http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-...

The difference is that with most socialised systems there are two system in parallel:

A public system whose priorities set based on measured impact, rather than by . E.g. in the UK, a separate agency develops guidance independently that measures how treatments affect "quality adjusted life years".

And a private system, whose priorities are, like in the US, based on how deep your pockets are.

For the vast majority the public system is the only one they use, but about 10% pay for private insurance. In practice this acts like a good indicator:

If takeup goes up it means more patients believe NHS care is slipping and makes them feel they need to "top it up".

If prices goes up (private insurance here is exceedingly cheap, since most providers are based on you going to the NHS first and then referring you privately if you e.g. don't get to see a specialist within X days) it's an indicator the providers see NHS as deteriorating (causing more claims from their customers).

The US could do the same - continue to allow private healthcare, but cover a certain level of treatment via a public system.

Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't get that. You get whatever the vanilla flavour of healthcare coverage is today. There's no contractual obligation, only whatever the government says is right today. You don't get a guarantee. Because there's no contract you can point to, even if you're legally allowed to sue (and I don't think you are.) you won't have a case to stand on.

And as I pointed out: If you think they are too strict, then you can pay for a private insurer to cover things the NHS doesn't cover or won't do fast enough for you.

Note that this is a very good cost containment strategy. Note also that this can probably not reduce patient outcomes at all. Note also that it is extremely unpopular.

https://www.cms.gov/medicare/medicare-fee-for-service-paymen...

The named defendant was the Secretary of Health and Human Services. The suit was over practices followed by Medicare contractors, but it's not like they were operating outside the knowledge of Medicare, they were acting as Medicare had directed them to act. The settlement agreement has Medicare changing the procedures the contractors will follow.

"...in which the plaintiffs alleged that Medicare contractors were inappropriately applying an “Improvement Standard” in making claims determinations for Medicare coverage involving skilled care..."

I'm hazy on the details myself, but briefly:

1. Healthcare insurers are covered under ERISA, the Employee Retirement Income Security Act, of 1974. Among the provisions of that act are limitations on the right to sue, under the theory that a retirement fiduciary is an agent of the employees. It's been a long time since I've looked at this, and I don't recall all the specifics, but yes, there are some limitations on suit for lack of coverage.

https://en.m.wikipedia.org/wiki/Employee_Retirement_Income_S...

2. Lawsuits against the government are possible and happen all the time. I'd have to see what specific limitations apply, if any, to Medicare, Medicaid, Disability, and VA care, but you'll find numerous instances of suits:

https://duckduckgo.com/?q=lawsuit+medicare+denial+of+(care%7...

Update, additional info on ERISA and its impact on lawsuits: appeals through the insurer must first be exhausted, but statute of limitations applies whilst lawsuits are blocked: https://www.lawyersandsettlements.com/articles/stock_option/...

With what money? And furthermore, what good will that do if you die before the trial is over?

There's an enormous information and power imbalance in the health insurance contractual relationship. The large number of medical bankruptcies by people that had health insurance is surely a testament to this fact.

Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors.

No, it tends to be a lot of care that isn't worth the cost that gets denied. This is very different from what an American expects, which is that everything they "need" (or what their doctor says they should do) ought to be covered.

The lap-band often passes, because it can be a relatively low-cost way to add a bunch of QALYs to a patient's life.

NB: I think having care decided on a cost-basis is a pretty good approach, at least to start from, but it is immensely unpopular in the US. On both sides of the aisle.

> Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors.

Often. Not always. In Canada only recently could a doctor offer the same services the government offered, and that was against the will of the legislature. Their supreme court had to rule on it. https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG)

I hope you understand that to Objectivists that sounds like saying "I often wonder if Frederick Douglass ever found himself suffer an accident at work with no master to take care of him because he isn't a slave".

I am sure there are better arguments possible against objectivist position, but the one you made is rather naive one.

You see, the GOP continually promised, on one hand, to tie the ACA up in legislative hurdles so it couldn't pass, or, on the other hand, vote for it if it met their requirements.

So, foolishly it turned out, the Democrats played ball with the GOP. In the end, the GOP still did everything they could to block it and voted against it en masse.

I think the error was that the Democrats believed the GOP would vote for the bill if they changed it enough. It was naive.

It was people like Ben Nelson, Joe Lieberman, and Max Baucus that played a rotating merry-go-round of scapegoats that the Democratic Party used to trump up reasons why they couldn't support more progressive reforms in the healthcare legislation.

Also, it wasn't Republicans that put a WellPoint Executive Lobbyist (Elizabeth Fowler) in charge of writing large portions of the actual legislation and acting as the liaison between the White House and the Senate.

In the end we got a big pageant and self-aggrandizing back-patting session from the Democrats who called it the greatest Democratic legislative accomplishment since the Civil Rights Act... which is ironic considering that the ACA is almost the spitting image of Republican Bob Dole's Heritage Foundation sourced (and AHIP sponsored) reform plan from just a few election cycles prior.

So... the greatest Democratic policy achievement in at least a generation was to pass a Republican policy proposal. Well played Democrats. Well played.

It's true that Sen. Lieberman, in coordination with Sen. Snowe, threatened a filibuster. At the time, Sen. Lieberman was an independent, not a Democrat. So, it was an independent and a Republican.

I know that's splitting hairs, but these are valid hairs to split.

While we're splitting hairs.

Anyway, HN is a place I relish usually being devoid of pointless political conversation, so I'm just going to drop it now and go back to reading about Zippers in Erlang.

It's the unpopular part of the law. But pretty much anything that works is going to have some unpopular component that needs to be swallowed in order for the whole thing to work.

When Republicans talk about getting rid of the individual mandate, it's because they are, in actuality, trying to kill the law. When Democrats talk about it, I really don't know what's going through their heads. Leftist wonks like Krugman or Klein keep on telling them exactly why it's needed.

I don't see how it would be, unless by "subtracting individual mandate" you mean "replacing an individual mandate backed with a fee/tax/penalty for failure to comply with a universal tax, an option to select a private option with the tax refunded as a subsidy, and a default of using the public option if no private option is selected". Which, really, is retaining the individual mandate, but making it impossible to break rather than penalizing breaking it.

I'd think education is the way around this. Start off with a "whats the worst case that could happen" then move to "whats the best that could happen." To me, you can convince people as long as you explain that their not going over a cliff. To me, this argument was never made. All I heard on the news was "it's socialism" or "it's good" but no selling the public on why it was in fact good. In this case, our leaders who were the proponents of single payer failed us. Single payer will happen, it'll just take a bit longer. The commercial healthcare industry is on a path to failure....there is no fixing it for the US. Eventually we'll end up with a system, that likely looks like what Germany/UK have (some mix of public/private).

I'm not sure what you're saying here. Are you saying I'll determine that to be the case if I'm lacking attention, or are you saying that I'm lacking attention and therefore don't know that? I'm also not sure what the point is either way, why the truth or falsehood of this statement is relevant to my comment.

> Of course poor people have been voting Democrat for over 50 years and they are, for the most part, still poor.

This also doesn't make any sense. Nobody said that voting for either party would make you rich. Making health care accessible to the poor doesn't make them less poor, it just gives them health care.

> Que Einstein quote.

What quote?