It's this thing where US political dialog has basically become "Well _I_ would like this but what about all these other people the media say won't like this? Won't someone think of them?" which short circuits to "Oh I don't want this"

Lots of people who worry a hell of a lot about the federal deficit when talking about whether they would like to be able to afford going to the doctor. Nevermind that this discussion rarely covers the deficit when it comes time to give tax breaks to "job creators".

Also the Democratic party is comically bad at politics in the US. Like "oh but you might lose your private insurance" is a discussion people in the primary are having _when you would be replacing private insurance with free healthcare_. What sort of positioning is even being had here? So many people are stuck in the 90s

> Like "oh but you might lose your private insurance" is a discussion people in the primary are having _when you would be replacing private insurance with free healthcare_. What sort of positioning is even being had here?

A common fear is that wait times to see a doctor would be much higher with universal healthcare compared to a system with private insurance.

Horror stories about people in Canada and the EU waiting months for a procedure that would be available immediately to someone with private insurance if in the US.

I don’t mean to start a health care debate in this thread. My main point is that there are reasonable (logical, rational) fears that people have causing them to be against universal healthcare. Understanding those fears and addressing them upfront is one way to get past them.

"I don't want to wait in line, so make sure poor people can't go to doctors", which is the reason there are lines and wait times, is basically a cartoon villain argument and anyone making it should be treated as such.

The anxiety is not about the wait but rather the potential consequences of the delay, such as the potential death or prolonged suffering of a loved one.

Got it. "my sick dying relative > your sick dying relative". Total morally reasonable now, thanks for clearing that up.

Why are there going to be lines and waits with expanded healthcare coverage? Because people who need to see doctors will be seeing doctors. If your logic train is "Expanding coverage will create lines, therefor don't expand coverage" and not "Expanding coverage will create lines and therefor we will need to find solutions to new problems when we expand coverage" IDK how you're not just doing some gatekeeping to keep services high for yourself at the expense of others.

>Got it. "my sick dying relative > your sick dying relative". Total morally reasonable now, thanks for clearing that up.

Yes, either that or one's own health being potentially at fault and having to wait too long for treatment. I didn't mean to insinuate that it was a morally correct choice; only that I thought it was a perspective not being considered. Better healthcare for all is a good thing and is something many people support, but doing so at cost of a loved one's health makes the decision far more difficult.

Oh no, it had been considered.

I will die on this hill. If you oppose expanding healthcare because you feel that then too many people will have healthcare and that will cause problems for you, you're a terrible person. "What about the smaller number of people who have a great situation" is never a counterpoint to "what about the much greater number of people who have a terrible situation"

If your tribal leaders support something, you do. Tribe comes before religion, race, or any other consideration, though admittedly many of those are correlated. In the end, for around 90% of Americans, its about R vs D.

The reason is pretty simple to understand- Those who can afford health insurance dont want their standard of care reduced on a 'free for everyone' system. Looking at the existing bureaucratic issues the current 'free' health programs have ( VA, Medicare, Medicaid, etc.. ) seems to indicate their fears might be well placed. In the VA for instance, you can go months just to get a first visit.

Basically, people who have a job and get health insurance dont want to be lumped in with the commoners and get worse care/longer wait times/less options/etc... Its fucked up, but its not hard to understand the pushback. They dont want their health care experience to turn into a 6 hour trip to the DMV.

That doesn't explain why people who can't afford health insurance are opposed to universal, government-funded healthcare, which is what the comment above you was about.

Meanwhile, I (SRE at a hedge fund) and all my liberal coastal elite friends can absolutely afford private doctors in an emergency without having to think about cost up front, and we do support universal healthcare—and we know it would be a larger tax bill for us.

(BTW, in practical terms, putting liberal elites in well-paying, politically-connected industries on your healthcare system is a great way to make sure it doesn't turn into the VA. America cares deeply about our happiness. It doesn't care about our veterans and sort of wishes they hadn't survive, so we could just remember their sacrifice instead of actually facing up to what we did to them.)

for a lot of deep-seated structural reasons, the US tends to be pretty bad at implementing most citizen-facing services. it doesn't seem unreasonable to think that we would also do much worse at universal healthcare than the europeans. for the services that the US does actually offer, we tend to spend more money and produce worse outcomes.

> (BTW, in practical terms, putting liberal elites in well-paying, politically-connected industries on your healthcare system is a great way to make sure it doesn't turn into the VA. America cares deeply about our happiness. It doesn't care about our veterans and sort of wishes they hadn't survive, so we could just remember their sacrifice instead of actually facing up to what we did to them.)

this is a pretty common talking point, but I don't really see this happening with the systems that already exist that wealthy people have to use. I, an upper-middle class white person, still have to take at least a half day of PTO any time I need to go to the DMV. my dad, wealthier than me, still had to spend a whole day at city hall disputing a $40,000 water bill (the city doesn't even have a functioning water meter on his property because DPW paved over the access; it's been "estimated" for twenty years).

>and we know it would be a larger tax bill for us.

It would quite possibly be a net saving. The UK, for example, spends less public money on healthcare than the US. There's no necessary reason why you should end up paying more in taxes for universal coverage than you pay currently for insurance.

convert your USD salary to pounds and then do a UK tax calculator. compare the UK NHS tax to your yearly premiums and copays plus the employer contribution (should be on your W-2). when I did this, I found that I would pay about $2k more for the UK tax than my total healthcare costs in the US (including the portion paid by my employer). I'm sure lots of people on this forum make even more than I do.

there are definitely some good arguments for universal healthcare, but software devs should not delude themselves that they will do any better than break even in most cases.

edit: probably not true, I didn't investigate the UK tax system enough.

What is the UK NHS tax? There is no such tax, as far as I'm aware. You may be thinking of "National Insurance", but that is not specific to the NHS (and nor do all NHS funds come from National Insurance).

I'm sorry, it's actually called national insurance. am I making an incorrect assumption? I'm just going off this tax calculator: https://www.moneysavingexpert.com/tax-calculator/

Yep, incorrect. National Insurance is not an NHS tax.

sorry to be obtuse, did I just call it the wrong name or is it completely different? I'm american and I just assumed that NHS is the government org that handles healthcare and a mandatory contribution is pretty similar to a tax.

See my comment above. Not all of National Insurance goes to the NHS, and not all NHS funds come from National Insurance. There exists no special tax whose revenue is earmarked for the NHS. Thus, there is no easy way to see how much of your pay you are contributing to the NHS. Similarly, someone in the US can’t easily see how much of their pay goes to the US military or to the National Science Foundation.

edit: On an individual level, a lot will depend on your income, and how expensive your US health insurance is. Here is an informative post:

https://www.quora.com/If-you-make-100-000-in-UK-what-percent...

That works out to about $560/month for someone with a salary of $100,000. If you take into account employer contributions, that's still less than a lot of Americans are paying. If you're on a lower income, you're likely to be paying significantly less in the UK for much better coverage.

And I almost forgot - copays! The amount you're paying in taxes in the UK really is paying for virtually the full cost of your treatment when you're sick.

understood, ty for the explanation.

>That doesn't explain why people who can't afford health insurance

It's because doctors et al don't want to work for less than $x/hr and there are people who don't produce enough to trade with doctors or prefer to spend their money on other things. There's no way to get a free lunch out of this.

Respectfully need to split a hair on the VA comment: once you're into the VA system, their access is incredible. If you can't get an appointment in less than 20 days, or if you need to drive more than 30 minutes, they'll pay for you to see a doc in your community. So you certainly do not need to wait months to get an appointment at the VA.

There are veterans who are still waiting to get paperwork processed to show a service connection for health issues -- they're still waiting to get into the VA system -- but that's a different bureaucracy. The wait time at most VAs once you're in the system is substantially less than through my employer-provided insurance.

I'll preface what I'm about to say by pointing out that I am all in favor of universal healthcare.

BUT.

I have a hard time thinking of getting a doctor's appointment in 20 days as "incredible access." If I need to see a doctor, I can get an appointment at the local clinic within a day or two. And my employer-provided health insurance is pretty crappy! If I tell the clinic I think it's important (like I'm in pain but it's not an emergency), they'll try to fit me in the same day if possible.

And that's not even considering the Urgent Care facilities 15 miles away..

> I have a hard time thinking of getting a doctor's appointment in 20 days as "incredible access."

According to kaitai, those "20 days" are the absolute upper boundary. As a German, I don't find that upper boundary particularly high. When I need to see a specialist about something that's not an emergency, a wait time of a few weeks is normal since there are only so many specialists per area.

Is 20 days period for seeing your family doctor or some kind of specialist?

But does it really reduce your standard in those systems? I know it's really hard to properly compare the costs of something like this between countries, but it would be interesting to know how much you need to spend on healthcare in the US to get similar benefits as in some European country purely with public healthcare. Since another benefit of public health care is that you can be reasonably sure people around you are healthy and not dragging themselves to work with god knows what since they can't afford treatment. Be it your colleague or the cashier at the store.

It's actually quite baffling how Americans generally seem much more generous, warm and helpful to their fellow human beings, but the idea of potentially paying for someone else's medical treatment seems absolutely outrageous to most.

> It's actually quite baffling how Americans generally seem much more generous, warm and helpful to their fellow human beings, but the idea of potentially paying for someone else's medical treatment seems absolutely outrageous to most.

this is just my personal take as an american. I think the disconnect has to do with locality/proximity. americans who have some surplus income (ie savings and not living paycheck-to-paycheck) are quite willing to help people they know with cash or free labor and will happily donate time or money to help people in their broader community. what americans hate is being forced by the government to help people far outside their circle. I think partially we are suspicious that the money doesn't get where it's supposed to go intact, but there's also an element of "fuck them, what do those people over there have to do with me?"

obviously this is suboptimal as entire communities can be disjoint and have serious imbalances in funds available. also it tends to leave a lot of efficiency from scale on the table. but perhaps this at least explains some of your bafflement.

This might be true but still sounds like the information given about public health systems is biased.

In Spain the public health system is still better than the private one and most of the long and most expensive treatments are done within the public circuit. You can wait months for "minor" issues and there is where a private insurance can help (actually I think is beneficial for the system that anyone being able to afford a complementary private insurance should pay for it)

Also, having experience in both systems I feel better when I am treated by someone with no economic interests.

It’s funny, I live in Japan where contrary to my experience in the states, I can go see a doctor any time - just walk in. No need for specialist referrals either. If doc says I need to see a specialist, I just walk in.

US politics, specifically from the right, lobbies pretty hard and uses fearmongering to the max. Lower standard of care? What’s that? Wait times? Sure, you may wait a bit longer that one day, but someone will see you. I remember when my wife needed to see a therapist for her depression, we had to wait 2 weeks to see someone “in network” in CA. This was with good insurance. Here, walk in, wait, see doc, walk out. My fellow Americans need to wake up to reality and try to understand that powerful interests are lobbying against you and using fear as primary means for arguing against “universal” healthcare. Let me be clear, I still pay a monthly premium and I still have co-payments, but one this is for sure - it’s practically impossible for me to go bankrupt due to a medical issue.

Which means there are more hospitals needed, more doctors and more nurses. So it may even create more jobs.

Because the US has so many successful corporations, its politics is controlled by corporate interests to an extent not seen in most other developed countries (where the political “right” tends to be the nativists and the propertied class). The “small government” concept in the US creates a political incentive for government to be ineffective and wasteful creating a self fulfilling process through which any politically visible part of the US government is terribly ineffective and the pieces that are behind the scenes are excellent. That’s why universal health care is likely to be a terrible boondoggle in the US.

There are always people a rung below you on the social ladder.

"Sure, I would love to get healthcare. But I don't want /them/ to get it. Especially if they are immigrants."

The tribal divide in American politics is another reason ("if they want it, it must be wrong), but since this level of hatred is quite recent, I think it cannot fully explain it.

Here's the explanation:

"Why doesn’t the United States have universal health care? The answer has everything to do with race." https://www.nytimes.com/interactive/2019/08/14/magazine/univ...

Americans are so racist, they'd rather get bankrupted by illness and die, than have universal health care help black people.

At the same time, they allow ~1 million mostly non-whites to legally immigrate every year.

I think insurance/medical industry lobbying is a far more consistent explanation. In general, if a story starts by bringing up racism from 150 years ago, it's more concerned with building a narrative than with explaining the current state of affairs.

Rather refreshingly, the NYT admits this: "It aims to reframe the country’s history, understanding 1619 as our true founding, and placing the consequences of slavery and the contributions of black Americans at the very center of the story we tell ourselves about who we are."

So why does the "I don't want to help people I don't like" attitude affect the healthcare system, but not immigration policy?

That is why I don't think the explanation holds water. Plus, Americans do support universal healthcare: https://www.cnbc.com/2018/08/28/most-americans-now-support-m...

It's fascinating that HN downvotes comments pointing to America's historic struggles with race (which did, beyond a doubt, exist and leave a fingerprint on the political reality of our current country) when people ask questions for which race is a potential answer. It's happened to me before too, IIRC also with a cited claim.

I mean, I totally understand avoiding the subject because it leads to flamewars, because some people respond very poorly to the suggestion that racism exists and has practical effects today. But then you're better off not having a discussion about the topic at all than a skewed, censored one where one plausible answer is just too politically incorrect to be debated.

-Yes, racism existed in the United States. Virulently so.

-Yes, racism still exists and, yes, it is a huge problem. We should work together to support all minorities.

-No, racism is not the primary or even a significant cause of every single bad thing that happens.

It's like the people in the story of the boy who cried wolf; hearing "racism" being trotted out by one-note progressives as a response to any question about the United States' woes (particularly when it's not even very plausible) is viewed as tiresome and unconstructive. And I say this as a minority who has experienced racism!

Are they against universal healthcare, or against the politicians that happen to support it? Big difference.

I don't think it's even about the money anymore, since nobody seems to take issue with massive deficit spending in the US.

A lot of Americans see it as a threat to their sense of individualism, and that is why they fight it. To them, any government program which makes our lives easier will cause people to be lazy and dependent. If we want universal healthcare, we need to address that message.

Nobody works harder than a Japanese worker. And Japan has government-administered “universal” healthcare. The idea that access to affordable healthcare makes people lazy requires mental gymnastics and total ignorance.

Please don't take HN threads further into ideological flamewar.

Also, personal attacks will get you banned here, so please don't do that either.

https://news.ycombinator.com/newsguidelines.html

Help me understand, which ideologies are allowed to be discussed? The person I replied to didn't understand why people don't vote for certain policies. I tried to help them understand the position of people who don't agree with increasing aggression.

It's not a question of one ideology rather than another. They're all equally bad when it comes to generic internet discussion, and especially flamewar. Such discussions have all been had a million times, they're all predictable and therefore tedious and therefore off topic here. HN is for curiosity. There's zero curiosity in "taxation is theft" (or "property is theft") flamewars. Ditto for "state aggression" here, which is a generic ideological tangent even from a subthread that was already one in its own right.

If you want to understand further, I've written a lot about this in the past: https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...

I'm a US citizen who does not want the government to run healthcare. I'm also an immigrant from a country where it does. I've seen what my family in my country of origin has to deal with and...no thanks.

Have you yet seen what you have to deal with here?

All systems have problems. Other systems don’t seem to bankrupt or kill as many people.

Other systems kill plenty of people. What I have to deal with here could be far better, but I definitely prefer it to the NHS.

You'd be an outlier then.

Also consider that as a "NYC Googler" you are not getting the true American healthcare experience.

No true Scotsman, eh?

Not at all -- you work for (and I assume are insured through) a rich company that contracts with insurers who are incentivized to keep that company happy and maintain their contract. Most Americans don't.

Google is also self-insured, which means that Google is actually paying for healthcare, not the insurer -- the insurer just manages the networks & relationships with providers, and it's just pure profit for them. Google, meanwhile, wants healthy employees. No one has an incentive to deny claims, so ultimately you are seeing the best side of the system, in which almost every actor wants good outcomes.

Contrast this with Medicare or Medicaid, or private insurance on the individual level, where the incentive is to reduce "medical loss", the industry term for...actually paying for healthcare. Arguing with insurers over denied claims is par for the course -- so much so that some insurers just routinely deny things (and patient is on the hook) that their own plans say should be covered, with the hope that patients won't realize they can appeal.

Having experienced both ends of this -- as a former Googler myself and in the individual market pre-ACA ("Obamacare") -- I can tell you the difference between the wealthy corporate insurance plans and the individual market is night and day.

Is your country of origin held up as having a particular high standard of nationalised healthcare?

I'm from England; I'll let you make your own determination about the reputation of the NHS.

Sorry for the very belated response. I'm also from England, and I have a number of American colleagues who live and work in the UK and strongly prefer the NHS (with all its drawbacks) to the American system of healthcare. So I'm surprised to hear your opinion.

This speaks more to your country of origin than it does to universal healthcare.

> This speaks more to your country of origin than it does to universal healthcare.

Ignoring the rudeness of your comment, who is to say that the implementation of universal healthcare in the US will not wind up as dysfunctional as the system in the parent poster's country?

The problem with endtime's argument is that it's a non-sequitur. It comes down to:

> There is a country where government-run healthcare is bad. Therefore a proposed government-run healthcare system is probably also bad.

This simply doesn't follow. I could make the same argument backwards by pointing to a country where government-run healthcare works well, and concluding that therefore universal healthcare in the US is going to be awesome.

endtime is demonstrating his/her sentiment, but does nothing to advance the discussion.

I was responding to a comment which said:

> No. There is a very large number of people in the US who are (for whatever reason) against universal health care.

I was responding specifically to the "for whatever reason" part, giving an example of a reason.