagine what it is like for a poorer shopkeeper or factory worker. For comparison, I earned $1000/month after 6-7 years of experience. $1700 after a decade of experience and ability to program in 3-4 languages. Most jobs will earn you around $500-$600/month.

That is why in India people save money because the parents tell them from childhood that hospitalizations / accidents can cost a lot of money so better save up in case you get sick.

If you make a lac/month, surgeries of the sort I've received will be one month of income. In the US, prices will be both higher relative to income and unknown, i.e. the doctor just won't tell you.

As for saving, people in the US don't save. And they refuse to spend money on medicine - I know a woman who easily spends $10-20k/year on entertainment, but balked at spending $8k to repair her knee.

Same thing in Vietnam. A family member ended up sick so she went to the brand new, for-profit hospital. Spent 1/2 a day in the ER and the cost was $150USD.

If people can afford it, they would never step into a gov't run hospital in Vietnam.

Interesting, but I want, in my lifetime, to see a more or less tax-based system that means I see my GP and pay nothing save what I'm taxed in my pay packet every fortnight. There needs to be caps on costs. Costs determined by government, not for-profit entities. In essence, health care is a basic human right. I don't mind a slight ~10% uptick in my taxes to pay for it. That 10% is still orders of magnitude less than I pay annually for health insurance, which is sinfully expensive. I'm praying Hillary Clinton, when she gets elected, will finish what she started.

> That 10% is still orders of magnitude less than I pay annually for health insurance, which is sinfully expensive.

I don't think you understand what "order of magnitude" means. You pay more than your gross salary for health insurance? If 10% is "orders of magnitude less", then you must pay at least 100%.

Also, I don't know where you are buying insurance from, but I can get insurance for about 4% of my gross salary.

Good on you, and I mean that nicely. My insurance monthly is 1/3 of my salary after taxes. Blue Cross through my employer. I tried to fall back on something from the ACA Web site, but because my employer offers insurance, I don't qualify for the better rates. Stupid rules.

> My insurance monthly is 1/3 of my salary after taxes. Blue Cross through my employer.

Uh, that 4% is if I was self-employed. I pay $35/month through my employer.

> I tried to fall back on something from the ACA Web site, but because my employer offers insurance, I don't qualify for the better rates. Stupid rules.

The price I can get insurance for through the ACA website is the same as the unsubsidized cost of what I get through my employer. I suspect that is because we are a small company that is not getting a break from Blue Cross. I honestly don't know if I am benefitting from being in Texas, but I can buy a gold plan for $350/month.